Term
How many levels of evidence are there?
(the academy of Neurologic Communication Disorders uses this rating system) |
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Definition
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Term
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Definition
| prospective, randomized, controlled clinical trial; masked outcome assessment in a representative population with qualifiers |
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Term
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Definition
| prospective, matched group cohort study, in a representative population; masked outcome assessment that meets class I criteria OR randomized controlled trial that lacks one criteria for Class I |
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Term
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Definition
| All other controlled trials (including well-defined natural history control subjects or patients serving as own control subjects) in a representative population where outcome assessment is independent of patient treatment |
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Term
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Definition
| Evidence from UNCONTROLLED studies, case series, case reports, or expert opinion |
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Term
| ANCDS (Academy of Neurologic Communication Disorders & Sciences)Practice Guidelines |
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Definition
| Gives guidelines for various neurogenic disorders. - over 700 Tx studies - meta-analysis - reports appear in Medical Journal of SLPathology |
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Term
| What are some resources for staying CURRENT in the Treatment of Aphasia? |
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Definition
(textbooks are out of date, 2 yr lag)
1. texts
2. journals
3. conferences
4. workshops/teleconferences/videos |
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Term
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Definition
1. Acquisition
2. Response generalization (untrained exemplars of trained behaviors, untrained behaviors)
3. Stimulus generalization
4. Maintenance (withdrawl, follow-up) |
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Term
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Definition
are they learning what you're working on?
are they acquiring the behaviors being treated? |
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Term
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Definition
1. untrained exemplars of trained behaviors.
2. untrained behaviors (related? what's gonna change together?) |
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Term
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Definition
| can they use what you've trained in DIFFERENT situations? |
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Term
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Definition
1. withdrawal
2. follow-up |
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Term
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Definition
| effects of treatment provided under IDEAL conditions (clinic almost reaches this) |
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Term
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Definition
| effects of treatment under routine conditions |
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Term
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Definition
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Term
| The majority of APHASIA THERAPY is comprised of what two types of approaches? |
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Definition
1. behavior modification
2. Stimulation-facilitation |
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Term
Behavior Modification
Theoretical assumption:
Targets of Tx:
Obtaining accurate response:
Tx mechanism:
Number of items in a task:
Feedback: |
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Definition
Theoretical assumption:
- no assumptions about aphasia
Targets of Tx:
- target a specific behavior
Obtaining accurate response:
- stimulus for particular response (modeling when necessary)
Tx mechanism:
- behavior change through consequence or the clinician's feedback
Number of items in a task:
- restricted number of stimulus items
Feedback:
- upon error or for positive performance |
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Term
Stimulation-Facilitation
Theoretical assumption:
Targets of Tx:
Obtaining accurate response:
Tx mechanism:
Number of items in a task:
Feedback: |
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Definition
Theoretical assumption:
- Impaired processes & preserved linguistic knowledge
Targets of Tx:
- Tx impaired processes
Obtaining accurate response:
- behaviors naturally elicited by a stimulus most of the time
Tx mechanism:
- power of a stimulus to elicit a response repeatedly
Number of items in a task:
- Large # of diff stimulus items that may vary from session to session
Feedback upon error:
- restimulation |
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Term
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Definition
Currently popular
- may employ behavioral mod, stimulation-facilitation, or combination of these two approaches |
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Term
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Definition
- within hours/days of onset (1-5 days)
- patient may stay on acute medical unit until d/c (discharged)
- patient may transfer to another setting |
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Term
| In the acute phase, what is priority? |
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Definition
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Term
| Pt should be ____ prior to initiating intervention (for speech) |
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Definition
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Term
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Definition
- pt experiences a partial reconstruction of their prior language skills (could be motor skills too)
- can last b/w 6- upwards of 12 months
Contributors to Spon. Recovery:
- diaschisis-reversal (reversal of when things don't work down the line)
- adaptive plasticity
- behavioral compensation |
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Term
| What are the three contributors to Spontaneous Recovery? |
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Definition
1. Diaschisis-reversal
2. adaptive plasticity
3. behavioral compensation |
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Term
| What are some psychological considerations? |
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Definition
- pts & fam dealing w/ mortality
- lang probs not first concern after "brush w/ death"
- pt & fam suffer from range of emotions (anxiety, fear, frustration, depression)
- pt may have initial confusion/cognitive deficits, unsure if from CVA or COPING with CVA |
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Term
| When educating Pt & fam, what is it good to do? |
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Definition
Provide WRITTEN information of what was discussed. Why?
b/c pt & fam may not be able to absorb the info due to what's happened |
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Term
It's good to know pt's & fam's level of knowledge about CVA.
Depending on severity of pt's CVA, may need to educate family/friends on best way to communicate w/ the pt. |
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Definition
| Pt or Fam's knowledge of CVA may be from family or friend, so circumstances/type of CVA may not apply |
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Term
| Determining assessment tools will likely depend on what? |
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Definition
| The pt's level of severity (mild, moderate, severe impairments) |
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Term
| With Mild-Moderate pts, can administer what formal assessments (if you have enough time)? |
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Definition
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Term
| With a SEVERELY impaired pt what may you need to do? |
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Definition
| administer BRIEF aphasia tests/screens and may need to administer more than once (baseline & progress) |
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Term
| What are some examples of BRIEF FORMAL APHASIA TESTS/SCREENS? |
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Definition
- Sklar Aphasia Scale
- BEST-2
- Aphasia Language Performance Scales
- Screening versions of:
Examining for aphasia-3
Aphasia Screening test-2
Language Modalities Test for Aphasia |
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Term
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Definition
- may be conducted first to determine what formal test to use
- problem: everyone does them differently
- SEVERELY impaired= limited in what can be conducted/assessed |
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Term
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Definition
- determined by facility
- sometimes in pts room
- limit # of ppl in room to avoid distraction ("helping") |
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Term
| Treatment time for acute aphasia may be limited due to: |
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Definition
- due to being in acute unit
- transfer to another facility |
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Term
| If short Length of stay (LOS) you may only be able to: |
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Definition
1. education (of CVA etc.)
2. quick assessment |
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Term
| Treatment for Acute Aphaisa is based on _____ |
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Definition
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Term
| Amount of Counseling/Education pt & fam receives depends on: |
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Definition
| ability to deal w/ event & new info. |
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Term
| Counseling/Education occurs from ____ onward |
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Definition
| the first meeting w/ pt & fam + |
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Term
| for families to better communicate w/ pt, ___ may be needed. |
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Definition
| Models of communication/interaction w/ pt |
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Term
| To plan for Discharge (d/c): |
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Definition
team member communication about pt's: status, progress, participation, & prognosis.
- All give input to recommend next level of care (d/c to home, rehab, ECF etc.) |
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Term
| What plays a role in determining the d/c plan for a pt? |
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Definition
- severity of impairments (communication/physical)
- family support |
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Term
| Questions to consider in determining d/c plan as a team |
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Definition
1. can pt go home & have home health/outpatient tx? Managed by family at home?
2. Would pt benefit from continued intensive tx? Able to participate and make progress?
3. Is the pt limited in participation/progress/family support? |
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Term
| Upon or After d/c, you should provide next SLP w/ what? |
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Definition
information regarding what was done (eval/tx)-release of info.
(Don't waste time/money by repeating services) |
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Term
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Definition
- is a severe loss of language comprehension with concomitant deficits in expressive aphasia
- 55% of pts in acute phase exhibit global aphasia |
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Term
| Lesion Site & Etiology for Global aphasia |
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Definition
1. large lesion affecting pre- & post- Rolandic areas (Broca's & Wernicke's)
2. Stroke-MCA
- w/ hemiparesis
- w/o hemiparesis
- Lg. hemorrhagic stroke |
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Term
| What is comprehension like in ppl w/ global aphasia? |
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Definition
- single word comprehension (functional/common words)
- several isolated areas of relatively preserved comprehension:
personally relevant info
recognition for specific wrd categories
familiar environmental snds
famous personal names (use for positive reinforcement) |
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Term
| What is verbal expression like in pts w/ global aphasia? |
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Definition
- very limited
- output: stereotypic recurring utterances & speech automatisms
- maintain use of suprasegmental aspects |
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Term
| ___ aphasia is the type of aphasia most likely to have cognition impacted |
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Definition
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Term
| Poorer cognition may lead to impaired ____ |
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Definition
| lexical semantic disturbances |
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Term
| Depression following CVA for __ types of apahsia has been unrecognized & under treated |
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Definition
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Term
| Why have persons w/ Global aphasia been excluded from depression studies? |
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Definition
| b/c of significantly impaired comprehension/expression abilities |
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Term
| Better improvement is demonstrated in ___ than in ___ for ppl w/ global aphasia |
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Definition
| comprehension (better!) expression (worse) |
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Term
| substantial improvement may occur from __-__ mos, but may continue up until __ mo post onset. |
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Definition
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Term
| Global aphasia may evolve into different types (__ - __ evolution across reports) |
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Definition
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Term
| What are some prognostic factors? |
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Definition
1. Age (younger better)
2. Hemiparesis (none, better; mild R arm weakness that improved w/in days, better)
3. Alertness/attention (more=better)
4. Language scores:
- PICA (gives prognosis): good Aud. comp, naming=better)
-other aphasia measures: no variability b/w Aud com and other measures=worse; Y/N responses to simple questions=BETTER! |
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Term
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Definition
- be more than a Dx (diagnosis)
- give pts STRENGTHS & WEAKNESSES |
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Term
| Formal testing should be conducted to sample behaviors across each lang domain |
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Definition
| - but may be inadequate for Tx planning |
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Term
| What is Matrix Assessment? |
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Definition
- method of systematically assessing basic skills across modalities
- administer at least 5 items per S-R (stimulus-response) relation
- multidimensional scoring suggested |
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Term
| What are prognostic limitations with respect to acute Global aphasia? |
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Definition
- global aphasia cannot be reliably discriminated
-conflicting findings regarding prognostic indicators
-early intervention appears to be associated with better progress |
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Term
| What are the treatment objectives respect to acute Global aphasia? |
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Definition
- Tx should be initiated early to facilitate recovery
- Education w/ family & staff to facilitate/enhance communication |
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Term
| What are goal revisions regarding time of intervention of acute global aphasia? |
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Definition
- varying degrees of improvement across patients
- improvement/evolution to less severe or another aphasia classification |
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Term
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Definition
- due to the dynamic nature of aphasia, early testing in only a measure of the pt's language functioning at a SINGLE POINT in time
[ongoing evaluation/probes will be needed/expected during all phases of treatment]
- Establishing & revising short-term tx goals are inherent principles of aphasia tx
[regardless of when tx is provided, this process will be repeated regularly throughout the term of the pt's rehabilitation regardless of type of aphasia] |
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Term
| What are some realistic goals for the Gobally aphasic patient? (Collins, 1997) |
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Definition
* IMPROVE AUDITORY COMPREHENSION
* Establish consistent system of yes/no responding
- improving ability to spontaneously produce several written (or verbal) responses/approximations, of functional or salient words of daily living.
- establishing use of several simple gestures
- improving drawing
*ensuring that a small, basic core of communication intentions can be conveyed in one or a combination of modalities |
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Term
| Treatment: Educating Staff & Family |
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Definition
Guidelines for communicating with the severely aphasic patient:
-simplify
- clue him/her in
-allow time
-guess
-confirm
-be clear
-reduce extraneous variables
-respect (no baby talk) |
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Term
| What are stimulation approaches for Auditory Comprehension? |
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Definition
1. Matching pictures-pairing real objects to realistic pic to line drawing
2. matching pictures: Eliciting: -responses -differentiated response - appropriate responses -accurate responses
3. Playing cards: based on the observation that global aphasic patients can recognize names with 2 salient features (e.g. queen of hearts) |
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Term
| Stimulation approaches for verbal expression |
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Definition
- associating meaning with speech movements
- conversational prompting
- voluntary control of involuntary utterances |
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Term
| Associating meaning with speech movements |
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Definition
1. tasks include: showing fingers, pointing, gesturing, writing, matching, selecting objects to confirm meaning to any successful verbalization
2. auto speech, imitated words/phrases
3. small # of wrds/ gestures, yes/no, greeting phrase, common phrases |
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Term
| Conversational prompting (Wambaugh thinks this is more of a higher level task, a bit too hard) |
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Definition
-10 conversational levels
-use modeling, expansion & feedback to develop verbal responses in conversational context.
- props and written cues are provided to facilitate verbal expression
-cueing hierarchy is utilized to promote language retrieval |
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Term
| Voluntary control of involuntary utterances |
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Definition
- purpose is to bring stereotypies into mmore productive usage
- during evaluation/tx-track words used involuntarily & inappropriately (that are consistent)
- for tx, words are trained in sequence at oral reading, confrontation naming & conversation
- goal is to build a vocabulary of 200-300 wrds |
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Term
Gestural Programs
(Approaches) |
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Definition
1. Amer-Ind code: best known code, system based on concepts underlying wrds rather than on the wrds themselves
2. visual action therapy: purpose is to utilize gestures to reduce apraxia & improve the pts verbal expression or ability to use symbolic gestures for communication
3. Pantomime
4. Limited manual signs |
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Term
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Definition
1. Cl gestures & says wrd simultaneously
2. Cl says wrd, cl & pt gesture simultaneously (cl may need to assist w/ gesture)
3. pt imitates gesture
4. pt imitates gesture after delay
5. pt gestures in response to auditory stimulus
6. pt gestures to aud stim after delay
- add written stimulus steps if appropriate
7. pt gestures in response to appropriate stimuli |
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Term
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Definition
Preparatory Training
Communication Boards
Computer-Aided Visual Communication (C-VIC)
Lingraphica System |
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Term
| Preparatory Training (an AAC approach) |
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Definition
| -Specific Treatment program for global aphasic pts for the purpose of establishing the necessary skills needed for the iconic/substitutional language system |
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Term
| Communication Boards (an AAC approach) |
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Definition
- will vary in type and complexity
- Boards include specific items that communicate wants & needs as pts progresses can include other areas of communication |
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Term
| Computer-Aided Visual Communication (C-VIC) [an AAC approach] |
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Definition
| - promising approach to establishing alternative communication in severely impaired patients |
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Term
| Lingraphica System (an AAC approach) |
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Definition
| - Tx program delivered to pts in a laptop computer in tx setting & at home |
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Term
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Definition
- drawing has been used for communication as well as strategy for deblocking verbal & written communication
- Back to the Drawing Board
- Other drawing approaches/tx |
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Term
| Future needs for Global aphasia |
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Definition
- evolution of global aphasia
- refining prognostic indicators
- I.D. relationship b/w site/extent of lesion & global aphasia in outcomes
- outcome info to be used for better management of global aphasic pts
- assessment/Tx specific to globally aphasic pts
- improving communication for globally aphasic pts as well as quality of life. (there's really not much out there) |
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