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Aphasia and AAC
SLA G304
Shelley Weiss, MS CCC-SLP
Aphasia
• Aphasia: An acquired communication
disability, usually a result of stroke or
head injury, that affects symbolic
language processing across modalities
(after Schuell)
• Deficits in auditory comprehension,
reading, writing, speech
Aphasia
• Apraxia: Impairment in ability to
program, sequence and execute
purposeful gestures, despite intact
mobility
– Oral
– Limb
• Test of Limb and Oral Apraxia (HelmEstabrooks)
Aphasia
• Candidacy for AAC strategies in
aphasia
– a) those who find speech inadequate
or inefficient in certain instances
– b) those who do not regain sufficient
natural speech for communication of
basic needs (after Hux, Beukelman, and Garrett,
1994)
Aphasia
• Revised Candidacy Classification
system (Garrett and Beukelman)
– Basic Choice Communicator
– Controlled Situation Communicator
– Comprehensive Communicator
– Specific Needs Communicator
– Augmented Input Communicator
Basic Diagnostic Protocol
• Assessment custom tailored
• Completed over extended period of time
• Across environments and communication
partners
• Assessment and intervention occur
simultaneously
• Interdisciplinary team
Interdisciplinary Assessment Team
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Physical therapist
Occupational therapist
Speech-language pathologist
Neuropsycologist
Physiatrist
Rehabilitation technician
Criteria-based Assessment
• Observe current level of function
• Observe changes over time
– More effective than norm referenced
– More sensitive to change over time
– Time efficient
Criteria-based Assessment
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Skills assessment
Communication needs inventory
Opportunities and constraints
Feature matching
Trial period
Skills Assessment
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Diagnosis and prognosis
Motor function
Vision, hearing
Sensory, perceptual
Motor speech
Language
Communication, pragmatics
Cognition, behavior, psychosocial
Communication Needs Inventory
• Present and future needs
• Four functions of communication
(Light, 1988)
– Information transfer
– Social closeness
– Basic wants and needs
– Social etiquette
Opportunities and Constraints
Assessment
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Adjustment to the disability
Stage of recovery
Changing skill levels
Multiple communication partners
Opportunities and Constraints
Assessment
• User environment (partner attitudes
towards AAC)
• Availability of technical support
• Medical protocol
• Financial resources
• Communicative desire, motivation
Feature Matching
• No single strategy or tool will have all
features to meet user’s needs
• Flexibility of system is greatest
consideration
Trial period
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Need adequate time to teach system
Implement in natural contexts
Re-assess
Modify
Re-assess
Mass Medicaid funds device trial
periods
Demands of Communication for Person
with Aphasia for basic needs conversation
(Garrett, 1996)
• Self aware
• Generate an action plan
• Generate a conceptual representation
• Be attentive to environment
• Posses an expressive modality
• Sufficient working memory
• Adequate semantic mapping/translation skills
• Pragmatic skills to determine if message is received
accurately
• Metacommunicative ability to revise, repair
Aphasia: Demands imposed by
AAC strategies (Garrett, 1996)
• Alternate physical access
• Novel symbol translation
• Sufficient working memory to complete
preceding symbol translation skills
before forgetting the intent
• New operational skills for technology
Aphasia: General Intervention
Strategies
• Communication access and success is
intermittent in aphasia. Use what works
from moment to moment
• Rely on residual world knowledge
• Keep physical access demands simple
• Keep visual display simple
Aphasia: General Intervention
Strategies
• Carefully inventory communication
needs using Light’s (1988) model
• Develop strategies to participate with
peer group
– Play Bingo
– Tell jokes
– Reminisce
– Share opinions
Aphasia: General Intervention
Strategies
• Assess most effective means and
organization of representation
– Visual spatial (maps, rating scales)
– Categorical
• words, messages
• pictures
– Topical
Aphasia: General Intervention
Strategies
• Practice strategies in situational roleplays
• Family, important communication
partners play a critical role in therapy
Aphasia Intervention: Remnant
Book
• Basic choice,controlled situation,
comprehensive communicator
• Mementos, remnants, photographs
• Content is concrete, salient and unique
to user
• Capitalizes on residual world
knowledge
Aphasia Intervention: Remnant
Book
• Vehicle for sharing information, social
closeness
• No expectations for regulating behavior
• Promotes topic generation and
initiation for user and partner
• Stimulates appropriate voluntary motor
response: page turning, pointing
Aphasia Intervention Remnant
Book
• Emotionally salient content may
stimulate user input/output modalities
• Doesn’t look like augmentative
communication aid
• Primes user and family for future AAC
systems
Aphasia: Remnant Book Study
Results
– (Weiss, S., Ho, K., Garrett, K., Lloyd, L., 1999)
 Conversational support in the form of
topical, personalized communication
books, regardless of symbolic
representation facilitated the
communication
Aphasia: Remnant Book Study
Results
 Remnants superior to pictographic
symbols for:
 establishing joint attention
 maintaining conversational control
 communication partner ratings of
comfort and efficacy
Aphasia Intervention:
Communication book
• Inventory messages using Light’s model
• Visual: Simple symmetrical organization,
layout to compensate for field cuts,
neglect
• Obvious categories, tabs to mark pages
• Directions to communication partner
• Remnant section, maps, calendars, clocks,
letter boards, rating scales
Aphasia Intervention:
Communication book
• Decrease cognitive-linguistic demands
– Teach in structured choice making
– Revise partners’ expectations of PWA
self initiation
• Teach partner to structure environment
• Identify opportunities to make choice
Aphasia Intervention: Written
Choice (Garrett, 1993)
• Partner provides written choices in
context of conversation
• Possible responses anticipated and
written in list form
• PWA selects correct response by
pointing
• Creates successful interaction
• Good for sharing information, social
closeness
Aphasia: Tool Box
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Alternative symbol boards, books
Retractable key chain
Remnant book
Maps, calendars, rating scales, clocks
Aphasia: Tool Box
• Dedicated VOCAs
– Simple: Macaw, MessageMate,
Cheaptalk
– Complex: Dynamyte, Dynavox
• Computer-based: Speaking
Dynamically, C-Speak Aphasia