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44 Cards in this Set

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In assessment, the quantitativeand qualitative data gathering process for the purpose of?

circumscribing an individual’scommunication function and activity limitations, understanding his or herparticipation restriction, and devising appropriate rehabilitation objectives

assessment includes tools and procedures that allow?

•A.establishing a diagnosis and prognosis


•B.describing and understanding all components of language functioning, as well asrelated functions that may positively or negatively influence language (e.g.cognitive and emotional status)


•C.gathering background information regarding the individual with aphasia andfamily


•D.seeking input from the person with aphasia and family about rehabilitationgoals


•E.supporting initial communication interactions with the individual with aphasia,providing family and other health care team members with accurate descriptionof the individual’s current strengths and weaknesses

what is formal assessment?

areany published quantification tool




Clinicians purchase these tests or find them in empiricalliterature.




Vary among many variablessuch as length and breadth (e.g. battery vs screening), their purposes (e.g.neurolinguistics vs quality of life), and the conclusions clinicians are ableto draw from results.




Are quantitativeand provide little guidance for development of specific treatmentprocedures.

what is informal assessment?

refers to process of creating andmanipulating stimuli for the purpose of making clinical decisions, usually byanswering hypothesis questions (e.g. Does phonemic cueing help client?).




Includes essential process of gatheringspecific background information through record review and interviews withperson with aphasia and his or her family and caregivers.

talk about quantitative vs qualitative results

•Quantitativeinformation is expressed in raw numbers or anymathematical transformation of raw data (e.g. percentiles, stanines, zscores). •Qualitativeinformation is gathered by observing client’sbehaviors, either spontaneous or triggered by clinician.


•Bothformal and informal assessments can yield quantitative and qualitativeinformation.

what is Evidence-Based Practice?

•“Refersto an approach in which current, high-quality research evidence is integratedwith practitioner expertise and client preferences and values into the processof making clinical decisions”

what are the EBP guidelines?

•Utilizingaphasia test procedures that have been evaluated and found appropriate inresearch literature


•Administeringaphasia test procedures in manner that they are empirically verified. This includes using tests only for theirstated purpose (e.g. using aphasia screening test to document presence ofaphasia, but not to quantify and qualify specific linguistic abilities) andwith client population and specific instructions, tasks, and scoring criteriawhere they are developed and standardized (e.g. using test standardized onindividuals from northeastern sections of US may be inappropriate with clientsfrom other geographic regions)•Considerclinical knowledge and skills, best available evidence in professionalliterature, and their specific client’s needs and preferences to help guideselection of aphasia test procedures

what is Formal Assessment

Highlycontrolled observations garnered during administration of one or more of thefollowing: bedside or screening tests, test batteries, or tests of specificcommunicative or cognitive functions.

what are the purposes for formal assessment ?

Isto establish current level of communicative and cognitive functioning in theindividual with aphasia, including identifying presence, type, and severity ofaphasia and delineating specific language and cognitive strengths andweaknesses.

what are the functions for formal assessment ?

•1.Can be used to establish pre-therapy performance level of individual withaphasia. Is fundamental to decisionsregarding need or further diagnostic procedures and whether treatment should beinitiated, but predicts recovery and treatment outcomes.


•2.Can contribute to distinguishing and prioritizing treatment goals.


•3.When administered during treatment process, test data inform decisionsregarding the need to continue, modify or discontinue treatment.

what is Standardization?

•Theprocess of administering a test to an ideally extensive sample of individualswho represent the population segment with whom the test will be used


•Minimizemeasurement error and permit comparing individual client’s performance tothose in normative sample.


•Overtime need to be revised to update normative sample so it remains representativeof target population’s demographic characteristics or so sampling procedurescan be enhanced (e.g. obtain larger normative sample or include more diverse groups in age, gender,education, language background, or ethnoculturalrepresentation)


•Testadministrators must ensure standardization sample of tests reflect demographiccharacteristics (e.g. age, sociocultural background, education level) of testexaminee)


•Mismatchcan result in inaccurate interpretation of individual’s test scores becauseboth reliability and validity of test may be compromised, leading to test bias

what is reliability?

•Providesinformation pertaining to the degree with which a test yields similar dataacross repeated administrations in similar testing circumstances


•Test-retestreliability


•Ifresults vary substantially across repeated administrations


•testhas poor or questionable reliability, when reliability coefficients fall below0.80, test reliability is suspect


•Testshould offer detailed directions for administering tasks, scoring responses,and interpreting test outcomes to help minimize intra- (i.e. repeated test usedby same examiner) and interexaminer(i.e. repeated test use across different examiners) measurement error, both cancompromise test reliability •Overalltest as well as subtest reliability should be reported if only select subtestscan be administered•Test-retestreliability should be considered when test is used to monitor linguisticchanges over time •Indicatesthat performance changes resulting from practice or chance are likely when testis administered more than once

what is Validity?

Thedegree of theoretical and empirical support a test has

what is Content Validity?

provides information regarding how welltest measures skills or functions that it contends to measure. Aphasia test should evaluate these linguisticabilities that theoretical and applied research have found essential tosuccessful communication.

what is Constructvalidity?

•Degreeto where a test corresponds with other tests designed to measure same functionor construct.


•Readingcomprehension test for example would be deemed poor construct validity ifclients’ performances on that test did not correlate well with theirperformances on other reading comprehension test.

what isCriterion-relatedvalidity (aka. Predictive validity)?

•Reflectsaccuracy with which a test determines a client has a deficit.


•Shouldbe used to distinguish clients with aphasia from those with other types ofcommunication difficulties (e.g. dementia) or from those with intactcommunication abilities)

what is Ecological validity?

•Atype of criterion-related validity that indicates how well clients’ test scoresreflect behavior in typical environments during daily activities andinteractions.


•Todetermine ecological validity of confrontation naming test, test developersneed to demonstrate that their test’s scores correspond well with wordretrieval abilities during conversations or other types of daily communicationactivities.

what is sensitivity?

•Reflectsproportion of individuals with given deficit who are correctly identified bytest to have that deficit. Help withconfident exclusion of deficit diagnosis.

what is specificity?

Reflects proportion of individualswithout deficit who are correctly identified by test not to have deficit. Help with confident identification of deficitdiagnosis.

why are Discourse Sampling and Analysis necessary?

•1.Connected speech or discourse is examined either minimally or not at all bymost formal aphasia or language test. Structured tests tend to evaluate language processing at sound, word, orsentence level in decontextualized manner. Is a concern because only a weak relationship between these levels oflanguage processing and discourse skills have been identified.


•2.Most structured aphasia and language tests were developed to documentimpairments at Body Functions level of the ICF model. Analysis of discourse provides informationpertaining to Activity Participation level. Discourse analysis may also yield information regarding EnvironmentalFactors (i.e. positive or negative communication strategies used by partnerwithout aphesis).


•3.Certain language skills (e.g. turn-taking, topic management) can be assessedonly through discourse sampling and analysis.


•4.Can be sensitive and useful for quantifying more modest treatment-relatedimprovements that may be missed on aphasia and language tests.

what are possible elicitation methods for Disourse Sampling and Analysis?

•SLPshould ideally evaluate number of discourse genres when eliciting spoken andwritten discourse samples. Possibleelicitation methods includes description of picture or picture sequence,role-playing, storytelling or retelling, video narration, interviewing,conversation, and description of procedure.




•Onediscourse task often inadequate, recommended sample of at least 300-400 wordsin length to ensure acceptable test-rest stability of discourse analysismeasure

why are test of cognitive skills important?

•Shouldbe included because literature shows individuals with aphasia often haveconcomitant cognitive deficits, but also negatively affect language abilities,treatment outcomes, and caregivers’ level of burden. Can’t always be predicted based on aphasiaseverity.




•Necessarybecause research with stroke patient population has found that informalevaluation alone will miss significant number of cognitive symptoms.

cognitive evaluation minimally includes...?

•includesformal screening procedures because cognitive test results may provideimportant information regarding prognosis, length, and type of treatment.




•Shouldassess attention, memory, and executive function abilities because each ofthese cognitive domains may be compromised in individuals with aphasia.

although many cognitive tests are available for each cognitive domain, why are many inappropriate for individuals with aphasia?

•becauseof significant language demands of traditional cognitive tests.


•Therearen’t a lot of these for non-English speakers


•Failureto use culturally and linguistically appropriate cognitive tests and normativedata can negatively affect diagnostic accuracy.

what is the purpose of Informal Assessment?

•Purposeis to distill the most appropriate clinical goals from analysis of abilitiesand behaviors of individual with aphasia at any level of ICFmodel.


•Manyclinicians describe as process of seeking answers rather than process of steps

In ICF domain of Body Function, formalassessment process yields

•quantificationof abilities individual with aphasia has. In other ICF domains, formal tests not as prevalent because fewer formaltests are developed.


•Inclinical setting, assessment of these domains more likely to be informal innature


•InActivity Participation, more functional tests (e.g. Communicative Effectivenessindex, CETI, Lomas et al) used


•PersonalFactors domain, some assessment tools available to analysis attitudes towardcommunication


•InEnvironmental Factors, some conversational analysis checklists used

•Afluid exercise in critical thinking...?

•Mustdesign tasks and probes to answer these questions


•Miniexperiment in intervention


•Problemsolving process


•Ahypothesis testing approach should be taken in assessment process


•Mustexercise observation skills and search for clues in behaviors individual withaphasia has


•Theway person answers question, types of errors committed, and slightest hint ofspontaneous compensatory strategy must be noted and must trigger furtherhypothesis questions

•Questionsduring informal assessment


•Notnecessarily in this order because any info can be gleaned from observationduring any activity related to informal and formal testing procedures. Are in order of progressive difficulty

•A.What is the extent of the problem?


•B.Where does the behavior break down?


•C.What helps the behaviors?


•D.What is/are the underlying mechanisms for the behavior?

What is the extent of the problem in informal assessment?

•Notall affected abilities can be realistically measured with formal tests


•Measuringadditional behaviors informally should provide a better picture


•Behaviorsmeasured should yield clinically useful information in addition tobasic quantification


•Informalquantification of attention skills should help determine whether theycontribute to comprehension difficulties, measuring writing skills may helpdetermine potential use of writing as cue or compensatory mechanism, andmeasuring social connectivity provides indication of psychosocial consequencesof communication impairment


•Informalmeasurement of these behaviors require generating set of stimuli oradapting tasks from other sources, data gathered are typically quantitative

Table 5.4 Examples of skills oftenmeasured informally and their clinical use


Why is communicativebehavior break down important to know? How can it be obtained?

•Theprecise area where the person with aphasia is starting to show difficulty must be delineated so that treatment progress can come from building on remaining skills


•Mayfigure out where ability breaks down can be from both formal and informal assessment •Maycome from observation (data will be qualitative) or in more controlled method(stimuli may be clinician generated, data is quantitative)

What helps communicative behaviors?

•Affectedcommunicative behaviors should be observed and manipulated to identify facilitating strategies


•Sometimesindividual with aphasia relies on spontaneous adaptations that facilitatecommunication


•Cliniciansmust rely on clinical observation skills and note these behaviors for potentialuse in therapy


•Cliniciansoften exploit their experience and clinical acumen to generate hypothesistesting questions to assist individual with aphasia increase performance(similar to dynamic assessment, where clinician switches roles from observer toactive participant)


•Interactionis contextualized, clinician switches roles from observer to active participant


•Informalassessment becomes collaborative effect between clinician and person withaphasia to maximize communication and is “relationship centered”

what is quality-of-life measurement?

Are designed to evaluate feelings,experiences, attitudes, and beliefs that may be positively or negativelyinfluence on individual’s ability to participate and take pleasure andsatisfaction in life.

what are the problems with measuring QOL?

•Aredisease or disorder specific because are developed to focus on effects of thatdisease or disorder that are most likely influence QOL•Althoughmany developed for variety of disorders that cause aphasia, few appropriate formost individuals with aphasia because each individuals with aphasia can’tcomplete QOL measure because of its language or cognitive demands or QOLmeasure focuses more on physical or cognitive rather than communication issues •Onlyfew QOL measure developed for individuals with communication limitations suchas aphasia (See Table 5.5, pg 96)


•Maystill have difficulty because severe linguistic or cognitive impairmentsconfound comprehension of test items or awareness of symptoms (spouse, familymember, or other person will need to serve as proxy rater)


•Proxyrating is to be interpreted with caution because there may be mismatches


•Agreementwith proxy raters and person with aphasia more likely when ratings pertain todirectly observable communication modalities such as writing ability

what is Caregiverevaluation?

•essentialwhen attempting to determine impact of aphasia on Activity Participation domainand the Environmental Factors of the ICF model because they’re most familiarwith the premorbid communication style and ability of individual with aphasia

what is caregiver evaluation important?

•Importantwhen evaluating individuals with aphasia who have more severe comprehensionimpairments or decreased insight


•Theirviews of aphasia and impact on daily interactions and activities are valuablefor treatment planning


•Bothformal and informal methods available to gather information about family andcaregivers about their view of communicative and cognitive strengths andweaknesses of individual with aphasia


•Cliniciansneed to collect information about caregivers’ communication skills and overallwell being, can assist in identifying treatment goals and activities


•Caringfor individuals with aphasia and other acquired cognitive or communicativedisorders can negatively affect caregiver’s physical and emotional health


•Theircommunicative behaviors can affect communication difficulties in individualswith aphasia


•Cliniciancan use conversational sampling and analysis protocols to measure

define reinforcement

•qualitativejudgement of response provided by clinician, usually verbal for adults withneurogenic communicative disorders




•impactof reinforcement on linguistic performance is doubtful, may increase motivation•Cliniciansshould use verbal praise more than negative statements in therapy interactions,even if response is incorrect

define feedback

•specificinformation clinicians provide to individual with aphasia describing how or whyparticular response was or was not successful




•Followingerror should specify how to modify response to produce desired target (i.e.corrective feedback)


•Shouldnot be used at all in assessment (formal or informal), talk about results afterassessment

define testing

•processof providing quantitative and qualitative information about the abilities ofindividual with communication disorder




•Testingcan be performed before and after rehabilitation period to measure change overtime


•Pre-and post therapy testing are performed with formal tests and measure overallskill

define baselining

•refersto pre therapy measurement or probing of clinical objectives, more specificthan testing because it quantifies particular objective associated withspecific methods


•Ex.After assessing aphasia individual, clinician target spoken word retrieval intherapy among other things, then develop several specific objectives likepracticing naming as many cools or kitchen utensils as possible, must nowbaseline objectives individually prior to start of therapy

NO/DO NOTS for testing and baselining?

•Itemsin testing material must never be used in treatment tasks because it’s“teaching to the test”


•Stimulifrom baseline probes can’t be used in therapy unless clinical objective targetsclosed set of stimuli


•Baselineitems should not be practiced in therapy so generalization can be examined

If individuals with aphasia use more thanone language, essential to

•essentialto assess each of their language to understand relative types and severities ofdeficits across language


•dependingon structure of languages used, some deficits may be detectable only in onelanguage

2 issues in Bilingual individuals and use ofinterpreters

•selectingassessment tools and identifying best person to perform assessment




•Unlessthere is a formal test battery in target language, all assessment will beinformal


•Clinicianis either bilingual and bicultural, or assess indirectly withtranslator/interpreter•Bilingualassistance should be from outside family and social circles of person withaphasia •Developpartnership with local university programs, professional interpreter programsin community, interpreters with emphasis on health care for confidentialityissues, hospital volunteers (competence in language and assessment proceduresmay vary)


•SLPshould train interpreter on assessment techniques

what if you can’t find bilingual assistance?

member of individual’s larger communityof more immediate family may be used, extensive training period should precedeassessment