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1 Part II: Specific AAC-Based Communication Strategies for People with Severe Aphasia.

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1 1 Part II: Specific AAC-Based Communication Strategies for People with Severe Aphasia

2 2 A.Overview of 6 Categories of Communicators Garrett & Lasker, © 2004

3 3 Overview of 6 Categories of Communicators cont.

4 4 The categories represent a continuum of communication ability…

5 5 The skills: Level of Independence/Need for Cues Initiation of Communication Symbol Comprehension Semantic Specificity Communicative Success in Familiar or Supported Contexts Communicative Success in Unfamiliar or Unsupported contexts Ability to Generate Novel Messages Metacognitive Ability

6 6 The point… MATCH communicators to an optimal package of communication strategies and systems.

7 7 Look at… Cognitive-linguistic capabilities How much partner support the person needs/will need to participate in communication Potential to improve communication competence with therapy

8 8 B. Descriptions/Illustrations of Specific Communicator Categories


10 10 1. Emerging (Basic Choice) Communicator Characteristics: Often prelinguistic, with minimal symbolic ability across modalities (reading, writing, speech, comprehension, gesture). Sometimes preintentional; at the very least, seldom initiate Poor aphasia quotients – untestable to 10/100. Variable awareness and responsiveness Do sometimes show preference & recognition Remind me of children and adults with severe- profound developmental disabilities

11 11 John: age 59, AQ =.6/100, 7 years post onset, profound aphasia across modalities, nonspeaking, severe limb and oral apraxia

12 12 1. Emerging (Basic Choice) Communicator cont. Treatment Focus: develop turn-taking develop choice-making ability develop referential skills develop clear signals for agreement, rejection, etc. teach partners to provide appropriate opportunities for above

13 13 1. Emerging (Basic Choice) Communicator cont. Specific Strategies - PWA: a. Choose items to meet needs during daily routines b. Reference pictures in photo album by pointing OR indicating appropriate facial expression when participating in dyadic reminiscing activity c. Choose pictured items in context of a functional activity (e.g, ordering garden seeds from a catalog)

14 14 Dan Fink (my grandfather) – featured in his reminiscing album. Multi-infarct aphasia and vascular dementia. Goals: to point reference), recognize, comment appropriately as able

15 15 1. Emerging (Basic Choice) Communicator cont. Specific Strategies – PWA cont.: d. participate in turn-taking within context of familiar visual games (e.g., tic-tac-toe, war) e. consistently signal affirmation (head nod) during choice-making activities for preferred items f. consistently signal rejection (pushing away, head shake) during choice-making activities for non-preferred items (dental floss, Hitler examples)

16 16 George’s own x on 3 rd turn

17 17 Lethargic, minimally responsive patient indicated a clear rejection signal for the 1 st time in response to this picture

18 18 John choosing fast food items (objects first, then corresponding symbols on VOCA)

19 19 John learning to choose between 4 symbolic (photo) representations of favorite activities

20 20 1. Emerging (Basic Choice) Communicator cont. Specific Strategies -- Partner: a. Develop contextual routines and opportunities in which the individual can utilize the above communication skills and increase meaningful participation in some life activities. b. create scrapbook c. facilitate participation in games

21 21 Video of John Activity: xxxxxx Data derived from a 12 month tx period 1X week individual tx 1X week group tx

22 22 Changes in Number of Behaviors from Communication Interview (modified from Schuler, Peck, Willard, & Theimer, 1989): Percentage of preintentional, intentional, and intentional/symbolic communication behaviors (total # behaviors rated = 14; total # of ratings = 159; 82% intrarater reliability)

23 23 Changes in target communication behaviors

24 24 Discussion!!!

25 25 2. Contextual Choice Communicator

26 26 Characteristics: Show a desire to communicate, but often can’t initiate request, questions or comments Emerging symbolic communication skills – but extremely limited use for communication May recognize familiar written words, understand meaning of simple pictures Some automatic and/or stereotypic speech may be present (“OK”, “Oh dear”); occasionally will fit transcortical motor profile -- good repetition, but not necessarily intentional.

27 27 Often have poor auditory comprehension skills as well Better comprehension in contextual situations But often nod as if understanding (but don’t!) Have difficulty following conversational topic shifts

28 28 Characteristics cont.: Good awareness of daily routine, clock time, familiar people Good recognition of preferences during daily routines (e.g,. foods, clothing, activities) Will vocalize to protest Increasingly communicative facial expression and vocal intonation Low aphasia quotients – 5 to 20/100

29 29 Treatment Focus: Develop use of AAC strategies and tools to allow participation in controlled, predictable exchanges and routine conversations Teach both patients and partners to participate in these exchanges – the partner has a huge role! (We’ll see…)

30 30 Increase symbolic awareness -- both comprehension of symbols and an understanding that external symbols assist in communicating messages to others Develop ability to comprehend key points in a conversation given “augmented input” (partners’ gestures, written key words, referential cues, drawings

31 31 a. Primary Communication Strategy: Written Choice Conversation (Garrett & Beukelman, 1992 & 1995) Supplementary Handout Packet Page ___ For people with severely limited verbal expression, but good awareness and linguistic recognition skills, PARTNERS can increase the PWA’s participation in social conversations by anticipating possible answers to questions and writing them in the form of: 1) Written Word Choices 2) Points on a Scale 3) Locations on a Map

32 32 In this strategy, the partner scaffolds the conversation by... Providing topic choices Asking open-ended conversational questions (sincere questions) Writing potential answers in the form of large print word/phrase choices (usually vertical, indicate start of phrase with * or -) OR graphic scales (see example) Asking the PWA to point to a choice/scale to communicate Continuing the conversation by asking a follow-up question

33 33 Dr. D. choosing a topic of discussion

34 34 Written Choice Sample Conversation #1 example Friend: “Can you give me advice on what to make for the school bake sale tomorrow?” PWA:[Nods ‘yes’] Friend: “Should I take an angel food cake, brownies, or cookies?” [writes choices vertically in notebook] * ANGEL FOOD CAKE * BROWNIES * COOKIES PWA: [Points to brownies] Continued…

35 35 Friend:Yes, those always sell fast? [circles brownies]. Should I make them from scratch or get a box mix? [writes choices] * SCRATCH * BOX MIX PWA:[laughs and points to box mix] Friend:[laughs and circles box mix]. Yeah, it’s hard to make them as good as Betty Crocker!

36 36 Friend:[Pause] what do you think about the kids’ elementary school? Do you think they’re getting a good education or a so- so one? [writes a rating scale on the page] Bad So-So Good  -------|--------|----------|---------|---------|-  12 3 4 5 PWA:[hesitates, points to ‘4’] Friend:[circles “4”] Yeah, we’re pretty happy with the school district. Too bad the classes are so big, though! PWA:[nods yes]

37 37 Steve’s wife, Diane, offering him choices about a wedding present

38 38 Conversational Question: “Where have you traveled?” While drawing … say and point to locations: “Right here in Nebraska? Up to Minnesota to fish? California, where it’s warm…?

39 39 Goals of Written Choice Technique Increase PWA’s participation in meaningful social conversations Establish social closeness Can also use for communication of Functional needs and wants E.g., * Aspirin? * Milk of Magnesia? Functional information transfer E.g., Your daughter lives…. * Pennsylvania? * New York?

40 40 Video Neil with daughter OR Steve with his wife Diane

41 41 Written Choice Conversation – Garrett 1993 Dissertation Research Data – Three participants with severe aphasia Aphasia Quotients ranging from 11 to 20 Nonspeaking or only automatisms or perseverative jargon Minimally communicative, few initiations At least 6 mos. post left CVA Ages 66-81

42 42 RESULTS BaselineWritten Choice Ave # of Turns/Topic 2.57.5 Range - # of Topics 5-91-2 Ave % Understandability 15%97% Ave % Response Accuracy 93%92%

43 43

44 44 Interpretation of data: In 10-minute conversations between a person with severe aphasia and a partner trained in the provision of sincere, consecutive conversational questions and potential answers in the form of written choices or scales: # of turns per topic during NO WRITTEN CHOICES was approximately 2-3 Fast turnover, short discussions, little content exchanged # of turns per topic during WRITTEN CHOICES ranged from 5 to 11 Little to no topic turnover, longer discussions, lots of content exchanged

45 45 Other findings: Subjects often requested written choices by pointing to tablet – even in 2 nd baseline! Accuracy of written choice responses (as verified by significant partner) was between 80 and 90% for all participants Meaning…participants could comprehend these orally/visually presented contextual choices even if reading comprehension scores on formal tests were low.

46 46 Also, participants were just as accurate when questions were in conversational order as when they were mixed up/in random order Meaning… you could use this technique to ask 1-shot questions (e.g., “How much pain do you have?”)

47 47 Followup study: Lasker, Hux, Garrett, Moncrief, & Eischeid (1997) 3 participants 3 modes of presentation Auditory-visual choices Auditory only Visual placement only Outcomes: each person differed in terms of BEST mode of presentation

48 48 The point... Assess whether your client benefits from: Presenting choices through all modalities Needs auditory choices only Needs a visual reference point only Regardless, it works!

49 49 Audience Participation Activity Try written choice technique Option A: 1 volunteer on overhead Option B: with each other

50 50. The second strategy for PWA b. When cued, learn to ask questions by pointing, gesturing, and/or using rising intonation (“uh...point]?”)

51 51 Dr. D pointing to ask his wife a question

52 52 John asking Sara for more info following HOH: now does spontaneously approximately 50% of the time

53 53 c. Answer partner’s tagged “yes/no” questions with reliable gestures, head nods, or verbal responses Partner: “Richard, do you like omelettes…yes…or no?” Richard: [tries to gesture thumbs up, then points down, then nods head ‘yes’ after pausing to work out the movement sequence] Partner: “Yes?” Richard: Confirms ‘yes’ by nodding head up- and-down.

54 54

55 55 d. Visually attend to partner’s presentation of augmented input; indicate via head nods, yes/no responses, or vocalizations whether message was understood

56 56 The communication partner has a significant role with the contextual choice communicator…

57 57 Specific Strategies -- Partner: a. Implement Written Choice Strategy Identify interesting conversational topics Learn to generate consecutive, meaningful, conversational questions Learn to generate potential/possible answers in the form of choices or scales

58 58 b.Utilize “tagged” yes-no question formats Ask a yes/no question, then follow it up with a verbal “tag” (..Yes?…or No?…) while modeling the appropriate head nod Example: “Do you like Grace Kelly, the actress…yes (nod head up-and-down) or no (shake head side-to-side)?”

59 59 Specific Strategies -- Partner cont.: c. Utilized “augmented comprehension” strategies when PWA doesn’t appear to understand incoming auditory messages. Write down: Key words Topics -- especially when they’re about to change Drawings that will establish reference (e.g., streets in Pittsburgh, family trees) Gesture (e.g., hand over back = past) Point to item being discussed

60 60 Sequential Description of Augmented Input Strategy 1.Partner identifies that PWA has misunderstood (blank expression, nodding ambiguously, looks away, answers incorrectly) 2.Partner then supplements the most difficult, or the most important concepts, by: a) writing key words on paper b) gesturing symbolically c) gesturing deictically (pointing) d) pantomiming 3. Recheck’s PWA’s comprehension (“Got it?”)

61 61 using his notebook computer in reverse – to augment Dr. D’s comprehension of a discussion about politics.

62 62 Sample instruction card: Hello. I had a stroke. Sometimes I’m not able to understand you. Can you: Watch my face – if I look confused, I probably didn’t understand you. Signal topic changes like this… “Now, I’d like to talk about something else…like baseball. Did you watch the Pirates game this weekend?” For key words or concepts, it helps if you: Gesture [swing bat for baseball, for example] Write down the words in large print PIRATES??? Draw

63 63 Specific Strategies -- Partner: d. Be a good responder to PWA Respond to all modes of communication Make an effort to interpret messages that PWA is trying to convey

64 64 The Story of Richard…. Therapy history Premorbid skills Progress on Natural Communication Skills Progress on Augmentative Strategies Ultimate level of Participation/Life activities

65 65 Discussion!!!

66 66 3. Transitional Communicator

67 67 Characteristics Initiates communication with minimal cues Recognizes pictured messages consistently; good text recognition for familiar words and phrases May use some natural communication modalities effectively including telegraphic or automatic speech, fragmented writing/spelling, some symbolic gestures However, frequently needs instruction and cues to communicate via augmented modalities, even if already has an extensive AAC message collection

68 68 Treatment Focus Assist PWA to transition to self- initiated communication via natural communication modalities (i.e., use gestures and partial speech to ask/request/comment) Assist PWA to initiate communication via low or high tech AAC strategies in structured contexts (e.g., bakery)

69 69 Specific Strategies -- PWA a. Call for attention/assistance b. Introduce self with low or high tech AAC strategy (card, wallet, VOCA) c. Search for previous written choices responses to answer similar conversational questions d. Search for biographical info in a simple reminiscing book/scrapbook to answer similar conversational questions

70 70 Violet learning to signal for assistance

71 71 e. Answer predictable questions (e.g., autobiographical, topical) by searching for, selecting and pointing to pre- stored messages on a simple VOCA I was in the Korean War The NAVY We never got hit2 years only

72 72 Fred answers conversational questions about farming given scripted support, min cues, and clinician-selected vocabulary on VOCA Video Clip

73 73 f. Hand a potential communication partner a tangible topic setter to initiate a conversation Game ticket Article from a newspaper Cigar from grandchild’s birth Sequentially-organized conversational starter book

74 74 John’s sequentially organized social communication wallet. His target behavior (cued): hand wallet to novel communication partners, then flip through it to ask prestored questions, share information. Note: topic setter message about Twin Towers

75 75 Constructed Topic Setter

76 76 Steve pointing to topic setter to converse about plane crash

77 77 Graphic Context Study: Results Garrett & Huth, 2002 Increased initiations with topic setter, especially for current events vs. personal events Increased message successfulness, but mostly with 1 st vs. 2 nd partner, and mostly for current events (2 nd partner was a good guesser regardless of amount of context that was available) Instructional implications…. Video if time

78 78 Specific Strategies – PWA cont.: g. Tell simple stories on a VOCA by activating multiple messages in a left-to-right sequence Cognitive demands are minimal (left to right sequence, no symbol selection required), but communicative output and participation level is rich. Prepares PWA to access stored messages more independently

79 79 My name is George I’m from Omaha, Nebraska My wife’s name is Laura. I worked in the Stockyards What time is it? T.V. Coffee Please Storytelling content vs. needs/requests Storytelling Needs

80 80 Jeff telling a “fish story” Video Illustration

81 81 A Quick Review: Types of Voice Output Communication Aids (VOCAs) Synthesized Speech Devices Large capacity devices Program sound-by- sound -- slow, sometimes complicated Can provide some users with access to spelling Digitized Voice Output Devices: Record messages by pushing the message square and record button, then speaking into the device. Instant, real voice Can’t create novel messages/spell

82 82 Examples of Digitized Message VOCAs -- 4 to 32 message spaces per level Go Talk (Attainment Company) Tech Speak (Assistive Technology, Inc.) Cheap Talk (Great Talking Box Co.) Message Mate (Words+) Black Hawk (Adamlab) DynaMyte (Dynavox, Inc.)

83 83 Tech Talk 32 -- AMDi

84 84 Cheap Talk (Great Talking Box Company)

85 85 ss. Synthesized Speech VOCAs: Dynavox Series 4 and Dynamyte

86 86 Specific Strategies -- Partner a. Suggest to PWA that s/he try to find info in conversation book, etc. to answer questions b. Pause and expect communication c. Provide opportunities for communication of specific information within contextual, familiar conversations and routines. “Tell me about your family” “Tell me about your best vacation” “I had something strange happened to me yesterday…(can you ask me?)” “Jerry would be able to help you….(call him).”


88 88 “Look at me -- I’m communicating with no cues!”

89 89

90 90 4. Stored Message Communicator

91 91 Characteristics: Frequent efforts to initiate communication – responses, comments, questions -- without waiting for cues Locates prestored messages symbolized with remnants, photos, pictographic symbols, or written words to communicate messages in specific contexts (e.g., community transactions, familiar conversations, doctor’s visits) But can only use vocabulary/systems that have been created by others (therapists, family) vs. generate complex, novel messages on their own

92 92 Often uses natural communication modalities to communicate specific information Gestures First letter spelling, number writing, air- writing, some drawing Spoken language - stereotypic phrases, intonation, some semantically specific words or short phrases Have specific environmental communication needs PWA experiences frequent communication breakdowns in unfamiliar contexts -- but is aware of them and attempts to repair them

93 93 Treatment Focus: Assist PWA to develop an organized means of storing messages and vocabulary for specific communication situations Low tech systems -- e.g., notebooks, card displays High Tech VOCAs -- stored messages on multiple levels Teach PWA to access stored messages in a timely and appropriate manner in real life communication contexts via role plays and scripting interactions

94 94 Develop and teach breakdown resolution strategies using natural communication modalities Simple social gestures Drawing Adding information Setting the topic by locating related messages on VOCA

95 95 Bus Page Drop me off at the: * VA Hospital * Vet’s club * Duquesne Clinic * Kaufmann’s downtown When is the next bus? * to the South Side * to downtown * to the stadium It helps if the bus can “KNEEL” Do I need a transfer? Environmentally- organized vocabulary

96 96 Some multimodal communication “It was over…”

97 97 Specific Strategies - PWA a. Participate in identification of specific situations, stories, or communication routines E.g., restaurant Vacation Family stories Bank Returning an item to a store Asking your spouse out on a date

98 98 b. Participate in selection and storage of specific vocabulary for each situation Example: Asking your spouse out on a date Honey, I’m tired of staying home. Let’s go out. Where would you like to go? The movies? Dinner? Nice restaurant -- The Lodge? Italian -- The Grotto? Your choice -- let’s look in the paper. Dancing? The horse races? I’m paying I love you

99 99 c. Practice accessing vocabulary during structured, scripted role playing situations (in therapy) d. Then communicate in real-life situations and evaluate: Effectiveness -- did I get my message across? Efficiency - was the partner fidgeting or uncomfortable? How many breakdowns did I have? Changes -- was there anything I could have done to make this interaction go better? Instructions to partner Other vocabulary Find messages faster

100 100 d. Evaluate pros and cons of VOCAs versus low tech communication options Make an informed decision and develop the final system with the clinician e. Gradually use the system in more demanding situations E.g., Return item to store that has a difficult clerk with no knowledge of aphasia Video Clip

101 101 5. Generative Communicator “go anywhere -- say anything”

102 102 Characteristics: Symbolic Very frequent efforts to initiate communication – requests, comments, questions Communicates about a variety of topics from the past/present Can engage in conversations about others’ issues Switches between multiple modalities to convey messages (gestures, writing, air- writing, drawing, stereotypic phrases, intonation, some semantically specific words or short phrases)

103 103 Clever communicators who will try anything to convey their message! BUT communication is fragmented and inefficient Circumlocutions or topic shifts are common as PWA attempts to backtrack or repair message Demonstrate awareness of communication breakdowns and frequently, significant frustration

104 104 Specific Strategies - PWA: a. Initiate introduction of self AND communication strategies Mike J: Broca’s- type aphasia (AQ = 47/100)

105 105 b. Communicate specific semantic info about a VARIETY of topics via AAC strategies and natural communication modalities Presidential elections Stories from childhood Difficulties collecting Social Security Events from past weekend

106 106 c. Establish topics prior to communicating complex conversational information Tangible topic setters Verbally Topic card

107 107 d. Communicate in a variety of situations with familiar and unfamiliar (untrained and sometimes unsympathetic) communication partners Family Stores Banks Social Security office Bars and social clubs Lectures/classrooms

108 108 e. Locate stored messages relevant to the topic on “hidden” pages in a communication book or “hidden” electronic levels in a high tech VOCA Chat PC

109 109 f. Shift between accessing STORED messages and creating NOVEL messages to convey a complete idea Target idea: “I earned a WWII medal from being in the Phillipines” “Big one” “Over there” [pointed east] “Peshitan” (Oh, the president) “yah”. [pointed to ‘m’ on alphabet card] [pointed to Pacific ocean on outline map of U.S.] Wrote “II” [World War II?” “Yeah yeah”. [pointed to left-most edge of U.S. map, then pointed to “F”. (F -- Fiji?) No…no. [pointed to M again] “Shoes…you know”. (Marcos? Oh, you were in a battle in the Phillipines! And you’re getting a medal for it…but just now…downtown)

110 110 g. Increase complexity of discourse by communicating relational semantic information via gestures, timelines, some speech Temporal: Past & present (motion backwards for “ago”). Spatial/locational: point to map to indicate “down the road” Preferential: saying “the best” while gesturing ‘thumbs up’ Additive: finding a message about baseball, saying “and”, then finding a message about enjoying “Steelers - football” Actions: Pantomiming doing the laundry, then saying “dryer”.

111 111 h. Combine symbols to convey novel meanings Spoken words: “Big one..” and “Warshendon” to mean “President”. AAC messages: access [Pittsburgh], then find “baseball” on hobbies page to communicate “Pirates baseball team”. Writing and speech: Write “2” then say “boys” to indicate size of family.

112 112 i. Ask questions of others Combine key words, enhanced intonation and gesturing (e.g., Vacation….you?) Point to question forms in Communication notebook or VOCA

113 113 j. Spell/write partial or complete words/phrases to generate novel messages

114 114 k.Writers: Use word prediction or abbreviation/expansion high tech strategies to supplement spelling Communicator types ‘t’ then ‘a’ computer generates “table”, “take”, “taking”, “talk” Communicator hits key/clicks to choose desired word GUS Pocket PC

115 115 l. Utilize specific, metacommunicative communication strategies to resolve communication breakdowns in conversation a. Determine rule for number of times it’s OK to repeat message (e.g., “no more than 2 -- then you have to try something else) Provide additional information/shift to new strategy during communication breakdowns Signal partner that s/he has understood/not understood Manage conversational dynamics/make decisions about whether to continue/quit

116 116 m. Work with clinician to assemble or program components of multimodal system: Vocabulary for specific situations Social messages for conversational discourse Graphics Alphabet/spelling system Numbers page Yearly calendar Pocket for remnants Pen and paper Lists (family, restaurants, baseball teams,…) Control phrases to repair conversational breakdowns

117 117 Multimodal System Examples and Components 1. Multi-modal Communication Notebook

118 118 Cover & Explanation Card. * * Can obtain pre- made cards from the (U.S.) National Aphasia Association (NAA)

119 119

120 120 Bus Page Drop me off at the: * VA Hospital * Vet’s club * Duquesne Clinic * Kaufmann’s downtown When is the next bus? * to the South Side * to downtown * to the stadium It helps if the bus can “KNEEL” Do I need a transfer? Environmentally- organized vocabulary

121 121 Timeline to Organize Autobiographical Storytelling

122 122 Preconstructed outline map to communicate familiar place names (vs. say “North Platte”)

123 123 Sample of natural drawing & writing – paper & pen

124 124 “It was over…”

125 125 Slide with breakdown phrases

126 126 Modality Instruction Card

127 127 Video – Mike J. Comprehensive Communicator Pre-intervention (with wife) Post Intervention (with Marcie)

128 128 Mike J’s Comprehensive Communicator Data Garrett, Beukelman & Low (1989) MeasurePre-AACPost AAC # Turns5188 # Initiations1242 % Initiations24%47% Ave # Turns Per Breakdown Sequence 154 % of Turns spent on resolving Communication Breakdowns 46%11%

129 129 Generative Communication Option #2: High Tech AAC System Communicator Multi-level VOCA – more advanced communicators can use these systems to combine symbols and create novel messages, to access a large number of messages, and/or to spell – with or without prediction.

130 130 Multilevel, high tech AAC Device - Dynavox

131 131 C-Speak Aphasia (Nicholas & Elliot – available through Mayer Johnson. Computer-based software – combine with Speaking Dynamically software)

132 132 Talk Boards (Dundee University – available through Mayer Johnson. Also requires Speaking Dynamically Pro)

133 133 Vanguard (PRC) with Minspeak software +  +TIME = Let’s get the mail now!

134 134 Other “brands”: Talking Screen (words+): install on laptop Lingraphica (now marketed as a language training tool – similar to C- Speak Aphasia) Chat PC Portable Impact

135 135 Video Illustration Rod Comments on Technology What proportion of the population of adults with aphasia can use high technology: Independently? For specific purposes? With assistance?

136 136 3. Writing Systems A few communicators with aphasia do not need high tech AAC speech supports…. Rather, they benefit from adaptive word processing programs for writing enhancement and support Use prediction to spell novel words Communicator types S + L computer generates slow, slam, slick, slide Communicator hits key to choose desired word Spelling assistance/spell checker Resources Article by Hux (see reference list) Don Johnston – Mfr. Of Co: Writer Video – Dr. A – if time

137 137 Enkidu Portable Impact Devices with Spelling/Prediction/Phrases

138 138 Specific Strategies - Clinicians/ Partners: a. Assist in compiling vocabulary b. Interpret and guess at appropriate moments in conversations c. Encourage PWA to try another modality d. Encourage use of conversational control strategies

139 139 Categories of Communicators Revisited

140 140 Discussion

141 141 6. Specific Need Communicators “I can communicate just fine except when…..”

142 142 Characteristics: May be able to access stored messages independently (Stored Message Communicator) OR May be able to speak/communicate intelligibly except in (Generative Communicator) BUT cannot communicate adequately in certain situations required specificity, clarity, or efficiency (e.g., ordering clothes through the catalog) Note: this category is NOT based on internal linguistic/communicative competence but on NEED

143 143 Examples of “Specific Needs” Remembering and recording grocery needs while at the store Taking phone messages Stating phone number or other numbers aloud Communicating bets at the race track Getting a specific style of haircut at a new hairdresser’s Saying “I love you” or another emotional expression via natural voice in a controlled manner (e.g., via VOCA) Writing thank you notes

144 144 Treatment Focus: Develop highly specific AAC mini- interventions to increase participation in important life activities: family rituals/activities communicating needs in the community writing supports telephone assists

145 145 Examples of Specific Strategies -- PWA: a.Learn to utilize single message VOCAs to communicate info by telephone, in community situations (e.g., “I have aphasia – give me time to communicate”) or to participate in ritual (prayer) b.Refer to phrase card to place bets at the race track, explain upcoming bus stop, place bridge bets c.Learn to use writing supports to generate real letters, cards

146 146 Groceries Request List – Mary’s story

147 147 Numbers page with printed out numerical words to assist an individual with severe semantic paraphasias (especially for numbers) to communicate numerical info by telephone

148 148 Sample Cloze Letter Format 1)___________ _____, 200___ Dear 2)______________________, 3)________________! How 4) ______________? I am 5)_________________________. This month we 6)_________________________________. We really 7) ______________________________. So, tell me about 8) ____________________. I hope you are 9) _________________. Please 10) ____________________________. 11)___________________, X_______________________________

149 149 List of Word and Phrase Choices JanFebMarchAprilMayJune JulyAugSeptOctNovDec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 ------------------------------------------------------------------------------------------------------- 2.(Names of family members/friends go here) ------------------------------------------------------------------------------------------------------- 3.Hello!Hi!Howdy!Greetings! ------------------------------------------------------------------------------------------------------- 4....are you? it going? your family? ------------------------------------------------------------------------------------------------------- 5.fineOKpretty goodterrifica little tired -------------------------------------------------------------------------------------------------------

150 150 Elaine’s letter copied onto script Elaine’s letter using script as a reference

151 151 Stories about Specific Needs Communicators….

152 152 Note…. The nature of AAC-type interventions to meet specific needs is only limited by the team’s creativity!

153 153 6. Specific Need Communicator cont. Specific Strategies -- Partners: a. Identify specific situations and specific messages b. Provide opportunities to use system components

154 154 Video – if time Grace on telephone with husband

155 155 Audience Participation Activity Select a case packet Identify the “type” of communicator Identify client strategies Identify partner strategies Select someone to report on decisions

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