Module 1

Question 1

Diagnosis

Answer 1

Diagnosis: label with supporting evidence

Origin of the word is greek

Literal meaning – “set apart” (This person has something that distinguishes themselves from others that don’t have it)

More specifically, – identification of disease, abnormality, or disorder based on symptom analysis

Can be an on going process

Question 2

Appraisal

Answer 2

Origin of the word is Latin

Quantitative value judgement

A statement of value, quality, or condition

Can refer to a process

Looking at person’s ability, placing numeric judgement on this (percentile)

Appraisal leads to diagnosis

Clinical problem solving

Question 3

Other synonyms to the terms “diagnosis” and “appraisal:”

Answer 3

evaluation and assessment

Subtle differences may depend on context

Can use these terms interchangeably

Question 4

Why use terms Diagnosis and Appraisal?

Answer 4

Similar words, different origins

Use them interchangeably

Technically, the diagnosis is a label;
while the appraisal is
the evaluation process that leads to the label.

Question 5

Diagnosis:

Prognosis:

Recommendations:

Answer 5

Diagnosis: Distinguish a person as having a disorder (or not).
Identify the specific disorder and its characteristic

PROGNOSIS: Judge whether the person is likely to benefit from treatment, and why.

RECOMMENDATIONS: Propose a plan of care for the person.

Question 6

What is a prognosis?

And what do you mean by recommendations?

Answer 6

It is a statement of opinion, based on evidence, that addresses whether the person is likely to improve

This is an orderly list of the next steps that are needed in order to follow up on the diagnostic session

Question 7

Three types of evidence

Answer 7

Three types:

(1) clinical expertise or expert opinion
(2) external scientific writings
(3) client- based data

Client-based evidence includes all information gathered during the evaluation. (can include historical information about the client, results, any information that you got from interacting with the client as a result can be considered as part of evidence)

Expertise includes everything you know about disorders and the diagnostic process

Scientific Writings includes quotations from books and articles

Evaluate all evidence to determine its relevance to the diagnosis, prognosis, or plan of care. (Not all evidence is considered relevant to the diagnosis or prognosis or plan of care).

Question 8

What is a prognostic indicator?

Answer 8

Any factor or piece of information
that contributes to decisions regarding the prognosis.

Examples –
Age (O)

Stimulability (O)

Concomitant disabilities (O): 1 disability versus several will probably have different prognoses

Length of time problem has existed (O)

Motivation (S)

Room for improvement (S)

Family support (and other types) (S): lack of family support can greatly impact prognosis

Question 9

What is label

Answer 9

A categorical designation

Question 10

Standardized Tests

Answer 10

Designed to categorize clients according to behaviors they exhibit.

Client’s numeric are compared to normative.

Excellent tool for assigning a diagnosis (or label).

Examples – any norm- referenced tool

Question 11

Non- Standardized Tests

Answer 11

Informal or formal activities
that are designed to:

Gain insight into specific abilities

OR, gauge progress resulting from treatment

Examples: language sample, oral- facial inspection, baseline data…

Question 12

Etiology

Answer 12

Etiology is the likely cause.

Where to look for the etiology :

• Case- history intake form
• Opening interview
• Always consider that there may be more than one explanation

Question 13

Static Testing

Answer 13

Static testing measures what the person does, in the absence of any clinical teaching

• Like a snapshot
• Most standardized testing is static
• Static testing is important to gain an accurate picture of person’s current performance.

Question 14

Dynamic Testing

Answer 14

Dynamic testing measures what happens if the person is exposed to clinical teaching.

• Like a video clip
• Provides insight that can be useful for identifying targets and suggesting prognosis.: VERY IMPORTANT!!!

Question 15

Stimulability Testing

Answer 15

Stimulability testing is a dynamic tool.

It evaluates the person’s response to clinical teaching in any area (e.g., Goldman-Fristoe Test of Articulation (GFTA): Stimulability Subtest)

What to do:

• Identify errors (or potential therapy targets),
• Provide opportunity to change performance,
• Evaluate whether the person changes and if so, what level of stimulation was needed.

Question 16

What is evidence based practice?

Answer 16

The pattern of practice where all clinical decisions are based on one or more of the three types of evidence

Comprised of four steps –

• Frame the clinical question
• Find the evidence
• Assess the evidence
• Make a clinical decision

Every clinical decision begins with a clinical question; so, properly-framed clinical questions are fundamental to clinical decision making.

Question 17

Examples of clinical decisions

Answer 17

Line of questioning during an interview

observation procedures

Informal and standardized
test selection

Diagnosis

Prognosis

Each part of the plan of care

Question 18

What is a clinical question?

Answer 18

Relative to diagnosis and appraisal, a clinical question is an answerable and relevant question that defines the scope of information that you hope to obtain through observation and testing.

PICO framework is recommended –
P – population
I – intervention or exposure
C – comparison (more relevant for dynamic testing or treatment decisions)
O – outcome

Question 19

What is professional documentation?

Answer 19

Every clinical activity results in written documentation (e.g., diagnostic report, treatment plan, and treatment summary…).

Our clinical reports are legal documents that can be subpoenaed in a court of law.
Therefore, clarity, accuracy, and precision are of the utmost importance.
The person with the CCC is the one who is responsible; so final decision is hers.

There are rules and formats that are appropriate. Capstone activity will help with this.

Question 20

The fundamental goal that applies to all diagnostic sessions is –

Answer 20

Arrive at
a good understanding
of the client’s
communication problem

Question 21

Three types of information you should have at the end?

Answer 21

diagnosis
prognosis
recomemendations

Question 22

What is basic diagnostic protocol?

Answer 22

Read and understand the completed case- history intake form

Opening interview with the client and/or family members

Formal standardized testing

Informal testing and strategic observations

Hearing screening

Oral- facial inspection

Closing Interview

Write the diagnostic report

Question 23

Framing the clinical question?

Answer 23

Use PICO framework.

Make sure that your question is relevant and answerable.

Your inquiry can be general or specific. (e.g., Does Mary Jo have an articulation disorder? Does Mary Jo change her speech pattern when giving a clinical teaching opportunity?)

Each procedure that you decide to do should be driven by a clinical question.

Question 24

Valid/ Reliable:

Answer 24

Valid: synonym for truth (a valid test tests what it claims to test)

Reliable: repeatable (if one person gives the test will it have the same results as someone else who gives a test)

Question 25

PICO example general

Answer 25

P – Mary Jo I – Select a test that is valid and reliable for identifying articulation disorders; also appropriate for Mary Jo’s age and dominant language . C – Compare to normative data O – Confirm or rule out an articulation disorder. Does the Clinical Assessment of Articulation and Phonology identify Mary Jo as a person with an articulation disorder?

Question 26

Does the Clinical Assessment of Articulation and Phonology (CAAP) identify Mary Jo as a person with an articulation disorder?

Answer 26

Read manual to determine whether the CAAP is reliable and valid for identifying articulation disorders, and appropriate for age and language. Administer the CAAP according to the manual. Record, score and interpret her responses. Compare results to normative data - Diagnosis or category - Severity rating Then assign a diagnosis using test results.

Question 27

PICO example specific

Answer 27

Does Mary Jo change her speaking pattern with clinical teaching? P – Mary Jo I – Select a test that is valid and reliable for evaluating stimulability, or a procedure known to effectively prompt change; should also be appropriate for Mary Jo’s age and language. C – Compare production before and after clinical teaching O – Confirm or rule out potential therapy targets. Does the GFTA: Stimulability Subtest identify Mary Joe as a person who responds positively to clinical teaching?

Question 28

Planning for the report from the beginning

Answer 28

Report Format Includes – Identifying information: - -Primary source: Case- history intake form Diagnosis: Primary source: Relevant evidence Introductory paragraph: Primary sources: Case- history intake form and opening interview Statement of the problem: Primary sources: Case- history intake form and opening interview, short and direct quote (intake form) or “why did you come here” answer Background information: Primary sources: Case- history intake form and opening interview, past tense, all information before testing Results of testing: Primary sources: Formal and informal testing, any data collection or data observations Clinical impressions: Primary source: clinical observation, (if the person is easy distracted, or highly motivated, or sociable) Summary (includes diagnostic statement): Primary source: The body of the report, "why you're going to make the diagnosis, prognosis, and recommendations", detailed, last sentence should start with "therefore" Prognosis: Primary source: The report summary, Where you want to write something meaningful if you think this person will benefit form treatment Recommendations: Primary source: The report summary, should always say if you recommend speech therapy and the frequency and include rationale. *Never say where to get speech therapy done*, also any follow up testing that should be done, any referrals Closing statement: Primary source: closing statement "it was a pleasure testing John today, if you have any questions, feel free to contact me. Signature lines: Primary source: individuals who participated, and their qualifications

Question 29

1. Once a person receives a diagnosis, changing it requires a doctor’s order: 2. Diagnosis is based on highly individualized data: 3. Prognosis can be opinion but prognosis statement but be based on 4. Prognostic statement is a prediction: 5. Inaccurate prognostic statements can be a source of professional liability:

Answer 29

1. FALSE 2. TRUE 3. EVIDENCE 4. FALSE 5. TRUE

Question 30

1. The primary purpose for administering a standardized test is ______ a person according to behavioral symptoms 2. Identifying the etiology for a communication patter can have a noteworthy impact on the plan of care: 3. Everyone’s speech should be present by age 4. All assessments should include dynamic testing: 5. Dynamic assessment includes activities to evaluate the client for response to: 6. All clinical decisions are based on:

Answer 30

1. CATEGORIZING 2. TRUE 3. 8 4. TRUE 5. Clinical teaching 6. EVIDENCE

Question 31

1. Professional documentation must be: | 2. The most important part of a basic diagnostic protocol is the standardized testing:

Answer 31

1. ACCURATE, CLEAR, and PRECISE Say it one time and say it in the right place 2. FALSE

Question 32

Clicker questions (4) 1. Potential clinical questions is most likely to be clinically relevant for John, a 12 year old whose mother reports that people find him difficult to understand: 2. It is best to begin planning for the clinical report after completing the diagnostic:

Answer 32

1. Does the conversational speech sample reveal age- inappropriate speech- sound errors for John? - not cognitive challenges - not social challenges 2. FALSE