Lecture 3 - Acute Flashcards
In acute care, patients can present with a variety of communication impairments from ABI. List them
- cognitive comm impairment
- aphasia
- dysarthria
- apraxia
- voice disorders
The focus of SLP role in acute care is to ____
identify and screen/assess for cognitive communication impairments (in addition to speech and language impairments)
T or F: time constraints and caseload demands make it difficult for SLPs to assess every ABI pt?
True
Patients with early ABI are often _____, ________ and ________ which can affect assessment/screening
- drowsy
- agitated
- acutely ill/ have multiple medical issues
T or F: lengthy assessments and goal setting are appropriate during the acute stage
F - screening is more appropriate
Why would we do a cognitive communication (CC) screening
to identify areas of impairment and the need for further Ax later on
Why must we consider formal and informal measures in ABI?
patients may perform well on testing but struggle in real world situations
What 3 factors must we consider that may contribute to an individuals performance?
- baseline factors (language, culture, education)
- emotional factors
- physical factors
What are the 4 general steps of a CC screening after reviewing the medical chart, obtaining consent, assessing the environment and introducing yourself and role?
1) conversation
2) interviews with family/caregivers re BL and/or new communication diff
3) Team reports
4) screening tools
During screening for CC what 6 domains do we address?
- orientation & attention
- auditory comp & info processing
- verbal expression & discourse
- reading comp
- written expression
- social comm & pragmatics
What do we look at when screening orientation in acute?
-oriented to person, place and time and reason for admission
What do we look at when screening attention in acute?
- focus attn
- hold attn (+/- distractions)
- shift attn between tasks
- be redirected when distracted
What do we look at when screening auditory comprehension & info processing in acute?
- slow processing of info
- consider amount, complexity and speed of info presented
- ability to answer Qs (Y/N & open ended)
- ability to follow commands (single and multi-step)
- comp of complex syntax/paragraph length
What do we look at when screening verbal expression & discourse in acute?
- screen for dysarthria, apraxia & voice disorders
- look for anomia & naming errors
- Discourse: sparse, vague, excessive detail, tangential or confabulated, reduced initiation
- consider procedural, narrative and conversational discourse
- automatic speech tasks, naming, picture description
When looking at reading comprehension and written expression what factors must be considered?
- Physical impairments (visual, motor)
- Baseline function (level of education, language barrier)
Why might you screen reading and writing in someone who has a trach or someone who is nonverbal?
may be a potential mode of communication other than speech
What do we look at when screening reading comp in acute?
- ability to identify letters
- oral reading words/sentences
- reading comp words/sentence level
- functional tasks (menu)
What do we look at when screening written expression in acute?
- mechanics
- functional tasks (name, address)
- generating sentences
What do we look at when screening social communication and pragmatics in acute?
- reduced conversational initiation
- difficulty following rules of conversational turn taking
- difficulties using/interpreting non verbal communication
What is the SLPs role in discharge planning from acute?
- consider support a pt will need once discharged
- aim to identify need for SLP follow up and recommend appropriate services
- advocate for patients
What is the Rancho scale?
8 level scale used to identify and describe patterns of behaviour and impairments commonly found in individuals with brain injury throughout recovery
The ranch levels are concerned primarily with _______ and _________ functioning
cognitive
behavioural
T or F: Rancho levels are used by allied health members and rehab facilities to communicate about a patient’s status and progress
True
T or F: SLPs can provide education and counselling to family and staff?
True - as it relates to cognitive communication impairments and behaviours seen during the brain injury recovery process
