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Aphasia and AAC

Aphasia and AAC

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Aphasia and AAC

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  1. Aphasia and AAC SLA G304 Shelley Weiss, MS CCC-SLP

  2. Aphasia • Aphasia: An acquired communication disability, usually a result of stroke or head injury, that affects symbolic language processing across modalities (after Schuell) • Deficits in auditory comprehension, reading, writing, speech

  3. Aphasia • Apraxia: Impairment in ability to program, sequence and execute purposeful gestures, despite intact mobility • Oral • Limb • Test of Limb and Oral Apraxia (Helm-Estabrooks)

  4. Aphasia • Candidacy for AAC strategies in aphasia • a) those who find speech inadequate or inefficient in certain instances • b) those who do not regain sufficient natural speech for communication of basic needs (after Hux, Beukelman, and Garrett, 1994)

  5. Aphasia • Revised Candidacy Classification system (Garrett and Beukelman) • Basic Choice Communicator • Controlled Situation Communicator • Comprehensive Communicator • Specific Needs Communicator • Augmented Input Communicator

  6. Basic Diagnostic Protocol • Assessment custom tailored • Completed over extended period of time • Across environments and communication partners • Assessment and intervention occur simultaneously • Interdisciplinary team

  7. Interdisciplinary Assessment Team • Physical therapist • Occupational therapist • Speech-language pathologist • Neuropsycologist • Physiatrist • Rehabilitation technician

  8. Criteria-based Assessment • Observe current level of function • Observe changes over time • More effective than norm referenced • More sensitive to change over time • Time efficient

  9. Criteria-based Assessment • Skills assessment • Communication needs inventory • Opportunities and constraints • Feature matching • Trial period

  10. Skills Assessment • Diagnosis and prognosis • Motor function • Vision, hearing • Sensory, perceptual • Motor speech • Language • Communication, pragmatics • Cognition, behavior, psychosocial

  11. Communication Needs Inventory • Present and future needs • Four functions of communication (Light, 1988) • Information transfer • Social closeness • Basic wants and needs • Social etiquette

  12. Opportunities and Constraints Assessment • Adjustment to the disability • Stage of recovery • Changing skill levels • Multiple communication partners

  13. Opportunities and Constraints Assessment • User environment (partner attitudes towards AAC) • Availability of technical support • Medical protocol • Financial resources • Communicative desire, motivation

  14. Feature Matching • No single strategy or tool will have all features to meet user’s needs • Flexibility of system is greatest consideration

  15. Trial period • Need adequate time to teach system • Implement in natural contexts • Re-assess • Modify • Re-assess • Mass Medicaid funds device trial periods

  16. Demands of Communication for Person with Aphasia for basic needs conversation (Garrett, 1996) • Self aware • Generate an action plan • Generate a conceptual representation • Be attentive to environment • Posses an expressive modality • Sufficient working memory • Adequate semantic mapping/translation skills • Pragmatic skills to determine if message is received accurately • Metacommunicative ability to revise, repair

  17. Aphasia: Demands imposed by AAC strategies (Garrett, 1996) • Alternate physical access • Novel symbol translation • Sufficient working memory to complete preceding symbol translation skills before forgetting the intent • New operational skills for technology

  18. Aphasia: General Intervention Strategies • Communication access and success is intermittent in aphasia. Use what works from moment to moment • Rely on residual world knowledge • Keep physical access demands simple • Keep visual display simple

  19. Aphasia: General Intervention Strategies • Carefully inventory communication needs using Light’s (1988) model • Develop strategies to participate with peer group • Play Bingo • Tell jokes • Reminisce • Share opinions

  20. Aphasia: General Intervention Strategies • Assess most effective means and organization of representation • Visual spatial (maps, rating scales) • Categorical • words, messages • pictures • Topical

  21. Aphasia: General Intervention Strategies • Practice strategies in situational role-plays • Family, important communication partners play a critical role in therapy

  22. Aphasia Intervention: Remnant Book • Basic choice,controlled situation, comprehensive communicator • Mementos, remnants, photographs • Content is concrete, salient and unique to user • Capitalizes on residual world knowledge

  23. Aphasia Intervention: Remnant Book • Vehicle for sharing information, social closeness • No expectations for regulating behavior • Promotes topic generation and initiation for user and partner • Stimulates appropriate voluntary motor response: page turning, pointing

  24. Aphasia Intervention Remnant Book • Emotionally salient content may stimulate user input/output modalities • Doesn’t look like augmentative communication aid • Primes user and family for future AAC systems

  25. Aphasia: Remnant Book Study Results • (Weiss, S., Ho, K., Garrett, K., Lloyd, L., 1999) • Conversational support in the form of topical, personalized communication books, regardless of symbolic representation facilitated the communication

  26. Aphasia: Remnant Book Study Results • Remnants superior to pictographic symbols for: • establishing joint attention • maintaining conversational control • communication partner ratings of comfort and efficacy

  27. Aphasia Intervention: Communication book • Inventory messages using Light’s model • Visual: Simple symmetrical organization, layout to compensate for field cuts, neglect • Obvious categories, tabs to mark pages • Directions to communication partner • Remnant section, maps, calendars, clocks, letter boards, rating scales

  28. Aphasia Intervention: Communication book • Decrease cognitive-linguistic demands • Teach in structured choice making • Revise partners’ expectations of PWA self initiation • Teach partner to structure environment • Identify opportunities to make choice

  29. Aphasia Intervention: Written Choice (Garrett, 1993) • Partner provides written choices in context of conversation • Possible responses anticipated and written in list form • PWA selects correct response by pointing • Creates successful interaction • Good for sharing information, social closeness

  30. Aphasia: Tool Box • Alternative symbol boards, books • Retractable key chain • Remnant book • Maps, calendars, rating scales, clocks

  31. Aphasia: Tool Box • Dedicated VOCAs • Simple: Macaw, MessageMate, Cheaptalk • Complex: Dynamyte, Dynavox • Computer-based: Speaking Dynamically, C-Speak Aphasia