Augmentative Communication for Older Adults

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Augmentative Communication for Older Adults

• Challenges and Considerations
• Caryn F. Melvin PhD CCC-SLP

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Words are, of course, the most powerful drug
used by mankind

• Rudyard Kipling

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Issues on the Plus Side

• Seasoned language users
• Seasoned, effective communicators
• Understand the power of communication
• Motivation
• Problem solving ability
• Educated
• World knowledge
• Cognition ?

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Challenges and Considerations

• Remembering normal communication
• Change in social role
• Change in family dynamics
• Grieving
• Financial worries
• Self esteem
• Have observed others with impairments
• Other health issues

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Measuring and Evaluating the Communication
Difficulty

• Impairment
• Functional limitations
• Disability

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Common Adult Disease Processes Requiring
Augmentative Communication

• ALS
• MS
• Parkinson Disease
• B-Stem CVA
• Severe Aphasia
• Others (SCI, GBS, TBI)

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Progressive or Acute Disease?

• It impacts more than just management!

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Progressive and Acute Disease

• ALS
• Parkinsons
• Huntingtons
• Progressive Supranuclear Palsy
• MS

• CVA
• TBI
• Gullian Barre syndrome

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Progressive Disease and AAC

• ALS
• Parkinson Disease
• PSP
• MS
• Do not always have expressive deficits
• Huntingtons Disease

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No Detectable Disorder

• Obtain base line information/scores
• Answer questions
• Provide education re disease
• As warranted
• Provide info re options for communication
• Avoid details re end stage of the disease
• Unless asked directly
• Use phrases like
• If you should need this___
• Some people experience____

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Obvious Disorder/Intelligible

• Minimize environmental interference
• Reduce rate
• Confirm topics
• Confirm listener understanding
• Voice amplification
• For Parkinson and PSP
• Possible AAC assessment/intervention
• In specific situations

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Reduced Intelligibility

• Complete AAC assessment
• If not already done
• Prosthetic Aids
• Palatal lift, alphabet board etc
• Reduce breath groups
• Compensatory strategies
• Maintaining communication opportunities
• Support group
• If warranted

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Loss of Useful Speech

• Total reliance on AAC
• Develop yes/no system for
• mealtimes
• emergencies
• bed/times of excessive fatigue
• Eyegaze boards

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AAC with Non Progressive Disorders

• Working backwards
• TBI
• Cognitive deficits
• CVA
• Language disorders, Apraxia
• B Stem CVA
• Cognitive and lang. Skills generally OK

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No Useful Speech

• No useful speech
• yes/no system
• If no recovery beyond this stage
• initial choice making
• eye gazing or blinking
• pointing
• head or hands
• multipurpose electronic AAC device
• may need scanning due to fatigue

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No Useful Speech

• Re-establishing subsystem control for speech
• AAC for interactions
• Tx focuses on
• increasing respiratory support
• improving phonatory and velopharyngeal control
• strengthening oral motor musculature
• coordinating actions of all subsystems

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Return of Speech

• Independent use of natural speech
• Compensatory strategies to increase
  intelligibility
• Alphabet board supplementation
• AAC for writing?
• Maximizing speech naturalness
• work on appropriate breath groups and stress
  patterns
• No detectable speech disorder
• Rare

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Multimodal Systems

• Natural speech
• Gestures
• High tech
• Voice output devices
• Low tech
• Alphabet boards
• Picture/word books
• Writing

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Compensatory Strategies For All AAC Users

• Establish breakdown and resolution strategies
• Quiet environment
• Face your listener
• Adequate lighting
• Try natural speech but know when to switch to AAC

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Maintaining Communication Opportunities for All
Users

• Topic setter cards
• Alphabet board supplementation
• Remnant books/memory books
• Loop tapes/single message tapes
• Miniboards
• High Tech for specific situations
• Writing, telephone, strangers

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Topic Setter Cards

• Family
• TV shows
• Outings
• Church
• Stories
• Any hobby or interest

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Single Loop Technology

• Go Talk button records one 10 second message
• Big Mack
• Big Step by Step

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A B C D E F G H IJ K L M N O P Q RS T U V W X
Y Znew word 1 2 3 4 5 6 7 8 9 10
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Almost Final Thoughts

• Stakeholders
• Empowerment
• Perceived success Vs failure with AAC

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Good communication is as stimulating as black
coffee, and just as hard to sleep after.
Anne Morrow Lindbergh