Miechelle McKelvey

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.

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.

Communication Styles of Persons with ALS as Recounted by Surviving Partners

The purpose of this study was to describe the communication patterns of individuals with Amyotrophic Lateral Sclerosis (ALS) as reported from the surviving spouses’ perspectives. Six surviving spouses of people with ALS participated in semi-structured interviews after the deaths of their partners. The interviews were transcribed and coded. Data analysis revealed four primary themes: communication styles, augmentative and alternative communication (AAC) use, decision-making, and lifestyle changes. Spouses described unique changes in communication styles as their partners began to use augmentative communication strategies and devices. AAC devices were described as essential for individuals with ALS with respect to decision making and maintaining social roles. Spouses stated the importance of adapting social activities in order to maintain involvement in the community as well as with family and friends.

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.

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.

The diverse vocational experiences of five individuals returning to work after severe brain injury: A qualitative inquiry.

Abstract Objective: The researchers explored the return-to-work experiences of five adults with severe traumatic brain injuries (TBIs) and those associated with them by performing a qualitative, multiple case study investigation involving in-depth, semi-structured interviews. Selection of this qualitative methodology allowed for personal, individualized accounts of adults with TBI returning to work. Specifically, this methodology promoted accurate representation of the idiosyncratic nature of each participant’s experiences. Methods: The researchers asked individuals to participate based on the diversity of their vocational experiences following TBI. Results: Four of the five participants had returned to their pre-injury jobs. Two were subsequently fired and, at the time of research participation, were unemployed. One participant never returned to paid employment; however, he had held two volunteer positions for several years post-injury. Salient content from interview transcripts allowed for the identification of five to eight themes pertinent to each case. Conclusions: Interpretation of the themes led to three main conjectures about return-to-work experiences following TBI: (a) job satisfaction may relate more to involvement in productive activities than monetary compensation; (b) adults with TBI can be successful in holding and maintaining positions with high cognitive demands; and (c) individualized job modifications and strategies are likely necessary for adults with TBI to succeed vocationally.

There is a continued need for empirical data supporting the treatment of people with aphasia in the acute care setting including the use of modified melodic intonation therapy

This review provides a summary and appraisal commentary on the treatment review by Conkly, D., Novac, E., Boissy, A. Bethoux, F., & Chemali, K. (2012). The effects of modified melodic intonation therapy on nonfluent aphasia: A pilot study. Journal of Speech, Language, and Hearing Research, 55, 1462–1471. Source of funding and disclosure of interest: The research project was internally funded; no external funding was reported. The authors reported no conflicts of interest.