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

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aphasia and aac

Aphasia and AAC

SLA G304

Shelley Weiss, MS CCC-SLP

  • 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
  • Apraxia: Impairment in ability to program, sequence and execute purposeful gestures, despite intact mobility
    • Oral
    • Limb
  • Test of Limb and Oral Apraxia (Helm-Estabrooks)
  • 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)
  • Revised Candidacy Classification system (Garrett and Beukelman)
    • Basic Choice Communicator
    • Controlled Situation Communicator
    • Comprehensive Communicator
    • Specific Needs Communicator
    • Augmented Input Communicator
basic diagnostic protocol
Basic Diagnostic Protocol
  • Assessment custom tailored
  • Completed over extended period of time
  • Across environments and communication partners
  • Assessment and intervention occur simultaneously
  • Interdisciplinary team
interdisciplinary assessment team
Interdisciplinary Assessment Team
  • Physical therapist
  • Occupational therapist
  • Speech-language pathologist
  • Neuropsycologist
  • Physiatrist
  • Rehabilitation technician
criteria based assessment
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
criteria based assessment1
Criteria-based Assessment
  • Skills assessment
  • Communication needs inventory
  • Opportunities and constraints
  • Feature matching
  • Trial period
skills assessment
Skills Assessment
  • Diagnosis and prognosis
  • Motor function
  • Vision, hearing
  • Sensory, perceptual
  • Motor speech
  • Language
  • Communication, pragmatics
  • Cognition, behavior, psychosocial
communication needs inventory
Communication Needs Inventory
  • Present and future needs
  • Four functions of communication (Light, 1988)
    • Information transfer
    • Social closeness
    • Basic wants and needs
    • Social etiquette
opportunities and constraints assessment
Opportunities and Constraints Assessment
  • Adjustment to the disability
  • Stage of recovery
  • Changing skill levels
  • Multiple communication partners
opportunities and constraints assessment1
Opportunities and Constraints Assessment
  • User environment (partner attitudes towards AAC)
  • Availability of technical support
  • Medical protocol
  • Financial resources
  • Communicative desire, motivation
feature matching
Feature Matching
  • No single strategy or tool will have all features to meet user’s needs
  • Flexibility of system is greatest consideration
trial period
Trial period
  • Need adequate time to teach system
  • Implement in natural contexts
  • Re-assess
  • Modify
  • Re-assess
  • Mass Medicaid funds device trial periods
demands of communication for person with aphasia for basic needs conversation garrett 1996
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
aphasia demands imposed by aac strategies garrett 1996
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
aphasia general intervention strategies
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
aphasia general intervention strategies1
Aphasia: General Intervention Strategies
  • Carefully inventory communication needs using Light’s (1988) model
  • Develop strategies to participate with peer group
    • Play Bingo
    • Tell jokes
    • Reminisce
    • Share opinions
aphasia general intervention strategies2
Aphasia: General Intervention Strategies
  • Assess most effective means and organization of representation
    • Visual spatial (maps, rating scales)
    • Categorical
      • words, messages
      • pictures
    • Topical
aphasia general intervention strategies3
Aphasia: General Intervention Strategies
  • Practice strategies in situational role-plays
  • Family, important communication partners play a critical role in therapy
aphasia intervention remnant book
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
aphasia intervention remnant book1
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
aphasia intervention remnant book2
Aphasia Intervention Remnant Book
  • Emotionally salient content may stimulate user input/output modalities
  • Doesn’t look like augmentative communication aid
  • Primes user and family for future AAC systems
aphasia remnant book study results
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
aphasia remnant book study results1
Aphasia: Remnant Book Study Results
  • Remnants superior to pictographic symbols for:
    • establishing joint attention
    • maintaining conversational control
    • communication partner ratings of comfort and efficacy
aphasia intervention communication book
Aphasia Intervention: Communication book
  • Inventory messages using Light’s 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
aphasia intervention communication book1
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
aphasia intervention written choice garrett 1993
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
aphasia tool box
Aphasia: Tool Box
  • Alternative symbol boards, books
  • Retractable key chain
  • Remnant book
  • Maps, calendars, rating scales, clocks
aphasia tool box1
Aphasia: Tool Box
  • Dedicated VOCAs
    • Simple: Macaw, MessageMate, Cheaptalk
    • Complex: Dynamyte, Dynavox
  • Computer-based: Speaking Dynamically, C-Speak Aphasia