Intro & Review Flashcards
Acquired disorders come before development
T or F
FALSE
Acquired disorders come AFTER development
SLPs work to ______ , ______, ______, and ______ speech, language, social communication, cognitive-communication, and swallowing disorders in children & adults
Prevent, Assess, Diagnose, & Treat
PAD-T
Although the setting and/or subject matter
may change (language vs. swallowing vs.
articulation…), the steps in an SLPs clinical
process are basically the same:
They include:
- Evaluation
- Treatment
Reasons we perform evaluations
- to determine if there’s impairment
- describe, diagnose, provide prognosis of impairment
- Guides treatment goals of IDT (interdisciplinary team)
- guides development of compensatory strategies
- guides discussions with patient & family regarding discharge plans
What to do when completing medical chart review
- Complete med. chart review a PRIOR to time with patient
- Find pertinent information (don’t just repeat everything)
- Personal information
- MD’s orders (SLP consult, ST Eval & Treat, etc.)
- Medical, social, surgical & treatment history
- Chief complaint
- History of Present Illness
- Current Medications
- Test Results/Imaging
- Function - may be complicated by side of medications
- Imaging (e.g. MRI) may give information about site of lesion, extent of brain damage, etc.)
Use information from your chart review to:
- Determine what assessments you’ll need
- Make a hypothesis about what you might expect during your evaluation
Rationale for Physical Examination
- Symptoms found during the exam can help localize where the problem is in the brain
- Indirect assessment of cognition & language
Components of Physical Examination
- General observations (alertness, posture)
- Vitals (respiratory rate, blood pressure, oxygen saturation rate, heart rate, temperature)
- Oral Mechanism exam
- Cranial Nerve Exam
- Vision/Hearing
Starting Physical exam
procedures
- Ready needed supplies
- Check in with patient’s nurse before entering
- Introduce yourself
- state why you are there & what your plan is
- may vary according to setting, hypothesis, etc.
Considerations for selection of assessments
Generally more than one is necessary to make a diagnosis
- Should be based on goal of assessment:
- Screening - to determine presence/absence of impairment
- Evaluation - describe impairment and/or diagnose
- Treatment planning
- Formal (data driven) vs. Informal (content driven)
- Standardized (scored in a consistent manner) vs. Nonstandardized (no uniformity in evaluation)
- Static (one period of time) vs. Dynamic (ongoing process)
- Instrumental (swallow studies, voice evals)
- Modality - auditory, verbal, written, etc.
- Reference type - norm, criterion, ipsative
- Psychometric Properties - reliability vs. validity
Assessment scored in a consistent manner
Standardized Assessment
Assessment that has no uniformity in evaluation
Nonstandardized Assessment
Static vs. Dynamic
- static - one period of time
- dynamic - ongoing process
Reference Types for Assessments
- Norm referenced - results can be compared to normative data
- Criterion-referenced - whether test takers performed well or poorly on a given task
- Ipsative - test takers are compared to previous performance
Psychometric Properties of Assessment
- Reliability - consistency of a measure; whether results can be reproduced under same conditions
- Validity - accuracy of a measure; whether it tests what it says it tests
Evaluation vs. Screening
- Screen : tool to identify presence of an impairment
- Usually a PASS/FAIL test
- ex. for cognition: MOCA, MMSE
- Evaluation: true diagnostic
- describes & scores the impairment; compares to normative data
- ex. for cognition: FAVRES
Types of Treatment
- Rehabilitative: intended to restore or return function
- Compensatory:
- intended to minimize impairment while waiting for function to return or if function does not return
Person centered intervention
- focuses on maximizing individual’s ability to participate in meaningful activities
- should be personally relevant
- consider cultural & linguistic background, social history, social context
- communication needs & personal desires
- patient can choose whether they want treatment
- should be personally relevant
Other treatment considerations
- try multiple strategies
- ensure materials are age-appropriate
- establish therapy routine that fits in with their schedule
- provide clear, ongoing instructions & feedback about therapy performance & progress
- ensure difficulty level is appropriate
3 components of EBP
- Clinical expertise/Expert opinion
- Evidence (external & internal)
- Client/patient/caregiver perspectives
Types of Evidence
Internal - data & observations collected on an individual client
- helpful in tracking a client’s performance
External - whether a treatment approach is effective in causing change in individuals
Appraisal of Evidence
To determine:
- Relevance
- refers to how closely connected the study’s elements (e.g., study aim, participants, method, results) are to your clinical question or fits your needs
- Limitations
- refers to shortcomings or external influences for which the investigators could not/did not control
Parts of Assessment
Helpful Resources
- Mentors
- ASHA Website
- External Evidence
- Continuing Education courses/Conferences
- Your IDT/IPT
- Social Media
