1 / 31

Aphasia and AAC

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.

Antony
Download Presentation

Aphasia and AAC

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

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

  2. 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

  3. Aphasia • Apraxia: Impairment in ability to program, sequence and execute purposeful gestures, despite intact mobility • Oral • Limb • Test of Limb and Oral Apraxia (Helm-Estabrooks)

  4. Aphasia • 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)

  5. Aphasia • Revised Candidacy Classification system (Garrett and Beukelman) • Basic Choice Communicator • Controlled Situation Communicator • Comprehensive Communicator • Specific Needs Communicator • Augmented Input Communicator

  6. Basic Diagnostic Protocol • Assessment custom tailored • Completed over extended period of time • Across environments and communication partners • Assessment and intervention occur simultaneously • Interdisciplinary team

  7. Interdisciplinary Assessment Team • Physical therapist • Occupational therapist • Speech-language pathologist • Neuropsycologist • Physiatrist • Rehabilitation technician

  8. 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

  9. Criteria-based Assessment • Skills assessment • Communication needs inventory • Opportunities and constraints • Feature matching • Trial period

  10. Skills Assessment • Diagnosis and prognosis • Motor function • Vision, hearing • Sensory, perceptual • Motor speech • Language • Communication, pragmatics • Cognition, behavior, psychosocial

  11. Communication Needs Inventory • Present and future needs • Four functions of communication (Light, 1988) • Information transfer • Social closeness • Basic wants and needs • Social etiquette

  12. Opportunities and Constraints Assessment • Adjustment to the disability • Stage of recovery • Changing skill levels • Multiple communication partners

  13. Opportunities and Constraints Assessment • User environment (partner attitudes towards AAC) • Availability of technical support • Medical protocol • Financial resources • Communicative desire, motivation

  14. Feature Matching • No single strategy or tool will have all features to meet user’s needs • Flexibility of system is greatest consideration

  15. Trial period • Need adequate time to teach system • Implement in natural contexts • Re-assess • Modify • Re-assess • Mass Medicaid funds device trial periods

  16. 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

  17. 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

  18. 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

  19. 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

  20. Aphasia: General Intervention Strategies • Assess most effective means and organization of representation • Visual spatial (maps, rating scales) • Categorical • words, messages • pictures • Topical

  21. Aphasia: General Intervention Strategies • Practice strategies in situational role-plays • Family, important communication partners play a critical role in therapy

  22. 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

  23. 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

  24. 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

  25. 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

  26. Aphasia: Remnant Book Study Results • Remnants superior to pictographic symbols for: • establishing joint attention • maintaining conversational control • communication partner ratings of comfort and efficacy

  27. 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

  28. 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

  29. 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

  30. Aphasia: Tool Box • Alternative symbol boards, books • Retractable key chain • Remnant book • Maps, calendars, rating scales, clocks

  31. Aphasia: Tool Box • Dedicated VOCAs • Simple: Macaw, MessageMate, Cheaptalk • Complex: Dynamyte, Dynavox • Computer-based: Speaking Dynamically, C-Speak Aphasia

More Related