AAC in the adult population

acquired

• Amyotrophic Lateral Sclerosis (ALS)

• Stroke/Aphasia

• Primary Progressive Aphasia (PPA)

• Dementia (Alzheimer’s)

• Traumatic Brain Injury

• Multiple Sclerosis

• Guillain-Barré Syndrome

• Parkinson’s Disease

developmental

Adults with developmental delays

rehabilitation/compensatory

acquired

habilitation

developmental

candidacy model

• Outdated model

• Based on prerequisites and what you can’t do

• People were viewed as “too” Too old, too young, too impaired

• Gatekeepers

• If you don’t have language or a reliable means of communication, how can you be “tested”

participation model

• Endorsed by ASHA

• Based on functional participation requirements of peers without disabilities who are the same age

• How do we remove barriers

• Looks at communication needs for today and in the future

2 types of Amyotrophic Lateral Sclerosis (ALS)

1. bulbar (brainstem)

2. spinal (limb)

bulbar (brainstem) ALS

• Speech and swallowing impacted early

• Dysarthria (slurred speech)

• May have intact limb movement*

spinal (limb) ALS

• Motor impairments in extremities*

• Mild dysarthria

both types of ALS…

• BOTH will eventually lose all ability to speak and move independently

• Extraocular muscles are usually unaffected*

• There might be some cognitive impairment or dementia

what is the typical cause of death of either type of ALS?

respiratory failure

life expectancy of ALS

2-5 years from time of diagnosis

Early Phase of ALS (monitor, prepare, support)

• Time of diagnosis

• Bulbar (brainstem)→Monitor speech rate, speech intelligibility

in the early phase of ALS, when should you initiate an AAC assessment?

Speaking rate of 125 wpm or speech intelligibility <90%

Early Phase of ALS: what do we do?

• Voice Banking/Message Banking

• Preserve communication as long as possible

• Amplification

• Speaking time for special occasions

• Smart Phone app

• Educate/Prepare

Middle Phase of ALS: Assess, recommend, implement

• Identify participation patterns and communication needs

  • (work, social, home, environment)

• Assess AAC needs (high/low tech)

• Help develop operational competence

• Partner support

Middle phase of Bulbar ALS

can still control AAC/technology

Middle phase of Spinal ALS

augmented writing system (work with OT, PT)

Late Phase of ALS: Adapt and accomodate

• Implementation of chosen AAC

• Assess changing needs and provide communication options (ongoing)

• Consider physical changes and adapt communication

Consider physical changes and adapt communication examples

• lying down more (work with OT/PT/ATP)

• what happens when they are out of their wheelchair? (OT/PT/ATP)

Language disorder that affects a person’s ability to communicate

Aphasia

Occur after a stroke, head injury, brain tumor

Aphasia

aphasia vs apraxia deficits

aphasia: Expressive and receptive deficits

apraxia: Impaired intelligibility

Brain disorder in which a person is unable to perform tasks or movements

Apraxia

Disrupts the sequential timing and coordination of articulatory movements

Apraxia

Neurodegenerative disease that causes gradual deterioration of language skills

Primary Progressive Aphasia

Aphasia, Apraxia, PPA recovery

• Recovery is on a continuum

• At each stage of recovery, there are different communication needs

• PPA will work on the opposite continuum

Aphasia, Apraxia, PPA: maximal support

signals for acceptance/rejection

Aphasia, Apraxia, PPA: transitional support

photos, visual scenes

Aphasia, Apraxia, PPA: specific/minimal support

a specific task (e.g., talking at a wedding)

“AAC will interfere with language recovery”

false

What is the role of AAC in Aphasia, Apraxia, PPA?

Caregivers/Communication partner to help co-create messages

__% of caregivers of Aphasia, Apraxia, PPA report any introduction to AAC within first 3 months

50%

What are we going to work on?

• NOT basic wants/needs, medical issues

• To remain socially relevant

• 9 general themes

9 general themes

1. Hobbies

2. Family

3. Travel

4. Work

5. Home/Places I’ve lived

6. Sports/Fitness

7. Religion

8. Animals

9. WWII

Social Media/Technology intervention→

share photos, tell a story can synchronous or asynchronous

Share photos intervention→

visual scenes (hi-tech), wallet of photos (low- tech)

Story Telling intervention→

visual scenes (hi/low tech options)

If someone can’t understand you→

gesture, write

Input/Comprehension intervention→

gesture, write keywords, draw, first letter/letter board (augmented input)

Written Choice intervention→

partner scanning

Pre-stored messages examples

hello, I have aphasia, please give me time

Guillain-Barré Syndrome tx:

short-term, low-tech options, yes/no, eye blinks

Parkinson’s Disease tx:

assistive technology (e.g., speech amplifier)

Multiple Sclerosis tx:

assistive technology, specific to the individual