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Clinical Evaluation


Where should you collect speech samples for a suspected stutter? In the primary settings in the which the individual interacts (i.e. home, school, and work settings)
When should you collect speech samples for a suspected stutter? At the initial evaluation, during subsequent therapy, and during “practice-based evidence.”
What are some examples of normal disfluency? phrase repetitions, whole word repetitions, occasional fillers, and interjections.
What are some examples of stuttering? Sound prolongations, sound and syllable repetitions, and broken words
How do you calculate a frequency count for disfluencies? number of disfluencies/number of words
What do we mean when we say the assessment process should be therapeutic? -We should do trails w/ different therapys during the initial eval to see how the pt responds. -Eval should reveal both severity of stuttering & the pt initial response to treatment. -Serves as a prognostic indicator & gives direction for intervention
What is the Stutter Severity Instrument 4 (SSI-4)? -Ages 2-10 -Gives info for frequency, duration, naturalness of speech and any Physical Concomitants -Min of 2 Clinic Samples -2 secs on test for non-readers/under third grade -% SS -Scale Scores -Picture Plates -Computerized Scoring
Test of Childhood Stuttering (TOCS) -Testing time: 20-30 minutes -Consist of 4 Speech Fluency Tasks- Rapid Picture Naming, Modeled Sentences, Structured Conversations, Narration -
What's the first thing you do when administering the TOCS? Rapid picture naming
Overall Assessment of the Speaker’s Experience of Stuttering (OASES) -OASES – S Ages 7-12 -OASES – T Ages 13-17 -OASES – A Ages 18 Up Examines: General Information, Reaction to Stuttering, Communication in Daily Situations and Quality of Life
Communication Attitude Test (KiddyCAT) Stuttering test for kids
What are the 5 Carey Temperament Scales (CTS)? 1)Early Infancy Temperament Scale(.1-4 months) 2)Revised Infant Temperament Questionnaire (4-11months) 3)Toddler Temperament Scale(1-3 years) 4)Behavioral Style Questionnaire(3-7 years) 5)Middle Childhood Questionnaire(8-12 years)
What do the 5 Carey Temperament Scales (CTS) attempt to asses? -Activity levels -Biological rhythmicity -Approach/withdrawal to new people/events -Adaptability or flexibility -Intensity -Mood -Persistence -Distractibility -Sensory threshold
What are the 6 commercial tests that Martin mentioned? 1)SSI-4 (Stutter Severity Instrument 4) 2)SPI (Stuttering Prediction Instrument for preschoolers) 3)TOCS (Test of Childhood Stutter)- ‘09 4)CAT/KIDDY CAT (CAT for (Adults)/ KIDDY CAT for kids) 5)OASES 6)CAREY TEMPERAMENT SCALES
What is the IDEA -the federal law that not only provides funding to public schools for special services, but also describes the types of services available for a given handicapping condition. -Individuals with Disabilities Education Act
What does IDEA say about children with stuttering (CWS)? Will give SLP services if: 1) academic assistance for CWS, even if they are not failing 2) recreational activities for CWS 3) counseling services for CWS
Clients should leave the fluency evaluation with what feelings? -Clients should leave the evaluation with a positive attitude and outlook. -They should have feelings of accomplishment, hope and trust (which is another reason why the evaluation should be therapeutic)
What are avoidance behaviors? “Tricks” that individuals who stutter use during speech as they anticipate the moment of stuttering.
What are some examples of avoidance behaviors observed during stuttering? 1) postponement 2) circumlocution 3) feigning an accent 4) altering the manner of their speech
What are some professionals who can refer a pt with suspected voice disorders -Otolaryngologist -Oncologist -Pulmonologist -Primary Care Physician -Physician assistant
What are some of the medications that can have an adverse effect on an individual’s voice quality -Inhaled steroids and antidepressants have been shown to affect voice quality. -Muscle relaxants and proton pump inhibitors do not adversely affect voice quality.
What should a thorough voice evaluation include? 1) an oral mechanism exam 2) an acoustic analysis of the patient’s voice 3) direct laryngoscopy (providing visualization of the focal folds) 4) pulmonary function measures 5) a subjective rating of the patient’s voice
What sorts of evaluations, while important for assessing other types of communication disorders, are part of the VOICE assessment? -the patient’s vital signs -clinical bedside evaluation of swallowing
What type of measures should be collected during the voice evaluation? 1) the patient’s mean fundamental frequency during conversation 2) the patient’s vocal frequency range 3) the patient’s maximum phonation time 4)Scream singing like rock star
What are some examples of vocal abuse? 1) throat clearing 2) cheering at athletic events 3) coaching sports or teaching aerobics classes 4) calling pets from the back yard
What does not constitute vocal abuse? Normal singing
What is the maximum phonation time you expect from an adult? Most adults can maintain phonation for 20 seconds
What is the average frequency range for an adult? Adults typically have a frequency range of 3 octaves
What is the CAPE-V and what does it measure? -Provides guidelines for a perceptual voice assessment. -Gives the degree of impairment for roughness, vocal strain, pitch, and loudness. -The patient’s voice is also rated for the degree of deviance and consistency.
What is a functional voice disorder? Occurs when there is nothing structurally wrong with the voice. The cause is usually abuse or misuse.
What is an example of a functional voice disorder? Muscular tension dysphonia
Of what use is videostroboscopy fo an SLP? 1)It assists the SLP in assessing voice disorders 2)Used during therapy to provide education & biofeedback to the patient 3)The SLP can store the video file for future reference (e.g. documenting change in laryngeal functioning & monitoring progress)
What does Videosrtoboscopy not do? -Does not help diagnosis cancerous lesions
What is FEES? -Endoscop is inserted through the nose into the hypopharynx to permit direct observation of the pharyngeal and laryngeal structures during swallowing. -Fiberoptic Endoscopic Evaluation of Swallowing
What does the FEES asses? 1:assess anatomy and physiology of structures in view 2:assess swallowing of food and liquid 3:assess response to therapeutic interventions
Pros of the FEES? -Allows for visualization of secretions -More portable -No radiation exposure; allows for longer time to attempt compensatory strategies and assess for effects of fatigue -Positioning difficulty; severity of illness/ transporting difficulty -Visualiza
Cons of the FEES? Difficult insertion of scope in some patients – facial trauma, etc. Is considered to be more invasive than MBSS White out during moment of swallow Focus is limited to pharyngeal phase
Penetration-Aspiration Scale (PAS) Can use PAS to quantify the penetration and aspiration that’s occurring and where it is occurring. Reported in the narrative section of assessment.
What is MBSS? -Swallow function is assessed radiographically as the patient swallows barium coated substances. -Exam is completed under fluoroscopy with Radiologist present -recorded -Modified Barium Swallow Study
What does the MBSS tell the SLP? -Helps SLP tell why the difficulty is occurring, not just visualize aspiration, penetration, or residuals -Helps SLP have pt attempt compensatory & facilitatory techniques -Helps SLP determine safest diet & deficits 4 swallowing therapy -Pt educat tool
What indicates a person should have a MBSS? -Unknown medical etiology: vague symptoms -Visualize oral phase -Visualize regurgitation/backflow (GERD/LPR) and site of origin -CP/UES stricture
What is Apraxia of speech and what is it characterized by? A motor planning disorder (i.e., it is not the result of motor weakness or paralysis) characterized by difficulty in sequencing of sounds in appropriate order for syllables and words, where misarticulations occur on vowels as well as consonants.
Oral apraxia Motor planning impairment; evident in nonspeech volitional movements; characteristic “groping” movements
Limb apraxia Impaired volitional movements of arms and legs
What is Dysarthria? Neuromuscular problem (i.e., it is a neurologic impairment that affects muscle function which, in turn, impairs articulation).
Causes of Dysarthria -May result from many neurological conditions, including CVA, brain injury, Parkinsons disease, ALS, MS, Huntington’s diease, etc.. -Is the result of impairment in muscle function – weakness, slowness and incoordination
Characteristics of Dysarthria -May affect respiration, phonation, resonance, articulation, and prosody -slurred speech that sounds like the person has been drinking.
What are some of the things an SLP should consider when reviewing a patients medical chart? 1) What was the admitting diagnosis? 2) What was the date of onset? 3) Patient’s past medical history (including surgeries)? 4) What was the patient’s profession? 5) Note hobbies/activities the pt has. Gives things to talk about during therapy
What type of approaches can you use to help a laryngectomee pt communicate? 1)A picture communication board 2)Pen and paper, a dry erase board, or Boogie Board writing tablet 3)An electrolarynx
When should you teach esophageal speech? ONLY when the patient is healed from surgery
You are performing a bedside swallow exam. What are some signs of aspiration? Coughing, choking, throat clearing, increased respiratory rate, and a change in the patient’s vocal quality could all be signs of aspiration.
A patient with a neurodegenerative disorder has been referred to you. Your evaluation should assess what functions? Voice, swallowing, and cognition.
What is a Passy-Muir Valve (PMV) and when is it used? -Used with tracheostomy tubes. The tube is open during inhalation but closed during exhalation, allowing the air to pas through the vocal folds so the patient can speak. -PMV evaluation may occur as early as 24 after tracheotomy (procedure)
When should you NOT use a PMV? Would not be used with a laryngectomee, since the larynx has been removed and there are no vocal folds for the air to vibrate
Criterion-related validity refers Criterion-related validity refers to the degree to which results from one test correspond with results from a different test that measures the same skill.
What is the World Health Organization’s International Classification of Functioning (WHO-ICF)? The CHO-ICF describes disorders in terms of the resulting limitations placed upon the individual. It includes, among other things, limitations in: 1) body functions 2) activities 3) participation 4) contextual factors
What is the WHO-ICF term for disability? Activity limitations
What is the WHO-ICF term for impairment? Body Function limitations
What is the WHO-ICF term for handicap? Participation limitations
Why do we perform situational observation? Adults with language disorders may do better/worse in everyday activities than would be predicted from the results of formal testing. Testing alone might under/over estimate how patients function in their everyday lives.This gives a better understanding.
What do we know about the typical recovery pattern from a stroke? The initial recovery is relatively rapid, after which the recovery tends to slow down.
What are some of the things you should consider when selecting a test to administer to an adult? Look at: -The validity data found in the Examiner’s Manual. -Which domain the test assesses (re: WHO-ICF) -Consider if the manner in which the test is administered and scored is appropriate for a particular pt.
What is NOT relevant when deciding what test to give your pt? Who publishes the test
According to the WHO-ICF, the inability to contribute to household earnings and decision-making would fall under what domain? Participation
What limitations fall under the WHO-ICF guidelines for body functions? Sensory, muscle, skin, sensation of pain, sleep
What limitations fall under the WHO-ICF guidelines for activities? Self help skills, hand & arm use, fine hand control
What limitations fall under the WHO-ICF guidelines for participation? work and employment
What limitations fall under the WHO-ICF guidelines for participation? social skills, ability to fulfill family, educational, or vocational roles
What methods might you use to calm an agitated patient with TBI? -Attempt to draw the patient’s attention away from the cause. -Turn down the lights -Turn off the TV/radio -Find a quiet area. -Let the person keep talking/moving. -Avoid quick movements -Don't scold/confront the person -Familiar faces are calming.
Recovery pattern for Traumatic Brain Injury? -Pattern of stepwise improvement: periods of little or no change interspersed with periods of sometimes rapid improvement -Acute impairment not a strong predictor of chronic impairment; more difficult to predict permanent deficits compared to stroke
When trying to assess limitations in body function and structure, you should select an instrument that measures what? -The type and severity of body function limitations. Level of independence, extent of functional communication, and quality of life measures, while seemingly important, are not relevant to this particular WHO-ICF domain
Why would you not use norm-referenced tests to assess the progress of a patient? -Intended solely to compare pt performance to his/her peers; not to determine what that pt knows or skills they possess. -Tells normal from disordered so the tasks don't reflect normal, interactive discourse. -Not intended for repeated administration.
What kinds of assessments provide discrete measures? -Formal or informal tests such as engaging in a conversation &, from that sample, calculate the % of non-stuttered syllables, the number of correct words per minute, mean number of morphemes -Discrete measures, however, must be quantifiable.
When does the assessment of a patient’s PROGRESS begin? Begins the minute you write the Subjective, Objective, Assessment Plan/Progress (SOAP note), in which you establish the baseline behavior. It is from that point where changes in behavior are noted and progress measured.
The Office of Special Education Programs (OSEP) of the U.S. Dept. Education mandates what outcome measure to be used for preschool children receiving special services? The Child Outcomes Summary Form (COSF) is designed to assist service providers & family in evaluating and reporting the child’s progress toward national child outcomes. -To be completed immediately after determining eligibility & before the IFSP
When are functional outcome measures documented? 1) at the beginning of treatment 2) periodically (often at prescribed intervals) during treatment 3) immediately following discontinuation of treatment
What goes into the different sections of the SOAP note? S = your impressions of the pt’s mood, motivation, participation, and awareness O = your objective data collected (targets met and unmet; skills not assessed and why) A= interpretation of the data P= Plan of action for the next session
A functional goal should include what information? Should be SMART S= Specific (what precisely should the patient be able to do &under what conditions) M= Mesaureable A= Attainable R= Relevant (How will this help the patient; not how will it improve a test score?) T= Time Bound (when?)
What are the primary reasons for the congressional effort to reform health care? 1)The belief that “fees for services” encourages more spending (i.e. more procedures more bills) 2)An increase in the use of services is disproportional to the number being served 3)There is a perception that fraud and abuse is frequent
What was the purpose for the Patient Protection and Accountable Care Act (PPACA) of 2010? Enacted to create bundling of services/payments and promote quality standards of care to combat sky rocketing cost of the fee for service. It also mandated patient outcomes reporting on Medicare Part B claims forms.
The field of speech-language pathology will soon begin to see more use of SLP Assistance (much like PT, OT, nursing, and physicians). What is the benefit of this? It is intended to maximize the amount of time a licensed SLP can spend providing skilled services.
Created by: aramos139



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