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Spring 2015 > AAC > Flashcards

AAC Flashcards

1
Q

____ is when the computer talks for you

A

Synthesized speech

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2
Q

____ is when a recorded voice is used from a device.

A

Digitized speech

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3
Q

Where/How is AAC used? 3

A

1 for research/studies
2 for hospitals/daily life
3 for school/learning

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4
Q

Is AAC strictly compensatory?

A

No, it can have some restorative functions

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5
Q

Is AAC a temporary or permanent solution?

A

it can be either, a day without speech can have a strong impact

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6
Q

Does AAC help with comprehension?

A

yes, by sharing the communication space, the communication partner may be able to access visual imagery to improve comprehension[

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7
Q

___% of Americans need AAC.

A

1.3

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8
Q

What are the 8 areas of participation for AAC? ESCPHTES

A 
1 employment/education
2 sexual and intimate behaviors
3 crime and abuse reporting
4 personal assistant management
5 health care mgmt
6 transportation mgmt
7 emergency communication
8 social interactions
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9
Q

What are Light’s 4 competencies?

A

1 Linguistic competence - language skills to operate
2 Operation competence - technical ability to run
3 Social competence - use it appropriately
4 Strategic competence - ability to deal with AAC limits

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10
Q

___ refers to what method of expressing the SLP/facilitator chooses

A

Message formulation strategy

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11
Q

What are methods of message formulation? 3

A

1 spelling (speed vs. generativity)
2 word by word (core vs. fringe vocab)
3 whole phrase/sentence

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12
Q

___ are words that should be in the AAC because everyone uses.

A

Core vocabulary

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13
Q

___ are words that are unique to that particular user.

A

Fringe vocabulary

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14
Q

How can whole phrase/sentence AAC method work?

A

if they are broken into thoughts, it can even work for public speaking!

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15
Q

What are the literacy levels and how do they relate to AAC message formulation? 3

A

1 pre-literate - can be trained: coverage and developmental vocab
2 non-literate - skills not expected to return
3 literate - more options, consider rate and physical ability

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16
Q

What is the difference between coverage and developmental vocabulary?

A

1 coverage covers only what they need in the moment

2 developmental provides them with word that they need to acquire

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17
Q

How does age affect vocab selection?

A

age changes academic/job setting and social roles/storytelling

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18
Q

How does gender affect vocab selection?

A

gender affects word choice and topic differences

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19
Q

How does personal interests and activities affect vocab selection? 3

A

1 important names
2 important places
3 hobby jargon

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20
Q

How does disabilities affect vocab selection? 3

A

1 medical mgmt (cardiologist v. neurologist)
2 terms related to their disability
3 terms related to ADLs

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21
Q

What is a generic conversation structure? Which part is the most variable?

A

1 greetings
2 small talk
3 content sharing
4 wrap up/conclusion

content sharing

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22
Q

___ is necessary for social politeness.

A

Small talk

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23
Q

What are the types of content sharing? 3

A

1 storytelling
2 procedural descriptions (sequential, could be caregiver directions)
3 content specific conversations (tied to social roles)

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24
Q

A(n) ___ is a person who knows the AAC user and can help to identify fringe vocabulary.

A

informant

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25
Q

What’s the best way to get fringe vocabulary?

A

select multiple informants with different relationships with the user

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26
Q

What are methods of obtaining vocab? 3

A

1 environmental inventory (watch person at same age & stage)
2 communication diaries (write down needed words, come back and discuss)
3 manufacturer vocab (some include fringe)

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27
Q

How does vocabulary maintenance work?

A

additions and subtractions of words/phrases (special event vocabulary + en vogue/passe phrases + friends that enter/leave our lives) - facilitators need to be invested and trained!

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28
Q

A(n) ____ is something that stands for or represents something else.

A

symbol

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29
Q

A(n) ___ is something that is represented by a symbol.

A

referent

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30
Q

A(n) ___ is something that the AAC device does.

A

behavior

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31
Q

What is iconicity?

A

how easy is it to identify the symbol by looking at it

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32
Q

What are the levels of iconicity?

A 
1 transparent (symbol clearly depicts referent)
2 translucent (with effort, referent can be determined from symbol)
3 opaque (no symbol-referent relationship)
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33
Q

What is the hierarchy of learning? how does that affect symbol usage?

A

Nouns first, adjectives, verbs later: nouns are easier to depict

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34
Q

What is the difference between aided and unaided symbols?

A

Unaided is uses body, aided requires an external device

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35
Q

What are examples of unaided symbols? 3

A

1 gestures (cultural)
2 vocalizations
3 manual sign systems

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36
Q

What are examples of aided symbols? 3

A

1 tangible symbols (objects)
2 pictorial symbols
3 orthography and orthographic symbols (letters, braille)

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37
Q

What is meant by tangible symbols in AAC? 2

A

1 real objects (hairbrush, concert ticket)

2 miniature objects (small versions of everyday objects, miniature hairbrush)

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38
Q

What is meant by pictorial symbols in AAC? 3

A 
1 Blissymbols (system of simple line drawings, abstract and difficult to learn)
2 Widgit (rebus) symbols (line drawings used to support reading
3 Picture Communication Symbols 
4 Photographs (2 types)
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39
Q

___ are simple line drawings which are abstract and difficult to learn.

A

Blissymbols

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40
Q

___ are line drawing used to support reading.

A

Widgit (rebus)

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41
Q

___ are the boardmaker symbols which can be in color or B/W and are in many languages.

A

Picture Communication Symbols

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42
Q

What are the 2 types of photographs in pictorial symbols?

A

contextualized and isolated

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43
Q

What are at the easiest end of the symbol hierarchy continuum?

A

real objects and color photorgraphs

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44
Q

What are at the hardest end of the symbol hierarchy continuum?

A

printed words and blissymbols

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45
Q

What rate enhancement/encoding strategies? 3

A

1 retrieval strategies (reducing keystrokes, incr comm efficiency, decr fatigue)
2 memory-based strategies
3 display-based strategies (codes are pictured or spoken aloud)

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46
Q

What is meant by word codes? 5

A

1 alpha-word codes (truncation codes PIC=picture, contraction codes PCTR=picture)
2 alphanumeric codes (combo lettersnumbers, Class1==classroom, Class2=classify)
3 letter category codes (first letter announces category, second letter announces word, V=vehicles, VC=car)
4 numeric codes (16=hungry)
5 morse code

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47
Q

What is meant by prediction strategies?

A

the AAC uses an algorithm to attempt to predict what word the person is trying to type. Single-letter prediction is less accurate than word-level prediction and phrase/sentence-level prediction is also limited.

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48
Q

___ is a glass board or clear sheet which uses eye gaze as a low tech AAC. Need reliable yes and no signals and is a time consuming method of communication.

A

eTran

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49
Q

What is a selection set? 3

A 
things that are available: could be 
1 messages (I need help) and/or 
2 functions/commands (go back) and/or 
3 symbols (letters, punctuation, symbols)
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50
Q

What are the different ways of configuring a selection set? 2

A 
1 grids (independent cells in rows and columns)
2 visual scenes (with hotspots OR with associated buttons)
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51
Q

What are some selection set considerations? 4

A

1 number of items/cells/locations/buttons
2 size (buttons/displays)
3 organization (cog/motor ability)
4 orientation of display (posture, visual ctrl, motor ctrl)

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52
Q

What is a hotspot in a visual scene?

A

an area of meaning (related to mom); the person touches it and it says something, like “mom”

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53
Q

What are display types? 2

A

1 static/fixed display (remain the same following a selection)
2 dynamic display (may automatically change following a selection)

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54
Q

What are low tech fixed displays? 2

A

1 communication book

2 communication vest

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55
Q

Are there hybrid displays?

A

PRC pathfinder - fixed buttons, with dynamic display at the top, producing synthesized speech
Scene-based hybrid display - fixed navigation ring, center scene dynamic

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56
Q

What is the ONLY indirect selection technique?

A

switch scanning

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57
Q

What are examples of direct selection? 5

A 
1 fingers, toes, elbows
2 dynamic eye gaze/fixed eye gaze
3 headstick
4 mouse emulator
5 laser pointer
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58
Q

When would you use head mouse vs. eye tracking?

A

head mouse is better for good intentional head movement, but eye tracking is for people who can keep his/her head very still

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59
Q

What are direct activating choices for touch? 3

A

1 activate immediately on touch
2 activate after dwelling on location
3 activate upon release

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60
Q

What are activation choices for cursor ctrl? 2

A

1 head tracking with dwell activation

2 eye tracking with either dwell activation or blink activation

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61
Q

What are the benefits of direct selection? 2 What are limitations? 1

A

1 faster
2 cognitively less demanding
BUT requires motor ctrl and attention for targeting

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62
Q

What are the patterns/paths for scanning? 4

A

1 linear
2 circular
3 row-column
4 group-item

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63
Q

What are the different scan methods of access? 3

A

1 auto scan/interrupted - press to start scanning, press again to select
2 directed scan (press and hold to scan, release to select)
3 step scan - press for each location, press repeatedly to move (2 switches or dwelling)

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64
Q

What mechanisms are available for switch scanning? 4

A

1 whack
2 touch
3 movement
4 voice

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65
Q

What are some names of switches? 7

A 
1 finger switch
2 grip switch
3 wobble switch
4 jelly bean switch
5 ribbon switch
6 sip and puff switch (pneumatic)
7 twitch switch
8 joystick
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66
Q

What are feedback techniques? 3

A

1 auditory (last ditch)
2 visual
3 tactile

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67
Q

What are feedback examples for visual? 3

A

1 zoom
2 highlighting (progressively filling in, frame, reverse image)
3 diode lights up - light in the corner

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68
Q

What are feedback examples for tactile?

A

physical sensation of movement

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69
Q

What are auditory feedback examples (last resort)? 2

A 
1 beep/click
2 voice (public/private)
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70
Q

What are 3 things we can say about typically developing children’s language development?

A

1 acquire lang rapidly
2 learn by hearing and producing words
3 access to all vocabulary they hear

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71
Q

How are AAC-using kids language development than TD kids? 2

A

adults speak less to children with Complex Communication Needs (AAC-users) so they have:
1 limited exposure to new vocab
2 limited repetition of vocab

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72
Q

What happens with vocab selection for kid AAC-users? 3

A

1 adult vs child selected choices
2 mismatched expressive/receptive vocabulary
3 over-generalization of symbols (last longer than TD kids)

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73
Q

What is meant by an input/output discrepancy for kid AAC-users?

A

the input is verbal, but they have to output choosing a symbol

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74
Q

What is meant by verbal correction/training for kid AAC-users?

A

when we correct children (kid points to elephant and chooses the symbol for dog), we correct them verbally, we need to find the correct symbol

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75
Q

What is difficult for children using AAC?

A

1 receptive morphology - difficulty understanding morphological markers
2 expressive morphology - frequent morphological errors (Wide range)

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76
Q

What are possible reasons AAC-users (kids) have problems with morphemes? 3

A

1 no access in AAC
2 too time consuming (and they already take a long time to make an utterance)
3 lack of instruction regarding morphemes

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77
Q

What are the characteristics of expressive syntax for kid AAC-users? 3

A

1 compound sentences are problematic
2 word order difficulties
3 verbs, articles, adjectives omitted

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78
Q

How does AAC affect kids pragmatics? 2

A

1 often limited to request and respond

2 they can be passive communicators with limited social communciation

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79
Q

What are the learning language contexts for children? 5

A 
1 physical context
2 functional context
3 language context
4 social context
5 cultural context
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80
Q

What is meant by physical context for children?

A

the lexical components of language in terms of people, objects, activities, and events in the child’s environment

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81
Q

What do we do for the child’s physical context? 2

A

1 maximize access to objects, events and people

2 promote independent mobility at an early age (e.g. wheelchair)

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82
Q

What is meant by functional context for children?

A

routines, events and activities that make up the child’s day

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83
Q

What do we do for the child’s functional context? 4

A

assess times
1 when lang is being learned (natural times)
2 when lang is not being learned (poor opportunities)
3 when child isn’t engaged
4 opportunities for additional stimulation

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84
Q

What is meant by language context for children?

A

linguistic code(s) of the kid’s environ; family/community code vs. child’s AAC code

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85
Q

What do we do for the language context for children? 3

A

1 AAC kids don’t get feedback for utterances as much as TD kids
2 choose more appropriate symbols (not just what comes in the device, since those might be designed for adults)
3 vocab selection - limited to available lexicon/overrepresentation of concrete & wants/needs/poor rep of question words

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86
Q

What is one of the most important language context to include for children AAC (arguably)?

A

question words (who, what, when, where, why, how) - this is how they learn new things.

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87
Q

What are the cons of preprogrammed msgs for children? 3

A

1 is it child appropriate?
2 less flexibility
3 limit experience sentence building variou sstructures

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88
Q

What are the pros of preprogrammed msgs for children? 2

A

1 speed

2 easy to understand

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89
Q

What do we do for the social context for children? 3

A

1 we provide high levels of support initially and gradually reduce support (don’t do this for AAC)
2 don’t talk over them (do talk over them, dominate interactions)
3 lots of practice with peers (minimal communication with peers for AAC)

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90
Q

What do we do for the cultural context for kids w/ AAC? 3

A

1 diverse values and expectations for language learning
2 different languages at home/school (when to code switch)
3 interventions reflect the norms and values of the schools (but we need to focus on family)

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91
Q

What are other issues for a child’s access to AAC? 2

A

1 kids may not have the OPERATIONAL competence to modify their device
2 kids may have limited access (sometimes device stuck at home or school)

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92
Q

What are methods of organizing for kid’s AAC? 4

A

1 Alphabetic Organization (not a good choice for kids generally)
2 Semantic-Syntactic Organization
3 Taxonomic Organization
4 Activity Based Organization

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93
Q

What’s another name for “Gateway Layout”?

A

Fitzgerald Key or Semantic-Syntactic Organization

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94
Q

What’s another name for “Activity Based Organization”?

A

Event Based Organization or Schematic Layouts

95
Q

What are the fundamentals for AAC for children? 3

A

1 no prerequisites to AAC! (communication starts as earliest behaviors of children)
2 early AAC communication includes: behaviors, gestures, cooperative actions, sounds; NOT DEPENDENT ON CTRL OF AAC
3 Inclusion for Schools - if they have AAC they can integrate more fully

96
Q

What are the steps in AAC intervention? 5

A

1 examine communicative contexts (ID opportunities)
2 select/design child appropriate AAC system
3 train parents and communication partners
4 infuse communication into daily routines
5 monitor progress and adapt as necessary

97
Q

How do we provide intervention taking physical context into account? 4

A

1 mobility strategies
2 pgm appropriate physical environmental vocab
3 encourage choice making of the environment
4 ID peer supports

98
Q

How do we provide intervention taking functional context into account? 3

A

ID appropriate times for language learning
1 routines highly individualized and nece
2 AAC system portable and durable
3 language to assist with care directing

99
Q

What is a CSI? What do we need?

A

a communication signal inventory: list of what the person is doing; consistency, routine, & repetition

100
Q

How do we provide intervention taking language context into account? 2

A

Provide access to appropriate vocabulary:
1 should be dynamic vocabulary (sets) (TD preschoolers learn around +5 words/day)
2 system should be always available

101
Q

How do we provide intervention taking social context into account? 3

A

1 provide opportunities to meet with peers and educate peers about communication styles & AAC
2 teach parents & teachers how to appropriately scaffold (don’t dominate!); give the kid some time
3 teach the child non-obligatory turns

102
Q

What is a non-obligatory turn? Why should an AAC user learn to take them?

A

a turn in a conversation, where there was a silence. 50% of the convo is the AAC-user’s responsibility, so they are 50% responsible for silence!

103
Q

What are parent expectations with AAC-user?

A

1 increased independence
2 increased communicative competence in all of Light’s areas
3 increases in # of communication partners
4 increases in # of communication opportunities

104
Q

What are Light’s 4 competency, again?

A

1 linguistic
2 social
3 operational
4 strategic

105
Q

What are parental expectations of the AAC team? 4

A

1 minimize jargon
2 eval is one moment in time - discuss results/recommendations with parents and consider parent’s reports
3 inform of timeline of AAC
4 ensure kid has a continued access to the AAC device from time of rental to actual delivery

106
Q

What are challenges faced by parents?

A

1 AAC is a new skill (change to status quo, affects comfort)
2 accomplishing a goal may be more important than “teaching” during activities (parents may not see these opportunities)
3 AAC is a new skill - responsibility is heavy (keeping vocab good)
4 parents desire natural speech

107
Q

Mom asks, “will my child talk?”

A

not an either/or question, non-speaking does not mean cannot use speech for communication; and some children develop speech with low intelligibility, most kids who can get voice, will use it!

108
Q

Mom asks, “won’t AAC interfere w/ my kid’s speech development?”

A

AAC facilitates speech - it increases interaction and provides speech model; kids use the quickest, most effective and fastest speech method, so if they start getting speech will use it.

109
Q

What are some components of AAC intervention? 3

A

1 Incorporate AAC into activities/existing routines (story time; don’t make the AAC the activity!! focus on the msg not the method)
2 Natural intervention approach (child directed learning, reinforce when they use AAC)
3 Incidental teaching (engineer environments to create opportunities - expectant pauses, purposefully miss an item, incomplete presentation of requested item, present wrong item) with models and cues

110
Q

What does modelling look like with AAC?

A

Verbal + on AAC
Clinician: “The car hit the truck”
Clinician: Selects CAR HIT TRUCK on device

111
Q

What do recasts look like on AAC?

A

add or correct utterance /s interrupting convo-flow:

same as with DLD, but with modelling on AAC, but dependent on morphological markers in AAC

112
Q

What does contingent queries look like on AAC?

A

pretend we don’t know what the child was saying, to provide a chance for the child to learn how to manage communication breakdowns (imagine how an unfamiliar listener would react to ambiguity)

113
Q

What does explicit instruction look like on AAC?

A

teaching trials (good a first when teaching icons or before stating a new activity)

114
Q

Why should we work on speech?

A

1 reassures family

2 broadens communication repertoire - multimodal communication (what if AAC breaks?)

115
Q

What are things to to consider when maximizing sound/vocalization support? 6

A

1 positioning support (swaddle if necessary so tongue does not lock)
2 incr breath support
3 reduce discomforts/poor posture
4 pair sounds with activity, model at or just above child’s sound ability
5 incr variability of kid’s sounds (imitation, modeling, plan activities with lots of sound opps)
6 associate sounds with meaning

116
Q

The ___ means that people had everything necessary to use the device. If they didn’t have the skills, didn’t get the device.

A

Candidacy model

117
Q

The ____ means that there are no pre-requisites for using AAC. We are looking for AAC that fits the person with CCN (includes high and low tech).

A

Participation model

118
Q

What are barriers to participation with AAC? 2

A

1 Opportunity barriers

2 Access barriers

119
Q

What is an opportunity barrier to participation with AAC?

A

barrier imposed by society or people other than AAC-user (not given opportunity to use device successfully), could include policy (bylaws of the hospital/school), practice (this is how we do it), knowledge/skill (facilitator doesn’t understand device), or attitudes (ppl don’t believe the AAC-user can communicate)

120
Q

What are access barriers to participation with AAC?

A

those imposed by AAC-user - vision, cognition, etc.

121
Q

What are the phases of the participation model? 4

A

1 Referral (AAC finder) - need to educate MDs
2 Initial assessment - plan for today
3 Plan for the future (4 button today, capability for dynamic tomorrow, or with degenerative maybe reversed)
4 F/u assessment

122
Q

What are assessment domains?5

A 
1 seating and positioning
2 access: direct v. scanning
3 cog/ling abilities
4 literacy
5 sensory abilities
123
Q

What are seating and positioning goals 3

A

1 provide comfort
2 increase safety and stability
3 increase functional skills

124
Q

What does seating and positioning accomplish? 3

A

1 minimizes sensory issues
2 prevent or delay physical disabilities
3 minimize issues with abnormal tone and reflexes

125
Q

What factors affect seating?

A

1 foot drop
2 muscle tone (low - difficulty holding posture, high - diff with mvt)
3 Reflexes - (Rooting reflex - head switches inacc; Asymmetrical Tonic Neck Reflex - turns head to side- extends arm, Symmetrical Tonic Neck Reflex - head goes up, arms go out)
4 Movement disorders (Athetoid cp, HD)
5 Spinal deformities (scoliosis, spina bifida)

126
Q

When we evaluate motor, need to separate assessment technique from what?

A

long-term technique

127
Q

What is needed for an motor assessment technique? 3

A

1 we need to make it direct (switch scanning errors are hard to ID in an eval)
2 make it as natural as possible (head nod, thumbs)
3 consider response speed

128
Q

What is needed for a long-term technique for AAC? 3

A

1 what is going to be fastest/easiest
2 what is going to limit fatigue, best for positioning
3 what is going to work in all environments (wheelchair, bed, watching tv)

129
Q

What is the trial order for direct selection access? 3

A

1 hand and arm
2 head and neck
3 leg and foot

130
Q

What should you eval in a motor assessment for direct selection? 3

A

1 Range of motion (reach for motivating targets, need strength supports?)
2 Control - steadiness - tremors? nystagmus w/ eye ctrl?
3 control - size of targets

131
Q

What should we assess with scanning? 4

A

1 look for reliable mvt
2 can they wait until target arrives
3 can they hold or can they release consistently to select
4 can they activate/reactivate intentionally

132
Q

What do we want to assess with cog for AAC?5

A

1 awareness of cause/effect (desireable reinforcer comes from using AAC)
2 comm intent/world knowledge (user has something to say)
3 memory (encoding strategies or not)
4 symbolic representation opts
5 metacognition

133
Q

What types of assessments do we use for AAC?

A

Criterion referenced (we don’t care about norms, these are individuals)

134
Q

Which symbols are best for each client? 4

A

1 objects, icons, printed words (make sure the know symbol, can see symbol, literacy)
2 functional use (what do you do with this? which one do you use to brush your teeth)
3 label and yes/no questions (point at the umbrella, is this an umbrella?)
4 use dynamic method (test, teach, retest)

135
Q

How else should we test symbols? 3

A

check
1 symbol to picture
2 spoken word to symbol
3 picture to symbol

136
Q

How do we determine organization format?

A

give person symbols to sort into groups (try to understand/use their system. e.g. hot dog under sports, rather than foods)

137
Q

What formal language assessments are appropriate for AAC assessments? 3

A

1 receptive knowledge of words (PPVT, ROWPVT)
2 understanding of verbs/action phrases (TACL, Bracken)
3 grammatical structures/morphemes syntax (Choice making activities - The girl push the boy, see if client can point to the one that matches sentence)
** interpret with caution! they need lots more vocab **

138
Q

Should we assess literacy in AAC evals? 6 LSPDRS

A

1 letter-sound correspondence (which letters make the “p” sound?)
2 sound blending (combine words)
3 phoneme segmentation - breaking words into sounds
4 decoding words and matching to pictures
5 reading comprehension (read and answer questions - but is difficult to due expression limits)
6 spontaneous spelling (spell “lamp”); first letter spelling (word prediction and alphabet supplementation

139
Q

What are the 3 onset patterns of ALS? How do they differ?

A

1 Bulbar onset (AAC in 6-12 months deterioration of speech)
2 Spinal onset (AAC in 3-6+ years, slow deterioration of speech)
3 Mixed onset (speech and AAC timeline varies)

140
Q

What is common with all three onset patterns of ALS?

A

eye movement is preserved

141
Q

What are the 3 phrases of disease progression of ALS?

A

1 Monitor, preserve, and educate
2 Assess, recommend, implement
3 Adapt and Accommodate

142
Q

What is normal speaking rate? What is the cutoff to move to phase 2 for ALS? What else do we look for?

A

150-200 WPM; <125 WPM

or intelligibility below 90%

143
Q

What is the SIT (used for ALS)?

A

Speech Intelligibility Test (disk with pre-stored sentences, like the computerized version of the AIDS, person with ALS reads sentences, is recorded, transcribed by an unfamiliar listener, computer calcs % of intelligbility & speech)

144
Q

What goes in to preservation with ALS?

A

maintain function as long as possible with NO OMX, strategies to save energy, use breath, look at your listener, over articulate and maybe alphabet supplementation

145
Q

What goes in to education about ALS with AAC?

A

remind them when they transition to AAC happens (125 WPM, <90% intelligibility)

146
Q

What is important to consider in AAC assessment for ALS? 3

A

1 participation patterns and AAC needs (social roles, email acceptance, telephone needs, face2face comm needs)
2 Support system assess - emotional, technical (facilitator), family support of AAC?
3 Future needs (Visual, Hearing, Cognitive, Linguistic (Literacy)

147
Q

Why is phase 3 of AAC so important with ALS?

A

we need the device to really train the facilitator!

148
Q

What are the methods of AAC access with AAC? 4

A

1 eye gaze (gold std, but they pt may pass away before they need it)
2 head mouse (could be used initially)
3 typing equipment (iPad won’t be useful forever)
4 switch access (some can use for a while, Stephen Hawking)

149
Q

What should you do with eTran?

A

write down the message so that their/your efforts won’t be lost if you forget a word!!

150
Q

What are causes of brainstem damage? 3

A 
1 CVA (basilar artery disruption)
2 TBI (brain swelling)
3 Tumor excision (gliomas)
151
Q

What are potential signs of brainstem damage? 7

A

1 quadriplegia (w/ or w/o preserved eye mvt and head/neck)
2 ventilator dependence
3 vision impairments (diplopia, convergence, hemianopsia)
4 anarthria (no usable speech)
5 attention and alertig decr
6 vertigo/dizziness (limited ability to sit up)
7 Locked-in-Sydrome (a.k.a. ventral-pontine syndrome; conscious but no functional mvts, often vertical eye mvts preserved)

152
Q

What are the phases of assessment for brainstem impairment? 4

A

1 Initial assessment
2 Early intervention
3 Formal assessment
4 Ongoing intervention

153
Q

What goes into initial assessment for brainstem impairment?

A

1 Educate regarding brainstem impairment, communication, and AAC (build rapport/trust, teach family to talk to/not around person)
2 Basic assessment of abilities (physical, sense, receptive language; identify times of alertness)
3 Call light access method (switches? if not, develop a time check system with RNs)
4 Establish consistent yes/no (one that is reliable & easy to interpret; post instructions for family and staff)

154
Q

What is “partner assisted scan”? What phase of assessment of brainstem stroke is this?

A

a procedure, with reliable yes/no, whereby a partner helps the pt with CCN scan through a low tech list of comm options or alphabet; this is Phase 2: Early Intervention

155
Q

What is the main component of formal assessment (Phase 3) for brainstem stroke?

A

introducing the speech generating device; consider fatigue and fit of AAC

156
Q

What is an ECU? What does it do?

A

environmental control unit - devices that attach to AAC that control lamps, fan, T.V. and change temperature etc.

157
Q

What is the main components of ongoing assessment (Phase 4) for brainstem stroke? 4

A

1 adding vocab
2 customization
3 training PWCCN
4 ID facilitator

158
Q

What are the types of MS? 4

A

1 RRMS - Relapsing-Remitting MS (most common 85%)
2 SPMS - Secondary-Progressive MS - initially relapse and remit, but symptoms continue to worsen
3 PPMS - Primary-Progressive MS - slow worsening (no relapse) (10%)
4 PRMS - Progressive-Relapsing MS - steadily worsening w/ acute relapses

159
Q

Why do we need to learn about MS before we work on AAC?

A

complicated by vision, cognitive limitations, and motor control issues (tremors, etc.)

160
Q

What are the phases of MS with AAC choices? 3

A

1 Early - Assistive technology employed to maintain lifestyle (screen readers, zoom features on screen, and motor assistance for motor)
2 Middle - Low tech strategies like alphabet supplementation
3 Late - ID Participation/Comm needs and assess vision, motor skills, cognitive abilities and language

161
Q

What is Guillain Barre? How is it similar and different from MS?

A

GB - progressive loss of myelination of PNS nerves
They both have demyelination, but MS is CNS. Also, GB can regenerate, but will take longer to regenerate (goes from top to bottom), 80-85% completely recover

162
Q

What is most pt’s AAC preference with Guillain Barre?

A

most prefer a low tech option (they are tired, drugged up with no energy for high tech

163
Q

What is primary progressive aphasia?

A

gradual loss of language with intact cognition over 2+ years, atypical dementia, onset 50s/60s

164
Q

What are the 2 patterns of primary progressive aphasia?

A

1 initial decline of expression (anomic) -> complete non fluent -> mute
2 inital decline in comprehension -> symptoms like Wernicke’s

165
Q

What do we need to do for primary progressive aphasia assessment with AAC? 6

A

1 assess quickly to establish baseline for tracking PPA progression
2 language function through formal battery and discourse assessment
3 oral mech exam
4 SIT to measure intelligibility
5 Cog assessment
6 Eval Participation needs (environments, partners, participation needs) (look at past & present to establish goals for future)

166
Q

Should we throw out AAC or Self-Generated strategies that patients find?

A

NO! We should discuss and examine effectiveness before we investigate/trial new strategies

167
Q

What goes into treatment of Primary Progressive Aphasia?

A

there is NO pharmacological intervention for PPA, we are it for tx (ID AAC strategies and education):
Maintain participation to greatest extent - focus on implementing strategies and communication partner training

168
Q

Should we do impairment level training for primary progressive aphasia?

A

NO! there is limited evidence and it is more important to focus on strategies and CPT

169
Q

____ is where we record messages for later use (done as part of early intervention for Primary Progressive Aphasia) Take a photo album and have the pt record statements about each picture. This is a “feel good” treatment.

A

Message banking

170
Q

What is important to remember for SGD for Primary Progressive Aphasia? 3

A

1 a static display may be good for “cares” (transportation, bathroom)
2 categorization is important for dynamic displays so that it is “aphasia-friendly”
3 needs may change (adults with AAC may be offered symbol-less AAC, but these individuals WILL NEED SYMBOLS … eventually)

171
Q

What is important for middle stage intervention strategies for Primary Progressive Aphasia? 3

A

1 use real artifacts to help with discussions
2 necessary to use images at this stage for message support
3 written choice strategy

172
Q

What is important for informal testing with dementia for AAC? 3

A

1 family members should describe problems
2 family members should tell frequency of problems
3 try salient tx (per problem) and continue to monitor

173
Q

What is important to do with observation with dementia for AAC? 3

A

1 SLP observes person with dementia in multiple environments
2 Trial strategies in environments and observe their effectiveness
3 modify strategies and repeat with disease progression

174
Q

Why is sensory testing important with dementia/AAC?2

A

1 many supports are visual (printed, corrective lenses)

2 decreased hearing ability looks like increase confusion but is not

175
Q

Are internal memory strategies good for dementia?

A

NO

176
Q

What are are good strategies for dementia? 7

A

1 calendars
2 planners
3 multifunctional devices: watches, iPods
4 shopping lists (need to be able to READ!)
5 special locations to place things
6 written cues- sticky notes
7 memory wallets/books

177
Q

What should you remember when modifying memory books for dementia?

A

as they decline, may need to limit language, use bullet points with pictures rather than lots of text

178
Q

What is the primary challenge of AAC with aphasia?

A

we are providing a new language system to a person with an impaired language system

179
Q

What is the primary challenge of AAC with aphasia?

A

we are providing a new language system to a person with an impaired language system

180
Q

How is a straight aphasia assessment different from an AAC aphasia assessment?

A

AAC looks at needs (What they are and how they can be met)

181
Q

What should we examine in a needs assessment for aphasia? 3

A

1 difficult situations for communication
2 previous/current social roles (what vocab is involved)
3 examine social networks (SNCommunication Inventory 5 categories; Partner Supported Communication Techniques)

182
Q

What are advantages of communicative drawing? 2

A

1 augments other forms of language/provides reocrd to refer to in future conversation
2 very limited reliance of language system

183
Q

What are characteristics of drawings by people with aphasia? 4

A

1 oversimplified
2 small in size
3 may only draw in particular quadrants of page
4 process may become slow and labored/dependent on skilled interpreter

184
Q

What are characteristics of drawings by people with aphasia? 4

A

1 oversimplified
2 small in size
3 may only draw in particular quadrants of page
4 process may become slow and labored/dependent on skilled interpreter

185
Q

___ is when a person provides extra support at the end of the question (Do you want grilled cheese, YES OR NO?)

A

Tagged questions

186
Q

___ is when an action picture or scenic image is present to the person with aphasia and the clinician cannot see it so the PWA has to describe and clinician documents their usage of strategies/methods of communciating

A

Barrier tasks

187
Q

Why are role playing activities effective for people with aphasia using AAC?

A

because you can identify if what they are using, if it is effective and trial new strategies

188
Q

Why are visual scenes easier for PWA? 3

A

1 require less navigation
2 message formulation is easier b/c it’s all in one place
3 msg representation is easier than text-based or super-opaque symbols

189
Q

What are the large AAC classifications of aphasias? 2

A

1 Partner dependent communicators (severe, fluent, nonfluent or global aphasia) - need support for msg formulation, selecting strategies, and initiating comm
2 Independent communicators (learn to use AAC strategies /s support of the comm partner and dont’ need cueing to initiate AAC use

190
Q

What are the finer AAC classification of aphasia? 6

A

1 Partner Dependent (PD) - Emerging Communicator
2 PD - Contextual Choice communicator
3 PD - Transitional Communicator
4 Independent Communicator (IC) - Stored Message Communicator
5 IC - Generative Communicator
6 IC- Specific Needs Communicator

191
Q

____ is the lowest level of communicator often following a major stroke. Variable awareness, responsiveness, minimal symbolic ability across modalities (reading, writing, speech, comprehension, gesture), poor initiation, unreliable y/n signal and choice making. Support y/n and choicemaking are good tx goals.

A

Emerging communicator (Partner dependent)

192
Q

What do you focus on for emerging communicators? 4

A 
1 turn-taking
2 choice-making
3 referential pointing
4 clear signal for agreement and rejection
(Practice in functional opportunities)
193
Q

What do you (SLP) focus on for emerging communicators? 4

A 
1 turn-taking
2 choice-making
3 referential pointing
4 clear signal for agreement and rejection
(Practice in functional opportunities)
194
Q

What do you (SLP) focus on teaching the partner for emerging communicators? 4

A

1 contextual routines and opportunities to use residual communication skills
2 create photo book
3 contingent feedback for referential, joint attention, affirmation, and rejection (ASSIGN MEANING!)
4 augmented input strategies (explore)

195
Q

____ have the desire to communicate, which leads to frustration. Difficulty with requesting, questioning, and commenting, some automatic and/or stereotypic speech (“ok” “oh dear”), vocalization to protest, comprehension improves with context, may recognize familiar written words and understand the meaning of simple pictures, nod as if understanding when confused, and have difficulty with topic shifts.

A

Contextual choice communicators (Partner dependent)

196
Q

What do we (SLP) focus on for contextual choice communicators? 4

A

1 increasing ability to answer contextual ?? through pointing to written or pictured chocies
2 answer tagged y/n ??
3 controll predictable exhcanges
4 comprehend symbols

197
Q

____ initiates communication with minA, consistently recognizes pictured msgs, recognizes printed words and phrases, may use some natty modalities effectively (telegraphic/automatic speech, fragmented writing/spelling, some gestures). Require support to USE AAC.

A

Transitional communicator (partner dependent)

198
Q

What do we (SLP) focus on for transitional communicator? 3

A

1 teach awareness of when AAC strategies are NEEDED
2 teach initiation of comm via low/high tech AAC
3 work from structured to less structured environments

199
Q

How do we work with partner strategies for transitional communicators? 4

A

1 teach to provide hints, or direct instructions to use strategies
2 Allow processing/wait time to give PWA opp to comm
3 communicate during routines and useing comm book
4 get them to store autobiographical/topical msgs

200
Q

___ use AAC strategies in trained contexts only, initiates communication /s cues, locates pre-stored msgs to communicate in specific contexts, use vocabulary/systems generated by others (can’t generate complex, novel msgs). They have frequent communication breakdowns with attempts to repair.

A

Stored message communicator (independent communicator)

201
Q

What do we (SLP) focus on with stored message communicators? 4

A

1 ID msgs to store on AAC (needs assessment)
2 developing an organization method for storing msgs and vocab (Situation specific)
3 teaching PWA to access msgs in a timely and appropriate manner (role play, scripts, etc.)
4 teach PWA to manage breakdowns with AAC strategies (gestures, drawing, setting the topic)

202
Q

With ___ communication is fragmented and inefficient, attempts to initiation convo frequently, communicates about a variety of topics from past/present, switches between multiple modalities to convey msgs and aware of breakdowns.

A

Generative communicators

203
Q

What do we (SLP) focus on for generative communicators? 5

A

1 intro self and comm strategy
2 comm specific semantic info about a variety of topics multimodally
3 establish topics prior to communicating
4 communicate in a variety of situations with various communication partners
5 ask questions (combine key words, enhanced intonation and gesturing OR point to question marks in AAC.

204
Q

___ only need AAC for specific interactions (email support, public speaking, telephone, etc.), access stored msgs independently, and can communicate intelligibly except specific situations.

A

Specific need communicator

205
Q

How do we help specific needs communicator?

A

they will tell us! family rituals/activities, communicating needs in community (outreach) and telephone/technical assists

206
Q

How does the approach to TBI with AAC differ from traditional forms? 3

A

1 start early and be flexible and adapt as progress occurs
2 plan for immediate needs
3 simultaneous tx for AAC and natural speech

207
Q

What are early phase AAC intervention /c TBI?4

A

1 choice based or yes/no
2 single switch devices
3 low tech
4 partner support

208
Q

What are mid phase AAC intervention /c TBI goals? 4

A

1 consistent response to y/n ??
2 signaling for attention
3 initiating communication for basic needs
4 generate 2-3 word phrases

209
Q

What are early phase (Rancho 1-3) AAC intervention /c TBI goals? 3

A

1 respond to one-step motor commands
2 discriminate btw choices (obj, people)
3 attend for brief periods of time

210
Q

With TBI, communication has an impact on several things that make a wait and see approach. What are those things? 5

A 
1 cognition
2 social participation
3 education participation
4 emotional health
5 participation in rehabilitation
211
Q

What are middle phase (Rancho 4-6) AAC intervention /c TBI? 3

A

1 basic communication boards
2 simple SGD
3 gather info for a high-tech AAC eval

212
Q

What are examples of visual deficits following a TBI? 3

A

1 accommodation
2 version
3 visual field integrity

213
Q

___ is intermittent or constant blurred vision, focusing from far-to-near or near-to-far, focusing near over time.

A

Accommodation deficits

214
Q

____ is abnormal saccades, pursuits, and fixations (affects reading and visual scanning).

A

Version deficits

215
Q

____ is when objects do appear to be in the same place as they are (inattention to visual field)

A

Visual field integrity deficits

216
Q

What are late phase (Rancho 7-10) AAC goals /c TBI? 5

A

1 express a variety of comm functions using AAC
2 select appropriate mode for setting
3 topic ctrl
4 encoding strategy usage
5 participate in vocational, educational, or recreational activities

217
Q

What are late phase AAC systems for TBI? 4

A

1 text 2 speech for unfamiliar listeners
2 system for telephone msgs
3 alphabet board for supplemented speech with familiar listeners
4 gestures and natural speech for family

218
Q

In what stage of TBI will a person regain speech?

A

Middle (Rancho 4-6)

219
Q

What are natural speech strategies for pts with TBI? 3

A

1 topic ID (speaker IDs topic!)
2 alphabet supplementation (speaker points to 1st letter of each words)
3 voice amplification (useful in noisy settings)

220
Q

What are issues in evaluating AAC in the ICU? 3

A

1 lots of people, confusion, and noise/machines
2 emotions may be overwhelming (panic, fear, anxiety)
3 fatigue, delirium, agitation

221
Q

With visual impairments following TBI, damage to the primary visual pathway to the occipital lobe results in what?

A

frank visual deficits

222
Q

With visual impairments following TBI, damage to the parietal-occipital lobe results in what?

A

spatial awareness problems

223
Q

___ is a pause of the eyes on a spot.

A

Fixation

224
Q

___ is a rapid movement from one poitn to another without processing.

A

Saccade

225
Q

___ is watching the whole course of a movement.

A

Pursuit

226
Q

What is the RASS (raez)?

A

Richmond Agitation and Sedation Scale (used for pts in the ICU)

227
Q

What is a good score on the RASS? What are bad scores?

A

0 means alert and calm; +4 indicates combativeness, -5 indicates unarousable

228
Q

What is the Confusion Assessment Method-ICU?

A

a bedside assessment tool to assess delirium. SLPs can administer as part of an AAC/cog-comm assessment

229
Q

What are AAC options for ICU pts who are cognitively intact and motorically intact? 5

A

1 alphabet board
2 writing (pen/paper preferable to dry erase, can refer back)
3 gestures
4 referential pointing - thing in room
5 laser pointers (point to clock, machines, food tray)
We don’t like high tech AAC b/c of ICU restrictions

230
Q

What are AAC options for ICU pts who are cognitively intact and motorically impaired? 4

A

1 alphabet boards (/c or /s laser pointer)
2 whole message boards for partener dependent scaning
3 eye gaze (eTran, spelling/whole message)
4 high tech AAC (still not great for ICU)

231
Q

What are AAC options for ICU pts who are cognitively impaired and motorically intact? 4

A

1 communication boards (/c symbols and BASIC info)
2 simple, low-tech AAC
3 referential pointing
4 gestures

232
Q

What are AAC options for ICU pts who are cognitively impaired and motorically impaired? 3

A

1 communication signal inventory
2 tagged yes/no questions
3 partner dependent scanning (simplified 2-3 choices, use images)

233
Q

What does the Confusion Assessment Method ICU measure? 4

A 
1 acute change or fluctuating course of mental status AND
2 inattention
AND
3 altered level of consciousness
OR
4 disorganized thinking

Spring 2015 (1 decks)

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