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Adult Language Disorders > Treatment & Related Issues > Flashcards

Treatment & Related Issues Flashcards

(48 cards)

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1
Q

Treatment Related Issues

A

Medical environment (cost benefit issue)

third party regulation (private insurance)

medicare limitations

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2
Q

Medicare Part A Limitations

A

20 days of care in hospitals

100 days in skilled nursing facilities

home health care

hospice care

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3
Q

Medicare Part B

A

Outpatient service over age 65, including doctor visits, outpatient hospital care, hospitalization beyond Part A coverage

80% of charges after annual deductible

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4
Q

Treatment Team - PT

A

Dx of muscle strength and range of movement for functional independence

Strengthen muscles

muscle atrophy and contracture prevention

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5
Q

Treatment Team - OT

A

Motor abilities for skilled activities of daily living

compensatory strategies for visual-spatial deficits

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6
Q

Treatment Team - Recreational Therapist

A

Programming activities to keep patients purposefully occupied

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7
Q

Treatment Team - Social Worker

A

Medical communication to patients/families

Discharge plans

Post-discharge care with suggestions for nursing facilities, state and social services

Medical directive follow ups: wheel chair, prosthetic needs

Coordination of competence evaluation

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8
Q

Treatment Team - Clinical Psychologist

A

Emotional and personality issues

treatment for psychoses and depression

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9
Q

Treatment Team - Dietician

A

Nutritive needs and delivery types

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10
Q

Treatment Team - SLP

A

Acute phase:
importance of communication
family reorientation
minimization of regression

Subacute phase (limited treatment)

Chronic phase: 
Prevention of communicative regression
Promotion of restitution,
Progress monitoring
Planning long term treatment
Family participation)
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11
Q

Effects of Brain Damage

A

Diminished response flexibility

Task-related anomalies:
impulsive responses
excessive caution

Perseveration

Reduced self-monitoring:
posterior lesion cases
Wrenches’ aphasics are bad at self-monitoring, doesn’t happen with an anterior lesion

Recognition with no anticipation of errors

Information processing deficit:
- Slow rise time : takes the person time to start listening/only gets last part of the phrase

  • Noise build up : after first few words there is too much “build up” in the system, can’t process later words in the phrase
  • Retention deficit : memory
  • Intermittent imperceptions : variable performance, scattered
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12
Q

Two Types of Perseveration

A

Recurrent: repetition of a response after other subsequent verbal attempts

Continuous: inappropriate uninterrupted prolongation of verbal attempt; have to change task

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13
Q

Poor Prognostic Indicators

A

Bilateral or large lesions

Multiple strokes

Verbal stereotypes (“let me tell you”)

Perseveration

No matching of common objects and pictures

Unreliable yes/no responses

Jargon

Lack of self-correction

Medical complications

Depression

Malingering

Negative attitude

Poor family support

Etiology:

  • occlusive lesions: good early recovery
  • hemorrhage: best in 2nd or 3rd month
  • traumatic: better and slower over a long time
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14
Q

Positive Prognostic Indicators

A

Self-correction

Awareness

Younger age

Short time post-onset

Good health

Motivation

Family support

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15
Q

Treatment Procedural Info. - Linguistic Processes to be Attended

A

Recognition

Discrimination

Comprehension (visual and auditory)

Productive (verbal and graphic)

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16
Q

Treatment Procedural Info. - Response Modes

A

Pointing

Gestures

Nodding

Writing

Verbalizing

Augmentative Modes

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17
Q

Treatment Procedural Info. - Response Delay

A

Greatest response increment in 3-5 seconds with most in 10 seconds

Responsiveness better with meaningful/novel stimuli

Natural contexts: greater accurate responses

Unison or delayed recall: unison better with severely involved patients

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18
Q

Treatment Procedural Info. - Method of Facilitation

A

Repetition

Cue

Combining Stimulus modes

Number of alternatives

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19
Q

Treatment Procedural Info. - Treatment Methods

A

Imitation

Matching

Selection

Completion

Comprehension

Spontaneous Production

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20
Q

Treatment Procedural Info. - Stimuli Construction

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A

Meaningfulness

Length (short length of word)

Complexity (causes serious problems, avoid excessive complexity)

Frequency

Relatedness (semantically related is good)

Concrete image

Size

Modality of ease

21
Q

Facilitation Procedures - Cueing Hierarchy

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A

What is this called?

Direction to state the object function

Direction to demonstrate the use

Statement of the function by clinician

Sentence completion

Sentence completion + silent articulated 1st phoneme

Sentence completion + vocalized 1st phoneme

Sentence completion + verbalized 1st 2 phonemes

Say “…..”

22
Q

What to Treat - Relative Impairment Approach

Study These Flashcards
A

Identification of communicative peaks and valleys

Tx to lower points to try to reduce the depth of the valley

Tx on peaks only if a smaller gap between peaks and valleys

23
Q

What to Treat - Fundamental Ability Approach

Study These Flashcards
A

Focusing on impaired processes/components

Focus on cognitive process underlying the deficit, not output behaviors like comprehension

In anomia: word production, sentence construction

Improve auditory comprehension

24
Q

What to Treat - Functional Ability Approach

Study These Flashcards
A

Focus on competencies needed in daily life

25
Goal Setting
Realistic and definitive short and long-term goals that are beneficial to patients, meet their communicative needs, and relevant to demonstrable outcome Practical Adequacy not perfection Patience with recovery Rationale for each step and activity Ask why for each Tx step No teaching or retraining - only facilitation Elicitation rather than forcing a response Focus on measurable aspect of communication
26
Treatment Planning - Stimulation Approach
Stimulate rather than teaching words The antecedent event - the driving force in improving responses, rather than the consequent event in behavioral therapy Maximizing 'arousal power' of the stimulus Auditory perceptual system
27
Difficulty of Tasks in Treatment
Difficulty at 40-50% level no more than 40-50% error responses increase complexity with performance stabilization (90-95% in consecutive sessions)
28
Session Organization
General activity Consolidation East tasks Difficult tasks Consolidation Cooling off
29
Base 10 Response Form
Form that includes list of stimuli and scores for a series of sessions, as well as a graph where progress can be charted easy, brief, provides visual feedback, retention of stimuli, provides a basis for termination
30
Measuring Generalization
Treatment task performance charting standardized test repetition probing of goal-related task independent of treatment
31
Generalization
Applications of acquired knowledge to: - tasks with shared features - situations that allow the knowledge application - enable conversation at home
32
Ways to Promote Generalization
Natural contingencies targeting behaviors related to patient's life training of sufficient exemplars - train a behavior into enough different settings for generalization loose training - stimulus conditions and response requireemtns vary to increase generalization - across responses - within a response class - one environment to other environment elicitation of responses by other means like mnemonics or mental imagery matrix training of distanced items (table of distances between words)
33
Measuring Communicative Effectiveness
Total number of words or utterances Number of content units Number of correct words in content units Number of bound morphemes Ratio index of lexical efficacy (number of words divided by content words) Index of grammatical support (average number of grammatical words in each content unit) Complexity index (clauses per utterance)
34
Discourse Analysis
Empty utterances (don't express content, "oh boy") Sub-clausal utterance (content words only) Single clause utterance (subject/verb only) Multi-clause utterances Agrammatic deletions (omission of grammatical markers)
35
Measuring the Effects of Treatment - Single Treatment Effects
Pre- and Post- treatment ABA a minimum of 3 phases Tx usually withdrawn but measurement continues Design: comparison of results from 2 phases
36
Measuring the Effects of Treatment - Multiple Baseline
Best way to demonstrate the effects of tx. A single tx to study: different behaviors within a patient the same behavior in several patients or the same behavior across different environments
37
Medical Treatment
Preservation of life by treating: - Myocardial infarct - BP - Edema - Cardia Thromboembolism (blood thinning with anticoagulants) - TIAs (platelet-inhibators - platelets with a source of growth factors lead to the formation of blood clots) - Thromboembolic strokes (vasodilators, tPA (tissue plasmogenic activator)) - Limiting infarct by decreasing metabolism (barbiturates) - Reperfusion (endarterectomy (done with external carotid artery) and stent and umbrella (for collecting broken parts of the plaque))
38
Pro-Activation (Brookshire)
Exposure to difficult-to-name objects interferes with subsequent easy-to-name items easy to name items facilitates subsequently difficult to name items priming: exposure to a stimulus to influence a response on a later stimulus
39
Importance of Contexts (Barten)
Open-ended conversation is the most effective in naming VCN to picture is less effective Naming from verbal description is the least effective
40
Traditional Treatment
Based on stimulus and response - not the most productive Targeted areas and components One or multiple modalities Incorporation of stimulation-response Performance measurement in % Pros - good training - focused exercises Cons: - poor generalization - limited practical value
41
Language Reorganization
Transfer intact functions to disrupted functions for promoting language reorganization 2 types: Intra-systemic Inter-systemic
42
Intra-Systemic Language Reorganization
Improving a communicative system by transferring downward or upward (eg verbal singing, controlled by the right brain)
43
Inter-Systemic Language Reorganization
Using unrelated functional system to reorganize an impaired system (eg gestures with verbalizations)
44
Deblocking (Bierwisch)
Removal of a masking effect on impaired function by an intact one ex. auditory mode to deblock reading, semantic description to deblock naming
45
MRI & Recovery
Measuring Tx Effects: - post-stroke right activation - successful training leading to a left shift - over learning leading to a shifted left activation in peri-lesion area Optimal recover = LH peri-lesion reactivation Time: - Increased RH activation w/in 2 wks after stroke and a return to baseline levels after 1 year - Increased LH activity gradually from acute to chronic stage - A temporary contribution of RH in the early post-stroke phase, but absent in chronic stages
46
Schuell's Auditory Stimulation Approach
Controlled intensive auditory stimulation to maximize reorganization of the brain includes controlled speech rate, meaningful stimuli, incorporation of graded complexity, control of stimulus length, monitoring loudness level (20 dB higher), combining sensory modalities, promoting face to face conversation
47
Family Support Group
Forum for meeting other survivors and caregivers, seeking help with adjustments, expressing feelings, social network
48
Benefits of Group Therapy
Communication in natural environments Opportunity for spontaneous conversation Generalization of learned skills Development of self-confidence Emotional support

Adult Language Disorders (9 decks)

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