Studied by 1 person
What is the purpose of Assessment?
Reimbursement - skilled services for the insurance
To plan for a session
To confirm medical services
To create a baseline
To make a prognosis
Interaction of Concepts ICF 2001
WK 4 S. 4
Appraisal
-the rapport building in the first session -> you must be sensitive to their concerns and needs -this can influence treatment
Purpose: -make a diagnosis (the label of their condition) -state a prognosis -focus treatment
What are some Sources of Data? (Chart review/interview)
-Biographical data
-Medical data
-Behavioral data
Handedness!!!
If a pt is left handed -> might be processing things differently
Biographical Data
-Patient's name, nickname
-Address
-Date of birth
-Education
-Date of onset of brain damage
-Premorbid and present handedness
-Interests and hobbies
-Marital status
-Occupational status
-Highest occupational level attained
-Est. premorbid communicativeness
-Est. premorbid intell.
-Premorbid languages
-Present environment
Medical Data
-vision
-hearing
-limb involvement
-brain stem signs
-etiology
-previous CNS involvement
-localization of brain damage
-specific medical diagnosis
-other major medical diagnoses
-medications
Behavioral Data
▶ Neurologist
▶ Physiatrist
▶ Psychiatrist
▶ Neuropsychologist
▶ Nurse
▶ Occupation therapist
▶ Physical therapist
▶ Speech-language pathologists
▶ Patient's family
Speech-Language Pathologist
Administer formal and informal measures to appraise aphasic pts commu. skills: -oral-expressive lang. -written lang. -auditory comprehension -reading -gestural commu -drawing
Info. is used to provide a diagnosis and prognosis -> to focus treatment
Factors influencing assessment
Work setting: -in-patient acute -in-patient subacute -in-patient rehabilitation center -out-patient rehabilitation center
Reimbursement issues
What are some types of assessment?
Bedside Assessment
Clinical Assessment: -standardized/nonstandardized -structured/unstructured
Unstructured Assessment
-get to the functional assessments
Elements of Bedside Assessment
Administered in a brief period of time
Identify communication skills/barriers to communication
Elicit spontaneous speech with... -open ended q's -personally relevant q's -picture description
Confrontation naming (holding up an obj or a picture and having them name it with no cueing/prompting): -real objects -pictured objects
Auditory comprehension: -yes/no responses -sequential commands -conversational speech
Repetition
Reading: -single words -sentences -paragraphs
Writing: -name -address -single word/sentence dictation -picture description
Gesture (praxis)
What are some screenings for bedside tests?
-Western Aphasia Battery Test (WAB)
-Aphasia Language Performance Scales (ALPS)
-The Aphasia Screening Test
McCauley and Swisher, 1984
Outlined criteria that all tests should possess ▶ Defined standardization sample ▶ Adequate sample size ▶ Control item difficulty, item validity, or both ▶ Report mean and SD for raw scores of relevant subgroups ▶Concurrent validity ▶ Predictive validity ▶ Test-retest reliability ▶ Interexaminer reliability ▶ Sufficient description of test administration ▶ Special qualifications required of the test administrator or scorer
HOW DO APHASIA TESTS MEASURE UP?
▶ Not particularly well for general language measures ▶ Frequently, no information is provided in the manual, but data exist in other published papers and books.
GENERAL LANGUAGE MEASURES
▶ Western Aphasia Battery (Kertesz, 2007) ▶ Boston Diagnostic Aphasia Examination (Goodglass & Kaplan, 2001) ▶ Porch Index of Communicative Abilities (Porch, 1981) ▶ Minnesota Test for the Differential Diagnosis of Aphasia (Schuell, 1965)
Eval samples (5, then 3)
Non-language observations ▶ Mood ▶ Humor ▶ Attention/effort
▶ Modes of communication ▶ Comprehension ▶ Verbal expression ▶ Repetition ▶ Reading ▶ Writing ▶ Aphasia Type? ▶Structured/unstructured? Comprehensive assessment or screening
WESTERN APHASIA BATTERY
Purpose: ▶ Diagnose presence and type of aphasic syndrome ▶ Evaluate main clinical aspects of language function ▶ Appraisal of non-verbal abilities ▶ Allow inferences about localization
You can cut it off when they are doing really well
There is no percentile, you need to finish the whole test to have a standardized score
BOSTON DIAGNOSTIC APHASIA EXAMINATION
Purpose: ▶ Diagnose presence and type of aphasic syndrome ▶ Allow inferences about localization ▶ Measure severity ▶ Measure change over time ▶ Provide comprehensive assessment of language strengths and weaknesses
CASE EXAMPLE
▶ 39-year-old patient with a closed head injury and near drowning incident in 1997, which resulted in a period of anoxia with vertebral artery occlusion. ▶ Patient with residual moderate-to-severe aphasia, voice disturbance, dysarthria, and right sided weakness.
SEVERITY BASED ON AQ
▶ 0-25-Very Severe ▶ 26-50-Severe ▶ 51-75-Moderate ▶ 76 and above- Mild
WAB
Praxis ▶ upper limb ▶ facial ▶ instrumental ▶ complex
Constructional, Visuospatial, & Calculation ▶ drawing ▶ block design ▶ calculation ▶ Raven's Coloured Progressive Matrices
STRENGTHS: ▶ Subtests can be administered relatively quickly ▶ Provides a comprehensive evaluation in all communicative modalities ▶ Patient performance is fairly easy to score ▶ Validity and reliability data exist
WEAKNESSES: ▶ Forces classification ▶ Accuracy and reliability of classification ▶ Discrete "cut-off" scores for classifying type of aphasia seem arbitrary ▶ AQ heavily loaded on tasks that require talking (diff. to assess change in severe oral-expressive impairment) ▶ Spontaneous speech assessment is limited ▶ Repetition tasks - less complex, less well structured
BDAE
Biographical, medical, behavioral info.
Conversational and expository speech ▶ informal exchange ▶ open-ended conversation ▶ picture description ▶ Narrative discourse
Auditory Comprehension ▶ word discrimination ▶ body-part identification ▶ commands ▶ complex ideational material ▶ Syntactic processing
Oral Expression ▶ oral agility ▶ automatized sequences ▶ recitation, singing, and rhythm ▶ repetition ▶ naming
Reading ▶ Symbol recognition ▶ Word identification ▶ Phonics ▶ Derivational and grammatical morphology ▶ Reading sentences and paragraphs
Writing ▶ Mechanics of writing ▶ Writing to dictation ▶ Oral spelling ▶ Written naming ▶ Written formulation
Praxis ▶ Limb ▶ Bucco-facial/respiratory
SCORES PROVIDED: 0-5 point Aphasia Severity Rating Scale Rating Scale Profile of Speech Characteristics ▶ used to classify into aphasia type Percentiles for performance on each subtest
STRENGTHS: ▶ Comprehensive appraisal of a wide range of abilities within each communicative modality ▶ Attempts to standardize profiles for different types of aphasia ▶ Measures for the qualitative aspects of speech
WEAKNESSES: ▶ Long time of administration ▶ Failure to classify to a specific syndrome in 40-60% of patients tested ▶ Test validation is based on factor and discriminant analyses, but the different types of reliability have not been reported.
BDAE vs. WAB
Similar purposes
Similar content
Significant agreement in comparison of severity, fluency, auditory comprehension, repetition, and naming
Different classifications (Wertz, Deal, & Robinson, 1984): ▶ WAB: classified 89% of the patients ▶ BDAE: classified 40% of the patients ▶ % agreement: 27%
Why do two measures designed to do the same thing do that thing so differently?
▶ Tendency for WAB to classify all patients and the BDAE to fail to classify 60% of patients
▶ Differences in the way each measure rates fluency
▶ Differences in the severity of auditory comprehension
▶ Differences in whether the patient is rated aphasic
