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COMMUNICATIVE DISORDERS An Assessment Manual
COMMUNICATIVE DISORDERS
An Assessment Manual
COMMUNICATIVE DISORDERS
An Assessment Manual
Kenneth G. Shipley, Ph.D. Califomia State University, Fresno
Julie G. McAfee, M.A. NovaCare, Inc.
Springer-Science+Business Media, B.V.
© 1992 Springer Science+ Business Media Oordrecht
Originally published by Singular Publishing Group, Inc. in 1992.
Typeset in 12/14 Times by CFW Graphics
Apart from any fair dealing for the purpose of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright Licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organization outside the UK Enquiries conceming reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page.
The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions that may be made.
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication data available
ISBN 978-0-412-49510-6 ISBN 978-1-4899-6641-4 (eBook)DOI 10.1007/978-1-4899-6641-4
D CONTENTS D
Preface ix
• PART I OBTAINING, INTERPRETING, AND REPORTING ASSESSMENT INFORMATION 1
Chapter 1 Obtaining Preassessment Information 3
Written Case Histories 4 Information-getting Interviews 5
Questions Common to Various Communicative Disorders 6 Questions Common to Specific Communicative Disorders 7
Information from Other Professionals 10 Conc1uding Comments 12 Sources of Additional Information 12 Appendix I-A Child Ca se History Form 14 Appendix 1-B Adult Case History Form 22 Appendix I-C Sampie Request for Information 27 Appendix 1-D Sampie Referral for Medical Evaluation 28
Chapter 2 Evaluating Information from Case Histories 31
Speech, Language, and Motor Development 32 Medical Conditions Associated with Communicative Disorders 40 Syndromes Associated with Communicative Disorders 51 Conc1uding Comments 61 Sources of Additional Information 61
Chapter 3 Reporting Assessment Findings 63
Information-giving Interviews 64 Illustrations to Use When Conveying Information 65 Writing Assessment Reports 68 Clinical Correspondence 71 Conc1uding Comments 71 Sources of Additional Information 72 Appendix 3-A Sampie Clinical Reports 73 Appendix 3-B Sampie Clinical Correspondence 77
• PART 11 RESOURCES FOR ASSESSING COMMUNICATIVE DISORDERS 81
Chapter 4 Assessment Procedures Common to Most Communicative Disorders 83
Oral-facial Examination 84 Interpreting the Oral-facial Examination 84
Assessing Diadochokinetic Syllable Rates 91
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vi ASSESSMENT IN SPEECH-LANGUAGE PATHOLOGY: A RESOURCE MANUAL
Chapter 4 (continued)
Speech and Language Sampling 93 Conversation Starters for Eliciting a Speech-Language Sampie 94 Pictures 95 Narratives With Pictures 100
Evaluating Rate of Speech 108 Determining Speech Rate 108
Determining Intelligibility 109 Syllable-by-Syllable Stimulus Phrases 115 Reading Passages 119 Charting 122 Conc1uding Comments 126 Sources of Additional Information 126
Chapter 5 Assessment of Articulation and Phonological Processes 129 Overview of Assessment 130 Screening 131 Articulation Tests 132 Speech Sampling 133 Identifying Sound Errors 134 Stimulability 138
Assessing Stimulability of Consonants 138 Developmental Norms for Phonemes 148 Age Ranges of Normal Consonant Development 150 Frequencies of Occurrence of Consonants 152 Descriptive Features of Phonemes 154 Distinctive Features of Consonants 155 Phonological Processes 157 Conc1uding Comments 165 Sources of Additional Information 165
Chapter 6 Assessment of Language 167 Overview of Assessment 168
Assessment Approaches 169 Understanding Language Deficiencies 170
Screening 171 Assessing Language 171 Observation and Informal Assessment 175 Formal Language Testing 182 Language Sampling 185 Determining the Mean Length of Utterance 188 Determining the Type-Token Ratio 192 Assessment of Pragmatic Skills 195 Assessment of Semantie Skills 198 Assessment of Syntactie Skills 199 Assessment of Morphologie Skills 209 Making a Diagnosis 213
CONTENTS vii
Chapter 6 (continued)
Conc1uding Comments 213 Sources of Additional Information 214 Appendix 6-A Assessment of Language Development 215
Chapter 7 Assessment of Fluency 223 Overview of Assessment 225 Screening 226 Speech Sampling 226
Evaluating the Speech Sampie 227 Descriptions of Dysfluencies 227 Dysfluency Indexes 228 Associated Motor Behaviors 233 Physiological Factors 238 Speech Rate 241 Assessing Feelings and Attitudes 241
Parental Concern 243 Avoidance and Expectancy 245
Adaptation and Consistency Effects 247 Criteria for Diagnosing Stuttering 247
Estimating Severity 248 Stimulability 250 Cluttering 251
Assessment 253 Stimulability 255
Conc1uding Comments 255 Sources of Additional Information 255
Chapter 8 Assessment of Voice and Resonance 257 Overview of Assessment 259 Screening 260 Need for Medical Evaluation 262 Examining the Voice 262 Assessment Instrumenta tion 267 Normal Fundamental Frequencies 268 Assessing Breathing and Breath Support 270 The S/Z Ratio 272 Assessing Resonance 273
Hypernasality 273 Hyponasality 273 Assimilation Nasality 274
Assessing Velopharyngeal Function 275 The Pressure Consonants 275 The Modified Tongue Anchor Procedure 277
Stimulability 277 Conc1uding Comments 277 Sources of Additional Information 278
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Chapter 9 Assessment of Neurologically Based Communicative Disorders· 281
Overview of Assessment 282 The Cranial Nerves 284 Differential Characteristics of Dysarthria and Apraxia 285 Assessment of Dysarthria 286 Assessment of Apraxia 292
Developmental Apraxia of Speech 300 Classification of Aphasia 300 Assessment of Aphasia 301 Assessment of Traumatic Brain Injury 303 Assessment of Neurogenic Dysphagia 314
Administration and Interpretation 315 Conc1uding Comments 322 Sources of Additional Information 322 Appendix 9-A Evaluation of Aphasia 325
Chapter 10 Assessment of Hearing 341
Types of Hearing Loss 342 Conductive Hearing Loss 342 Sensorineural Hearing Loss 342 Mixed Hearing Loss 343 Central Auditory Disorder 343 Retrocochlear Pathology 343
Standard Classification of Hearing Loss and the Effects on Communicative Development 344
Screening 346 Interpreting Audiograms and Tympanograms 349
Audiograms 351 Tympanograms 355
Speech Audiometry 358 The Acoustic-phonetic Audiogram 359 Environmental Noise Levels 360 Hearing Aids 361
Troubleshooting Hearing Aid Problems 361 Cochlear Implants 363 Vibrotactile Aids 364 Conc1uding Comments 364 Sources of Additional Information 364
Appendix A Dialectical and Bilingual/Multicultural Considerations 365
Appendix B Evaluating Formal Tests Used for Assessment Purposes 379
Glossary 387
References 399
Index 413
D PREFACE D
The purpose of the Assessment in Speech-Language Pathology: A Resource Manual is to provide students and professionals with a variety of information, materials, and procedures for use in the assessment of communicative disorders. The Resource Manual is a practical collection of resource materials applicable to a variety of assessment and diagnostic activities. The items inc1uded are practical, easy-to-use, and helpful for a wide range of assessment processes. Materials published previously, but unavailable in a single source, as well as materials developed specifically for this work are inc1uded.
A valid assessment of an individual's communicative abilities and disabilities is the foundation on which all future c1inical activities are based. Clinicians use assessment information to make professional diagnoses and conc1usions, identify the need for treatment, determine the focus of treatment, determine the frequency and length of treatment, and identify the need for referral to other professionals. Clinicians also make decisions ab out the structure of treatment; for example, individual versus group sessions or treatment with or without caregiver involvement. Clearly, all initial c1inical decisions are based on information derived from the assessment process.
The following is a general overview of the assessment process:
1. Obtain historical information about the c1ient, the c1ient's family or caregivers, and the nature of the disorder.
2. Interview the c1ient, the c1ient's family or caregivers, or both. 3. Sampie and evaluate the c1ient's speech and language use and abilities in the
areas of articulation and speech, language, fluency, voice, and resonance. 4. Evaluate (or screen) the structural and functional integrity of the oral-facial
mechanism. 5. Screen the c1ient's hearing or obtain evaluative information about hear
ing ab ilities. 6. Evaluate assessment information to determine impressions, diagnosis or
conc1usions, prognosis, and recommendations. 7. Share c1inical findings through an interview with the c1ient or caregiver, for
mal written records (such as areport), and informal verbal contacts (such as a telephone contact with a physician).
The emphases of an assessment differ depending on the c1ient, the type of disorder, the setting, the c1ient's history, the involvement ofthe caregiver, and so forth. For example:
• Some disorders will have extensive histories, while others will not.
• Clients will have different primary communicative problems. Some will exhibit problems of articulation, others of voice, still others of fluency, and so forth.
• Some cases will involve extensive interviewing, while others will not. • Some cases will require detailed written reports, while others will not.
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Even though assessment emphases will differ across clients, some consideration of each of the seven general areas just listed will be necessary with most clients.
This resource is divided into two major sections. Part I provides procedures and materials for obtaining assessment information; interpreting assessment findings; and reporting assessment findings to clients, caregivers, and other professionals. It includes ca se history forms and a wide range of interpretive information; interview questions for various and specific communicative disorders; and materials, instructions, and exampIes for reporting assessment information.
Part II begins with Chapter 4. This part provides a variety of materials and suggestions for assessing communicative disorders. Chapter 4 includes general assessment procedures, worksheets, and materials that are useful for all speech-Ianguage assessments regardless of the specific disorder a client exhibits. Chapters 5 through 9 provide assessment procedures for specific types of communicative disorders. Each of these chapters includes a variety of reference materials, hands-on worksheets, pro ce dural guidelines, and interpretive assessment information that are specifically designed to address the unique characteristics of articulation, fluency, language, voice, resonance, or neurologically based disorders. Practical reference materials about the assessment of clients with hearing impairment are provided in Chapter 10.
Appendix A contains information on speech and language differences commonly found with Black, Spanish, and Asian language speakers. Areas to consider when evaluating an assessment instrument, including excerpts from the Code ofFair Practices in Testing, are provided in Appendix B. We have attempted to define new or potentially unknown terminology as it was introduced throughout the Resource Manual. A Glossary is also included for better understanding of selected terms.
Assessment in Speech-Language Pathology: A Resource Manual can be a valuable resource for beginning or experienced clinicians. To our knowledge, no other manual provides such a comprehensive package of reference materials, explanations of assessment procedures, practical stimulus items, and hands-on worksheets and screening forms. Students and professionals can use these items in a variety of clinical settings. However, the resource is not intended to be a textbook or primary resource for understanding and administering speech-Ianguage assessments. We believe that the greatest use of the Resource Manual will be as a comprehensive resource for the assessme nt process. A large and varied collection of materials, guidelines, suggestions, and interpretive information is provided in this single source.
D ACKNOWLEDGMENTS D
Our grateful appreciation is extended to our colleagues, friends, and family members who offered support and he1p with this pröject. Bette J. Baldis, Tracey J. Baldwin, Deborah Davis, Jeffrey L. Danhauer, M. N. Hegde, and Christine Strike Roussos reviewed portions or all of the text at various stages of preparation and provided helpful suggestions and comments along the way. We also thank the staff and consultants at Singular Publishing Group, particularly Marie Linvill, Pam Rider, Randy Stevens, Angie Singh, and Sadanand Singh, for their guidance during the review and production process. Appreciation is also extended to the many publishers and authors who allowed us to inc1ude their works in this book. Our families were especially encouraging, supportive, and understanding during the development of this Resource Manual. We extend our love and appreciation to Peggy, Jennifer, and Adam.
LIST OF TABLES
3-1 Phonetic Symbols of the English Language 68 4-1 Syllable-by-Syllable Stimulus Phrases 116 5-1 Words and Phrases for Assessing Stimulability 140 5-2 Five Commonly Cited Norms for Consonant Development 149 5-3 The Frequency of Occurrence of Individual English Consonants 153 5-4 The Sounds of English Categorized by PI ace, Manner, and Voicing 154 5-5 Distinctive Features of English Consonants 156 6-1 Basic Procedures for the Assessment of Language 174 6-2 Major Milestones of Language Acquisition in Children 176 6-3 Several Formal Tests for the Assessment of Language 183 6-4 Developmental Norms for the Assessment of Mean Length of Utterance 189 6-5 Common Semantic Relations 198 6-6 Developmental Stages in Early Syntactic Acquisition 199 6-7 Elements of the Noun Phrase 201 6-8 Elements of the Verb Phrase 203 6-9 Derivational and Inflectional Morphemes 209 7-1 Severity Rating Guide 249 7-2 Fluency Modification Techniques 250 7-3 Differential Characteristics of Stuttering and Cluttering 252 8-1 Voice Disorders Classified According to Functional or Organic Etiology 258 8-2 Buffalo III Voice Screening Profile 260 8-3 A Three-Point Scoring System for Screening Voice Disorders 261 8-4 Normal Fundamental Frequencies for Males 268 8-5 Normal Fundamental Frequencies for Females 269 9-1 The Cranial Nerves - Types and Functions 284 9-2 Differentiating the Six Dysarthrias 287 9-3 Types of Aphasia According to the Boston Classification 301
10-1 Description of Hearing Loss Severity by Decibel Levels 345 10-2 Effects of Hearing Loss on Communication and Types of Habilitative
Intervention with Children 345 10-3 Symbols Commonly Found on Audiograms 350 10-4 Environmental Noise Levels 360 10-5 Troubleshooting Hearing Aid Problems 362 A-I Phonemic Contrasts Between Black English and Standard American English 367 A-2 Grammatical Contrasts Between Black English and Standard American English 368 A-3 Pragmatic and Nonlinguistic Contrasts Between Black English and Standard
American English 370 A-4 Phonemic Contrasts Between Hispanic English and Standard American English 371 A-5 Grammatical Contrasts Between Hispanic English and Standard American English 372 A-6 Pragmatic and Nonlinguistic Contrasts Between Hispanic English and Standard
American English 373 A-7 Phonemic Contrasts Between Asian English and Standard American English 374 A-8 Grammatical Contrasts Between Asian English and Standard American English 375 A-9 Pragmatic and Nonlinguistic Contrasts Between Asian English and Standard
American English 377
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LIST OF FORMS
l-A Child Case History Form 14 I-B Adult Case History Form 22 4-1 Oral-facial Examination Form 87 4-2 Diadochokinetie Syllable Rates Worksheet 92 4-3 Assessing Intelligibility Worksheet 112 4-4 Charting Worksheet - I 124 4-5 Charting Worksheet - 11 125 5-1 Comparison of Sound Errors from an Artieulation Test and Connected Speech 135 5-2 Sounds That Are Stimulable 146 5-3 Phonological Processes Worksheet 162 6-1 Checklist for an Informal Assessment of Language 178 6-2 Worksheet for Recording a Language Sampie 186 6-3 Type-Token Ratio for the Analysis of Semantie Skills 193 6-4 Assessment of Pragmatie Skills 196 6-5 Assessment of Syntactic Features 207 6-6 Assessment of Morphologie Features 211 6-A Assessment of Language Deve10pment 215 7-1 Fluency Charting Grid 230 7-2 Frequency Count for Dysfluencies 231 7-3 Calculating the Dysfluency Index 232 7-4 Assessment of Associated Motor Behaviors 234 7-5 Assessment of Physiologieal Factors Associated with Stuttering 239 7-6 The Modified S-Scale 242 7-7 Parental Speech Chart 244 7-8 Checklist of Cluttering Characteristics 254 8-1 Vocally Abusive Behaviors Checklist 263 8-2 Vocal Characteristies Checklist 265 8-3 Identification of Breathing Patterns 271 9-1 Identifying Dysarthria 289 9-2 Checklists for Limb, Oral, and Verbal Apraxia 295 9-3 Identifying Apraxia 299 9-4 Informal Assessment of Traumatic Brain Injury 307 9-5 Adult Dysphagia Bedside Evaluation 318 9-A Evaluation of Aphasia 325
10-1 Hearing Screening Form 347 B-l Test Evaluation Form 383
3-1 The Brain 3-2 The Ear 3-3 The Oral Cavity
LIST OF ILLUSTRATIONS
3-4 The Vocal Folds - Open 3-5 The Vocal Folds - Closed 3-6 The Vocal Tract
65 66 66 67 67 67
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LIST OF FIGURES
4-1 Speech-Language Samp1e Stimulus - Farm 96 4-2 Speech-Language Samp1e Stimulus - Park 97 4-3 Speech-Language Samp1e Stimulus - Amusement Park 98 4-4 Speech-Language Samp1e Stimulus - P1ayground 99 4-5 Lydia and the Anima1s (Narrative with Pietures) 100 4-6 Jacob's Day (Narrative with Pietures) 104 5-1 Age Ranges of Normal Consonant Deve10pment 151
10-1 Audiogram of a Conductive Hearing Loss 351 10-2 Audiogram of a Sensorineural Hearing Loss 352 10-3 Audiogram of a Mixed Hearing Loss 352 10-4 Audiogram of a Conductive Hearing Loss Caused by Otosclerosis 353 10-5 Audiogram of a Hearing Loss Caused by Presbycusis 353 10-6 Audiogram of a Noise-induced Sensorineural Hearing Loss 354 10-7 Audiogram of a Moderate Sensorineural Hearing Loss 354 10-8 Type A Tympanogram - Normal Pressure and Compliance Functions 356 10-9 Type B Tympanogram - Fluid in the Middle Ear 356
10-10 Type C Tympanogram - Retracted Tympanie Membranes 357 10-11 Type As Tympanogram - Shallow 357 10-12 Type Ao Tympanogram - Deep 358 10-13 Acoustie-phonetie Audiogram 359
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