AAC in the Intensive Care Unit and Acute Care

1. AAC in the Intensive Care Unit and Acute Care SLA G304 Kim Ho, PhD CCC-SLP

2. Overview • Hand back papers • Review Seating and Positioning • Review Literacy • Quiz • Lecture (Happ, Garrett, & Roesch, 2003) • Three EBP presentations

3. Purpose and Features of ICU • Specialized unit to monitor vital functions • Immediate life-saving interventions • Critical condition - injury or major surgery • May not be able to see due to swelling • Low arousal level, unconsciousness, or coma • May be orally intubated - precludes speech • CVA and trauma two most common Dx

4. Features of the ICU Cont’d • Patient stay is typically short • AAC services must not interfere with medical care • Majority of patients are 41-65 years old • Communication is a medical necessity • Training is critical

5. Features of the ICU Cont’d • Systems change on a daily basis since patient may improve/deteriorate rapidly • Need to communicate more than medical needs; novel messages • Simpler the better Pt and staff

6. Lack of Speech with Critical Illness • Frightening • Reduces patient participation in care and decision-making • Impairs pain and symptom assessment

7. Nonvocal communication Techniques • Mouthing, words, gestures, writing, and head nods • May not be consistently able to use • Nurses do not typically receive training in maximizing their use

8. Dowden et al (1986a/b) • Successful use of AAC for 50 temporarily nonspeaking ICU patients • Prosthetic oral approaches rec’d • But demonstrated higher usage rates • Direct selection systems • Natural speaking approaches • Most common reasons for intervention failure • Decreasing cognition (51%) • Patient’s rejection (27%) • Decreasing motor control (20%)

9. Hemsley et al (2001) Communication boards were preferred over electronic devices by 4/5 ICU survivors

10. Voice banking (Costello, 2000) • SGD use with 43 patients, 2.8 to 44 years • Prior to surgery • Patients and family members recorded 30 to 40 vocabulary items under topic cues • Expressed general satisfaction with communication intervention • Did not report exhaustion, isolation, or fear related to the inability to speak in ICU

11. Barriers to widespread use of AAC in ICU (Happ, Garrett, & Roesch, 2003) • Patients’ physical/cognitive fluctuation or deterioration • Poor positioning • Physical restraint use • Discontinuity in communication partner(s) • Staff lack of knowledge • Access to AAC devices

12. ICU Communicative Interaction (Yorkston, 1992) • Wants and needs • most are met through daily routines of hospital • distinguish essential needs • Information transfer • Pt. Hx posted by bedside or in chart • Provide communication boards/notebook to answer evaluation questions • Provide AAC strategies to facilitate communication regarding family and business affairs

13. ICU Communicative Interaction Cont’d (Yorkston, 1992) • Social closeness • Family members and friends may find it difficult to communicate with Pt • Create remnant book • Social etiquette • Allow Pt. thank hospital staff, make courteous comments • Simple SGD

14. Acute Care • Acute Rehab: Hospital setting to regain functional skills • Trend is to receive patients much earlier after onset due to managed care • Issues with spontaneous recovery • Pt still changing rapidly so can’t treat indefinite long-term needs as inpatient