NURS 2023 Health Of Adults

You will create a portfolio of three separate tasks and a reference list, focused on the assessment and diagnosis of clients with aphasia resulting from left hemisphere stroke.

Your guide will include the following components:

An overview of the general principles of assessment for clients with aphasia including aims/goals of the assessment process the different sources of information and their relevance/importance (e.g. reported observations, comprehensive assessment batteries, assessments of specific linguistic function/behaviours) the types of information that may be obtained and why (i.e. quantitative and qualitative)

A brief introduction to the A-FROM (Kagan et al., 2008) including:

its domains, rationale and explaining how it relates to the International Classification of Functioning, Disability and Health (ICF)

Key assessment activities mapped to each of the A-FROM domains of the A-FROM (e.g. Participation in life situations, etc.) including

identify and briefly describe between 2 (two) to 4 (four) different assessment activities for each domain include formal and informal assessment methods

You will develop a study to the assessment and diagnosis of semantic disorders for clients with aphasia

'Real-life' indicators of presence of semantic issues and and/or possible real-life implications for the client

that may be used to assess semantics including
developed within the context of the cognitive-neuropsychological model; and
that are representative of semantic abilities above the level of the single-word

Task 3 - Annotated bibliography

Task 1: Guide to the assessment of clients with aphasia

Individual clients with aphasia are basically identified by clinicians present in a hospital. In a particular acute setting, the pathologist always have a brief dimension in which they do clear clinical assessment and evaluator examination in order to identify the existence and overall effects of aphasia(Baker, Rorden & Fridriksson,2010).

Accurate assessment of aphasia usually depends upon proper and precise clinical examination (Fridriksson, Richardson, Baker & Rorden, 2011). Comprehensive and precise assessment of language capabilities by the speech pathologist is important as it is aimed at the development of a clear wide range of knowledge of patient communication ability involving the strengths and weaknesses of an individual's speech (Fridriksson et al, 2011).

Key assessment activities

Standardized assessment. These are an assessment in which the given procedure involved for the correct administering of the test items are well prescribed in a properly defined manner offering room for comparisons.

Norm-Referenced tests. These usually yield outcomes that can be quantitively compared with the performance of a normative test sample. The activities include both corrected and standard scores from a formal comparison group. A criterion-referenced test gives outcomes with a given standard and not performance. The western Aphasia battery is an example of such a test activity. It is aimed at determining aphasia severity and not the placement of patients with aphasia with a normal comparison group (Coppens, 2016).

Dynamic assessment. These activities take an experimental approach in a bid to identify the negative impacts of factors such as task modifications, context factors, and environmental supports

Formal and informal methods. Formal assessment involves systematically applied procedures and process whereas informal lacks clearly defined procedures. The activities done include systematic assessments such as functional behaviour assessment (Cheng et al, 2014).

Methods and procedural activities

The WHO'S ICF usually recommends assessments of the various levels of impairment, limiting activities participation mode restrictions and barriers to the physical and personal environment. Clinicians and speech pathologist assess the functional effect of a person's cognitive communication difficulties on social performance (Hurkmans et al, 2012).

Sources of information and Importance

• Observations
• Research studies on periodicals, newspapers, websites,
• Interviews with patients in the society.
• Questionnaires conducted to nurses and speech pathologist
• Hospital previous data

Determine the presence of aphasia

This assessment might be composed of unstructured evaluations which are considered around more test-style tasks and techniques. The rise of this particular informal approach has risen from clinician experts to form a great awareness on the patient's requirements in the early stages and also to respond to the periodical environmental acute settings (Knollman, 2008). Researchers indicate that the utilization of non-standardized examination is important in the diagnoses of the existence of the conditions effects on individual patients. In acute settings, it is not mandatory to conduct a comprehensive standardized testing for diagnostic aims and objectives (Poslawsky, Schuurmans, Lindeman & Hafsteinsdóttir, 2010).

Evaluations differ according to their period required to be done and content. However each of the available speech pathologists typically asse3ss the following major language concepts such as repetition of words, reading, writing, word finding and comprehension of a particular spoken language with the continuous follow-up of command sand questions.

A judgment of severity is thus a significant clinical measure to assess aphasia. In addition to aiding with prognosticating process measure, severity ratings also give a useful and important guide for the proper selection of treatment goals and intervention plans, for example, giving and assigning individual patients to language treatment groups (Lazar et al, 2010).

ICF normally provides the required policies and guidelines which are both comprehensive and reliable. Their flexibility nature enables proper evaluation goals to be clearly examined by the clinical nurses. The persons with such severe conditions and those with minimal communicative abilities are known, identified and recorded (Lambon et al, 2010).

Domains mapped

Domain
Impairment	Difficulties in body structures and functions like important  deviations and loss	Impaired or abnormal neuroanatomical, neurophysiological structures and various functions that provide support to cognitive-communication.E.g abnormal memory, visual language
Participation in life activities	The various domains of functioning based on societal perspective	Participating in everyday tasks and involving in social situations may be difficult because of problems in conversations, limited ideas, social isolation and opinion. A patient’s inability to resume to initial lifestyle roles.
Contextual environmental factors	Affect disability of individuals environment	Difficulties imposed like impaired cognitive functioning, inflexibility in work environment and societal altitude
Contextual personal factors	Individual patient influences on performance in a more personal level environment.	For example lifestyle,background,age,motivation,basic upbringing and the character to adjust to aphasia disability

Task 2: Adult Stuttering Assessment plan.

The context describe both the historical and the current approaches to stuttering treatment to the adults. Here the treatment is handled under the approaches in different management practices, the fluency capability and both the combined. Generally the fluency shaping approaches tend to be more robust compared to the stuttering management practices. 

Assessment for the adult stuttering.

Attention for the adult who stutter.

In most of the studies the stuttering is described as the surface fear that may result from the shame, anxiety and even hopeliness .Most methods of behaviour therapy is enhanced through the version, through the cognitive behaviour therapy and through the use of multidimensional factors. The assessment reveals the surface stuttering which addresses primarily the cognitive dysfunction.

The Neurophysiological and the genetic assessment resolution.

Receptive language is generally referred as the understanding words and languages (Bishop, 2014). It revolves getting the necessary information and then deciding the targeted meaning from the identified routine( for example the lesson is over so it is not to go home ),getting the appropriate information from the within and outside environment  (for example on road on seeing the green light means to cross),interpreting sounds and words (for example hearing bell and corresponding to the activity ) , concepts on colours ,different sizes and lastly the written information.

Expressive language explains how people communicate on their wants and needs. It revolves around both the verbal and nonverbal communication and how an individual uses language techniques (Bishop, 2014). 

The process involved in adult stuttering.

The following are the processes used in receptive and expressive language based on the contest of cognitive and the psychological model.

1. Being attentive and concentrating. This involves sustained efforts, carrying various activities without the distraction and being in a position to keep the activity carried out for a long time (Chareet al, 2014).
2. Carrying out pre-language activities. Involves the way we express our ideas and communicate without the use of the words. This uses nonverbal communication skills such as gestures, facial expressions and use of eye conduct to convey some information.
3. The aspect of social skills. Forms a vital process whereby it can be determined through one's ability to interact with different people either verbally or non-verbally. Also compromising and being able to conform to different values and norms.
4. Play skills form the core building block for receptive and expressive language. This involves engaging activities voluntary which may not be of an important or without a certain goal (Chareet al, 2014).

How receptive and expressive language processes can be disrupted in adult stuttering.

It is categorized in different levels.

1. First is on the level of linguistic. In most cases at this level, you find that agent or the speaker of information comes up with his or her own ideas and then try to encode those ideas into specific words that give a certain meaning. The common communication disorder here is the aphasia whereby the shortage of adequate oxygen gas in brains tissues causes the language shortcomings (Dodd, 2013).
2. Disruptions based on physiological level. The communication shortcoming comes from the disruptions in the vocal structures. Dysarthria is on impairment which is mostly found in nerves thus hindering the transfer of signals from the brain tissues to the mouth, tongue, and lips. On another hand, dyspraxia involves difficulties in alternating words, challenges in pronouncing long words and also constraints in sequencing words in specific utterances. Hearing impairment hinders the ability to monitor sound from the speech, different sounds thus propagating to a number of errors and in so doing difficulties in articulation (Dodd, 2013).
3. Thirdly is disruption on the acoustic level. This mostly occurs in noisy places, for example, holding a conversion in a room with loud music. One cannot concentrate keenly and neither can he talk loudly nor be heard.
4. Lastly is the multi-component disruption. This mostly appears to people with stroke and head injury thus leading to difficulties in expressing languages, leading to dysarthria and also facilitating the receptive language disorders. Therefore this forms the communication disorder which disrupts receptive and expressive languages in most of the people.

Real life indicators of semantic issues.

Semantic issues are evident in different ways (Kaderavek, 2011).The following are some of the problems experienced by people thus showing the semantic problems.

1. Difficulties in following and using critical verbal directions.
2. Use of a few words to describe something.
3. Challenges in asking and answering questions. Mostly found in young people.
4. Struggling to comprehend the relationship between words, sentence construction and identifying the word with the suitable category.
5. Difficulties in following different conversations and failing to identify the figurative languages in sentences.

Tasks used to assess semantics.

The following subtasks help in assessment semantics (Kaderavek, 2011).Tasks involved in the context of the cognitive and psychological model are;

1. The task on semantic similarity between different words and the identified phrases. In this task, it focuses to evaluate the similarity in different words and the sequences resulting from the various words. (For example on close interaction, the contact) –the sequence is semantically relevant and close to the meaning. In this task, it explains core problems experienced in word sequencing pair which form semantically distinct phrases (Manolitsi & Botting, 2011).The task is formal since the evaluation criteria are given based on ability to recall and remember phrases. All languages should be submitted precisely.
2. Secondly, the task involves the use of semantic in compositionality in context. Involves ability to determine whether a word or a phrase is used in context either literal or in figurative language (Medwetsky, 2011).For example, using a word such as a "big school" to mean a certain figure. One is in a position to know whether a word is used as a figuratively within a context.

Task 3- Annotated bibliography.

Assessment and diagnosis of the cognitive disorder in clients with aphasia.

Simmons-Mackie, N., Threats, T. T., & Kagan, A. (2005). Outcome assessment in aphasia: A survey. Journal of Communication Disorders, 38(1), 1-27.

The journal argues that there is increased attention for the speech-language. The journal describes the survey that was to reveal the outcome of the assessment in aphasia. The issue is evident mostly in adults. Funding sources need to improve communication in order to enhance the quality of people with aphasia (Simmons et al,2005).The disorder is common among young with an adult giving a small percentage. The journal shows how speech-language pathologists have been in a position to use various tools to detect the outcome of the aphasia. Simmon et al, 2005 page 45 show the exact number 45% with aphasia disorder. The author shows how different assessment have been achieved to curb aphasia.

Salis, C., Murray, L., & Bakas, K. (2018). An International Survey of Assessment Practices for Short-Term and Working Memory Deficits in Aphasia. American journal of speech-language pathology, 27(2), 574-591.

Salis et al, 2018 shows how an international survey has been practicing different measures in order to treat the short-term aphasia disorder. It focused to identify short-term memory and the active memory. The major aim was to identify assessment on the number of individuals with aphasia, search assessments criteria that includes the active memory and then form positive attitudes on the short-term assessment. The journal is different from the previous work which concentrated more on aphasia assessment practices (Salis et al, 2018).Clinical procedures are outlined each with the corrective procedures for the disorder. The aspect of carefulness is advocated in evaluating the assessment task identified during the research.

Rosenfeld, R. M., Culpepper, L., Doyle, K. J., Grundfast, K. M., Hoberman, A., Kenna, M. A., ... & Yawn, B. (2004). Clinical practice guideline: otitis media with effusion. Otolaryngology-Head and Neck Surgery, 130(5), S95-S118.

The clinical assessment shows how children are prone to aphasia. The diagnosis and treatment of disorder have important aspects to the children. A literature review carried in 2004 about the speech communication disorder shows the major assessment methods that guided the clinic measures. Recommendations about disorders and treatment need to be apt and effective (Rosenfeld et al, 2004). Alternative treatments and use of medicine are highly preferred. The critique and justification for treatment are evident on page 56 on the table about clinical measures to curb the communication disorder. The evaluation on the task forms a formal criterion that target on performance that is reflecting the semantic usage of words and phrases.

Papathanasiou, I., Coppens, P., & Davidson, B. (2016). Aphasia and Related Neurogenic Communication Disorders: Basic Concepts, Management, and Efficacy. Aphasia and Related Neurogenic Communication Disorders, 3.

The authors of this book known as Coppens aims to impart readers with basic knowledge and research skills regarding the communication disorder in patients with aphasia. Readers will be able to define the aphasia topic and describe the epidemiology of aphasia. It also basically describes the principles of care of the individual patients suffering from aphasia to ensure proper understanding of the ICFG framework (Papathanasiou et al, 2016). It enables clinicians to understand key issues regarding the efficacy of aphasia therapeutic practices. Its main objective is to study the Assessment and diagnosis of cognitive disorder in clients with aphasia in order to offer support to patients with aphasia

Swartz, R. H., Cayley, M. L., Lanctôt, K. L., Murray, B. J., Cohen, A., Thorpe, K. E., ... & Herrmann, N. (2017). The “DOC” screen: Feasible and valid screening for depression, Obstructive Sleep Apnea (OSA) and cognitive impairment in stroke prevention clinics. PloS one, 12(4), e0174451.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0174451

https://query.library.utoronto.ca/index.php/search/q?kw=Author:Karen%20R%20Lien

The aim of this website article is to describe the feasible screening methods for individuals with impaired cognitive communication development. In the modern era, clients are being affected by the disorder without their knowledge (Swartz et al, 2017).These websites are aimed at creating awareness to individuals in the society of the presence of aphasia condition and its effects on speech and communication. Since the global world has been greatly influenced by technological advancement in the communication websites, patients suffering from the disorder can get the chance to access the website. This is aimed to give them a platform to air their ideas, opinions and converse with other individuals. This gives them a conducive environment to develop their communication in the internet

Conclusion

In the current era, there exists a gradual rise in various patients suffering from aphasia conditions in the society (Paul & Norbury, (2012).It is a severe condition which affects the cognitive ability of individuals thus affect effective communication in the society and the personal ability of an individual to conduct his/her lifestyle roles in a conducive environment. Speech is a very significant aspect of human life(Savage et al ,2015).The conducted significant research aimed at improving the situation of the patients and also offer probable solutions on the same (Whitworth Webster & Howard, 2014). It gave made me acquire important knowledge on how to handle such clients and create awareness on the existence of the disorder. It ensured obtaining of a higher understanding of modern medical status of patients (Shipley & McAfee, 2015.The information obtained from the research ensured future providence of education, care and support for patients by focusing on their functioning, personal interests and individualised care (Snowden et al, 2011).These possible research findings are significant in backing up future clinical rationale and also the existing management plans for aphasia conditions.

References.

Baker, J. M., Rorden, C., & Fridriksson, J. (2010). Using transcranial direct-current stimulation to treat stroke patients with aphasia. Stroke, 41(6), 1229-1236.

Cheng, B., Forkert, N. D., Zavaglia, M., Hilgetag, C. C., Golsari, A., Siemonsen, S., & Alawneh, J. (2014). Influence of stroke infarct location on functional outcome measured by the modified rankin scale. Stroke, 45(6), 1695-1702.

Coppens, P. (2016). Aphasia and related neurogenic communication disorders. Jones & Bartlett Publishers

Fridriksson, J., Richardson, J. D., Baker, J. M., & Rorden, C. (2011). Transcranial direct current stimulation improves naming reaction time in fluent aphasia: a double-blind, sham-controlled study. Stroke, 42(3), 819-821.

Hurkmans, J., De Bruijn, M., Boonstra, A. M., Jonkers, R., Bastiaanse, R., Arendzen, H., & Reinders-Messelink, H. A. (2012). Music in the treatment of neurological language and speech disorders: A systematic review. Aphasiology, 26(1), 1-19.

Knollman-Porter, K. (2008). Acquired apraxia of speech: a review. Topics in stroke rehabilitation, 15(5), 484-493.

Lazar, R. M., Minzer, B., Antoniello, D., Festa, J. R., Krakauer, J. W., & Marshall, R. S. (2010). Improvement in aphasia scores after stroke is well predicted by initial severity. Stroke, 41(7), 1485-1488.

Lambon Ralph, M. A., Snell, C., Fillingham, J. K., Conroy, P., & Sage, K. (2010). Predicting the outcome of anomia therapy for people with aphasia post CVA: Both language and cognitive status are key predictors. Neuropsychological Rehabilitation, 20(2), 289-305.

Poslawsky, I. E., Schuurmans, M. J., Lindeman, E., & Hafsteinsdóttir, T. B. (2010). A systematic review of nursing rehabilitation of stroke patients with aphasia. Journal of clinical nursing, 19(1?2), 17-32.

Whitworth, A., Webster, J., & Howard, D. (2014). A cognitive neuropsychological approach to assessment and intervention in aphasia: A clinician's guide. Psychology Press.

American Speech-Language-Hearing Association. (2016). Scope of practice in speech-language pathology.

Bishop, D. V. (2014). Uncommon Understanding (Classic Edition): Development and disorders of language comprehension in children. Psychology Press.

Chare, L., Hodges, J. R., Leyton, C. E., McGinley, C., Tan, R. H., Kril, J. J., & Halliday, G. M. (2014). New criteria for frontotemporal dementia syndromes: clinical and pathological diagnostic implications. J Neurol Neurosurg Psychiatry, 85(8), 865-870.

Dodd, B. (2013). Differential diagnosis and treatment of children with speech disorder. John Wiley & Sons.

Kaderavek, J. N. (2011). Language disorders in children: Fundamental concepts of assessment and intervention. Pearson/Prentice.

Manolitsi, M., & Botting, N. (2011). Language abilities in children with autism and language impairment: using narrative as a additional source of clinical information. Child Language Teaching and Therapy, 27(1), 39-55.

Medwetsky, L. (2011). Spoken language processing model: Bridging auditory and language processing to guide assessment and intervention. Language, Speech, and Hearing Services in Schools, 42(3), 286-296.

Paul, R., & Norbury, C. (2012). Language disorders from infancy through adolescence-E-Book: Listening, speaking, reading, Writing, and Communicating. Elsevier Health Sciences.

Savage, S., Hsieh, S., Leslie, F., Foxe, D., Piguet, O., & Hodges, J. R. (2013). Distinguishing subtypes in primary progressive aphasia: application of the Sydney language battery. Dementia and geriatric cognitive disorders, 35(3-4), 208-218.

Shipley, K. G., & McAfee, J. G. (2015). Assessment in speech-language pathology: A resource manual. Nelson Education.

Snowden, J. S., Thompson, J. C., Stopford, C. L., Richardson, A. M., Gerhard, A., Neary, D., & Mann, D. M. (2011). The clinical diagnosis of early-onset dementias: diagnostic accuracy and clinicopathological relationships. Brain, 134(9), 2478-2492.