- [Instructor] Hi
everybody, and welcome to
our session this afternoon,
this morning, or this evening,
depending on where you're at.
We are gonna talk about the CLQT,
the Cognitive Linguistic Quick Test+.
Today we're gonna be
here for about an hour,
so sit back and relax,
and hopefully you all feel comfortable
to interact with me as necessary.
There is a handy little chat feature
at the bottom left of your screen.
Feel free to type your message in there
or type a question in
there as we go along.
If I can't answer you today,
I do have a few resources
that we'll be able to send out
answers to you all after today's session.
So, you know, just
because we talk to folks
from all over the country, and oftentimes
all over the world, I'd
be interested to know
where everybody's from, so
just go ahead and type in
where you're all listening
into in the chat box.
I'd love to hear you, hear
and see where you're at.
I'm in Florida, so funny enough,
I had a friend visit me from
New Jersey the other day
and he said, "Is it," and
he called it, "Africa hot?"
Meaning is it hot as Africa down there,
and I didn't even really
think about that much
until the other day when
I saw a comparative map
that had the longitudes of
all of the states compared to Europe,
and I couldn't believe it,
but Florida was actually
in line with parts of Egypt.
So yes, it's hot here in Florida,
and as my friend from
New Jersey would say,
it is definitely as hot as Africa.
And so, there you go, that's
kind of where we're at.
Oh, I see a lot of folks from
all over the country, great!
Oh, I have one, somebody
from Kenya, awesome!
So, anyway, let's get talking today.
We are gonna address a lot of the CLQT+.
I'm going to go over what we do know
and have known since 2001 as the CLQT.
I'm gonna talk a little bit
about the background there,
I'm gonna talk about some
of the interpretation
and uses of this test, and
we are gonna have some time
for questions and answers at the end,
but please don't hold me
to this minute agenda,
because I tend to talk about
certain issues as they come up.
These are the learning objectives
that you all have with
regards to the ASHA CEs,
so rate them appropriately
based on your experience today,
and hopefully you all get
answers to these questions
throughout the hour today.
When we talk about the CLQT+,
it is an update of the original
Cognitive Linguistic Quick Test
that was published originally in 2001,
and that edition of the test
was designed as a quick measurement
of cognitive functioning,
and we were supposed to
be able to, at that time,
and we continue to be
able to really effectively
look at strengths and
weaknesses in five domains.
We're looking at attention,
memory, executive functions,
language, and visuospatial skills.
So, that's where the
original CLQT drove us,
and the CLQT+ had some
interesting adaptations to it,
and I'll get into those in a second.
It was authored by Dr.
Nancy Helm-Estabrooks,
there's her picture in the
top right of the screen.
The age range for the CLQT and the Plus
is 18:0 through 89:11,
so it's applicable for
a number of different categories
of clients or patients,
and you can adapt it as necessary.
Again, the publication
date originally was 2001,
2017 was this Plus edition.
The qualification level
for this test is B,
so if you have any questions about that,
please feel free to go to our website,
pearsonclinical.com/qualifications,
and you'll get detailed
information about that.
But I'm assuming, since
we're on a webinar today
talking to mostly SLPs, you
all feel comfortable about
what that qualification level is
and you should all be able to
meet that qualification level.
Again, we are talking
about a quick test here,
so we're looking at 15 to 30 minutes tops.
This is something that
can be done at bedside,
it can be done in a quick
across-the-table session if necessary,
but it is a very quick snapshot of
a person's cognitive skills.
It is a paper and pencil test,
so you will need to have the record form,
the response book, and the
manual handy if necessary.
And in terms of scores and interpretation,
there are different ways
the tests are developed.
So, the first way that many
of us are familiar with
deals with standard scores,
and that standard score,
what that does is it compares
a person's performance
to a particular group,
so a sample group of, say, for age,
and it says, hey, well,
that person scored,
let's say a raw score of 10 on this test,
and that means that the score is
commensurate or comparable to whatever
percentage of the population
scored a 10 at that age.
The difference with a test like the CLQT+
is that the CLQT+ uses
criterion cut scores
that has severity ratings
associated with that.
And what that means is we're looking at
a specific range or a specific cut
that we are comparing a
person's performance to to say
this person's skill in an area,
let's say attention or memory,
is below what we would
expect them to have.
So, at that point we're saying
this cut score is a level that
we feel comfortable saying
below that level, this
person is likely to have
impairment of some kind.
And the descriptive severity ratings
also go along with that.
So, say if somebody
comes below a cut score,
we're able to then go further and say
that this person's
impairment is likely mild,
moderate, or severe.
And it does have other
languages available,
so the Spanish version is
available for the CLQT only.
Let's give a quick test here,
a little quick question,
and I have a few of these
throughout today's session,
and I realize that
there are a bunch of you
in sessions together,
there are a bunch of you
watching together, so feel
free to answer as necessary,
and then, you know, take
a poll of the group.
Let's go through some of these questions,
and my question to you
is, what population do you
most often assess with the
CLQT, the original one?
So, let's kind of go back to,
if you haven't changed over yet,
what do you usually tend
to use the test for?
Okay, you should all see the results
coming through on the screen now.
We have a nice little color-coded bar,
bars jumping up and down,
and I see a large number of you,
oh, it's kind of evening out now, okay.
So, actually, you're
all using the test for
very common reasons.
TBI, dementia, stroke.
Oh, it should say stroke, not S-T-R-O-K,
I apologize for that.
Left or right hemisphere strokes or other.
And if you have others, what other areas
are you assessing with the CLQT?
Go ahead and throw that in the
chatbox on the bottom left.
I'll be interested to see
what you're using it for.
So, we are all using this for very common,
very, very similar purposes,
TBI, dementia, and stroke,
and if you have any other questions
or any other categories,
please feel free to type those in.
In addition, the next
question I have for you is
does this test provide
you with the information
that third-party payers need?
That's always one of the questions
that makes us sit back and, you know,
put our thinking caps on about, right?
Are we going to get paid for this,
is this giving us appropriate information?
So, go ahead and feel free to rate that
based on strongly agree,
all the way down to
strongly disagree.
As you guys are filling this out,
I did have some folks type in
some responses to my previous question.
I had one person say
developmental disability
and autism in older folks
or adults, young adults,
and another person say cognitive screening
pre-cochlear implant surgery,
so thank you for putting
that information in.
So, most of you are saying that
you are getting enough
information from the CLQT
to deliver to the third-party payers.
Thank you for that information as well.
Okay, so when we look at the update,
you might wanna think,
"What is really new with the CLQT+?
It is very, very similar to
what the previous edition was,
but we do have now an
aphasia administration.
So this is really the
main bread and butter
of what the new Plus adds to your toolkit.
The traditional administration
has Personal Facts,
Symbol Cancellation, Confrontation
Naming, Clock Drawing,
Story Retelling, the Trails
Test, Generative Naming,
Design Memory, Mazes,
and Design Generation,
and the new assessment has all
of those traditional tests,
but it also adds Semantic Comprehension,
which is a test that will contribute to
what's called the Auditory
Comprehension measure
or Auditory Comprehension index.
And you also see that there are
some little stars next to tests,
such as Symbol Cancellation,
Symbol Trails, and Mazes.
Oh, and Mazes, I apologize,
I saw the wrong one.
And essentially what
that means is there are
some additional measures on those tasks,
some additional questions that we can ask
that will drive our evaluation of
a person with aphasia,
so it will help us understand
their auditory comprehension
in a much better fashion.
So, there were some adaptations made there
to make the measures much more effective
in that assessment.
So, who uses the CLQT+?
Primarily it's going to be
speech and language pathologists,
primarily it's going to be
in a non-school setting,
but many of your other colleagues
in clinics, or hospitals, or acute care
may also be accessing this assessment.
OTs are going to be a large population of
professionals using it,
psychologists and
neuropsychologists as well
if they need a quick measure
of cognitive abilities.
With regard to the benefits
and special applications of this test,
what I want you to think about is
various flexibilities in administration.
You have the ability to look at
specific subtests, if necessary,
to look at cut scores,
although, you know, a lot of
times in those situations,
because the test is so short,
cutting it down is not necessary,
but you have flexibility
in either delivering
the traditional battery
or the aphasia battery.
Again, it does have a better
interpretive potential
or a more robust interpretive potential
for people with aphasia
and language disorders.
We also know that it's quick and reliable
at the table or bedside,
so in certain situations
where you're seeing
somebody who's bedridden,
or you know, post-stroke or post-TBI,
you can also give it in those settings.
And again, we have support for English
and Spanish-speaking adults.
In terms of special applications,
this is a good one, because I
want you to think about these
in a little bit more detail
as we go through the hour today,
but progress monitoring is something that
can be accomplished with the CLQT+
or the CLQT with clock drawings.
So, clock drawing over
time can help us understand
a person's response to
or development throughout
treatment and intervention,
so that's a good one to use
for progress monitoring.
Driving assessments, that's another one.
I wonder how many of you are in
the driving assessments arena.
I know occupational therapy and psychology
tend to be in that arena
a little bit more often,
but I wonder how many
of you on today's call,
and just go ahead and shout out there,
throw a yes in the chatbox,
how many of you are using this
for driving assessments as well?
Competency assessment, of course,
that's going to be a huge
use of something like this.
We can use the findings from CLQT+
to help us drive our professional opinions
about a person's competency.
And then also research, that's the fourth
special application we can use it for.
Essentially, you have a lot
of tools in your toolkit,
and why would you pick the CLQT+
for this specific purpose?
We wanna make sure we're
using the right assessment
to answer the right questions.
Essentially, I have these
five questions up here,
and they will help you drive choosing,
when you need to choose the
CLQT+ versus another assessment.
If you need to screen
for rehab and acute care
prior to psych evals, this
is a good use of the CLQT+.
If you need a tool that helps you detect
early cognitive decline
or other conditions
as they present together,
this is a good assessment
for that purpose.
If you need a tool for
progress monitoring,
you can use this test.
If you need something that helps
to inform intervention planning.
I always talk to folks
quite frequently about
the main use and the
secondary use of assessments.
The main use is really the one that
kind of sits there right
in our face, right,
which is we take a test, we give it,
we look at a person's
strengths and weaknesses,
their skill deficits, whether
or not they have a pattern
that leads us to a diagnosis, for example.
But the secondary uses of a test
sometimes are more important,
which is how do we drive interventions,
how do we make sure that what
we're doing is effective.
And I like to say that
that is, oftentimes,
that is the most important
component for me.
I know it's not for everybody, but for me,
that tends to be one of the
most important components,
and the CLQT+ can be used if
that's one of your questions.
And also, that last one
there is you need the tool
to help supplement driving evaluations.
Driving evaluations are quite complex
and do include or incorporate a number
of different areas for the assessment,
but cognitive functioning
should be one of those areas.
So using the CLQT+ in that area as well
can be quite effective.
Let's just go into this a
little bit more in detail
in terms of driving evaluations,
but Certified Driver Rehab
Specialists and generalists
use this as part of the assessment process
to indicate a need for on-road assessment,
or to really support
that talk that you have
around stopping driving
with older individuals.
I remember that conversation that was had,
and I'm going back to
probably the late 90s,
with my grandfather, at the time,
who could not drive anymore.
And that discussion that was had with him
was a very difficult one.
I don't know if anybody
here has had that experience
with a client, with a patient,
but that discussion's very difficult,
and you wanna make sure
that in those situations,
you have as much data as possible
to have that discussion.
It's a tough one to have,
and folks tend to have
a very difficult time
accepting that finding.
So let's talk about the
development of the new tasks,
'cause again we have a few new tasks here,
and we talk about how they were developed
for the CLQT+.
The picture stimuli for the
Semantic Comprehension task,
which is a new test, were taken
from the Confrontation Naming task.
And then the verbal stimuli were developed
to elicit nonverbal responses so that
the examinee you're
testing can demonstrate
their knowledge free from
the requirements of language.
So that's really helpful there.
The CLQT users at the
time this was developed
were contacted by Pearson to participate
in a study to collect their responses
on Semantic Comprehension, as well as some
of the other CLQT tasks.
Now, because it was so
important at that time
and during development
to collect responses
from individuals of language impairment,
the clinicians who were
doing the testing were asked
to target people diagnosed
with only a left hemisphere
stroke and probable aphasia.
But additional inclusion
criteria at the time included
pre-stroke right-hand dominance,
proficient English-language
skills prior to aphasia,
non-concomitant diagnoses of
TBI, dementia, Parkinson's
or other neurodegenerative diseases,
as well as vision and hearing intact
within normal limits.
This led us to the study of error.
So reliability, that number
three there, is an assessment,
or is a way that we look, in
test lingo, at a test error.
Now, every test has error.
As close as it gets to r =
.10, which is unattainable,
which would be no error in a test,
the better the test is.
Just a quick shout-out
here to the psychometrics
of the CLQT+, that CLQT+
has a split-half reliability
of .91, which is considered high.
So, essentially what
we're talking about here
is that it means that
the test has a low amount
of error, and you can use it effectively
for the purposes that we're stating.
I do wanna go over some of these numbers,
just to show you what it looks like
in terms of the differentiation
between aphasic and non-clinical samples,
and I have a couple slides here
that will give you some
information in that.
I won't go into detail about this,
but just so that you can
all see what it looks like
and see what the numbers look like.
So if I look at, let's pick one that is...
Let's pick one like Generative
Naming, for example.
Generative Naming in the aphasic sample
had a mean of 1.74, in
the non-clinical sample
had a mean of 6.57.
So a pretty significant difference there.
Now, I'm not looking
at significance levels,
I'm just showing you the differences
between the scores in the samples.
Another one, Confrontation
Naming, we have 6.51
in the aphasic sample, and 10.00
in the non-clinical sample.
So this is for 18 to 69, this
is the 18 to 69 age group.
If we go over then and
look at the 70 to 89 group,
we see a very similar pattern.
So if we're looking at something like
Confrontation Naming, we see
6.63 in the aphasic sample,
9.94 in the non-clinical sample.
And really, you can look
at these at your leisure.
Feel free to look at those and send me
some questions later on.
I just wanted to show you this to show you
that the pattern really stands true
for all of these tests
that we have in the CLQT+.
In addition, what this does
is it shows us, this slide,
which is Table S.4 from the manual,
shows us that each of the tests included
in the CLQT does show a difference
between the clinical and
non-clinical samples.
So essentially what
we're looking at here is,
at the p value of .01, less than .01,
each of the tests
differentiates significantly
between clinical and non-clinical samples.
What you don't see up
here are effect sizes,
which is another way for us to evaluate
whether it is effective in differentiating
between clinical and non-clinical,
and I will tell you that,
based on information provided
by the researchers in the manual,
the effect sizes are
all moderate to large,
which means that we can
really see the difference
if we're using this test
with clinical and non-clinical groups.
Let's throw up another question here,
just thinking about
third-party-dictated time parameters,
I know a lot of you said it
wasn't applicable to you,
but does the test time
of 15, 30 minutes, fit
within third-party-dictated
test-time parameters?
Do you find that it is
helpful, or that it fits
into your evaluation timeframe?
Okay, so, most of you are
coming through with Agree.
I think the comedy in
this question is that,
unless it's like five
minutes, nothing really fits
within the test-time parameters
for third party theorists
but, by and large, 15 to 30 minutes
will effectively fit in that timeframe.
Thanks, everybody.
So let's talk about administration.
We have a bunch of slides
to get through about administration.
I am gonna go through each of the tests,
even the ones that were CLQT Traditional,
just so that we get a sense of what it is,
kinda rehash our assessment
here and review our memories,
and we'll go through
and look at them each,
and I'll probably go through some of them
a little bit quicker than others.
This is really, I have
Diminished Language Capacity
vs. Aphasia Administration,
essentially that was a
mistype on my part, I apologize for that.
This is about the aphasia
administration for the CLQT+,
so something I mistyped and
then I forgot to go back
and fix it, so I apologize for that.
But when you're administering the CLQT+
to someone who has diminished
language capability,
these are the processes you need to do.
First, you'll administer
the original ten tasks.
When you administer
them, you wanna make sure
that you're taking note
of any modifications
that you make to the tests,
as well as any modifications
that are requested or required,
based on an aphasic administration,
and they will be contained in the banner
at the beginning of each subtest.
I'll show you those in a minute.
Also, what you're going to do is
complete the examiner-rated items
in the Symbol Cancellation,
Symbol Trails, and Mazes.
So what you'll see as we go along here,
there's some additional
questions that are asked
on those tests that will then be used
for the Auditory Comprehension score.
Additionally, for aphasic folks, patients,
you'll administer the
Semantic Comprehension task
and then calculate the
Auditory Comprehension score.
So that's basically where those are,
that's basically the process.
So let's go actually look
at that in more detail.
I did have a question that came across.
Ryan asked if you could get a copy
of the presentation slides versus the ones
that I sent out last night.
I actually can't send you the
ones that I'm using today,
and the reason why is I
made a specific handout deck
that I sent out to you all last night,
you should have gotten it in an email,
probably came out about
ten o'clock, ten-thirty
Eastern time last night.
The reason they are different is because,
you can see here exactly on slide 21,
there are items included
in my presentation
that will not be included in the handout.
So we try to limit the
amount of test material
that goes out and is
available for printout.
So that's the reason why
there are some differences
in the handout versus
what you're seeing today.
So I apologize, I can't
send that stuff out.
So let's look at the first test.
It is Personal Facts, and
again, pretty straightforward,
we're asking some basic
facts for the client,
and it's an easy
question-and-answer system
and feedback system.
What I want you to do is--
