Assessment Principles & Methods (Midterm 2)

True or false - all aspects of the WHO international classification of functioning disability and health were considered in assessment initially

False - initially only the body structure & function part (impairment) was focused on

Which aspects of the WHO international classification of functioning disability and health were focused on in assessment later on?

activities, participation, personal factors, and environmental factors

Assessment is __________ and __________

broad and holistic

True or false - a "one-size-fits-all" assessment exists

False - a one-size-fits-all assessment does not and should not exist, you need to be thoughtful and knowledgeable

What is the thing you should consider in assessment?

Considering the purpose of the assessment - why are you doing it?

How might an assessment approach differ in a patient who had a LH stroke and is 3 days post-stroke vs a patient who is further along in their stroke recovery and in a rehab facility?

For the patient who is 3 days post-stroke: focus is on the purpose of assessment and determining goals, a full assessment would not be done at this time, just a brief screening test.
For the patient who is further along: use more comprehensive assessment tests and determine what level they are functioning at

What should your assessment structure be based on?

Based on the patient's goals

What are some goals that might structure your assessment? (7 of them - not the whole list)

1. identify presence, type and severity of aphasia and/or cognitive deficit
2. to assist in prediction of outcome
3. to establish weaknesses and strengths in linguistic, cognitive, and functional skills
4. to determine candidacy for and prognosis in SLP and other treatments
5. to establish baseline measures for treatment and measure efficacy
6. to understand restrictions in life participation
7. to identify specific area of cognitive dysfunction underlying overt symptoms

Assessment procedures are divided into which two types?

Informal and formal

Formal assessment

administration of standardized tests, results in a number/score (e.g., MMSE)

Informal assessment

strategies employed by the clinician that are behaviour-focused, you are not getting a score but rather a behavioural impression by gathering information and observing behaviour

A good assessment includes both _________ and ____________

formal and informal assessments

Formal testing usually yields what?

quantitative results

Informal testing usually yields what?

qualitative results

What usually in the first step in a prototypical assessment?

Getting the referral

After receiving the referral for assessment, what should you do?

find out as much as you can before seeing the person by reviewing pertinent records and collecting relevant information

What kinds of record may you want to review before meeting a new patient for the first time?

Records containing health, rehabilitation, school, pre-interview forms completed by family members, etc.

What kinds of information should be collected in the record review?

Demographics, reason for referral, premorbid status, history of present illness (severity, stroke type, etc.) and post-illness functioning

What can a record review do?

Allow you to hypothesize where this person may be in term of their impairment and functioning/QOL

What is the second step in a prototypical assessment?

Informal assessment - interviews and behavioural observations

What might the interview process involve?

1. Verifying, clarifying, and expanding on information obtained in record review
2. Focusing especially on individuals perceptions of current strengths and needs - their short-term and long-term goals and expectations of therapy
3. Opportunity to determine family and caregiver perspectives (activity and participation domains)
4. Identifying discrepancies between individual and caregiver

Who might the S-LP conduct the interview with?

The patient, family, and other professional

When should behavioural observations be made?

Observations should be made at all points in time, obtaining observations during all contacts ideally over several assessment session - you should be observing behaviour all the time

During behavioural observations what should an S-LP do?

Observe verbal and non-verbal behaviours, vary partners, environments, and activities and involve role play of specific situations

What questions should be considered during informal assessment?

1. What is the extent of the problem?
2. Where does the communicative behaviour breakdown?
3. What helps the communicative behaviour?
4. What are the underlying mechanisms for the communicative behaviour?

What is the third step in a prototypical assessment?

Formal assessment - administration of assessment measures

What is the purpose of administering assessment measures?

Objective evaluation of strengths and weaknesses within the client, relative to the normative group, and relative to their pre-morbid state

True or false - The administration of assessment measures involves only S-LPs

False - it can be multi-disciplinary are involve psychologists, OTs, etc.

What areas are the main focus when using assessment measures?

Language, functional communication, and life impact of communication disorder

What other area can be considered when using assessment measures?

Cognition (attention, memory, learning, visuo-spatial skills, executive functioning as it affects communication)

How should assessment instruments be chosen?

By using evidence-based practice, keeping abreast of and critically evaluating advances in tests and procedures for assessing aphasia - keep educated & up to date

Factors to consider in measure selection

High quality psychometric properties (standardization, reliability, validity), time since injury and type of injury (what is appropriate for specific case), assessing different domains discretely, predicting real-life functioning, and using multiple tests of each domain

True or false - Other factors (such as auditory & visual impairments) may co-occur with aphasia and affect assessment

True - for example, someone with hemiplegia or hemiparesis may not be able to fill out forms or write anything

What are some impairment factors that may co-occur with aphasia and need to be considered in assessment?

Auditory/visual impairments
motor speech disorders (AOS, dysarthria), hemiplegia/hemiparesis
other cognitive deficits like memory deficits or limb apraxia psychological issues
cultural and/or linguistic diversity
learning disabilities.

What are the different types of assessment measures?

Bedside & screening tests
Comprehensive aphasia batteries
Tests of specific language functions
Tests of cognitive skills (attention, memory)
Discourse sampling and analysis
Functional communication measures
Quality of life and psychosocial measures

Content validity

Does the test measure all the behaviours that it should? Does it cover all it is supposed to?

Construct validity

Does the test relate to other measures of the same construct?

Criterion-related or predictive validity

Does the test predict performance on a criterion measure? How accurately does the measure measure the outcome it is supposed to measure?

Reliability

Refers to the consistency of scores obtained by the same person under variable examining conditions and is expressed as a correlation coefficient

Correlation coefficient

Expresses degree of correspondence between 2 sets of scores

Test-retest reliability

Obtained by repeating identical test on a second occasion to test consistency

Alternative form reliability

Obtained by testing with one form on one occasion and an equivalent form on a second occasion. Two different forms of the same test.

Split half reliability

Obtained by dividing test into equivalent halves. (A test for a single knowledge area is split into two parts and then both parts given to one group of students at the same time)

Standardization

To allow comparison of patients' performance to other representative groups and requires establishment of test norms

Norm-referenced tests

Tests where a individual's performance is compared with a group norm, describing how the individual did in relation to the norm group. Results are standard scores or percentiles.

Criterion-referenced tests

Tests where the individual's score is compared to a standard/predetermined score or criterion. End up putting people into categories based on severity or diagnosis. Scores are percentages or number of correct answers.

True or false - The Western Aphasia Battery is a norm-referenced test

False - it is a criterion-referenced test

True or false - The Boston Aphasia test is a criterion-referenced test

False - it is a norm-referenced test

Aphasia Language Performance Scales (ALPS)

Beside/screening test, contains 4 scales with 10 items each

What are the 4 scales of the ALPS test?

listening, reading, writing, and talking

True or false - the ALPS test has a cut-off point so if you fail a certain number of items in a row you stop there

true

Frenchay Aphasia Screening Test (FAST)

Beside/screening test, contains 4 scales with 18 items total

What are the 4 scales of the FAST?

comprehension, expression, reading, and writing

True or false - shortened versions of comprehensive tests can be used as bedside/screening tests

True

What are the 2 most common comprehensive tests that their shortened versions are often used as beside/screening tests?

Boston Diagnostic Aphasia Exam (BDAE-3) and the Western Aphasia Battery (WAB-R)

What are the pros of using bedside and screening tests?

They are an efficient means to determine presence/absence of impairment and to develop ideas for further assessment or initial treatment and are useful in early stages of recovery, for tracking progress or decline over time

What are the cons of using beside and screening tests?

They are short in length and may not represent true levels of abilities and they are impairment-based (no testing of QOL or function)

What are comprehensive aphasia batteries?

They evaluate language "comprehensively" and are designed to assess presence, type, and severity of aphasia. They evaluate specific functions in different modalities and along continuum of complexity.

What functions do comprehensive aphasia batteries evaluate?

Spoken language (fluency/spontaneous speech, verbal repetition, naming), auditory comprehension, and sometimes reading and/or writing.

When do you use comp. tests and when do you use beside/screening tests?

Comp. is used when someone is further along (post-stroke) and you want to look at treatment goals or a diagnostic question is asked. While beside is really quick and is just an initial screening.

Briefly describe the Western Aphasia Battery (WAB-R)

It is designed to identify type and severity of aphasia and there are 3 versions of it

True or false - a score of 85 or above on the WAB-R is indicative of being non-aphasic

False - a score of 94 and above is indicative of non-aphasic

True or false - Someone who scores 55 on the WAB-R would be considered to have severe aphasia

False - this would be moderate aphasia

True or false - Someone who scores 20 on the WAB-R would be considered to have very severe aphasia

True

A score between 26 and 50 on the WAB-R is considered

severe

A score between 76 and 93 on the WAB-R is considered

mild

A score between 0 and 25 on the WAB-R is considered

very severe

A score between 51 and 75 on the WAB-R is considered

moderate

What are the 3 versions of the WAB-R?

Bedside, standard, and supplemental

True or false - the beside version of the WAB-R is the most common version used

False - the standard version is most commonly used

The standard version of the WAB-R assesses which domains?

spontaneous speech, aud-verbal comprehension, repetition, naming, and word-finding

The supplemental version of the WAB-R assesses which domains?

reading, writing, apraxia, constructional, visuospatial and calculation

Briefly describe the Boston Diagnostic Aphasia Exam (BDAE-3)

It contains 3 versions (short, standard, and extended), has 6 subsections, it is a normative-based test that allows for language profiles to be classified according to traditional scheme (Broca's, Wernicke's, etc.)

What are the subsections of the BDAE-3?

Conversational & expository speech, auditory comprehension, oral expression, reading, writing, and praxis

True or false - the normative group for the BDAE-3 contains 'healthy' individuals as well as aphasic individuals

False - it only contains aphasia individuals

True or False - any S-LP can administer the BDAE-3 regardless of their background in aphasia

False - it requires a thorough understanding of aphasia as the profile integration and aphasia diagnosis is complex.

What are the advantages of the BDAE-3?

It provides a detailed assessment of patient strengths and weaknesses, and the diagnosis is not "automated" so it allows for clinicial judgement

True or false - the WAB-R is shorter than the BDAE-3

True

True or false - the BDAE-3 is less detailed and less sensitive than the WAB-R

False - the WAB-R is less detailed and less sensitive

True or false - the WAB-R is always able to detect milder aphasias

False - it may not detect them

True or false - the classification of aphasia is 'automatic' with WAB-R

True

Which comp. test is easier to administer, but has less room for clinician judgement?

WAB-R

True or false - you should administer both the WAB-R and BDAE-3 when assessing comprehensive language impairments?

False - choose one based on patient and assessment question

What are some notable subtests of the BDAE-3?

Cookie theft and Boston Naming Test

True or false - The cookie theft and Boston Naming Test subtests of the BDAE-3 are commonly used to supplement the WAB-R

True

How are strengths classified in the BDAE-3?

Above 50 percentile

How are weaknesses classified in the BDAE-3?

Below 50 percentile

Describe what tests of specific language functions do?

They allow for in-depth examination of specific abilities (e.g. reading, naming) and for assessment of a greater range of item difficulty

When might someone administer a specific language function test?

If someone is having particular difficulties in one area, so that you can focus on that difficulty and examine in more detail

Functional Communication

The ability to receive or to convey a message, regardless of the mode, to communicate effectively and independently in a given environment

True or false - Linguistic and cognitive impairments are correlated with functional communication and QOL

False - they are not necessarily correlated

True or false - formal measures can be used on their own for assessment

False - formal measures must be used in conjunction with informal assessment

What do discourse measures do?

They assess comprehension and production of connected language units (i.e., multiple sentences)

Examples of discourse measures

Discourse comprehension test, discourse production analyses, and conversation analyses

Discourse production analysis

an analysis of main concepts so statements that form a skeletal outline of the essential information in pictured stories

Individuals with aphasia tend to produce fewer _______________ and __________________ and more _________________ and ____________________

complete and accurate concepts; incomplete and inaccurate concepts

Briefly describe tests of cognitive skills

They assess cognitive deficits (especially in attention, memory, ECF) that impact communication outcomes and function

What are two examples of SLP tests for cognitive skills?

Cognitive Quick Test (CLQT) and Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN)

What is an example of a discourse analysis?

Correct information units (CIU)

What is CIU?

it is a measure of the relevance of lexical items to the discourse in which they occurred