SLP 307 Midterm

steps of evidence based practice

1. frame your question

   • PICO - population, intervention, comparison, outcome

2. gather evidence

   • internal - practice-based

   • external - research from scientific literature

3. assess evidence

   • internal - determine if intention has impacted client

   • external - determine reliability, importance, and applicability of research to client’s condition and needs

4. make decision

   • based on previous steps

perspectives of EBP Blame Game

evidence evangelists - “its an SLPs job to read research”

disregard research: trust your clinical intuition only

PICO

population - patient or problem

intervention - treatment

comparison - main alternative to treatment

outcome - what you want to accomplish

screening

• prevention based, not just a short test

• Goals: determine risk, identify group of ppl who need closer look, and determine who will likely fail diagnostic test

different ways of obtaining medical/developmental history

• chart review (medical setting)

• review of IFSP (early intervention)

• review IEP (school setting)

• review forms from caregivers

• review doctor/therapists reports

• review previous test results

USE over MEANING

ask for an example rather than “what they mean”

use open-ended

how does __ affect __

restate

in EXACT words not paraphrasing

summarize

summarize and allow them to correct you

avoid multiple questions

only ask one at a time

avoid leading questions

say “tell me about __” instead of “what don’t you like about __”

avoid “why” questions

(so you don’t seem judgemental) “what is your reasoning for __”

norm referenced testing

• standardized testing

• compares score with similar aged peers

criterion referenced testing

• determines individual’s level of skill in particular area

• individual can be compared to themselves, and is judged against particular standard

• measures a student’s performance against a predetermined set of standards, learning objectives, or criteria

behavioral observation

observing how an individual uses communication for functional purposes in the real world — allows us to see how they use communication naturally

dynamic assessment - what, why, & importance for diverse populations

• test for a particular skill while providing cues or models so that the child can perform skill, then test again

• to analyze how much & what types of support/assistance are needed is needed

• normative sample may not be representative of child/patient

true positive

positive test result, client has the disorder

true negative

positive test result, client does not have the disorder

false positive

negative test result, client does not have the disorder

false negative

negative test result, client has the disorder

sensitivity

(statistical measure) how well a diagnostic test detects a disease

specificity

(statistical measure) how well a diagnostic test can identify people who do not have a condition or disease

considerations when designing treatment

effectiveness - will it work

efficiency - more is not always better BUT if increased frequency/intensity is effective, then do it

feasibility - is it attainable

purposes of treatment

prevention - do we want to prevent a disorder from emerging?

remediation - do we want to slow the progress or reverse the course of a disorder?

compensatory - do we want to help a person cope with a disorder whose symptoms are not likely to dissipate?

elements of SMART goal

Specific, Measurable, Attainable, Relevant, Timely

approaches to intervention

Behaviorist - communication can be learned through operant condition ing (positive or negative reinforcement)

Linguistic-cognitive - treats language and communication impairments by addressing underlying cognitive processes (attention, memory, etc)

Social-interactionist - social interaction is necessary for language development and social skills

Family centered - emphasizes individual’s participation within family contexts

articulation disorder

(typically) does not compromise word meaning, but may compromise intelligibility

phonological disorder

involves the rules that govern sound patterns — may compromise the meaning of the word and intelligibility

Calculating PCC

divide the number of correctly produced consonants by the total number of consonants — then multiply by 100

phonological processes

fronting - ex: tat for cat

stopping - ex: tea for sea or right for fight (replace long sound for short sound)

gliding - [r] become [w] or [l] becomes [y] or [w] - ex: yewwow for yellow

backing - ex: top for cop

traditional articulation approach

motor-based speech therapy method focused on teaching physical placement and movement of the articulators to produce clear speech sounds

phonological intervention approaches

• contrastive

• stimulability

• minimal pairs approach

• maximal opposition

• complexity

contrastive intervention approach

Focuses on teaching the child that sound differences change the meaning of words. Instead of practicing a sound in isolation, the clinician contrasts two or more words that differ by specific phonemes

stimulability

short-term, transitional intervention designed to expand a young child's phonetic inventory by directly targeting sounds the child cannot yet produce spontaneously

minimal pair approach

pairs of words or phrases that differ by only a single sound (phoneme) in the same position, yet have completely different meanings

maximal opposition approach

uses word pairs differing by multiple distinctive features to reorganize a child's sound system

complexity approach

choosing targets above the child’s developmental level, they will gradually aqcuire smaller targets as they achieve the big one

placement

where the articulators need to go

phonetic shaping

using a sound the patient already knows to teach them a new sound

facilitation

using phonetic, contextual, or linguistic supports to help a child produce target sounds

“branding issue” in child language disorders

there are many many different names used to refer to child language disorders, so everyone uses a different name and it can be very confusing as to if they are referring to the same or different thing.

language delay

show delays in early stages of language development — usually called “late-talkers” and will catch up to their peers around age 3-4

language disorder

occurs when an individual exhibits significant and persistent difficulties with the comprehension and/or expression of spoken, written, or sign language.

language form

structure of langue - morphology and syntax

language content

meaning expressed through language - semantics, lexicon

language use

how language is used in social contexts

DLD

developmental language disorder — persistent challenge with receptive and/or expressive oral language that impacts daily function without a clear etiology (cause)

Dyslexia

a specific learning disability, characterized by difficulties with accurate and/or fluent word recognition and poor spelling and decoding abilities

CLD therapy targets

consider: age, strengths & weaknesses, and client/caregiver goals

CLD therapy strategies

the “how”/manner in which targets are addressed

child-centered vs clinician directed

child centered CLD strategy

child sets pace and chooses toy, clinician will use focused stimulation approach (provide multiple, salient models of the target) to work towards the client speaking/target

clinician directed CLD strategy

clinician chooses lesson (usually based on clients interests), and has structured the lesson around desired goals

what is generalization

the process of expanding and transferring newly learned communication skills from the controlled clinical environment into everyday, real-world situations, settings, and conversational partners

types of strokes

ischemic - blockage in the arteries

hemorrhagic - rupture/leakage

aphasia

• acquired language disorder

• “without language”

• caused mainly by strokes, but also infectious disease, tumors, exposure to toxins/poisons, hydrocephalus, nutritional or metabolic disorder

types of paraphasias

phonemic paraphasia - substitution/transposition of sound (“dankle” for “candle”)

semantic paraphasia - word is substituted (“bed” for “chair”)

RHD

• caused by injury to the right cerebral hemisphere

deficits: extra wordy, social cues, left neglect, prosopagnosia - difficulty recognizing faces, difficulty with higher-level skills such

TBI

• caused by sudden injury that causes damage to the brain

  • deficits: psychosocial skills (emotions, empathy, pragmatics), cognitive skills (attention, planning, memory), and linguistic skills (vocabulary, grammar, conversation)

Dementia

• chronic, progressive decline in memory, cognition, language, and personality

  • deficits: memory impairment impairment in cognitive skills aphasia, apraxia, or agnosia (inability to recognize objects, words, or sounds) 

Types of apahasia

• Broca’s

• Transcortical Motor

• Global

• Wernicke’s

• Transcortical Sensory

• Conduction

• Anomic

Broca’s

• slow labored speech

• macrographia (large handwriting)

Transcortical Motor

• anomia with phonemic paraphasias

  • slow/labored speech

Global

deficits across all modalities

• poor auditory comprehension

• poor repetition abilities

Wernicke’s

• poor auditory comprehension

• jargon

Transcortical Sensory

• poor auditory comprehension

  • great repetition skills

Conduction Aphasia

• difficulty with oral reading

• difficulty with repetition

  • 
    

Anomic

• very impaired in naming

• impaired word retrieval for written language