communicative disorders assistant - clinical competencies

Communicative Disorders Assistant - Clinical Competencies Integrated Stroke Program

Name: Professional Designation Number of years in current position: Date: o

October 2019

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Novice

Marginal conceptual understanding, minimal clinical experience, very little foundational knowledge of the topic area, textbook/classroom knowledge

You frequently seek assistance in making clinical decisions

You have minimal practice in this area

Advanced Beginner

Conceptual understanding, minimal clinical experience, some foundational knowledge of the topic area

You have had limited exposure to clinical situations

You are able to identify normal findings

You are guided by what you need to do rather than by patient responses

Competent

Conceptual understanding and skill performance (competent) and clinically experienced

You have had varied exposure to many situations

You are able to identify normal and abnormal findings

You have an awareness of patient and family view points

You are able to manage complex situations

You are able to prioritize based on patients needs

Proficient

Conceptual understanding, proficient performance, clinically experienced, and able to make quick and accurate clinical judgments

You have had extensive exposure in most situations

You are able to anticipate potential assessment changes

You are able to prioritize in response to changing situations

You are able to interpret the patient and family experience from a wider perspective

Expert

Analysis, synthesis, application, highly skilled clinically with extensive and well-developed knowledge

You have had extensive exposure with deep understanding of the situation

You are able to rapidly and consistently identify actual and potential assessment changes

You are able to rapidly change priorities under all conditions

You are able to keep personal values in perspective and therefore able to encourage and support patient and family choices.

Not Applicable The topic area is not relevant to your practice. In your current role, you would not require this knowledge/skill.



October 2019

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Core Competencies for Stroke

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Resources https://www.corhealthontario.ca/resources-for-healthcare-planners-&-providers/core-competencies/disciplines/speech-language-pathology

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1. Principles of Stroke Care

1.1 Acknowledges cultural differences and values and supports persons with stroke and caregivers’ cultural needs and coping styles.

1.2 Discuss the principles, goals and importance of evidence-based practice, and supports best practice stroke care (i.e. Assessment Tools) & QBP’s

1.3 Discuss and compare roles of other disciplines involved in the care of persons with stroke within the context of an interprofessional model of care.

2. Anatomy and Physiology of Stroke

2.1. Describes the following: •Neuroanatomical structures that impact stroke clinical recovery •Brain functions according to lobe and hemisphere •Penumbra region and vascular supply •Differences between ischemic and hemorrhagic strokes and their clinical presentation

2.2 Summarize the effects of a stroke and potential complications.

3. Cardiovascular and Respiratory Effects

https://www.corhealthontario.ca/resources-for-healthcare-planners-&-providers/core-competencies/disciplines/speech-language-pathology






October 2019

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3.1 Identify cardiovascular and respiratory systems complications as a result of a stroke and the impact of these complications on swallowing and communication.

4. Psychosocial Effects

4.1 Recognize potential changes in the emotions of the person with stroke and caregivers related to the stroke event and understand the importance of addressing coping abilities.

4.2 Demonstrate awareness of depression screening tools and how to contribute to assessment with team to inform appropriate responses to psychosocial changes in stroke.

4.3 Determines the person with stroke and caregiver’s understanding of the effects of stroke, and their learning needs.

5. Communication

5.1 Awareness of standardized and non-standardized measures used by SLP to screen for and/or assess functional communication status including:







October 2019

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•Auditory comprehension such as auditory processing and following directions

•Expressive language including word finding, use of grammar and language organization

•Reading comprehension including symbols words, sentences, paragraphs and reading rate

•Written expression including spelling, punctuation and grammar

•Oral motor including neuromuscular aspects (dysarthria) and motor planning (apraxia)

•Voice resonance

•Respiration for speech purposes

•Non-verbal receptive and expressive components such as facial expression and body movements

•Pragmatics (use of language) and social and interaction skills

•Augmentative and alternative communication systems. Extra linguistic skills, use of intonation, rhythm, pitch, rate, prosody

•Hearing loss and visual perceptual deficits.







October 2019

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5.2 Carry out comprehensive care plan developed by SLP for a person with stroke that may include:

•Individual treatment to address speech-language deficits

•Group treatment (e.g., supported conversation)

•Education of caregiver and significant others about communication strategies and devices (e.g., supported conversation techniques and communicating with a hearing loss).

5.3 Ability to provide alternative communication strategies and/or low technological devices.

6. Independence in Mobility and Prevention of Complications of Immobility

6.1 Identifies that the quality of the person with stroke’s movement can be affected by the following changes that accompany a stroke:

•Muscle tone

•Posture

•Balance







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•Muscle weakness/motor loss

•Sensory loss

•Cognitive, perceptual, behaviour changes

•Fatigue

6.2 Demonstrates safe proper handling and positioning of the persons with stroke with hemiplegia to prevent complications and optimize mobility and function.

7. Routine Activities of Daily Living

7.1 Demonstrates awareness of the components of Activities of Daily Livings (ADLs).

8. Instrumental Activities of Daily Living

8.1 Identify components of Instrumental Activities of Daily Living (IADL’s) including meal preparation, financial management, driving, medication management and return to work.

8.2 Demonstrates ability to support use of assistive devices by persons with stroke.







October 2019

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9. Cognitive, Perceptual and Behavioural Changes Following Stroke

9.1 Describes common cognitive changes that may be associated with stroke including level of arousal, attention, memory, orientation, ability to follow directions, insight, judgement, problem solving and motor planning and the effect that they have on communicative function.

9.2 Describes perceptual changes that may be associated with stroke including neglect, hemianopia, apraxia, visual spatial deficits.

9.3 Collaborates with team members to implement and evaluate a comprehensive plan of care based upon the client’s individual cognitive needs and assists team members in understanding and adjusting cognitive treatment in consideration of communication challenges.

10. Sexuality

10.1 Provide communication strategies in collaboration with SLP for patients to discuss concerns related to sexuality post stroke.







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10.2 Describes issues related to changes in sexual functioning and relationships following stroke which may include: altered body image, fear; changes in physical mobility; impact of medications; energy levels; self-esteem; spouse versus caregiver role; continence; family planning and changes in sexual behaviours related to frontal lobe changes.

11. Nutrition

11.1 Demonstrates the importance of adequate nutrition for stroke recovery and secondary stroke prevention.

11.2 Demonstrates an understanding of the need for therapeutic and/or modified diets for some patients with stroke. Also recognizes the increased risks for dehydration and malnutrition with modified textures.

11.3 Demonstrates the ability to recognize the risks of modified textures and the increased risk of dehydration and malnutrition after a stroke.

11.4 Demonstrates knowledge of the various alternative‐feeding methods used with persons with stroke (e.g., tube feeding, total parenteral







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nutrition) and the implications these may have for the plan of care

11.5 Demonstrates knowledge of the role of nutrition in palliative and end of life care, and act as a resource for staff and family on life sustaining measures (i.e. feeding tubes), oral care, and comfort feeding for quality of life.

12. Dysphagia

12.1 Discuss the importance of stroke patients remaining nil per os (NPO) until a validated swallowing screening or clinical swallowing assessment has been completed.

12 .2 Demonstrate awareness of management strategies including considerations about positioning, feeding, and mouth hygiene to reduce aspiration risk, and improve and maximize hydration and nutrition.

Demonstrate an understanding of resources that can be used with stroke survivors and caregivers about safe feeding practices.

12.3 Implement treatment strategies under direction of SLP to change the physiology or the developmental pattern of the swallow, to improve the safety, efficiency and effectiveness







October 2019

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of the oropharyngeal swallow and maintain nutrition and hydration including:

•Compensatory strategies that can enhance the physiology of the swallow

•Exercises to improve oral motor functioning

•Exercises to improve laryngeal strength and coordination

12.4 Discuss how positioning, feeding and mouth hygiene affect dysphagia management and patient outcomes.

12.5 Demonstrates knowledge of the role of nutrition in palliative and end of life care, and act as a resource for staff and family on life sustaining measures (i.e. feeding tubes), oral care, and comfort feeding for quality of life.

12.6 Demonstrates the ability to promote the stroke survivor to self‐feed to reduce the potential for aspiration.

13. Skin Care

13.1 Discuss skin breakdown as a risk/symptom of dehydration/malnutrition as it relates to dysphagia and texture modification recommendations.







October 2019

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14. Continence Management

14.1 Describe bladder and bowel issues related to stroke and demonstrate knowledge of the following:

•how bowel and bladder issues post-stroke may impact speech therapy goals

•the role of the SLP within the team in addressing bowel an bladder care plan strategies

14.2 Provide communication strategies under supervision of SLP and adapt the communication environment to support continence retraining in collaboration with the health care team and specialists, as appropriate, to manage the factors that can lead to incontinence.

15. Primary and Secondary Stroke Management

15.1 Describes the principles of primary and secondary stroke prevention.

15.2 Identifies the signs of stroke and transient ischemic attacks and demonstrates appropriate interventions.







October 2019

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15.3 Discuss the pathophysiology, clinical presentation and management of secondary stroke complications including:

•Hemorrhagic transformation

•Reperfusion injury

•Increased intracranial pressure

•Cerebral edema

•Seizures

•Recurrent stroke

16. Transition Management

16. 1 Provide observations to the SLP to ensure effective and efficient transfers of care and information to the next stage and setting of care.

16.2 Has knowledge of expectations about other care environments and uses this information to educate, support, and prepare the stroke survivor for a change from one care environment to another.







October 2019

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communicative disorders assistant - clinical competencies

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