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95 Cards in this Set
- Front
- Back
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Reasons to Diagnose Aphasia
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To determine functional level and severity level
To determine if therapy is indicated Identification of problem in differential diagnosis Accountability for record (diagnosis for insurance) Planning for therapy Determine treatment baseline Making a prognosis |
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Minnesota Test for Differential Diagnosis of Aphasia (MTTDA)
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Developed by Schuell in the late 1960s-1970s
Oriented towards assessment of patient strength/weaknesses in all language modalities as a guide to planning tx Aids in differential diagnosis and prognosis Based on unidimensional view of aphasia Intended to differentiate aphasia from normal levels of language function 2-3 hour administration time 46 Subtests divided into 5 sections: - auditory - visual and reading - speech and language - visuo-motor and writing - numerical relations and arithmetic processes Method of scoring: varies some among subtests - mostly +/- scoring Does Not give a true overall scaled score - still gives good info, reliable test No guidelines in manual for translating test results into treatment plan |
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Porch Index of Communicative Ability (PICA)
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Developed by Porch
Most completely standardized test for aphasia (originally standardized on 260+ aphasic adults) Reliable and sensitive measurement of degree of deficit and amount of recovery Uses same method of direction and response (made PICA original) 18 subtests on the 4 language modalities: identified as either gestural, verbal, or graphic Scoring system involves multidimensional 16 point scale based on 5 dimensions of patient responses: accuracy, responsiveness, completeness, promptness, efficiency Give a point to begin treatment by displaying a performance pattern (indicates which areas of language function are successful but challenging to the patient) |
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Problems with the PICA (Porch Index of Communicative Ability)
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Homogeneity of test items - same 10 test items used for each subtest
Extensive training needed in order to administer Statistical variables associated with test construction - validity of scoring system has been investigated w/ respect as to whether or not truly represents a hierarchy of behavior Provides very little descriptive data |
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Boston Diagnostic Aphasia Examination - III (BDAE-3)
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Developed by Goodglass, Kaplan, and Barresi
Most commonly used test currently (esp. in the ECU clinic) Reliable and sensitive measure of degree of deficit and amount of recovery Aimed towards dx of presence and type of aphasia - leads to inferences concerning location of the lesion Samples language behaviors which have been demonstrated to be discriminative in the identification of aphasic syndromes 2 hour administration Similar to Minnesota - can administer parts of the test Profile of speech characteristics and severity rating provided (based on sample of conversational and expository speech) Provides extended and supplementary testing of verbal and nonverbal functions (includes a parietal lobe battery) Contains lots of test items - gives good sample of patients abilities relative to language function Probably best test in terms of stimulus items Scoring system is weakness of test |
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Western Aphasia Battery (WAB)
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Developed by Kertesz
Based on Boston Diagnostic Aphasia Examination (BDAE) - considered sister test Commonly used test Purpose is to identify syndromes of aphasia (premise is same as BDAE) Provides an Aphasia Quotient (AQ) - key score relative to severity of aphasia - Based on a score of 100 - the cutoff for aphasia is a score of 93.8 or below - downfall of AQ is its use of classifying patient into aphaisa type Provides a Cortical Quotient (CQ) - broader measure taking all language and non-language tasks into account Test uses scores to place patient into a classification (aphasia type) based on the score pattern only Not as good at determining type of Aphasia as the BDAE because it uses AQ - BDAE is MUCH better at determing aphaisa type because it uses behaviors |
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Neuro-sensory Center Comprehensive Examination for Aphasia
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Developed by Spreen and Benton
Developed as more of a research tool to look at recovery of function Consists of 20 subtests - including the use of 32 objects arranged on 4 trays for several tasks 2 hour administration Scoring is +/- for most subtests with a 5 point scale for the naming subtests Profile sheet provided on which pattern of deficit is recorded Frequently used in studies of recovery |
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Aphasia Diagnostic Profiles
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Developed by Helm-Estabrooks
(Dr, Hough's fave test) Straightforward language structured test - looks at some social and emotion variables as well Quick but extensive survey of language and communication impairment Series of brief clinical tasks which yield scores on language expression and comprehension, alternative means of communication and general social-emotional state |
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Multilingual Aphasia Examination
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Developed by Spreen, Varney, and Benton
Extensive battery revised several times Examines all aspects of language in French, Spanish, and English Often used in studies of prognosis |
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Bilingual Aphasia Test (1993)
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Developed by Paradis
Each version is culturally and functionally equivalent in content (versus simply direct translations) Another test that offers several language variations |
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Examining for Aphasia and Related Disorders - IV
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Developed by LaPointe and Eisenson
Long standing test based on similar principles as the MTTDA (Minnesota) LaPointe = aphasiologist whom Eisenson sought out to improve the test Better scoring system than MTTDA |
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Neuropsychological Assessment Battery: Language Module
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Developed by Stern and White (2003)
Six modules Language module consists of assessment tasks for oral production and writing |
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Burns Brief Inventory of Communication and Cognition: Left Hemisphere Inventory (1997)
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One of three modules - the left hemisphere section addresses typical tasks to administer to aphasic patients
Based a lot on the work of Schuell and Eisenson |
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Language Modalities Test for Aphasia
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Developed by Wepmen and Jones
First real test of aphasia Not really used much anymore Most other tests based on this one |
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Skalr Aphasia Scale
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Developed by Skalr
Screening test Provides a measure of degree of impairment of language function in 4 language modalities Takes 20-30 minutes to administer |
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Aphasia Language Performance Scale
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Developed by Keenan and Brassell
Screening test Looks at 4 language modalities (listening, reading, talking, writing) Administration time of 20-30 minutes Items increase in complexity within each modality |
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Bedside Evaluation Screening Test
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Developed by Fitch-West and Sands
20 minute test Can be conducted at bedside using a portable kit with magnetic display board Language screening instrument - uses 7 subtests to assess competence across 3 modalities: speaking, comprehension, and reading Found to highly correlate with BDAE and PICA |
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Acute Aphasia Screening Protocol
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Developed by Crary et. al.
10 minute check of attention and orientation, auditory comprehension, and basic expressive abilities |
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Aphasia Screening Test
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Developed by Whurr
Language screening test aimed at moderate to severe patient Yields quantitative as well as qualitative info Provides profile on which to base treatment Not really a true screening - goes more in depth than most screening tests |
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Functional Communication Profile
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Developed by Sarno
Supplementary Test Focuses on use of language in every day situations Examines aphasic individual's independence as a language user Administration slightly less structured compared to other tests Each item is rated on a 9-point scale looking at 45 communicative behaviors divided into 5 categories (gesture, speaking, understanding, reading, and other) Ratings obtained partly from informal interview with the patient which precedes the formal testing |
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Communicative Activities of Daily Living - 2 (CADL)
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Developed by Holland
Test of functional language skills (not necessarily a test of aphasia - examines communicative adequacy) Looks at how patient communicates in a variety of situations -Role Playing using a scoring system developed by Boller and Green: - 2, 1, 0 - 2 = appropriate response, 1 = in the ballpark, 0 = inappropriate response Well normed in regard to cutoff scores for normal and aphasic patients Correlation between CADL and PICA = .94 Correlation between CADL and BDAE = .86 CDLA appears to relate to language structure skills 35-40 minute administration time Has been used as a post hoc measure of recovery |
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Token Test
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Original Test developed by DeRenzi and Faglioni in 1962
Measures subtle comprehension and memory deficits A shortened version was developed in 1978 (Journal Cortex) Contains 6 parts which incorporate most of the changes of content since the original version Uses plastic tokens Does NOT provide for differential diagnosis Revised Token Test - McNeil and Prescott have a more elaborate scoring system in which administration and scoring are fashioned after the PICA |
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Auditory Comprehension Tests for Sentences (ACTS)
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Developed by Shewan
Examines contribution of length, vocabulary difficulty, and syntactic complexity to auditory comprehension Intended to primarily help treatment planning 15 minute administration time Scoring: correct/incorrect Consists of 25 sentences and patient points to one of four pictures that corresponds to meaning of the sentence |
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Reading Comprehension Battery for Aphasia - 2 (RCBA)
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Developed by LaPointe and Horner
Investigates nature and degree of reading impairment Consists of subtests which progress from word to paragraph level of difficulty |
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Reporter's Test
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Developed by DeRenzi and Ferrari
Turned Token Test around in order to create a measure of mild to moderate disorders of verbal expression |
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Boston Naming Test
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Developed by Kaplan, Goodglass, and Weintraub
Vocabulary naming test consisting of black and white pictures which increase in difficulty as they decrease in word frequency Used to assess extend of word finding difficulty Seperate in terms of scoring and what you can do with this test (from the Boston) A lot of info on typically aging adults as compared to aphasics |
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Test of Adolescent/Adult Word Finding
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Developed by German
Standardized test of word retrieval skills in adolescents and adults Word retrieval is measured on the dimension of accuracy and speed with the test divided into picture naming for nouns and verbs, category naming, sentence completion, and descriptive naming |
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Boston Assessment of Severe Aphasia (BASA)
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Developed by Helm-Estabrooks, Ramsbarger, Morgan, and Nicholas
Test is used for early post-stroke administration at bedside Particularly probes the spared language abilities of severely aphasic adults Both gestural and verbal responses to items are scored |
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Psycholinguistic Assessments of Language Processing in Aphasia (PALPA)
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Developed by Kay, Lesser, and Coltheart
Set of resource materials that enables user to select language tasks that can be tailored to the investigation of an individual patients impaired and intact abilities Profile - results can be interpreted within current cognitive models of language Tool for the more experienced clinician |
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Efficiency of Communication in Assessment
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Developed by Yorkston and Beukelman
Looking for a way to quantify higher level verbal expression Number of content units Syllables per minute - typically older adults speak @ 193 syllables/min - mild aphasics speak @ 121 syllables/min contents per minute -typically older adults produce 33.7 content units/min - mild aphasics produce 18.7 content units/min |
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Pragmatic Protocol
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Developed by Prutting and Kirchner
Directs examiner to score patients on 30 parameters (speech acts and pragmatic behaviors) after observing their participation in a 15 minute structured conversation with familiar comm. partners 30 parameters divided into 7 areas and include: speech acts, turn-taking, lexical selection/use, stylistic variations, paralinguistic aspects, and nonverbal acts |
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ASHA Functional Assessment of Communication (ASHA FACS)
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Developed by Frattalli et al.
Mandate by ASHA to develop something beyond what was currently available for aphasia Functional measure specifically geared toward communication in adults (not necessarily language) Includes 7-point rating scale assessing level of independence Targets social communication, communication of basic needs, daily planning, and reading/writing/numerical concepts Looks at promptness, adequacy Can be measured qualitatively |
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Communicative Effectiveness Index (CETI)
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Developed by Lomas et al.
Social validation measure Rating scale scored by spouse or caregiver on individual with neurogenic language disorder Based on comparing patient's current communicative performance with pre-morbid abilities |
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ASHA Quality of Communication Life Scale
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Developed by Paul-Brown et al.
Consists of 18 statements for which patients are asked to state their agreement Uses a 5-point printed vertical scale and average rating is calculated by clinician 20 minute administration time |
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Stroke-Specific Quality of Life Scale
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Developed by Williams et al
Involves patient ratings of function and quality of life related to physical, pyschosocial, communication, and energy domains Up to now has been used primarily with stroke patients |
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Burden of Stroke Scale
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Developed by Doyle et al
Incorporates items addressing function, participation, and quality of life Unlike SSQLS items are combined to address each level of description and patient responds to a 5 point scale Follow up probes are available if patient indicates difficulty with a particular area of function Includes items in domains of mobility, communication, cognition, swallowing, social relations, energy and sleep, and negative and positive moodes |
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Dementia
Bases of Disorder |
Constellation of disorders due to brain-damage involving generalized cerebral atrophy resulting in generalized intellectual impairment - brain damage is diffuse and bilateral (unlike aphasia)
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Characteristic Description of Dementia
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Decrease in verbal and nonverbal cognitive functioning
Deteriorating memory for more recent events with progression of the disease resulting in difficulty with more remote memory Thought processes become disorganized Individual is disoriented to place, person, or time Personalities changes |
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Linguistic/Communicative Characteristics of Dementia
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Language disorder is viewed relative to overall cognitive impairment
Language impairment is primarily in semantic and pragmatic areas with phonology and syntax spared Primarily distinguished from aphasic patient with respect to pragmatics of communication Semantic problems crop up in naming tasks, specifically word fluency, and then confrontation naming Confabulation also evident (esp. in Alzheimers) Confrontation naming reveals difference between mildly demented patients and typically aging adults Pragmatics: - lack of questions or commands - more egocentric speech - decrease in topic maintenance - introduce new topics without closing old ones - tend to feel there is more shared knowledge between speaker and listener than there really is |
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Traumatic Brain Injury - General Description
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Mostly 15-24 year old males and preschool children
Head traumas occur most often on weekends in the spring between 10 PM & 4 AM Need to get these patients in the rehab process very early |
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TBI - Nature of the Injury
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Blow to head - may or may no cause skull fracture (blunt force injury)
Non-penetrating injury that leads to alteration in level of consciousness with subsequent cognitive and behavioral deficits Acceleration - deceleration injury Brain is moving very fast and brought to abrubt stop. Shearing of nerve fibers with diffuse axonal damage. A lot of disruption of nerve fibers themselves (sub-cortical white matter) with our without cortical damage (diffuse white matter and possibly cortical damage) |
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Post Traumatic Amnesia (PTA)
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Duration of PTA is a predictive variable to cognitive ability
Begins in the time period from when person is coming out of coma but is still in an altered state of consciousness Ends when patient is able to recall current daily events and is oriented x3 (person, place, time) Age is a factor of prognositic significance - but it is relative How long a person is in a coma is of significance but there are mixed reports in literature relative to the symptom outcome |
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Galveston Orientation and Amnesia Test (GOAT)
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Scale which determines the beginning and end points of PTA time
PTA may have prognostic significance - the longer the PTA time the more severe the cognitive symptoms will be PTA < 5 minutes = very mild deficits or non-significant PTA < 1 hour = mild deficits PTA 1-24 hours = moderate deficits PTA 1-7 days = severe deficits PTA 7+ days = profound deficits |
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Ranchos Los Amigos Levels of Cognitive Functioning
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Scale (Hagen): Treatment emphasis
Levels I - III: focus on arousal & alerting to general stimuli Level IV: focus on attention and perception of environment; reduce agitation Level V: focus on discrimination & orientation to environment; get patient to selectively attend Level VI: focus on categorization and sequencing; work on speech and language skills Level VII and VIII: focus on memory and higher level cognitive and language skills; vocational and education issues |
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Research with TBI patients has revealed:
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They may perform better on standard language tests of aphasia
Show pragmatic deficits including: inappropriate prosody, inappropriate affect, topic selection, topic maintenance, problems with initiation, turn-taking, pause time in convo Show deficits in both quantity and conciseness in convo - difficulty following conversation |
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Right Hemisphere Communicative Impairment
Characteristics of Right Hemisphere Processing |
Can comprehend concrete nouns - typical of aphasic individual
Can read concrete words, particularly nouns Poor ability to deal with abstract nouns Can deal with with basic semantic relationships (such as super-ordinate, subordinate) Involved in processing emotional information Not involved in syntactic functioning - does not use phonological information |
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Right Hemisphere Communicative Impairment
Visual Deficits Affecting Communication |
Visual neglect - typically left sides of space (appears to be a directed attentional problem)
Visual-spatial processing disorder - map reading, pattern recognition - problems dealing with visual orientation Prosopagnosia/facial recognition - may relate to general simultagnosia (difficulty dealing with two bits of information simultaneously and integrating them) Anosagnosia - denial of illness |
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Right Hemisphere Communicative Impairment
Emotional Deficits Affecting Communication |
Poor judgement as the result of problems with affect
Reduced affect (reduced flat emotional state - difficulty processing or comprehending emotion) |
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Right Hemisphere Communicative Impairment
Communication, Language, Pragmatics |
Syntax and phonology is intact
Semantic and Pragmatic problems show up in relatively unstructured communication Difficulty in using contextual info to find appropriate interpretation (very literal) - may not interpret sarcasm Difficulty in organizing information in efficient, meaningful way - not simultaneously integrating information (even at a low level) Difficulty integrating elements into a single coherent theme Impaired ability to appreciate humor Difficulty in recognizing relationships between actions and fail to infer meaning based on those relationships - more responsive to what is said than what is meant Impaired in recognizing emotions expressed |
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Motor Speech Disorders: Apraxia & Dysarthrias
Etiology and Area of Damage |
Etiological characteristics differentiate apraxia of speech and aphasia from the dysarthrias
Both apraxia of speech and aphasia are caused by focal lesions in the left cerebral cortex Dysarthrias may result from these causes and a variety of diseases which affect central and peripheral nervous systems below the level of the cortex Within cortex, damage to pre-motor region or Broca's area produces apraxia of speech while damage while damage to frontal and/or posterior regions produces aphasia, both of which are sudden onset Dysarthrias may appear suddenly or gradually depending upon etiology |
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Motor Speech Disorders: Apraxia & Dysarthrias
Nature of Disorder |
Dysarthrias are manifestations of muscle weakness in the speech mechanism - strictly a speech disorder
Apraxia and aphasia do not involve paralysis/paresis of the speech mechanism Both dysarthrias and apraxia are motor speech problems - not language Dysarthrias are impairments of volitional and non-volitional movement Apraxia is primarily impairment of volitional movement - the more salient the task the more difficult Most dysarthric errors are consistent - most apraxic errors can be inconsistent (controversy about consistency of apraxic errors) |
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What is the main diagnostic problem with respect to aphasia and apraxia of speech?
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Sound substitutions in aphasia and those in apraxia of speech - articulatory problems of Broca's aphasia are usually a product of an accompanying apraxia of speech
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Stimulation Approach
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We should always use a stimulation approach to some degree
Emphasizes understanding what stimulus factors may impede or enhance the patients' current linguistic abilities Expose patients to stimulus and task hierarchies that will stimulate functioning of compromised langauge functions and modalities Tasks are not a means to an end - they are always building on each other |
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Cognitive Neuropsychological Treatments
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Using models of normal and/or disordered language used to motivate treatment targets/procedues
Focuses on improving the disrupted processes or capitalize on more intact processes Evaluating how therapy affected change in trained as well as untrained linguistic stimuli, functions, and modalities Therapy procedures may be very simliar to those in stimulation approach; however, rationale for these procedures in this approach is not the same |
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General Principles/Considerations of Remediation
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Work at a level at which performance is slightly deficient but not completely errorneous (60-80%)
Keep stimulus items simple and relevant Elicit a large number of responses Begin session on a familiar, easy task (warm up) Score and provide feedback Emphasize process rather than specific stimulus items Use repetitive sensory stimulation New materials/procedures should be extensions of familiar materials/procedures Each stimulus should elicit a response |
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Objectives of Treatment
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Long-term process
Improve the patient's use of language in comprehension and expression Improve the patient's ability tp communicate thoughts and feelings Should be realistic |
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Planning a Task
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1. Consider modality to be exercised
2. Identify cognitive process within modality which needs practice - relate activity to targeted process 3. Define tasks further in regard to the semantic content of language and its referents (based on familiarity, naturalness, everyday usefulness) 4. Any structured task is a means to an end, and not an end in itself |
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Convergent Stimulus
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Indirect
Stimulus designed to converge on one particular response Generally used with more severe patients (but not always) Repetition, naming, sentence completion, etc |
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Divergent Stimulus
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Indirect
Multitude of possible responses More typical of communication Word fluency, feature generation, semantic feature analysis, association tasks, role-playing Broaden patient's practice of word retrieval |
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Promoting Aphasics' Communicative Effectiveness (PACE)
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Direct
Developed by Davis and Wilcox - out of recognition that standard and direct stimulation approaches do not coincide with structure of natural conversation Focuses patient and clinician on ideas to be conveyed (rather than struggle for linguistic accuracy) Active participation of the listener Format is NOT a specified task Procedures are derived from 4 principles 1 - Clinician and patient participate equally as senders and receivers of message 2 - Exchange of new info between client and clinician (most difficult principle to maintain) 3 - Patient has free choice as to which communicative channels he/she may use to convey new info 4 - Feedback is presented by the clinician as receiver 7.5 point scoring system based on successfulness of communication 4 = message conveyed 1st attempt 3 = message conveyed after general feedback indicating lack of understanding 2 = Message conveyed after specific feedback 1 = Message not completely understood 0 = message not understood |
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Drawing
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Direct Multi-modality approach
Visuo-spatial skills remain relatively intact in aphasia and most patients retain at least a basic ability to draw Drawing ability may be compromised by by motor impairments/visual acuity Use in a total communication approach Programs : Communication Drawing Program, Back to the Drawing Board (John Lion) |
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Gesture
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Multimodality Approach
Used to further enhance communicative effectiveness May be limited by motor impairments Many gestural codes available such as Amer-Ind For more severe verbal deficits, using pantomime or Visual Action Therapy (VAT) |
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Computer-Assisted Visual Communication (C-VIC) or Lingraphica
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Requires patients to select and sequence icons representing various lexical items to compose messages; can be installed on a laptop
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Personal Communication Assistant for Dysphasic People (PCAD)
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Has potential for functional use - runs on a palmtop computer
Can be adapted for individual patients |
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Training Communication Partners
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Identify communicative behaviors that disrupt communication and work to eliminate behaviors
Providing structured training in behaviors that support successful interactions with patient |
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Modifying physical environment
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Acoustics
Lighting Clocks Calendars Consistent Routines |
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Global Aphasia
Prognosis of Improvement |
Sarno (1981, 1988) studied patterns of globally aphasic patients - all recovered to some extent - comprehension improved the most, propositional speech the least
Largest amount of improvement occurred in period of 6 months to 1 year post-onset stroke - at 6 months post-onset there was more spontaneous use of gestures |
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Global Aphasia
Improve Auditory Comprehension |
1. Association between words
2. answering yes/no questions 3. following simple commans |
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Global Aphasia
Verbal Expression |
1. Functionally relevant words
2. words that are phonetically easy to articulate 3. Imitation, cuing, looking at general responsiveness 4. Programs such as Helm-Estabrooks Voluntary Control over Involuntary Utternaces 5. Phonological Treatment involving phoneme to grapheme matching, phoneme discriminations, auditory word-picture matching, written word-auditory word matching |
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Global Aphasia
Nonverbal Expression |
1. Language Boards (sometimes will not work)
2. Bliss symbols, use of Rebus symbols 3. Using gestural systems |
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Broca's Aphasia
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Goals in auditory comprehension are higher level than those for global aphasia
Focus on comprehension at the sentence and paragraph level Syntactic information should be manipulated - use of context to circumvent syntactic comprehension problems |
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Broca's Aphasia
Verbal Expression |
Higher level thought organization skills and divergent tasks such as sequencing, categorizing, procedures, etc
Writing goals should focus at word and sentence level |
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Broca's Aphasia
Agrammatism |
Typically these patients:
Omit initial unstressed word in a sentence (pronouns, articles, prepositions) Start sentence out with stressed word that caries a lot of content (noun) Greater tendency to have verb and object construction that subject and verb construction Syllabic morphemes are more readily produced than nonsyllabic difference in use of /s/ morpheme Use of adverb to mark things Look at subject-verb-object (SVO) structure from cognitive viewpoint |
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Broca's Aphasia
Other Aspects of Verbal Output |
Use of Response Elaboration Treatment - increases utterance length and information content in verbal output
Melodic Intonation Therapy - stimulation approach producing words/phrases in intoned and rhythmic manner |
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Broca's Aphasia
Reading |
Work on grapheme to phoneme conversion with difficulty decoding letters and letter combinations
saying key words beginning with particular letter and then saying first sound of word corresponding to target letter working on "sounding out" nonwords |
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Wernicke's Aphasia
Improve Auditory Comprehension |
1. Single word level (similar to Global Aphasia)
2. Treatment for Wernicke's: capitalizing on patient's more intact reading and repetition skills 3. Investigate whether visual system is stronger than auditory - if so, these patients will repsond better to the printed word |
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Wernicke's Aphasia
Decrease Paraphasic errors and perservation |
Increase patient's awareness of paraphasic errors and attempts to modify and correct errors
As comprehension improves they will be able to better deal with paraphasic errors Use of Treatment of Aphasic Perserveration (TAP) |
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Wernicke's Aphaisa
Lexical-Semantic deficits |
Objectives/goals:
Sorting/matching by semantic categories or associations Spoken or written naming tasks using cuing hierarchy Spoken/written phrase or sentence completion task Matching pictures/words to definitions Semantic Feature Analysis (SFA) |
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Conduction Aphasia
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Improve higher level auditory comprehension skills
Strong emphasis on improving (decreasing) paraphasic errors Higher level thought organization tasks Use context to aid word retrieval abilities Writing tasks should be similar to those used with Broca's aphasia *Remember* This population is overperfectionistic |
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Anomic Aphasia
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Improving word retrieval abilities with emphasis on developing self-cuing strategies with patient
Improve auditory and visual comprehension skills as needed Writing tasks should be functional in nature, similar to Broca's and Conduction Aphasia |
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Pharmacological Treatment
Enhancing the catecholamine system |
Use of bromocriptine - Language initiation and verbal fluency may be supported by this neurotransmitter (Positive effects in word retrieval and verbal fluency in nonaphasics)
Use of amphetamines - positive findings when drugs complemented behavioral treatments in acute stages of recovery |
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Pharmacological Treatment
Enhancing the cholinergic system |
Use of specific cholinergic agents (galantamine, piracetam) with acute or chronic aphasia has resulted in improvements in naming, auditory comprehension, and repetition
Piracetam associated with gains in phonological, semantic, and syntactic aspects of spontaneous verbal output With both of these drugs, question has been when to administer, how much, when are they affects Most effective when a thrombotic CVA and administered w/in first 3-4 hours of stroke |
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Evidence Based Practice
Definition |
Conscientious, explicit, and judicious use of current best evidence in making decisions about care of individuals
Framework for integrating clinical expertise, patient values, and best available evidence into the clinical decision making process that informs patient care Requires clinicians to apply critical appraisal to determine relevance, validity, and accuracy of available evidence to determine what constitutes the current best evidence and consequently to make decisions about which treatments will be most appropriate for which patients |
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Evidence Based Practice
Benefits |
1. Reduce variations in clinical practices that may negatively affect patient outcomes
2. Increase cost effectiveness of patient care 3. Provide rationale for allocating more health care resources and consistent reimbursement for SLP services by third-party payers 4. Provides standard approach for identifying and documenting evidence deficiencies as well as generating more and better evidence 5. Benefits Graduate education by having a framework for teaching skills needed to develop competency in the knowledge base |
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Evidence Based Practice
Process (5 steps) |
1. Converting the need for information into an answerable questions
2. Identifying with maximum efficiency the best evidence with which to answer a question 3. Critically appraise the evidence for it's validity, importance, precision, and usefulness (Includes four Clinical Outcomes Research Phases) 4. Apply results of appraisal in clinical practice 5. Evaluation you performance |
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Evidence Based Practice
Process Step 1 Converting the need for information into an answerable questions |
Requires focus on specific aspect of practice
Who and what are you specifically examining as well as when and how |
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Evidence Based Practice
Process Step 2 Identifying with maximum efficiency the best evidence with which to answer that question |
Clinicians should use effective search strategies to produce a good return on their time investment - where is the evidence?
Clinicians must develop efficient search strategies to ensure that the search is broad enough to include all relevant sources but exclude those that do not directly address the question |
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Evidence Based Practice
Process Step 3 Critically appraise the evidence for its validity, importance, precision, and usefulness |
Process of deciding whether a specific piece of evidence can help answer the clinical question
Use of outcomes measurement which includes both outcome and efficacy research Efficiency - high productivity or maximum effect for effort expended - necessary to establish efficacy and effectiveness prior to evaluating it's efficiency Clinical Outcomes Research Phases |
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Evidence Based Practice
Process Step 3: Clinical Outcomes Research Phase 1 |
Discovery Phase including case studies, single-subject studies, small group experiments
Select a treatment effect, identify if that effect is present, and estimate magnitude of effect |
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Evidence Based Practice
Process Step 3: Clinical Outcomes Research Phase 2 |
Begin preparations for conducting a clinical trail which refine the primary hypothesis
Develop an explanation for why treatment works Refine selection criteria for target population Identify and select outcome measures that are proven to be valid and reliable and determine treatment dosage (intensity and duration) Still small sample sizes not requiring control patients |
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Evidence Based Practice
Process Step 3: Clinical Outcomes Research Phase 3 |
Clinical trials designed to test efficacy of treatments developed and optimized in Phases 1 and 2
Involves large sample sizes, multiple sites with possible random assignment to treatment versus control (no treatment) groups |
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Evidence Based Practice
Process Step 3: Clinical Outcomes Research Phase 4 |
Examine treatment's outcome in ordinary clinical practice (effectiveness) after having established treatment efficacy with large sample sizes but no control groups
Evaluate treatment outcomes when population service delivery model, clinician training are varied |
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Evidence Based Practice
Process Step 3: Clinical Outcomes Research Phase 5 |
Effectiveness research expanding to efficiency explorations to determine who benefits from treatment and evaluating costs of providing treatment
Both large group or multiple replications of single-subject studies are appropriate - no control groups required |
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Evidence Based Practice
Process Step 3 |
Apply results of appraisal in clinical practice
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Evidence Based Practice
Process Step 5 |
Evaluate your performance using empirical methods to track clinical progress for patients
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