Augmentative Communication for Older Adults Challenges and Considerations Caryn F. Melvin PhD CCC-SLP
“Words are, of course, the most powerful drug used by mankind” Rudyard Kipling
Issues on the Plus Side Seasoned language users Seasoned, effective communicators Understand the power of communication Motivation Problem solving ability Educated World knowledge Cognition ?
Challenges and Considerations Remembering normal communication Change in social role Change in family dynamics Grieving Financial worries Self esteem Have observed others with impairments Other health issues
Measuring and Evaluating the Communication Difficulty Impairment Functional limitations Disability
Common Adult Disease Processes Requiring Augmentative Communication ALS* MS* Parkinson Disease* B-Stem CVA Severe Aphasia Others (SCI, GBS, TBI)
Progressive or Acute Disease? It impacts more than just management!
Progressive and Acute Disease ALS Parkinson’s Huntington’s Progressive Supranuclear Palsy MS * CVA TBI Gullian Barre syndrome
Progressive Disease and AAC ALS Parkinson Disease PSP MS Do not always have expressive deficits Huntington’s Disease
No Detectable Disorder Obtain base line information/scores Answer questions Provide education re: disease As warranted Provide info re: options for communication Avoid details re: end stage of the disease Unless asked directly Use phrases like; If you should need this___ Some people experience____
Obvious Disorder/Intelligible Minimize environmental interference Reduce rate Confirm topics Confirm listener understanding Voice amplification For Parkinson and PSP Possible AAC assessment/intervention In specific situations
Reduced Intelligibility Complete AAC assessment If not already done Prosthetic Aids Palatal lift, alphabet board etc Reduce breath groups Compensatory strategies* Maintaining communication opportunities* Support group If warranted
Loss of Useful Speech Total reliance on AAC Develop yes/no system for mealtimes emergencies bed/times of excessive fatigue Eyegaze boards
AAC with Non Progressive Disorders Working backwards TBI Cognitive deficits CVA Language disorders, Apraxia B Stem CVA Cognitive and lang. Skills generally OK
No Useful Speech No useful speech yes/no system If no recovery beyond this stage; initial choice making eye gazing or blinking pointing head or hands multipurpose electronic AAC device may need scanning due to fatigue
No Useful Speech Re-establishing subsystem control for speech AAC for interactions Tx focuses on increasing respiratory support improving phonatory and velopharyngeal control strengthening oral motor musculature coordinating actions of all subsystems
Return of Speech Independent use of natural speech Compensatory strategies to increase intelligibility Alphabet board supplementation AAC for writing? Maximizing speech naturalness work on appropriate breath groups and stress patterns No detectable speech disorder Rare
Multimodal Systems Natural speech Gestures High tech Voice output devices Low tech Alphabet boards Picture/word books Writing
Compensatory Strategies For All AAC Users Establish breakdown and resolution strategies Quiet environment Face your listener Adequate lighting Try natural speech but know when to switch to AAC
Maintaining Communication Opportunities for All Users Topic setter cards Alphabet board supplementation Remnant books/memory books Loop tapes/single message tapes Miniboards High Tech for specific situations Writing, telephone, strangers
Topic Setter Cards Family TV shows Outings Church “Stories” Any hobby or interest
Single Loop Technology Go Talk button records one 10 second message Big Mack Big Step by Step
ABCDEFGHI JKLMNOPQR STUVWXYZ new word
“Almost” Final Thoughts Stakeholders Empowerment Perceived success Vs failure with AAC
“Good communication is as stimulating as black coffee, and just as hard to sleep after.” Anne Morrow Lindbergh