AAC in the Intensive Care Unit and Acute Care

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AAC in the Intensive Care Unit and Acute Care

• SLA G304 Kim Ho, PhD CCC-SLP

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Overview

• Hand back papers
• Review Seating and Positioning
• Review Literacy
• Quiz
• Lecture (Happ, Garrett, Roesch, 2003)
• Three EBP presentations

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Purpose and Features of ICU

• Specialized unit to monitor vital functions
• Immediate life-saving interventions
• Critical condition - injury or major surgery
• May not be able to see due to swelling
• Low arousal level, unconsciousness, or coma
• May be orally intubated - precludes speech
• CVA and trauma two most common Dx

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Features of the ICU Contd

• Patient stay is typically short
• AAC services must not interfere with medical care
• Majority of patients are 41-65 years old
• Communication is a medical necessity
• Training is critical

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Features of the ICU Contd

• Systems change on a daily basis since patient may
  improve/deteriorate rapidly
• Need to communicate more than medical needs
  novel messages
• Simpler the better Pt and staff

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Lack of Speech with Critical Illness

• Frightening
• Reduces patient participation in care and
  decision-making
• Impairs pain and symptom assessment

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Nonvocal communication Techniques

• Mouthing, words, gestures, writing, and head nods
  
• May not be consistently able to use
• Nurses do not typically receive training in
  maximizing their use

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Dowden et al (1986a/b)

• Successful use of AAC for 50 temporarily
  nonspeaking ICU patients
• Prosthetic oral approaches recd
• But demonstrated higher usage rates
• Direct selection systems
• Natural speaking approaches
• Most common reasons for intervention failure
• Decreasing cognition (51)
• Patients rejection (27)
• Decreasing motor control (20)

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Hemsley et al (2001)

• Communication boards were
• preferred over electronic devices by
• 4/5 ICU survivors

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Voice banking (Costello, 2000)

• SGD use with 43 patients, 2.8 to 44 years
• Prior to surgery
• Patients and family members recorded 30 to 40
  vocabulary items under topic cues
• Expressed general satisfaction with communication
  intervention
• Did not report exhaustion, isolation, or fear
  related to the inability to speak in ICU

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Barriers to widespread use of AAC in ICU (Happ,
Garrett, Roesch, 2003)

• Patients physical/cognitive fluctuation or
  deterioration
• Poor positioning
• Physical restraint use
• Discontinuity in communication partner(s)
• Staff lack of knowledge
• Access to AAC devices

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ICU Communicative Interaction (Yorkston, 1992)

• Wants and needs
• most are met through daily routines of hospital
• distinguish essential needs
• Information transfer
• Pt. Hx posted by bedside or in chart
• Provide communication boards/notebook to answer
  evaluation questions
• Provide AAC strategies to facilitate
  communication regarding family and business
  affairs

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ICU Communicative Interaction Contd (Yorkston,
1992)

• Social closeness
• Family members and friends may find it difficult
  to communicate with Pt
• Create remnant book
• Social etiquette
• Allow Pt. thank hospital staff, make courteous
  comments
• Simple SGD

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Acute Care

• Acute Rehab Hospital setting to regain
  functional skills
• Trend is to receive patients much earlier after
  onset due to managed care
• Issues with spontaneous recovery
• Pt still changing rapidly so cant treat
  indefinite long-term needs as inpatient