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

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)

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)

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

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 Physical therapist Occupational therapist Speech-language pathologist Neuropsycologist Physiatrist Rehabilitation technician

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 Assessment Skills assessment Communication needs inventory Opportunities and constraints Feature matching Trial period

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

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 Adjustment to the disability Stage of recovery Changing skill levels Multiple communication partners

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

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

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) 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) 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 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 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 Strategies Assess most effective means and organization of representation –Visual spatial (maps, rating scales) –Categorical words, messages pictures –Topical

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

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 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 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 –(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 Results  Remnants superior to pictographic symbols for:  establishing joint attention  maintaining conversational control  communication partner ratings of comfort and efficacy

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 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) 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 Alternative symbol boards, books Retractable key chain Remnant book Maps, calendars, rating scales, clocks

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