1
Q
What does the
Clinical Reasoning Cycle do?
A
Provides an overt description of the clinical reasoning (thinking, decision making) process that underpins effective practice.
2
Q
In which SP sessions does the Clinical reasoning cycle happen?
A
All of them
3
Q
Clinical reasoning cycle -
Step 1:
(red)
A
Consider the Patient Situation -
*DESCRIBE (context, people, situation)
WHO, WHERE, WHAT, WHEN, WHAT
4
Q
Questions to ask in Step 1 of the clinical reasoning cycle:
A
WHO client is
WHERE they exist
WHAT thei percieved speech pathology related concerns are
WHEN these SP related concerns began
WHAT activities are important to them… and other information
5
Q
How is the ICF relevant to getting a case history?
A
Hx collection gathers information about:
a) presenting condition
b) impact on everyday life
c) possible barriers/facilitators to management/intervention
ICF ensures a HOLISTIC view with a focus on the dynamic interaction between the health condition (a, above) and the clients contextual factors (b and c, above).
6
Q
How are disability and functioning viewed by ICF model?
A
As outcomes of interactions between health conditions (diseases, disorders, injuries) and CONTEXTUAL FACTORS
7
Q
ICF Environmental factors include:
A
- Social attitudes
- architectural characteristics
- legal and social structures
- Climate, terrain,…
8
Q
ICF Personal factors include:
A
- Gender
- Age
- Coping style
- Social background
- education
- Profession
- Past and current experience
- overall behaviour patters
- character
- other factors that influence how disability is experienced by the individual…
9
Q
3 levels of functioning, classified by the ICF:
A
- Body or body part
- Whole person
- Whole person in a SOCIAL CONTEXT
10
Q
ICF: Body Functions:
A
physiological functions of body systems (including psychological functions).
11
Q
ICF: Body Structures
A
Anatomical parts of the body such as organs, limbs and their components.
12
Q
ICF: Impairments
A
problems in body funtion or structure, such as significant deviation or loss.
13
Q
ICF: Activity
A
The execution of a TASK by an individual.
14
Q
ICF: Participation
A
Involvement in a life situation.
15
Q
ICF:
Activity Limitation
A
Difficulties individuals may have in executing activities (executing tasks).
16
Q
ICF: Participation restriction
A
Problems an individual may experience in INVOLVEMENT in LIFE SITUATIONS
17
Q
ICF: Environmental factors
A
phsyical, social and attitudinal environment in which people live and conduct their lives
18
Q
ICF chapters under BODY FUNCTION
A
- Mental Functions
- Sensory Functions and Pain
- Voice and Speech Functions
- Functions of the Cardiovascular, Haematological, Immunological and Respiratory Systems
- Functions of the Digestive, Metabolic, Endocrine systems
- Genitourinary and Reproductive Functions
- Neromusculoskeletal and Movement-Related Functions
- Functions of the Skin and Related Structures
19
Q
ICF chapers under BODY STRUCTURE
A
- Structure of the Nervous System
- The Eye, Ear and Related Structures
- Structures involved in Voice and Speech
- Structures of the Cardiovascular, Immunological and Respiratory Systems
- Structures Related to the Digestive, Metabolic and Endocrine Systems.
- Structures Related to Genitourinary and Reproductve Systems.
- Structures Related to Movement
- Skin and Related Structures.
20
Q
ICF: Activites and Participation
A
- Learning and Applying knowledge
- General Tasks and Demands
- Communication
- Mobility
- Self Care
- Domestic Life
- Interpersonal Interactions and Relationships
- Major Life Areas
- Community, Social and Civic Life
21
Q
ICF: Environmental Factors
A
- Products and Technology
- Natural Environment and Human-Made Changes to Environment
- Support and Relationships
- Attitudes
- Services, Systems and Policies
22
Q
Ways to facilitate communication: - PRODUCTS AND TECHNOLOGY
A
- FM device to amplify teacher’s voice and transmit sound directly to children with hearing loss.
- AAC devices including ipads, visual scripts, communication books for improving expressive and receptive language.
23
Q
Ways to facilitate communication: - NATURAL ENVIRONMENT AND HUMAN-MADE CHANGES TO THE ENVIRONMENT
A
- Soft furnishings, carpets, to decrease reverberation and improve sound quality.
- Closing doors, turning off a/c or TV to reduce ambient noise (esp. w/ elderly people).
24
Q
Ways to facilitate communication: - SUPPORT AND RELATIONSHIPS
A
- Teach family/significant others to identify communication breakdown
- Teach strategies to overcome communication breakdown and promote communication succes (ie asking for repitition, “Show me”, using contextual information to gather meaning).
25
Ways to facilitate communication: - ATTITUDES
* Provide education about communication development and impairment
* Teach strategies for improving understanding (looking at individual, using available cues, list of pronunciations).
26
Ways to facilitate communication: - SERVICES, SYSTEMS AND POLICIES
* Adovate for appropriate services for clients.
| * Provide information about supports/resources available.
27
Which 3 (plus 1) sources does good EB3P incorporate data from?
* Best research evidence
*Clinical Expertise
* Patient values
(and clinical context in some models)
28
Clinical Reasoning Cycle: Step 2:
| orange
Collect cues/information
* REVIEW (current info: handover reports, referral)
* GATHER new information (ASSESSMENTS - Hx, OMA, SS, formal/standardised +)
* RECALL knowledge ie make sense of info in light of what I know as an SP
29
Which clinical steps does the CBOS unit 1 - ASSESSMENT align with?
```
Steps 1 (Consider the client situation - DESCRIBE) and
Step 2 (Collect cues/information - REVIEW info, GATHER new info, RECALL subject knowledge)
```
30
Clinical reasoning cycle: Step 3
| yellow
Process information
* INTERPRET (analyse data, understand signs/symptoms, compare normal/abnormal)
* DISCRIMINATE relevant/irrelevant info, recognise inconsistancies, narrow info to important stuff, recognise gaps in info
* RELATE cues to find relationships/patterns
* INFER theories/opinions logically from subjective and objective cues, consider alternatives and consequences.
* MATCH current situation to past situation with same client or other past clients
* PREDICT outcome
31
Clinical reasoning cycle:
Step 4
(lime)
Identify problems/issues
| *SYNTHESISE subjective and objective data to diagnose problem. Report so info communicated meaningfully.
32
Which Clinical reasoning cycle steps align with CBOS unit 2: ANALYSIS AND INTERPRETATION
Steps 3: Process information (INTERPRET, DISCRIMINATE, RELATE, INFER, MATCH, PREDICT)
and
Step 4: Identify problems/issues (SYNTHESISE)
33
Clinical reasoning cycle step 5:
| green
Establish goal/s
| *DESCRIBE desired outcome, timeframe --> SMART GOAL (WHO will do WHAT, HOW and by WHEN?)
34
Clinical reasoning cycle step 6:
| light blue
Take Action
| *SELECT a course of action between different alternatives available
35
Which step/s of the clinical reasoning cycle align with CBOS unit 3: PLANNING EVIDENCE-BASED SPEECH PATHOLOGY PRACTICES, and with some of CBOS unit 4: IMPLEMENTATION OF SPEECH PATHOLOGY PRACTICES?
Step 5: Establish goals and
| Step 6: Take Action (SELECT a course of action from between alternatives)
36
Clinical reasoning cycle: step 7
| dark blue
Evaluate outcomes
*EVALUATE effectiveness of actions, compare intervention results with earlier client data or normative data. Similar process with step 3 - process information (yellow)
37
Clinical reasoning cycle: step 8
| purple
Reflect on process and new learning
*CONTEMPLATE (Gibbs (1988) appropriate. What have I learnt from this process? What would I do differently next time? What else do I need to know?)
38
Which step/s of the clinical reasoning cycle aligns with CBOS unit 4: IMPLEMENTATION OF SPEECH PATHOLOGY PRACTICE
Step 7: Evaluate outcomes (evaluate effectiveness of therapy) 1.3-1.6
and
Step: 5 (Establish goal/s) and Step 6 (Take action)
39
Which step of the clinical reasoning cycle aligns with CBOS Unit 7: LIFELONG LEARNING AND REFLECTIVE PRACTICE?
Step 8: Reflect on process and new learning.
40
What is the purpose of a SP assessment?
1. Determine if communication and/or swallowing are disordered.
2. Determine the nature and extent of the problem (client's capabilities, consistency, severity of involvement, simulalbility, patterns)
3. Look for causal factors and correlates of disordered behaviour.
4. Utilise all relevant information to develop a set of recommendations for effective and efficient managment of problem (STRUCTURAL, ENVIRONMENTAL, PSYCHOLOGICAL, NEUROLOGICAL)
5. Determine prognosis (WITH/WITHOUT INTERVENTION)
41
Comprehensive assessment includes the components of the International Classification of Functioning, Disability and Health (ICF) (WHO, 2001):
identifying the underlying body functions and structures that impair the client’s communication and swallowing abilities
identifying the extent to which the communication and swallowing condition impacts on the client’s ability to perform everyday life activities
identifying how to facilitate the client’s participation in educational, employment and social interactions on a daily basis.
CBOS (2011, p.12)
42
First step in the assessment process is to gather background information about the client, including:
* Developmental information
* Medical history
* Current skills/ concerns
* family /support network
43
What can we do with info from a referral?
- Can help guide us with planning
- -> Prioritisation - when and for how long a client can attend the service (service dependant).
- -> Hypothesising about the kinds of difficulties a client may present with, based on the referral information helps us to plan our assessment more accurately and plan for management.
44
Please could you see Miss Samantha Webb, a 39 year old woman, who has recently been diagnosed with bilateral vocal nodules. She is experiencing some dysphonia that is impacting on her work as a teacher. Thank you.
Dr Parsons , ENT
How could I start planning for the first session?
What is dysphonia? What are voice problems?
What causes it? How does it present and what is its prognosis? How does it impact on her voice? What is the incidence/prevalence of dysphonia and voice problems, particularly in teachers? These pieces of information can help me to think about:
how to prioritise this case amongst other cases on my caseload
what kind of assessments might be useful
developing a preliminary clinical hypothesis of how this individual may present
45
Bob - 75yr old man admitted with stroke. Left hemiplegia including facial droop. Speech slurred. SP called for swallowing and speech assessment.
What ICF info do we already have?
Already have:
* Stroke - right side, as left hemiplegia.
* Facial droop
* Slurred speech
* 75 y.o.
46
Bob - 75yr old man admitted with stroke. Left hemiplegia including facial droop. Speech slurred. SP called for swallowing and speech assessment.
What ICF info do not yet have, that we need to collect?
Need to collect:
* Imapact on speech and communication
* Swallowing, hearing, muscle/body movement.
* Environmental and personal factors - family, culture, confidence, attitude, other health conditions.
47
Bob - 75yr old man admitted with stroke. Left hemiplegia including facial droop. Speech slurred. SP called for swallowing and speech assessment.
Which RoPAs?
Speech, language, swallowing, voice, MMC
48
Bailey, 18 mnths. Not tolerating lumpy food, not yet walking, not using any real words.
What ICF info do we already have?
Already have:
* Difficulty with lumpy foods (textures? swallowing?)
* Not yet walking
* No real words
* 18 months old.
49
Bailey, 18 mnths. Not tolerating lumpy food, not yet walking, not using any real words.
What ICF info do we not yet have, that we need to collect?
Need to collect:
* Pregnancy / gestation (maternal drug use?).
* family medical history
* Developmental milestones (incl. babbling, pointing)
* Other services involved (Dietitian / OT)
* What are the parent's biggest concerns?
* What are the impacts of his difficulties on daily life?
* Other health conditions/sensitivities (recurrent ear infections? other sensory sensitivities?)?
50
Bailey, 18 mnths. Not tolerating lumpy food, not yet walking, not using any real words.
What RoPAs do we need to look at?
RoPAs:
* Language (considering age and development, more interested in language than speech sounds)
* Swallowing
51
What is an Oro-motor assessment (OMA) useful for? When would we use one?
As part of early assessment across all motor-sensory practice areas.
Provides info about structure and function (muscles and cranial nerves relevant to SP practice --> V, VII, IX, X, XI, XII)
52
Which common assessment tools did we cover at residential school?
* Case history
* Oro-motor assessment
* Speech/language samples
* Standardised, published test: DEAP (speech sounds), CELF-5 (language)
53
Bob - 75yr old man admitted with stroke. Left hemiplegia including facial droop. Speech slurred. SP called for swallowing and speech assessment.
* Assessing presenting condition (in terms of range of practice areas).
* Functional Impact of that on their daily life.
* Possible barriers and facilitators to intervention.
* PRESENTING CONDITION: 75 yr.old, R stroke, L hemiplegia, facial droop, slurred speech
* IMPACT OF DIFFICULTIES ON DAILY LIFE: unable to walk, use L arm, probably swallowing difficulties, Probably poor lip seal, ?difficulty being understood by others
* POSSIBLE BARRIERS/FACILITATORS TO INTERVENTION: stroke spontaneous recover period, ?family support/capacity, distance from therapy...
54
Bob - 75yr old man admitted with stroke. Left hemiplegia including facial droop. Speech slurred. SP called for swallowing and speech assessment.
--> What are the assessment modalities that should be used?
Variety of assessment modalities:
* Case history
* OMA
* Speech/language sample
* swallowing assessment
* possible standardised speech Ax,...
55
Intervention cycle model:
| process for intervention
1. Data gathering
2. Goal setting
3. Intervention selection
4. Implementing intervention
5. Evaluation
- -> 1. Data gathering....
56
In which speech pathology session/s do you collect baseline measures (mini assessments to see where the client is at?)
EVERY session. Part of SOAP notes (O)
57
How to set goals in a SP clinical context:
* talk about whether intervention is needed at this point or not.
* talk about long-term and short-term outcomes.
* Goal setting including client and client’s family/significant others. Client’s priorities and preferences.
58
Why do we undertake intervention?
* To change a client's ability to participate in activities that are important to them.
* Positive change
* Improve quality of life
* going after goals --> seeing change and client feels they are progressing/achieving their goals (purpose, better mental health).
59
Stages of assessment:
* Case history
* Interview
* OMA
* Hearing screen (if relevant, ie paediatric speech)
* speech-language sample (always)
* Formal assessment
* Stimulability testing
* Observation of other skills
* Provide feedback (always should give some)
* Analyse and write report
60
Case history - what is needed?
* Demographic data, contact details, referring agent, GP
* Background info: - Family Hx, Pre-morbid abilities
* Medical/developmental Hx: birth/pregnacy - developmental info - sig. medical events - other interventions/services
* Social/Educational/Occupationa info
61
Case history - what is the purpose?
TO IDENTIFY AREAS OF CONCERN
* Historical duration/intensity
* Antecedents and consequences
* Impact on client and others
* Previous attempts to deal with concerns
62
What are we examining in an OMA?
RANGE, RATE, STRENGTH
* Face
* Lips
* Tongue
* Teeth
* Hard Palate
* Soft Palate
63
Which CN are assessed during OMA?
* CN V (trigeminal)
* CN VII (facial)
* CN IX (glossopharyngeal)
* CN X (vagus)
* CN XI (accessory)
* CN XII (hypoglossal)
64
What is the purpose of a speech-language sample?
Can look at:
* Syntax
* Semantics
* Morphology
* Pragmatics
* Intelligibility
* Fluency
* Voice
- > across different contexts and conversations (and with different people) -> good indication of real issues in different contexts, factors that make things better/worse...
65
Things to consider when choosing an assessment?
* Purpose of the test
* Construction of test - adequate theoretical and practical model, evidence base
* Test procedure - admin, scoring, interpretation procedures described and adequate?
* Norms, validity and reliability of data sound and appropriate for client.
* Standardisation sample adequate
66
Strengths of formal/standardised assessment?
* De-contextualised formal for assessing speech/language.
* Published, standardised, norm referenced --> if standardisation sample is linguistically, culturally, SE, age similar can make valid comparison to where the 'average' is at.
67
How to know validity of standardised test?
| degree to which the test actually measures what it says it measures
* Face validity: match b/n test's intended purpose and actual content.
* Content validity: Do test items adequately sample domains that the test purports to measure?
* Construct validity:
a) test measures what it purports to measure
b) Normative data accurately represents population
68
How to know standardised test reliability?
| Degree to which test scores reflect true ability
* Test-retest reliability: consistency of scores obtained by same person when retested with SAME test or EQUIVALENT TEST
* Inter-rater reliability: Consistency of scores regardless of who administers test (really decontextualised).
69
How to know standardised test Internal Consistency (reliability)?
* Split-half reliability: Scorers on 1st half of test compared with scores on 2nd half of test.
* Odd-even reliability: Scores on odd-numbered items compared with even-numbered items.
* Equivalent forms reliability: Two forms of a test are found to measure the same thing.
70
What are standard scores (SS)?
Scores on a standardised test derived from raw scores using the norming information gathered when the test was developed.
71
What can standard scors (SS) on a standardised test indicate?
* How far above/below average (mean) an individual score falls, using a common scale (ie one with an 'average' of 100)
* Used to compare individuals from different grades or age groups, as all scores are converted to the same numerical scale.
72
What is the standard error of measurement (SEM)?
* Takes into account that in any test, performance may vary from one occasion to another, so any single performance measure is an estimate of true score.
* Measurement error = diff. b/n individual's hypothetical true score and obtained score.
* SEM represents variation that would be present if a person took the test multiple times.
* SEM provides the confidence range/confidence interval.
* A RELIABLE Test only has a small SEM - 90% -95% confidence interval common.
- -> clinicians can state they are XX% confident that results reflect a client's skills
73
Why shoud age-equivalent scores on a standardised test be treated with caution?
* 1 yr delay at 3 yrs not the same as 1 yr dela at 9 yrs.
* Significance of deficit shouldn't be decided on basis of age comparisons, but on impact on performance, ability to participate in age-appropriate activities across contexts, and need for assistance to participate in those contexts.
* age-equivalent functioning can distress parents.
74
What is the purpose of stimulability testing?
To determine whether client is able to use speech/language structure when provided with cues and prompts (dynamic assessment) ie initial syllable prompt for Judy.
75
Why is stimulatbility testing important?
*Important for determining intervention goals ie if someone can achieve word recal with initial syllable prompt, then initial syllable prompting can be part of their goals (ie training communication partner).
76
Different levels of stimulability testing?
* Discrimination/comprehension
* Isolation/syllable (speech)
* syllable
* word
* sentences
77
Other skills SP should be observing while interacting with client or observing them in the waiting room:
* Non-verbal communication
* play
* Motor skills (fine and gross)
* cognitive skills
78
What kind of feedback does one provide at the end of assessment?
* Discuss outcomes of Ax with client, family and referral agents.
* Talk about intervention options
* Analyse results (examine formal Ax results and informatal observations/speech-language samples) for strengths/areas of difficulty. Provide EVIDENCE for statements.
* Provide recommendations and rationale (objectives, duration of intervention, dosage)
79
What is dynamic assessment?
TEST - TEACH - RETEST
--> method in which individual is tested, skills are addressed, then individual is retested to determin treatment outcome.
80
Practical considerations when planning an assessment:
* fatigue (do most important tests first)
* Time of day of Ax session
* number of people present
* Location/environment for Ax
* Materials used in Ax
* Formal vs informal Ax
* cultural appropriatness
* clients level of comprehension or cognition.
81
When conducting an assessment we are looking for information that fits into which 3 categories?
1. Presenting condition
2. Impact of difficulties on daily life.
3. barriers/facilitators for intervention (considerations for managment)
82
What does an OMA assess, and why is it important?
Assesses oro-motor STRUCTURE and FUNCTIONING in client, incuding (but not limited to) cranial nerve functioning. Important when considering clients with swallowing, speech and voice difficulties.
83
When analysing results of Ax, what do we need the results for?
1. To know about client's communication/swallowing skills.
| 2. To assist intervention planning.
84
What is an independent analysis re: looking at Ax results?
Looking at swallowing/communication skills the client already has. ie in paediatric speech we look at the sounds and syllable shapes that the client is already able to produce.
85
what is a relational analysis re: looking at Ax results?
Enables us to see what skills a client doesn't yet have that we would expect at their age. ie in paediatric speech we could compare Ax result to developmental speech norms.
--> How do skills compare with age-level expectations? Typical abilities of others? Pre-morbid skills and abilities?
86
What can 'change' refer to in intervention practice?
1. alteration or transformation of certain aspects in the existing situation, thereby making things better for the individual concerned.
2. A predicted, undesireable outcome is prevented.
(Bunnings, 2004)
87
What can 'movement' refer to in intervention practice?
1. a desired shift from an existing point.
2. a delay or arrest in the natural course of a progressive condition.
(Bunnings, 2004)
88
What is intervention?
The mobilisation of specific resources to address identified needs of individuals. Can be about the acquisition of new skills and the maintenance or modification of existing skills. Planned action to modify or prevent an unwanted outcome.
(Bunnings, 2004)
89
According to Bunnings (2004) two main aspects of therapy activities are:
1. Planning therapy: *interpretation of data collected in context of personal and environmental factors.
* Content of therapy (Goals, WHAT will be done to achieve them)
* Process of therapy (supporting actions and HOW it will be done)
* Context of therapy
2. Implementation of therapy plan (others involved).
90
List the main goals of SP intervention:
| Bunnings, 2004
1. Developing and Enhancing communicaiton
2. Developing and supporting autonomy.
3. Promoting health
4. Developing and adapting identity.
5. Identifying barriers and promoting participation.
91
CBOS Unit 2:
ASSESSMENT
2. 1 Analyse and interpret SP assessment data
2. 2 Identify gaps in information required to understand the client's communication and swallowing issues.
2. 3 Determine the basis for or diagnosis of the communication and/or swallowing condition and determine the possible outcomes.
2. 4 Report on analysis and interpretation.
2. 5 Provide feedback on results of interpreted speech pathology assessments to the client and/or significant others and referral sources, and discuss managment.
- -> Steps 3 and 4 Clinical Reasoning Cycle
92
CBOS Unit 3:
PLANNING EVIDENCE-BASED SP PRACTICE
3.1 Use integrated and interpreted information relevant to the communicaiton and/or swallowing condition, and/or the service provider's policies and priorities to plan evidence-based speech pathology practice.
3.2 Seek addition information required to plan evidence-based speech pathology practice. [Bunning's 'GOAL SETTING' (below)]
3.3 Discuss long term outcomes and collaborate with the client and/or significant others to decide wether or not speech pathology strategies are appropriate and/or required.
3.4 Establish goals for intervention in collaboration with client and/or significan others
[Bunning's 'INTERVENTION SELECTION' (below)]
3.5 Select evidence-based speech pathology approach or intervention in collaboration with the client and significan others.
3.6 Define roles and responsibilities for the management of clien'ts communication and/or swallowing condition.
[OTHER - documenting]
3.7 Document speech pathology intervention plans, goals, and outcome measurements.
93
CBOS Unit 4:
IMPLEMENTATION
[Bunning's 'IMPLEMENTING INTERVENTION']
4.1 Establish rapport and facilitate participation in speech pathology intervention.
4.2 Implement an evidence-based speech pathology intervention according to the information obtainted from speech pathology assessment, interpretation, and planning.
4.6 Undertake prevantative, educational and/or promotional projects or programs on speech pathology and other related topics as part of a team with other professionals.
[Bunning's 'EVALUATING' (below)]
4.3 Undertake continuing evaluation of speech pathology intervention and modify as necessary.
4.4 Document progress and changes in the speech pathology intervention, including outcomes, decisions and discharge plans.
[other - below]
4.5 Identify the scope and nature of speech pathology practice in a range of community and work place contexts.
94
Some therapy roles of a speech pathologist:
* Teacher
* Coach
* Facilitator
* Support crew
* Case manager
* Advocate
- plus more, depending on context and client needs
95
Lack of change/ineffective intervention may be due to...?
| Bunnings, 2004
* misguided decisions
* poorly articulated goals; changed priorities
* Strategies not carried out as planned
* client disengagement
96
Transferability of skills gained in intervention to other contexts. Facilitated by:
(Bunnings, 2004)
* Involving significant others in therapy; responsibility for change is shared.
* reducing barriers to the communication environment, providing support and facilitators.
* enhancing self-advocacy skills.
97
What is meant by a DYNAMIC CYCLE of intervention?
| Bunnings, 2004
A Constant interaction between assessment, analysis, interpretation, planning and implementing.
98
What does intervention look like?
| Bunnings, 2004
WHO? team, collaboration; Equal and reciprocal process
WHERE?/HOW? Play based, natural environments; Culturally contextualised, evidence-based
WHY? Goals; Positive and Functional change; Improve quality of life; seeing change aka measuring outcomes
99
Why are contextual factors important for SLPs?
| [Howe, 2008]
* As part of a holistic approach to addressing communication functioning.
* Aim is to improve communication in everyday language, not just in the clinic.
* Communication is a collaborative process and one needs a communication partner.
* Environmental factors can influence the functioning of people with communication difficulties (communication requirements of different activities, potential adaptations, and collaborate with all parties involved to increase/facilitate participation).
100
ICF 5 domains of environment - 1) plus examples:
Products and technology:
-human or natural products ie ipads, communication devices, communication book, products to thicken fluids, memory wallets for people with dementia, colour coded signage with pictures, botox injections for those with spasmodic dysphonia
101
ICF 5 domains of environment - 2) plus examples:
Natural environment and human-made changes to the environment:
- soft furnishings and carpets, closed off areas to manage sound reverberation, turning off TV, a/c etc to reduce background noise, humid environment helping people with dysphonia due to vocal nodules.
102
ICF 5 domains of environment - 3) plus examples:
Support and relationships:
| - communication partners, significant relationships, support from groups with same disorder, therapy dogs...
103
ICF 5 domains of environment - 4) plus examples:
Attitudes:
- from society (attitudes around disability, 'elderspeak', ignorance of communication disorder, belief that people with a stutter are rushing)
104
ICF 5 domains of environment - 5) plus examples:
Services, systems and policies:
- government and social services that dictate how speech pathology services operate and how clients can link in with these services; time limits for service in banks doesn't allow time for people with aphasia to communicate their needs
105
Georgie 4;5 girl. Tongue tie at birth. Normal hearing. Eats range of food. Speech difficult to understand. Brothers speak for her and she doesn't readily engage in others' conversations. Milestones on late side of normal.
Environmental modifications to facilitate her communication?
Products and technology: egg timer or something fund to time programs so Georgie knows time is up for that part of play.
Natural environment and human-made changes to the environment: Communication signage for Georgie to follow such as visual of daily routines (in school, at home).
Support and relationships: Teach people close to Georgie to communicate clearly --> short, clear instructions. Ensure parents are both consistant with communication approach.
Attitudes: ?
Services, systems and policies: ratio changes potentially required or additional funding for educational support.
106
SMART goals are...
```
Specific
Measurable
Attainable/Achievable
Relevant
Time bound
```
107
Assessment/
| Diagnostic reports
Concerns/presenting problem, results of assessment, professional’s diagnosis, recommendations (including options for management and/or requests for further information)
108
Interim/
| Progress reports
Record intervention and progress to date, issues/concerns with intervention, future action
109
Clinical/
| progress notes
Content and outcomes of intervention sessions
110
Discharge reports
Content and outcome of intervention program, reasons for discharge, recommendations
111
Referrals
Request assessment, recommendations or second opinion
112
Medico-Legal reports
Independent assessment of person’s capacity, or professional judgement of another professional’s work
113
SOAP
| Why use this format?
Subjective, Objective, Analysis and Plan - ensures that all relevant information is included in the report.
114
How can I check whether environmental change has been effective in supporting individuals with communication difficulties?
Re-evaluate behaviour of the individual during or following environmental changes. Increased participation?
115
Top 4 assessments to do pretty much always?
1. Case history
2. OMA
3. Speech/language sample in different contexts, reading, informal, formal, normal talking, rainbow passage...
4. approriate standardised and/or formal assessment ie DEAP (paediatric speech sounds), CELF-5 (paediatric language), MPT (voice - not st)
