Curiosity, Dialogue, and Knowledge
Collecting Pt. History
Importance of chart review: (important to know all these things because it directs you in therapy)
Etiology: type, date of onset:, differential Dx, lesion Location
Previous diseases/related illnesses
Physician’s desk Notes
Physical Health Problems
Written by patient care personnel recording of chronological physical state, behavior and metal status
What information should you gather or collect about the patient?
Ask about heath, how they are feeling, their family, occupation, ask them to tell you if they are having trouble talking ect., and to tell you about it.
What can this information tell you?
Gives you an Idea of who that person is and how to direct therapy with them. You can get a sense of their personality and what communication needs they and their family members need to have met.
How does the patient spend their normal day?
Prepare for a first meeting with a pt, what are the factors you should consider?
Look at chart, know it, so you can see if they match up with it
Establishing a Prognosis
Pt general Characteristics
Age, gender, education, occupation, pre-morbid intelligence, handedness, personality, emotional state
Type, and location and extent of the lesion – most support for prognosis
Look at their age and overall health
Associated conditions that could compromise the pt recovery
Sensory and motor impairments
Are they motivated?
How are they acting?
How do they feel about therapy
Before you Assess:
Do your homework from medical records and interview, have in mind a plan
Choose an appropriate place for testing- quiet, well-lit and free of distractions, should be comfortable
Schedule testing to maximize pt performance
Make testing a collaborative effort
Select test(s) that are appropriate for the patient
Test battery should be at different levels of difficulty
Should be standardized
Should sample in a consistent way the input modalities through which test instructions are delivered, metal process for tasks, and output modalities
Multidimensional scoring should be used
Suggest reason for the deficient performance
What is the purpose of speech/Language screenings? Identify pt who have no communication/language impairments
Patients who have complications that will hinder them for being able to be formally tested
Identify patients with severe irreversible impairments
Also helps SLP decide what test to administer and the level of difficulty to begin at
Also can provide enough information for SLP to write-up an initial impression, diagnosis and recommendations to be placed in progress notes
What kind of testing items do they typically include?
Word to picture matching
Rating of connected speech
Letters to dictation
Words to dictation
What is the purpose of comprehensive standardized testing of language?
They assess four modalities: Auditory comprehension, Speech, Reading, Writing
They are used to classify the disorder
Determine language and communication abilities
Make a prognostic statement
And provide guidance for treatment
What tests are available?
WAB – Western aphasia battery
BDAE – Boston diagnostic Aphasia Examination
MTDDA – Minnesota Test for differential diagnosis of aphasia
Communication and Pragmatics in daily activity
ASHA FACS, Pragmatic Protocol, CADL, Functional Communication Profile
Tests that make a prognostic statement:
MTDDA or PICA
Which of them provide a “classification” for aphasia?
What are the pros and cons of each?
Not as comprehensive
No profile just classification
What methods and assessments are available for assessing pragmatics and functional communication? What are the pros and cons of each?
Elicit a conversation sample
Analysis – the Pragmatic Protocol
Verbal and paralinguistic and non-verbal aspects
Looks at: social communication, communication of basic need, reading and writing, number concepts, daily planning
Looks at pt getting message across and also the conversation partner understanding and getting their message across
Picture description and role play
Less conversational interactive
Not as good b/c adults don’t usually pretend they feel stupid doing this
Good for moderate to severely impaired
Family/caregiver rates person on a variety of areas on a scale from “not at all able” to ‘as able as before stroke”
Visual analog scale
Single world level
Recitation, rhymes, Automatized sequences
Responsive naming – what do you tell time with?
Generative naming – name all the animals you can think of
Variables that affect naming accuracy:
Frequency of occurrence
Length and phonological complexity
Word definition test
Make a sentence from a word task
Picture description (picnic scene, stealing cookie scene)
Interview and conversation
Single world level
Carrier phrase: Point to the:
Point to objects in environment
Variables that affect single word comp:
Frequency of occurrence (do they hear that word, know that word)
Semantic/acoustic similarities b/t target word and foils
Fidelity – can you hear the question
Question, perform a task to spoken command
Yes/no question – easier, easier if they are relevant
Are you a doctor, do you cut grass with and ax?
Variables that affect this:
Read out loud a short story then the patient answers questions
Read magazine that they enjoy, bible study, book, then ask them question, they will do better if its relevant
Variables that affect spoken discourse:
Salience- the way the speaker makes important information stand out
Directness – how directly you say your information compared to having them infer the information
Redundancy – how many times you repeat or reword the same idea- repetition makes it easier
Speech rate and emphatic stress- should use slow speech rate and exaggerated emphasis on the discourse to help pt do better
Single word level
Oral reading of words
Match word with picture
Match printed word to spoken word
Oral reading of sentences
Comprehension of printed sentence or text
Reading rate – how well they can read and comprehend under normal time constraints
Reading capacity – how well they can read if they have as much time as they need (do better with this)
Want to bring RR and RC closer together
Single word level
Generating ‘automatic” sequences (sign name, address, date)
Writing to diction
Writing to self formulated materials
Writing to diction
Writing a story
Most clients depending on occupation might only need to sign name and write lists. After school we don’t do as much writing depending on occupation