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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

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
Overview
  • TBI Review
  • AAC Review
  • Clinical examples
definition of tbi
Definition of TBI
  • Sudden injury to a normal brain that results in a cluster of deficits:
    • Cognitive
    • Linguistic
    • Behavioral/psychological
    • Physical
tbi statistics
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
definition of tbi5
Definition of TBI
  • Degree of impairment associated with size and type of lesion
    • Focal lesions
    • Diffuse lesions
definition of tbi6
Definition of TBI
  • Frontal lobe damage most common
    • Executive function deficits
  • Memory deficits
    • Anterograde
    • Retrograde
cognitive linguistic deficits
Cognitive-Linguistic Deficits
  • Frontal lobe lesions associated with
    • Disinhibition
    • Reduced initiation
    • Anxiety and disorganization
    • Reduced flexibility
    • Reduced comprehension
    • Decreased ability to generalize
rancho los amigos scale of cognitive functioning revised hagen 1997
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
ranchos scale cont d
Ranchos Scale (cont’d)
  • Middle stages of recovery
    • Confused-agitated

Maximal assistance

    • Confused,-inappropriate-non-agitated

Maximal assistance

    • Confused-appropriate

Moderate assistance

ranchos scale cont d10
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

definition of aac
Definition of AAC
  • Augmentative communication
    • Strategies in combination with natural speech or writing
  • Alternativecommunication
    • Strategies that replace natural speech or writing
  • Clinical examples
symbols and techniques
Symbols and Techniques
  • Aided communication
    • Electronic aids
    • Nonelectronic aids
  • Unaided communication
aac process key components
AAC Process—KeyComponents
  • Representation
  • Selection
  • Transmission
criteria based assessment
Criteria-based Assessment
  • Observe current level of function
  • Observe changes over time
    • More effective than norm-referenced
    • Sensitive to change over time
    • Time efficient
criteria based assessment15
Criteria-Based Assessment
  • Skills Assessment
  • Communication needs inventory
  • Opportunities and constraints
  • Feature matching
representation assessment
Representation Assessment
  • Symbol type
    • Acoustic
    • Graphic
      • Remnants
      • Photographs
      • Line drawings
      • Traditional orthography (TO)
    • Manual
    • Tactile
selection assessment
Selection Assessment
  • Access should be transparent
    • Direct selection
    • Scanning
tbi intervention protocol
TBI Intervention Protocol
  • Avoid new learning tasks
  • Tap into residual world knowledge
  • Keep physical access demands to a minimum
intervention cont d
Intervention (Cont’d)
  • Train functional communication

Effectiveness of message production

Efficiency

Effort

  • Structured environment
  • Errorless learning
  • Repetitive practice
organizing displays
Organizing Displays
  • System should be transparent and concrete
  • Simple displays
video clips
Video Clips
  • Adult
  • Augmentative user
  • Child
  • AAC tool for cognition
  • Decrease challenging behavior
summary
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