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Reasons for evaluation
- Establishes or rules out disorder (eligibility)
- Establishes severity level
- Establishes intervention plan (POT)
- Establishes prognosis
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Preliminary Assessment
- Look at referrals
- Look at the old case history or the new case
- history that you have them do
- Be able to fill in the blanks – read between the lines
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Assessment
Common aspects/procedures
- Perform oral-peripheral exam
- Screen hearing
- Obtain language sample
- Administer standardized tests
- Administer other evaluation measures
- Conduct disorder specific evaluations
- Observe a variety of skills
- Analyze the results
- Determine impressions/recommendations and discuss as appropriate
- Write a report
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Perform oral-peripheral exam
Helps you determine the structure and function of the oral cavity
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Obtain language sample
- Important assessment instrument
- Allows assessment in natural context
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Administer standardized tests
Reliable, valid, and culturally sensitive
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Areas of Assessment
- Language
- Motor speech
- Voice
- Fluency
- Hearing
- Augmentative/Alternative communication (AAC)
- Collateral areas
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Domains of Language
3 areas
- Content AKA semantics
- Form AKA syntax, morphology, phonology, and prosody
- Use AKA pragmatics including interactional aspects, conversational rules, adapting/adopting listener perspective
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Content – Semantics
2
- Speech and language problems have an increased probability of occurring together
- Semantics – vocabulary, concepts in regard to content, and linkage of ideas.
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Form – Syntax
4
- Syntax – the organization of words to provide meaning
- Morphology – the structure of a word (prefix, suffix, vowel sound change due to placement, plurals, tenses
- Phonology – sound system
- Phonemes, articulation
- Prosody – stress, intonation, pitch, projection (loudness), and rhythm
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Use – Pragmatics
- Asking for clarification
- Ability to protest
- How do you express language?
- How do you use language?
- You cannot directly observe comprehension.
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The clinician’s way of questioning does influence the client’s response.
- Open ended questions are best
- Rather than “What is this?” ask them “Tell me about this” because it opens the opportunity for the clinician to make lots of observations about language
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Motor-speech
4
- Speech intelligibility increases communication effectiveness
- Analysis of spontaneous speech provides the most valuable information regarding intelligibility
- Oral peripheral exam is very important to see what structures look like and the way that they are functioning
- This can tell you why someone may have an intelligibility issue
- Diadochokinesous
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Areas of Assessment
7
- Language
- Motor speech
- Voice
- Fluency
- Hearing
- Augmentative/alternative communication (AAC)
- Collateral areas
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Voice - 7 areas
transgender
- resonance, phonation, pitch, loudness, quality, rate, and respiration
- In transgender communities we may work on voice but it is not a disorder it is a difference
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Fluency
This is often accompanied with some physical issues such as eye blinking, grimaces, twitches, tension
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Methods of Assessment
3
- Norm-referenced or standardized tools
- Criterion referenced tools
- Observation tools
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Statistical considerations:
- Reliability
- Validity
- Standardization or norming sample
- Descriptive statistics
- Error
- Test scores and norms
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Norm referenced
4
- Standardized
- Compare an individual’s performance to the performance of others with similar demographic characteristics
- Useful for determining existence of a problem and establishing eligibility for services
- Help determine goals and objectives and help determine what to work on first
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Reliability
- The dependability of a test or procedure to result in consistent results over repeated administrations and by different examiners
- Reported in coefficients - .90 or better is desirable
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Validity
The degree to which a procedure actually measures what it proposes to measure
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Descriptive statistics
- Normal distribution
- Mean score-average
- Standard deviation
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Error
Standard Error of Measurement and Confidence Interval
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Test scores and norms
2 types
- Scores of relative standings
- Developmental scores
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Scores of relative standings
5
- Raw score
- Standard scores
- Percentile scores (not the same as percentages)
- Z-scores
- T-scores
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Developmental scores
2
- Age equivalents
- Grade equivalents
- (do not be surprised if you are required to do this)
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Administration of Norm-Referenced Tests
- Administer exactly as detailed
- Deviations affect the results and must be reported. Interpret with caution.
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Criterion Referenced Tools
- Allow us to measure skills in terms of absolute levels of mastery
- Do not tell us if persons vary from a normative group
- Useful in baseline measurements and developing intervention targets
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Behavior Observation
A method to objectively describe behavior in a systematic fashion without reference to any predetermined standard.
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Behavior Observation is useful for measuring
4
- Presence/absence of a behavior
- Frequency, rate, magnitude or duration of its occurrence
- Situations in which it is likely to occur
- Involves Ethnography, conversation analysis
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Ethnography
Considering the client’s culture
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THE ASSESSMENT PROCESS FLOW CHART
7
- Referral
- Data gathering
- Diagnostic
- Results
- Recommendations
- Share information with client/family
- Complete clinical report
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Referral
- Must be addresses within 24 hours
- must make contact within 24 hours
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Data gathering
3
- Relevant records
- Case history information
- Client/family interview
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Diagnostic
5
- Client observation
- Test administration
- Informal measurements
- Screen related and collateral areas
- Stimulability
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Results
5
- Score tests
- Analyze/integrate data
- Develop profile of strength and needs
- Start to think about goals and objectives
SEVERITY PROGNOSIS REFER
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Recommendations
What ever we say we recommend we must do, if not it may be a lawsuit
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Share information with client/family
Show empathy for the feelings of these families as we share information
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Complete clinical report
done in writing
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