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AAC Resource for Individuals with Aphasia

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AAC Resource for Individuals with Aphasia AAC Resource for Individuals with Aphasia CAYA, Revised December 2017– Tessa Lowis, Michelle Bunney, Tiffany Visser, Tara Commandeur, Monica Francella This document is based on the AAC Aphasia Category framework by Garrett and Lasker (2005). The framework differentiates between two types of communicators with Aphasia: 1. Independent communicators: individuals who are able to independently initiate use of different communication strategies. 2. Partner Dependent communicators: Individuals who consistently depend on a partner to manage informational demands and provide communication choices within highly familiar contexts. These five assessment questions help us determine which category best describes the client: 1. Does the person with Aphasia (PWA) use unaided communication strategies (e.g., gestures, writing drawing)? If so, with what degree of cueing? 2. Are partner dependent strategies being used? (e.g. partner writing key words, providing choice of responses) 3. Can the PWA use external stored information/messages on a communication board? The Multi-Modal Communication Screening Task for Persons with Aphasia (MCST-A) can be used to assess this skill. Free download: https://cehs.unl.edu/documents/secd/aac/assessment/picture.pdf (stimulus book), and https://cehs.unl.edu/documents/secd/aac/assessment/score.pdf (score form) 4. Can the PWA access stored messages on a speech generating device? ‘Aphasia -Stored Message Assessment’ pages available in TouchChat through iShare: Go to Public Files > Adult > General Communication > Aphasia-Stored Message Assessment. 5. Can the PWA formulate/generate messages to communicate? These questions may be answered by observing the PWA and a partner in role play situations. Refer to the checklist below to determine which category best matches your client. Use the page for the specific category to guide your assessment and treatment. Consider using Talking Mats to assist with AAC system development (E.g. topic selection). Visit www.talkingmats.com for more information. AAC-Aphasia Categories of Communicators Checklist Adapted from Garrett, K. & Lasker, J. (2005). Adults with severe aphasia. In D.R. Beukelman and P. Mirenda (Eds.) Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs, 3rd edition. Baltimore: Brookes Publishing Co. Available at: http://aac.unl.edu. PARTNER DEPENDENT COMMUNICATORS Communicator Type Skills Challenges Target Skill required for AAC Assessment Ideas Therapy ideas AAC Options – low tech / high tech Emerging Increased Poor comprehension EXPRESSIVE (*Multimodal) 1. Target those skills required for AAC at Low-Tech – Supported Communication this level to maximize life participation. Approach attentiveness to without visual or Ability to use gestures BDAE -3: Praxis subtest Communicator tangible objects personal context E.g., (e.g., clothing), Inconsistent or Ability to draw Informal – E.g., draw common establish reliable yes/no Augmented partner input (with training) personal photos, or nonexistent signal for objects, faces, etc. response: learn to communicate Gestures reminiscence items “yes” or “no” Ability to point to an object / photo Object / photo/ symbol selection affirmation with a head nod and Written key words Emerging ability to May demonstrate /symbol given an array of choices to: given a verbal cue for a target refusal with a head shake Drawings make a choice picture / symbol demonstrate emerging awareness of to choose pictured items in the Specific context supports direct care Select a target object / photo/ (nonverbal) daily routine, but is easily context of a functional activity Premade pages for the partner to answer question symbol to answer a question acceptance or confused by changes in (e.g. choosing items in grooming use for: Select a target object / photo/ rejection of a the routine or new assist with identifying direction routine) . Choice of activities symbol to complete a carrier tangible choice events of conversation (topic) . Directing personal and phrase (spoken / written) 2. Communicate affirmation and refusal Looks up when No functional speech or medical care E.g. MCST-A: Section A (e.g. head nod/shake), symbols to greeted gestures . Participation in games RECEPTIVE (*Multimodal) represent affirmation and refusal) Takes objects and Yes /No questions using personally . Writing letters Reliability of yes / no returns them to relevant or context bound 3. Modeling yes/no responses – gestural . Financial management thumbs up/down command within questions responses (eg. Head nod/shake) in . Etc. familiar routines pointing to written cues supported conversation **training partners is key Family scrapbook / visual scenes (low READING / WRITING tech / high tech) to assist with retelling of Word recognition an asset Picture word matching 4. Focus on Partner Assisted family events Communication / Supported Conversation SYMBOLIC ABILITY Assess ability to associate meaning Training Simple conversational scripts using Typically limited with objects, photos, picture modality available to client (e.g. personal symbols 5. Increase attention to visual supports (e.g. photos, gestures, eye gaze) PRAGMATIC cards, tic tac toe) Scripts for Social situations Assess ability to take turn in Boogie board/white board 6. Conversational Group Greetings conversation Responses Eye contact 7. Functional role plays to practice using the Mid to High-Tech AAC Carrier phrases with a choice low tech solutions set up to support LINGUISTIC OPERATIONAL Partner Assisted Communication. None Recommended CONSIDERATIIONS Assess ability to attend to stimuli Typically limited presented, recall information with 8. Conversation scripts, E.g., greeting and repeated teaching through response sequence informal observation 9. Games to target turn taking COGNTIVE COMPONENT Attends to Environmental supports Do they respond to environmental 10. Practice copying/ writing the names of provided by partner supports E.g., use of photos objects (select objects that will be used written supports, pictorial cues, illustrating communication on a daily basis and can be used to assist gesture cues, object cues locations and activities for with directing care etc) scheduling AAC-Aphasia Categories of Communicators Checklist Adapted from Garrett, K. & Lasker, J. (2005). Adults with severe aphasia. In D.R. Beukelman and P. Mirenda (Eds.) Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs, 3rd edition. Baltimore: Brookes Publishing Co. Available at: http://aac.unl.edu. PARTNER DEPENDENT COMMUNICATORS Communicator Type Skills Challenges Target Skill required for AAC Assessment Ideas Therapy ideas AAC Options – low tech / high tech Contextual Some attempts to Speech or gestures are EXPRESSIVE (*Multimodal) 1. Teach key partners: Low-Tech – Supported Communication communicate via minimally Ability to indicate a choice by Select a target word given verbal cue To use augmented input strategies Approach Choice natural modalities comprehensible pointing if visually presented, Select a target word to answer a when needed Can clearly indicate Generate little Ability to indicate a choice with question given a choice of 3-4 words Respond to all communication modes Augmented partner input (with training) Communicator an answer or information on their gesture / vocalization if presented Select a target word to complete a and interpret communication Gestures preference by own auditorily carrier phrase (spoken or written attempts Written key words Drawings pointing to a choice Seldom initiates, even Ability to point to a word given a list Use tagged yes/no questions Informal observation To use written choice conversation of by pointing or of choices to make a choice /direct MCST-A, response to written choice Notebooks for use in supported objects, pictures, or vocalizing care/answer question/assist with technique strategy interactions large print written Poor comprehension of identifying direction of conversation BDAE – 3, WAB, informal 2. Teach communicators Strategies: Written choice, rating words decontextual auditory (topic) observations to reference their topic by pointing, scales to communicate opinion, Can participate in information (e.g., RECEPTIVE (*Multimodal) gesture preferences, and qualitative multi-turn commands, questions Comprehension of written words, Assess ability to answer personally Turn taking in conversation with responses and augmented partner conversations given that do not pertain to picture or other visual symbols in relevant yes/no questions gestures, written key words, input partner supported events in the present shared context Assess ability to provide response drawings and a list of choices Instruction card for notebook strategies (written and/or personally when written choice technique used meaning of graphic symbols cover describing strategies choice, tagged yes- relevant information) BDAE-3, MCST-A reliable yes/no response (gesture, no questions, Family scrapbook / visual scenes (low READING / WRITING pointing, verbal) augmented tech / high tech) to assist with retelling of Recognize a word in context Assess ability to match pictures to how to indicate choice in response to comprehension) family events Read at the word or phrase level in words, and understand written questions Confirms or selects context words/phrases in context to initiate/ask questions by pointing topics of interest Remnant Communication
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