Topic 3: Ch. 6 - Assessment and Appraisal

Assessment

The clinical evaluation of a client’s disorder

1. Phase 1 Appraisal- the collection of data (too little: does not provide adequate info to provide best services; too much: wastes client’s valuable time and money)

2. Phase 2 Diagnosis- the analysis of data to come to conclusion about nature of behavioral patterns

Guidelines for Assessment

ASHA provides the Practice portal to help clinicals remain consistent in their practices

• Important: appraisal is not just about what the child can’t do

2 main appraisal processes: (the collection of data)

1. Screening: produces to determine if the individual merits further evaluation

2. Diagnostic speech assessment: activities and tests that provide sufficient information for the clinician to determine diagnosis

Both guided by the research question: Does this individual communicate effectively, efficiently, and appropriately across multiple contexts of interest compared to a developmental functional model?

1. Case History

2. Parent and client perspectives

3. Hearing Screening

4. Oral Facial Examination

5. Standardized speech assessment and stimulability measures

6. Conversational speech sample

7. Additional information that may provide detail

Initial procedures: At a minimum, SLP’s collect data in

1. ________ _______

2. ____ _______

3. _______ _________

4. ____ _________ ___________

5. _____________ ______

6. ________ _________

7. __________

2. Case History

- Developmental

Several basic diagnostic functions:

2. Begin with ____ _______ information – preexisting or relevant information. (You also want to know if they take any medication or allergic to anything, family history, and developmental history, communication at home, home routine, who’s the primary caregiver, do they attend daycare, what does the child enjoy, what are their hobbies, and anything and everything related to speech or language).

- _____________ history – first words, milestones, etc.

- Final question – “Do you have anything else that you want me to know?”

Hearing screening

Several basic diagnostic functions:

3. Always begin assessment with a _______ _________ – current hearing status (hearing screenings are only good for 1 year)

- All sounds are frequencies

20dB, 25dB

SLP's can only screen hearing at ___dB for people 18 years old or younger and at ___dB for people 19 years old or older.

structure and function

Several basic diagnostic functions:

4. An Oral Peripheral Examination (OPE) to look at the _________ and ________

communication sample

Several basic diagnostic functions:

5. A ____________ ______ to look at intelligibility (what speech sound errors are causing them to be unintelligible?)

contexts

Several basic diagnostic functions:

6. we look at what the effects of the communication disorder on the child's everyday communication ________. (if so, how and where)

rapport

Initial Impression:

Establishing _______ starts when you meet the client/caregivers. They are checking you out just like you are checking them out.

interactions, relevant

Initial Impression:

The therapist should be closely observing ____________ (you need to always be listening). Document any and all data ________ to communication.

gained

- barriers and facilitators

- planning and organizing

Initial Impression:

From the information ______:

- give preliminary information about ________ and ____________ of communication.

- aid in ________ and __________ the assessment process. (if a child is constantly on their iPad, go ahead and plan to give a language assessment)

Initial Evaluation Procedures

The following are _______ __________ __________ (the first 4 are screeners)

1. Case history

2. Hearing screening

3. OPE

- Items needed for examination: Mirror, Tongue depressor, Pen light, Gloves, Mask

4. Communication sample

5. Screening

6. Comprehensive evaluation

Screenings

__________ are activities or tests that identify individuals that require further assessments.

- hearing, oral mechanism, communication sample

- there are also commercial versions

Comprehensive evaluation

_____________ __________ or formal test, is a series of activities or tests that allow for a more detailed and complete collection of data.

Oral Peripheral Examination

____ _________ ___________ (OPE)- major goal is to determine the structural and functional integrity of the articulators and speech mechanisms.

head and face, breathing, oral and pharyngeal

During the OPE, you are examining the ____ and ____, the _________, and the ____ and __________ cavity structures (teeth, lips, tongue, hard and soft palates, pharyngeal wall - tonsils, uvula).

You are also checking for functioning Lips, Jaw, Tongue, and Soft Palate.

1. age

2. standardized score

3. errors

4. relevant

Factors to consider when selecting a standardized assessment:

1. Appropriateness for the ___ or developmental level

§ Check age of norm sample first!!!

2. Ability to provide a ____________ _____.

3. Analysis of sound ______.

- Goldman-Fristoe gives the most information on this

4. Inclusion of an adequate sample of the sounds ________ for the client

5. Gives information you want to know

spontaneous

A ___________ speech sample is a basic necessity of all assessments

systematic

Spontaneous speech sample organization:

Planned and executed in a __________ manner to minimize time investment and maximize results

- elicit

- length

- diversity

- gloss

- before

- recording

Spontaneous speech sample organization:

- Provide objects, pictures, play scenarios that ______ possible errored sounds / wide range of communication contexts.

o Plan to set up a scenario that gets the most natural language.

- Plan the ______ of the sample.

- Plan for _________ in the sample

- Monitor the recording and _____ any utterances that might be difficult to understand.

- Listen to a small portion ______ recording the actual sample.

- Test the _________.

o HIPAA and your cellphone

o You will want to take some notes during the collection of the sample.

Stimulability testing

_____________ _______ means that you are testing the client's ability to produce a misarticulated sounds following a model. provide 1-5 models. Testing in Isolated - (nonsense) Syllable - word. Differing views regarding stimulability and therapy targets.

Context testing

_______ _______ means using specific phonetic contexts to possibly facilitate correct productions.

Multisyllabic word

_____________ ____ testing (we don't necessarily do this; unless you know they have errors, and no tests are showing them)

This type of testing reflects many aspects of speech production.

- Phonotactics, prosody, language, phonological processing skills

- 10 words - Ambulance, Hippopotamus, Computer, Spaghetti, Vegetables, Helicopter, Animals, Caravan, Caterpillar, Butterfly

- Language

- Prosody

- Phonemic Awareness

- system

Additional testing - standardized tests for (many listen in textbook):

- ________ (we always screen for language in comm. sample)

- _______ (most comes from childhood apraxia of speech, so do a CAS test)

- Phonological and ________ _________ (Kann-Lowis, 40% and up)

- Analysis of emerging phonological ______

o Inventory of phonemes

o Inventory of speech sounds (phones)

o Inventory of syllable structures / mean babbling level (table 6.8)

o at least

o pre-literacy / literacy

Additional Screenings in Other Areas:

- Research shows that a percentage of children with speech sound disorders also have language disorders.

o So we have to __ _____ screen language.

-Research has also demonstrated that a percentage of children with speech sound disorders also have difficulties with phonological awareness.

o We also need to screen ___-________ / ________ as appropriate.

- In the on-campus clinic, we use the communication sample to screen voice, fluency, and language in the clients we have with speech sounds disorders.

Three

Organizing Artic Test Results: Describing the Error:

There are _____ different scoring systems describe sounds errors.

- We typically stick with the S.O.D.A Chart (I.e., the five-way scoring

Two-Way Scoring

Organizing Artic Test Results: Describing the Error:

1. ___-___ _______ = Right or wrong (kind of what you do on the Goldman-Fristoe)

- Limitations in useable information so not the best option for a standardized test

- Most, if not all, standardized testing based on this; does not tell us why, when, where, or how.

Five-Way Scoring

Organizing Artic Test Results: Describing the Error:

____-___ _______ =

- Correct

- Deletion or Omission – sound deleted completely.

- Substitution – sound replaced with other sound.

- Distortion – target sound is approximated but not exact.

- Addition – sound(s) added to intended sound.

Limitations:

1. Does not give enough information about articulatory patterns such as dialects that are normal

2. Ambiguous definitions of deletion, substitution, and distortion

Phonetic Transcription

Organizing Artic Test Results: Describing the Error:

________ _____________ = Represents spoken words with written symbols.

Advantages:

1. Precise

2. Gives more information about misarticulation (helpful for assessment and intervention)

3. Most universally accepted way to give information about misarticulation by professionals.