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Flashcards in Assessment/Diagnosis Deck (43):

Differences in Testing Tools

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


Types of Assessment Tools

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


Screening Tools

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.


Comprehensive Assessment Tools

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


Requirements for Diagnostic Tests




Range of item difficulty



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



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



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


Range of Item Difficulty

From very easy to very high

Homogenous test items ordered

Difficulty range rise in a linear fashion


Rating Scale Options

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)


Ideal Aphasia Test Attributes

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


Wechsler Adult Intelligence Scale - Third Edition



Picture completion


Digit symbol


Block design


Matrix reasoning

Digit span - how many digits the pt. can remember

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

Picture arrangement - sequencing


Symbol search - Sustained attention - TBI and R Hemisphere

Letter-number sequencing

Object assembly


Boston Diagnostic Aphasia Examination - General Info

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)

Conversational and expository language
auditory comprehension
verbal expression


Boston Diagnostic Aphasia Examination - Severity Rating

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


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Melodic line

Phrase length

Articulatory agility

Grammatical form

Paraphasia in running speech

Word finding

Repetition and auditory comprehension


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Melodic Line

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


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Phrase Length

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)


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Articulatory Agility

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)


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Grammatical Form

Variety of grammatical constructions, use of grammatical morphemes

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


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Paraphasia in Running Speech

Rate if phrase length is more than 4

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


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Word Finding

Relative to frequency

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


Boston Diagnostic Aphasia Examination - Speech Profile Rating

Repetition & Auditory Comprehension

Different subtests

Score conversion to percentiles


Western Aphasia Test Battery - General Info

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


Western Aphasia Test Battery - Quotients

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


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


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


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


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


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


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)


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)


Tests of Specific Aspects of Language

Token Test


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)


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)


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


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

Correct = 2
Adequate = 1 (giving a false age bc you think its rude someone asked)
Wrong = 0

35 mins.


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

Stimulus cues provided, if the subject is still unsuccessful proceed to phonemic cueing


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)


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


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

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)

Confabulation, denial, delayed, error, irrelevant, perseveration, self-connect, tangential


Cognitive Linguistic Quick Test

Personal facts
symbol cancellation
confrontation naming
clock drawing
story retelling
auditory comprehension
symbol trails
generative naming
design memory
design generation


Additional Issues in Assessment

Pre-morbid language and intelligence

Socio-cultural habit of communication

Ethnic influence

- Second language testing
- Pre-morbid language ability in native language
- motivation/attentiveness


Bilingual Tests

Bilingual Aphasia Test

Multilingual Aphasia Exam

BDAE and Token Test and WAB and CADL in other languages


Report Writing Format

first sentence should include lots of info self description of symptoms


developing picture (medical history, educational history, vocational and social history)

testing results


summary (most revealing)

2 most important parts of report: Developing picture and summary