Augmentative and Alternative Communication (AAC) and Traumatic Brain Injury (TBI) SLA G304 Kimberly M. Ho, PhD CCC-SLP Shelley J. Weiss, MS CCC-SLP

Overview TBI Review AAC Review Clinical examples

Definition of TBI Sudden injury to a normal brain that results in a cluster of deficits: Cognitive Linguistic Behavioral/psychological Physical

TBI Statistics Leading cause of death for people under million sustain TBI More than twice as many males as females 80,000 to 90,000 experience long- term or lifelong disability

Definition of TBI Degree of impairment associated with size and type of lesion Focal lesions Diffuse lesions

Definition of TBI Frontal lobe damage most common Executive function deficits Memory deficits Anterograde Retrograde

Cognitive-Linguistic Deficits Frontal lobe lesions associated with Disinhibition Reduced initiation Anxiety and disorganization Reduced flexibility Reduced comprehension Decreased ability to generalize

Rancho Los Amigos Scale of Cognitive Functioning – Revised (Hagen, 1997) Scale of I-X Early Stages of recovery (I-III) I. No response II. Generalized response III. Localized response Maximal Assistance required

Ranchos Scale (cont’d) Middle stages of recovery IV. Confused-agitated Maximal assistance V. Confused,-inappropriate-non- agitated Maximal assistance VI. Confused-appropriate Moderate assistance

Ranchos Scale (cont’d) Late stages of recovery VII. Automatic-appropriate Minimal assistance for daily living skills VIII. Purposeful and appropriate Stand-By assistance IX. Purposeful and appropriate Stand-By assistance on request X. Purposeful and appropriate Modified independent

Definition of AAC Augmentative communication Strategies in combination with natural speech or writing Alternative communication Strategies that replace natural speech or writing Clinical examples

Symbols and Techniques Aided communication Electronic aids Nonelectronic aids Unaided communication

AAC Process—Key Components Representation Selection Transmission

Criteria-based Assessment Observe current level of function Observe changes over time More effective than norm-referenced Sensitive to change over time Time efficient

Criteria-Based Assessment Skills Assessment Communication needs inventory Opportunities and constraints Feature matching

Representation Assessment Symbol type Acoustic Graphic Remnants Photographs Line drawings Traditional orthography (TO) Manual Tactile

Selection Assessment Access should be transparent Direct selection Scanning

TBI Intervention Protocol Avoid new learning tasks Tap into residual world knowledge Keep physical access demands to a minimum

Intervention (Cont’d) Train functional communication Effectiveness of message production Efficiency Effort Structured environment Errorless learning Repetitive practice

Organizing Displays System should be transparent and concrete Simple displays

Video Clips Adult Augmentative user Child AAC tool for cognition Decrease challenging behavior

Summary TBI characterized by an array of deficits Frontal lobe lesions Ranchos Los Amigos Scale AAC supplement/replace speech or writing Criterion-based assessment Intervention protocol