Adult Language Assessment and Intervention Exam 1

World Health Organizations (WHO) primary concern

how is quality of life affected by health conditions?

WHO's 6 main aspects of health-related quality of life

physical, psychological, level of independence, social relationships, environment (physical or psychological), spiritual

what framework did the WHO publish?

International Classification of Functioning, Disability, and Health (ICF)

what countries follow the ICF?

every country

what is the ICF

internationally recognized conceptual framework and common knowledge

what are the two categories of the ICF framework?

functioning/disability and contextual factors

what are the subcategories of the functioning/disability portion of the ICF framework?

body structure, body function, and activities/participation

what falls under the subcategory of body structure in the ICF framework?

anatomy

what falls under the subcategory of body function in the ICF framework?

physiology; ex: talking

what falls under the subcategory of activities/participation in the ICF framework?

things you can do alone or with 1 or more people

what are the subcategories of the contextual factors portion of the ICF framework?

personal and environmental factors

what falls under the subcategory of personal factors in the ICF framework?

things you can't change

what falls under the subcategory of environmental factors in the ICF framework?

physical environment, social networks, things that affect feelings, beyond yourself

define capacity

individuals ability to execute a task or action in a regular environment (possibly with supports)

define performance

individuals ability to execute a task or action in the current environment or actual context in which he/she lives

what does A-FROM stand for?

Living with Aphasia: Framework for Outcome Measurement

could A-FROM also represent individuals with other neurological conditions?

yes; like TBI or dementia

what is A-FROM?

ICF framework in a different form

what are the 4 aspects of A-FROM?

participation in life situations; personal identity, attitudes, and feelings, severity of aphasia, and communication and language environment

A-FROM examples of participation in life situations

activities, communication and conversation, roles and responsibilities, and relationships

A-FROM examples of personal identity, attitudes, and feelings

the future, your view of yourself, aphasia and who you are, and feelings

A-FROM examples of severity

understanding other people, speaking, writing, and reading

A-FROM examples of communication and language environment

services, systems, and policies; attitudes of others to you and the aphasia; help with communication and conversation

example of medical model for treatment

"Her impairment is the problem. We need to fix her."

example of social model for treatment

"The stairs are the problem. We need to build a ramp."

pertinent medical chart history

check physicians orders, H & P (history and physical), consultations, tests, progress notes, ancillary notes

what pertinent medical chart history should you look at IF time allows?

nurses notes, vital signs, and meds

what consultations on the medical chart history are pertinent to SLP?

specialists (MD's or DO's); cardiologist, neurologist, nephrologist, ENT

surgery/Op notes pertinent to SLP

laryngeal, brain

relevant tests in medical chart Hx

Brain MRI, Head CT, EKG, anything from stomach up

how should you read progress notes?

backwards

what are ancillary notes?

allied health or non-physicians

who else should you gather medical chart Hx and status from?

nurse, PT, OT, RT, family, pt., physician

what should you include in the writing history portion of Ax?

1. age

2. gender

3. handedness (prior to event)

4. date of admission

5. referral/consultation source and reason

6. primary language

7. primary history of (PHO)

8. past medical history (PMH)

9. current medical history (CMH)

10. social/family Hx

11. prior to event/hospitalization status (level of functioning)

12. recent tests which pertinent to SLP Ax and Tx

13. precautions

what do you put under the "personal history of (PHO)" section?

things that could happen again

what do you put under the "past medical history (PMH)" section?

1 time event

what do you put under the "current medical history (CMH)" section?

what pt. is currently being treated for

S portion of SOAP note

subjective observations; what you notice about pt., pt's complaints, and/or family members comments (pt. oriented)

O portion of SOAP note

objective observations; data and facts; measurable things- numbers and/or actual examples (pt. oriented)

A portion of SOAP note

assessment; analysis and summary; similar to "clinical impressions" section of some reports; comparable info (pt. and clinician oriented)

P portion of SOAP note

plan; steps and measures to be taken and/or how you handled a situation AND/OR pt./family/staff education (clinician oriented)

tips for writing SOAP notes

"KISS" the chart- keep it short and sweet; can omit some functor words- do not have to write in complete sentences; use active voice and word as patient-oriented as possible; be as positive as possible- look for and state the good, but also identify problems

Goal-writing

establish objective, measurable, functional goals with time frames that address the limitations identified in baseline measurements

what are the kinds of goals?

short-term goals and long-term goals

components of a goal

functional outcome, qualifier, condition/frequency (if applicable), and techniques/strategies

FOURC goal model is applicable to whom?

patients in acute care/rehab centers

what is the FOURC goal model?

communicate, comfort, comprehension, and care

FOURC model rating scale; 4

fully successful; not a problem at all

FOURC model rating scale; 3

mostly successful minor problem

FOURC model rating scale; 2

sometimes successful; moderate problem

FOURC model rating scale; 1

rarely successful; frequent problem

FOURC model rating scale; 0

not at all successful; severe problem

what should you do first before choosing a goal with a rating scale of 0 or 1?

see the patient

what is SBAR?

can be used for oral or written reports/discussions in medical/clinical settings

when should you use SBAR?

when speaking to other professionals

what does SBAR stand for?

Situation

Background

Assessment

Recommendation

traditional definition of Transient Ischemic Attack (TIA)

brief focal cerebral event in which symptoms develop rapidly; a part of the brain has temporarily become ischemic

current definition of TIA

a transient episode of neurological dysfunction caused by focal brain ischemia without acute infarction

what is infarction?

dead brain tissue

what does transient mean?

temporary

what does ischemic mean?

lack of blood flow

what is the traditional duration of a TIA?

2 minutes up to 24 hours

what is the current duration of TIA?

it is no longer specific

what is a TIA often referred to?

a mini stroke

Does the dead tissue caused by a TIA go away?

yes; there is no final dead tissue

definition of a stroke

a sudden and severe onset of a prominent and frequently persistent neurological deficit

what is stroke a result of?

damage to the circulation of the brain and brain infarction occurs

what are the two types of stroke?

occlusive (ischemic) and hemorrhagic

what is an occlusive (ischemic) stroke?

complete or partial occlusion of arteries

causes of occlusive stroke

thrombotic occlusion of artery or embolic occlusion of artery

what is thrombosis?

stationary blockage along an arterial wall; bacteria, cholesterol, blood clot

what is an embolus?

particle that breaks away/floats around in the bloodstream; bacteria, cholesterol, blood clot

what is an hemorrhagic stroke?

rupture of blood vessel anywhere within the skull or brain; bleeding from a complex of abnormally formed vessels (arteriovenous malformation)

what eventually occurs when a blood vessel ruptures?

eventually spring a leak and spills on brain tissue

where can a hemorrhagic stroke occur?

in the brain (intracerebral) or in the skull (intracranial)

where can a hemorrhagic stroke intracerebrally?

parenchyma of brain (actual brain tissue); the closer you get to parenchyma=more serious

where can a hemorrhagic stroke intracranially?

subarachnoid space, subdural space, and epidural space

subarachnoid space

space between arachnoid and pia

subdural space

between dura and arachnoid

epidural space

between dura and skull

what are the two main types of arteries that supply the brain?

vertebral and internal carotid arteries

what do the vertebral arteries supply?

posterior brain; come up through back of neck

what are the two branches of the vertebral arteries?

basilar and posterior cerebral arteries

what does the basilar artery supply?

the brain stem and cerebellum

problems due to damage of the basilar artery in the brainstem

CN III-XII, diplopia, hearing problems, dysarthria, dysphagia, dysphonia, hemiplegia, respiratory->ventilator, full coma or death

diplopia

double vision

hemiplegia

paralysis of one side of the body

hemiparesis

weakness on one side of the body

why does damage to the brainstem cause respiratory problems?

the brainstem is the center for breathing

problems due to damage of the basilar artery in the cerebellum?

ataxia, ataxic dysarthria, cognitive problems

ataxia

balance and coordination problems

ataxic dysarthria

unusual prosody

what do the posterior cerebral arteries supply

occipital cortex, thalamus, and internal capsule

problems due to damage of the occipital cortex

cortical blindness and hemianopsia (unilateral or bilateral)

cortical blindness

nothing wrong with eyes just can't see

hemianopsia

blindness in half the visual field

problems due to damage of the thalamus

sensory integration dysfunction and subcortical aphasias

problems due to damage of the internal capsule

motor movement dysfunction, upper motor neuron dysarthria, hemiballismus

hemiballismus

motor restlessness on half of body

branches of internal carotid artery

anterior cerebral arteries and middle cerebral arteries