week 7 Flashcards
CVA/TBI
SOCIAL NETWORKS
Social Networks
- Communication is multi modal
- The person with complex communication needs has 5 circles of communication partners
- 1 = family you live with, 2 = close friends other family, 3 = acquaintances, 4 = paid carers, health professionals, 5 = strangers, shop assistants etc
- Step 1 : Identify specific communication partners in each circle
- Step 2 :Identify what modes of communication are currently used with each communicator/circle
- Step 3: Identify what “types of communication” are required with each circle, further specify conversation topics for each communication partner
SOCIAL NETWORKS GOALS
- increase balance of circles by identifying new communication partners
- improve quality of communication by increasing modes of communication used with current communication partners and better targeting and refining vocabulary and topics
- education communication partners on how to facilitate communication with the client using their identified communication modes
Importance of low or no-tech in AAC
- Reduces cognitive and linguistic demand.
- Provides an ideal situation to assess scanning, vision, comprehension, semantics and literacy to determine impact on AAC makeup and layout
- Allows time to learn target vocab and organize symbols
SPEECH GENERATING DEVICES
- digital speech devices
- dynavox products
o vmax+
o dynavox T10 - PRC products
- PC based software
APHASIA systems
- Preference for natural speech
- Systems are often icon/symbol based and/or whole words & phrases
- AAC may need to aid comprehension and expression
- Generally, AAC “under-utilised” - lower levels of acceptance and generalisation
Aphasia Considerations for AAC
- Can they match meaning to symbols
- Can they cope with icons / drawings or do they need real pictures
- How many targets can they cope with at a time
- Can they cope with several semantically and phonemically related items
- Can they categorize
- Identify residual strengths and capitalize on old learning
- Can they read at single or short phrase level
- Start small and slowly grow the layouts
- Review and modify regularly
- Include carers in assessment
Role of AAC in aphasia
- Replacing Natural Speech - person is non-speaking
- Supplementing Natural Speech - limited verbal output
- Scaffolding Natural Speech - word retrieval difficulties
common considerations!
- Cognition (memory, attention, perceptual processing)
Language (symbols, text, pictures) - Motor capabilities/ Mobility (Access Method)
Insight/motivation - Receptive/ expressive language
Some implications for AAC use
- Slower at performing tasks
- Difficulty shifting between strategies
- Difficulty composing complete messages
- Difficulty with word prediction
- Reduced self-monitoring
- Non-use through lack of insight
- May damage any equipment when frustrated
- Difficulty using multiple levels (dynamic display) to construct a message
- Difficulty learning how to use new equipment
- Difficulty remembering key sequences (eg. for stored messages)
- Difficulty introducing strategies to new, unfamiliar partners
Considering cognition in AAC
- System should be as automatic and familiar as possible
- Direct access is more concrete than indirect (scanning)
- Static display can be “easier” than dynamic display
- Reduce sequencing demands and opt for logical layouts
- Consistent linkages in multi-page systems
- Identify residual strengths and capitalize on old learning
- Use natural motor responses if possible to minimize new learning
- Include family members in assessment as they directly affect the success and acceptance of AAC systems.
- Review and modify regularly
AAC intervention stages
- Stage 1 Stimulation Level
- Stage 2 Structured Level
- Stage 3 Compensation Level
Stage 1
o “inconsistent levels of arousal. may start to respond to one step directions or recognise family members”
o Aim: To stimulate a consistent response and to shape this response into meaningful communication.
o Elicit and track responses to stimuli
o Identify various response modes, and maximise consistency of responses to specific stimuli.
o Shape responses into meaningful communication opportunities
o Include family in assessment and intervention
stage 2
o Able to perform previously learned tasks with structure, may still be confused or agitated and distractible. New learning very difficult. Some speech may emerge.
o Aim : To assist patient to convey wants and needs and increase participation during familiar routines
o Assess specific communication needs
o Assess capabilities that affect AAC
o Assess visual/perceptual abilities and physical access
o Assess message representation and symbol use
o Considerations for recommending a speech generating device
stage 3
o Usually behaves in socially appropriate ways and often goal oriented. Able to communicate needs and ideas about familiar topics in non stressful settings.
o Aim: Assist patient to communicate needs and ideas across partners and settings and use strategies to increase communication participation and efficiency at work, home and the community.
o Reassess communication needs and methods
o Reassess visual acuity, perception, and motor access
o Reassess message generation Vs symbol use
o Provide trials with Speech Generating Devices
PRIMARY PROGRESSIVE APHASIA
- Language capabilities progressively decline
- Caused by neurodegenarative disease Alzheimer’s / Fronto temporal dementia
- Starts with language problems and progresses to cognitive issues
- Can start with quite complex AAC systems but will eventually require picture support and later stages are unable to cognitively cope with high tech AAC
