SP14 SLPA200

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SP14 SLPA200
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2014-05-11 22:21:11
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SP14
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  1. 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
  2. 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
  3. Reliability
    repeated measures of the same skill result in consistent scores
  4. Baseline
    • Starting point - Very important information.
    • Base is established before starting treatment to improve reliability.
  5. Validity
    Measures only the targeted skills.
  6. Client Specific Measures
    Designed specifically for an individual patient.
  7. Most frequently assessed behaviors
    • Fluency of speech
    • Syntactic & morphologic features
    • Conversational speech samples
    • Auditory comprehension skills
    • Repetition skills
    • Naming skills
    • Speech production
    • Writing
  8. Dementia
    Progressive neurological disease which affects cognitive skills, social and personal behavior, continues to deteriorate.
  9. Apraxia
    Speech disorder, neurologically based, motor processing - NO muscle weakness.
  10. Dysarthria
    Speech disorder, motor planning disorder, weakness, slowness of speech muscles - connection between brain and mouth not working.
  11. Degrees of deficit (4)
    Mild, moderate, severe, profound.
  12. Risks for having a stroke
  13. Receptive vs Expressive Aphasia
    Primary difference=
  14. Confrontation Naming vs. Word Fluency
  15. Global Aphasia
    • Broca's + Wernicke's
    • Affects expressive and receptive language
    • Affects all communication skills, including non-verbal
  16. Characteristics of Broca's Aphasia (5)
    • Nonfluent
    • Agrammatic speech
    • Slow speech
  17. Brain lobes
    • Frontal
    • Parietal
    • Occipital
    • Temporal
  18. Aphasia
    language disorder based on recent brain trauma or injury
  19. Aphasia - Causes
    • TIAs (mini-strokes)
    • CVAs (cerebrovascular accidents: ischemic, hemorrhagic)
    • Brain Trauma
    • Tumors
    • Infections in brain (bacterial & viral)
    • Toxemia
    • Epilipsy
    • Progressive neurological diseases
  20. Anatomic orientations
    • Superior
    • Inferior
    • Anterior
    • Posterior
  21. 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.
  22. 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
  23. 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
  24. 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.
  25. 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
  26. 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
  27. 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
  28. Assessing Reading Skills
    • Oral reading skills
    • Reading comprehension
    • Matching pictures to words
    • Read book
  29. Assessing writing skills
    • letter formulation (hand use)
    • writing skills
  30. Assessing Motor Speech Skills
    • Oral facial/Oral motor exam
    • Apraxia- conversational speech
    • Dysarthria- conversational speech
  31. Assessing nonverbal communication skills
    • common gestures
    • pantomine
    • signs
  32. 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.
  33. Agnosias (4 types)
    • Auditory-
    • Auditory Verbal-
    • Visual-
    • Tactile-
  34. 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.
  35. 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
  36. 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
  37. Aphasia-General Treatment Targets
  38. 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

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