AAC for TBI

prevalence of TBI

APPROXIMATELY 2.5. MILLION ER VISITS OCCUR YEARLY DUE TO TBIS IN THE

U.S.(CENTERS FOR DISEASE CONTROL AND PREVENTION, 2019

Rancho levels of cognitive functioning scale

• DESCRIBES COGNITIVE AND LANGUAGE BEHAVIORS THAT OCCUR DURING RECOVERY

•• AAC TEAMS USE THESE TYPES OF SCALES TO GUIDE THE DESIGN OF AAC AND OTHER INTERVENTIONS BASED ON

THE APPROPRIATE STAGE

TBI COMMUNICATION DISORDERS ARE THE RESULT OF…

SOME LANGUAGE CHARACTERISTICS ARE A CONSEQUENCE OF COGNITIVE IMPAIRMENTS

•• LANGUAGE DISORDERS MAY OCCUR DUE TO DAMAGE TO A SPECIFIC LANGUAGE-PROCESSING AREA OF THE BRAIN

•• SOME COMMUNICATION DISORDERS ARE CAUSED BY DAMAGE TO THE MOTOR CONTROL NETWORKS AND

PATHWAYS OF THE BRAIN THAT OCCURRED DURING TIME OF INJURY.

3 levels of recovery

1. the early stage

2. the middle stage

3. the late stage

assessment during th4e early stage

• aac team attempts very little formal

  assessment.

  • The team documents observations of

  changes in the individual's responses

  and identifies functional mobility.

  Families can assist with this!

intervention in early stage

• goal should be to increase

consistency of responses into

meaningful communication.

• Limit the number of symbols (1-4)

• Make symbols brightly

colored/exaggerated

• Stimuli should be motivating and

personally relevant

assessment in middle stage

• Identify residual capabilities that the individual can use to achieve communication goals.

• Seating and postural adaptations

• Motor control capabilities to determine direct selection or scanning options

• Memory and attention capabilities (early scanning should be either circular or linear, complex scanning

consists of row-column or group-item)

• Visual perceptual and visual acuity (cortical blindness or visual field cuts)

what rancho level is the early stage?

levels 1,2, and 3

what rancho level is the middle stage?

level 4 and 5

what rancho level is the late stage?

6,7, and 8

intervention in middle stage

Choose 1-2 goals to target that relate to wants, needs, and info sharing

• Nonelectric (i.e., alphabet boards, pictures, yes/no techniques) or a single or limited number of displays

• Encoding is almost always too difficult at this stage

• Can choose small activity displays with specific content, rather than large, complex communication boards

containing multiple areas of interest

• Use good organization of items

• Can use single switches

• Communication partners play an integral role in this stage (help to structure interactions, introduce topics for

conversations, etc

assessment for late stage

• Can use the Participation Model to guide assessment and intervention

planning

• Assess for opportunity barriers

• Identify communication needs, capabilities/constraints, and use this to

personalize AAC interventions

intervention for late stage

• Individuals are generally oriented and able to demonstrate goal-

directed and socially appropriate behaviors

• However, they may still have difficulty with learning new information

because of residual cognitive impairments

• Many people in this stage can interact and converse with their

families/friends through natural speech.

• May require AAC for writing support or long-term communication

support

• Can target wants/needs, share info, achieve social closeness, social

etiquette routines