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Augmentative Communication for Older Adults

Augmentative Communication for Older Adults. Challenges and Considerations Caryn F. Melvin PhD CCC-SLP. “Words are, of course, the most powerful drug used by mankind”. Rudyard Kipling. Issues on the Plus Side. Seasoned language users Seasoned, effective communicators

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Augmentative Communication for Older Adults

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  1. Augmentative Communication for Older Adults Challenges and Considerations Caryn F. Melvin PhD CCC-SLP

  2. “Words are, of course, the most powerful drug used by mankind” Rudyard Kipling

  3. Issues on the Plus Side • Seasoned language users • Seasoned, effective communicators • Understand the power of communication • Motivation • Problem solving ability • Educated • World knowledge • Cognition ?

  4. Challenges and Considerations • Remembering normal communication • Change in social role • Change in family dynamics • Grieving • Financial worries • Self esteem • Have observed others with impairments • Other health issues

  5. Measuring and Evaluating the Communication Difficulty • Impairment • Functional limitations • Disability

  6. Common Adult Disease Processes Requiring Augmentative Communication • ALS* • MS* • Parkinson Disease* • B-Stem CVA • Severe Aphasia • Others (SCI, GBS, TBI)

  7. Progressive or Acute Disease? It impacts more than just management!

  8. ALS Parkinson’s Huntington’s Progressive Supranuclear Palsy MS * CVA TBI Gullian Barre syndrome Progressive and Acute Disease

  9. Progressive Disease and AAC • ALS • Parkinson Disease • PSP • MS • Do not always have expressive deficits • Huntington’s Disease

  10. No Detectable Disorder • Obtain base line information/scores • Answer questions • Provide education re: disease • As warranted • Provide info re: options for communication • Avoid details re: end stage of the disease • Unless asked directly • Use phrases like; • If you should need this___ • Some people experience____

  11. Obvious Disorder/Intelligible • Minimize environmental interference • Reduce rate • Confirm topics • Confirm listener understanding • Voice amplification • For Parkinson and PSP • Possible AAC assessment/intervention • In specific situations

  12. Reduced Intelligibility • Complete AAC assessment • If not already done • Prosthetic Aids • Palatal lift, alphabet board etc • Reduce breath groups • Compensatory strategies* • Maintaining communication opportunities* • Support group • If warranted

  13. Loss of Useful Speech • Total reliance on AAC • Develop yes/no system for • mealtimes • emergencies • bed/times of excessive fatigue • Eyegaze boards

  14. AAC with Non Progressive Disorders • Working backwards • TBI • Cognitive deficits • CVA • Language disorders, Apraxia • B Stem CVA • Cognitive and lang. Skills generally OK

  15. No Useful Speech • No useful speech • yes/no system • If no recovery beyond this stage; • initial choice making • eye gazing or blinking • pointing • head or hands • multipurpose electronic AAC device • may need scanning due to fatigue

  16. No Useful Speech • Re-establishing subsystem control for speech • AAC for interactions • Tx focuses on • increasing respiratory support • improving phonatory and velopharyngeal control • strengthening oral motor musculature • coordinating actions of all subsystems

  17. Return of Speech • Independent use of natural speech • Compensatory strategies to increase intelligibility • Alphabet board supplementation • AAC for writing? • Maximizing speech naturalness • work on appropriate breath groups and stress patterns • No detectable speech disorder • Rare

  18. Multimodal Systems • Natural speech • Gestures • High tech • Voice output devices • Low tech • Alphabet boards • Picture/word books • Writing

  19. Compensatory Strategies For All AAC Users • Establish breakdown and resolution strategies • Quiet environment • Face your listener • Adequate lighting • Try natural speech but know when to switch to AAC

  20. Maintaining Communication Opportunities for All Users • Topic setter cards • Alphabet board supplementation • Remnant books/memory books • Loop tapes/single message tapes • Miniboards • High Tech for specific situations • Writing, telephone, strangers

  21. Topic Setter Cards • Family • TV shows • Outings • Church • “Stories” • Any hobby or interest

  22. Single Loop Technology • Go Talk button records one 10 second message • Big Mack • Big Step by Step

  23. A B C D E F G H IJ K L M N O P Q RS T U V W X Y Znew word 1 2 3 4 5 6 7 8 9 10

  24. “Almost” Final Thoughts • Stakeholders • Empowerment • Perceived success Vs failure with AAC

  25. “Good communication is as stimulating as black coffee, and just as hard to sleep after.”Anne Morrow Lindbergh

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