Chapter 15 Flashcards
Aphasia
An impairment of the ability to interpret and formulate language resulting from brain injury
More than 1 million people in the US live with aphasia
Most people with aphasia acquire it after the age of 60
Up to 40% of all people with aphasia will experience chronic, severe language impairments across all modalities
Aphasia
Sequence of Neurological Steps for Communication are Affected
Comprehending what others say
Creating ideas
Retrieving words and sentence structures
Executing the motor movements to speak
Aphasia
Activities Impacted
Reading Writing Computing Emailing Using electronic devices and ATMs Listening in crowded or noisy venues Placing an order fro tangible goods Asking and answering questions in face-to-face situations and by telephone
Aphasia
TX Overview
Defies a straightforward, unitary tx approach
Early stages:
Help reestablish meaningful communication as rapidly as possible
Partner-supported AAC strategies can be beneficial
Determine whether individuals are likely to regain natural speech and functional comprehension
Restorative intervention strategies are emphasized
Later stages:
AAC strategies and interventions if aphasia continues to restrict participation in important life activities
High- and Low-tech Supports Serve Many Functions
- Enhancing the comprehension of individuals with auditory comprehension deficits
- Providing a means of expressing preferences, needs, or basic personal information
- Serving as a word or phrase bank for more elaborate topics
- Serving as a comprehensive communication tool to generate both spoken and written language
- Offering a specific technique to enable some individuals to participate with more independence
Aphasia Comm Strat
Usually involves multimodal communication strategies
Classification system:
Individuals who can learn to communicate independently with AAC strategies
Individuals who function best when AAC is used in partner-supported contexts
Hierarchy for Designing Interventions
Partner-Dependent AAC Communicators with Aphasia
-Emerging AAC Communicators
-Contextual Choice AAC Communicators
-Transitional AAC Communicators
Independent AAC Communicators with Aphasia
-Stored-Message AAC Communicators
-Generative AAC Communicators
-Specific-Need AAC Communicators
-Speech-Generating Device Choices for Independent AAC Communicators
Emerging AAC Communicators
Characteristics
- May be labeled as having global aphasia
- Have extreme difficulty speaking, using symbols, and responding to conversational output
- Apraxia of speech may be profound
Intervention Strategies
- Low-tech AAC strategies can assist
- Develop turn taking, choice-making ability with tangible -objects or photographs, referential skills, and clear signals for agreement and rejection
- Partners learn to provide choice-making opportunities
- Table 15.1
Contextual Choice AAC Communicators
Characteristics:
- Indicate basic needs spontaneously
- Recognize visual symbols
- Are aware of daily routines and schedules
- Do not have the linguistic ability to initiate or add to a conversation on their own
- May be labeled with global, severe Broca’s, transcortical motor, or severe Wernicke’s aphasia
Intervention Strategies
- Typically embedded within conversations about familiar topics
- Teach to point to what they are talking about, understand the meaningfulness of graphic symbols, make choices, and begin to ask questions
- Partners use “augmented input” techniques
- Table 15.2,
Intervention Strategies Continued
Written choice conversation approach
Figure 15.5
Yes/No Responses to Partner’s Tagged Questions
Figure 15.6
Augmented Comprehension (input) Techniques -Gesture, write key words, or draw to supplement speech (augmented input/augmented comprehension)
Transitional AAC Communicators
Characteristics
Use external symbols and strategies to help them communicate
May have fluent or nonfluent aphasia
Some gesture, draw, or speak to initiate conversations
May have communication notebooks or SGDs
Typically need cues from the partner to use an external strategy
Intervention Strategies
Focus on teaching to initiate
Intervention Strategies Continued
Introductions and topic setters
-Scripted interactions/role playing
-Present a remnant
Asking Questions
-Encourage them to point or gesture toward conversational partners to ask questions
-Hand-over-hand to point then move to modeling
Storytelling
-Consecutive segments of the story are prestored
Visual Scenes
-Action photographs with phrases printed adjacent to the photo
Stored-Message AAC Communicators
Characteristics
- Can independently locate stored messages within their low- or high-tech AAC systems
- Initiate communication
- Seldom generate enough novel info due to insufficient spelling, speech, and AAC skills
Intervention Strategies
- Create an inventory of messages and topics for specific situations
- Assist in storing these messages
- Need practice using their systems in role-playing or actual communication situations
Generative AAC Communicators
Characteristics
- Speakers and/or writers who can convey some novel info on their own
- Often fragmented or inconsistent for effective communication – breakdowns result
- May have conduction, moderate anomic, or Broca’s aphasia
Intervention Strategies
- Identify anticipated participation patterns, clarify communication needs, identify topics of interest, manage a variety of AAC techniques
- Include instruction and guided practice to teach when to use techniques
- Page 427 – difficulties using high-tech AAC systems
Generative AAC Writers: Intervention Strategies
Use writing with software
Includes spell checker, predictive text, and maybe prefabricated sentences
Page 429 Lightwriter mentioned
Specific-Need AAC Communicators
Characteristics:
-Speech and gestures are adequate/optimal for MOST social situations
-Some situations require high degrees of specificity, clarity, or efficiency
-May have mild expressive aphasia
Intervention Strategies
-Determine situations in which AAC may be needed
-Analyze person’s ability to manage the task
-Help them prepare (create cue card, set up SGD with message by the phone, etc.)
-Role play for using technique
Speech-Generating Device Choices for Independent AAC Communicators
No prescriptive formula Suggestions for trials Lingraphica, SentenceShaper DynaVox visual scene displays Recommend higher tech when settled into a reasonably consistent living situation or until a support network has been identified
Assessment of Domains
Cognitive Linguistic Sensory Motor Representational Communicative
Assessment
Identifying Communicator Profiles
- Baseline Modality Assessment
- Conversational Strategy Trials
- Multimodal Communication -Screening Task for Persons with Aphasia
- Speech-Generating Device Trials: Transactional Role Play
- Advanced Systems Trials: Combining Stored and Generative Messages
Assessing Other Capabilities
Assessing Communication Needs in Real-Life Contexts
Identifying Communicator Profiles
Answer 5 Basic Assessment Questions in Table 15.7
See checklist on the Barkley AAC website for present or emerging communication competencies
http://aac.unl.edu/screen/aphasiachecklist.pdf
When the majority of communication behaviors appear within a single category, it is likely that the person is functioning primarily within that category.
Baseline Modality Assessment
Use barrier activity with a modified PACE (Promoting Aphasics’ Communicative Effectiveness) procedure
Observe individual’s overall success, methods used by individual to communicate, methods for communication breakdowns,
Conversational Strategy Trials
Assess expressive and receptive linguistic skills in a conversational context with and without AAC or contextual supports
Clinician selects a personally relevant conversational topic
Introduces it to the individual while modeling partner-supported communication strategies
http://www.youtube.com/watch?v=XUAOqKuPIyU
Minute 22:11 Control Conversation
Partner-supported conversation strategies
Written choice conversation
Augmented input
Cued question asking
Photo or visual scene referencing
Tagged yes/no responses
Multimodal Communication Screening Task for Persons with Aphasia
Reveals how a communicator answers situational questions by gesturing, spelling, pointing, or locating pictorial symbols
Provides info on the personal’s ability to categorize and to point referentially when telling a story
Clinical experience suggests this effectively distinguishes between partner supported and independent communicators
Speech-Generating Device Trials: Transactional Role Play
How effectively does individual access stored messages on a voice-output device?
Develop scripted scenario, program device(s)
When selecting a conversational scenario to practice
Consider time constraints for message delivery, whether messages can be stored and retrieved, communication functions expressed (social closeness vs basic needs), familiarity with content and partner, how important info is to individual.
Individual not asked to switch levels or pages
Advanced Systems Trials: Combining Stored and Generative Messages
Use role playing
Individual asked to demonstrate message retrieval and formulation
Can they repair breakdowns with natural modalities? Combine unaided and aided strategies? Initiate?
Clinician creates scenario and programs device
May include page/level changes
Role play, score, provide instruction, repeat role play, score again
Was cuing needed?
Assessing Other Capabilities
Residual Language Skills Cognition Representational Skills Motor Skills Hearing Operational Skills Life Experiences and Vocabulary Partner Skills
Assessing Residual Language Skills
Standard Aphasia batteries on page 439
Keyboards and spelling?
Assessing Cognition
Research is needed to correlate subtest performance with individual’s ability to use AAC
Low tech may work better for some
Assessing Representational Skills
Often able to
Recognize logos/signs
Identify photographs and drawings related to people and places
Remember info about the relative relationships of size, shape, goodness, and importance among objects and experiences
Assessing Motor Skills
Usually retain the ability to control their limbs on at least one side of the body
May experience difficulties when asked to complete a complex sequence of motor movements
May have difficulty physically carrying or manipulating heavy devices
May need to consult with OT or PT
Assessing Hearing
Standard hearing screening procedures can be used to ID hearing impairments
Assessing Operational Skills
May have to learn new operational skills
Turning the device on and off
Comprehending synthesized/digitized speech
Locating messages stored on invisible levels
Using flowchart operational menus
Keyboarding
Charging the device
Assessing Life Experiences and Vocabulary
Lived for a considerable period of time
Experienced relatively typical, routine lifestyles
Knowledge about the world is extensive
Informally assess interests, topics, and autobiographical info through interviews
Assessing Partner Skills
Observe interactions with the individual with aphasia
Is partner able to learn new ways to communicate? Interested in learning these?
Observe partner’s speaking style, understandability, handwriting legibility, reading skills, hearing, and vision
Assessing Communication Needs in Real-Life Contexts
Needs Assessment Interview
List communication situations that are challenging/difficult
Imagine situations in which there may be opportunities for meaningful communication
Topic Sorting
Sort topics into preferred and nonpreferred categories prior to engaging in conversational training
Social Networks
Identify specific communication partners
May use photos
Compare pre and post stroke
Intervention Issues
Individual’s and/or family’s desire to work on speech alone
Difficulty with acceptance of AAC alternatives
Adherence to a medical model of treatment vs a participation model
Discontinuation of tx
Inappropriate match of system features
Limited availability of personalized messages
Lack of practice in contextual situations
Limited support network to assist in message development
Lack of communication opportunities
Intervention Issues
Group therapy
Content of AAC system remain dynamic
Train new people who enter the individual’s life
