Augmentative and Alternative Communication (AAC) and

Traumatic Brain Injury (TBI)  

 SLA G304Kimberly M. Ho, PhD CCC-SLP

Shelley J. Weiss, MS CCC-SLP

Overview TBI Review

AAC Review

Clinical examples

Definition of TBI Sudden injury to a normal brain

that results in a cluster of deficits: Cognitive Linguistic Behavioral/psychological Physical

TBI Statistics Leading cause of death for people

under 45 1.5 million sustain TBI More than twice as many males as

females 80,000 to 90,000 experience long-

term or lifelong disability

Definition of TBI Degree of impairment associated

with size and type of lesion

Focal lesions

Diffuse lesions

Definition of TBI Frontal lobe damage most common

Executive function deficits

Memory deficits Anterograde Retrograde

Cognitive-Linguistic Deficits Frontal lobe lesions associated with

Disinhibition Reduced initiation Anxiety and disorganization Reduced flexibility Reduced comprehension Decreased ability to generalize

Rancho Los Amigos Scale of Cognitive Functioning – Revised (Hagen, 1997)

Scale of I-XEarly Stages of recovery (I-III)

I. No responseII. Generalized responseIII. Localized response

Maximal Assistance required

Ranchos Scale (cont’d)

Middle stages of recoveryIV. Confused-agitated

Maximal assistance

V. Confused,-inappropriate-non-agitated

Maximal assistance

VI. Confused-appropriateModerate assistance

Ranchos Scale (cont’d)

Late stages of recoveryVII. Automatic-appropriate

Minimal assistance for daily living skills

VIII. Purposeful and appropriateStand-By assistance

IX. Purposeful and appropriateStand-By assistance on request

X. Purposeful and appropriateModified independent

Definition of AAC Augmentative communication

Strategies in combination with natural speech or writing

Alternative communication Strategies that replace natural speech or

writing

Clinical examples

Symbols and Techniques Aided communication

• Electronic aids• Nonelectronic aids

Unaided communication

AAC Process—Key

Components Representation

Selection

Transmission

Criteria-based Assessment Observe current level of function

Observe changes over time More effective than norm-referenced Sensitive to change over time Time efficient

Criteria-Based Assessment Skills Assessment

Communication needs inventory

Opportunities and constraints

Feature matching

Representation Assessment

Symbol type Acoustic Graphic

• Remnants• Photographs• Line drawings• Traditional orthography (TO)

Manual Tactile

Selection Assessment Access should be transparent

Direct selection

Scanning

TBI Intervention Protocol Avoid new learning tasks

Tap into residual world knowledge

Keep physical access demands to a minimum

Intervention (Cont’d) Train functional communication

Effectiveness of message productionEfficiency Effort

Structured environment Errorless learning Repetitive practice

Organizing Displays

System should be transparent and concrete

Simple displays

Video Clips

Adult Augmentative user

Child AAC tool for cognition Decrease challenging behavior

Summary

TBI characterized by an array of deficits Frontal lobe lesions Ranchos Los Amigos Scale AAC supplement/replace speech or

writing Criterion-based assessment Intervention protocol