Diagnosis And Evaluation In Speech Pathology Pdf

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CHAPTER III - Assessment Methods for Young Children With Communications Disorders - Continued

Speech-language pathologists SLPs play a crucial role in assessment and treatment of individuals with primary progressive aphasia PPA. The speech-language evaluation is a critical aspect of the diagnostic and rehabilitative process, informing differential diagnosis as well as intervention planning and monitoring of cognitive-linguistic status over time.

The evaluation should include a thorough case history and interview and a detailed assessment of speech-language and cognitive functions, with tasks designed to detect core and associated deficits outlined in current diagnostic criteria. As such, the speech-language evaluation allows the medical team to provide individuals with PPA and their families with appropriate recommendations for the present and the future.

Primary progressive aphasia PPA is a disorder marked by a gradual loss of communicative function caused by neurodegenerative disease affecting speech and language networks in the brain 1 , 2. The last two decades have brought a great deal of progress in clarifying these clinical phenotypes and their neuropathological underpinnings and, increasingly, patients are referred to speech-language pathologists SLPs for assessment and treatment. This paper will focus on approaches to assessment in PPA, the purposes of which are threefold: 1 to establish the PPA diagnosis and clinical variant, when possible, 2 to determine appropriate interventions for patients and their families, and 3 to track progression of deficits over time.

Current consensus criteria for PPA diagnosis recommend a two-tiered diagnostic process 1. First, a PPA diagnosis should be established based on the following general criteria 1 , 2 : the most prominent clinical feature at onset and for initial stages of disease should be communication difficulty and this should be the primary contributor to impaired activities of daily living; symptoms should not be attributable to other neurological, psychiatric or medical disorders; and prominent non-language cognitive or behavioral impairments should not be present initially.

It is important to note that not all individuals with PPA can be classified into one of the established clinical variants 4 - 8. However, when possible, determination of clinical variant is an important step, as it may help to inform the diagnostic picture as well as nature and likely progression of speech-language deficits. Speech-language phenotype, in conjunction with in vivo biomarkers e.

With the emergence of clinical trials targeting specific pathological processes, the SLP may play a contributing role in discerning the likelihood of a given underlying disease based on clinical phenotype.

Even more importantly from a rehabilitation standpoint, determination of clinical variant can help to elucidate the linguistic nature of deficits semantic, phonological or grammatical and strengths, which may guide treatment planning. Lastly, while there is considerable variability in rate and nature of progression from patient to patient, diagnosis by variant may aid the clinical team in predicting the most likely progression of cognitive, linguistic and motoric features 11 - As such, establishing PPA subtype may inform the medical and rehabilitative plan of care and help patients and families to prepare for the future.

Current consensus criteria enumerate core and associated speech-language features that must be present for diagnosis by variant 1. As with any standard diagnostic battery performed by a speech-language pathologist, it is critical that a thorough case history be obtained from the individual with possible PPA.

It is important to gain information regarding the initial presentation, the emergence of any additional symptoms with time, and the degree of linguistic versus cognitive or motoric impairment at the time of assessment.

During the interview, clinicians should take note of speech-language features e. Any family history of dementia or other relevant medical diagnoses especially neurodegenerative conditions should be ascertained, if not already noted in the medical record. Impaired hearing or vision may need to be addressed before a valid assessment can be performed, and assessment materials should be linguistically appropriate to the speaker.

To inform treatment planning, the clinician should inquire about current functional communication needs and limitations. In addition to a clinical interview, a thorough speech-language evaluation should be conducted, which allows for characterization of impaired versus preserved speech-language abilities.

This evaluation also serves to establish a quantitative index of aphasia severity that can be used as a baseline measure from which to track the progression of symptoms and document potential treatment gains. Standard aphasia batteries developed for use with stroke-induced aphasia are commonly used in PPA research centers as well as typical clinical practice.

However, it is likely that aphasia batteries developed for stroke may not be adequately sensitive to detect the subtle deficits that are observed in early stages of PPA. A recent systematic review identified nine neuropsychological assessments that were developed or adapted specifically for diagnosis or characterization of PPA Several of these can be used successfully to differentiate between clinical variants 19 - 22 , and two were designed specifically to gauge severity and progression in PPA 19 , The Sydney Language Battery SydBat is a brief battery of tasks picture naming, word comprehension, semantic association, and repetition designed to differentiate amongst PPA subtypes The Repeat and Point Test is a brief measure developed to differentiate between semantic and nonfluent variants by requiring patients to repeat 10 multisyllabic words and point to the target amongst semantic and phonological distractors The SLP completes the scale after a questionnaire is filled out by an informant and a structured interview is conducted with both patient and informant.

The Progressive Aphasia Language Scale PALS 19 also involves clinician ratings of speech-language features motor speech and grammatical features in spontaneous speech, naming, single word repetition and comprehension, and sentence repetition and comprehension but is based on signs observed during a prescribed set of speech-language tasks, rather than symptoms reported via an interview or questionnaire.

Lastly, the Clinical Dementia Rating CDR 24 , a dementia severity rating scale based on a semi-structured interview as well as clinical judgment, now includes a language domain 25 , which confers additional sensitivity relative to the original CDR for detecting and tracking symptoms and functional impairments in language-prominent dementias such as PPA. These assessments also provide crucial information regarding spared and impaired speech-language and cognitive processes that may be relevant when designing an intervention plan.

Several assessments have been developed or adapted to measure a specific linguistic or motoric domain in PPA, including assessments of: lexical retrieval 26 , syntax 20 , 27 , nonverbal semantic processing 28 , and apraxia of speech We outline relevant assessments from each of these categories below.

Naming impairment is a ubiquitous feature in PPA and is a core feature of both semantic and logopenic variants. Confrontation naming may be assessed using a graded picture naming test such as the Boston Naming Test From this measure, the severity of the naming impairment can be determined and types of naming errors can be noted, which can assist in distinguishing amongst the variants of PPA.

Individuals with the semantic variant are likely to be anomic on all but the highest frequency items, and are likely to produce superordinate or coordinate semantic errors or to omit words 31 , These individuals are unlikely to be aided by phonemic cues and may also do poorly when given multiple-choice options Additionally, logopenic individuals are more likely to produce phonemic paraphasias than those with semantic variant. The Northwestern Naming Battery assesses both noun and verb production as well as comprehension and has proven sensitive to different patterns of deficits in agrammatic PPA impaired verb naming and spared comprehension versus semantic variant PPA impaired noun naming and comprehension To assess object knowledge, nonverbal semantic processing assessments such as picture association tests and picture-sound or object-function matching tests can be used.

A short version of the Pyramids and Palm Trees Test 39 , a picture association test, has proven sensitive to object knowledge deficits in semantic variant PPA as compared to the other clinical variants. To test knowledge of people, individuals may be asked to identify photographs of famous individuals and celebrities 35 , Single-word comprehension is usually tested via spoken or written word-picture matching tasks e.

These measures are especially sensitive for identifying individuals with semantic variant PPA, for whom single word comprehension deficits are a core feature.

Impaired comprehension of syntactically complex sentences e. However, individuals with logopenic PPA may show impairment on items that contain sentences of greater length, or that have lower probability 44 , due to deficits in phonological working memory. For patients with very limited output or concomitant motor speech impairment, the Northwestern Anagram Test NAT , which does not require spoken production, may be used to assess expressive grammar This assessment requires individuals to arrange anagrams in the correct order to generate sentences of varying syntactic difficulty that correspond to pictures presented by the clinician.

Notably, this assessment, in conjunction with a test of lexical semantics Peabody Picture Vocabulary Test , has proven effective in distinguishing amongst PPA variants 6 , To assess repetition, subtests or tasks from comprehensive aphasia batteries may prove useful e.

By contrast, logopenic individuals have difficulty repeating words and sentences due to deficits in phonological short-term memory 44 , 47 , As such, they are likely to perform more poorly on longer, lower probability items and those without semantic content, such as nonwords or anomalous sentences e. This type of assessment can reveal characteristics of mild dysarthria or AOS, which may not be salient in conversational speech.

From this measure, speech rate, utterance length, grammatical competence, lexical retrieval ability, and motor speech features can be assessed. Speech and language measures derived from a picture description task have been shown to aid in distinguishing amongst the PPA variants Nonfluent patients will show simplified grammar or agrammatic constructions with a relative paucity of verbs relative to nouns.

Speech fluency may also be disrupted by slowed rate and effortful, distorted production resulting from motor speech impairment AOS and, in some cases, dysarthria. By contrast, individuals with the logopenic variant will show frequent pauses for word finding, phonological paraphasias, and may demonstrate use of paragrammatic constructions related to abandoned or rephrased utterances in the context of word retrieval failure.

Writing and reading of single-words and text should be incorporated into the PPA evaluation, as characteristic deficits may help to differentially diagnose its variants 1 , 53 , 54 and may indicate whether written language can be utilized as an alternate communication modality.

Stimuli for assessment of single-word reading and spelling should vary by frequency high versus low , regularity regular words, such as stop and irregular words, such as tomb , and lexical status words versus pseudowords. Attempts to read or spell irregular words may result in phonologically plausible errors e.

Individuals with the logopenic variant of PPA show pronounced deficits in reading and spelling nonwords, which require sound-letter conversion and are particularly taxing for the phonological system Assessment of cognitive status is important in order to establish baseline cognitive performance, to rule out other possible diagnoses e. Impairment of nonlinguistic cognitive domains should be less prominent than that of language function.

However, subtle executive function and other deficits may be present Standard cognitive screening tools such as the Mini-Mental State Exam 61 or the Montreal-Cognitive Assessment 62 should be used with caution. These measures are largely language-based and, as such, may overestimate cognitive impairment in PPA Even a relatively brief neuropsychological battery can be informative for differential diagnosis, which may obviate the need for lengthy batteries that may be difficult or impossible for patients with dementia to complete In this paper, we have discussed assessments that may be used when evaluating the speech-language and cognitive characteristics of individuals with PPA.

Initially, it is important that the medical team including the SLP establishes that the individual meets criteria for a diagnosis of PPA. Subsequently, subtyping by clinical variant will allow for interventions to be developed and administered with greater precision. As clinical drug trials become more widely available for specific underlying pathologies, accurate subtyping of PPA variant may aid in determining appropriate candidates for these studies.

The three variants of PPA present with unique linguistic and cognitive features that may be discerned via a detailed case history and formal evaluation. The current consensus criteria should be consulted when selecting assessments in order to ensure that the test battery targets the established core and associated impairments characteristic of each clinical subtype.

Many of the assessments reviewed in this paper were initially developed to characterize speech-language changes secondary to stroke e. WAB , or to capture changes in cognitive status in dementia more broadly e.

Nevertheless, some assessments have been developed in the past decade to aid specifically with subtyping PPA variant e. SydBat , to evaluate deficits characteristic of each clinical variant e. Collectively, this compendium of assessments enables the SLP to characterize the cognitive-linguistic features of PPA, supporting diagnostic decision-making, informing treatment planning, and helping to monitor and predict changes in communication status over time.

This work was funded by the National Institutes of Health M. National Center for Biotechnology Information , U. Semin Speech Lang. Author manuscript; available in PMC Jul 1. Maya L. Henry , Ph. Grasso , M. Author information Copyright and License information Disclaimer. A , Austin, TX , , ude. Copyright notice. The publisher's final edited version of this article is available at Semin Speech Lang.

See other articles in PMC that cite the published article. Abstract Speech-language pathologists SLPs play a crucial role in assessment and treatment of individuals with primary progressive aphasia PPA. Keywords: primary progressive aphasia, assessment, diagnosis, dementia.

The Evaluation Process Case history and interview As with any standard diagnostic battery performed by a speech-language pathologist, it is critical that a thorough case history be obtained from the individual with possible PPA.

How to Write an Evaluation Report – with Examples!

Writing Evals can be time-consuming, not exactly rewarding, yet pretty darn important to get right for many reasons. Ex: Current and previous diet for therapists looking at swallowing. Include at least one diagnosis when applicable and, if possible, the severity level for every diagnosis you include minimal, mild, moderate, severe, profound You can use your discipline specific jargon here. The prognosis is based on your professional judgment on a scale of excellent, good, fair, to poor. For example, its documentation system may include descriptions for each prognosis level. Examples of Prognosis Excellent Prognosis: Patient will likely make a full recovery due to excellent insight and motivation, mild deficits, high previous levels of functioning, and excellent family support Poor Prognosis : Patient may make some progress with a few goals due to poor insight of deficits, ongoing medical issues, severity of deficits, and minimal support at home. Your recommendation for duration and frequency of therapy visits.

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a new coauthor and invite a new group of students and practitioners to consider the complex and fascinating arena of assessment in communication disorders. For.

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Several standardized tests and alternative assessment methods have been developed to provide a more in-depth assessment of children who have a possible communication disorder. In-depth assessment can be used in several ways to assess children with possible communication disorders, including to:. The following recommendations address some of the specific techniques that are available for the in-depth assessment, especially the analysis of spontaneous language samples. Other techniques may be used but are not described in as great detail because no scientific studies were found that met the criteria for evidence.

Speech-language pathologists SLPs play a crucial role in assessment and treatment of individuals with primary progressive aphasia PPA. The speech-language evaluation is a critical aspect of the diagnostic and rehabilitative process, informing differential diagnosis as well as intervention planning and monitoring of cognitive-linguistic status over time. The evaluation should include a thorough case history and interview and a detailed assessment of speech-language and cognitive functions, with tasks designed to detect core and associated deficits outlined in current diagnostic criteria.

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Speech and language: resources, solutions, and training

From birth, we learn to communicate our basic needs, and over time, more complex thoughts and emotions.

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Assessment of Individuals with Primary Progressive Aphasia

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1 Response
  1. Pietisultten1988

    A popular, practical, and comprehensive text that approaches the diagnosis and evaluation of speech and language with a special focus on the relationship between clinician and client.

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