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38 Cards in this Set
- Front
- Back
3 Stages of Spontaneous Recovery
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Acute (onset to Day 3)
Subacute (3-21 days post stroke) Chronic (anything past 30 days) |
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Purposes of Assessment
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1. To identify specific problems (is there an aphasia?)
2. To describe language behaviors 3. To determine intervention goals 4. To identify factors that facilitate the retrieval of language |
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Assessment Outlines (parts of an assessment)
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1. Patient History
2. Speech and Language testing 3. Informal Observation 4. Additional testing (cognition, hearing, swallowing, motor speech) |
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Patient History (what to include)
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1. Medical Chart/Case History form
2. Personal history 3. Medical History 4. Identify dx 5. Medical Orders (for hospital or if insurance requests) |
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What is the nature of impaired auditory comprehension?
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-Difficulty applying meaning to incoming words
-Difficulty understanding word relationships -May be be confounded by a memory impairment |
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Auditory Comprehension Assessment Tasks
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-Single word comprehension
-Comprehend objects by function -Follow 1,2,3, step directions -Comprehend simple yes/no ?s -Comprehend complex yes/no ?s -Comprehend simple and complex Wh- ?s -Comprehend narratives of increasing length -Understand simple conversation with others |
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Memory deficits that can be associated with impaired auditory comprehension
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-Slow rise time
-Noise build up -Retention deficit -Information capacity deficit |
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Comprehension is inversely proportional to...
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the level of abstractness, intellectual complexity, semantic relatedness, rate of presentation, sometimes length
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Conditions that facilitate auditory comprehension
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-word frequency of occurrence
-word class -imageability -salience -presence of context -repetition -personal interest -number of answer choices |
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With how many answer choices does performance decrease?
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7-8 unrelated pictures
or 3-4 related pictures |
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Nonlinguistic factors that facilitate comprehension
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-decreasing rate of speech; pauses
-repetition and redundancy -gestures and visual stimuli |
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What is the nature of impaired verbal expression?
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-Deficiencies in word finding including some paraphasic errors
-Syntactic impairment -Motor speech production impairment (apraxia or dysarthria) |
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Marshall's Hierarchy
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Delay (LEAST IMPAIRED)
Semantic Association Phonetic Association Description Generalization (MOST IMPAIRED) |
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What is the nature of impaired reading comprehension?
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-Process is slowed and more effortful
-Difficulty understanding syntax -Difficulty understanding words -Visual problems (hemionopsia) -May be associated with memory deficit (can't be sure if it is a decoding problem or a memory problem) |
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Assessment tasks for impaired reading comprehension
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-Match letters, words
-Match words to pictures -Recognizing and reading letters -Read/comprehend sentences of increasing length, then syntax -Comprehend main point of, then detail question of, paragraphs of increasing length -Comprehension of daily life materials (menu, bible, etc.) |
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Description of nature of writing disturbances
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-Paresis or nondominant hand use; mechanical errors
-Literal, verbal neologistic paraphasias in writing only -Complete agraphia |
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Assessment tasks for written expression disturbances
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-Copying letters/words
-Writing to dictation letters/words -Automatic writing tasks (name, address, numbers) -Writing 1 word/short phrase answers to questions -Writing a picture/object description |
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Broca's Aphasia
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-Nonfluent; agrammatic, telegraphic, abnormal prosody, decreased length, word-finding problems
-May have apraxia -Mild-Severe naming/repetition -Good comprehension -Good reading -Writing difficulties b/c hemiplegic/telegraphic/agrammatic; decreased output |
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Wernicke's Aphasia
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-Fluent; grammatical, but no content; paraphasia; logorrhea
-Good articulation -Mild-Severe naming and repetition -Poor comprehension and reading -Writing reflects speech output |
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Conduction
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-Fluent with paraphasic errors
-Good articulation generally -Mild-Severe naming impairment -EXTREMELY POOR REPETITION -Mild/Mod comprehension, trouble with complex or mult. speakers -Reading usually good -Writing reflects speech |
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Anomic
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-Fluent with WORD FINDING PROBLEMS
-Good articulation -SPECIFIC DIFFICULTY with NAMING -mild/mod repetition and comprehension -reading and writing are good |
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TCM
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-Less severe than Broca's; speech can be fluent/sparse
-May have apraxia -Naming better than expected -CAN REPEAT -good comprehension, reading, writing |
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TCS
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-Similar to Wernicke's but more paraphasias; lacks nouns; no logorrhea
-Mod/Sev naming -CAN REPEAT -Poor comprehension -Good reading and writing |
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Global
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-Nonfluent, few words, serial utterances, stereotypic phrases, uncommon expletives
-Severely impaired naming, repetition, comprehension, reading, and writing |
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How do you facilitate expression?
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-Recall what we know about what words/structures to select.
-Discuss activities participated in before the stroke -Find out nature of the activities/what % of time was devoted to each -Ask if the person can still do this things: life now vs. before the stroke -Counsel about adjusting to life now (what makes a person competent and good?) |
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How do we use Marshall's Hierarchy to judge expression?
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Judges a patient's errors form least to most impaired.
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How do we use Marshall's Hierarchy as a cueing system?
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Delay: give least amount of info, but give pt time to think
Semantic: give 2 words semantically related to target Phonetic: "It starts with /b/" Description: describe the target Generalization: SLP says the target word and patient repeats |
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What is the most salient cueing association?
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Semantic cues and initial sound of the word
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What does CART stand for?
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Copy And Recall Treatment
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What are the steps for CART?
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1. ACT (Anagram, Copy Treatment): Pt writes down word given a picture; if can't do it, SLP tells pt the word; if still can't do it; SLP gives the letters in any order
2. CART homework: if successful in therapy 3. Conversation: ask questions to elicit target words (use functional words) |
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What is VCIU?
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Voluntary Control of Involuntary Utterances
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What are the steps for VCIU
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1. Create a list of real words that anyone has heard the pt say spontaneously.
2. Write words on notecards. 3. Show pictures of targets and ask pt to say; if can't, show written word and ask to read; Only keep words pt can name 4. ask questions requiring target words to answer with picture cue and eventually without picture cue. Can use cloze. |
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What does RET stand for?
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Response Elaboration Training
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Who would you use RET with?
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Patients with some verbal expressive abilities (higher level than CART and VCIU). Can be nonfluent or fluent. Works for apraxia.
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What are the steps for RET?
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1.Verbal instruction and stimulus presentation.
2. Elaboration, model, reinforce 3. Cue with a wh- question 4. Combine pt response, model, reinforce 5. Request repetition and model 6. Reinforce, model |
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What is the goal of RET?
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To activate the semantic network.
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What is the hypothesis behind semantic feature analysis?
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Impaired access or slowed processing to get to the lexicon. If we directly work on the semantic system, it should improve their comprehension and expression.
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How does semantic feature analysis work?
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Patient comes up with words and SLP comes up with semantically-related features.
-What does it look like? -How do you use it? -When do you use it? -Who uses it? -Why do you use it? |