Mtdda and BASA pp - class lecture PDF

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Minnesota Test for Differential Diagnosis of Aphasia – MTDDA – Hildred Scheull *grandmother of aphasia testing Aka Minnesota or scheull Development started in 1948 – revised 7 times before it was first published Primary purpose  Assessment of strengths and weakness in all language modalities as a guide for treatment planning Secondary purpose  Differential diagnosis of aphasia  Assist in making prognostic statements Description  Administration time – 2 to 6 hours  Compositions – tests 5 areas using 46 subtests and over 500 stimuli o Auditory o visual and reading o speech and language o visuomotor and writing o numerical relations and arithmetic processes  Difficulty increases as one advances through them Overview of major sections  Page 1 o Clinical record of patient o Summary of test scores  Page 2 o Social history o Medical history o Present illness (how much isn’t related to aphasia?) o Diagnostic findings  Page 3 o Clinical ratings (the grandmother of outcome scales) o Initial rating  retest ratings o Diagnostic scale  Section A – auditory disturbances o Recognizing common words o Discriminating between pair words o Recognizing letters o Identifying items names serially o Understanding sentences o Following directions o Understanding paragraphs o Repeating digits

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o Repeating sentences Note 1 o Nonbehavior terminology in most subtest titles Note 2 o Appreciate her attempt to eliminate errors being based on response modality in first 7 subtests  Recognizing common words  Discriminating between pair words  Recognizing letters  Identifying items names serially  Understanding sentences  Following directions  Understanding paragraphs o The other two subtests (repeating digits and sentences must use the verbal modality) Section B - Visual and reading disturbances o Subtests  Matching forms  Matching letters  Matching words to pictures  Matching printed to spoken words  Reading comprehension, sentences  Reading rate, sentences  Reading comprehension, paragraph  Oral reading, words  Oral reading, sentences o Note 1  First two tasks are not language tasks and do not involve reading o Note 2  See error analysis on tasks 3 and 4  (matching words to pictures and matching printed to spoken word) o note 3  last two tasks – different types of reading (see check list on item 9) Section C – speech and language disturbances o Subtests  Imitation gross movements  Rapid alternating movements  Repeating monosyllables repeating phrases  Counting to 20  Naming days of the week  Completing sentences answering simple questions  Giving biographical information  Expressing ideas producing sentences

 Describing pictures  Naming pictures  Defining words  Retelling paragraphs o Note 1  First two tasks are not speech or language o Note 2  Describing picture and naming task (in order) o Note 3 – look at scale for the last task  Section D – visuomotor and writing disturbances o Subtests  Copying greek letters  Writing numbers to 20  Reproducing letters  Writing letters to dictation  Written spelling  Oral spelling  Producing written sentences  Writing sentence to dictation  Writing paragraphs o Note 1  Why greek letters? Because they are unfamiliar to everyone so it gives everyone the same type of chance o Note 2  First 4 tasks do not involve language (writing)  Section E – disturbances of numerical relations and arithmetic processes o Subtests  Making change  Setting clock  Simple numerical combinations  Written problems MTDDA materials, administration, scoring, norms, and reliability  Materials o Record booklet o Administrative manual o Interpretation manual o 2 bound books for visual stimuli o also need a few objects for A6  administration o designed to be given in standardized manner and from beginning to end o in actual practice, it most often given informally in style and content o often modified during testing to focus on and explore stimulability o often modifies during administration to save time

o may be given over multiple sessions  scoring o tallies o number of correct/number possible o some scales scores for complex behaviors o extensive notes  norms o developed for aphasic adults and on normal adults o scheull didn’t think norms were good on diverse population  reliability o undetermined  test retest  intra judge  inter judge  the question of patient stability  the short scheull? Differential diagnosis interpretation and prognosis  differential diagnosis based on scheulls definition of aphasia (not syndromes) based on patterns of performance o simple aphasia – excellent  reduced language function in all modalities o aphasia with visual problems - excellent  simple aphasia with more severe reading and writing o mild aphasia with persisting dysfulency - excellent  dysarthria? o Aphasia with scattered findings of generalized brain damage – limited but functional  Aphasia and visual and motor problems o Aphasia with sensory motor involvement (aphasia and AOS) – limited but functional  Adams oliver syndrome – rare congenital disease when deficits of the scalp and cranium, transverse effects of the limbs and mottling of the skin o Aphasia with intermittent auditory imperceptions – limited but functional  (behaved like they had aphasia were “deaf” occasionally) o Irreversible aphasia syndrome – poor across all modalities except auditory comprehension  very severe aphasia – almost complete loss of language function  these were based on her history of working with people with aphasia in different categories MTDDA – treatment planning  note – almost any test can be used to help plan treatment following general guidelines o based on test results….

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Select a task that is challenging for client but one that the client has some success with (50%)  Select stimuli (similar to those used on the test) that are strong enough to elicit correct responses most of the time (scaffolding) but are not so strong as to force a correct response  Present stimuli, elicit responses, and provide feedback about response  MTDDA determines level at which performance breaks down in each language modality and provides information about the nature of the breakdown  Mtdda samples major language modalities and allows task analysis as well as task and item comparisons useful for treatment planning  Graduated difficulty and range of tasks within 5 sections helps identify which tasks are “easy challenging” and “impossible”  Helps identify what the patient can and cant do when compared to what the patient needs or wants  identify logical starting points within the 5 areas tested MTDDA test validity  Validity – does a test do what it says its going to do? Does the test achieve its purpose and meet the foals it has set?  Does it achieve its primary goal of assessment of strengths and weaknesses of the patients in all language modalities as a guide for treatment? How? o Yes it achieves its primary goal of assessing strengths and weaknesses by testing 5 areas – auditory, speech and language, reading and visual, visuomotor and writing, numerical o Difficulty increases as test progresses o Get a large sample of responses with 500 stimuli  Does it achieve its secondary goal of differentially diagnosis aphasia? How? o Yes o She categorizes patients not into syndromes, but into descriptive groups  Simple aphasia  Aphasia with visual problems  Mild aphasia with persisting fluency problems  Aphasia with scattered findings of generalized brain damage  Aphasia with sensory motor involvement  Aphasia with intermittent auditory imperceptions  Irreversible aphasia  Does it achieve its second goal of assisting the examiner in making a prognostic statement? o Yes. By each differential diagnosis definition, she suggests what their prognosis should be based on her prior experience with working with patients of all sorts  Does it correlate well with other tests that say they are assessing aphasia for these purposes? BASA – Boston assessment of severe aphasia – Estabrooks, ransberger, morgan, Nichols Primary purposes

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To identify and quantify preserved abilities that might help begin rehab problems for severely aphasic patients o Stimulus materials and tasks were selected to probe for areas of retained ability to process linguistic and paralinguistic information that is not typically examined by other standardized aphasia exams o Uses strong emotional and personally relevant stimuli to elicit responses o Allows for partially correct responses to be scored accordingly o includes specific item that bridge is specific treatment programs specifically designed for severe aphasia adults  secondary purposes o quantification leading to detection of change over time areas examined  auditory comprehension o social greetings o personally relevant yes no questions o oral questions o matching spoken words to coins (G) o map localization (G) o matching spoken words to action pictures (G) o G for gestural?  praxis o bucco-facial (G) o Limb (G)  oral gestural expression o sustained “ah” production (V) o oral repetition (V) o singing (V) o oral object naming o action picture description o famous faces o reading emotional words or phrases o symbol description  reading comprehension o choosing correct month from 3 written names (G) o matching number symbol to spoken words (G) o matching number symbols to 3 fingers (G) o matching written word to action pictures (G) o matching written word to glasses and coins (G) o matching swastika to hitler (G)  gesture recognition o matching gesture to action picture (G)  writing o signature (G)

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visuospatial tasks o draw a man (G) o match designs (G) o memory for designs (G) BABA Reliability, validity, norms and percentiles  reliability?  Validity o Assessment is looking at tasks easier than those typically found on most aphasia tests o This helps find preserved ability aka starting points for rehab  Norms and percentiles o Available for first 4 areas, other areas, and basa total  Only available to severe and global patients  Specific treatment program suggestion o Good single word reading and reading comprehension  VCIU (voluntary control of involuntary utterances) o Good matching designs and memory designs  VAT (visual action therapy), VIC (visual communication), and or CVIC (computerized VIC) o Ability to sing  MIT (melodic intonation therapy) o Lots of perseverations  TAP (treatment of aphasic perseveration)...