Chapter 8

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Chapter 8
2014-05-26 14:01:49
sp14 200

Assessment of Aphasia
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  1. What are the goals of assessment of aphasia?
    • 1.  Understand patients past, present and future.
    • 2.  Patients communication skills.
    • 3.  Patients health problems.
    • 4.  Quality of life.
    • 5.  Family and social support system.
    • 6.  Occupational information
    • 7.  Social Dynamics
    • 8.  Cultural background.
  2. What strategies can clinicians do to maximize their assessment time to collect needed information?
    1.  Ask patient what troubles them the most?

    2.  Assess most prominent features of aphasia and probe for less prominent features later.

    3.  Assessment is an ongoing activity-Diagnostic therapy.

    4. Interview the client and family over the phone and go over case history to clarify the information before the assessment session.

    5.  Select tests that are relatively brief yet as reliable and valid as some of the longer ones. 

    6.  Use client-specific assessment procedures .

    7.  Obtain previous reports.
  3. What are the most frequently assessed behaviors?

    (know at least 5)
    • 1.  Fluency of speech
    • 2.  Syntactic and morphologic features
    • 3.  Conversational speech samples
    • 4.  Auditory comprehension skills
    • 5.  Repetition Skills
    • 6.  Naming skills
    • 7.  Speech production
    • 8.  Writing
    • 9.  Reading aloud and reading comprehension
    • 10.Automatic speech and singing
    • 11. Nonverbal communication
  4. Activities used on assessment - Most clinicians use a combination of standardized and nonstandardized procedures to sample behaviors that will help diagnose aphasia and plan for treatment.
    • 1.  Conversation
    • 2.  Answering questions
    • 3.  Describing pictures
    • 4.  Producing rapidly alternating movements.
    • 5.  Reciting days of the week and months of the year.
    • 6.  Naming objects and pictures
    • 7.  Naming friends, colleagues and family members.
    • 8.  Naming with various cues.
    • 9.  Pointing to named objects or pictures.
    • 10.  Matching printed words to pictures.
    • 11.Repeating clinician modeled words, phrases and sentences.
    • 12.  Saying as many words as possible that starts with the same letter.
  5. Direct and Repeated observation of a patient
    • Patient should be observed prior to administering standardized diagnostic tests.
    • The observations need to be repeated often and beyond the point of standardized test administration.
  6. Standardized test in assessing aphasia
    Both screening and diagnostic aphasia tests are available.  Some standardized diagnostic tests are designed to assess and classify aphasias into specific types.  Other tests assess various behaviors of interest and do not attempt a typological classification.

    An initial screening test, a more detailed diagnostic test, and client specific assessment procedures (including direct observations and conversational speech samples) will help assess both the needs and strengths of the patient.
  7. Selected screening tests of aphasia
    Most screening tests are a brief instruments that help make a quick, initial, and bedside assessment.

    Screening tests sample only a few language and related functions.  They are typically followed by the administration of a diagnostic test and other client specific procedures.

    Most screening tests take 10 to 20 minutes to administer.  They include items to assess verbal expression, auditory comprehension, repetition naming, automatic speech and limited reading and writing.

    • Quick Assessment for Aphasia
    • Tanner and Culbertson Assessment (1999)
  8. Outline of Assessment- Groups assessment tasks into seven major categories
    • 1.  Case history
    • 2.  Verbal expression
    • 3.  Auditory comprehension
    • 4.  Reading skills
    • 5.  Writing skills
    • 6.  Motor speech
    • 7.  Nonverbal communicative skills
  9. Detailed Case History
    1.  Patient's history - age, education, occupation, oral and written language skills and hobbies and interests.

    2.  Current family constellation - living arrangements, family members who live with the patient and others who might be able to help in supporting treatment.

    3.  Medical data - health history, potential causes and consequences of aphasia, associated diseases, current physical condition, current medications

    4.  Behavioral observations- diagnostic and treatment implications may emerge from observation of general and communicative behaviors.
  10. Assess Verbal Expression
    • 1.  Record a Conversational speech sample-
    • Record a patients conversational speech during the interview.  Make a analysis of sentence structures, production of grammatic morphemes, comprehension of spoken speech, speech fluency, word finding problems, associated dysarthric features, conversational turn taking and topic maintenance.

    • 2.  Assess repetition skills -
    • repetition of single words
    • repetition of sentences

    • 3.  Assess naming skills-
    • Responsive naming- ask direct questions

    Confrontation naming - name an object but no other clue.

    4.  Assess speech fluency- analyze pauses, repetitions and general flow of speech. (name all the animals you can think of.)

    • 5.  Assess automated speech and singing -
    • alphabet, poems, sing a song

    • 6.  Assess syntactic and morphologic aspects of verbal expression -
    • Use recorded conversational speech sample to understand the syntactic and morphologic aspects of language production.
  11. Assess auditory comprehension of spoken language
    Assess responses to commands, understanding of single words and comprehension of connected speech.  Generally patients respond better to: 

    • personal questions than to neutral
    • frequently occurring commands than to infrequent or unusual commands
    • stories of daily events
    • simpler sentences

    • Assess comprehension of commands
    • Assess comprehension of single words
    • (point to blocks)

    Assess comprehension of sentences
  12. Assess reading skills
    Oral reading and reading comprehension
  13. Assess writing skills
    • Letter formation
    • Ask patient to write a paragraph
  14. Assess Motor speech skills
    • Assess for apraxia and dysarthria
    • Oral facial exam
  15. Assess Nonverbal Communicative skills
    Assess gestures and pantomime.