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CSD 332 - Unit 4
| Question | Answer |
|---|---|
| Selecting Target Behaviors | -select a few behaviors -teach more complex targets after they have mastered the simple ones |
| Sequencing the treatment | -You must design a logical sequence of treatment |
| Two main approaches to selecting target behaviors | Normative Approach Client Specific approach |
| Normative Approach | select targeted behaviors that are appropriate for the client according to the norm for their age (example: refer to slide 5) |
| Client Specific Approach | focus on targets that make an immediate and significant difference in client’s communication regardless of the norms |
| Three guidelines for selecting target behaviors | Select behaviors that will make an immediate and socially significant difference Select behaviors that will be produced and reinforced at home and other natural settings Select behaviors that help expand communication skills. |
| Setting goals with the patient and family/caregiver | Allows discussion for setting realistic goals given the patient’s neurological, cognitive, and language profile. Establish functional therapy goals, clinicians must consider patients wants, needs and what the patient can do |
| Communication Questionnaire: | •To be filled out by members of the family, caregivers, and/or the patient. • What does a typical day look like for them, and does anyone help them with these tasks? •Can help lead a discussion for setting realistic goals. |
| Patient Centered Goals | Goals defined by the client in partnership with the clinician and family Optimize the individual’s potential to participate in meaningful activities Demonstrates to payers’ (insurance) the value of skilled services |
| Considerations Prior to Creating Goals | What is the gap between the patient’s current baseline and the individual's prior level of function What intensity of services are needed to return the patient to their prior level of function (how often and for how long?) Longevity? |
| Considerations with Children | Determine their present level of function Compare their present level to what is typical of age and developmental peers (use this instead of prior level of function) |
| Long Term Goals | Should reflect the highest level of desired function anticipated upon discharge. |
| Short-term goals | The steppingstones, targeted specific areas that are used to increase overall function to achieve the LTG Typically have multiple short-term goals for each long-term goal |
| LTG | • Will understand spoken language in simple 1:1 conversation by responding appropriately when no cues are provided. Ex: the client will be able to consume at least five spoons of soft solids of one texture from a variety of caregivers within 3 months. |
| STG | •follow one-step commands with 90% accuracy to enhance the patient’s • 90% acccuracy with questions A.The client will produce automatic speech (greetings) 90% of the time while interacting with new communication partners to increase the ability to co |
| Specific | •A specific goal has a much greater chance of being accomplished than a general goal. Anwer 6 W's |
| Measurable | •There MUST be tangible criteria for measuring progress toward the attainment of each goal you set. how Much? How Many? When will it be accomplished? |
| Achievable/Attainable | •Sometimes called Actionable or Achievable •Set goals that can be realistically achieved. |
| Realistic | A realistic goal is one that is attainable but also one the patient and family agree they are willing to work toward. |
| Timely | A goal should be grounded within a time frame. Frequency: The number of times in a week that the treatment is provided. Duration: The number of weeks, or number of treatment sessions for the plan of care. |
| Why do we need SMART Goals? | •Accountability •To assess improvement and track progress •Reimbursement (use language that makes it clear that your patient needs a skilled speech-language pathologist). •Allow others to replicate the treatment •To motivate the patient |
| Writing better goals | •Goals should be written in functional terms. •A functional goal tells why you are working on the goal. •It should be written in terms that a non-SLP can understand. |
| Making Goals Functional | check goal writing (slide 22) |
| Writing Better Short-Term Goals | •Not a functional goal: Patient will improve word finding •Functional goal: Patient will improve word finding with the use of compensatory strategies 90% of the time to effectively communicate with others during conversation. |
| Include Cueing | •Include what skilled cueing (help) the patient will need. •Include how much, what type, and how frequently you will cue them to help them be successful with the goal. |
| Cueing | •Cueing can be measured in… •Frequency: rare, occasional, frequent •Type: visual, verbal, tactile |
| How much can cueing be measured | maximal=75% of the time or more • moderate=25-75% of the time • minimal=25% of the time or less |
| Type of Cueing | verbal, visual, written, tactile, phonemic, articulatory placement |
| Verbal Cues | include verbal instruction on how to produce the response |
| Visual Cues | include hand gestures (pointing to remind your patient to increase their volume, tapping on a calendar to remind them to use aids to recall the date). |
| Written Cues | include written instructions on how to complete a task |
| Tactile Cues | When you provide a touch in a way that helps the patient |
| Phonemic Cues | when you provide a specific sound (during aphasia or motor speech therapy) |
| articulatory placement cues | specific positioning cues |
| Articulation LTG (speech sound disorders) | increase intelligibility, the client will produce age-appropriate consonant sounds with 80% accuracy at the sentence level during structured activities with fading support. |
| Articulation STG (speech sound disorders): | STG: The client will produce /l/ in all positions of words at the phrase and sentence level with 90% accuracy during structured activities across 3 sessions. |
| Fluency Example (LTG) | The client will participate in activities to promote fluent speech and reduce dysfluencies. |
| Fluency Example (STG) | The client will use fluency enhancing techniques (stretchy speech, slow speech) in words and sentences with 90% accuracy when given a model. |
| Voice Example (LTG) | The client will demonstrate overall improvement of vocal quality through decreasing excessive laryngeal tension and allowing the vocal muscles to function effectively. |
| Voice Example (STG) | The client will use diaphragmatic breathing during hierarchical speech tasks (word, phrase, sentence, conversation) 90% of the time to improve the efficiency of vocal effort. |
| Language Example (LTG) | The client will improve expressive language skills through play-based activities to increase effective communication of wants/needs/ ideas across environments with multiple communication partners. |
| Language Example (STG) | The client will imitate newly introduced two-word utterances (i.e. action+object) to request items and show needs 15 times per session, given verbal models and/or visual stimuli as needed. |
| Cognition Goal (LTG) | The client will independently use external aids and compensatory strategies for attention and memory to decrease cognitive burden during functional activities of daily living. |
| Cognition Goal (STG) | The client will recall novel information following a 5-minute delay with 80% accuracy using compensatory strategies as needed. |
| Swallow Goal (LTG) | The client will utilize compensatory strategies with optimum safety and efficiency of swallow function during oral intake without overt signs/symptoms of aspiration for the highest appropriate diet level. |
| Swallow Goal (STG) | The client will perform a chin tuck maneuver 90% of the time while drinking nectar consistency liquids to improve airway protection and reduce the risk of aspiration with minimal cues from the clinician. |
| Treatment | The re-arrangement of relations between speakers and their environment includes teaching, training, and any type of remedial or rehabilitated work and all the attempts at helping people by changing their behavior and teaching new skills. |
| Treatment | Treatment techniques are typically disorder specific We need to determine the type of disorder first, so we know how to treat the problem |
| Commonality v Uniqueness | Commonality: basic principles of treatment are common - Uniqueness: specific treatment procedures may be unique to the disorder, client or both |
| Treatment Principals vs. Treatment Procedures | - Treatment Principals: Empirical Rules from which treatment procedures are derived - Treatment Procedures: Technical operations that the clinician performs to effect changes in the client's behavior |
| Three distinctions between treatment principals and procedures | 1. Broad vs. Specific 2. Fewer vs. Many 3. Abstract vs. Concrete |
| Treatment Paradigm | - defined as an overall philosophy of treatment |
| Contingency | describes the relationship between 2 events; these events influence one another Ex: one thing influences the other |
| Two types of Contingencies | Genetic or Neurophysiologic Contingency |
| Environmental Contingency | can be manipulated more successfully they have a delay in their language or speech |
| Three Reasons to Collect Data | 1. To assess a client's behavior 2. To motivate our clients 3. For accountability |
| Three Interrelated Variables of Environmental Contingencies | • Antecedent Events (Stimuli) • Response • Consequences: based on how they respond -All treatment = objective, measurable, replicable, and empirical: you want to make sure you are able to be taking some data to show that they made some improvement |
| Five units of measurement | 1. Simple Enumeration: counting the number of times a specific behavior occurs 2. Number of Correct Examples: they got 8/10 correct 3. Percentage of Correct Responses: 2 and 3 go often together and it would turn into a percentage 80% |
| Five units of measurement | 4. Learning Curves: plotting the number of correct responses over a period of time 5. Latency of Response: measuring the time between when the clinician presents the stimuli and the client responds |
| Objective vs. Descriptive Rating Scales | Objective Rating Scales Descriptive Rating Scales: subjective rating scales using terms like mild, moderate, severe |
| Empirical Validity vs. Logical Validity | Empirical Validity: Procedures have been experimentally demonstrated to be effective • Logical Validity: There is no experimental research to back it up |
| Treatment Targets vs. Treatment Procedures | Treatment Targets: The treatment target is what the client is expected to do Treatment Procedures: The treatment procedures are the behaviors that the clinician does to teach the target |
| Treatment Programs and Variables | Treatment Programs: A treatment program describes all of the clinician and client behaviors Treatment Variable: The technical operations performed by the clinician to induce, reduce, or eliminate certain client behaviors |
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