-
Aphasia-Goal of Assessment
- Collect patient history
- Assess patient ability in communication
- Assess patient health problems
- Assess patient quality of life
- Assess family and social support systems
- Obtain occupational information
- Assess social dynamics
- Assess cultural background
-
When Assessing
- Ask patient what troubles them most
- Assess most prominent features first then less prominent later
- Go over case history
- Assessment is an ongoing activity - Diagnostic Therapy
- Select tests vs client specific assessment (may change based on family/patient goal)
- Obtain previous reports
-
Reliability
repeated measures of the same skill result in consistent scores
-
Baseline
- Starting point - Very important information.
- Base is established before starting treatment to improve reliability.
-
Validity
Measures only the targeted skills.
-
Client Specific Measures
Designed specifically for an individual patient.
-
Most frequently assessed behaviors
- Fluency of speech
- Syntactic & morphologic features
- Conversational speech samples
- Auditory comprehension skills
- Repetition skills
- Naming skills
- Speech production
- Writing
-
Dementia
Progressive neurological disease which affects cognitive skills, social and personal behavior, continues to deteriorate.
-
Apraxia
Speech disorder, neurologically based, motor processing - NO muscle weakness.
-
Dysarthria
Speech disorder, motor planning disorder, weakness, slowness of speech muscles - connection between brain and mouth not working.
-
Degrees of deficit (4)
Mild, moderate, severe, profound.
-
Risks for having a stroke
-
Receptive vs Expressive Aphasia
Primary difference=
-
Confrontation Naming vs. Word Fluency
-
Global Aphasia
- Broca's + Wernicke's
- Affects expressive and receptive language
- Affects all communication skills, including non-verbal
-
Characteristics of Broca's Aphasia (5)
- Nonfluent
- Agrammatic speech
- Slow speech
-
Brain lobes
- Frontal
- Parietal
- Occipital
- Temporal
-
Aphasia
language disorder based on recent brain trauma or injury
-
Aphasia - Causes
- TIAs (mini-strokes)
- CVAs (cerebrovascular accidents: ischemic, hemorrhagic)
- Brain Trauma
- Tumors
- Infections in brain (bacterial & viral)
- Toxemia
- Epilipsy
- Progressive neurological diseases
-
Anatomic orientations
- Superior
- Inferior
- Anterior
- Posterior
-
Cranial Nerve X - Vagus
- Primary function is respiration
- Secondary function is speech
Very important nerve for functions of larynx, respiratory system, cardiac system and GI system.
-
On Old Olympus Towering Tops A Fat Ass German Viewed Aging Hops
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Acoustic/Vestibular
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
-
Global Aphasia-Major Language Characteristics (7)
- Globally impaired communication skills
- Severely reduced fluency
- Extremely limited verbal expressions
- Impaired repetition
- Impaired naming
- Impaired auditory comprehension
- Impaired reading and writing skills
-
Assessments SLPs use
- Functional living: driving, shopping, etc
- Life skills: traffic signals, playing cards, etc
- Bilingual tests
- Independent tests for specific skills: test for auditory comprehension, Token Test, etc.
-
Outline of Assessment
- Assess case history
- Current problems vs premorbid communication and intellectual skills
- Patient history: age, education, occupation, hobbies
- Family History: living arrangements
- Medical History: meds, health history, psych history
- Behavioral history
-
Assessment Techniques-Verbal Expression
- Record speech sample
- Repetition skills-single words and sentences
- Naming skills-responsive naming (what color is a banana?) and confrontation naming
- Speech fluency
- Automated speech and singing (alphabet, prayers)
- Syntactic & morphologic aspects: speech sample
-
Assessment Technique-Auditory Comprehension
- Verbal commands
- Assess hearing-refer to audiologist
- Assess vision
- Always look for ways to refer patients
- Patients usually respond better to:
- personal vs neutral questions
- frequent commands vs infrequent
- stories of daily events vs general
- simple sentences vs more complex sentences
- Comprehension of commands
- comprehension of single words
- comprehension of sentences and connected speech
-
Assessing Reading Skills
- Oral reading skills
- Reading comprehension
- Matching pictures to words
- Read book
-
Assessing writing skills
- letter formulation (hand use)
- writing skills
-
Assessing Motor Speech Skills
- Oral facial/Oral motor exam
- Apraxia- conversational speech
- Dysarthria- conversational speech
-
Assessing nonverbal communication skills
- common gestures
- pantomine
- signs
-
Differential Diagnosis
Determination of which of the two or more diseases with similar symptoms it truly is. It examines all the possible causes for the symptoms to arrive at a diagnosis.
-
Agnosias (4 types)
- Auditory-
- Auditory Verbal-
- Visual-
- Tactile-
-
Aphasia Treatment-Effectiveness vs Improvement
Spontaneous recovery - in 1st year-when patient improves to an extent without professional help.
Patients who receive treatment attain better communication skills than patients who do not.
Variables which affect treatment-timin of treatment initiation, family involvement (positive), severity.
-
Aphasia - Principles of Language Treatment
- intact skills & deficiencies
- family communication patterns and support
- expectations regarding treatment = social and occupational demands
- client specific and meaningful target behaviors=greatest improvement
- intensive treatment regimen as possible
- maximum amount of stimulus control in the beginning (objects, role playing)
- fading, modeling
- *target language skills = 80% accuracy
- *provide immediate corrective feedback to improve self-monitoring
- independent self-monitoring skills
- training significant others
-
Aphasia-Special Considerations in Treatment
- Both patient and the family need to learn to live with Aphasia
- Family members-educated
- compensatory communication strategies taught
- realistic prognosis
- treatment - client specific
- team based treatment (RT, OT, SLP, MT,ACT, NSG)
- be prepared to make judgment regarding ethics to continue treatment
-
Aphasia-General Treatment Targets
-
Nature of Auditory Comprehension Deficits
Slow rise time: does not comprehend the 1st few words but comprehends the rest
Noise build-up (*Auditory Fade): comprehend the 1st few words, but not the last few words of the message as it gets louder
Info processing lag: comprehends the 1st and last few words, but does not comprehend the middle
|
|