Module 1 Flashcards
Diagnosis
Diagnosis: label with supporting evidence
Origin of the word is greek
Literal meaning – “set apart” (This person has something that distinguishes themselves from others that don’t have it)
More specifically, – identification of disease, abnormality, or disorder based on symptom analysis
Can be an on going process
Appraisal
Origin of the word is Latin
Quantitative value judgement
A statement of value, quality, or condition
Can refer to a process
Looking at person’s ability, placing numeric judgement on this (percentile)
Appraisal leads to diagnosis
Clinical problem solving
Other synonyms to the terms “diagnosis” and “appraisal:”
evaluation and assessment
Subtle differences may depend on context
Can use these terms interchangeably
Why use terms Diagnosis and Appraisal?
Similar words, different origins
Use them interchangeably
Technically, the diagnosis is a label;
while the appraisal is
the evaluation process that leads to the label.
Diagnosis:
Prognosis:
Recommendations:
Diagnosis: Distinguish a person as having a disorder (or not).
Identify the specific disorder and its characteristic
PROGNOSIS: Judge whether the person is likely to benefit from treatment, and why.
RECOMMENDATIONS: Propose a plan of care for the person.
What is a prognosis?
And what do you mean by recommendations?
It is a statement of opinion, based on evidence, that addresses whether the person is likely to improve
This is an orderly list of the next steps that are needed in order to follow up on the diagnostic session
Three types of evidence
Three types:
(1) clinical expertise or expert opinion
(2) external scientific writings
(3) client- based data
Client-based evidence includes all information gathered during the evaluation. (can include historical information about the client, results, any information that you got from interacting with the client as a result can be considered as part of evidence)
Expertise includes everything you know about disorders and the diagnostic process
Scientific Writings includes quotations from books and articles
Evaluate all evidence to determine its relevance to the diagnosis, prognosis, or plan of care. (Not all evidence is considered relevant to the diagnosis or prognosis or plan of care).
What is a prognostic indicator?
Any factor or piece of information
that contributes to decisions regarding the prognosis.
Examples –
Age (O)
Stimulability (O)
Concomitant disabilities (O): 1 disability versus several will probably have different prognoses
Length of time problem has existed (O)
Motivation (S)
Room for improvement (S)
Family support (and other types) (S): lack of family support can greatly impact prognosis
What is label
A categorical designation
Standardized Tests
Designed to categorize clients according to behaviors they exhibit.
Client’s numeric are compared to normative.
Excellent tool for assigning a diagnosis (or label).
Examples – any norm- referenced tool
Non- Standardized Tests
Informal or formal activities
that are designed to:
Gain insight into specific abilities
OR, gauge progress resulting from treatment
Examples: language sample, oral- facial inspection, baseline data…
Etiology
Etiology is the likely cause.
Where to look for the etiology :
- Case- history intake form
- Opening interview
- Always consider that there may be more than one explanation
Static Testing
Static testing measures what the person does, in the absence of any clinical teaching
- Like a snapshot
- Most standardized testing is static
- Static testing is important to gain an accurate picture of person’s current performance.
Dynamic Testing
Dynamic testing measures what happens if the person is exposed to clinical teaching.
- Like a video clip
- Provides insight that can be useful for identifying targets and suggesting prognosis.: VERY IMPORTANT!!!
Stimulability Testing
Stimulability testing is a dynamic tool.
It evaluates the person’s response to clinical teaching in any area (e.g., Goldman-Fristoe Test of Articulation (GFTA): Stimulability Subtest)
What to do:
- Identify errors (or potential therapy targets),
- Provide opportunity to change performance,
- Evaluate whether the person changes and if so, what level of stimulation was needed.
What is evidence based practice?
The pattern of practice where all clinical decisions are based on one or more of the three types of evidence
Comprised of four steps –
- Frame the clinical question
- Find the evidence
- Assess the evidence
- Make a clinical decision
Every clinical decision begins with a clinical question; so, properly-framed clinical questions are fundamental to clinical decision making.
Examples of clinical decisions
Line of questioning during an interview
observation procedures
Informal and standardized
test selection
Diagnosis
Prognosis
Each part of the plan of care
What is a clinical question?
Relative to diagnosis and appraisal, a clinical question is an answerable and relevant question that defines the scope of information that you hope to obtain through observation and testing.
PICO framework is recommended – P – population I – intervention or exposure C – comparison (more relevant for dynamic testing or treatment decisions) O – outcome
What is professional documentation?
Every clinical activity results in written documentation (e.g., diagnostic report, treatment plan, and treatment summary…).
Our clinical reports are legal documents that can be subpoenaed in a court of law.
Therefore, clarity, accuracy, and precision are of the utmost importance.
The person with the CCC is the one who is responsible; so final decision is hers.
There are rules and formats that are appropriate. Capstone activity will help with this.
The fundamental goal that applies to all diagnostic sessions is –
Arrive at
a good understanding
of the client’s
communication problem
Three types of information you should have at the end?
diagnosis
prognosis
recomemendations
What is basic diagnostic protocol?
Read and understand the completed case- history intake form
Opening interview with the client and/or family members
Formal standardized testing
Informal testing and strategic observations
Hearing screening
Oral- facial inspection
Closing Interview
Write the diagnostic report
Framing the clinical question?
Use PICO framework.
Make sure that your question is relevant and answerable.
Your inquiry can be general or specific. (e.g., Does Mary Jo have an articulation disorder? Does Mary Jo change her speech pattern when giving a clinical teaching opportunity?)
Each procedure that you decide to do should be driven by a clinical question.
Valid/ Reliable:
Valid: synonym for truth (a valid test tests what it claims to test)
Reliable: repeatable (if one person gives the test will it have the same results as someone else who gives a test)
PICO example general
P – Mary Jo
I – Select a test that is valid and reliable for identifying articulation disorders; also appropriate for Mary Jo’s age and dominant language .
C – Compare to normative data
O – Confirm or rule out an articulation disorder.
Does the Clinical Assessment of Articulation and Phonology identify Mary Jo as a person with an articulation disorder?
Does the Clinical Assessment of Articulation and Phonology (CAAP) identify Mary Jo as a person
with an articulation disorder?
Read manual to determine whether the CAAP is reliable and valid for identifying articulation disorders, and appropriate for age and language.
Administer the CAAP according to the manual.
Record, score and interpret her responses.
Compare results to normative data
- Diagnosis or category
- Severity rating
Then assign a diagnosis using test results.
PICO example specific
Does Mary Jo change her speaking pattern with clinical teaching?
P – Mary Jo
I – Select a test that is valid and reliable for evaluating stimulability, or a procedure known to effectively prompt change; should also be appropriate for Mary Jo’s age and language.
C – Compare production before and after clinical teaching
O – Confirm or rule out potential therapy targets.
Does the GFTA: Stimulability Subtest identify Mary Joe as a person who responds positively to clinical teaching?
Planning for the report from the beginning
Report Format Includes –
Identifying information: - -Primary source: Case- history intake form
Diagnosis: Primary source: Relevant evidence
Introductory paragraph: Primary sources: Case- history intake form and opening interview
Statement of the problem: Primary sources: Case- history intake form and opening interview, short and direct quote (intake form) or “why did you come here” answer
Background information: Primary sources: Case- history intake form and opening interview, past tense, all information before testing
Results of testing: Primary sources: Formal and informal testing, any data collection or data observations
Clinical impressions: Primary source: clinical observation, (if the person is easy distracted, or highly motivated, or sociable)
Summary (includes diagnostic statement): Primary source: The body of the report, “why you’re going to make the diagnosis, prognosis, and recommendations”, detailed, last sentence should start with “therefore”
Prognosis: Primary source: The report summary, Where you want to write something meaningful if you think this person will benefit form treatment
Recommendations: Primary source: The report summary, should always say if you recommend speech therapy and the frequency and include rationale. Never say where to get speech therapy done, also any follow up testing that should be done, any referrals
Closing statement: Primary source: closing statement “it was a pleasure testing John today, if you have any questions, feel free to contact me.
Signature lines: Primary source: individuals who participated, and their qualifications
- Once a person receives a diagnosis, changing it requires a doctor’s order:
- Diagnosis is based on highly individualized data:
- Prognosis can be opinion but prognosis statement but be based on
- Prognostic statement is a prediction:
- Inaccurate prognostic statements can be a source of professional liability:
- FALSE
- TRUE
- EVIDENCE
- FALSE
- TRUE
- The primary purpose for administering a standardized test is ______ a person according to behavioral symptoms
- Identifying the etiology for a communication patter can have a noteworthy impact on the plan of care:
- Everyone’s speech should be present by age
- All assessments should include dynamic testing:
- Dynamic assessment includes activities to evaluate the client for response to:
- All clinical decisions are based on:
- CATEGORIZING
- TRUE
- 8
- TRUE
- Clinical teaching
- EVIDENCE
- Professional documentation must be:
2. The most important part of a basic diagnostic protocol is the standardized testing:
- ACCURATE, CLEAR, and PRECISE
Say it one time and say it in the right place
- FALSE
Clicker questions (4)
- Potential clinical questions is most likely to be clinically relevant for John, a 12 year old whose mother reports that people find him difficult to understand:
- It is best to begin planning for the clinical report after completing the diagnostic:
- Does the conversational speech sample reveal age- inappropriate speech- sound errors for John?
- not cognitive challenges
- not social challenges - FALSE
