SLP 548 AAC Midterm Study Guide

AAC

Augmentative & alternative communication refers to all forms of communication (other than unimpaired natural speech) that are used to express thoughts, needs, wants and ideas.

Unaided AAC

No external equipment is used; examples include gestures, sign language, and facial expressions.

Aided AAC

Uses external tools/devices, ranging from low-tech (communication boards, picture cards) to high-tech (speech-generating devices, apps).

Communication Competencies

For a person using AAC to be communicatively competent, they must achieve functional, adequate, efficient communication in their contexts.

Linguistic Competence

Knowledge of language (vocabulary, grammar) in spoken/written and AAC modes.

Operational Competence

Technical skills required to use the AAC system, including accessing, selecting messages, and using the device.

Social Competence

Skills of interaction, social conventions, pragmatics, turn-taking, initiating, and sustaining conversation.

Strategic Competence

Compensatory strategies used when breakdowns occur, such as repair, alternative access, and partner assistance.

Key Considerations for AAC Recommendation

Includes the person's expressive and receptive communication skills, prognosis of speech production, access capabilities, social and participation demands, preferences, motivation, environment, technology, cost, maintenance, and the risk of withholding.

Right to Use AAC

Individuals who require AAC have the right to communicate in all life-domains/contexts.

Core vocabulary

A small set of words used very frequently across contexts (e.g., 'go', 'want', 'more', 'it', 'I').

Fringe vocabulary

More specific words, personal to the individual, less frequent (e.g., 'guitar', 'volleyball', 'mom's car').

Participation Model

A framework to guide AAC assessment/intervention with a participation-focus (i.e., what participation the individual needs).

Current participation patterns

What does the person currently do, with whom, how often?

Desired participation

What do they need or want to do (education, community, employment, social)?

Communication supports

What supports the person now, including barriers and facilitators?

AAC assessment process

Typically includes referral and screening, comprehensive assessment, intervention planning, implementation and monitoring, and follow-up and evaluation.

Referral and screening

Identify potential users of AAC (people whose speech cannot meet their needs).

Comprehensive assessment

A multi-disciplinary team (SLP, OT, PT, educator, engineers, family) evaluates current communication abilities, motor, sensory, cognitive, perception, vision/hearing, literacy skills.

Current communication abilities

Expressive/receptive language, speech intelligibility, existing communication modes.

Motor, sensory, cognitive, perception, vision/hearing, literacy skills

Skills assessed during the comprehensive AAC assessment.

Access methods

What physical/motor movements are available for selection.

Environment and participation demands

What are the communication contexts, partners, tasks.

Symbol and message needs

What vocabulary, what layouts, message types are required.

Device/system evaluation

Consideration of aided systems and technology.

Partner and system factors

Training, funding, and support related to AAC use.

Intervention planning

Select appropriate AAC system and set goals.

Implementation and monitoring

Trial device/system, evaluate effectiveness, adjust.

Follow-up and evaluation

On-going monitoring of participation, performance, satisfaction.

Acquired communication disorders

Disruptions in previously intact communication abilities due to an event or disease.

Etiologies of acquired communication disorders

Common causes include stroke, traumatic brain injury, degenerative neurological diseases, apraxia of speech, head and neck cancer, and progressive cognitive-linguistic conditions.

Stroke

A sudden onset event that can lead to acquired communication disorders, including aphasia.

Traumatic brain injury (TBI)

Injury to the brain caused by an external force, often resulting in communication disorders.

Degenerative neurological diseases

Conditions like Amyotrophic Lateral Sclerosis (ALS), Primary Progressive Aphasia, and Parkinson's Disease that progressively impair communication.

Apraxia of speech

A neurologic impairment affecting motor planning for speech.

Head and neck cancer

Cancer that affects speech, often requiring surgery or radiation.

Progressive cognitive-linguistic conditions

Conditions such as dementia that lead to a decline in cognitive and linguistic abilities.

Signs/symptoms of degenerative conditions

Includes progressive decline in speech intelligibility, comprehension issues, and motor planning impairments.

Fatigue and dual-task difficulties

Challenges that affect communication in adults with degenerative or cognitive/linguistic conditions.

AAC intervention

Augmentative and alternative communication strategies that must consider anticipated decline and focus on participation and quality of life.

Four competencies

The essential skills needed for effective communication, including linguistic, operational, social, and strategic competencies.

Monitoring AAC effectiveness

The process of evaluating whether AAC systems enable participation and making necessary adjustments.

Partner training

Training provided to communication partners to effectively support individuals using AAC.

Cognition and language impact

The effects of cognitive impairments on language processing and communication abilities.

Speech intelligibility

The clarity of speech that can decline in individuals with degenerative conditions.

Word-finding difficulties

Challenges in retrieving words during communication, often seen in conditions like dementia.

Executive function

Cognitive processes that manage and regulate other cognitive abilities, impacting language use.

Motor access methods

Techniques used to operate AAC devices, which may be impaired in degenerative conditions.

Early introduction of AAC

Even if some speech remains, to ensure communication access and prevent isolation.

Customized device/access

Selecting suitable access (e.g., eye‐gaze, switch scanning) given motor or cognitive limitations.

Vocabulary and message planning

Focusing on urgent/essential messages (medical, emergency, daily needs), then expanding to social, leisure, employment.

Training communication partners

Family, caregivers, clinicians must learn to facilitate, model AAC use, create opportunities.

Integration in natural contexts

Embedding AAC use in daily routines, clinical contexts, community, employment.

Monitoring & adaptation

Assuming change over time (especially degenerative conditions) - plan for transition, system upgrades, decrease complexity or increase supports as needed.

Focus on participation and quality of life

Beyond speech replacement, supporting the person's engagement in meaningful life roles.

Literacy supports

For those able, providing reading/writing options to increase generative communication.

Emerging communicators

Those with very limited functional speech or none, heavy reliance on AAC for basic needs.

Context-dependent communicators

Can communicate in familiar contexts, with familiar partners, but struggle in new or complex contexts, need support.

Independent communicators

Able to use AAC with minimal support across contexts, may use generative communication, literate modes.

High support

Constant partner assistance, partner‐scanning, minimal independent use of device; perhaps large symbols, simple layout.

Moderate support

Some independent use, partner scaffolding, some generative capability, require training and system optimization.

Low support / minimal support

User operates AAC independently in many contexts, minimal partner assistance, capable of device maintenance, vocabulary expansion, literacy.

Types of AAC

Unaided vs Aided; consider motor/access, language, participation

Recommend/withhold AAC

When natural speech insufficient; consider access, participation, prognosis, supports

Areas of right to use AAC

Social, education, employment, community, health care, independence

Vocabulary & messages

Core vs Fringe; message management; symbol representation; generative vs fixed

AAC assessment components

Referral/screening; current abilities; access; environment/participation; device evaluation; planning; follow-up

Acquired communication etiologies

Stroke, TBI, degenerative diseases (ALS, PPA, Parkinson's), apraxia, cancer, etc

Signs/symptoms of degenerative/cognitive/linguistic conditions

Declining speech intelligibility, comprehension, memory/attention/executive impairments, motor access changes

Intervention strategies for acquired disorders

Early AAC introduction; customized access; partner training; vocabulary planning; participation focus; monitoring & adaptation; literacy supports

Categories of communicators & levels of support

Emerging/Context-dependent/Independent; High/Moderate/Low support levels; apply to aphasia/apraxia populations

Emergent Communicator

Most help- no reliable method of symbolic communication (often severe global aphasia)

Contextual Choice Communicator

High support- can indicate basic needs/choices when options are provided. Cannot generate novel messages

Transitional Communicator

Moderate help- starts to use AAC independently but still requires support to initiate or clarify

Stored Message Communicator

Moderate/low help- Can use stored phrases/messages but cannot always generate new content

Comprehensive/generative Communicator

Minimal help- Can combine symbols/words to create novel messages w/ AAC

Specific Need Communicator

Least Help- Independent speaker who only needs AAC in specific situations (phone, noisy environment, fatigue, etc.)

Order of AAC Communicator Categories (Most to Least Support)

Emergent Communicator -> Contextual Choice Communicator -> Transitional Communicator -> Stored Message Communicator -> Comprehensive Communicator -> Specific Need Communicator

ALS

UMN & LMN degenerative (no regeneration). Progressive muscle weakness

MS

Demyelination in the CNS (progressive). Axons damaged but some remyelination possible

Guillain-Barre Syndrome (GBS)

Immune systen attacks myelin in the PNS. Axons in PNS CAN regenerate

Brainstem Stroke

Vascular (CNS). Damage to cranial nerve nuclei. Static or gradual improvement. Severe dysarthria

Cortical Stroke (Left Hemisphere)

Vascular (CNS). Language areas affected. Variable recovery