Transcript Strategic Use in Context: Alternative Communication

Part II:
Specific AAC-Based
Communication Strategies
for People with Severe
Aphasia
34
A. Overview of 6 Categories
of Communicators
Garrett & Lasker, © 2004
PARTNER DEPENDENT COMMUNICATORS
1.
EMERGING (BASIC CHOICE) COMMUNICATORS
2.
CONTEXTUAL C HOICE COMMUNICATORS
3.
TRANSITIONAL COMMUNICATORS
35
Overview of 6 Categories of
Communicators cont.
INDEPENDENT COMMUNICATORS
4.
STORED MESSAGE COMMUNICATORS
5.
GENERATIVE COMMUNICATORS
6.
SPECIFIC NEEDS COMMUNICATORS
36
The categories represent a continuum of
communication ability…
37
The skills:

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

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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
38
The point…

MATCH communicators to an
optimal package of communication
strategies and systems.
39
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
40
B. Descriptions/Illustrations
of Specific Communicator
Categories
41
PARTNER DEPENDENT
COMMUNICATORS
42
1. Emerging (Basic Choice)
Communicator

Characteristics:

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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 severeprofound developmental disabilities
43
John: age 59, AQ = .6/100, 7 years post onset,
profound aphasia across modalities,
nonspeaking, severe limb and oral apraxia
44
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
45
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)
46
Dan Fink (my
grandfather) – featured
in his reminiscing
album.
Multi-infarct aphasia
and vascular dementia.
Goals: to point
reference), recognize,
comment appropriately
as able
47
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)
48
George’s
own x on
3rd turn
49
Lethargic, minimally responsive patient indicated a clear
rejection signal for the 1st time in response to this picture
50
John choosing fast food items (objects first,
then corresponding symbols on VOCA)
51
John learning to choose between 4 symbolic (photo)
representations of favorite activities
52
1. Emerging (Basic Choice)
Communicator cont.
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Specific Strategies -- Partner:
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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
53
Video of John
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Activity: xxxxxx
Data derived from a 12 month tx
period


1X week individual tx
1X week group tx
54
% of Communication
Signals/Total Opportunities
Changes in Number of Behaviors from Communication Interview
(modified from Schuler, Peck, Willard, & Theimer, 1989):
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
54%58%
PreTx
PostTx
26%
18%
11%
0%
Preintentional
Intentional
and Symbolic
Percentage of preintentional, intentional, and
intentional/symbolic communication behaviors (total # behaviors
rated = 14; total # of ratings = 159; 82% intrarater reliability)
55
Changes in target communication behaviors
PreTreatment
PostTreatment
10%
70%-100%
Answers Written
Choice Q uestions
0%
85%
Requests Contextual
Objects (from routine)
By pointing to
pictures or Dynavox
symbols
0%
83%
Max cues
75% min.
cues
Answers Tagged Y/N
Questions
References others
prior to
communicating
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2. Contextual Choice
Communicator
57
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Characteristics:
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Show a desire to communicate, but often
can’t initiate request, questions or
comments
Emerging symbolic communication skills
– but extremely limited use for
communication

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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.
58
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Often have poor auditory
comprehension skills as well


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Better comprehension in contextual
situations
But often nod as if understanding (but
don’t!)
Have difficulty following
conversational topic shifts
59
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Characteristics cont.:
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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
60
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Treatment Focus:
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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…)
61

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
62
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:
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1) Written Word Choices
2) Points on a Scale
3) Locations on a Map
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In this strategy, the partner scaffolds the
conversation by...
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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
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Written Choice Sample Conversation #1
Friend:
“Can you give me advice on what to make
for the school bake sale tomorrow?”
 example
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:
Continued…
[Points to brownies]
65
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!
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Friend:
[Pause] what do you think about the
kids’ elementary school? Do you think
they’re getting a good education or a soso one? [writes a rating scale on the
page]
Bad
So-So
Good
-------|--------|----------|---------|---------|-
1
PWA:
2
3
4
5
[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]
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While drawing … say and point
to locations: “Right here in
Nebraska? Up to Minnesota to
fish? California, where it’s
warm…?
Conversational Question: “Where have you traveled?”
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Goals of Written Choice Technique

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Increase PWA’s participation in meaningful
social conversations
Establish social closeness
Can also use for communication of

Functional needs and wants
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E.g.,
* Aspirin?
* Milk of Magnesia?
Functional information transfer
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E.g., Your daughter lives….
* Pennsylvania?
* New York?
69
Written Choice Conversation –
Garrett 1993 Dissertation Research
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Data – Three participants with severe
aphasia
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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
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RESULTS
Baseline
Written
Choice
Ave # of
Turns/Topic
2.5
7.5
Range - # of
Topics
5-9
1-2
Ave %
Understandability
15%
97%
Ave % Response
Accuracy
93%
92%
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72
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
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
Other findings:
 Subjects often requested written
choices by pointing to tablet –
even in 2nd 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.
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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?”)
75
Followup study: Lasker, Hux, Garrett,
Moncrief, & Eischeid (1997)
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3 participants
3 modes of presentation
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Auditory-visual choices
Auditory only
Visual placement only
Outcomes: each person differed in
terms of BEST mode of presentation
76
The point...

Assess whether your client benefits
from:

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Presenting choices through all
modalities
Needs auditory choices only
Needs a visual reference point only
Regardless, it works!
77
Audience Participation
Activity

Try written choice technique


Option A: 1 volunteer on overhead
Option B: with each other
78
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The second strategy
for PWA
.
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b.
When cued, learn to ask
questions by pointing,
gesturing, and/or using
rising intonation
(“uh...point]?”)
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c. Answer partner’s tagged “yes/no”
questions with reliable gestures,
head nods, or verbal responses
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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 upand-down.
80

d. Visually attend to partner’s
presentation of augmented input;

indicate via head nods, yes/no
responses, or vocalizations
whether message was
understood
81
The communication
partner has a
significant role with
the contextual
choice
communicator…
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Specific Strategies -- Partner:

a. Implement Written Choice Strategy


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Identify interesting conversational topics
Learn to generate consecutive,
meaningful, conversational questions
Learn to generate potential/possible
answers in the form of choices or scales
83

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)?”
84

Specific Strategies -- Partner cont.:
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c. Utilized “augmented
comprehension” strategies when
PWA doesn’t appear to
understand incoming auditory
messages.
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Write down:

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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
85
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:

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a) writing key words on paper
b) gesturing symbolically
c) gesturing deictically (pointing)
d) pantomiming
3. Recheck’s PWA’s comprehension (“Got it?”)
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using his notebook computer in reverse – to augment Dr.
D’s comprehension of a discussion about politics.
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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
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
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
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The Story of Richard….
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Therapy history
Premorbid skills
Progress on Natural Communication
Skills
Progress on Augmentative
Strategies
Ultimate level of Participation/Life
activities
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3. Transitional Communicator
Q u ic k T im e ™ a n d a
YUV4 2 0 c o d e c d e c o m p r e s s o r
a r e n e e d e d t o s e e t h is p ci t u r e .
91
Characteristics
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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
92

Treatment Focus


Assist PWA to transition to selfinitiated 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)
93

Specific Strategies -- PWA



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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
94
Violet learning to signal for assistance
95

e. Answer predictable questions (e.g.,
autobiographical, topical) by searching
for, selecting and pointing to prestored messages on a simple VOCA
I was in the
Korean War
The NAVY
We never got hit
2 years only
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QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
Fred answers
conversational
questions about
farming given
scripted support,
min cues, and
clinician-selected
vocabulary on
VOCA
Video Clip
97

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
98
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
99
Constructed Topic Setter
100
Steve pointing to topic setter to
converse about plane crash
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
101
Graphic Context Study: Results
Garrett & Huth, 2002


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Increased initiations with topic setter,
especially for current events vs. personal
events
Increased message successfulness, but
mostly with 1st vs. 2nd partner, and mostly
for current events (2nd partner was a good
guesser regardless of amount of context
that was available)
Video if time
Instructional implications….
102

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

103
Storytelling content vs.
needs/requests
My name
is George
My wife’s
name is
Laura.
I’m from
Omaha,
Nebraska
What time is it?
I worked
in the
Stockyards
Coffee Please
Storytelling
T.V.
Needs
104
Jeff telling a “fish story”
Video Illustration
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
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A Quick Review: Types of Voice Output
Communication Aids (VOCAs)



Synthesized Speech
Devices
Large capacity devices
Program sound-bysound -- 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
106
Examples of Digitized
Message VOCAs -- 4 to 32
message spaces per level

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
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

Go Talk (Attainment Company)
Tech Speak (Assistive Technology, Inc.)
Cheap Talk (Great Talking Box Co.)
Message Mate (Words+)
Black Hawk (Adamlab)
DynaMyte (Dynavox, Inc.)
107
Tech Talk 32 -- AMDi
108
Cheap Talk
(Great Talking Box Company)
109
ss. Synthesized Speech
VOCAs: Dynavox Series 4 and
Dynamyte
110

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).”
111
INDEPENDENT
COMMUNICATORS
112
113
4. Stored Message
Communicator
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
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
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
115

Often uses natural communication
modalities to communicate specific
information
Gestures
 First letter spelling, number writing, airwriting, 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
116

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
117

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

118
Bus Page
Drop me off at the:
* VA Hospital
* Vet’s club
* Duquesne Clinic
* Kaufmann’s downtown
When is the next bus?
Environmentallyorganized
vocabulary
* to the South Side
* to downtown
* to the stadium
It helps if the bus can “KNEEL”
Do I need a transfer?
119

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
120
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
121


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
122

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
123
5. Generative Communicator

“go anywhere -- say anything”
QuickTime™ and a
YUV420 codec decompressor
are needed to see this picture.
124

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, airwriting, drawing, stereotypic phrases,
intonation, some semantically specific
words or short phrases)
125
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
126

Specific Strategies - PWA:

a. Initiate introduction of self AND
communication strategies
Mike J: Broca’stype aphasia (AQ
= 47/100)
127

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

128

c. Establish topics prior to
communicating complex
conversational information



Tangible topic setters
Verbally
Topic card
129

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
130
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
131
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)
132

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”.
133

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.

134
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

135

j. Spell/write partial or complete
words/phrases to generate novel
messages
136
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
137
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
138

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
139
Multimodal System Examples and
Components

1. Multi-modal Communication
Notebook
140
Cover &
Explanation Card.
****
Can obtain premade cards from
the (U.S.) National
Aphasia
Association (NAA)
141
142
Bus Page
Drop me off at the:
* VA Hospital
* Vet’s club
* Duquesne Clinic
* Kaufmann’s downtown
Environmentallyorganized
vocabulary
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?
143
Timeline to Organize Autobiographical Storytelling
144
Preconstructed outline map to communicate
familiar place names (vs. say “North Platte”)
145
Sample of natural drawing &
writing – paper & pen
146
“It was over…”
147
Slide with breakdown phrases
148
Modality Instruction Card
149
Video – Mike J.

Comprehensive Communicator


Pre-intervention (with wife)
Post Intervention (with Marcie)
150
Mike J’s Comprehensive
Communicator Data
Garrett, Beukelman & Low (1989)
Measure
# Turns
Pre-AAC
51
Post AAC
88
# Initiations
12
42
% Initiations
24%
47%
Ave # Turns Per
Breakdown Sequence
15
4
% of Turns spent on
resolving
Communication
Breakdowns
46%
11%
151
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.
152
Multilevel, high tech AAC
Device - Dynavox
153
C-Speak Aphasia
(Nicholas & Elliot – available through Mayer
Johnson. Computer-based software – combine with
Speaking Dynamically software)

154
Talk Boards
(Dundee University – available through Mayer
Johnson. Also requires Speaking Dynamically Pro)

155
Other “brands”:




Talking Screen (words+): install on
laptop
Lingraphica (now marketed as a
language training tool – similar to CSpeak Aphasia)
Chat PC
Portable Impact
156
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?
157
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





Spelling assistance/spell checker
Resources



Communicator types S + L
computer generates slow, slam, slick, slide
Communicator hits key to choose desired word
Article by Hux (see reference list)
Don Johnston – Mfr. Of Co: Writer
Video – Dr. A – if time
158
Enkidu Portable Impact
Devices with
Spelling/Prediction/Phrases
159

Specific Strategies - Clinicians/
Partners:

a.
b.

c.

d.

Assist in compiling vocabulary
Interpret and guess at
appropriate moments in
conversations
Encourage PWA to try another
modality
Encourage use of conversational
control strategies
160
6. Specific Need
Communicators

“I can
communicate
just fine
except
when…..”
161

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
162
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
163

Treatment Focus:

Develop highly specific AAC miniinterventions to increase participation
in important life activities:
family rituals/activities
 communicating needs in the community
 writing supports
 telephone assists

164

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
165
GROCERY LIST
We need to buy:
Day:
FOOD
CLEANING SUPPLIES
Drinks
•Bath Soap
•Soft Soap
•Beer
•Milk
•Coffee
•Toilet Paper
•Ajax
•Bleach
•Tea
•Juice
•Scouring Pads
•Paper Towels
-OJ
-Grapefruit
• Soda
-Pepsi
-Coke
-7-up
Groceries Request
List – Mary’s story
COSMETICS
•Shampoo
•Deodorant
•Bandaids
•Shaving Cream
BASICS
•Bread
• Rice
•Cheese
•Margarine
• Macaroni
• Spaghetti Noodles
•Ketchup
•Mustard
•Mayonnaise
• Spaghetti Sauce
• Lettuce
• Onions
•Salt
• Pepper
MEATS
•Hamburger
•Tuna
•Chicken Breast
•Bacon
•Ribeye
•Delmonico's
166
Numbers page
with printed out
numerical words
to assist an
individual with
severe semantic
paraphasias
(especially for
numbers) to
communicate
numerical info by
telephone
167
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_______________________________
168
List of Word and Phrase Choices
Jan
Feb
July
March
Aug
April
Sept
May
Oct
Nov
June
Dec
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?
...is it going?
...is your family?
------------------------------------------------------------------------------------------------------5.
fine
OK
pretty good
terrific
a little tired
-------------------------------------------------------------------------------------------------------
169
Elaine’s letter copied
onto script
Elaine’s letter using
script as a reference
170
6. Specific Need Communicator
cont.

Specific Strategies -- Partners:


a. Identify specific situations and
specific messages
b. Provide opportunities to use
system components
Audience Application Activity:
Identify appropriate tx strategies for cases
171
Note….

The nature of AAC-type
interventions to meet specific needs
is only limited by the team’s
creativity!
172