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

2. Overview TBI Review AAC Review Clinical examples

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

4. TBI Statistics Leading cause of death for people under 45 1.5 million sustain TBI More than twice as many males as females 80,000 to 90,000 experience long- term or lifelong disability

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

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

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

8. 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

9. 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

10. 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

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

12. Symbols and Techniques Aided communication Electronic aids Nonelectronic aids Unaided communication

13. AAC Process—Key Components Representation Selection Transmission

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

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

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

17. Selection Assessment Access should be transparent Direct selection Scanning

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

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

20. Organizing Displays System should be transparent and concrete Simple displays

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

22. 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