Aphasia Test 3
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126 terms
Terms | Definitions |
|---|---|
 cognition and aphasia | could have aphasia and cognition problems, but cognitive problems not a part of aphasia |
| relationship between degree of aphasia and cognitive problems | no relationship. |
| what is teh challenge in examining cognitive skills? | most tests require language |
| Four cognitive domains | 1. attention 2. memory 3. executive functions 4. visuospatial skills |
| relationship between cognitive skills | overlap, but some skills will clearly tax a particular cognitive task over others |
| components of executive function | inhibition, planning, goal selection, initiation, problem-solving, flexibility, self-evaluation |
| what does trailmaking test tax? | attention/executive function |
| what does Rey complex figure test? | attn, memory, executive function |
| if only time for one cognition test... | draw clock, put numbers, set for 10 minutes to 11. tests attn, executive funciton, visual neglect |
| regarding order | make sure have one for evaluation AND treatment |
| 5 important things regading assessment | 1. have order 2. review file for etiology, past med history, family, work status 3. formal eval? 4. supplemental tests? 5. arrange to cotreat or observe |
| way to describe if don't knwo exactly | "most consistent with" |
| assessment concerns for broca's | comprehensive verbal skills and further examination of AC, bc mild deficits may be overlooked |
| five areas of verbal to look at for broca's | 1. syntactic constructions 2. grammatical constructions 3. compensatory strategies 4. ability to initiate and maintain conversation 5. discourse ability |
| concern for wernicke's assessment | may benefit from more pragmatic approach that looks at all language modalities in real-life situations (invite clients to use all skills they have); thorough testing of AC. However, sicne third-party payers often demand functional progress, standardized tests have been developed |
| 4 standardized tests to measure function | 1. Assessment of Language Related Functional Abilities 2. CADL-2 3. ASHA-FACS 4. Communicative Effectiveness Index |
| Formal tests for Wernicke's AC | 1. Token Test or Revised Token Test, BUT need to look at comprehension of natural langauge SO 2. FUnctional Auditory Comprehnsion Test 3. Discourse Comprehension Test |
| assessment concerns for conduction | 1. AC relatively good, so delve further 2. repetition -- multisyllabic words, sentences, real words v. nonwords to see phonologic deficits 3. word finding- mostly see phonemic paraphasias, but also semantic |
| tests for word finding | 1. BNT, spontaneous pseech sample (paraphasias, empty words, circumlocution, pauses) |
| assessment for transcortical | difference between spontaneous and rep? they will not be perfect on reps, but we are looking for a discrepancy |
| assessment for global | do they have any strengths at all? --- formal assessemnt may not be possible. We need to knwo abilitiy to 1. follow simple commands, 2. use a simple communication board, 3. use and comprehend gestures, 4. answer YN Qs for ADLs, 5. read, write draw |
| who are comprehensive tests for? | moderately impaired clients; subtle deficits need supplemental tests, and severe aphasia requires BASA or informal assessment |
| 3 comprehensive tests | BDAE, MTDDA, WAB |
| 3 reasons for standardized for global | 1. determien competency for legal purposes 2. compensation 3. payers like to see #s |
| why evaluate gestures? | tos ee if can use as comm mode, can help ID apraxia |
| why evaluate automatic speech/singing | allows us to access right hemisphere |
| lapointe 5 purposes of evaluation | 1. aid differential diagnosis 2. aid treatment planning 3. establish prognosis 4. monitor change 5. evaluate maintenance of treatment gains |
| 4 ways to assess anomia | 1. confrontation 2. generative naming 3. free recall 4. pictured scene description |
| how determien fluency | use three conditions that vary in emotional content, taxing memory and vocab, obtain three best utterances from each and average |
| 4 areas of testing for AC | 1. single words (various categories) 2. following commands 3. YN 4. lengthier material |
| types of repetition to assess | words, phrases, sentences AND high/low frequency AND phonemic complexity |
| who talk to for case history | family, other therapists, nurses, physicians, dietician |
| areas we want to know about case history | 1. family/living 2. responsibilities at home 3. work status 4. etiology/site 5. past medical history 6. medications 7. educational 8. current physical environment 9. languages 10. hemiparesis or paralysis 11. visual impairment 11. hearing |
| what 2 things does eval depend on? | setting and pt ability to oparticipate |
| what you want to cover in eval | 1. Ac and where break down 2. verbal expression, where break down, examples 3. reading comp 4. writing 5. reps 6. nice to know if sth helped |
| assessment may include any and all | 1. standardized 4 areas and more 2. informal 3. observations 4. probes 5. supplemental 6. functional |
| why use bedside? | determine if aphasia exists/strenthgs/wekaness |
| end line of report | Client presents with moderate Broca's aphasia, as evidenced by X. or Unable to differentially diagnose. Client appears most consistent with X. |
| when do formal assessement | when past natural recovery |
| 5 comprehensive tests | 1. Boston diagnostic Aphasia Evaluation 2. Western Aphasia Battery 3. Minnesota Test for Differential Diagnosis of Aphasia 4. Boston Assessmento f Severe Aphasia 5. Porch Index of Communicative Abilities |
| 8 exampleso f supplmental standardized | 1. CADL 2. ASHA functional Assessment of Communicative Skills for Adults 3. Northwestern University Sentence Comprehension Test and Verb Production Battery 4. Token Tests 5. Auditory comrehenson test for Sentences ACTS 6. Discourse Comprehension Test DCT 7. Functional Auditory Comprehension Test FACT 8. Reading Comprehension Battery for Adults RCBA |
| to transition to AC during ifnormal | let's takea break from talking now,a nd just listen |
| parts of informal | 1. introduction 2. conversation 3. AC 4. naming 5. rep 6. reading and writing if time 7. apraxia 8. singing |
| to transiton to reps | OK, great, now just listen to me and say exactly what I say. |
| responsive naming | what do you use to sweep? |
| three ways to assess naming | confrontation, responsive, generative |
| when assess reading? | if ac was poor |
| when assess writing? | if verbal expression was poor |
| deblocking, or asset approach | use intact skills and abilities to restore unavailable skills. for example, use intact reading ability to deblock AC and naming. write key words down adn allow pt to read them. pair pictures with their written worda dn eventually remove written cue. |
| response elaboration training | for nonfluent. 1. offer stimulus to get open-ended 2. acknowledge corretness 3. model longer 4. they imitate |
| ultimate goal of ret | improve patient's ability to elaborate on conversational topics |
| schuell said | if we improve AC, improve overall communication |
| schuell's stimulation approach | intensive auditory stimulation, to creat new pathways to stimulate old learning. |
| Pace stands for | Promoting Aphasics Communication Abilities |
| feedback is simply the success of communicating | PACE |
| PACE | encouraged to use any expressive modality. natural convo that goes back and forth with cards. |
| goal in medical model | cure problem |
| goal in social model | promote positive change; bridge gap btwn language barriers and real-life needs; may target compensation |
| most likely to observe anomia... | during ocnversation |
| which two systems scientists agree we need to name | semantic and phonological |
| 4 ways to activate semantic system | 1. phonologic input. say it. 2. object recognition 3. read it 4. it;s used to make a sandwich |
| which 2 aphasias may have semanti csystem probs? | TSA and global. bc posterior. anteror has syntactic probs, not semantic or phono. |
| if patient recognizes object, what level of cue? | phonemic |
| another way to activate phonological system, besides phonemic cue | go-withs |
| cueing hierarchy | 1. tell me somethign aobut it. 2. semantic cue 3. gesture 4. go-with 5. phonemic |
| 5 goals of treatment | 1. neuroanatomical change (restorative) 2. compensatory 3. education and counseling 4. self-confidence adn attitude 5. supportive communicaiton environment |
| another name for restorative approach | stimulation-facilitation therapy |
| how do you tell what can adn can't do | standardized |
| how do you tell what does do | observation |
| bridge gap bgtwn what | can, can't, does AND want, need (impairment and functional communication) |
| 5 different approaches | 1. restorative 2.c ompensaotry 3. social model 4. funcitonal 5. published treatment procedures |
| what affects tx outcome? | 1. neurological variables -- progressive? TBI or RHD? hemorrhagic or thromboembolic? 2. cognition -- attention, mem, exec function, visuospatial skills 3. metacognitive skills 4. langauge profile -- severity, strenths/weaknesses 5. age 6. premorbid skills 7. occupation 8. past med history 9. extent and location - smaller, fewer better 10.medical status 11. hearing/vision/motor 12. timing of treatment 13. length 14. intensity of treatment 15. family involvement |
| five components of metacognitive | 1. selfl-awareness 2. motivation 3. self monitoring 4. self initiation 5. goal oriented behvaior |
| how soon initiate tx? | at least 6 months |
| how often tx? | at least 3 h week/5 months |
| when spontaneous? | 6-8 weeks |
| any recovery after how logn is due to treatment? | 6 months |
| 3 explanations for neuroanatomical change | 1. spontaneous 2. rebuilding connections (axonal resprouting) 3. other parts of brain take over, either due to redundancy or reorganization |
| what subtests are included in the bdae? | 1. conversational and expository speech 2. AC 3. oral expression 4. reading 5. writing 6. apraxia assessment |
| different versions of bdae | 1. short form 2. standard form 3. extended testing standard encompasses short form. |
| how do you select which subtests to administer from the conversational and expository speech section? | simple social responses, free conversationa nd picture description are ALL essential |
| which subtests contribute to severity rating? | simple social responses, free conversation and picture description |
| which subtests on bdae for discourse analysis? | picture description and free conversation |
| voluntary control of involuntary utterances best for... | severely nonfluent aphasic NOT Wernicke's, who can match words correctly to pictured objects and actions. unilateral, left-hemisphere stroke, often subcortical. |
| best candidate for using more intact modality of reading comp to stimulate oral reading, then repetition, then AC | Wernicke's who are moderately to severely impaired with single-word processing. overall AC score less than or equal to 40th percentile on bdae. single word discrimination less than or equal to 45th percentile. repetition on bdae less than or equal to 30th percentile. Relatively good ability to comprehend written stimuli at single word level, greater than or equal to 50th percentile. |
| overall AC score for twa | less than or equal to 40th |
| single word discrimination for twa | less than or equal to 45th |
| repetition score for twa | less than or equal to 30th |
| new name for HElpps | SPPA -- sentenece production program for aphasia |
| best candidate for melodic intonation therapy | fairly severe broca's but better than vciu. moderately preserved AC -- greater than 45th percentile. Poorly articulated speech. |
| best candidate for visual action therapy vat | client who is already using gestures...global or severe apraxia |
| best candidate for treatment of aphasic perseveration (tap) | clients who perseverate, but have mdoerately preserved AC and good memory |
| best candidate for anagram copy and recall therapy | severely impaired writing, fairly good VE OR limited VE but has retained some writing. good graphomotor skills. good single word reading comp. relatively spared memory. semantic skills. |
| treatment for Broca's | PACE, CVT adn HELPSS (sppa), MIT, RET |
| treatment for Wernicke's | deal with AC and poor self-monitoring, press of speech first -- TWA, Schuell's , conversational therapy liek PACE, comprehensive variety of strategies |
| treatment for conduction | NOT AC work, NOT MIT, NOT syntax |
| tma treatment | capitalize on spared naming to expand sentence structure |
| treatment for global | VAT, PACE |
| 3 ways to work on single word AC | body parts, action pictures, object/picture identification |
| 3 ways to work on sentence AC | yes/no (simple to complex, A only or with pic), commands, choose picture being described from field |
| 3 ways to work on discourse AC | reading them simple to complex paragraphs, conversation, narratives followed by quesitoning for main idea, details and implied details |
| 3 ways to work on funcitonal AC | conversation providing natural cues, directions presentaed naturally, using stimuli from his life |
| name a therapy that uses asset approach | MIT |
| how decide where to start based on bdae results | 1. look where some skills NOT 0-20th percentile 2. Look where make biggest impact on communication |
| why allow communication failure? | 1. in order for them to trust you 2. allows them to modify their communication |
| why is it important to create tasks where client can respond correctly? | 1. build confidence 2. not reinforce negative practice |
| ways to make task easier | 1. just make easier. 2. reduce # items 3. pay attention to semantics |
| ways to cue if they're not gettin git | 1. give simpler explanation 2. use gestures 3. pre-cue them |
| who is more likely to have cognitive deficits? | client with aphasia in R hemisphere |
| explain difference in progress btwn thromboembolic and hemorrhagic | ischemic more progress at beginning, but plateau. hemorrhagic slow to start progress but better overall. |
| what type of lesion will make wernicke's mroe persistent? | if it extends into parietal |
| what to do when talking to famiy | 1. strengths that contribute to good prognosis 2. strengths related to what he can do language-wise. 3. explain type of aphasia and explain related terms like paraphasia |
| better way to say poor prognosis | guarded |
| whether anomia is semantic or phonemic, difference in way of addressing? | yes. if phonemic, road map is missing, but still has semantic info. if semantic, storage place is bombed. |
| what type of anomia: knowing how to activate meanings and interconnections won't help because knowledge is not there | semantic level |
| before using the TAP you must administer what? | the 7 naming categories form the bdae |
| never use MIT for these people | good repeaters |
| neuroanatomical change -- 2 types | 1. redundancy 2. substitution/reorganization |
| pace | new information, both communicators, any type of comm, feedback based on whether they adequately conveyed message |
| 4 major categories that affect prognosis | 1. neurological variables 2. cognition 3. metacognitive skills 4. language profile |
| what helps for verbal expression | high frequency words, manipulable objects better than those that can't be held, objects better than pictures, realistic drawings better than line, give extra time for response, sentence completion, running cues, functional description, alphabet board |
| what types of cues to use first | weaker, to determine where to start |
| running cues? | It's a..... |
| semantic feature analysis | teach client to provide descriptions including physical features and function |
| three types of semantic treatment | word associations, semantic feature analysis, gestures |
| four types of phonological treatments for naming | word repetition, oral word reading, phonologic training, semantic category rhyme therapy |
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