Introduction to ACAT Service

1
Introduction to ACAT Service

• We are a multi-disciplinary service working
  across East Kent (Clinical Scientist, SLT, OT,
  TAP, Clinical Technologist, admin)
• We provide EAT for AAC and/or alternative
  computer access
• We provide 3 types of service Provision,
  Consultation, Assessment
• We also work with the CYP service for Transition
  of Young adults

2
What are we learning from our clients with
aphasia who use high tech AAC?

• Fiona Panthi and Karen Reed
• Adult Communication and Assistive Technology
  Service

3
Stroke and Aphasia

• Our focus is aphasia as a consequence of a
  stroke.
• Aphasia is an impairment of language, affecting
  the production or comprehension of speech and the
  ability to read or write. Aphasia is often
  associated with concomitant disorders e.g.
  apraxia of speech.

4
The clients

• Seven clients (one female/ six male) with aphasia
  and apraxia of speech.
• Clients were seen between one and ten years post
  stroke.
• All clients are able to use direct access.

5
The families

• Six clients are married with family support.
• One client with limited family support.
• Four spouses retired.
• Two spouses working and out for long periods.

6
Augmentative and Alternative Communication what
was in place?

• Clients were using a variety of methods to
  communicate air writing, white board/pen/paper,
  pointing and gestures.
• No clients were using any low tech communication
  books at the time of referral.

7
High tech AAC intervention

• AAC assessment/provision. Identification of
  appropriate communication apps and
  personalisation/customisation of vocabulary.
• Training provided and support visits for the
  clients and their families.
• AAC user group
• Joint working with community speech therapists
  and the Stroke Association.

8
Making good use of high tech AAC

• Clients using other apps and features to augment
  communication e.g. Google maps, showing
  photographs.
• Helpful for social interaction sharing news and
  holiday photographs.
• Toggling between symbols/keyboard.

9
Obstacles to successful use of high tech AAC

• Majority of clients not having regular/any
  opportunities to use their communication aid with
  family or other communication partners. Family
  beliefs re AAC?
• Lack of conversation partners. Social isolation,
  in some cases.
• Families possibly unaware of the commitment
  required from them to support the client both
  technically and during day to day conversations.

10
Obstacles language

• Clients appeared disappointed with the limited
  vocabulary available on the device.
• Difficulties with symbol recognition especially
  abstract symbols.
• Limited use of AAC during speech and language
  therapy sessions as client focus appeared to be
  improving upon impaired skills.

11
Obstacles other

• Family saying they get by with usual method of
  communication.
• iPad proving a distraction for some clients.
• Clients rarely using their AAC out of home
  environment.

12
AAC User Group

• Held in November 2012, clients/families/carers/SLT
  s attended, 100 attendance.
• Activities to build on AAC skills for both client
  and family.
• Social opportunity to meet and make friends.
• Positive feedback.

13
AAC intervention what went well?

• Clients with some residual literacy skills were
  able to use predictive text and keyboard.
• AAC enabled one client to interact with his young
  daughter, sing songs and play games.
• Widened social interaction possibilities, enabled
  clients to have control over topic of
  conversation.

14
Cont..what went well?

• Clients and families contributed to selection of
  vocabulary.
• Using AAC with new conversation ptnrs.
• Better outcome when clients were familiar with
  technology.
• Initial rejection of AAC then acceptance.
• AAC User Group.

15
What have we learnt?

• High tech AAC intervention can be a convoluted
  process, so many considerations.
• Clients/families expectations and beliefs re AAC
  vs our (ACAT) expectations and what we are hoping
  to achieve.
• Communication opportunities are paramount!
• Time and commitment required by all involved.
• Most clients were partner dependent communicators
  re using their AAC.
• Acceptance and readiness for AAC re clients and
  their families.
• Speech therapy AAC not always part of this
  process.

16
Looking forwards

• Embed AAC early in speech therapy intervention.
• Be very clear regarding time for
  learning/training and the commitment required to
  help achieve positive outcomes.
• One size cannot fit all when it comes to making
  decisions about treatment approaches.
  (Mahendra,2011). Continue to shape service
  delivery.
• Regular AAC user groups.
• The need for Conversation Partners. Increasing
  social participation and activities.
• Managing expectations Clients and their families
  

17
References

• Beck, a R (2011) AAC and message enhancement or
  persons with aphasia chap 6. in Augmentative and
  Alternative Communication for Adults with
  Aphasia. ED Koul, R. Emerald Group Publishing.
  UK.
• Phillips,P. (2009) Can People with Aphasia Use
  High-tech AAC? Communication Matters 23 (1)
  p23-26.
• Robertson, E. Schneider, H.(2011) Not a
  bandage. Advocating AAC assessment in aphasia.
  Communication Matters 25 (2) p15-16.
• Mahendra, N (2011) Overview of Aphasia and
  Approaches to Aphasia Intervention chap 2. in
  Augmentative and Alternative Communication for
  Adults with Aphasia. ED Koul, R. Emerald Group
  Publishing. UK.