AAC and Acquired Disorders

Aphasia• There are different types of aphasia.• With aphasia there is a rehabilitation period.• There is a Psychological Impact• 1. Can they adjust and cope?• 2. Emotions vary-grief, inadequacy, anger, guilt, • vulnerability and confusion. Will they be willing to accept assistance?• It’s their prerogative to accept help or decline.• Using an AAC system may be perceived as “giving in”.• Acceptance of an AAC system may take weeks or months.

An AAC Treatment for Aphasia will focus on communication and participation rather than recovery of speech alone.

Aphasia• Assessment- The Multimodal Communication Screening Tool for Aphasia 2005, revised

2007 Dr. Kathy Garrett (Alternative Communication Therapies) and Dr. Joan Lasker (Emerson College)

A functional approach that focuses on: * what they can do now * what they might be able to do with supports

Create 2 groups:Partner dependent communicators- more severeIndependent Communicators- probably those whose language and executive functioning are relatively intact but may experience Apraxia.

Emerging/Contextual Communicators(people with poor comprehension)

Use Partner Dependent Strategies-Strategy 1: Augmented InputThe communication partner (CP) identifies nonverbal responses, gestures, etc. as communication attempts.SP may point to items, gestures or point to pictures for responses or written choices.

Strategy 2: Written choice conversationCP generates written key-word choicesCP presents choices on a rating scale or locations on a map

Transitional CommunicatorsStrategies-Strategy 1: Stored Message Retrieval to promote initiation and symbol use.Use simple sentencesPractice should occur in contextual situations.Use low tech picture/text communication boardsUse a simple SDG

Strategy 2: Topic initiation (must talk to family for relevant personal information.Use souvenirs, photo albums, menusCPs pose questions and client is encouraged to begin an interaction.

Strategy 3: StorytellingStories should be sequenced on communication systems.Visual scenes can be used.

Wouldn’t it make sense to use Activity Based Communication Displays???

Strategy 1: Stored Message RetrievalUse with SDGs with pre-stored messages and scripted routines

Strategy 2: Multimodal Communicationusing spelling, drawing pictures, natural speechIntroduce abbreviations and word prediction for spelling

Other strategies (Praactical AAC.org)• 20 questions- not the most efficient• Alphabet supplementation- Client points to the first letter of a word. Problem-Many can’t think of the word they want to say. Must be taught!!• Topic Cards- client indicates the topic by using a card. This can improve comprehension by 29% Hanson, Yorkston, Beukelman (2004) Must be taught!!

Creating Conversations

Pick a topic

AAC and ALS• These clients have dysarthria.• 75% will need AAC.• AAC with ALS is all about access! Not language.• Speech disturbance will be progressive.• Psychological Impact 1. Can they adjust and cope? 2. Emotions vary-grief, inadequacy, anger, guilt, vulnerability and confusion.• Will they be willing to accept assistance? It’s their prerogative to accept help or decline. Using an AAC system may be perceived as “giving in”. Acceptance of an AAC system may take weeks or months.

Before oral communication goes…

• Establish a communication environment that is comfortable for the client.

(Do they like you to finish their sentences?)• Have them slow down and over articulate.• THEY WILL FATIGUE.• Reduce the distractions in the room. Sit close and

look at nonverbal cues.• Repeat the parts of the sentences you understand.

(words at the end of sentences tend to become unintelligible)

When it starts to go…• Amplification• Gesturing – thumbs up, signing, yes/no, facial gestures, eye movements Adult assisted scanning!!• Low tech- writing, letter boards, picture boards,

create a phrases chart (with numbers), alpha coding NG:need glasses • Alternate access- eye gaze, laser pointers, stylus’

High Tech• APPS• Computers with voice output software• Speech Generating Devices- these will have

environmental controls, too.REMEMBER IT’S ALL ABOUT ACCESS

• Locked in Syndrome- only the eyes work• Total Locked in Syndrome- eyes can’t be used Currently there are no devices available

Other disabilities• Throat cancers- Roger Ebert (beginning then jump to 4 minutes)

Must live with the future in mind!Voice and Sound BankingMessageBanking.com- allows you to record messages in your own voice..These can be transferred to speech generating devices.Model Talker- records 1800 utterances- you can get a personalized voice

Dementia- treat like Aphasia