Joanne P. Lasker

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

This article discusses components of the AAC Acceptance Model, a theoretical framework for understanding the factors involved in the acceptance of augmentative and alternative communication (AAC) by adults with acquired communication disorders. To clarify the AAC Acceptance Model, a case study is provided of an individual with acquired aphasia and apraxia of speech who seemed initially to be an “ideal” candidate for optimal use of AAC. A trial period conducted prior to acquisition of an AAC system included analysis of the clients communication behaviors using an AAC loaner device in conversation with unfamiliar partners in the clinical setting. After a device was acquired, the individual was reluctant to use it in public places with unfamiliar partners. Clinicians employed specific treatment techniques to promote AAC acceptance. Intervention focused on increasing the users communicative effectiveness and comfort level in community-based interactions. This case study highlights the importance of all three branches of the AAC Acceptance Model (milieu, person, and technology) in the clinical decision- making process. In addition, the case study illustrates the need for appropriate clinical outcome measures for adults with aphasia.

Helping a professor with aphasia resume teaching through multimodal approaches

Background: Research and clinical evidence suggest that employment after stroke may be an important aspect of preserving personal and social identity; however, few people with significant aphasia manage to return to work, particularly if their jobs are communicatively and cognitively demanding.Aims: This study presents the case of a professor with aphasia, JK, who resumed teaching through a combination of voice-output technology and the Key Word Teaching technique. Researchers investigated student attitudes towards two teaching approaches—one utilising voice-output technology alone and the other combining voice-output with the Key Word Teaching technique.Methods & Procedures: Ten student participants attended two simulated class sessions—one utilising voice-output technology alone and the other combining voice-output with the Key Word Teaching technique. Investigators analysed attitudinal survey results using nonparametric analyses. Qualitative approaches were employed to analyse transcripts of focus group discussions and written teaching evaluations. The investigators also compared university-based teaching evaluations from before JKs stroke to results obtained after the training protocol was completed. In addition, investigators videotaped and reviewed in-class teaching examples.Outcomes & Results: In the Combined condition, students rated the professor and the presentation more positively on dependent measures related to rate, comfort, understandability, and their willingness to participate. In a ranking task, all students preferred the Combined teaching approach. The scores on JKs university-based teaching evaluations provided by her students the semester after Key Word Teaching training were similar to evaluations from before her stroke. In addition, excerpts from JKs classroom discourse revealed that she was now combining natural speech and synthesised speech output to enhance her teaching.Conclusions: Results suggest that students preferred the Combined teaching approach utilising both the synthesised speech from the computer and the Key Word Teaching technique. Also, the training protocol enabled JK to combine natural speech and synthesised computer output within the classroom setting in ways that she had been unable to prior to training. The results demonstrate how a thorough analysis of JKs communication needs, accompanied by explicit training in techniques to overcome barriers to participation, resulted in a successful vocational outcome that enabled JK to retain an important aspect of her identity.

Motor learning guided treatment for acquired apraxia of speech: a case study investigating factors that influence treatment outcomes

ABSTRACT Purpose: The purpose of this study was to examine factors that might influence the treatment effectiveness of motor learning guided (MLG) treatment approach for apraxia of speech (AOS). Specifically, this study examined the effects home practice and the stimuli selection on speech production. Method: This is a case study across two treatment cycles involving a 52 year-old male five months post left CVA (due to a carotid artery dissection). Each treatment cycle used three conditions of practice to investigate the influence of practice frequency on treatment outcomes. The personal relevance of stimuli within and across treatment conditions differed in the treatment cycles to investigate stimuli selection influence on treatment outcomes. Results: Changes in speech motor learning occurred in all conditions of practice only after therapy began. Phrases practiced in therapy and at home met criterion for mastery in fewer sessions than therapy only and untrained phrases. The content of the stimuli did not appear to have a direct influence on speech motor learning. Conclusion: This case study contributes to the growing evidence on the effectiveness of MLG treatment for acquired AOS. Future studies using an experimental design are needed to advance and strengthen the evidence for MLG.