Final exam

Question 1

What are the communication symptoms associated with ALS?

Answer 1

-Mixed flaccid-spastic type
-Out of 300, only 7% still able to use natural speech at time of death
-Only 5% have cognitive and behavior changes

Question 2

What is the focus of early phase intervention with patients who have ALS?

Answer 2

-At time of diagnosis, natural speech often still functional
-Monitor speech performance and refer to AAC team when appropriate
-Speech intelligibility Test- Sentence Version (Yorkston et al, 2007)
-Screen cognitive and behavior function
-Message banking vs. voice banking https://www.youtube.com/watch?v=0WLs7iZuPNY
-AAC supports to preserve communication effectiveness
-Education about AAC

Question 3

What is the focus of middle phase intervention with patients who have ALS?

Answer 3

AAC evaluation
* Identify participation patterns and communication needs
* Assess current and anticipated capabilities
* Assess potential constraints
* Select low- and high-tech options to meet future needs

Question 4

What is the focus of late-phase intervention with patients who have ALS?

Answer 4

-Provide communication options to meet changes

http://store.lowtechsolutions.org/etran-board-communication-board/

Question 5

What is the difference between voice banking and message banking?

Answer 5

Voice banking - The voice that comes out of the communication device is your recorded voice.

-You record random phrases from a voice banking provider to bank your voice
-Still sounds somewhat robotic (but recognizably your voice)

Message banking - phrases that come out of the device are spoken in your natural voice, which you record and use directly on the device
-Ideal for personal messages or phrases you say a lot
-Take less tie than voice banking + have more personality/emotion

CAN USE A MIX OF BOTH BANKING TYPES

Question 6

What are the communication symptoms associated with multiple sclerosis?

Answer 6

-Dysarthria
-Often spastic-ataxic
-Cognitive and linguistic impairments
-Communication Participation Item Bank:
https://ancds.memberclicks.net/assets/docs/Handouts/carolyn%20baylor%20final%20handout%2010-28-15.pdf

Question 7

What is the focus of early, middle, and late-phase intervention with patients who have multiple sclerosis?

Answer 7

Early: Assistive technology
Middle: Compensatory support of natural speech
Late: For those with severe or profound dysarthria, natural speech is no longer functional to meet needs
AAC supports have to be personalized based due to vision problems, spasticity, ataxia, or intention tremor

Question 8

What are the communication symptoms associated with Guillain-Barre syndrome?

Answer 8

-Flaccid dysarthria or anarthria
-Cognition and language typically unaffected

Question 9

What is the focus of early, middle, and late-phase intervention with patients who have Guillain-Barre syndrome?

Answer 9

Early (maximal paralysis)
- 1-3 weeks of onset
Low-tech options during loss of speech

Middle
- weeks to months Low tech or high tech until recovery of speech
-Transition back to functional speech

Late - weeks to months
-Intervention to maximize the effectiveness of natural speech

Question 10

What are the communication symptoms associated with Parkinson’s disease?

Answer 10

Hypokinetic dysarthria

Question 11

What is the focus of early, middle, and late-phase intervention with patients who have Parkinson’s disease?

Answer 11

Early:
-AAC supports not typically necessary
-Lee Silverman Voice Treatment or SPEAK OUT

Middle:
-Assistive technology and AAC supports to supplement natural speech

Late:
-AAC technology as needed

Question 12

What are the communication symptoms associated with brainstem stroke?

Answer 12

-Dysarthria: Brainstem strokes can result in dysarthria, which is a motor speech disorder characterized by difficulty in articulating sounds, leading to unclear or slurred speech.

-Swallowing Difficulties: Brainstem strokes may also affect the muscles responsible for swallowing, leading to dysphagia (difficulty swallowing). This can result in choking, aspiration, or difficulty eating and drinking safely.

-Motor Impairments: Depending on the location and severity of the stroke in the brainstem, individuals may experience motor impairments affecting facial muscles, tongue movement, and vocal cord function, all of which contribute to difficulties in speech production.

-Language and Cognitive Impairments: Brainstem strokes can also lead to language and cognitive impairments, such as aphasia (difficulty understanding or producing language) and cognitive deficits like memory loss, attention problems, and executive functioning difficulties.

Question 13

What is the focus of early, middle, and late-phase intervention with patients who have sustained a brainstem stroke?

Answer 13

Early Phase Intervention:
-Basic Functional Responses: Initially, the focus is on helping the individual develop basic functional responses. This may include activities aimed at improving motor function, coordination, and sensory awareness.
-Monitoring Speech and Cognitive Function: Assessing and monitoring speech production and cognitive function are crucial in the early phase to understand the extent of communication impairments and cognitive deficits.

Middle Phase Intervention:
-AAC Assessment: As the individual progresses beyond the acute phase, an assessment of their communication needs and capabilities is essential. This may involve evaluating various augmentative and alternative communication (AAC) options to determine the most suitable system for facilitating communication.
-Identification of Needs and Capabilities: Understanding the individual’s evolving communication needs and capabilities is vital during the middle phase to tailor interventions effectively.

Late Phase Intervention:
-Intense Instruction for Operational Competence: In the late phase, there is a greater emphasis on providing intense instruction to enhance operational competence with the chosen AAC system. This may involve training the individual and their communication partners in using the AAC system effectively.
-Personalized AAC Support: As the individual’s needs continue to change, it’s important to provide personalized AAC support to meet those evolving needs. This may involve modifications to the AAC system or strategies to ensure optimal communication efficacy.

Question 14

What is the brain computer interface?

Answer 14

a technology that establishes a direct communication pathway between the brain and an external device, such as a computer or a prosthetic device. The primary goal of a BCI is to enable individuals to interact with their environment or control external devices solely through neural signals, bypassing traditional pathways involving peripheral nerves and muscles.

Question 15

What are the communication symptoms associated with Huntington’s disease?

Answer 15

-Hyperkinetic Dysarthria: Dysarthria is a motor speech disorder characterized by slurred or imprecise speech due to muscle weakness or paralysis. Hyperkinetic dysarthria, specifically associated with HD, is characterized by involuntary, jerky movements (chorea) affecting the muscles involved in speech production. This can result in irregular speech patterns, disrupted articulation, and difficulty with speech clarity.
-Cognitive Communication Impairments: HD can also affect cognitive functions related to communication, including memory, attention, executive functioning, and language processing. Individuals with HD may experience difficulties with word finding, organizing thoughts, maintaining attention during conversations, and understanding complex language.
-Variable Symptom Presentation: The symptoms of HD can vary widely among individuals, and the progression of the disease can impact communication abilities differently. Some individuals may experience more pronounced motor symptoms affecting speech production, while others may primarily struggle with cognitive impairments impacting language comprehension and expression.
-Impact on AAC System Selection: Due to the complex interaction between motor symptoms and cognitive impairments in HD, selecting an appropriate augmentative and alternative communication (AAC) system can be challenging. The variability in symptom presentation necessitates a personalized approach to AAC intervention, considering the individual’s unique communication needs, capabilities, and preferences.

Question 16

What is the focus of early, middle, and late phase intervention with patients who have Huntington’s disease?

Answer 16

Early Phase Intervention:
-Compensatory Strategies: In the early stages of HD, the focus of intervention often involves providing compensatory strategies to address emerging communication difficulties. This may include techniques such as spaced retrieval training to improve memory recall and environmental supports to facilitate communication.
-External Supports: As motor and cognitive symptoms begin to manifest, external supports may assist individuals in maintaining effective communication. For example, individuals may benefit from using AAC applications on personal devices, such as tablets or smartphones, to support interaction with unfamiliar listeners.

Middle Phase Intervention:
-Communication Partnerships: As the disease progresses and communication challenges become more pronounced, the role of communication partners becomes crucial. Communication partners, such as family members, caregivers, and speech-language pathologists, play a vital role in supporting interactions and facilitating effective communication.
-AAC Evaluation and Implementation: Depending on the severity of communication impairments, individuals may require augmentative and alternative communication (AAC) systems to convey their wants, needs, and thoughts. AAC systems can range from low-tech options, such as communication boards or books, to high-tech devices with dynamic display screens. The focus during this phase is on frequent AAC redesign and upgrades to accommodate changes in cognition, language, and motor skills.

Late Phase Intervention:
-Reliance on AAC: In the late stages of HD, individuals may become increasingly reliant on AAC systems as their natural speech abilities decline. AAC devices or strategies serve as essential tools for functional communication, enabling individuals to maintain connections with others and participate in meaningful activities.
-Augmentation or Alternative to Speech: AAC systems may serve as either an augmentation or alternative to natural speech, depending on the individual’s abilities and needs. The focus of intervention during this phase is on ensuring that AAC systems effectively support communication and promote quality of life for individuals with HD.

Question 17

What are characteristics of patients with aphasia who are classified as emerging communicators?

Answer 17

-Severity of Aphasia and Apraxia: Emerging communicators may exhibit profound to severe aphasia and apraxia, experiencing extreme difficulties in speaking, using symbols, and responding to conversational input.
-Difficulty Speaking and Using Symbols: These individuals have significant challenges in speaking and using symbols for communication. They may struggle to produce verbal expressions and may also face difficulties in using symbolic communication aids.
-Limited Response to Conversational Input: Emerging communicators may have limited responses to conversational input. They may find it challenging to engage in interactive communication and may have trouble understanding and responding appropriately to verbal prompts or cues.
-Apraxia Across Motor Planning Systems: Apraxia can occur at various levels of the motor planning system, including oral motor, laryngeal, speech, gestural, and even respiratory systems. This difficulty in motor planning further complicates their ability to communicate effectively.
-Intervention Focus on Foundational Communication Skills: The primary focus of intervention for emerging communicators is on developing foundational communication capabilities. This includes skills such as turn-taking, communicating choices with tangible objects, developing referential skills, and providing clear signals for acceptance and rejection.

Question 18

What is the focus of intervention with an emerging communicator?

Answer 18

-Foundational Communication Capabilities: The intervention for emerging communicators with severe aphasia and apraxia focuses on developing foundational communication capabilities. This includes skills such as turn-taking, communicating choices with tangible objects, referential skills, and clear signals for acceptance and rejection.
-Choice-making and Referential Skills: The goals include helping the individual choose items to meet their needs during daily routines by pointing or reaching. Additionally, developing contextual routines, life activities, and opportunities for the individual to utilize choice-making, turn-taking, and referential skills are crucial aspects of intervention.
-Utilizing Contextual Supports: Intervention strategies involve referencing familiar photographs in a photo album, creating simple scrapbooks or photo albums, choosing preferred items within the context of functional activities, and facilitating participation in simple, age-appropriate games and activities.
-Communication Partner Strategies: Partner strategies complement communicator strategies by providing contingent feedback, facilitating participation in games and activities, utilizing augmented input strategies, and incorporating humor and nonpreferred choices into choice-making routines.
-Affirmation and Rejection Signals: It’s important for emerging communicators to consistently signal affirmation or agreement for preferred items during choice-making activities, as well as signal rejection for non preferred items. Partner strategies include utilizing tagged yes/no question formats and providing contingent feedback for communicator’s referential and rejection signals.

Question 19

What are characteristics of patients with aphasia who are classified as contextual choice communicators?

Answer 19

-Limited Spoken Communication: Contextual choice communicators typically have difficulty expressing themselves verbally, often relying on nonverbal communication or gestures to convey their needs or preferences.
-Understanding Visual Symbols: They are often able to recognize and understand visual symbols, such as photographs, labels, written names, and signs. This ability helps them in selecting choices or responding to questions presented visually.
-Basic Needs Communication: Contextual choice communicators can indicate their basic needs by pointing to objects or items in their environment. For example, they may point to a picture of food or drink to indicate hunger or thirst.
-Awareness of Daily Routines: They are usually aware of their daily routines and schedules, which can aid in communication. For instance, they may use visual supports to navigate through familiar activities or environments.
-Limited Conversation Initiation: Contextual choice communicators may struggle to initiate or contribute to conversations independently. Instead, they rely on visual cues or prompts from communication partners to engage in communication exchanges.
-Difficulty with Unfamiliar Topics: While they may be proficient in communicating about familiar topics or routines, contextual choice communicators may have difficulty participating in conversations involving unfamiliar or abstract concepts.
-Dependence on Partner Support: They often require substantial support from communication partners to facilitate successful communication, especially in unfamiliar or challenging situations.
-Inability to Initiate Visual Communication: Unlike emerging communicators who may initiate communication through gestures or nonverbal cues, contextual choice communicators may not spontaneously point to pictures, people, or objects to communicate unless prompted or supported by their communication partners.

Question 20

What is the focus of intervention with a contextual choice communicator?

Answer 20

-Identify Basic Needs: Assist the individual in indicating basic needs by pointing to objects and items. This involves recognizing and responding to the individual’s gestures or indications of needs.
-Utilize Visual Symbols: Support the individual in easily recognizing visual symbols such as photographs, labels, written names, and signs. These visual cues can help facilitate communication and comprehension.
-Establish Awareness of Daily Routines: Help the individual become aware of daily routines and schedules, enabling them to navigate familiar environments and activities more effectively.
-Facilitate Communication in Familiar Contexts: Recognize that contextual choice communicators may not have the linguistic competence to initiate or add to a conversation on their own. Therefore, intervention should focus on supporting communication within familiar contexts and activities.
-Implement Written Choice Conversation Strategy: Teach the individual to answer conversational questions by pointing to written word choices, points on a scale, or locations on a map. This strategy helps the individual participate in conversations by providing structured options for communication.
-Use Tagged Yes/No Questions: Encourage the individual to answer yes/no questions with reliable gestures, head nods, or verbal responses. Employing tagged yes/no questions with exaggerated intonation can enhance comprehension and facilitate communication.
-Develop Gestural Communication: Teach the individual to ask questions, express preferences, and communicate using gestures, pointing, and rising intonation. Gestural communication can supplement verbal expression and enhance interaction.
-Provide Augmented Comprehension Strategies: Support comprehension by using augmented input strategies such as writing/drawing key words, gesturing, or pointing to reference items being discussed. This helps ensure that the individual understands incoming auditory messages.

Question 21

What are characteristics of patients with aphasia who are classified as transitional AAC communicators?

Answer 21

-Inconsistent Speech Production: They may demonstrate variability in their ability to produce speech, with periods of fluent or near-fluent speech interspersed with instances of difficulty or breakdown.
-Limited Verbal Output: While they may have some ability to communicate verbally, their speech output is often limited and may be difficult for others to understand.
-Difficulty with Complex Communication Tasks: They may struggle with more complex communication tasks, such as expressing abstract ideas or engaging in extended conversations, leading them to rely on alternative means of communication.
-Intermittent Reliance on AAC Methods: These individuals may use augmentative and alternative communication (AAC) methods intermittently, depending on their level of verbal ability and the demands of the communication situation.
-Frustration with Communication Challenges: They may experience frustration or anxiety when faced with communication difficulties, especially during periods of verbal breakdown.
-Varied Communication Success: Their communication success may vary depending on factors such as fatigue, stress, or familiarity with the communication partner or environment.
-Desire to Improve Communication Skills: Despite their challenges, transitional AAC communicators often demonstrate a desire to improve their communication skills and may be motivated to explore and utilize AAC strategies to enhance their ability to communicate effectively.

Question 22

What is the focus of intervention with a transitional AAC communicator?

Answer 22

-Improving Communication Flexibility: Helping the individual develop strategies to switch between verbal and AAC communication methods fluidly based on their communication needs and abilities in different contexts.
-Enhancing AAC Skills: Providing training and support to optimize the use of AAC tools and techniques, including selecting appropriate AAC systems, mastering device operation, and customizing vocabulary to meet individual communication needs.
-Building Communication Confidence: Boosting the individual’s confidence in using AAC methods by providing opportunities for successful communication experiences and addressing any negative attitudes or concerns related to AAC use.
-Increasing Communication Independence: Promoting independence in communication by teaching self-advocacy skills, empowering the individual to initiate and participate in conversations, and providing strategies for problem-solving communication breakdowns.
-Facilitating Social Interaction: Supporting the individual in developing social communication skills, such as turn-taking, topic maintenance, and nonverbal communication, to foster meaningful interactions with others using both verbal and AAC modalities.
-Providing Communication Partner Training: Educating communication partners, including family members, caregivers, and healthcare professionals, on how to effectively support and facilitate communication with the transitional AAC communicator, including strategies for encouraging and validating verbal attempts while also respecting and utilizing AAC methods.
-Monitoring Progress and Adjusting Intervention: Continuously assessing the individual’s communication skills and needs, monitoring progress in both verbal and AAC communication, and making adjustments to intervention strategies as necessary to ensure continued improvement and success.

Question 23

What are characteristics of patients with aphasia who are classified as stored message communicators?

Answer 23

-Limited Verbal Output: They have severely restricted verbal output, often consisting of only a few words or short phrases. They may struggle to produce spontaneous speech or may be completely nonverbal.
-Reliance on Pre-stored Messages: These individuals heavily rely on pre-stored messages or phrases within augmentative and alternative communication (AAC) devices or communication boards to express themselves. They may use these stored messages as their primary means of communication.
-Difficulty Generating Novel Language: They have difficulty generating novel language and may rely on familiar and frequently used messages to communicate their needs, thoughts, and feelings. Generating spontaneous responses or participating in open-ended conversations may be challenging for them.
-Limited Language Output Variety: Their communication tends to be repetitive, as they often reuse the same set of pre-stored messages across different communication contexts. They may have a limited vocabulary available within their AAC system.
-Difficulty With Abstract Concepts: They may struggle to comprehend or express abstract concepts or ideas, relying instead on concrete and straightforward language.
-Frustration with Communication Limitations: These individuals may experience frustration or feelings of inadequacy due to their limited ability to express themselves verbally. They may become frustrated when they are unable to convey their needs or thoughts effectively.
-Dependence on Caregivers or Communication Partners: Due to their reliance on stored messages, they may require assistance from caregivers or communication partners to navigate their AAC devices, select appropriate messages, and communicate effectively in various situations.
-Potential for Isolation: Limited verbal output and reliance on pre-stored messages may contribute to social isolation or communication breakdowns in social settings, leading to decreased participation in conversations and activities.

Question 24

What is the focus of intervention with a stored message communicator?

Answer 24

-AAC System Familiarization: Providing comprehensive training on the functionality and operation of the AAC device or communication board to ensure the individual feels comfortable and confident using it.
-Message Selection and Organization: Teaching strategies for selecting appropriate pre-stored messages or phrases to express a wide range of needs, wants, and thoughts. This may involve categorizing messages based on topics or contexts to facilitate efficient communication.
-Vocabulary Expansion: Expanding the individual’s vocabulary within the AAC system by adding new pre-stored messages that reflect their evolving communication needs and interests. This can involve incorporating personalized messages and frequently used phrases into the system.
-Message Customization: Assisting the individual in customizing pre-stored messages to better suit their communication style, preferences, and personality. This may involve modifying existing messages or creating new ones to align with the individual’s unique communication needs.

-Promoting Message Retrieval Skills: Teaching strategies to facilitate efficient retrieval of pre-stored messages, including navigation techniques within the AAC system, using visual or auditory cues, and practicing message retrieval in various contexts.
-Encouraging Message Expansion: Encouraging the individual to expand beyond their pre-stored messages by incorporating simple language generation techniques, such as combining existing messages to form new sentences or expressing basic concepts using limited vocabulary.
-Facilitating Social Interaction: Providing opportunities for the individual to practice using their AAC system in social settings, including interactions with family members, friends, and caregivers. This may involve role-playing scenarios and real-life communication situations to improve social communication skills.
-Supporting Communication Partners: Educating communication partners on how to effectively support and facilitate communication with the stored message communicator, including strategies for interpreting pre-stored messages, providing appropriate feedback, and fostering a supportive communication environment.

Overall, intervention with a stored message communicator aims to empower the individual to communicate more independently and effectively using their AAC system, while also promoting social inclusion and participation in everyday activities.

Question 25

What are characteristics of patients with aphasia who are classified as generative AAC communicators?

Answer 25

1. Limited Verbal Output: While they may have difficulty producing spontaneous speech, they retain some ability to generate novel language, albeit with challenges.
2. Varied Language Output: They can produce a range of language outputs, including single words, short phrases, and occasionally longer sentences, although their language may be fragmented or grammatically incorrect.
3. Ability to Use AAC Systems: They are capable of using augmentative and alternative communication (AAC) systems to supplement their verbal communication. This may include speech-generating devices, communication boards, or other AAC tools.
4. Difficulty with Complex Language Tasks: They may struggle with more complex language tasks, such as formulating detailed explanations or engaging in extended conversations. They may rely on simpler language structures to convey their message.
5. Flexibility in Communication: These individuals demonstrate flexibility in their communication approach, utilizing both verbal and AAC methods based on their communication needs and abilities in different situations.
6. Desire for Independence: They often express a desire for greater independence in communication and may actively seek opportunities to improve their language skills and functional communication abilities.
7. Frustration with Communication Challenges: Like other individuals with aphasia, they may experience frustration or difficulty when faced with communication breakdowns, especially when they struggle to express themselves effectively.
8. Potential for Progress: With appropriate intervention and support, generative AAC communicators may demonstrate improvement in their language abilities over time, including increased fluency, expanded vocabulary, and enhanced communication confidence.
   Overall, generative AAC communicators represent a diverse group with varying levels of language ability and AAC proficiency, but they retain some capacity for language generation and are motivated to improve their communication skills using both verbal and AAC modalities.

Question 26

What is the focus of intervention with a generative AAC communicator?

Answer 26

-Language Expansion: Providing opportunities for the individual to expand their vocabulary and language skills within the AAC system, including introducing new words and phrases relevant to their interests, needs, and communication goals.
-Promoting Language Generation: Teaching strategies to facilitate spontaneous language generation, such as word-finding techniques, sentence construction, and expressing ideas or opinions on a variety of topics.
-AAC System Customization: Assisting the individual in customizing their AAC system to better meet their communication needs, preferences, and abilities. This may involve organizing vocabulary, adjusting access methods, and personalizing the system interface.
-Building Communication Competence: Supporting the development of functional communication skills, including initiating and maintaining conversations, asking and answering questions, and participating in social interactions using both verbal and AAC modalities.

-Increasing Communication Independence: Empowering the individual to use AAC systems independently to express themselves in various contexts and situations, reducing reliance on others for communication support.
-Facilitating Language Practice: Providing structured opportunities for the individual to practice using their AAC system in real-life communication situations, including role-playing scenarios, group discussions, and everyday interactions with family, friends, and caregivers.
-Improving Communication Confidence: Boosting the individual’s confidence in their ability to communicate effectively using both verbal and AAC methods, celebrating successes, and providing positive reinforcement for their communication efforts.
-Supporting Generalization: Helping the individual generalize their language and communication skills from structured therapy sessions to real-world contexts, promoting functional communication across different environments and with various communication partners.
-Collaborating with Communication Partners: Educating and involving communication partners, including family members, caregivers, and healthcare professionals, in supporting and facilitating communication with the generative AAC communicator, ensuring consistency and reinforcement of communication strategies across settings.

Overall, intervention with a generative AAC communicator aims to maximize their communication potential, promote language growth and independence, and enhance their overall quality of life through effective communication.

Question 27

What are characteristics of patients with aphasia who are classified as specific need communicators?

Answer 27

-Variable Communication Abilities: Their communication abilities may vary depending on the specific context, situation, or activity. They may demonstrate relatively preserved language skills in certain areas while experiencing significant difficulty in others.
-Difficulty with Specific Language Tasks: They may have particular difficulty with specific language tasks or activities, such as recalling names, numbers, or specific vocabulary related to their daily routines, interests, or hobbies.
-Situational Communication Challenges: Their communication difficulties may be more pronounced in specific situations or environments, such as during conversations with unfamiliar people, in noisy or distracting settings, or when discussing complex or abstract topics.
-Limited Communication Needs: They may have relatively narrow communication needs focused on specific tasks, activities, or topics relevant to their daily life, such as requesting assistance, participating in routine activities, or expressing preferences and opinions.
-Compensatory Strategies: They may employ compensatory strategies to overcome specific communication challenges, such as using gestures, writing, or relying on context cues to convey their message when encountering difficulty with verbal expression.
-Awareness of Communication Difficulties: They may demonstrate awareness of their communication difficulties and express frustration or dissatisfaction when faced with challenges in specific communication situations.
-Motivation to Improve Specific Skills: Despite their challenges, they may express a strong motivation to improve their communication abilities in specific areas that are important to them, such as regaining the ability to communicate effectively with family members, engage in hobbies, or participate in social activities.
-Individualized Communication Goals: Intervention goals are often tailored to address their specific communication needs and priorities, focusing on improving functional communication skills in targeted areas while acknowledging and working around areas of relative strength and difficulty.

Overall, specific need communicators represent a diverse group with unique communication profiles and challenges, requiring individualized intervention approaches that address their specific communication needs and goals.

Question 28

What is the focus of intervention with a specific need communicator?

Answer 28

-Identifying Specific Communication Needs: Conducting a thorough assessment to identify the individual’s specific communication strengths, weaknesses, and needs across different contexts, activities, and topics.
-Setting Individualized Goals: Collaborating with the individual and their support network to establish individualized communication goals that target specific areas of difficulty or priority, such as requesting assistance, participating in social interactions, or engaging in activities of daily living.
-Implementing Context-Specific Strategies: Introducing and practicing a range of context-specific communication strategies and techniques tailored to address the individual’s unique communication challenges and goals. This may include strategies for improving naming, comprehension, conversational turn-taking, or topic maintenance in specific situations.
-Providing Functional Communication Training: Offering structured training and practice opportunities to improve the individual’s ability to use functional communication strategies and tools to meet their specific communication needs, such as using gestures, writing, or utilizing augmentative and alternative communication (AAC) devices.
-Increasing Communication Confidence: Building the individual’s confidence in their ability to communicate effectively in targeted situations by providing positive reinforcement, celebrating successes, and offering encouragement and support during challenging communication tasks.
-Generalizing Skills to Real-World Settings: Facilitating the transfer of communication skills learned in therapy sessions to real-world contexts and situations through role-playing exercises, simulated scenarios, community outings, and opportunities for practice with familiar and unfamiliar communication partners.
-Promoting Independence and Participation: Empowering the individual to become more independent in meeting their communication needs and actively participating in meaningful activities, routines, and social interactions that are important to them.
-Collaborating with Communication Partners: Educating and involving communication partners, including family members, caregivers, and healthcare professionals, in supporting and reinforcing the use of specific communication strategies and techniques in everyday settings.

Overall, intervention with a specific need communicator aims to enhance their functional communication skills, promote independence and participation in daily life, and improve their overall quality of life by addressing targeted communication challenges and goals.

Question 29

What are communication partner roles for stored message, generative and specific need communicators?

Answer 29

Stored Message Communicators:
Message Retrieval Assistance: Helping the communicator locate and select pre-stored messages or phrases within their augmentative and alternative communication (AAC) system.

Facilitating Communication: Encouraging and allowing the individual to use their stored messages to express themselves, providing opportunities for communication initiation and response.

Interpretation and Clarification: Interpreting the intended meaning of the communicator’s messages, clarifying ambiguous or unclear messages, and ensuring accurate communication exchange.

Device Support: Assisting with device operation, troubleshooting technical issues, and ensuring the AAC system is functioning properly.

Promoting Independence: Encouraging the communicator to use their AAC system independently, while providing support and guidance as needed.

Generative AAC
Communicators:

Language Support: Encouraging and facilitating the individual’s efforts to generate spontaneous language, offering verbal prompts, cues, or suggestions when needed.

Modeling Language: Modeling appropriate language structures and communication strategies, providing examples of how to express ideas or respond to communication partners.

Patience and Understanding: Demonstrating patience and understanding when communicating with the individual, allowing them time to formulate their responses and providing support without rushing or interrupting.

Feedback and Validation: Providing positive feedback and validation for the communicator’s language attempts, regardless of fluency or accuracy, to foster confidence and motivation.

Creating Communication Opportunities: Creating opportunities for the individual to practice and develop their language skills in various social situations, including conversations, group activities, and everyday interactions.

Specific Need Communicators:
Contextual Support: Recognizing and responding to the specific communication needs and challenges of the individual in different contexts or situations.

Task-Specific Assistance: Offering targeted assistance and support for communication tasks or activities that the individual finds challenging or requires additional help with.

Adaptation and Flexibility: Being flexible and adaptable in communication approaches, adjusting communication strategies and techniques to accommodate the individual’s specific needs and preferences.

Advocacy: Advocating on behalf of the individual to ensure their communication needs are understood and accommodated in various settings, including healthcare, education, and community environments.

Collaborative Problem-Solving: Collaborating with the individual to identify solutions to communication barriers and challenges, brainstorming alternative communication strategies, and working together to overcome obstacles.

Question 30

What is the rationale for using visual scene displays for people with aphasia?

Answer 30

Visual scene displays are ideal for people with Aphasia because they make use of preserved skills, including:
–Visual spatial processing
–Retention of information about life experiences
–Retention of general world knowledge

Question 31

What are the crucial elements for contextual richness of visual scene displays?

Answer 31

• Environmental context (setting, people, objects, and activities)
• Interaction with people or the environment
• Personal relevancy
• Clarity regarding elements key to the implied relationships

Question 32

What reading supports are beneficial for patients with aphasia?

Answer 32

• Supports for aphasia patients:
  – Abundant white space
  – Large and standard fonts at least 18 point
  – Simplified syntax
  – Relevant images (photos/line drawings)
• Emerging research suggests:
  – Use text to speech while reading for:
  Person with mild aphasia to increase reading rate and maintained comprehension

Question 33

What are assessment considerations for patients with aphasia?

Answer 33

• Unaided modalities
  – Does the person with aphasia use unaided strategies (e.g., residual natural speech, writing, gestures, drawing) to augment or substitute for ineffective spoken messages? If not, can the person be taught to do so?
• Partner-supported techniques
  – To reestablish a communication exchange, does the person with aphasia benefit from partner-supported communication strategies, such as augmented input and the written-choice conversation strategy? Can the person with aphasia learn to use tangible supports, such as pictures or objects, in predictable conversational
  routine? If the person with aphasia does not currently use these strategies, can the person be taught to do so?
• External stored information
  – Does the person with aphasia demonstrate the ability to respond to questions by accessing messages represented by symbols, such as pictures in a communication book, on a simple speech generating device, or on a letter board? Does the person need cues to do so?
• Stored messages via prepared speech output
  – Does the person with aphasia utilize pre-stored whole messages, such as those created ahead of time by a facilitator on a speech-output AAC device, to communicate? If not, can the person be taught to do so?
• Generative messages through speech output
  – Does the person with aphasia generate novel communicative messages bit by bit using letters, photographs pictures, or symbols in low-tech and high-tech AAC devices? If not, can the person be taught to do so?

Question 34

What are assessment considerations for those with degenerative conditions?

Answer 34

• Individual participation patterns and communication needs
  –Interview, needs assessment
• Assess opportunity barriers and supports
• Assessment of individual’s capabilities and access barriers
  –Natural abilities
  –Potential for environmental adaptions
• Access barriers, current communication
  –Potential to use AAC systems
• Operational requirements
• Constraints/capability profile
• AAC trials/skills
  Low tech is most recommended for those with dementia (high tech in rare cases can work)

Question 35

What is the focus of early, middle, and late-phase intervention for those with degenerative conditions?

Answer 35

Early phase:
Dementia
* Providing compensatory strategies for information to be remembered
– Spaced retrieval
* Environmental supports (reminding them or give them envrionemtnal cues about basic things around them)

Primary Progressive Aphasia
* Need strategies for communication breakdowns due to word finding difficulty
Focus on accuracy and fluency?

Huntington’s disease
* External supports may assist with maintenance of communication in the early stages

Middle phase:
Dementia
* Communication partners need to support interactions
Primary Progressive Aphasia
* Generative message or transitional communicators

Late phase:
Dementia-
* Reliance on communication partner

Primary Progressive Aphasia-
* Contextual choice communicators

Question 36

What Rancho levels are associated with the three recovery levels of TBI patients?

Answer 36

1. Early (Rancho I-III) (1-3)
   Consider: Reestablishing intentional communication is important
2. Middle (Rancho IV-VI) (4-6)
   Patients are usually:
   Confused
   Agitated
   Conscious
3. Late (Rancho VII-X) (7-10)
   Patients are usually:
   Most have regained the cognitive capacity to become natural speakers
   AAC evaluation is most appropriate for this stage

Question 37

What are the considerations for early, middle, late phase intervention with TBI patients?

Answer 37

EARLY PHASE
* Goal is to increase the consistency of responses and to shape these into meaningful communication
* Identify a response modality and shape into a communicative behavior
* Choice based systems or yes/no systems
* Eye gaze or other direct selection
* Visual deficits and spasticity are common

MIDDLE PHASE
* Recovering speech but may present with severe language and/or motor impairments or may speak functionally with confused messages
* Need AAC to participate in rehab and convey wants and needs
* Frequent AAC redesign and upgrades with continued improvement in cognition, language, and motor skills
* Communication partners play a role in structuring communication interactions

LATE STAGE
* Unable to use natural speech for communication due to severe language or motor speech impairment
* Need AAC for functional communication
* Strategies and devices augment speech or serve as an alternative
* AAC evaluation following Participation Model