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Aphasia and AAC

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Aphasia: An acquired communication disability, usually a result of stroke or ... Simple: Macaw, MessageMate, Cheaptalk. Complex: Dynamyte, Dynavox ... – PowerPoint PPT presentation

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Title: Aphasia and AAC


1
Aphasia and AAC
  • SLA G304
  • Shelley Weiss, MS CCC-SLP

2
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

3
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)

4
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)

5
Aphasia
  • Revised Candidacy Classification system (Garrett
    and Beukelman)
  • Basic Choice Communicator
  • Controlled Situation Communicator
  • Comprehensive Communicator
  • Specific Needs Communicator
  • Augmented Input Communicator

6
Basic Diagnostic Protocol
  • Assessment custom tailored
  • Completed over extended period of time
  • Across environments and communication partners
  • Assessment and intervention occur simultaneously
  • Interdisciplinary team

7
Interdisciplinary Assessment Team
  • Physical therapist
  • Occupational therapist
  • Speech-language pathologist
  • Neuropsycologist
  • Physiatrist
  • Rehabilitation technician

8
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

9
Criteria-based Assessment
  • Skills assessment
  • Communication needs inventory
  • Opportunities and constraints
  • Feature matching
  • Trial period

10
Skills Assessment
  • Diagnosis and prognosis
  • Motor function
  • Vision, hearing
  • Sensory, perceptual
  • Motor speech
  • Language
  • Communication, pragmatics
  • Cognition, behavior, psychosocial

11
Communication Needs Inventory
  • Present and future needs
  • Four functions of communication (Light, 1988)
  • Information transfer
  • Social closeness
  • Basic wants and needs
  • Social etiquette

12
Opportunities and Constraints Assessment
  • Adjustment to the disability
  • Stage of recovery
  • Changing skill levels
  • Multiple communication partners

13
Opportunities and Constraints Assessment
  • User environment (partner attitudes towards AAC)
  • Availability of technical support
  • Medical protocol
  • Financial resources
  • Communicative desire, motivation

14
Feature Matching
  • No single strategy or tool will have all features
    to meet users needs
  • Flexibility of system is greatest consideration

15
Trial period
  • Need adequate time to teach system
  • Implement in natural contexts
  • Re-assess
  • Modify
  • Re-assess
  • Mass Medicaid funds device trial periods

16
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

17
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

18
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

19
Aphasia General Intervention Strategies
  • Carefully inventory communication needs using
    Lights (1988) model
  • Develop strategies to participate with peer group
  • Play Bingo
  • Tell jokes
  • Reminisce
  • Share opinions

20
Aphasia General Intervention Strategies
  • Assess most effective means and organization of
    representation
  • Visual spatial (maps, rating scales)
  • Categorical
  • words, messages
  • pictures
  • Topical

21
Aphasia General Intervention Strategies
  • Practice strategies in situational role-plays
  • Family, important communication partners play a
    critical role in therapy

22
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

23
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

24
Aphasia Intervention Remnant Book
  • Emotionally salient content may stimulate user
    input/output modalities
  • Doesnt look like augmentative communication aid
  • Primes user and family for future AAC systems

25
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

26
Aphasia Remnant Book Study Results
  • Remnants superior to pictographic symbols for
  • establishing joint attention
  • maintaining conversational control
  • communication partner ratings of comfort and
    efficacy

27
Aphasia Intervention Communication book
  • Inventory messages using Lights 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

28
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

29
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

30
Aphasia Tool Box
  • Alternative symbol boards, books
  • Retractable key chain
  • Remnant book
  • Maps, calendars, rating scales, clocks

31
Aphasia Tool Box
  • Dedicated VOCAs
  • Simple Macaw, MessageMate, Cheaptalk
  • Complex Dynamyte, Dynavox
  • Computer-based Speaking Dynamically, C-Speak
    Aphasia
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