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ALD > L11: General Ax Principles > Flashcards

L11: General Ax Principles Flashcards

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1
Q

what are the 6 general considerations of the scientific method?

A

beward of a priori conceptions

stick to first order facts

choose the simplest explanation consistent w the facts

keep conclusions tentative rather than absolute

respect the relevance of norms

seek the counsel of other professionals

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2
Q

beware of a priori conceptions =

A

minimize the influences of biases and preconceptions on our thinking (ex. global aphasia = AAC)

observe and record behaviours, translate, or define as carefully as possible while minimizing inferences of biases on what we observe (ex. report from previous SLP)

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3
Q

stick to first order facts =

A

use few inferences; describe and record verbatim rather than speculate or interpret (ex. non-fluent verbal expression = anterior cerebral infarct)

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4
Q

choose the simplest explanation consistent w the facts =

A

complicated interpretations and assumptions are to be questioned and avoided unless facts indicate otherwise (ex. non fluent verbal expression = meningitis)

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5
Q

keep conclusions tentative rather than absolute =

A

do not be afraid to change your mind or to admit that another possibility may exist

ethical and professional obligations are to seek the best possible solns

conclusions and recommendations are professional statements not personal pronouncements/opinions

based on results… chart course of treatment

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6
Q

respect the relevance of norms

A

understanding what is deviant/disordered depends upon understanding what is normal

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7
Q

when designing an ax protocol consider…

A

not a prescribed approach (not just every type of pathology but every client may require customized approaches; multiple tools)

formal, informal/diagnostic, combination

quantitative and qualitative

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8
Q

formal =

A

standardized, published, norm or criterion referenced

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9
Q

informal/diagnostic =

A

clinician generated tasks/measures

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10
Q

what are some hierarchical considerations? (3)

A

easy to difficult to easy

psycholinguistic parameters

acute, sub- acute, rehab, LTC settings

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11
Q

psycholinguistic parameters include…

A

freq of occurence

personal relevance

semantic and visual relatedness

phonological complexity

length of word

cog considerations (mem and attention sys and processes)

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12
Q

what are the 10 principles of assessment?

A

determine goals of testing and choose instruments

choose familiar instruments

evaluate instruments carefully

evaluate continuous, fx, and spontaneous comm behaviours

record/describe behaviours, contexts, and partners

seek a profile of abilities and disabilities

examine variety of performances in all modalities

sample behaviours on continuum from simple to complex

ensure reliability of clinical performances and validity of performances

scoring sys should be comprehensive, discriminating, easy to administer and not time consuming

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13
Q

evaluate instruments carefully:

A

rationale based in comm

how meaningful will test and results be for client and for you as clinician

know psychometric properties of tests

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14
Q

record/describe behaviours, contexts, and partners =

A

examine type, freq, and pattern of behaviours

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15
Q

sample behaviours on continuum from simple to complex where …

A

person is able to perform w/o error

performance begins to breakdown

performance is always in error

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16
Q

scoring sys should be comprehensive, discriminating, easy to administer, and not time consuming … 4 parts:

A

+/- or binomial; sys not discriminating vs multidimensional sys

% or percentile scores: give minimal comparison, may yield some comparison to N’s or other similar syndromes

quantitative vs qualitative measurements: both should be available to clinician

look for patterns in performance(s): record and analyse verbal, paralinguistic, and non-linguistic behaviours (facial expressions, pantomime, gestures, body lang etc)

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17
Q

what are the 9 purposes of an assessment?

A

does a problem exist

describe lang and comm strengths and weaknesses

identify existing probs and influences on Rx

determine type and severity of disorder

help generate Dx - description of etiology

determine diff bw clients w similar or disimilar lang, speech and comm behaviours

help generate recovery profile (prognosis)

help set goals of intervention

monitor progress - discharge planning

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18
Q

identify existing prob(s) and influence(s) on Rx =

A

identify coexisting probs and factors that precipitated, maintain, and exacerbate present lang and comm problems

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19
Q

5 indications (suggests a certain ax is appropriate)=

A

alert, oriented, conscious, medically stable

motivated, wants to comm, distressed over not being able to communicate

need for DDX/DX, severity, type determination

need to identify compensatory strategies for staff, client, family, other caregivers

research implications

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20
Q

4 contraindications (suggests a certain ax is not appropriate)=

A

person not awake, alert, medically stable

no overt diff w comm, no voiced complaints

to be transferred shortly (yes and no)

person does not want assistance

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21
Q

what is included in the assessment protocol?

A

referral source (context on who, when, why)

presenting complaint(s)

histories from client and sig others

data from preliminary ax

interdis ax

screen hearing

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22
Q

histories from client and sig others includes…

A

PMHx

SHx (social)

language (handedness, ESL, proficiency etc)

educational

occupational

cognitive

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23
Q

inter-dis ax allows for

A

us to minimize overlap in data collection, optimize info sharing, enhance provision of care

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24
Q

what are 13 things you need to consider when selecting standardized instruments?

A

model/theory used as basis for dev

diagnosis

areas of lang, discourse, and comm examined

type(s) of disorder

age groups in standardized sample

scores for normal vs abnormal

on which popns

when standardized (cohort, social influences etc)

type of scoring

scores reported

sub-test scores available

time of admin

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25
boston ax of severe aphasia - age range? - time? - admin? when? who? what is scored?
no age range 30-40 min admin = indv designed for post stroke cases soon after the onset of symptoms, preferably at bedside (can be given long bf other ax appro) for person w severe aphasia and provides diagnostic info needed for immediate treatment across modalities both gestural and verbal responses to items are scores, and refusals, affective responses, and perseverative responses also recorded
26
what are the 3 steps to evidence based practice for ax?
remain current w ax protocols use/interpret tests in ways they were dev and verified empirically consider your knowledge level and limitations
27
remain current w ax protocols involves...
new versions = normative and standardization data may change which may alter how you use a test new normative data = may not always be released as a new published version, many updates are published in the lit applicable popns = most often will find published in lit, need to stay current on tests that you use often
28
what should you avoid when using and interpreting tests?
making interpretations based on subtests of a comprehensive battery when test was validated only as a comprehensive battery making interpretations using test for an indv profile not included in standardization sample using screening tests inappro
29
what should one consider about their knowledge level and limitations about tests?
familiarity w a particular test familiarity w a particular popn knowledge of relevant lit for interpreting results; implementing info from ax for rx
30
what needs to be considered when scoring?
consistency of correct and incorrect (day, time, etc) self corrections (reflects ability of sys and subsys) test and re-test scores (raises issues related to psychometric props) on-line, dig audio, and/or vidoe data base
31
during the ax of multilingual indvs, consider heterogeneity related to... (5)
lang proficiency in L1 and L2 (not static) freq and patterns of lang use age of first exposure and circumstances surrounding acq ling distance of langs lang preference and attitudes towards
32
2 ways to assess pre-stroke lang proficiency
self ratings = 5 or 7 likert scale, bisecting a line w 2 end points; no ability and perfect like a native speaker caregiver ratings = same numerical or visual scales; identify over or underestimation
33
3 considerations when assessing multilingual indvs:
assess domains in all languages used by client select appropriate tools selecting who should adminster the tool(s)
34
why assess all languages used by client in multilingual indvs?
profile of aphasia and cog comm impairments may differ across lang (multiple patterns of lang organization in polyglots) diff langs influence imp diff (i.e. syntax, grammar)
35
why is it important to select appropriate tools in multilingual indvs?
translated tests may not always be best solution (can be used as informal measures; normative data may not be valid) forward vs backward translations: allows for comparisons for quality and accuracy consider psycholinguistic controls and cultural influence formal test batteries originally dev, standardized, and normed in target lang are ideal
36
bilingual aphasia test (BAT)=
designed to assess each lang of a bi/multi ling indv w aphasia in an equivalent way
37
addenbrooke's cog examination=
cog screening tool for use w pts >50y w suspected dementia available in more than 30 lang
38
who should administer the tools for multiling indvs?
use of professional interpreters coach informal interpreters to interpret verbatim prepare prof and informal interpreters for the session (describe jargon) ensure objectivity ideal = bilingual and bicultural clinicians
39
what are two alternatives to standardized ax?
verbal fluency narrative output
40
verbal fluency =
evaluates lexical-sematic access allows clinicians to quickly provide a score in each lang and measure change over time recommend 2 semantic categories and 2 letters/initial sounds a) semantic (ex. animals) b) phonetic (ex. name as many words that start w F)
41
narrative output has 2 diff types
procedural discourse task sequential picture task
42
procedural discourse task examples:
making a common food how to play a sport the PWA indicates they know tell me about you job
43
sequential pic task =
choice amongst 4 options allows for measure of syntax, semantics, morphology, pragmatics, and discourse
44
what are the 6 considerations for testing environments?
use adult-oriented materials for informal ax consider sensory issues and use aids as needed minimize distractions minimize anxiety associated w testing consider optimal testing times observation of client in diff enviros
45
ways to minimize distractions
recording (you and equipment) observers office/room clutter noise - across all modalities
46
ways to minimize anxiety associated w testing =
intro tasks inform client about purpose of ax offer rest breaks create a relaxing/comfy context
47
things to consider for optimal testing times
meds visitation schedules other procedures/treatments fatigue
48
performance on testing may differ based on....
setting partners tasks comparisons w scores from standardized ax meds fatigue time of day depression other rxs
49
testing adults w ALD: minimize...
chatter bw test items distracting and may neg impact testing
50
testing adults w ALD: reinforcement = dos and donts?
"qualitative judgement of a response" usually verbal (can be pos or neg) praise should be limited to generic statements (ex. you are giving it your best) target-specific reinforcement should be avoided (ex. youre correct)
51
testing adults w ALD: feedback = dos and donts?
specific info that defines why or why not response was correct/incorrect ("you pointed to the comb, thats right") should not be used at all during most ax activities reserved for baseline measures/probes and therapy
52
baseline probes = used for?
stimili that serve as a baseline for performances or behaviours in a specific area used to measure outcome post rx for specific targets (in addition to or in lieu of standardized measures) sample thru out course of rx to assess influence of Rx on performance(s) - be aware of learning effects - trained and untrained baseline probe items
53
4 steps to measuring outcomes for rx
pre-rx (single time point; multiple baseline behaviours) during rx post rx follow up
54
pre-rx=
baselines behaviours that are expected to change w Rx
55
during rx=
influence of rx - is progress as expected? does something need to be modified? are targets being mastered? is it time to intro new targets?
56
post rx =
effect of rx on baseline behaviour (was rx effective? were goals met?)
57
follow up =
a future point in time (4 weeks, 3 m) after rx w/ drawn are rx gains maintained? does client need to be re-engaged in Rx to stabilize improvement?
58
ideal therapy outcome expectations =
improvement on trained stimuli generalization to untrained stimuli improvement on formal ax measures (may not occur dep on the measure) generalization to spon lang (discourse measures) maintained gains for a duration post rx w/o intervention (may have reduced performance by expected to stay sig above baseline)
59
comprehensive aphasia batteries are typically
the first test administered in protocol (imp based)
60
comprehensive aphasia batteries are designed to detect
presence, type, and severity of aphasia/cog comm disorder
61
comprehensive aphasia batteries are typ global ax which are generally...
not sufficient for identifying specific ling and cog contributions to comm disturbances limited number of items sampled for each domain need to complete follow up testing in an imp domain
62

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