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Advanced Diagnostic Audiology > w2 - guidelines > Flashcards

w2 - guidelines Flashcards

1
Q

What are the four existing guidelines on APD?

A

1) Canadian (2012)
2) American (2010)
3) New Zealand (2019)
4) British (2018)

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2
Q

Which APD CPG is the best?

A

New Zealand (2019)

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3
Q

What does CPG stand for?

A

Clinical practice guidelines

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4
Q

Define CPG?

A

A CPG is a set of evidence-based recommendations and statements that guide healthcare professionals in making decisions about appropriate patient care.

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5
Q

What is the aim of a cpg?

A

To assist in standardizing practices, improving patients outcomes, and promoting consistency in healthcare diversity

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6
Q

What does a cpg tell you?

A

what tests to use, how to screen, and how to deliver services at different levels

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7
Q

What are the steps for developing a cpg?

A

1) forming a group/committee
2) define the scope and objectives
3) systematic review of the evidence
4) grading the evidence
5) formulating recommendations
6) identifying facilitators and barriers to application
7) external review and validation
8) finalizing the guidance based on external factors
9) dissemination and implementation
10) regular updates (every 3-5 years)

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8
Q

are cpg guidelines always followed?

A

no

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9
Q

According to the canadian guidelines on APD, what are the 4 limitations in existing evidence?

A

1) lack of knowledge in contributing mechanisms, routed in bottom up/top down processes
2) limited high quality evidence
3) limited standard, valid tests of AP
4) limited tests with specificity and sensitivity to APD, not cognitive or mental conditions

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10
Q

Can APD - only ____% of audiologists reported offering AP assessments for children due to: (3)

A

1) lack of time
2) lack of confidence in the tests
3) lack of available intervention services following assessment

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11
Q

Can APD - what 2 things does the guideline recommend?

A

1) APD tests/assessment should be part of a standard set of core competencies
2) the importance of continued learning

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12
Q

Can APD - about ____ of children may show improved test results within the typical range over time

A

20-30%

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13
Q

Can APD - appropriate terms: for abnormal test results in the first Ax:

A
  • delay in the development of auditory capacities
  • hypothesis of apd
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14
Q

Can APD - appropriate terms: for improvement in performance over time towards the normal range:

A

developmental delay in auditory capacities

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15
Q

Can APD - persistence of abnormal results over time with little or no change:

A
  • APD (rather than maturation)
  • 3 could also have an impact from “practice effect” and “age effect”
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16
Q

Can APD - recommended APD test battery:

A
  • the canadian guidelines do not recommend an APD test battery
  • it only reviews existing evidence and provides general recommendations based on expert opinions
  • more like a literary review (no clear recommendations)
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17
Q

Can APD - the guidelines emphasizes that the APD test battery (TB) should have appropriate: (4)

A

sensitivity, specificity, efficiency, and pass/fail criteria

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18
Q

what is sensitivity?

A

the ability of a test to correctly identify individuals who have a disorder

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19
Q

what is specificity?

A

the ability of a test to pass individuals who do not have the disorder

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20
Q

what is test efficiency?

A

the overall percentage of individuals correctly classified as those with (true positives) and those without APD (true negatives)

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21
Q

Can APD - what are the 3 final levels of recommendations?

A

1) future development and research
2) training clinicians and facilitating continued learning
3)providing effective services for clients

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22
Q

Can APD - what 4 things can lead to future development and research in APD?

A

1) need a consensus for criteria
2) ecological model (ICF) for diagnosis and intervention
3) explore other populations at risk for APD
4) more research

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23
Q

Can APD - what is the ICF?

A

International classification of functioning
- integrates the medical and social models of disability
- consists of 3 components: body structure/function, activity/participation, and contextual factors

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24
Q

Can APD - why is the ICF recommended to define health-related services?

A

1) the ICF is well organized internationally
2) it integrates the strengths of both medical and social models of disability
3) it was approved for the use by the WHO in 2001 after extensive testing across the world
4) it builds a common language and framework for the description of health and health-related services

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25
Q

Can APD - what 3 ways can we train clinicians and facilitate continued learning?

A

1) APD diagnosis and management should be included in audiology and SLP programs
2) practicum experiences
3) continued education

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26
Q

Can APD - what 2 ways can we provide effective services for clients?

A

1) forming interdisciplinary team of professionals to address the needs of individuals with APD
2) introducing available services to individuals with APD

27
Q

USA APD - individuals at risk for APD such as (3)

A

1) history of chronic otitis media
2) history of developmental disabilities or educational difficulties
3) older adults

28
Q

USA APD - what are the limitations of checklists and questionnaires for APD screening?

A

Poor sensitivity, specificity, and validity leading to over referrals (identifies as WNL once behavioural measures are used)

29
Q

USA APD - What are the first steps in the APD test battery?

A
  • testing peripheral auditory function (using OAEs, immittance measures, pure tone audiometry, and word recognition performance)
  • to rule out middle ear and cochlear auditory dysfunction
30
Q

USA APD - The APD TB should: (3)

A

1) consist of a minimum number of tests (at least 2)
2) tests should have validity, reliability, sensitivity, specificity, and efficiency in identifying CANS dysfunction
3) be administered within 45 to 60 minutes (to minimize fatigue)

31
Q

USA APD - should audiologists use software programs (audacity, adobe’s audition) to create and manipulate stimuli for AP tests?

A

This is difficult because norms are already based on specific stimuli

32
Q

An untreated peripheral HL could lead to ____

A

APD (not all cases of HL have difficulty in AP)

33
Q

HL = ____, and APD = ____

A

peripheral, central

34
Q

Why can’t we test someone for APD if they have HL?

A
  • those with HL already have difficulty with AP, we have no way to separate the two
  • APD norms are made for those with peripheral hearing WNL
35
Q

Those affected by ____ and ____ experience more effects of AP difficulties than just ____ alone

A

HL, APD, APD

36
Q

What are confounding factors?

A
  • there are many factors that impact APD (age, sex, gender, HL, job, environment, lifestyle)
37
Q

untreated HL leads to ____

A

maladaptive neuroplasticity

38
Q

USA APD - do they recommend using AEP tests (auditory evoked potential) in the APD TB? why?

A
  • there are no widely accepted criteria for including AEPs in APD TBs
  • we don’t have norms for APD when it comes to AEP tests
  • not able to separate APD from other similar disorders (same result for APD as a language disorder)
39
Q

USA APD - what are the limitations for recommending the use of AEPs?

A
  • cost implications (more $ than behavioural tests)
  • limited availability in audiology clinics
  • poor sensitivity in differentiating APDs from language, reading, or attentional disorders
  • results within normal limits in many cases with APD
  • not providing additional information beyond behavioural tests
40
Q

USA APD - when are AEPs recommended?

A
  • cases suspected in neurologic disorders
  • young children due to low cooperation
  • when behavioural tests fail to reveal clear deficits
41
Q

NZ APD - the cpg follows what guidelines?

A

ICF model

42
Q

NZ APD - functioning and disability are influenced by: (3)

A

1) environmental and social activities and participation
2) health condition
3) personal and environmental factors

43
Q

NZ APD - what are the two approaches?

A

1) test battery approach
2) hieratical approach

44
Q

NZ APD - what is the TB approach?

A
  • recommended by musiek (2011)
  • using a TB including 2 or 3 APD tests with appropriate sensitivity and specificity
  • use fixed Ax included in the TB (used for everyone)
45
Q

NZ APD - what is the hieratical approach?

A
  • proposed by dillon (2012)
  • using a fixed TB may have no relation to all cases suspected of APDs
  • the recommend starting with a small number of tests sensitive to different skills necessary for understanding speech in difficult listening conditions
  • followed by additional tests based on the failed tests if needed
  • current literature is in support of this approach
  • use 1-2 Ax, then for difficulties that are flagged, will go deeper into other tests.
  • if difficulty with processing dichotic stimuli, do more dichotic tests
46
Q

NZ APD - what 7 ways do they judge tests?

A

1) appropriate age norms
2) test-retest reliability has been published
3) reported validity
4) sensitivity and/or specificity have been published
5) clinically acceptable
6) published studies
7) they note any limitations

47
Q

NZ APD - What is the best test for auditory discrimination?

A

STAR2 IMAP Frequency Discrimination Test (FDT)
- doesn’t meat all the criteria but the best one

48
Q

NZ APD - What is the best test for dichotic listening - binaural integration?

A

1) dichotic digits test (DDT)
2) competing words test - free recall (SCAN 3C and SCAN 3A)

49
Q

NZ APD - What is the best test for auditory discrimination - binaural separation?

A

1) competing words test - directed ear (SCAN 3C and SCAN 3A)
2) competing sentences test (SCAN 3C and SCAN 3A)

50
Q

NZ APD - What is the best test for distorted speech?

A

1) time compressed sentence test
2) filtered words test

51
Q

NZ APD - What is the best test for speech understanding in background noise?

A

1) auditory figure ground tests (at 0, 8, 12 dB S/N ration)
2) bamford kowal bench speech in noise test (BKB SIN)

52
Q

NZ APD - What is the best test for spatial segregation?

A

listening in spatialized noise - sentences test (LiSN-S)

53
Q

NZ APD - What is the best test for temporal processing?

A

1) gaps in noise test (GIP)
2) adaptive tests of temporal resolution (ATTR)
3) gap detection test

54
Q

NZ APD - What is the best test for pattern perception?

A

1) pitch pattern sequence test (child and adult versions)
2) frequency pattern test (FPT)

55
Q

NZ APD - What is the best test for auditory attention?

A

1) auditory continuous performance test (ACPT)
2) test of variables of attention (TOVA)

56
Q

NZ APD - What is the best test for auditory memory?

A

1) clinical evaluation of language fundamentals recalling sentences, number repetition forwards and backwards

57
Q

NZ APD - the only cpg that looks at what?

A

processing attention and memory

58
Q

NZ APD - where are AEPs most currently used?

A

hoc basis and in research

59
Q

NZ APD - the use of AEPs in APD TBs requires consensus regarding (6)

A

1) optimal stimuli
2) recording parameters
3) tests diagnostic power
4) reducing testing time and costs
5) improving accessibility
6) continuous education and training

60
Q

NZ APD - ____ are recommended in clinical evaluation for APD

A

acoustic reflexes

61
Q

NZ APD - what are some symptoms of listening problems not consistent with results of basic hearing Ax?

A
  1. difficulty following spoken directions unless they are brief and simple
  2. difficulty attending to and remembering spoken information
  3. slowness in processing spoken information
  4. difficulty understanding in the presence of other sounds
  5. being overwhelmed by complex or busy auditory environments
  6. sensitivity to loud sounds or noise
  7. poor listening skills
  8. preference for loud television volume
62
Q

NZ APD - common AR results in children with APD

A

1) elevated or absent AR thresholds especially in the crossed condition
2) reduced growth of AR amplitudes

63
Q

NZ APD - what is the teacher evaluation of auditory performance?

A

A checklist on the developmental sequency of phonological skills

64
Q

What are the 5 limitations of existing CPGs on APD?

A
  1. they are not up to date
  2. they have developed based on a low level of evidence
  3. a lack of consensus on the criteria for screening, diagnosis, and management of APD
  4. limited interprofessional teamwork in developing guidelines and drawing recommendations
  5. they are primarily expert driven (not following the recommended steps in developing guidelines)

Advanced Diagnostic Audiology (5 decks)

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