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Slide1
Assessment in Life Participation Approach to Aphasia
NOTE:
The associated document, “Course Module: Assessment in Life Participation Approach to Aphasia”, contains information regarding relevant standards/guidelines, learning objectives, additional learning materials, and assessment activities. The document, “Summary of Assessment References” contains the references.
Slide2Academic Module Sponsors
:
Slide3Academic Module Committee
Slide4About Aphasia Access
Received its 501c(3) designation in May 2014
Membership includes representation from 33 states and 5 Canadian Provinces. The Life Participation Approach to Aphasia (LPAA) is the core philosophy.
Produces videos, webinars and podcasts that are used internationally to educate speech-language pathologists, healthcare professionals, students, nonprofit board members and community leaders.
Advocates for aphasia care and communication access throughout health care.
Slide5How can SLPs assess people with aphasia using the LPAA?
Assessment in
Life Participation Approach to Aphasia
Slide6Target Audience
This presentation has been developed for speech-language pathology (SLP) students and current practitioners and is one portion of a series of LPAA academic modules for adoption in pre-professional and continuing education.
Slide7LPAA Curriculum Modules
The Working Group on Academic Curriculum of the Education and Research Committee of
AphasiaAccess
has developed this module to
Describe principles and processes for assessment when adopting the Life Participation Approach to Aphasia
Slide8Learning Objectives
Upon successful completion of this learning module, participants will be able to:
Differentiate between using the LPAA model from impairment-based models of assessment
Apply the LPAA model to assessment processes and procedures for people with aphasia
Slide9This module will cover…
What is the Life Participation Approach to Aphasia (LPAA)?
Why use the LPAA in assessment of people with aphasia?
When? Where? and How can SLPs
use the LPAA in assessment of people with aphasia?
Slide101. What is the Life Participation Approach to Aphasia (LPAA)?
A brief summary
Slide11Life Participation Approach to Aphasia (LPAA)
LPAA is an underlying philosophy which supports treatment for individuals with aphasia
(LPAA project group, 2000).
LPAA Core Values
Goal is enhancement of life participationServices are available to all affected by aphasiaChanges in the environment are essential to participationSuccess is measured by documented life changesServices are available as needed at all stages
Slide12LPAA
LPAA places life concerns of people with aphasia
at the center of all decisions.
Clinicians strengthen daily participation in activities of
their client’s choice.The clinician works not only on communication but also on establishing and maintaining social links…for it is within this environment that one communicates.
Slide13LPAA expands the role of the SLP
Slide142. Why use LPAA in assessment of people with aphasia?
A foundation in best practices
Slide15LPAA Assessment is best practice
Aligns
with practice guidelines
ASHA Scope of practice, Aphasia United, Australian Aphasia PathwayComplements impairment level assessment of language (Hinckley, 2015) Incorporates activity, participation, environmental and personal factors http://www.asha.org/uploadedFiles/ICF-Aphasia.pdfRecognizes critical role of patient-reported outcomes
(
Boothe
& Richardson, , 2011)
Slide16LPAA assessment is purposeful
Determines current activity and participation levels
Identifies future activity and participation goals
Evaluates factors that impact participation: communication, physical, personal and environmental factors
Reveals immediate and future needs for communicationAssesses social connectedness and social supportConsiders emotional well-being and quality of lifeGuides further assessment and treatment
Slide17LPAA assessment is personally meaningful
“
What do people with aphasia want ?
”
People with aphasia and their families want Activity and participation goals (Worrall et al., 2011) People with aphasia want to improve communication....and… return to valued activities (hobbies, returning to work, to travel) (Rohde,Townley-O'Neill et al., 2012)
Slide18LPAA assessment is relationship centered
A change in perspective from impairment-based to LPAA assessment is based upon relationship centered care.
Relationships in health care include the personhood of the participants
Affect and emotion are important components of these relationships
All health care relationships occur with reciprocal influenceGenuine relationships in health care are morally valuable (Beach, Inui & Relationship-Centered Care Research Network, 2006)
Slide19LPAA Assessment is consistent with the WHO-ICF
Impairments
: problems in body function or structure
Activity
: doing a task or action.Participation: involvement in a life situation.Environmental Factors: physical, social and attitudinalPersonal Factors: age, coping styles, education http://www.who.int/classifications/icf/icfbeginnersguide.pdf?ua=http://www.who.int/classifications/icf/icfbeginnersguide.pdf?ua=1http://www.who.int/classifications/icf/icfchecklist.pdf?ua=1
Slide20LPAA Assessment is informed by A-FROM Aphasia Framework for Outcome Measurement (Kagan et al., 2007)
A-FROM is conceptualized around four domains
Impairment
Participation
Environment Personal factorsPremise focuses on increasing access while reducing barriers in healthcare facilitating participation in personally relevant activities
Slide21Image retrieved 4/24/17 from: https://s-media-cache-ak0.pinimg.com/originals/5a/7a/8b/5a7a8bfda03065cc0214711a4132b1f7.png
Considers:
Family’s skills
Communication support
Friends’ attitudes and knowledge
Adaptation to activities
Considers
:
Conversations
Relationships
Leisure activities
Volunteer opportunities
Community activities
Considers
:
Confidence
Self-esteem
Identity and autonomy
Considers:
Language activities to support specific roles
Vocabulary for KEY interests
Scripts for specific activities
A-FROM
(Kagan et al., 2008)
Slide22Comparison of impairment-oriented and LPAA assessment
(Whiteside, 2017, LPAA Academic Module)
Impairment-oriented Assessment
LPAA
AssessmentLanguage functions intrinsic
to the individual
Spoken language production
Understanding spoken language
Written language production
Understanding written language
Modalities
All
domains of living with aphasia
Language & communication strengths
Participation goals
Environment and context
Personal factors
Emotional well-being
Slide233. When, where, and how do SLPs apply LPAA assessment?
A primer in LPAA assessment
Slide24Times
for LPAA assessment
Assessment using the LPAA takes place across the life-span of a person living with aphasia
(Simmons-Mackie, King, & Beukelman, 2013).Soon after onset in acute care During active rehabilitation Any time new needs arise
Slide25Example:
After onset in Acute Care
W
hen the SLP arrived to assess Mr. A’s communication, his wife was sitting tearfully next to him. Mr. A had been unable to read his menu and did not like anything on his food tray.
Using the process of Contextual Analysis, the SLP observed: ENVIRONMENTAL factors (text-based menu) PERSONAL factors (food preferences and caring spouse) and LANGUAGE factors (reduced reading comprehension). Using a process of Dynamic Assessment, a 6-square picture menu of breakfast items was used. Mr. A selected preferred foods. His wife observed this supported conversation approach.Identified LPAA Goal: Mr. A will select his preferred food items using a pictographic menu
Slide26Places for
LPAA assessment
Assessing using the LPAA takes place within all settings where the SLP meets people with aphasia.
Hospital
(McCooey - O’Halloran et al., 2004) Skilled nursing facility Home (Haley et al., 2010) Outpatient clinic Aphasia Center (Kagan et al., 2008) Community (Dalemans et al., 2010)
Slide27Example:
Home Care
Mr. and Mrs. B. talked with the home care SLP about how life had changed since coming home from the hospital.
Using a patient report tool, the
Communication Activities Checklist (COMACT) (Cruice, 2001, Cruice et al., 2010), the client’s communication interests were assessed. The SLP determined that Mr. B. wanted to read more. Using the A-FROM framework, the SLP considered: ENVIRONMENTAL factors (He and his wife read in the living room every evening) PERSONAL factors (They missed the social closeness of reading together) and LANGUAGE factors (Significantly reduced reading comprehension). Identified LPAA Goal: To enjoy reading together with wife using audio books from public library
Slide28Assessment can be ongoing, as new needs arise
What
new participation need or interest has the person identified?
What are possible communication participation barriers?
Needs access to public transportation system
Able to use phone
to reserve the metro van?
Wants to volunteer on a community board
Able to listen to a group discussion and take notes?
Needs a new apartment
Able to
read an apartment search phone app?
Slide291. Standardized Assessments
empirically developed with statistical reliability and validity
2. Self-Report/Family/ or SLP Report Measures rating scales, inventories or questionnaires3.. Ethnographic Interviewing / Biographic Narrative open-ended questions, restatement, and clarification4. Observation and Contextual Analysis variables affecting and interacting with communication participation5. Dynamic Assessment real-life situation task assessment; treatment applied and changes notedhttp://www.asha.org/Practice-Portal/Clinical-Topics/Late-Language-Emergence/Assessment-Tools-Techniques-and-Data-Sources/
Methods for
assessment in LPAA
Slide30Examples of assessment
The following 5 slides will highlight brief clinical examples of LPAA assessment using:
Standardized Assessment Tool
An Interviewing Process
Self-Report ToolsContextual AnalysisDynamic Assessment
Slide31LPAA Assessment:
1) Standardized Tool
Purpose
To reveal immediate needs for communication participation
Mr. A, 78, living alone after recent CVA
Tool
Communication Activities of Daily Living
- 3
(Holland,
Fromm, & Wozniak, 2018
)
Outcome
Identified impairment in reading prescription instructions;
Mr. A
needs
to manage his medications at home independently.
Slide32LPAA Assessment :
2) Interviewing
Purpose
To
identify the individual’s life participation goals Mrs. B, age 63, 3 years post CVA
Process:
Ethnographic Interviewing
(Simmons-Mackie
& Damico, 2001
)
Counseling/coaching
(Holland & Nelson, 2013)
Outcome:
Identified
Mrs. B’s participation goal:
T
o present testimony about her recovery in her church
WHO-ICF participation
domain:
d930 Religion and spirituality
(WHO-ICF, 2003;
Pollens &
Glista
, 2016)
Slide33LPAA Assessment:
3) Self report Tools
Purpose
To
evaluate current impact of aphasia on participation and emotional well-being Mr. C,
42 year old teacher, anomic aphasia, 2 years post CVA,
unable to return to work.
Tools
Assessment for Living with Aphasia (ALA)
Depression screening (Visual Analog Mood Scale)
Outcome
ALA identified
lowest scores in the domain of personal/psychosocial factors; positive screen for depression
Slide34LPAA Assessment:
4) Contextual Assessment
Pollens &
Glista, 2016)PurposeTo identify impact of environmental factors Mr. D, age 27, 1 year post CVA, wants to schedule rides from local paratransit system
Process
Real-life situation task assessment
in natural context
Outcome
When Mr. D attempted to use the telephone system, the ride dispatcher was unable to understand Mr. D’s ride requests. Dispatcher did not demonstrate supportive communication approaches.
Slide35LPAA Assessment:
5) Dynamic Assessment
(
Hersh
et al., 2013; Hersh, 2012)Pollens & Glista, 2016)
Purpose
To evaluate current impact of aphasia on participation and to guide treatment
Mrs. E, 58 with
nonfluent
aphasia, 3
months post onset
Process
At the skilled nursing facility, the
Interprofessional
Team meeting noted that Mrs. E was
not following safety instructions for use of her new walker. This was a barrier to her goal to reside in her own home.
The SLP observed PT working with Mrs. E and assessed
her
ability to follow the spoken instructions. SLP then provided key word visual support
to determine impact on following safety instructions.
Outcome
Mrs. E’s personal goal of discharge to her home will
require treatment of communication strategies for increasing comprehension of safety instructions.
Slide36Program-specific “choice” can be another assessment tool
Many Aphasia Centers and Aphasia Groups offer people with aphasia choices from menus of participation activities.
Many people with aphasia and their care partners state
what they want
to do in their lives (Worrall et al., 2011). The client’s choices can reveal participation needs, interests, and hopes (Glista & Pollens, 2007).
Slide37Client Choice
Please rate these
Do you want to
teach other people
about aphasia?Not at all Maybe Very much
Do you want to
use the internet
and
discuss current events?
Not at all Maybe Very much
Do you want to improve your
spelling and writing
?
Not at all Maybe Very much
Do you want to visit an Art Museum and discuss the paintings?
Not at all Maybe Very much
(
Glista
& Pollens, 2007)
Slide38Additional variables may influence SLP decisions in methods of assessment (Coppens & Simmons-Mackie, 2018)
Preferences of the person with aphasia
Age and life situation/role of the person with aphasia
Level of communication ability
Cognitive abilitiesSensory functioning Availability of time or resourcesSLP knowledge, experience, and expertise
Slide394. What are some tools used in LPAA
assessment?
A selection of assessments and interviews
Slide40Interviewing…Educating…Counseling
How do we listen to truly hear what clients and families want?
What’s one thing that will truly make a difference?
What is happening in your life - now?
What are your hopes for the future? Biographic narrative (Corsten et al., 2013)Coaching/Active listening (Holland & Nelson, 2014)Ethnographic interviewing (Simmons-Mackie & Damico, 2001)Life story narratives (Shadden, 2007; Hinckley, 2015)
Slide41Assessments
A variety of assessments tools and processes can be used within the LPAA. A selection of assessment descriptions follows in alphabetical order.
For a comprehensive list see…
Brandenburg, C., Worrall, L., Rodriguez, A., & Bagraith, K. (2015). Crosswalk of participation self-report measures for aphasia to the ICF: What content is being measured? Disability and Rehabilitation, 37(13), 1113-24.For a comprehensive discussion of assessment related to Quality of Life… See Hilari & Cruice (2017)
Slide42TOOL
Assessment for Living with Aphasia
(Aphasia Institute, 2010)
Description
Pictographic self-report measure of aphasia-related quality of life across multiple domains that impact life with aphasia MeasurementOverall score of person’s perceptions of life with aphasia. Also domain specific scores
(language, participation, personal/psychosocial factors and environmental factors).
Example Result
Person with aphasia expresses high need to resume reading for pleasure in every day activities.
Slide43TOOL
Aphasia Communication Outcome Measure (ACOM)
(Hula et al., 2015)
Description
Person with aphasia self reports
communicative functioning
Measurement
Measures perception of how effectively
person with aphasia completes communication-related behaviors, tasks, activities, and life situation.
Example result
Person with aphasia indicates she does not talk very effectively with her best
friend and care partner.
Slide44TOOL
Burden of Stroke Scale
–
BOSS
(Doyle et al., 2003) DescriptionPerson with aphasia self reports health status difficulty in functioning across mobility, self-care, swallowing, energy and sleep, communication, cognition, and social relations.
Measurement
Scores of physical limitations, cognitive limitations, and psychological distress obtained.
Example result
Person with aphasia indicated difficulty communicating with a familiar person on the phone.
Slide45TOOL
Communication Abilities
of Daily Living – 3
(Holland, Fromm, & Wozniak, 2018)
DescriptionThe clinician assesses 1. Reading, writing, and using numbers 2. Social interaction 3. Contextual communication 4. Nonverbal communication 5. Sequential relationships 6. Humor / metaphor /absurdity 7. Internet basics
Measurement
A raw score is obtained from which percentile rank and stanine score are available.
Example Result
Person with aphasia was successful in using multiple modalities to express ideas.
Slide46TOOL
Communication
Activities Checklist COM
ACT
(Cruice, 2001; Cruice et al., 2010)DescriptionPerson with aphasia self-reports engagement in types of communication activities.
Measurement
Talking
, listening, reading, and writing a
ctivities are identified, and frequencies are tallied
.
Example result
Person with aphasia expresses wish to increase talking with her neighbor from once per month to once per week.
Slide47TOOL
Communication Confidence Rating Scale for Aphasia - CCRSA
(
Babbit
&
Cherney
, 2010)
Description
Person
with aphasia rates self confidence in 10 examples of social and functional communication.
Measurement
Determines how self-confident the person
with aphasia feels in communication and the change in self confidence over time.
Example result
Person
with aphasia rates self as “moderately” confident in
ability to talk with other people
.
Slide48TOOL
Communication Disability
Profile - CDP
(Swinburn & Byng, 2006)
DescriptionPerson with aphasia self rates activity, social participation, external influences, and emotional consequences. Pictures facilitate discussion with clinician.Measurement
Measures of the impact of aphasia by obtaining scores for individual items.
Example result
Person with aphasia identified she could not do her own grocery shopping independently.
Slide49TOOL
Communication Effectiveness Index – CETI
(Lomas et al., 1989)
Description
Communication partner rates functional change in communicating basic needs
, life skills, and social needs through questionnaire.
Measurement
Change in
functional communication over time is recorded for 16 items.
Example result
Spouse reported change
in “getting someone’s attention” from
not
at all able
to
same as before stroke
.
Slide50TOOL
Community Integration Questionnaire – CIQ (
with or without pictographs
)
(
Dalemans
et al., 2010)
Description
Person with aphasia selects how often an activity is performed in area of home integration, social integration, and productive activities. Originally developed for TBI survivors; adapted for persons with aphasia
Measurement
A raw score from 0 - 29 is obtained; the higher the score, the more community
integration reported.
Example result
Person
with aphasia reported
not
grocery shopping for family; she wants to resume responsibility.
Slide51TOOL
L!V Cards (Life Interests and Values Cards)
(Haley et al., 2010)
Description
Communicate with person with aphasia or family/friend about valued life activities. Drawings on cards depict life activities in four categories: Home & Community, Creative & Relaxing, Physical, and SocialMeasurementDetermine list of “wants to do more” activities in each area
Example result
Person with aphasia chose
c
amping and traveling
as a family life activity to resume.
https://www.med.unc.edu/ahs/sphs/card/resources/livcards/score-sheets
Slide52TOOL
Quality of Communication Life Scale - ASHA QCL
(Paul et al., 2004)
Description
Person with aphasia self rates the impact of aphasia on relationships; communication; interactions; participation in social, leisure, work, and education activities; and overall quality of life.
Measurement
Vertical
analog scale is marked from low to high points using key words and pictures which reflect perceptions of life quality, social roles, and interactions.
Example result
Person with aphasia
chose lowest point of the scale to rate,
My role in the family is the same.
Slide53TOOL
Social
Activities Checklist -
SOCACT
(Cruice et al., 2010) DescriptionPerson with aphasia is interviewed to quantify range and frequency of involvement in social activities.
Measurement
Weekly, biweekly,
monthly, rarely, not at all and not applicable used to collect information about social activity and participation.
Example
result
Person with aphasia wants to go to church with his spouse every week.
Slide54TOOL
Stroke and Aphasia Quality of Life Scale SAQOL-39
(
Hilari
et al., 2003)DescriptionPersons with aphasia evaluate function in physical, psychological, communication, and energy. MeasurementDifficulties
are reported for
39 items on a 5-point scale using two formats,
e.g. could not do it at all/no trouble at all; definitely yes/definitely no
.
Example result
When asked,
During the past week, did you feel withdrawn
from other people
, p
erson with aphasia chose “definitely yes.”
Slide55TOOL
Visual Analog Mood Scale
(Stern, 1997)
Description
Person with aphasia selects from simple schematic faces to report mood states.MeasurementMood states include choices of sad, afraid, angry, tired, energetic, happy, and confused
Example result
Person with aphasia selects faces depicting sad and afraid during three consecutive sessions.
Slide56TOOL
WHO-ICF checklist
(http://www.who.int/classifications/icf/icfapptraining/en/)
Description
This checklist of major categories of the International Classification of Functioning, Disability and Health (ICF) of the World Health Organization can be a practical tool to elicit and record information on the functioning and disability of an individual.
Measurement
Through an interview, version 2.1a, Clinician Form, part 2 collects information about performance and limitations of activities.
Example result
Person with aphasia has problems with holding conversations with family and friends.
Slide57Additional Resources
Slide58Additional Resources
Slide595. How do SLPs use LPAA assessment information to design treatment?
An
AphasiaAccess
module on LPAA Treatment
Slide60Summary
When using the LPAA approach to assessment, the SLP addresses the
Language,
Participation,
Environmental, and Personal Factors domains.The LPAA approach to assessment results in treatment models which can address all of these factors.
Slide61Comprehensive LPAA treatment“I want to learn to email with my family”
Slide62See AphasiaAccess LPAA Treatment Module
Slide63Questions?
How will you use the LPAA to assess people with aphasia?
Slide64Summary of Assessment References
A complete list of references can be found at
https://
aphasiaacc.memberclicks.net
/assets/Academicmodules/AA%20Assessment%20Course%20Module%20Outline%20March%2014-%20UPDATED2AUG2018.pdf