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Augmentative and Alternative Communication (AAC) and Traumatic Brain Injury (TBI)

Augmentative and Alternative Communication (AAC) and Traumatic Brain Injury (TBI) .  SLA G304 Kimberly M. Ho, PhD CCC-SLP Shelley J. Weiss, MS CCC-SLP. Overview. TBI Review AAC Review Clinical examples. Definition of TBI.

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Augmentative and Alternative Communication (AAC) and Traumatic Brain Injury (TBI)

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  1. Augmentative and Alternative Communication (AAC) and Traumatic Brain Injury (TBI)  SLA G304 Kimberly M. Ho, PhD CCC-SLP Shelley J. Weiss, MS CCC-SLP

  2. Overview • TBI Review • AAC Review • Clinical examples

  3. Definition of TBI • Sudden injury to a normal brain that results in a cluster of deficits: • Cognitive • Linguistic • Behavioral/psychological • Physical

  4. 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

  5. Definition of TBI • Degree of impairment associated with size and type of lesion • Focal lesions • Diffuse lesions

  6. Definition of TBI • Frontal lobe damage most common • Executive function deficits • Memory deficits • Anterograde • Retrograde

  7. Cognitive-Linguistic Deficits • Frontal lobe lesions associated with • Disinhibition • Reduced initiation • Anxiety and disorganization • Reduced flexibility • Reduced comprehension • Decreased ability to generalize

  8. Rancho Los Amigos Scale of Cognitive Functioning – Revised (Hagen, 1997) • Scale of I-X • Early Stages of recovery (I-III) • No response • Generalized response • Localized response • Maximal Assistance required

  9. Ranchos Scale (cont’d) • Middle stages of recovery • Confused-agitated Maximal assistance • Confused,-inappropriate-non-agitated Maximal assistance • Confused-appropriate Moderate assistance

  10. Ranchos Scale (cont’d) • Late stages of recovery • Automatic-appropriate Minimal assistance for daily living skills • Purposeful and appropriate Stand-By assistance • Purposeful and appropriate Stand-By assistance on request • Purposeful and appropriate Modified independent

  11. Definition of AAC • Augmentative communication • Strategies in combination with natural speech or writing • Alternativecommunication • Strategies that replace natural speech or writing • Clinical examples

  12. Symbols and Techniques • Aided communication • Electronic aids • Nonelectronic aids • Unaided communication

  13. AAC Process—KeyComponents • Representation • Selection • Transmission

  14. Criteria-based Assessment • Observe current level of function • Observe changes over time • More effective than norm-referenced • Sensitive to change over time • Time efficient

  15. Criteria-Based Assessment • Skills Assessment • Communication needs inventory • Opportunities and constraints • Feature matching

  16. Representation Assessment • Symbol type • Acoustic • Graphic • Remnants • Photographs • Line drawings • Traditional orthography (TO) • Manual • Tactile

  17. Selection Assessment • Access should be transparent • Direct selection • Scanning

  18. TBI Intervention Protocol • Avoid new learning tasks • Tap into residual world knowledge • Keep physical access demands to a minimum

  19. Intervention (Cont’d) • Train functional communication Effectiveness of message production Efficiency Effort • Structured environment • Errorless learning • Repetitive practice

  20. Organizing Displays • System should be transparent and concrete • Simple displays

  21. Video Clips • Adult • Augmentative user • Child • AAC tool for cognition • Decrease challenging behavior

  22. 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

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