Chapter 4: Principle of Communication Assessment

Infants, toddlers, and preschoolers

*Otoacoustic emmissions* (OAE) & *auditory brainstem responses* (ABR) are automatic physiological responses • conditioning procedures such as *visual reinforcement audiometry* (VRA) and *play audiometry* used too

Adults

*aphasia* is a loss of language that may result from a stroe, degenerative disease, tumor, or TBI among others •areas include: •*naming*- common characteristic is *anomia* (word-finding problem). includes: confrontation naming, category naming, and automatic closure naming (finishing open-ended questions). Aphasia produces paraphasic errors, unintended words or sound substitution, and produce pseudowords (nonwords) •*fluency*- degree of fluency is determined by # of words produced in connected, grammatical utterances. and if they are ordered grammatically. *Fluent speech* defined as 8 or more *nonfluent* determined as less than 5. •*repetition*- assessed by presenting words that range from single syllable to multisyllabic and from phonemically simple to complex. •*comprehension*- tested at single-word level, sentence level, complex commands, and paragraph level •*cognitive screening*- done by psychologist, or SLP screens orient by asking "what is ur name? Where are u?, what year is it?" Attention can be done by asking to spell word backward. Sequencing, organization, and planning assessed by describing a 5 step activity

*Fluency*

*stuttering* has been described as a fluency dis. involving: •affective component- is the emotional aspect •behavioral component-type and frequency of specific dysfluent element •Cognitive component- what the client thinks about his/her actual dysfluencies • Dysfluencies generally counted in 3 speaking contexts : no structure, nor pressure; structure, no pressure; structure, pressure •% of dysfluent syllables determined by counting the # of time a core b. of stuttering occurs during 3 100-syllable samples •core behaviors include: "blocks" such as tense pause b4 the word book, "part-word repetitions" such as ta-ta-table, and prolongations such as mmmooon •also observe the frequency and type of secondary b.

Adults

Aquired *apraxia of speech* and/or *dysarthria of speech* referred to as motor speech disorders •*Apraxia* defined as impaired capacity to plan or program sensorimotor commands for directing movements that result in phonetically and prosodically normal speech •*Dysarthria* group of neurologic speech disorders resulting in abnormalities in strenght, speed, range, steadiness, tone, or accuracy of movements required for the control of the respiratory, phonatory, resonatory, articulatory, and prosodic aspects of speech •asses. involves perceptual, and instrumental methods and speech intelligibility

*Areas of Assessment* *Language*

includes: semantics, phonology, syntax, morphology, pragmatics. •assess receptive and expressive for each domain •receptive lang may be somewhat challenging, so typically involve pointing to objs. or pics. •lang. production involves eliciting speech samples in all domains, includes a varietey of discourse types •ALSO assess reading readiness and other literacy related skills for older students

Case History Interviews

information gathered used to focus the assessment on presenting problems, investigate contributing factors, and understand the social context of the client's comm.

Elementary School and Adolescents

motor speech and articulation skills mastered by mental age 7. •consider child's speech production skills at the phoneme, word, and sentence level and influence of word length on overall intelligibility •assess impact of production on interactions in variety of settings

*Informal tools* Interviews

opened ended questions about client's history, concerns, perceptions about his/her comm. skills

*Speech*

requires articulation, or the motor processes involved in in the planning and execution of movement of articulatiors •Speech intelligibility refers to how well a speaker is understood, analyze % of words understood •Speech perception testing involves listening to pairs of sounds and indicating whether they are the same or diff. •Assess oral mech. •Speech production assess. typically involves examining the ability to produce speech sounds in isolation, syllables, words and in running speech.

Prognosis

the prediction of future comm. skills either with/out intervention •factors that may influence: age, severity of comm. dis., family support, and co-occurring medical conditions

Assessment/Evaluation

the process of gathering and interpreting info. for the purpose of making decisions •outcome determines presence or absence of a communication disorder

Determining Eligibility for Services

therapy is supported by public funding or by 3rd party sources and each have specific guidelines to determine if a client is eligible •necessary to document by means of assessment, the type and severity of each client's comm. disorder

Infants and Toddlers

typical levels of intelligibility: •50% at 2 yrs. •75% at 3 years •100% at 4 yrs. •important to understand the range of normal variation in speech and lang. dev. •differential diagnosis for the underlying cause can be difficult to determine, provide intervention •speech perception may also be difficult cuz child may yet not understand linguistic concepts

Interdisciplinary Teams

we work w/ and/or collaborate w/ other professionals to meet needs of the clients w/ whom we work •as a member we may receive *referrals* from other proffessionals, or from client's fam., caregivers or the individual themself

*Purpose of Assessment* Screening

a brief procedure used to determine the presence of a disorder •informs clinician whether a comprehensive eval is indicated. •will result in a pass or fail determination based on various predetermined criteria •may focus on one particular area (hearing, language, etc) •differs for adult and child

Dynamic Assessment

allows clinician to determine how clients respond to diff. support strategies •goal: to determine what approaches or intervention techniques will promote change

*Methods of Assessment*

four main types: •Case history •Norm-reference tests (formal test) •Criterion- reference tests •Observational tools

Adults

Oral motor exam obtained w/ special attention to the impaired cranial nerves

*Sensorimotor Speech Examination*

an assessment of the structure and funtion of the oral motor mech. that supports speech and swallowing •consists of exam. facial symmetry, dentition, the structure and function of lips, tongue and jaw, and VP, and respiratory, phonatory, and resonance functions •begin with exam of external visible structures and progress to structures w/in oral cavity •Swallowing is screened during the asses. by dry swallow and by swallowing liquids as well as solids •gag reflex too

Elementary School and Adolescents

assess ability to meet the demands of the classroom •understanding of classroom discourse rules, decontextualized lang., metalinguistic skills (using lang. to talk about lang)

Infants, Toddlers, and Preschoolers

assessing lang. comprehension involves pointing to objs., pics., body parts, following directions and routines •uses formal procedures or informal such as play/observation •lang. production can be elicited by engaging in play routines and parent reports •use of comm. to accomplish intentions is also imp., includes: eye contact, taking turns, initiating and responding to comm. with others

Recommendations

assessment also involves in recom. that describe whether speech and language therapy is warranted and if so, the frequency of the therapy

*Alternative and Augmentative Communication* (AAC)

can be used by any client to supplement restrictions in speech n lang. production and comprehension •for some AAC can be the primary means of comm. •AAC can be simple or complex •Used by clients who have severe cognitive or physical disabilities •there is no standard battery of test that compromise an AAC evaluation

*Hearing*

can change over time, and should be revaluataed throughout life span •SLP can screen clients for hearing loss; middle ear pathology and all speech and lang. evals. should include hearing screening

Norm-Reference Tests

compares a client's performance to a sample of individuals who are similar to the client •properties include •*representative samples*- the norming sample, to whom client taking test is being compared. Should be big (min of 100 subjects), and be representative, individuals with typical range of performance •*standard scores*-bell shaped curve represents normal distribution. SS represents how far 4m average score a particular raw score (# correct) •*percentile ranks*- % below score •*standard error measurement*- (SEM)- average degree to which the obtained score differs from the theoretical "true scores" •*standardization*- consistency •*validity*- measures what is says it measures •*reliability*- scores remain stable regardles who gives test or when client takes it. measured in *inter-rater reliability* (one tester tests, then a second) and *test-retest reliability* (test's consistency over time) •not done in a naturalistic situation and may influence performance

Behavioral Observaion

describes behavior in systematic way, w/out reference to predetermined criteria, conducted in settings where client typically comm.

Criterion-Referenced Procedures

does not compare an individual's performance to others, compares to certain predetermined expectations •can be administered in a naturalistic environment, and modifications can be made •Standard Scores not obtained •helps determine what comm. functions client can/n't perform

EBP

established by ASHA as the gold standard when making decisions about eval. procedures and materials, in addition to our expertise and experience as an SLP, and client's preferences and values

*Voice*

evaluate strengths/weaknesses of vocal function, including the id. of impairments , associated activity, and limitations in participation in comm. interactions. •asses. involves assess. obtaining a speech sample, pitch range, dynamic rage, the s/z ratio (done by producing s and z for as long as possible to determine whether is any glottal closure during phonation and a ratio of 1:1.4 is normal, higher indicates air leakage in glottis) ratings regarding vocal abuse, and observation of m. tension

Documenting Progress

when a clinician assess a client and describe the client's comm. in detail, they are establishing the client's *baseline* performance •describes current level of comm. functioning, including both strengths/ weaknesses •used to determine the starting point of intervention and to serve as a point of comparison against assess. data collected after some intervention took place •documentation not only provides accountability for services but also to adjust therapy goals and methods to max. progress or to decide therapy is no longer achieving targeted outcomes

Diagnosis

when a comm. disorders exists a diagnostic label is established and describes the client's swallowing or comm.disorder. •required for billing, reimbursement, or special education eligibility •helps determine goals and methods of intervention appropriate for the client