CDIS 4433 1st EditionExam # 2 Study Guide (Chapter 8: Assessment- I mistakenly put on the previous study guide.)Chapter 9: Treatment of aphasia- Effectiveness vs. Efficacyo Effective - achieving maximum productivity with minimum wasted effort or expense.o Efficacy - the ability to produce a desired or intended result.o It’s possible to be effective without being efficacious, but you want therapy to be both.- Effectivenesso It all depends on whether the proper treatment is used.o Bad tx (treatment) yields bad results every time. If the dx (diagnosis) is inappropriate, the tx will be inappropriate, as well. o Variables affecting outcome: Pt. age Premorbid language skills Pt. Education Neuropathology Medical, neurological, behavioral status Hearing acuity Visual acuity Motor skills (not necessarily language related) Severity of aphasia (duh!) Timing of tx Treatment technique (choose well – look forEvidance Based Practice) Accuracy of tx application – (do your tx correctly) Length of tx Intensity of tx (extremely important, and a problem for university clinics) Family involvement (also extremely important) General health (improving or declining) Spontaneous recovery (our BFF)- Pharmacological Treatment for Aphasia (stroke)o IC thrombolytic therapy – specifically Tissue Plasminogen Activator (t-PA)- what Dr. Schaefer had to take. Timing is critical- 3 hour window “symptom reverser”o Antiplatelet agents – meds that prevent clot coagulation (aspirin therapy) “preventer”o Anticoagulation agents – meds include heparin, warfarin, Plavix, Eliquis (new). “preventer”o Carotid endarterectomy – removal of plaque in the internal carotid arteries (surgical procedure) “symptom reverser”- Principles of language treatment for aphasiao Good diagnostic informationo Understanding the client’s family situationo Understand expectations (counseling?) o Mobilize support systemso Select meaningful target behaviorso Sequence target behaviors appropriatelyo Intense tx regimeno Provide max stim control to establish target lang skillso Reduce stim control in gradual stepso Provide immediate feedback (despite what Hegde says – not always positive feedback)o Provide immediate correctiono Arrange naturally occurring consequences o Train in self-monitoringo Train family to help w/ home tx, and supporto Create a family social and support systemo Follow up to monitor improvement and maintenance- Special considerationso Family Counseling – critical – Expectations must be appropriate, and the family needs to be encouraged to assist.o Teach compensatory communicative strategieso Provide a realistic prognosiso Practice, Practice, Practice, and then practice some more. Caveat – Insurance doesn’t like to pay for practice. Use family and maybe an SLP-A for practice time. o Tx should be client specific. No cookie-cutter therapyo Team-based tx.o Have an exit strategy. You have to decide when tx is no longer useful, and then it must be terminated.o Understand ethnocultural, financial resource, transportation, environmental, and other factors that might affect the progression of therapy. - Treatment for auditory comprehensiono Limiting factors: Slow rise time (lag between stimulus and response) Noise buildup Information processing lag Capacity deficit Retention deficito Promoting factors Comprehend more frequently used wds Comprehend nouns better than verbs (more concrete) Comprehend pictured verbs better than abstract Comprehend unambiguous better than ambiguous Comprehend shorter sentences better Comprehend syntactically simpler better Comprehend active sentences better than passive Comprehend relevant sentences better Comprehend slower rate of speech w/ pauses Comprehend better when stress important words Comprehend better w/ no background noise Comprehend better when message is redundant Comprehend better when message is repeated Comprehend better if number of choices is limited  Comprehend better when pair visual stimulation w/ auditory stimulation Comprehend better if speaker’s face is visible Comprehend better w/ alerting stimulation – This is BIG, and needs to be shared with family.o Progressions are important (keep language at the right level for the client, and work from simple to complex) For Comprehension of singles words- Pointing to single objects should precede pointing to action picso Objects are easier than picso Good color pics are easier than black and white line drawingso More basic (or concrete) is easier than more abstract For Comprehension of action pics- Action pics can be very busy! Be careful- Make the stim item clear – no ambiguityo May need to model correct response, or instruct. Remember tx is a teaching process, not just a testing process Comprehension of spoken sentences- Response to spoken questions may need a LOT of instruction- Start with “yes or no” – progress to short (one word) responses, and then longer responses Following spoken directions- Much more stressful- Start with short directions, then increase number, length, and complexity Sentence Verifcication – Is the statement correct- Like true or false. Look at a pic and ask – “Is the woman riding a bicycle?” - With progression, the patient can correct false statements. Discourse Comprehension- Read a story aloud and ask questions, increasing in complexity (Order:Main idea, Characters, Specific details, Implied details, Projected outcome) - Might also check whether the patient can properly sequence a re-telling of the story. Understanding questions in conversation.- Again start simple. Yes-no answers. Simple confirmation. More complicated confirmation. More abstract.- Verbal expression treatmento Many, many different levels of tx, hereo May be extremely high level, or extremely low levelo Again, success depends on a good foundational dxo Again, progression of therapy from simpler to more complex is critical to success. You can’t skip steps. The hierarchy is important. - Treatment for namingo Often the inability to name is caused by a variety of different problems, so what works for one patient may not work with another – (Is it a memory issue, a word-finding issue, a cognitive issue, or something else?)o Types: Word Production Anomia (motor problem)- Pre-frontal anomia – like TMA- Articulatory