1. Introduction to ACAT Service We are a multi-disciplinary service working across East Kent (Clinical Scientist, SLT, OT, TAP, Clinical Technologist, admin) We provide EAT for AAC and/or alternative computer access We provide 3 types of service: Provision, Consultation, Assessment We also work with the CYP service for Transition of Young adults

2. What are we learning from our clients with aphasia who use high tech AAC? Fiona Panthi and Karen Reed Adult Communication and Assistive Technology Service

3. Stroke and Aphasia Our focus is aphasia as a consequence of a stroke. Aphasia is an impairment of language, affecting the production or comprehension of speech and the ability to read or write. Aphasia is often associated with concomitant disorders e.g. apraxia of speech.

4. The clients Seven clients (one female/ six male) with aphasia and apraxia of speech. Clients were seen between one and ten years post stroke. All clients are able to use direct access.

5. The families Six clients are married with family support. One client with limited family support. Four spouses retired. Two spouses working and out for long periods.

6. Augmentative and Alternative Communication: what was in place? Clients were using a variety of methods to communicate: air writing, white board/pen/paper, pointing and gestures. No clients were using any low tech communication books at the time of referral.

7. High tech AAC intervention AAC assessment/provision. Identification of appropriate communication apps and personalisation/customisation of vocabulary. Training provided and support visits for the clients and their families. AAC user group Joint working with community speech therapists and the Stroke Association.

8. Making good use of high tech AAC Clients using other apps and features to augment communication e.g. Google maps, showing photographs. Helpful for social interaction – sharing news and holiday photographs. Toggling between symbols/keyboard.

9. Obstacles to successful use of high tech AAC Majority of clients not having regular/any opportunities to use their communication aid with family or other communication partners. Family beliefs re AAC? Lack of conversation partners. Social isolation, in some cases. Families possibly unaware of the commitment required from them to support the client both technically and during day to day conversations.

10. Obstacles: language Clients appeared disappointed with the limited vocabulary available on the device. Difficulties with symbol recognition especially abstract symbols. Limited use of AAC during speech and language therapy sessions as client focus appeared to be improving upon impaired skills.

11. Obstacles: other Family saying they ‘get by’ with usual method of communication. iPad proving a distraction for some clients. Clients rarely using their AAC out of home environment.

12. AAC User Group Held in November 2012, clients/families/carers/SLT’s attended, 100% attendance. Activities to build on AAC skills for both client and family. Social opportunity to meet and make friends. Positive feedback.

13. AAC intervention: what went well? Clients with some residual literacy skills were able to use predictive text and keyboard. AAC enabled one client to interact with his young daughter, sing songs and play games. Widened social interaction possibilities, enabled clients to have control over topic of conversation.

14. Cont..what went well? Clients and families contributed to selection of vocabulary. Using AAC with new conversation ptnrs. Better outcome when clients were familiar with technology. Initial rejection of AAC then acceptance. AAC User Group.

15. What have we learnt? High tech AAC intervention can be a convoluted process, so many considerations. Clients/families expectations and beliefs re AAC vs our (ACAT) expectations and what we are hoping to achieve. Communication opportunities are paramount! Time and commitment required by all involved. Most clients were partner dependent communicators re using their AAC. Acceptance and readiness for AAC: re clients and their families. Speech therapy: AAC not always part of this process.

16. Looking forwards Embed AAC early in speech therapy intervention. Be very clear regarding time for learning/training and the commitment required to help achieve positive outcomes. ‘One size cannot fit all when it comes to making decisions about treatment approaches.’ (Mahendra,2011). Continue to shape service delivery. Regular AAC user groups. The need for Conversation Partners. Increasing social participation and activities. Managing expectations: Clients and their families

17. References Beck, a R (2011) AAC and message enhancement or persons with aphasia chap 6. in Augmentative and Alternative Communication for Adults with Aphasia. ED; Koul, R. Emerald Group Publishing. UK. Phillips,P. (2009) Can People with Aphasia Use High-tech AAC? Communication Matters 23 (1) p23-26. Robertson, E. & Schneider, H.(2011) Not a bandage:. Advocating AAC assessment in aphasia. Communication Matters 25 (2) p15-16. Mahendra, N (2011) Overview of Aphasia and Approaches to Aphasia Intervention chap 2. in Augmentative and Alternative Communication for Adults with Aphasia. ED; Koul, R. Emerald Group Publishing. UK.