new Final Exam EBP

What are the three areas of EBP that need to be considered when making the best EBP clinical decision?

• external scientific evidence

• clinical expertise

• client values/perspectives/preferences

PICO

• patient/ problem

• intervention

• comparison

• outcome

why is PICO important

it helps clinicians create focused clinical questions and search for evidence efficiently

According to Horton & Munoz (2021), all steps of the EBP triangle exist within cultural context. What does this mean and what might be an example?

means culture influences:

• research interpretation

• clinical expertise

• client perspectives/preferences

reliability

• Consistency of results

• If repeated, results should be similar

validity

Whether the test measures what it claims to measure

why are reliability and validity important

clinicians need assessments that are both accurate and consistent in order to make appropriate diagnoses

sensitivity

Ability of a test to correctly identify individuals who HAVE a disorder (true positives)

specificity

Ability of a test to correctly identify individuals who DO NOT have a disorder (true negatives)

why does sensitivity and specificity matter for assessment tools

because poor sensitivity may miss disorders, while poor specificity may over-identify disorders

norm-referenced

• Standardized

• Compares client to peers

• Uses norms and bell curves

criterion-referenced

• Measures mastery of skills

• Compared to specific criteria rather than peers

authentic assessment

• Real-world observation and performance

• Functional/contextual assessment

authentic assessments are best when

• Assessing bilingual students

• Evaluating functional communication

• Reducing cultural bias

• Observing real-life performance

What are the steps in making an evidence-based clinical decision?

1. Ask a clinical question

2. Search for evidence

3. Evaluate evidence quality

4. Combine evidence with expertise and client preferences

5. Implement intervention/assessment

6. Evaluate outcomes

What are the different levels of evidence in EBP?

From strongest to weakest:

1. Systematic reviews/meta-analyses

2. Randomized controlled trials

3. Cohort studies

4. Case-control studies

5. Case studies

6. Expert opinion

What are some different types of cultural bias that might be present in an assessment tool?

• Linguistic bias

• Socioeconomic bias

• Cultural knowledge assumptions

• Nonrepresentative norming samples

• Bias in test content or scoring

How does eye contact differ across cultures?

• Some cultures view direct eye contact as respectful and attentive.

• Other cultures may view prolonged eye contact as disrespectful or confrontational.

Clinicians should avoid assuming lack of eye contact indicates a disorder.

What is the purpose of an interprofessional team

To improve patient outcomes through collaborative care.

what are the four IPEC core competencies

1. Values/Ethics

2. Roles/Responsibilities

3. Interprofessional Communication

4. Teams and Teamwork

When and how might you work with an interpreter

You may work with an interpreter when:

• A client/family speaks another language

• Communication barriers exist

Best practices:

• Speak directly to the client

• Brief interpreter beforehand

• Use simple language

• Avoid jargon

• Debrief afterward

What are some pre-assessment tasks that you would want to complete and why?

• Review case history

• Obtain consent

• Gather medical/developmental history

• Check hearing/vision information

• Prepare materials

• Calculate chronological age

What are key parts of the intake interview

• Medical history

• Developmental history

• Family concerns

• Educational history

• Communication concerns

What are key parts of the exit interview

• Review findings

• Explain diagnosis/results

• Recommendations

• Answer questions

• Discuss next steps

When conducting an orofacial examination, what type of things are you looking at and for what reasons?

• Lips

• Tongue

• Jaw

• Dentition

• Soft palate

• Facial symmetry

• Range of motion

• Strength

• Sensation

• to see if it affects speech and swallowing

What are ways to elicit a speech and language sample

• Conversation

• Play

• Story retell

• Picture description

• Narratives

What are ways to analyze a speech and language sample?

• MLU

• Grammar

• Pragmatics

• Speech sound errors

• Vocabulary

• Fluency

• Narrative structure

diagnosis depends on

• Standard scores

• Functional impact

• Clinical observations

• Language sample

• Eligibility criteria

Consider the morphology of AAE, MAE, Asian, and Hispanic-influenced language production. How are they similar or dissimilar? Why does this matter?

Differences may include:

• Verb tense marking

• Copula deletion

• Final consonant production

• Plural marking

This matters because clinicians must distinguish:

• Language difference
  vs.

• Language disorder

Incorrect interpretation can lead to misdiagnosis.

ASD

• Social communication deficits

• Restricted/repetitive behaviors

SCD

• Social communication deficits ONLY

• No repetitive/restricted behaviors

How is a differential diagnosis made between ASD and SCD?

Presence of repetitive behaviors is a major distinguishing factor

Developmental Speech Sound Disorder

Consistent articulation/phonological errors

Childhood Apraxia of Speech (CAS)

• Motor planning deficits

• Inconsistent errors

• Difficulty sequencing sounds

• Prosodic abnormalities

motor-based!!

What are some early risk factors of selective mutism that you could ask about in your intake interview?

• Anxiety

• Family history of anxiety

• Behavioral inhibition

• Shyness

• Bilingualism

• Traumatic experiences

• Social withdrawal

Reading Assessment

• Decoding

• Fluency

• Comprehension

• Phonological awareness

Writing Assessment

• Spelling

• Grammar

• Organization

• Sentence structure

• Written expression

Stuttering Assessment

• Repetitions

• Blocks

• Prolongations

• Secondary behaviors

Cluttering Assessment

• Rapid/irregular speech rate

• Reduced intelligibility

• Disorganized speech

• Excessive disfluencies

Describe some cultural considerations when assessing dysphagia

• Dietary restrictions

• Feeding practices

• Religious food practices

• Communication differences

• Personal space/touch

• Beliefs about illness/treatment

Clinicians should use culturally responsive care and avoid assumptions.