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Aphasia and AAC
SLA G304
Shelley Weiss, MS CCC-SLP
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
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)
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)
Aphasia
• Revised Candidacy Classification system (Garrett and Beukelman)–Basic Choice Communicator –Controlled Situation Communicator–Comprehensive Communicator–Specific Needs Communicator–Augmented Input Communicator
Basic Diagnostic Protocol
• Assessment custom tailored
• Completed over extended period of time
• Across environments and communication partners
• Assessment and intervention occur simultaneously
• Interdisciplinary team
Interdisciplinary Assessment Team
• Physical therapist• Occupational therapist• Speech-language pathologist• Neuropsycologist• Physiatrist• Rehabilitation technician
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
Criteria-based Assessment
• Skills assessment• Communication needs inventory• Opportunities and constraints• Feature matching• Trial period
Skills Assessment
• Diagnosis and prognosis• Motor function• Vision, hearing• Sensory, perceptual• Motor speech• Language• Communication, pragmatics• Cognition, behavior, psychosocial
Communication Needs Inventory
• Present and future needs• Four functions of communication
(Light, 1988)– Information transfer–Social closeness–Basic wants and needs–Social etiquette
Opportunities and Constraints Assessment
• Adjustment to the disability• Stage of recovery• Changing skill levels• Multiple communication partners
Opportunities and Constraints Assessment
• User environment (partner attitudes towards AAC)
• Availability of technical support• Medical protocol• Financial resources• Communicative desire, motivation
Feature Matching
• No single strategy or tool will have all features to meet user’s needs
• Flexibility of system is greatest consideration
Trial period
• Need adequate time to teach system• Implement in natural contexts• Re-assess• Modify• Re-assess• Mass Medicaid funds device trial
periods
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
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
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
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
Aphasia: General Intervention Strategies
• Assess most effective means and organization of representation–Visual spatial (maps, rating scales)–Categorical
• words, messages• pictures
–Topical
Aphasia: General Intervention Strategies
• Practice strategies in situational role-plays
• Family, important communication partners play a critical role in therapy
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
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
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
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
Aphasia: Remnant Book Study Results
Remnants superior to pictographic symbols for: establishing joint attention maintaining conversational control communication partner ratings of
comfort and efficacy
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
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
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
Aphasia: Tool Box
• Alternative symbol boards, books• Retractable key chain• Remnant book• Maps, calendars, rating scales, clocks
Aphasia: Tool Box
• Dedicated VOCAs– Simple: Macaw, MessageMate,
Cheaptalk–Complex: Dynamyte, Dynavox
• Computer-based: Speaking Dynamically, C-Speak Aphasia