Aphasia and AAC

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Aphasia and AAC

• SLA G304
• Shelley Weiss, MS CCC-SLP

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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

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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)

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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)

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Aphasia

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

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Basic Diagnostic Protocol

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

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Interdisciplinary Assessment Team

• Physical therapist
• Occupational therapist
• Speech-language pathologist
• Neuropsycologist
• Physiatrist
• Rehabilitation technician

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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

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Criteria-based Assessment

• Skills assessment
• Communication needs inventory
• Opportunities and constraints
• Feature matching
• Trial period

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Skills Assessment

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

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Communication Needs Inventory

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

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Opportunities and Constraints Assessment

• Adjustment to the disability
• Stage of recovery
• Changing skill levels
• Multiple communication partners

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Opportunities and Constraints Assessment

• User environment (partner attitudes towards AAC)
• Availability of technical support
• Medical protocol
• Financial resources
• Communicative desire, motivation

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Feature Matching

• No single strategy or tool will have all features
  to meet users needs
• Flexibility of system is greatest consideration

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Trial period

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

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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

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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

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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

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Aphasia General Intervention Strategies

• Carefully inventory communication needs using
  Lights (1988) model
• Develop strategies to participate with peer group
• Play Bingo
• Tell jokes
• Reminisce
• Share opinions

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Aphasia General Intervention Strategies

• Assess most effective means and organization of
  representation
• Visual spatial (maps, rating scales)
• Categorical
• words, messages
• pictures
• Topical

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Aphasia General Intervention Strategies

• Practice strategies in situational role-plays
• Family, important communication partners play a
  critical role in therapy

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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

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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

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Aphasia Intervention Remnant Book

• Emotionally salient content may stimulate user
  input/output modalities
• Doesnt look like augmentative communication aid
• Primes user and family for future AAC systems

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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

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Aphasia Remnant Book Study Results

• Remnants superior to pictographic symbols for
• establishing joint attention
• maintaining conversational control
• communication partner ratings of comfort and
  efficacy

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Aphasia Intervention Communication book

• Inventory messages using Lights 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

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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

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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

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Aphasia Tool Box

• Alternative symbol boards, books
• Retractable key chain
• Remnant book
• Maps, calendars, rating scales, clocks

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Aphasia Tool Box

• Dedicated VOCAs
• Simple Macaw, MessageMate, Cheaptalk
• Complex Dynamyte, Dynavox
• Computer-based Speaking Dynamically, C-Speak
  Aphasia