Augmentative Communication for Older Adults Challenges and Considerations Caryn F. Melvin PhD CCC-SLP

“Words are, of course, the most powerful drug used by mankind” Rudyard Kipling

Issues on the Plus Side Seasoned language users Seasoned, effective communicators Understand the power of communication  Motivation  Problem solving ability  Educated  World knowledge  Cognition ?

Challenges and Considerations Remembering normal communication Change in social role Change in family dynamics Grieving Financial worries Self esteem Have observed others with impairments Other health issues

Measuring and Evaluating the Communication Difficulty Impairment Functional limitations Disability

Common Adult Disease Processes Requiring Augmentative Communication ALS* MS* Parkinson Disease* B-Stem CVA Severe Aphasia Others (SCI, GBS, TBI)

Progressive or Acute Disease? It impacts more than just management!

Progressive and Acute Disease ALS Parkinson’s Huntington’s Progressive Supranuclear Palsy MS * CVA TBI Gullian Barre syndrome

Progressive Disease and AAC ALS Parkinson Disease PSP MS  Do not always have expressive deficits Huntington’s Disease

No Detectable Disorder Obtain base line information/scores Answer questions Provide education re: disease  As warranted Provide info re: options for communication Avoid details re: end stage of the disease  Unless asked directly Use phrases like;  If you should need this___  Some people experience____

Obvious Disorder/Intelligible Minimize environmental interference Reduce rate Confirm topics Confirm listener understanding Voice amplification  For Parkinson and PSP Possible AAC assessment/intervention  In specific situations

Reduced Intelligibility Complete AAC assessment  If not already done Prosthetic Aids  Palatal lift, alphabet board etc Reduce breath groups Compensatory strategies* Maintaining communication opportunities* Support group  If warranted

Loss of Useful Speech Total reliance on AAC Develop yes/no system for  mealtimes  emergencies  bed/times of excessive fatigue Eyegaze boards

AAC with Non Progressive Disorders Working backwards TBI  Cognitive deficits CVA  Language disorders, Apraxia B Stem CVA  Cognitive and lang. Skills generally OK

No Useful Speech No useful speech  yes/no system If no recovery beyond this stage;  initial choice making eye gazing or blinking  pointing head or hands  multipurpose electronic AAC device may need scanning due to fatigue

No Useful Speech Re-establishing subsystem control for speech  AAC for interactions  Tx focuses on increasing respiratory support improving phonatory and velopharyngeal control strengthening oral motor musculature coordinating actions of all subsystems

Return of Speech Independent use of natural speech  Compensatory strategies to increase intelligibility  Alphabet board supplementation  AAC for writing? Maximizing speech naturalness  work on appropriate breath groups and stress patterns No detectable speech disorder  Rare

Multimodal Systems Natural speech Gestures High tech  Voice output devices Low tech  Alphabet boards  Picture/word books Writing

Compensatory Strategies For All AAC Users Establish breakdown and resolution strategies Quiet environment Face your listener Adequate lighting Try natural speech but know when to switch to AAC

Maintaining Communication Opportunities for All Users Topic setter cards Alphabet board supplementation Remnant books/memory books Loop tapes/single message tapes Miniboards High Tech for specific situations  Writing, telephone, strangers

Topic Setter Cards Family TV shows Outings Church “Stories” Any hobby or interest

Single Loop Technology Go Talk button records one 10 second message Big Mack Big Step by Step

ABCDEFGHI JKLMNOPQR STUVWXYZ new word

“Almost” Final Thoughts Stakeholders Empowerment Perceived success Vs failure with AAC

“Good communication is as stimulating as black coffee, and just as hard to sleep after.” Anne Morrow Lindbergh