CSD 515: WK 4

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