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Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC. Joanne P. Lasker, Ph.D. Florida State University Kathryn L. Garrett, Ph.D. Duquesne University. Presentation at the American Speech-Language-Hearing Association Convention November 22, 2003 Chicago, IL.

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cognitive linguistic profiles of aphasic communicators who use aac

Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC

Joanne P. Lasker, Ph.D.

Florida State University

Kathryn L. Garrett, Ph.D.

Duquesne University

Presentation at the American Speech-Language-Hearing Association Convention

November 22, 2003

Chicago, IL

a statement of the problem
A. Statement of the Problem
  • Many people with severe aphasia have unmet communication needs.
  • Which individuals with chronic aphasia will benefit from augmentative and alternative communication strategies (AAC)?
  • Which type/class of AAC strategies?
  • Are there systematic ways of assessing this issue?
  • Is there a “profile” of an effective AAC communicator?
b cognitive linguistic considerations in aac
B. Cognitive-Linguistic Considerations in AAC
  • definition of aphasia
    • “Language” or “symbolic deficits” across modalities
    • Intermittency of processing (Brookshire, 1978; McNeil, 1983)
  • more recently we have seen attention to possible cognitive aspects of aphasia
cognition and aphasia
Cognition and Aphasia
  • Aspects of cognition related to aphasia may include: (Purdy, 2001; Hinckley, 2002)
    • attention
    • memory
    • executive function skills
    • resource allocation
    • pragmatics
demands of aac techniques
Demands of AAC Techniques
  • Think to initiate communication through external means -- “outside” of the communicator’s own head and language system (Garrett & Kimelman, 2000)
  • Verbal memory for messages
  • Spatial memory for message location
  • Symbol translation skills -- from icons to meanings
  • Executive function skills -- to judge which method of communication best fits the situation
  • Attention and perseverance to complete the message transaction
resource allocation
Resource Allocation
  • to balance the cognitive demands of using a novel form of communication…
  • …with the pragmatic demands of speaking to a communication partner
  • And the linguistic demands of encoding messages
  • And any other stressors in the communication environment
    • Balancing
    • Noise
    • Multiple speakers
    • Multiple topics
    • Interruptions
    • Communication breakdowns
challenges with aac and aphasia
Challenges with AAC and Aphasia
  • Limited information is available re: who is and is not successful.
  • “Matching” AAC approaches to skills/needs of communicator involves many variables.
  • Limited knowledge is available about how to effectively train people with aphasia to use AAC in real-life situations.
still more challenges
Still More Challenges
  • People with aphasia tend to be isolated, and therefore have limited social opportunities to communicate.
  • Message pools selected for AAC systems may not be appropriate or meaningful for adults with aphasia.
  • Negative or ambivalent attitudes toward technology may be held by adults with aphasia and/or communication partners.
recent research
Recent Research
  • Helm-Estabrooks (2002) described a case study of a person with aphasia who used a high tech AAC system (C-Speak Aphasia; Nicholas & Elliot).
  • Her analysis of the individual’s cognitive-linguistic profile revealed:
    • mild-moderate aphasia as measured by the WAB
    • relatively strong cognitive skills on specific subtests of the Cognitive-Linguistic Quick Test (Helm-Estabrooks, 2001)
      • Trail Making
      • Design Generation
      • Mazes
testable hypothesis
Testable Hypothesis
  • Certain measures of cognition may serve as reasonable predictors of an individual’s ability to use an AAC system to communicate meaningfully.
c our purpose design
C. Our Purpose/Design
  • Case study approach.
  • generate a cognitive-linguistic and behavioral profile of successful AAC users with aphasia
      • Independent Communicators
      • Partner Dependent Communicators
      • Nonusers
  • aid in assessment and intervention planning
proposed test battery
Proposed Test Battery
  • Western Aphasia Battery (Kertesz, 1982)
  • Raven’s Coloured Progressive Matrices (Raven, Raven, & Court, 1998)
  • Cognitive-Linguistic Quick Test (Helm-Estabrooks, 2001)
  • Wisconsin Card Sort Task (Kongs, Thompson, Iverson, & Heaton, 2000)
  • Multimodal Communication Screening Task (Garrett, 1998)
  • The Assistive Technology Device Predisposition Assessment Consumer Form (adapted from Scherer & McKee, 1989 by Lasker & Bedrosian, 2000; under revision)
  • Categorical Assessment of Communicators with Aphasia (Garrett & Beukelman, 1998; under revision)
cognitive linguistic quick test helm estabrooks 2001
Cognitive-Linguistic Quick Test (Helm-Estabrooks, 2001)
  • criterion-referenced test
    • relative skills in the areas of:
      • attention
      • memory
      • language
      • executive function
      • visuospatial skills
    • does require verbal skills for some tasks (e.g., story retelling)
clqt tasks and composites
Personal Facts

Symbol Cancellation

Confrontation Naming

Clock Drawing

Story Retelling

Symbol Trails

Generative Naming

Design Memory


Design Generation

Yield composite scores:



executive function


visuospatial skills

CLQT – Tasks and Composites
wisconsin card sort test
Wisconsin Card Sort Test
  • sort cards by:
    • number
    • shape
    • color
  • rules change after 10 correct sorts
sample questions from the technology predisposition survey
Sample questions from the “Technology Predisposition Survey”
  • I will benefit from using this AAC system.
  • This AAC system will help me achieve a goal that I have.
  • I will feel comfortable using this AAC system in public.
  • This AAC system will improve the quality of my life.
  • I will feel comfortable using this AAC system around my family.
jv emerging communicator
JV -- Emerging Communicator
  • WAB AQ - .6/100
  • BASA -- 2nd %ile for people with global aphasia
  • Raven’s -- 0/36
  • CLQT -- N/A
  • Technology Attitudes
    • Minimal experience
    • Interested in trying technology
    • Required specific training to use symbols to request
    • Max assist to locate symbolized messages
aa rc contextual choice communicators
AA & RC -- Contextual Choice Communicators
  • WAB AQ = 9.2
  • Reading: 11/100
  • Writing: 10.5/100
  • Ravens: 15/36
  • CLQT
    • Symbol Trails: 1/10
    • Design Memory: 2/6
    • Mazes: 0/8
    • Design Generation: 6/13
  • Technology Attitudes:
    • Minimal to some computer experience
    • Willing to learn to operate simple AAC systems
    • Less willing to use in real-life
sa transitional communicator
WAB AQ = 93.4

Reading = 80/100

Writing = 71/100

Praxis = 55/60

Block Design = 7/9

Calculation = 24/24

Raven’s = 16/20

Moderate dysarthria

Technology Attitudes:

Moderate computer experience

Interested in Palmtop PC-type device because of social acceptability

SA - Transitional Communicator
gw deferred technology user
WAB = 35

Broca’s profile

1 year post onset


Computer experience

Technology Attitudes --

No interest in learning to use AAC at present

GW--Deferred Technology User
client mh
Client: MH
  • 52-year old woman
  • left CVA in March, 2001
    • 2 years post
  • 14 years of education
  • right hemiparesis
  • lives with mother who is in frail health
  • completed assessment phase of project before relocation
  • diagnosed with moderate receptive and severe expressive aphasia
  • limited speech therapy
mh strengths challenges

emotional issues:




social isolation

impaired auditory comprehension

impaired executive skills

severity of speech deficit





MH – Strengths & Challenges
mh current status
MH – Current Status
  • relocated after assessment
  • currently not receiving any services
  • SLP attempting to contact an area SLP to continue intervention and device trial
client jk
Client: JK
  • 53-year-old tenured geography professor
  • earned doctorate
  • left CVA in 3/2001
    • 8 months post at first visit
  • employed by university for 21 years (since 1982)
  • lives with husband (also a professor) and young daughter (5 years old)
  • diagnosed with moderate expressive aphasia and mild receptive aphasia
student evaluations first teaching experience after stroke
Student Evaluations: First Teaching Experience After Stroke
  • “It was very interesting to see how Dr. Kodras put her sentences together and got her point across to the class.”
  • “Topic ---- instructor ---- extremely well versed ---- passionate about topic ---- makes all difference ----- instructor ----- exceptional.”
  • “I could see that living with aphasia does not mean that you have to stop living.”
jk strengths and challenges

communication needs

impaired executive skills






familiarity with technology

family support

JK – Strengths and Challenges
jk current status
JK – Current Status
  • Participating in intervention to utilize a combination of EZ Keys and “Key Word Teaching” to lecture to her graduate classes.
  • Continues to use EZ Keys to prepare lectures.
  • Continues to negotiate support from department.
client rm
Client: RM
  • 62-year-old
  • education: 14 years
  • retired airport manager
  • left CVA occurred 1995
  • diagnosed with moderate aphasia and moderate-severe apraxia of speech
device usage press behaviors
Device Usage - “Press Behaviors”

“I like a cheeseburger and coke please.”

rm challenges and strengths

poor spelling

unable to use word-based pages on device effectively

resistant to change of relatively inefficient layout of device




positive attitude about everything

multimodal to the extreme

willing to use device in public, on phone, as email tool

RM – Challenges and Strengths
rm current status
RM – Current Status
  • increase and enhance facilitative behaviors on device
    • category-based word search
    • word by word formulation
  • decrease non-facilitative behaviors
    • inappropriate topic setting
    • device navigation
  • participating in motor-based learning study to increase speech output
  • acts as ambassador and community educator
e summing up

E. Summing Up

What did we learn?

categories cont58
Categories (cont.)

MH and SA

RM and JK

e summary what did we learn
E. Summary: What did we learn?
  • Clinician judgment (via AAC trials) differentiated independent from partner-dependent communicators.
    • Test results verified these judgments.
  • Potential “suspects” for determining outcome – likely a complex picture. . .
    • AQ’s
    • expressive writing task
    • attitude toward AAC system
    • cognitive tasks on CLQT
as always
As always…
  • Further research is warranted
  • Your comments are appreciated
  • Handouts: give us one week to post them on the ASHA website