Diagnostics 2
Terms
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- evaluation
- informal way deter strength and weakness. Pinpoint potential prob areas, need for thearpy
- diagnosis
- dx
- diagnosis process
- ongoing, focus on person(not disorder), working on a jigsaw puzzle start with framework, and fill in pieces
- Important for therapist
- flexible, critical, objective, insightful, professional, rapport
- Flexible
- important for therapist-change thearpy plan to meet goal. What works one time or with one client not necessarily w/another
- Critical
- important for therapist-trust education and instinct does therapy idea makes sense
- insightful
- important for therapist to sense something that is not quite right
- Objective
- important for therapist-report what you see not what you think about person
- professional
- important for therapist don't let personal life get in way of therapy.
- Rapport
- important for therapist-build trust by being sincere and honest
- Why do evaluations
- Determine reality of prob, determine etiology, determine appro. options, facilitate implementation of plan
- Deter. reality of prob.
- why evaluate: disorder? difference? treatable?
- Difference in speech
- different from others, listener distress, speaker disress, interferes w/ msg.
- Disordered speech?
- age, cognition, cultural norms
- Determine etiology
- why evaluate: find probable cause of the problem
- Determine appro. options
- why evaluate: take info from eval to form best plan
- Science of diagnosis
-
Organized
Predictable
Procedural
objective
Inquisitive
Overlaps with art - Art of diagnosis
-
Flexible
Sensitive
Insightful
Curious
Experience
Overlaps with science - Eligibilty Issues
- Educational setting, Medical setting,Why can private practice be different?,Severity Rating Scales
- Educational setting
- 2 measurable test score-fall 1.5 SD below avg., observation by teacher-test must be supported by observation-a lot kids one therapist
- Medical Setting
- Private practice-anyone can qualify-no issue w/ crowd. Funct. Goals-what can do b4? vs. what can do now? defecit canidate for therapy.
- Severtiy rating
- rated severity of disorder 1-4 higher points-more involved the case is-results in less clients
- Considering young kids
- Spend time w/ kids, no what the it thing is, let them teach you, limit choices, play, be flexible
- Considering adolescents
- Respect, explain what's going on, get know what's popular.
- Components of effective eval
- informal observation, standardized test, case history, interview w/ responsible person, results of prior testing: one alone can not be appro. eval.
- determine and report a prognosis
- level of cognition, present level of perform (motivation), severity of prob, support, age, health, previous incidence, length of time since incident, co existing conditions, stimulability
- Prognostic statement
- ie. Prognosis is judged to be good for recovery of speech to prior level of function due to:
- Prep for interview
-
Getting the environment ready
Know what you want to know
Know why you need to know
Practice asking questions- out loud
Get your behavior under control - Get environment ready
- quiet, unclutter, chairs, respectful, arrangement, show your listening, unintimidating.
- Know what you want to know
- outline before, names of people in interview
- Know why you need to know
- don't ask personal questions unless they are necessary
- Practice asking ?s
- out loud conversational phrasing, clear and concise
- Getting behavior under control
- nervous habits, volume, pitch, semantics(children v. kid), no cursing, stay away from tech jargon, dress, professional presentation
- Types of interview questions
- open-ended, primary, neutral all questions should be clear, relavent, related to topic, straight forward, accessible to variety of language levels.
- Open ended questions
- prompts-more than yes/no-tell me about-non-directive-opp. of closed question: good for getting info-both will make up interview
- Primary question
- First question to set up topic. start w/ a list of primaries, but another one not listed may come up.
- Secondary question
- Used to clarify and follow up a primary question
- Neutral question
- thers' no bias opp. of leading
- Leading Question
- Force the person to answer in a certain way-answer is suggested within question
- Interview openers
-
start w/ ice breakers, Summarize problem
Explain events up to now
Refer to referral source
Ask a question
Combo - Advantage to open ended questions
- Rapport-info that may not be exposed otherwise
- Problem with open ended
- may not share, tell a person what they want to know, rambliong, irrelavant info, time
- Advantages of close ended
- specific info quickly
- disadvantages of close ended
- Not in depth info
- Patterns of stuctural sequence
- funnel, inverted funnel, tunnel
- Funnel sequence
- start with an open ended question moves to closed ended question
- Inverted funnel sequence
- Start with a closed ended question move to open ended question
- Tunnel
- funnel questions together
- Types of testing
-
Screenings
Diagnostic tests
Informal Tests and Descriptive Statistical Analysis - Screening
- determine if further testing is needed-efficient-good for large group, filter-if a screening id's too many people it's not appropriate
- Flhuarty screening
- ten cards w/ difficult blends
- diagnostic test
- statistical comparison, part of determining eligibility for school, id strength and weakness, guide for futher eval.
- informal test
- describe behave in natural environ, language sample, determine goals-not appropriate to write goals base on standard test, measure
- dynamic assessment
- change assessment base on child
- Test Selection
- Client Characteristics, Test Characteristics
- Client Characteristics for test selection
- age, cognition, disorder specific, disability.
- Test Characteristics for test selection
- valid and reliable for client's characteristics
- Reliablity
- How consistently a test measures what it measures
- split half reliabilty
- first half of test and 2nd half are both equally as reliable.
- Interjudge reliability
- two therapist give the same test-yields same results
- internal reliability
- ever item is reliable
- Validity
- the degree to which a testt measure what a test says it's going to measure
- Test of language
- Must test all aspects of language to be valid
- Types of formal tests
- normative, criterion reference test
- Normative
- standardized/norm referenced
- Criterion reference test
- need to meet a certain criterion to pass.
- Common Errors in use of norm. ref test
- Determine TX targets, measuring TX progress, overall disorderr from one test, non natural environment, framentation of integrated system.
- Interpretation of test
- Normal dist., Raw score, range, mean, median mode
- Normal distribution of scores
- bell curve, distribution of scores
- Raw score
- Total # minus total errored-meaningless w/o %
- Range
- lowest score-highest score
- Mean
- average
- Median
- numbers in order middle #
- Mode
- most frequent number
- standard score
- conversion of raw score which compares one's performance to others
- Percentile rank
- type of standard score % of people that you scored better than
- stanine
- divides normal distribution in nine segments-not equal 9 best
- 50 percentile
- always the mean
- standard deviation
- square root of the variance-to figure out normal range
- variance
- how much variablility there is in the score dispersion from the mean
- average range
- within 1 SD of the mean -1-+1 68% of the population
- Normal range
- within 2 SD of the mean -2-+2 96% of the population
- 16th percentile
- always -1 SD
- 84th percentile
- always +1 SD
- 98th percentile
- always +2 SD
- 2nd percentile
- always -2 SD
- z score
- mean of zero SD of 1
- T score
- mean of 50 SD of 10
- Transitions
- seamless, accented, abrupt
- Seamless
- type of transition-ideal, no break, move from one topic to another
- accentetd
- type of transition-bridge from one topic to another, indicate topic movement w/ transition. We've been doing X, lets move on to Y
- Abrupt
- type of transition-get back to therapy from tangent
- Dealing w/ tears
- Tissues, stop talking, empathize by validating person's feelings
- Facilitation and probes
-
Uh huh
Nodding
“Tell me more…â€
Pregnant pause-stop to allow person to cont. - Possilbe responses to clients comments
- support, reassurance, empathy, confrontation, reflection, interpretation,
- Support as response to client comments
- you're doing the right thing
- Reassurance as response to client comments
- Remind them of the right thing
- Empathy as response to client comments
- I know you're going through a difficult time-validate feelings
- confrontation as response to client comments
- pointing out what you see
- reflection as response to client comments
- saying back to the person what they said
- interpretation as response to client comments
- combo of empathy and reflection
- Assisted
- A with cirlce around it
- Activity of Daily living
- ADL
- twice per day
- bid
- with
- c with a line over it
- complaining of
- c/o
- cerebral vascular accident
- CVA
- discontinue/discharge
- dc
- history
- hx
- independent
- I with a circle around it
- left
- L with a circle around it
- liquid
- liq
- medical/medication
- med
- nothing by mouth
- npo
- occupational therapy
- OT
- Prior level of function
- PLF
- po
- by mouth
- everyday
- qd
- whenever necessary
- prn
- physical therapy
- PT
- four times a day
- qid
- right
- R with a circle around it
- without
- s with a line over it
- subjective, objective, assessment, plan
- SOAP
- speech therapy
- ST
- treatment
- tx
- Within normal limites
- WNL
- Change
- triangle
- true score
- never really know, but use observed score
- confidence interval
- range within which a person would fall if test again. Range of score that are reported larger % means higher confidence interval
- Standard error of measurment
- allows for uncontrolled errors and room for error-take observed score and standard error from it and also add standard error to get confidence interval.