Sunday, June 7, 2015

APGAR

APGAR - a backronym

APGAR - Chart

APGAR Scoring for Newborns


A score is given for each sign at one minute and five minutes after the birth. If there are problems with the baby an additional score is given at 10 minutes. A score of 7-10 is considered normal, while 4-7 might require some resuscitative measures, and a baby with apgars of 3 and below requires immediate resuscitation.
Sign0 Points1 Point2 Points

A

Activity (Muscle Tone)AbsentArms and Legs FlexedActive Movement

P

PulseAbsentBelow 100 bpmAbove 100 bpm

G

Grimace (Reflex Irritability)No ResponseGrimaceSneeze, cough, pulls away

A

Appearance (Skin Color)Blue-gray, pale all overNormal, except for extremitiesNormal over entire body

R

RespirationAbsentSlow, irregularGood, crying


Copyright © 1994 - 1998 by Childbirth.org All rights reserved.

Each category is scored with 0, 1, or 2, depending on the observed condition.
Breathing effort:
If the infant is not breathing, the respiratory score is 0.
If the respirations are slow or irregular, the infant scores 1 for respiratory effort.
If the infant cries well, the respiratory score is 2.
Heart rate is evaluated by stethoscope. This is the most important assessment:
If there is no heartbeat, the infant scores 0 for heart rate.
If heart rate is less than 100 beats per minute, the infant scores 1 for heart rate.
If heart rate is greater than 100 beats per minute, the infant scores 2 for heart rate.
Muscle tone:
If muscles are loose and floppy, the infant scores 0 for muscle tone.
If there is some muscle tone, the infant scores 1.
If there is active motion, the infant scores 2 for muscle tone.
Grimace response or reflex irritability is a term describing response to stimulation such as a mild pinch:
If there is no reaction, the infant scores 0 for reflex irritability.
If there is grimacing, the infant scores 1 for reflex irritability.
If there is grimacing and a cough, sneeze, or vigorous cry, the infant scores 2 for reflex irritability.
Skin color:
If the skin color is pale blue, the infant scores 0 for color.
If the body is pink and the extremities are blue, the infant scores 1 for color.

If the entire body is pink, the infant scores 2 for color.
NSU - SLP 6000 PPT (c) 2015

Friday, June 5, 2015

Mrs. R's clinical directives

As soon as lab class is over confirm w/materials room your mailing address
Contact: Rh1088@nova.edu Remy or Ad2437@nova.edu Andrea
  • You'll be in a group - make sure someone can sign for it…
  • All lectures are posted on Bb - Mrs. R chckeing w/Dr. L. to see if these are available - these will tell you what to do..
Materials are for 13 days only; then mail it on to next person on the list…

TESTS: Mrs. R's info is on syllabus - contact her via e-mail or ph if needed, but Bb preferred… Be checking Bb religiously for any msg from Mrs. R.! NOTE MRS R's name in Bb msg…

Review all testing materials as they'll be used in program…

Test forms are important -1/person - just take yours only

When you get the test review manual to decide how you're going to present when giving test.

Description of Assignment:
  • Normal subjects preferred, but you may use non…
  • PLS-5 birth-7
  • PPVT-IV
  • RIPA2 (Ross Info ) tell person to miss some whether it be on purpose to help us better score this…
OJO to getting materials to where they need to be!

Typewritten!

Finals - make a video of any one of the tests you admin'd… and submit link on YouTube UNLISTED and mail link…
Points from lab get added to Dr. L's work

Grading criteria:8
16 total (4X4 tests)
Test form(s) + Project sheets
+ 4 for final video
20 points total
Last person to get box - mails this back to NOVA, not Mrs. R
As soon as you have the box, e-mail Mrs. R. let her know condition of material, if anything was missing, etc.

Start planning whom you're going to test - view videos online on Bb

Make a copy of your work before USPS mailing to Mrs. R

Record 1st 10 minutes
1pt rapport (more than intro yourself) & tellthem what you're gonna do
2nd Did  you give trial item, and did u admin properly
3rd Enthusiasm & empathy
4th give them feedback every now and again - w/o sounding mechanical… point to… (turn page…)

Project form: e.g. EOWPVT - typewrite project fomr
  • .5 chrono age see 1st lect
  • List scores, esp., Std
  • Interpretation - mean 100 -/+ "J" with 105 SS w/in 1 SD of the mean…

Box is sent via FedEx… large box!

Mrs. R suggests not using RIPA2…

You pay the fee to mail the test to the next person…

You can mail - USPS - tracking # & insurance…

4 protocols; 4 project forms; 1 URL… - due on JULY 24!!!!

Feel free to forward qq. to Mrs. R. !!!!

  • This is all to help you self-critique and learn from your experience!!!
Check for Mrs. R's notes on Bb every week…



SLP 6000 - W3 Class Notes


RECORDED PORTION:

Be a 'why' person - know why you are asking what you're doing should cx want to know reason behind your line of qq.

Get case hx, gather info and really start to have this discussion w/family members…
Clarify info from case hx -
Dr. L. starts her interview w/case hx form
  • Ideally, you should have this from cx b4hand
SLIDE 3 - Interview has 3 components
OJO - make sure you don't use professional jargon during the interview…
Be empathetic to anxiety level of family - Emphasize major pts (they may not be listening too much); put them at ease… Using big words = opposite of being professional…  Talk at a level they will understand -> very important!

SLIDE 4 - Interview - You want ppl to be comfortable - lay it out,  make sure they understand, and don't leave you more confused..
  • You may not be able to view case hx prior to meeting the client…
SLIDE E ex of CE qq

SLIDE 6 What is significant - look for patterns…

SLIDE 7 - Define professional terms &
  • Prof writing is clear, concise, to the pt….

Is a problem is child is delayed in multiple areas

When was first word - were they talking around when they started to walking? Another way to ask…

Slide 7 - CS vs vaginal… emergency? Vaginal = still typical (best practice) even if CS are more common - was baby in distress, cord around next - put baby at higher risk for s/l delay - did baby stay in nicu, etc, jaundice? What does jaundice lead to - brain damage… not many ppl know that as it's so easily trreated, but you have to think about places where med attn is not available… important to monitor to make sure it was treated…  where proper tx available - bilirubin levels checked etc,
  • APGAR- only ppl who ask are SLPs… how children are presenting at birth..  Test to determine if child can breathe, whether heart trouble, etc. how the BABY is doing outside the womb… 1-10 higher = better.. 7-9 =  normal; lower than that suggest med attn…

Complicational pregnancy - premies
  • Breathing probs lead to sucking/swallowing probs,  leads to oral-motor devel in prep for SPEECH as we strengthen these muscles… 
Medications - important to know if mothers on during preg, child thereafter… As we go thru case history, we start to piece what things together case hx

Babbles then stops… helps w/ diff dx - autism? Hearing disorder?

Lang dominance vs difference … is it a q of exposure vs disorder..

2nd/3rd lang use.. Know what degree
  • 1st lang tests out well…
  • 2nd lang doesn’t, so what's been the exposure
  • Trouble in both langs?
  • Loss of 1st lang (child enters in school speaks more English … to expose self to 2nd lang community).
  • Ball park lang expos % is 40% exposures… , then assess in that language
Kayser & Langdon - best prac article… SLPs tended to test using std test (in English) to test EL children, even tho formalized testing there does… What is our best assessment? No assessment is the same, and no child can be treated the same…

Gather info on:
Age of acq simul before age of 3 or seq aftr age of 3
To whom did they speak English to, Nanny, in-laws
ASHA - to be proficient in a lang - one must be able to read, write & speak … in that lang

Informal procedure -review

ADULTS - previous ed  & skills
Hobbies, etc. what can we do to bring back fxl communication

  • When adults come in we know they have a probl and we want to bring them back to that fxl communication
OE & CE qq…
OE - begins w/ axn verbs, dialogue, etc.
CE -come much more naturally…

Both have benefits, and both  - OE - open dialogue, lead to other areas…, like CR
CE - gets to more specific, to the point info - like Std test

IN your communication - define prof. terms… ppl who aren't in our field don't know this… professional writing should be clear, precise and to the point…

SUNDAY quiz 9 am - 5 qq 1 hour/1 sitting! No going in and out.. Closed notes and book…  closes end of day…

Discussion board pract OE/CE -

Syndrome Proj - use notes column to expand…

DESP-8, ch. 2

INTERVIEWING

This is a key/central piece in SP
                                                   Vehicle for
                                                giving info

Medium for Therapy -> INTERVIEWING <- Means of estab/sustaining relationship
                                                  ^
                                                  |
                                            Data collecting tool

COMMON INTERVIEWING CONSIDERATIONS:

- Fears of clinician - more perceived than real - good prep, positive outlook, establ good rapport w/cx
- Lack of specific purpose - prep, prep, prep

AN APPROACH TO INTERVIEWING:
-Goal 1: obtain info
1,Setting tone - intro, set groundwork expectations, answer client qq/concerns, etc.
Asking qq

  1. respondent perception of prob
  2. When/conditions prob developed
  3. How has it changed until now?
  4. Consequences (handicapping condition) of prob
  5. How cx/family copes w/it
  6. Impact on the rest of the family
  7. Cx/family expectations regarding dx'ic session

This can be done by "shifting styles"
- asking objective & subjective qq./
- inverted funnel (gen to specific

2. The presenting story: circumstances in recent or distant past that have brought everyone to the table - be aware of distracting antecedents in this process (car wouldn't start, burnt breakfast, etc).

3. Nonverbal msgs: how family/cx reacts, behaves, projects...

4. Things to avoid in the interview:

  1. Avoid over use of CE qq.
  2. Avoid inhibiting line of qq.
  3. Avoid talking too much
  4. Avoid concentrating on phys symptoms
  5. Avoid info overload early on
  6. Avoid hemming and hawing... be direct and straightforward, e.g., "What impact did that have on you?"
  7. Avoid negativistic or moralistic responses verbal/non to cx stmt. - even "good" implies a judgment and keep "why" qq to a minimum (this is not an interrogation)
  8. Should cx wander, avoid abrupt transition to bring cx back on pt.
  9. Avoid allowing cx to provide only superficial answers   
    1. - crosshatch or interlocking qq are often useful in this case to get more details when topics are glossed over
  10. Avoid letting client reveal too much in one interview
  11. Avoid trusting to memory

Goal 2. Give info - no one likes uncertainty - ensure that client leaves with an clear idea of what's going on and what to expect going forward

1. The qq the cx asks;

  1. QQ dealing with info/content - I want to know more about...
  2. QQ with predetermined opinions - Dr. Oz says... what do u think about that?
  3. QQ that are "faint knocking on the door" cx seeks reassurance or support of some kind

6 basic principles for imparting info to cx:

  1. Emotional confusion happens - client may not hear the whole msg 
  2. Refrain from being overdidactic
  3. Use simple lang w/follow clarifying examples/illustrations
  4. Provide parent/cx with something that can be ACTED upon - give'em somethin' to do!
  5. Say what you need to say pleasantly, but FRANKLY!
  6. You may have to be the bearer of bad tidings (what cx and everyone else has been avoiding) and take the brunt of cx anger, etc. 

Goal 3. Provide Release & Support: This is ongoing, not the last thing done in the interview...

USING INTERVIEWING SKILLS BEYOND THE DX'IX EVAL:

1. Ethnographic interviewing - law requires families to be part of IFSP/IEP process
2. Curriculum-based assessment - what are the demand for lang use child is facing vis-a-vis instruction...

IMPROVING INTERVIEWING SKILLS:


  1. Read widely from variety of sources
  2. Listen to all sorts of ppl - get acquainted w/how different ppl talk, project, interact
  3. Specialist support group to compare notes
  4. Role play in prep for interviews
  5. Record your first interviews, analyze, critic with help from instructor...

DESP-8, ch. 1

Diagnosis & Eval in Speech Pathology, 8th ed. (DESP-8)  by Haynes & Pindzola

Diagnosis is an ongoing process to get answers, at least partial answers...

Msmt is based on,
1. RTI - short-term (ST) response
2. EBP - Measures effectiveness of intervention; chooses psychometric instruments - tx - ongoing data collection to aid clinician
3. Dynamic assessment (DA): "therapy-like interaxns to determine prognosis, tx direction, and diagnostic category.

RTI - departure from classic "discrepancy formulas" or 'wait to fail' model
- RTI attempted to be proactive by attending to student needs earlier on
-- Tier I Modif goals of gen ed by gen ed teacher
-- Tier II SLP collab with gen. ed. personnel w/suggestions for indirect svc
-- Tier III SLP provides intensive ST intervention and monitor student progress
-- Tier IV SpEd svcs are provided for students who fail to respond to tx in Tier III
EBP - based in high-qlty research - Clinician expertise - Client pref.

DA - must be goal oriented to be effective -> it builds on Dx
- vs. Static assessment a "snapshot" - see p. 10 for differences (chart)
Stdzd Assessment (SA) = child as passive participant; Examiner = observer; Results id deficits; stdzed admin
DA = active; participant; results describe modifiability; admin = fluid, responsive (examiner's responss contingent on child's behavior...)
- heavily relies on Vygotsky's notion of ZPD

WHO: 'comprehensive assessment'
1. Body strx/fx
2. Activities & participation
3 Contextual factors:

ASHA PPP 'preferred practice pattern' - ASHA PPP (a position paper or a body of practice?) check it out...
1. Measuring outcomes.
2. Going beyond SA:
3. Approaching Assessment scientifically:

Dx to determine the reality of the problem (disorder or no?)
1. Speech diff vs disturbance (breakdown in the msg) => disorder (handicapping condition)
2. Intelligibility of the message
3. Handicapping condition..

Dx to determine etiology of the problem:
Forest through the trees & vice versa... neither relegating cx to a label, nor going clean slate in the approach to dx/eval...

Dx to provide clinical focus: Using qq on condition(s); kn. of cx; expertise; aux svc; intervening factors, etc.

Dx: Science & Art
- Art - clinician's abilities, skills, experience, instinct - beware of "fat folder syndrome" - more is known of the clinician vs client!
- Sc. - EBP, etc. albeit this alone can be confining..

Dx vs eligibility: working w/in parameters of public policy...

Dx'n as a factor
- Experience; flexibility; healthy skepticism to critically eval... interpersonal relationship attributes; objectivity

Cx-Clinician relationship:

Cx as a factor - children-adolesc-adults

. Young children:
Apprehension may stem from:

  1. Inadequate prep for exam by parents
  2. Uncertainty as to how to approach this
  3. Vivid memories of trauma to specialist visits (dentist, etc.) 


  • Help parent prep for dx session (don't come empty handed)
  • Play over small talk to engage child 
  • Gen rule: Ask less/observe more!
  • Learn everything about normal children in order to provide baseline...
  • Limit choices you offer child
  • Be flexible in your use of tests/examinations
  • Absolute honesty and candor - don't make promises you can't keep
  • Whole assessment doesn't have to be done in one session
  • Watch language complexity when talking to child

- Teens: may be resistant & diff to assess

  • Understand pressures they experience
  • Desire to conform to perceived group norms & stds
  • Don't become a teen
  • Tolerance and good humor
  • Explain procedure - satisfy their qq
  • If cx/family is critical of school/staff - avoid being judgmental
  • Review results w/client b4 family/staff

- Elderly cx
* Take into account fatigue, don't talk down to, reduce distrxns, noise, interference...

Putting Dx to work - synthesizing...

  • Bedrock - clinician's kn & skill base
  • 6 boxes => case hx; prior testing & reports; observ cx; interview findings; informal/formal testing
  • Synthesis of findings
  • 5 boxes => Clinical mgmt suggest; referral; progn; further testing; parent info & counseling + Additional clinic experience & kn. base...

PROGNOSIS:
1. Age
2. Length of time of impairment existence
3. Existence of other probs
4. Rxn of significant others
5. Client motivation


PRECEPTS REGARDING THE CLINICAL EXAM:

  • Persons not communic prob
  • clinical exams r conducted interpersonally
  • Sh*t happens
  • OJO - a thorough understanding of normalcy is important
  • Dx doesn't nec happen in a single session
  • Tx is often Dx'ic
  • Determine person's self-image/perception
  • Cx's adjustments to certain prob may be a cover; while these may be part of the prob, they are not hte prob...
  • Behavior is a fx of the ind and situation - cx needs to be able to generalize
  • Dx should be conducted in a multitude of environments
  • Tests = tools
  • Testing can be iatrogenic in that it can suggest probs that may not reflect cx reality
  • Etc.

Wednesday, June 3, 2015

PLS-5

Preschool Language Scale, 5th ed. (PLS-5) - latest version...

This test is both Exp/Rec
This test can take up to 1 hour to admin...
birth to 7;11 - can be used for students in primary for whom other tests may be too much...

Refer to cx by first initial for confidentiality purposes...

Form: 3 tests  in one
Aud Comp - receptive
Expressive Comm - Expre
Total Lang - every bit as important as other 2 and vice-versa.. (it is NOT enough, esp. if there's a massive discrepancy bw AC & EC

From RW -> get SS for each AC & EC => add SS from each to...

Given 1x/yearly... but can be readmin from say, K then 1st - see improvement (or not)

You don't have to do the lang sample checklist for A/P devel

Discrepancy comparison to compare scores AC vs EC

Home Communic QQ - for cx under 2;6 age - additional info (fairly quickly admin'd).

This tests delves into so many different aspects beyond mere Ex/Rec vocab...
- it's useful to uncover weakness/strengths and finding a good starting pt for therapy

Basal = 3 consec right...

CR - caregiver report (if child was reluctant to perform) 1 = right; 0 = wrong

Make sure you have all materials ready to go when testing so you don't lose child;
Take breaks as needed.

RIPA-2

Ross Information Processing Assessment, 2nd ed. (RIPA-2).

* assesses persons with possible right-side brain damage from traumatic brain injury (TBI), e.g. Gabby Gifford. For persons with left-side brain damage, say with aphasia, Alzheimer's, the APD is more appropriate.

* Advantage with this test -> no material is involved, just test protocol 100 qq total or 10 subsets of 10 qq each

Testing best practice: testing subjects are late teen/adults (ages 15-77), so don't talk down to them,,,

* Disadvantage: OJO - this test is AUDITORY ONLY, so rules out visual (no pix)\

TEST
- Each subtest deals w/memory (loss typical from TBI incident)
- Interpretation is based on IMPAIRED (TBI) population

* In hospital, be aware of noise levels, and in general make sure to control for distractions when admin'ing this test.
** Some qq on test may appear "ridiculous", so consult manual...

- Establish rapport w/cx
- Scoring during test:
0 = unintelligible or nothing
1 = participation - even if it's wrong
2 = almost right (of total #)
3 = all right

* If they get 0 on 1st 4 prompts, stop subtest and reflect it on score...

OJO Review Diacritical Marks - these are extra info on how cx answered/participated...


Profile: Make one up as you'll be testing non-TBI or typical person for this practice...


PPVT

PPVT - Form B (Receptive)
Form A & Form B... depending on the test kit you have... make sure you have the right form/kit...

Input ID info...
Chron age - years/months... you can add a 3rd line (day), esp. if you have to borrow from months...

Plot SS on line on cover page of protocol...as well as %ile, CI...
Cx just points...
On back they allow you to compare vocab over time..typically a test is re-admin after 1 year...

You don't need to fill out # of nouns vs other parts of speech, but this test helps with that..

Diff bw PPVT & EOWPVT - PPVT talks about a set...

Page 3 - 1-12 = set we're keeping track of sets...
Complete set rule: depending on how old they r is the set 2;6 to 90;0
- BASAL rule = 1 or 0 wrong of set and you continue testing forward until they miss 8 in a set
-- if in the first set, they get 2 wrong, you finish entire set, then go back to previous set until they get 1 or 0 wrong in set...
-- then move on the following (new) complete set

- Ceiling is reached where 8 errors+ in a set, but if they miss 1st 8, I still need to complete whole (12 prompts) set.

PROMPTS: U typically don't use an "article" Show me 'candy'" or w/younger children you may need to establish like "touch"... older kids can tell you the #...
Give directions first, use trial items b4 going onto starting pt test... ALWAYS start from TOP of set.... it's ok to refocus child who perservates, say only points to 'top right'...


Put slash "/" thru errors
Write # of errors... subtract from ceiling item.

EOWPVT-Video

Mrs. Reicher

EOWPVT-4:
Always refer to the Manual - it's allowed to be visible & open during (any) testing...
- Expressive test, so cx will be talking vs receptive (pointing).
- Normally receptive is usually MUCH higher
-- Parent: My 2 y/o child (HE) isn't talking that much... Well, is he following directions, etc....
- It's a VOCAB & some categorization test, so be aware, there may be other concerns grammar, sent length, etc.
- 15-20 minutes for the practiced clinician, longer for a novice
- You can highlight, make notes on it... you may use pencil (hospitals may require using pen...).

Protocol: Fill in identifying info (name, etc.)
Chron Age:
- Do not round up months if days > 15..., though some tests may allow this...
Comments = child wasn't sitting in seat & cooperating - anything you think could be helpful for eventual dx. /r/ troubles or errors noted... to follow up - cx not penalized for other errors beyond scope of test
Raw: adding to later convert to SS
SS: BIG SCORE - then MARK "X" on chart!
No comparison of Ex to Rec lang vocab (as we're not doing ROWPVT)
Confid Level: we're confident that the score that we find is w/in the 90% or 95% range - a statistical variation...
-- Confid Interval on the back of protocol (95%)
ERGO what ever the SS is, you'll subtract & add CI from SS...
- Gen Instrxns on Protocol..

1. You don't have to read verbatim - keep it conversational to engage cx
"I'm going to show you some pix, and I want you to tell me about what you see"
OJO start of the test = trial items!!!
-- it's good practice, so do it regardless
-- only time in the test wherein if they get it wrong, you can correct them - teachable moment. "Yes, it does go bowwow, but it's a dog... What is it?" you can't help in the rest of the test
If on the test, there's an arrow and cx names the whole, you can "cue" the part, "yes, but what is this..."
-- test allows part of a major word - 'eat' for 'eating'
-- Categorization (trial prompt 4): "that's right, what are they? Are these foods?

BASAL: for test to be Valid & Reliable (V/R) must have 8 consecutive right answers...
- Space - write what they say when they give you the answer
- put a slash thru each error, so Mrs. R. know what's wrong... record all words to present examinee from making analysis of his/her progress
- You can prompt "What is this?" for the first few prompts, change up, or say nothing... "Name this", "Tell me about this one?"
Testing is predicated on easiest to hardest...

E.g., We're starting on item 35,
-- I'm going to be making notes thru/o, so don't worry about what I'm writing.
-- If they get all 1st 8 right, put a bracket as this will show BASAL... we'll assume all 34 previous = correct (even if they might have gotten them wrong if asked).

CEILING: 6-in-a-row wrong... and bracket!

TEST MATH - Ceiling item - errors = raw score...transfer to front of protocol, consult Manual for RW to SS conversion - read top title of SS pages ... use correct chrono age... always be on the right page...
MANUAL: be accurate, e.g., cx = 5;3... use a paper to guide your vision for column to not waylay...
46 RW => 84 SS
-- %ile range - follows SS, on p. 96 of manual SS column ...
-- Age Equiv (AE) - don't make a big deal of this...

EXAMPLE OF BASAL...
- W/in first 8 consec., once an error happens, e.g., 4th or 5th prompt, you have to then go backwards (not forwards!) until cx can establish 8-in-a-row... all the way to the very beginning if need be. ONCE you have 8 consec, you pick up from where you left off (following prompt) "+" for correct. If NO basal (going to beginning), then write note in comments - DID NOT ESTABL a BASAL...... If they do not get 6 wrong... DID NOT ESTABL a CEILING...

Bracket last 8 b4 the first error (even if a 2nd basal gets established earlier in the test form)/ USE THE HIGHEST BASAL of a DOUBLE BASAL... some tests have it, some don't... EOWPVT does...

IGNORE ALL MISTAKES occurring b4 the HIGHEST BASAL... (even if this occurs after chron starting point... there could be 3 basals... if there are too many basals, maybe you're giving too many cues/chances - keep to the directions..... it's unusual...  check FAQ on p. 31

- Do not go forward if they don't get 8-in-a-row right..

= Interpreter, e.g., English & Spanish - only 1 prompt in each is allowed, but answer in either language is acceptable...

INTERPRETATION: Project Form (PF) - in syllabus...
Chron Age
List Scores, espec - SS & %ile
Put PF w/in Protocol when sending along to Mrs. R.
Brief interpretation of results... with a mean of 100 and SD of +/- of 15 "J" with standard score of 84 is within 2 SD below the mean
If they are w/in normal limits - above/below 1 SD which is w/in normal limits - DON'T use "AVERAGE" (we don't know what that is...)
-- for most Stdzd tests 100 mean; 15 SD...

Tuesday, June 2, 2015

SLP 6000 - W2 Class Notes

Dr. L. - 1st half class - finish up topic 1

Slide 9: Screenings:
Determine whether indepth/more testing is necessary
  • To determine if additonal testing..

Slide 10
  • Formal, eg., PLS-5, celF, ETC.
    • Always get parent permission
  • Beware of false positive - yes in screening; but does well in additional tesitng
  • Vs. false neg - child passes screening, but in further testing fails…
Slide 11 - cliff notes
  • DIAL-3 w/cheat sheet of what testing entails
  • Fluharty preschool

Slide 14 outcome passes->stop or…

Slide 15 Prognosis - prediction of the outcome…
  • It's the piece of info that tells the family if s/he will get better and how soon…
  • Speech SLH -
    • Age - when was tx begun?
      • 60 y/o stroke px vs 80 y/o
    • Health issues
    • Motivation
    • Family involvement
  • Artic
    • Stimulability is a factor
Slide 16 - prog stmts
  • You're not a fortune teller…
  • It's similar to a severity stmt that helps with acctability
See ex….
Family involvement - family bringing child to therapy, etc.


Slide 17 thoughts on prog
  • It's ok to wait to write this a few sessions into working w/px
  • It doesn't nec have to be positive
Slide 18 Universal precautions: intro'd bw 1985-1988
  • Bloodborne pathogens - considered potentially infxcious - see what your site follows and become familiar with facilities rules… hand washing, etc. protect self and px…
Slide 21 - Hand washing most important & 1st line of defense against germs
Slide 22 - Psychometrics…
  • Reliability - if you gave a test over and over… you'd get the same results
  • Validity - the test measures what it proposes to measure, e.g., PLS-5 measures child's language skills - so a child who does well there will do well in a pre-k /life environment w/in pre-k age range
Slid 23 - Norm-ref
Designed to look at a large sample
Seen in a bell curve -majority will average 100 or score w/in the middle range +/- 15

SD
e.g. bw 2-3 sd below/above or 3 (w/in) sd above/below mean

  • Or SD was 106 which is .4 SD or within 1 SD above the mean…
Next-next week - CASE HISTORY FORMS

SLP 6000 - W1 Class Notes

Screenings; Dx; Universal precautions; psychometrics

Goal of Eval: Obtain as much info on client and his/her commdis
  • Determine existence of prob
    • Valid info… observe, data, bkgrd…
    • Then we take all of this and org/rev and interpret it -> this makes us clinicians - we're not just testers
    • We label, then refer for svcs…
    • Assessment should be TAILORED to each client
    • Include families, environment…
  • ADULTS Vs CHILDREN
    • Children - we're looking to see if there's a prob to tx or monitor
    • Adult - usually know there's one and want it addressed
  • Keep open-mind/
    • Avoid beginning preconceived notions
    • Dx = ongoing process
    • Confidentiality
    • Professionalism
Components of an eval:
ALL AREAS of SL (even if kiddo comes in w/ just /r/…)
Possible co-occurrence of disorders - e.g., /s/ may co-occur with plurals, for example… 75% co-occurrence speech & language disorder…

This doesn't mean it's comprehensive …
  • We can use lang sample into an informal artic sample.

SLP 6000 - Ch. 3 of ASLP-5

Obtaining Pre-Assessment Info

Written case hx - be aware of value of case hx form & its limitations
1. cx may not understand all the info/terminology
2. cx may not have sufficient time to fill out the form
3. cx may have vague recall of events from past (months/years ago)
4. after significant time elapsed from onset of prob - harder for cx to recollect
5. Other life events may hinder cx recall
6. CLD perspective may interfere with accurate provision of info

OJO - allergy awareness - know this upfront!!!

Interview cx/family/caregivers

OPENING Phase:
Introductions
Describe purpose of mtg
Indicate how much time this might take

BODY of Interview:

Discuss cs history & current status in depth
If written case hx has been filled out beforehand, review w/cx

CLOSING Phase:
Summarize major pts from body of interview
Express your appreciation to cx
Indicate follow up steps...

QQ most commonly asked for the different CommDis areas, pp. 68-73


Info from other professionals

SLP 6000 - Ch. 2 of ASLP-5

Multicultural considerations
Working with culturally and linguistically diverse (CLD) cx.

Knows the culture of the cx: Different groups have different views on
1. disability and tx
2. woman's role in society
3. familial authority
4. displays of respect and addressing different persons w/in group
5. what to disclose on personal & family hx
6. Stdzed testing
7. Indiv vs group achievement
8. how children should behave around adults
9. eye contact appropriateness
10. concept of time
11. express disapproval in varying ways
12. perception of personal space
13. how much small talk is sufficient b4 going into more serious matters
14. mistrust toward other (dominant or not) groups...

Ethnography - one method of becoming more culturally knowledgeable

Hx of client - in some cases getting a verbal report may be easier for EL cx as they may have difficulty reading/writing in English

Know what's "normal" in cx's language

Normal patterns of 2nd-Lang acquistion:

1. Interference or transfer: communic behaviors of 1st lang to 2nd.
2. Fossilization: 2nd-lang errors become ingrained even after speaker has achieved high level of 2-lang proficiency
3. Interlang: speaker devel a sort of personal ling system in the process of learning the 2nd lang
4. Silent period: time when EL is actively listening and learning but speaking little
5. Code-switching: EL unknowingly alternates bw languages
6. Lang loss: decline of EL's 1st lang

BICS (home/playground language) basic interpersonal communic skills
CALP (academic/classroom lang) cognitive academic language proficiency

Good assessment practice with CLD cx:

1. use culturally appropriate materials
2. test in cx dominant lang & English
3. Collect multiple S/L sampls
4. Use narrative assessment
5. Focus on cx's ability to learn rather than focusing on what cx already knows
6. be prepared to modify your assessment approach as you learn cx's abilities.
7. consult w/other professionals
8. Consult w/interpreter
9. Be sensitive when meeting w/cxs or caregivers in an interview situation

SLP 6000 - Ch. 1 of ASLP-5

In grad school, I am becoming re-acquainted with the Assessment in Speech-Language Pathology..., 5th ed. (ASLP-5) by Shipley & McAfee. The first closed-book/note test upon me, I need to connect the dots from Ch. 1 - 3, so here it goes:

Ch. 1 Foundations of Assessment

Overview - a good assessment = one that is thorough, uses variety of assessment modalites, valid, reliable, and is tailored to the individual client.

This entails, 1.obtaining historical info on client, family/caregiver(s) & nature of disorder;  
2. interview with client &/or family/caregiver(s), or both;
3. evaluating the structural and fxn'l integrity of oralfacial mechanism;
4. taking adequate speech-language sample(s) and evaluating it/them in light of use/abilities of the various areas of communication - in the case of dysphagia, assessing client's chewing/swallowing abilities;
5. screening clients hearing abilities (or obtaining eval info on this);
6. evaluating  assessment info to determine impressions, diagnosis or conclusions, prognosis, and recommendations;
7. sharing clinical findings thru and interview with client, formal (written) report or informally, e.g., phone contact w/physician.

Keep in mind - some disorders have extensive history (hx), others do not; Client(s) (Cx) has/have different primary communicative problems. Some cases require extensive interviewing or more detailed report writing, whereas others do not.

* No matter the lengths required for this effort, some consideration for each of the 7 areas listed above is necessary...

NORMED-REF tests

Should be normally distributed along the bell curve
Should be standardized (scorable to std. & %ile)
Should be normed to a population from which a rep sample has been taken
Should be valid:
- Face: tests what it claims to
- Content: rep of the content domain it sets out to test, e.g., articulation
- Construct: measures pre-determined theoretical content, e.g., PLS-5 tests skills that show, based on empirical observation, skills that the typical child will master by the various ages...
Criterion: established by external criterion -
-- Concurrent: in comparison to a widely accepted standard, e.g., GFTA-2 and tests created thereafter, or Stanford-Binet IQ test...
-- Predictive: test should be able to show what Cx is able to do down the road, e.g., GRE purports to show how students will perform in grad school...

Reliability = results are replicable
- Test-retest: refers to test's stability over time
- Split-half: refers to tests internal consistency
-- scores from one 1/2, e.g., odd #s are compared against those of the other 1/2, e.g., even #s of test.
- Rater: refers to level of agmt among indiv rating test
-- intra - establishes results consistent by one indiv over time
-- inter - establishes results consistent by multiple indiv over time
Alternate form (aka, parallel form): refers to test's coefficient with a similar test, or do they both produce similar results when admin'd to similar groups of ppl.

Standardization(aka, formal): std != to norm-ref - it simply means a score is attached (but not necessarily reviewed for validity/reliability).

* What to look for in testing manuals:
- Purpose(s) of test
- Age range it's designed and stdzed for
- Test constrxn & development
- Admin & scoring procedures
- Normative sample group and statistical info derived from it
- Test VALIDITY/RELIABILITY

CHRONOLIGICAL AGE OF CX: how to establish.
* I noticed a variance among the ASLP-5 and some automated (Pearson, Superduperinc) forms out there. I'll need to clarify what constitutes a month, how it all applies (borrow previous/later one), if Feb is it 28 days, or 29 + for leap year, and banker's year (30 days for every month), 31 days, or the actual amount of the month borrowed from...

BASAL: what's the starting point for the test?

CEILING: what's the test's ending point?

ACCOMMODATIONS/MODIFICATION OF STDZED TESTING:
** Stdzed admin.: Follows protocol to the letter
- Accommodations: minor adjustments to testing situation that don't comprise stdzed procedure, e.g., large print version, etc.
- Modifications: changes to testing protocol, e.g., re-wording test, allowing extra time, etc. -

Understanding Stdzd Scores:

- Z- score: tells how many std deviations (SDs) a stdzed score (SS) is from mean
- Stanine = 9-unit scale where a score of 5 = ave. performance. Each score, exc. 1 & 9, is equally distributed across the curve
- Confidence interval: rep. degree of certainty on the part of test developer - the higher the better, e.g., 95%. Thus, a range or reliable scores, not just a single one.
- Age/Grade equivalency: least useful of the SS and most misleading = the average raw scores on a test...

Health Insurance Portability and Accountability Act (HIPAA)
Fed law designed to improve health care system by
Protecting privacy & confidentiality (among other things)

PLEASE READ BEFORE PROCEEDING: 

* A disclaimer/note of caution, of sorts: To anyone seeing this, these are drafts at best, and full of misleading typos and errors at worst. While imitation is the highest form of flattery, the assumption is that any use of these notes is at the user's own risk for which s/he therefore assumes all responsibility required of a student at the grad school level. This entails following instructor's directives for learning and test taking, consulting any and all sources directly, etc. In no way can the author of this blog be responsible for your grade or the soundness of the doctrine herein contained. You are now warned; proceed at your own risk!

To put this more informally: What can I say? I made this blog (selfishly, I will admit) to suit my own needs, fill my own gaps in knowledge of the materials required toward becoming an SLP going for the CCCs (all in due time)!


Intro -

In the spirit of the wonderful little tome by William Zinsser, Writing to Learn, I dedicate myself to putting on paper in succinct, punctual, and condensed form all that I will be studying - hopefully learning - over the course of my 3 year program at Nova Southeastern University (NSU). Not only will this exercise afford me a sounding board, if you will, but also access to information I hope will prove useful in the learning of materials, preparing of exams, and the eventual practicing as a full-fledged clinician now and going forward in my career. Let the games begin!