Adult Comm 2

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Adult Comm 2
2013-02-23 09:56:23
Adult Comm

Adult Comm 2
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  1. what is assessment & why do we do it
    • It is the systematic process of obtaining info from many sources, through various means, in diff settings
    • We do it to verify & specify comm. strengths & weaknesses, identify possible causes of problems, & make plans to address them
    • Why- to determine what is causing a client’s difficulty; diagnose a disorder; describe client’s strengths & weaknesses; determine goals & objectives; measure progress
  2. when do we assess
    • Before we start working with a client (initial diagnosis; determine initial goals & plan treatment)
    • While we’re seeing a client (get an idea of progress; continue to adjust our goals; create objectives)
    • When we are done seeing a client (determine if goals are met; determine current abilities- are they the best we can get them)
  3. initial goals of assessment process
    Verify there are comm. problems; describe & quantify deficits & strengths; state the severity; determine etiology; make recommendations for treatment; give a prognosis
  4. common assessment procedures
    Case history; opening interview; systematic observations/sampling (observing clients in more than 1 setting, transcribing a large chuck of speech); hearing screening; oral motor examination; standard testing (norm referenced or criterion referenced); dynamic assessment; consolidation of findings (making the diagnosis); closing interview (go over the outcome); write up
  5. how to organize a diagnostic report
    Indentifying info (basic demographic info); background info (case history info, prior medical info); biological info (hearing status, structure/function of oral mechanism, neurological symptoms); basic comm. processes of lang, artic, voice/resonance, & fluency that are within normal/functional limits; diagnostic test results focusing on areas of concern (standardized, non-standardized); clinical impressions; summary & recommendations
  6. components of WHO's international classification of functioning, disability, & health framework
    Body functions & structures (functions, structures); activities & participation (capacity, performance); environmental & personal factors (barriers, facilitators)
  7. aims of the WHO framework
    • To provide a scientific basis for consequences of health conditions
    • To establish a common lang to improve comm.
    • To permit comparison of data across- countries, health care disciplines, services, time
    • To provide a systematic coding scheme for health info systems
  8. application of the WHO framework
    Statistical, research, clinical, social policy, educational
  9. potential elements relating to activities & participation components of the framework
    Learning & applying knowledge; general tasks & demands; comm.; movement; self care; domestic life areas; interpersonal interactions; major life areas; community, social & civic life
  10. psychometric properties of assessments
    • Standardization
    • Reliability: repeat test in same conditions & get similar results
    • Validity: does it measure what its supposed to measure
  11. components of the A-FORM domains
    • Participation in life situations- activities; comm. & conversation; roles & responsibility; relationships
    • Personal identity, attitudes, & feelings- the future; your view of yourself; aphasia & who you are; feelings
    • Severity of aphasia- understanding other people; speaking; reading; writing
    • Comm. & lang environment- services, systems, & policies; attitudes of others to you & the aphasia; help with comm. & conversation
  12. aphasia therapies
    • Stimulation approach: repetition & auditory bombardment; focus on restoration; influential therapy (intensive auditory stimulation)
    • Localization: types of aphasias classified by lesion site & symptoms (broca’s, wernicke’s, etc); therapy depends on type of aphasia (aphasia-sepcific treatment); hypothesized mechanism of change (restoration, reconstitution, compensation); influential therapy (melodic intonation, visual action therapy, voluntary control of involuntary utterances)
    • Neurolinguistic: reteaching of linguistic rules- the principles of experience-dependent plasticity (use it or lose it; training of grammatical structures such as wh movements); neurologically caused lang disorder; restoration is the hypothesized mechanism of change.
    • Cognitive neurophyshological: aphasia as- components of the lang processing system are selectively impaired; process of therapy- teaching lang processes or alternative methods; mechanism of change- restoration, reconstitution, compensation; therapy techniques- mapping therapy, naming facilitation techniques.
    • Pragmatic/functional: comm. disability that effects social interaction & everyday comm. activities; therapy- teaching conversational principles & training compensational strategies to client & comm. partner; hypothesized mechanism of change- conversation coaching & training, teach real world compensation strategies (including comm. partner)
    • Social: therapy- holistic & client directed, living with aphasia approach; techniques- community aphasia groups, stroke support groups, caregiver support & education; changing comm. barriers by training comm. partners.
    • Biopsychosocial (ICF): takes into account clients actual physical impairment at biological level combining the patients activity limitation & participation restriction; client & therapist choose goals across biopsychosocial spectrum
  13. model of auditory comprehension
    Heard word --> auditory phonological analysis --> phonological input lexicon --> semantic system
  14. neurological pathway of auditory comprehension
    • Ears- auditory cortex (both temporal lobes)
    • Encoded message goes to Wernicke’s area in  left (rt temporal- corpus callosum), message is decoded (phonologic/sounds, semantic/words, syntactic/grammar)
    • Response message sent to appropriate areas
  15. compare & contrast
    • Auditory agnosia: inability to recognize familiar non-speech sounds
    • Pure word deafness: bilateral damage to temporal lobes (usually); limited documentation due to high levels of spontaneous recovery; patient unable to understand, repeat or write to dictation the words heard; speech & reading not significantly impaired; can hear sounds
    • Word form deafness: more rare than pure word deafness; can make minimal pair distinctions; cannot word to pic match when distracters are phonologically related.
    • Word meaning deafness: patient can repeat & write heard words to dictation but cannot understand the meaning of the words; intact repetition but disconnected from meaning
  16. major markers of Wernicke's aphasia & Transcortical Sensory aphasia
    • Wernicke’s apahsia: impaired naming & impaired lang comp; both phonological & semantic errors; jargon may be present.
    • Transcortical sensory aphasia: comp is poor but repetition is intact; rarer type of aphasia & disorder
  17. components to assessment in auditory comp disorders
    Diagnose the impairment while considering the person & his/her perception of difficulties; person’s communicative needs; formal & informal assessment (linguistic performance, conversational behavior, observations of behavior; interviews, self and/or other reports); consider role of hearing acuity; consider functional impact; assessing at single word may not predict person’s ability to understand discourse in context; where, why, & in what situations is the person trying to understand spoken lang.
  18. potential stimuli in auditory comp assessment
    • Sound, nature- bell, alarm, phone, dog bark
    • Phonemes- in isolation, in syllables
    • Words- single words (objects/nouns, verbs, body parts, shapes, color, numbers); tested using single pictures, pic arrays, objects, pic-vocab tests
    • Phrases- (in the garden, my son Bob, etc), carrier phrases- (point to the ___)
  19. what is graduated for intervention in auditory comp
    • Listening comp & memory (cannot be separated; short term memory deficits are part, but not all, of auditory comp problems)
    • Recovery; comp can support spoken production but the reverse is not true
    • Improving the impaired process; compensating to improve comp
  20. examples of activities for intervention in auditory comp
    Lip reading effective for word sound deafness; mouth drawing to highlight diff b/w phonemes; consonant-vowel discrimination tasks; word to pic matching, written words; combo of auditory & written presentations.
  21. comm partner training considerations
    Minimize noise; ensure appropriate seating & lighting; gain person’s attention before speaking; emphasize key words; simplify sentences; use concrete words; avoid topic changes; use appropriate rate & pauses; use gestures, facial expressions, intonation & writing to support
  22. basic neurological pathway to word productions (oral & written lang)
    • Expressive lang- spontaneous speech, repetition, writing, oral reading, gestures—wernickes; area formulates message; neurally encoded message is sent via arcuate fasciculus to Broca’s area; message decoded, recoded into motor plan; primary motor cortex, via pyramidal system, cranial nerves, muscles; speech production, or writing, or gestures.
    • Repetition- starts with auditory cortex loop; tests entire circuit for reception & expression/production
    • Oral reading- starts with visual cortex loop; similar to repetition but info comes from visual cortex.
  23. potential error types across aphasia types
    • Phonemic paraphasia (kack for jack)
    • Semantic paraphasia (clock for watch)
    • Augmentation (sojie watch for watch)
    • Part word (noculars for binoculars)
    • Paraphrase (here she is for is she here)
    • Partial phrase (300 dollars for 321 dollars)
    • Circumlocution/description (blow it for whistle)
    • Phonemic error on semantic paraphasia (miskroscope for binoculars)
    • Neologistic paraphasia (kargy for whistle)
    • Unrelated real words (thunder time for scissors)
    • Stereotypy (bukky bukky for watch)
    • Other (I know this one but I cant think of the word)
    • Unintelligible, nontranscibable
    • Visual perceptual (trash cans for binoculars)
  24. paraphasia examples
    • Phonemic: phonological errors, sound substitutions or transpositions (shooshbrush, tevilision)
    • Semantic: incorrect word, usually related/same category (door for window, knife for fork)
    • Unrelated: cigarettes for motorcycle
    • Perseverative: unintentionally substitutes a previous word
  25. fluent & nonfluent speech
    • Fluent: speech flows smoothly & effortlessly; speech rate, intonation, & emphatic stress is normal; damage is typically posterior to central sulcus
    • Nonfluent: speech is halting, requires much effort; speech rate is slow, intonation is restricted, stress is diminished; damage is typically anterior to central sulcus
  26. major markers of Broca's, transcortical motor, global, mixed nonfluent aphasia
    • Broca’s aphasia: nonfluent, telegraphic/agrammatic (uh… mother & dad… no… mother dishes, running over, water)
    • Transcortical motor aphasia: nonfluent, marked reduction in output; good repetition; anterior superior frontal lobe damage (what do you do- bakery; tell me more- bakery)
    • Global aphasia: dovanday, dovanday
    • Mixed nonfluent aphasia: better than global, pooer than broca’s; severe anomia; sometimes associated with stereotypies, but sometimes produce sparse, meaningful speech with articulatory effort, phonemic paraphasias, perseverations
  27. discrete retrieval model of word production &
    interactive retrieval model of word production
    • Sound & word retrieval occur in 2 distinct phase
    • Sound & word retrieval interact with each other & the systems cross-talk
  28. semantic assessment tasks in word production
    • Word freq (how common is a word compared to other words in the lang); should administer tasks with words of high, medium & low freqs; the more freq a word is, the stronger the representation is in the lexicon; pic naming, naming words in response to a def.
    • Imageability (the degree to which a concept denoted by a word can be mentally pictured); word def tasks; if someone has more difficulty retrieving word names of abstract concepts, this indicates impaired spread of activation b/w the semantic & lexical networks
  29. phonological assessment tasks in word production
    • Word-length effect; longer words are harder to produce than shorter word; include words 1-4 syllables in length
    • Lexicality effect; whether or not a phoneme string is a real word in a speaker’s lang; strings of phonemes that resemble the words in the speaker’s lang & respect phonological rules are called pseudowords; phonological processes must be intact (strime)
  30. intervention in word production disorders
    • Semantic feature analysis: talk around a target word
    • Verb network strengthening treatment: 4 word utterances are elicited by presenting a card with a verb written on it along with other cards with nouns that could be the agents of the verbs, & nouns that could be the patients of the verbs. (agent- chef, patient- flour, both go with verb measure, wh-question pairings)
    • Cueing hierarchies: imitation, first sound or first syllable, sentence completion, word spelled aloud, rhyme, syn/ant, function/location
    • Response elaboration training: step 1- clinician- verbal instruction & stimulus presentation (30 black & white line verb drawing), client- spontaneous description (crying); step 2- clinician- expansion, model, reinforce (a man is crying, good), client- no response; step 3- clinician- wh cue (why is he crying), client- elaboration (hit head); step 4- clinician- combine patient responses, model, reinforce (great, the man is crying b/c he hit his head), client- no response); step 5- clinician- request repetition, model 9try to say the whole sentence after me. Say, the man is crying b/c he hit his head), client- imitation (hit head, crying); step 6- clinician- reinforce model (nice going. The man is crying b/c he hit his head)

    • ·     
    • Priming: semantically related words;
    • phonologically related words; unrelated words; attempts to increase strength of
    • connections
  31. intervention considerations
    • WHO model (impairment)
    • Maintenance: long term maintenance of improved word & phoneme retrieval abilities
    • Generalization: of improvements to untrained stimuli & to contexts other than the treatment setting