Biomedical Engineering Reference
In-Depth Information
evaluating the evidence. In the end, teams place the individual's benefits first when applying
EBP, pose specific questions of direct practical importance, objectively and efficiently evalu-
ate the current best evidence, and take appropriate action guided by evidence (Gibbs 2003).
14.1.3 AT Assessments and the SLP
Applying the systematic steps of the EBP model becomes even more critical when no stan-
dardized battery of tests compose the AT evaluation. Minimal research exists to support
a specific AT evaluation model (Hill and Scherer 2008). In addition, no current, standard-
ized, evidence-based AT procedures exist to determine if an individual would benefit
from AT. However, evidence is available to identify procedures for conducting reliable,
valid, and dynamic or authentic assessments that can be recommended to collect data to
identify an individual's abilities, needs, and expectations. These data are then used for the
feature match process.
A primary role for the SLP as a team member assessing an individual for AT is to collect,
analyze, and interpret evidence (data) related to speech, language, oral and written com-
munication, swallowing abilities, needs, and expectations. The unique knowledge that
SLPs bring to the AT evaluation is their ability to assess the subsystems of language—
phonology, morphology, syntax, semantics, and pragmatics—as they relate to spoken and
written language (ASHA 2001). Consequently, the SLP answers questions that the team has
about an individual's basic language knowledge at the level of sounds, words, sentences,
and interactive conversation regardless of whether the communication disorder is devel-
opmental in nature or acquired.
For the pediatric population with disabilities and associated communication disorders,
the SLP contributes evidence related to how the child is progressing through the transi-
tions of speech and language acquisition. Three major transitions take place during the
first 5 years of life (Paul 1997): (1) pragmatics to semantics, (2) semantics to syntax, and
(3) phonology to metaphonology. Following a developmental model provides evidence to
guide SLPs and the AT team in determining the capabilities of the child and the cognitive-
linguistic requirements of an AT intervention (Hill 2009). In addition, these transitions
provide benchmarks for when, what, and how to collect data to monitor the effectiveness
of AT interventions and when to modify or revise AT decisions.
For the adult population with disabilities and associated communication disorders,
the SLP contributes evidence related to the type, severity, and prognosis of the disor-
der. Adults with acquired communication disorders who may benefit from AT must be
evaluated to determine a course of AT treatment to support regaining skills (e.g., aphasia
or traumatic brain injury). In other cases, the individual may be evaluated to determine
an AT solution to maintain function across the course of the underlying disease com-
plex (e.g., amyotrophic lateral sclerosis or Huntington's chorea). In either case, the SLP
contributes evidence by administering clinically, linguistically, and culturally appropri-
ate approaches to assess the current cognitive-linguistic abilities. This information then
serves as baseline data.
A clear distinction exists among the type of assessments conducted to identify speech,
language, and overall oral and written communication capacities. A thorough and com-
prehensive evaluation of cognitive-linguistic skills is paramount to beginning the feature-
match process. For both the pediatric and adult populations who may benefit from AT,
identifying the shared and distinctive targets assessed by the SLP and other educational
or rehabilitation professionals highlights the importance in collecting thorough evidence.
Table 14.1 illustrates the overlapping domains of language and literacy assessed by SLPs
