Aimee Dietz

AAC for adults with acquired neurological conditions: A review

The purpose of this review is to describe the state of the science of augmentative and alternative communication (AAC) for adults with acquired neurogenic communication disorders. Recent advances in AAC for six groups of people with degenerative and chronic acquired neurological conditions are detailed. Specifically, the topics of recent AAC technological advances, acceptance, use, limitations, and future needs of individuals with amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), brainstem impairment, severe, chronic aphasia and apraxia of speech, primary progressive aphasia (PPA), and dementia are discussed.

AAC Assessment and Clinical-Decision Making: The Impact of Experience

People with complex communication needs often require a comprehensive augmentative and alternative communication (AAC) assessment to maximize participation in daily interactions. Assessment of AAC is a complex process and limited practice guidelines exist. The purpose of this qualitative study was to explore how 25 speech-language pathologists with varying levels of experience approach the AAC assessment process. Participants were classified as either (a) General Practice Speech-Language Pathologists (GPSLPs), (b) AAC Clinical Specialists (AAC-CS), or (c) AAC Research/Policy Specialists (AAC-RS). In-depth, semi-structured interviews were conducted to explore the participants’ approach to AAC assessment. The results revealed that GPSLPs approach AAC assessment differently than the AAC-CS and AAC-RS; however, the Specialists reported a similar approach that may help guide the development of practice guidelines for AAC assessment.

Personnel Roles in the AAC Assessment Process

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

Reading and Writing with Aphasia in the 21st Century: Technological Applications of Supported Reading Comprehension and Written Expression

Abstract Purpose: People with aphasia struggle to keep up with today’s text-based communication, because of their reduced ability to comprehend and compose written messages. Therefore, the communication gap between people with aphasia and the communities around them continues to grow. The purpose of this article is to highlight the literature regarding supported reading comprehension and written expression techniques for people with aphasia and to discuss the role of these interventions in the context of Web-based communication and information sharing. Methods: This article presents an overview of compensatory strategies that support reading comprehension such as aphasia-friendly text principles, pairing text with highly contextualized pictures, the notion of reading ramps, and written expression supports including word prediction, speech-to-text, and voice banking. Additionally, ideas for integrating these strategies into Web-based communication and information-sharing applications are reviewed. Conclusion: Speech-language pathologists must consider available Web-based communication strategies during the aphasia rehabilitation process. In particular, interventions designed to support the reading comprehension and written expression of people with aphasia should be adapted to meet the increasing trend to utilize Web-based technology to maintain or redefine social roles following a stroke.

Using Visual Scene Displays as Communication Support Options for People with Chronic, Severe Aphasia: A Summary of AAC Research and Future Research Directions

Abstract Research about the effectiveness of communicative supports and advances in photographic technology has prompted changes in the way speech-language pathologists design and implement interventions for people with aphasia. The purpose of this paper is to describe the use of photographic images as a basis for developing communication supports for people with chronic aphasia secondary to sudden-onset events due to cerebrovascular accidents (strokes). Topics include the evolution of AAC-based supports as they relate to people with aphasia, the development and key features of visual scene displays (VSDs), and future directions concerning the incorporation of photographs into communication supports for people with chronic and severe aphasia.

Constraint-Induced Aphasia Therapy for Treatment of Chronic Post-Stroke Aphasia: A Randomized, Blinded, Controlled Pilot Trial

Background Few studies have documented the possibility of treatment-induced improvements in language functions 12 months or longer after stroke. The purpose of the current study was to provide a preliminary estimate of efficacy of constraint-induced aphasia therapy (CIAT) when compared to no-intervention in patients with chronic (>1 year) post-stroke aphasia in order to provide the data needed to design an appropriately powered trial. Material/Methods This was a randomized, controlled, single-blinded, pilot trial. We identified 32 patients with chronic post-stroke aphasia. Of these, 27 were offered participation, and 24 were randomized (CONSORT diagram): 14 to CIAT and to 10 to no-intervention. CIAT groups received up to 4 hours/day of intervention for 10 consecutive business days (40 hours of therapy). Outcomes were assessed within 1 week of intervention and at 1 and 12 weeks after intervention and included several linguistic measures and a measure of overall subjective communication abilities (mini-Communicative Abilities Log (mini-CAL)). To maintain blinding, clinicians treating patients (CIAT group) did not communicate with other team members and the testing team members were blinded to treatment group assignment. Results Overall, the results of this pilot trial support the results of previous observational studies that CIAT may lead to improvements in linguistic abilities. At 12 weeks, the treatment group reported better subjective communication abilities (mini-CAL) than the no-intervention group (p=0.019). Other measures trended towards better performance in the CIAT group. Conclusions In this randomized, controlled, and blinded pilot study, intensive language therapy (CIAT) led to an improvement in subjective language abilities. The effects demonstrated allow the design of a definitive trial of CIAT in patients with a variety of post-stroke aphasia types. In addition, our experiences have identified important considerations for designing subsequent trial(s) of CIAT or other interventions for post-stroke aphasia.

The impact of interface design during an initial high-technology AAC experience: a collective case study of people with aphasia.

Abstract The purpose of this collective case study was to describe the communication behaviors of five people with chronic aphasia when they retold personal narratives to an unfamiliar communication partner using four variants of a visual scene display (VSD) interface. The results revealed that spoken language comprised roughly 70% of expressive modality units; variable patterns of use for other modalities emerged. Although inconsistent across participants, several people with aphasia experienced no trouble sources during the retells using VSDs with personally relevant photographs and text boxes. Overall, participants perceived the personally relevant photographs and the text as helpful during the retells. These patterns may serve as a springboard for future experimental investigations regarding how interface design influences the communicative and linguistic performance of people with aphasia.

The renegotiation of social roles in chronic aphasia: Finding a voice through AAC

Background: Aphasia robs people of their previously established identities and limits their ability to fully participate in life activities. In an effort to help people with aphasia (PWA) successfully participate in life activities, clinicians often call upon caregivers to act as proxies to determine their communicative needs. However, PWA often learn to use their residual linguistic abilities and augmentative and alternative communication (AAC) strategies to renegotiate their social roles to participate in life activities. Aims: The aim of this phenomenological case study was to (a) explore the social role changes experienced by PWA, (b) understand the use of communication strategies when attempting to reclaim previous social roles, and (c) determine whether discrepancies existed between PWA and their potential proxies regarding social role changes/adaptations. Methods & Procedures: A phenomenological qualitative approach was employed through 1–2-hour semi-structured interviews. Participants included three triads of people, which included one person with chronic, moderate-severe aphasia, their primary caregiver, and another member of their social network. The researchers used inductive analysis to identify segments of the transcripts that lead to insights regarding the adaptation of social roles following stroke and subsequent aphasia. Outcomes & Results: Three major themes unfolded that influenced the renegotiation of the social roles of three PWA: interpersonal life changes, community interactions and hobbies, and AAC. Incongruity was noted between the triads of participants. Caregivers tended to report more severe life changes than the PWA and the other members of their social network. Conclusions: Every participant expressed shifts in their social and interpersonal lives, community interactions and hobbies as well as communication changes since the onset of aphasia. However, AAC strategies provided PWA a means to communicate their opinions, feelings and find their own voice when redefining their roles and identity.

Inner speech deficits in people with aphasia

Despite the ubiquity of inner speech in our mental lives, methods for objectively assessing inner speech capacities remain underdeveloped. The most common means of assessing inner speech is to present participants with tasks requiring them to silently judge whether two words rhyme. We developed a version of this task to assess the inner speech of a population of patients with aphasia and corresponding language production deficits. Patients’ performance on the silent rhyming task was severely impaired relative to controls. Patients’ performance on this task did not, however, correlate with their performance on a variety of other standard tests of overt language and rhyming abilities. In particular, patients who were generally unimpaired in their abilities to overtly name objects during confrontation naming tasks, and who could reliably judge when two words spoken to them rhymed, were still severely impaired (relative to controls) at completing the silent rhyme task. A variety of explanations for these results are considered, as a means to critically reflecting on the relations among inner speech, outer speech, and silent rhyme judgments more generally.

Assessment With Children Who Need Augmentative and Alternative Communication (AAC): Clinical Decisions of AAC Specialists

Purpose The purpose of this study was to explore how speech-language pathologists (SLPs) who are augmentative and alternative communication (AAC) specialists approach the assessment process for 2 case studies, 1 child with cerebral palsy and 1 with autism spectrum disorder. The aim of the study was to answer the following questions: (a) How do clinicians with expertise approach the AAC assessment process for children with developmental disabilities? (b) Can any initial hypothesis be drawn about how SLPs approach the assessment of children with motor versus social interactive deficits? Method This study used a phenomenological qualitative design. The researchers conducted 2 in-depth, semistructured interviews with 8 SLPs who specialized in AAC and self-identified as primarily working with children. Results Four major themes emerged from the data: area of assessment, method of assessment, evaluation preparation, and parent education. Each major theme contained multiple subthemes and categories within those subthemes. Conclusions Participants discussed similar areas of assessment for both cases, indicating that some aspects of AAC assessment are universal. However, the specific aspects of what they were assessing and how they went about assessing them differed between the 2 cases. The results of the current study provide an outline of an assessment protocol for children with complex communication needs.