Assessment/Diagnosis Flashcards

(43 cards)

1
Q

Differences in Testing Tools

A

Practicality
Test nature: what are they testing and how
Procedural issues
Philosophy: some are based on clinical issues, some on psychometrics, psycholinguistics, neurolinguistics

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2
Q

Types of Assessment Tools

A

Screening tools - these have died out because people can design their own, Help us do very basic things

Comprehensive tests - less practical because they take lots of time

Progress evaluating tests - can be done over time

Tests for patient counseling

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3
Q

Screening Tools

A

Only thing these tell us is if the pt. is impaired or not

Limited clinical accuracy

Little info about:

  • lang. functions
  • functional living of the pt.
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4
Q

Comprehensive Assessment Tools

A

Evaluation for strengths/weaknesses

Initial severity assessment - this is important bc its associated with recovery potential

Sampling of all potentially disturbed linguistic areas - takes a long time, not very practical

Identification of types and deficits

Philosophy reflection

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5
Q

Requirements for Diagnostic Tests

A

Standardization

Reliability

Validity

Range of item difficulty

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6
Q

Standardization

A

Key to any testing

Procedure formalization for administration

  • scoring and time
  • controlled procedures to minimize measurement errors such as cueing, prompting, time limit

Provides consistency and objectivity of how tests are administered and scored

Establishes norms

  • range of scores from a reference group
  • controlled subjects/normal as well as pts.
  • mean and median
  • high/low distribution of scores
  • scaled value - percentile or SD scores
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7
Q

Reliability

A

The degree to which an assessment tool produces stable and consistent results

On repeated administration, similar results from the same subjects

Demonstration of reliability through

  • alternate test forms at same/subsequent sessions
  • odd/even test items
  • comparing with normal/healthy subjects

Unaffected by

  • pt. to pt. testing
  • time to time variability
  • examiner to examiner differences
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8
Q

Validity

A

The extent to which a test measures what it says it measures

The degree to which evidence supports the interpretations of test scores

Demonstrated by

  • predictor validity - discrimination from normal
  • construct validity - performance correlation with other known test
  • content validity - adequacy of sampling from the domain of behaviors to be measures; rigid selection of test items, well reasoned content areas, range and diversity of test content
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9
Q

Range of Item Difficulty

A

From very easy to very high

Homogenous test items ordered

Difficulty range rise in a linear fashion

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10
Q

Rating Scale Options

A

Mild/moderate/severe (subjective)

Pass/fail (doesn’t take into account responses in other modalities)

Descriptions (impractical)

Multidimensional (best but fewer available, allows you to capture other behaviors like pauses before responses)

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11
Q

Ideal Aphasia Test Attributes

A

Explores all potentially disturbed modalities

Employs subtests that discriminate among various clinically meaningful types of aphasia

Includes graded (hierarchical) test items to examine a representative range of severity

Contains enough items to eliminate day to day and test to test learning

Represents practical length for its administration in one sitting

Minimizes effects of intelligence and education to measure language

Discrimination between normal subjects from patients with aphasia and dementia

Has internal consistency and comparability of scores

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12
Q

Wechsler Adult Intelligence Scale - Third Edition

WAIS-III

A

Categories:

Picture completion

Vocab

Digit symbol

Similarities

Block design

Arithmetic

Matrix reasoning

Digit span - how many digits the pt. can remember

Information - Factual info. Pt. answers questions about factual, general knowledge

Picture arrangement - sequencing

Comprehension

Symbol search - Sustained attention - TBI and R Hemisphere

Letter-number sequencing

Object assembly

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13
Q

Boston Diagnostic Aphasia Examination - General Info

A

Identification of aphasic syndromes

Time duration of 1-2 hours for original version

Based on psycholinguistic model with neurolinguistic interpretation

First test battery to evaluate spontaneous verbal output

There are 3 Forms

  • Short form (optimal, takes 30 minutes)
  • standard form (detailed, takes 1-2 hours)
  • extended form (research version)
Tests: 
Conversational and expository language
auditory comprehension
verbal expression
reading
writing
praxis
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14
Q

Boston Diagnostic Aphasia Examination - Severity Rating

A

0 level: no communication

1 level: only limited communication

2 level: familiar comm

3 level: unassisted comm

4 level: moderate aphasia

5 level: minimal aphasia

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15
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

A

Melodic line

Phrase length

Articulatory agility

Grammatical form

Paraphasia in running speech

Word finding

Repetition and auditory comprehension

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16
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Melodic Line

A

Sentence intonation extending the entire sentence

ranges from word-by-word or aprosodic, to sentence imitation limited to short phrases, to normal melody for full sentences

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17
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Phrase Length

A

Wernicke’s do very well here

Rate 1 word, 4 words, 7 words
longest occasional uninterrupted run of words in 10 starts (not the mean number of words)

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18
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Articulatory Agility

A

Rate from 1-7

facility at phonemic and word level (groping for initial sounds, simplifications, distortions, delays, moving sounds within words, Broca’s will be at low end and Wernicke’s will be high)

19
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Grammatical Form

A

Variety of grammatical constructions, use of grammatical morphemes

Ranges from no syntactic word groupings to simplified or incomplete forms to normal range of syntax

20
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Paraphasia in Running Speech

A

Rate if phrase length is more than 4

Ranges from paraphasia present in every utterance, 1-2 utterances per minute of conversation, to absent

21
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Word Finding

A

Relative to frequency

Ranges from fluent but empty speech, informational words proportional to fluency, to output primarily content words

22
Q

Boston Diagnostic Aphasia Examination - Speech Profile Rating

Repetition & Auditory Comprehension

A

Different subtests

Score conversion to percentiles

23
Q

Western Aphasia Test Battery - General Info

A

Classification of syndromes based on 3 performance tests and 4 language tests

Goals are diagnosis, recovery, and treatment efficacy

Testing areas include 
conversational and expository language,
auditory comprehension
verbal expression
reading
writing
praxis
24
Q

Western Aphasia Test Battery - Quotients

A

Aphasia quotient : Summary of 4 subtests (spontaneous speech, conversation, repetition, naming); rated from 1-100

Language quotient : Composite of all language functions including reading and writing

Performance quotient : Reading, writing, apraxia, and construction

Cortical quotient : All test performance

25
Neurosensory Center Comprehensive Examination for Aphasia (NCCEA)
Goal is not to determine typologies No spontaneous speech sample - a weakness for us, but this wasn't developed for SLPs, very few SLPs use this test 20 subtests Standardization : normative data for children, mean score for all ages, linear effects of age This is the only test battery that tells us if a pt. has a problems with the corpus callosum
26
Minnesota Test of Differential Diagnosis
No one uses this test anymore Based on pt's potential to recover To determine strengths and weaknesses within all modalities A guide for treatment No differentiation of disorder types Additional dx of perceptual and motor disorders Degree of deficit-percentage of errors Classification of aphasia plus sensorimotor disorders - 5 Groups with recovery potentials
27
Minnesota Test of Differential Diagnosis - Classification
Group 1 = simple aphasia - most potential for recovery Group 2 = aphasia is complicated by "central involvement of visual processes" Group 3 = simple aphasia + sensorimotor involvement Group 4 = simple aphasia + visual involvement and dysarthria Group 5 = Global aphasia
28
Porch Index of Communicative Ability (PICA) - General Info
Provision for repeated testing for residual functions, language recovery Portrayal of performance in a numerical format (1-10) Processing test Recovery documentation with precision Ideal for plotting recovery Conforms to psychometric procedures for reliability Requires certification to give - Worst part about this test Liked by VA SPPA clinics Multidimensional scoring on 1-16 scale - Best part about this test
29
PICA - Areas and Subtests
3 areas and 18 subtests: verbal (4), gestural (8), graphic (6) 10 objects for homogeneity Sequentially arranged test items Looks at several input and output modalities for central language processing
30
PICA - Five Dimensions of Response
Accuracy (degree of correctness) Responsiveness (ease with which an appropriate response is elicited) Completeness (extent to which the task is entirely carried out) Promptness (degree of immediateness in the response) Efficiency (proficiency of production)
31
PICA - Data
There are 18 subtests with 10 items each - 180 items Data is transformed into: Test means (means for each subtest) Modality means (mean for each of the 3 modalities) Overall performance score (divide the 18 subtests into the 9 highest and the 9 lowest, then find the mean of each)
32
Tests of Specific Aspects of Language
Token Test CADL Boston Naming Word Fluency test Raven's Progressive Matrices (part of the WAB) Ross Information Processing Assessment (R Hemispheric lesions and cognitive impairments) Cognitive Linguistic Quick Test (TBI)
33
Token Test
A test battery for auditory comprehension Short test least intellectual difficulty considerable linguistic weight 20 tokens of 2 sizes & shapes, and 5 colors no cues from SLP gestural responses to verbal commands (no speech required)
34
Reporter's Test
Used as a research test just like the Token Test but for expressive language incorporates Token Test stimuli and commands Pt. commentates on what the SLP is doing
35
Communicative Abilities of Daily Living (CADL)
Focus on functional communicative ability Performance in simulated activities of daily importance (phone calls, shopping) Emphasis on communication rather than language Responses in any mode of communication Construction : 68 items Scoring: Correct = 2 Adequate = 1 (giving a false age bc you think its rude someone asked) Wrong = 0 35 mins.
36
Boston Naming Test (BNT)
Standard version has 60 pictured objects, short version has 15 items mark correct response, response latency (time), verbatim incorrect response start at item 1 for young children and aphasics, start at item 30 for older children and non-aphasics discontinue after 8 consecutive failures Cues: Stimulus cues provided, if the subject is still unsuccessful proceed to phonemic cueing
37
Word Fluency Test
Good indicator of intact brain function - quick bedside assessment One of the most sensitive tests for brain injuries Normal is 10 words/min (must be done in 1min) Semantic fluency (name as many foods in one min) Phonemic fluency (give a phoneme and list all words that start with that sound)
38
Raven's Progressive Matricies
Test of nonverbal reasoning Non-controlled so we can give it Focuses on intelligence and reasoning with lower verbal load Patient has to choose the missing piece of the pattern Normative data for adults and kids
39
Ross Information Processing Assessment (RIPA)
Not a true IQ test Can be given in a very short amt. of time Looks at: Information organization Auditory processing and retention ``` Subtests: immediate memory (repetition of numbers and sentences) ``` recent memory (how long have you been in the hospital) temporal orientation (current year, season) spatial orientation (what state/city/building) orientation to environment (who am I? name?) recall of general info (president) problem solving (if you run out of gas) Scores: Confabulation, denial, delayed, error, irrelevant, perseveration, self-connect, tangential
40
Cognitive Linguistic Quick Test
``` Tests: Personal facts symbol cancellation confrontation naming clock drawing story retelling auditory comprehension symbol trails generative naming design memory design generation ```
41
Additional Issues in Assessment
Pre-morbid language and intelligence Socio-cultural habit of communication Ethnic influence Bilingualism - Second language testing - Pre-morbid language ability in native language - motivation/attentiveness
42
Bilingual Tests
Bilingual Aphasia Test Multilingual Aphasia Exam BDAE and Token Test and WAB and CADL in other languages
43
Report Writing Format
first sentence should include lots of info self description of symptoms Referral developing picture (medical history, educational history, vocational and social history) testing results impressions/classifications summary (most revealing) 2 most important parts of report: Developing picture and summary