34 Part II: Specific AAC-Based Communication Strategies for People with Severe Aphasia.

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Part II: Part II: Specific AAC-Based Specific AAC-Based

Communication Strategies Communication Strategies for People with Severe for People with Severe

AphasiaAphasia

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A. Overview of 6 Categories of Communicators

Garrett & Lasker, © 2004

PPPAAARRRTTTNNNEEERRR DDDEEEPPPEEENNNDDDEEENNNTTT CCCOOOMMMMMMUUUNNNIIICCCAAATTTOOORRRSSS

1. EMERGING (BASIC CHOICE) COMMUNICATORS

2. CONTEXTUAL CHOICE COMMUNICATORS

3. TRANSITIONAL COMMUNICATORS

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Overview of 6 Categories of Communicators cont.

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4. STORED MESSAGE COMMUNICATORS

5. GENERATIVE COMMUNICATORS

6. SPECIFIC NEEDS COMMUNICATORS

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The categories represent a continuum of communication ability…

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The skills: 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

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The point… MATCH communicators to an

optimal package of communication strategies and systems.

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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

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B. Descriptions/Illustrations of Specific Communicator

Categories

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PARTNER DEPENDENT COMMUNICATORS

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1. Emerging (Basic Choice) Communicator

Characteristics: 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 severe-

profound developmental disabilities

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John: age 59, AQ = .6/100, 7 years post onset, profound aphasia across modalities, nonspeaking, severe limb and oral apraxia

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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

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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)

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Dan Fink (my grandfather) – featured in his reminiscing album.

Multi-infarct aphasia and vascular dementia.

Goals: to point reference), recognize, comment appropriately as able

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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)

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George’s own x on 3rd turn

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Lethargic, minimally responsive patient indicated a clear rejection signal for the 1st time in response to this picture

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John choosing fast food items (objects first, then corresponding symbols on VOCA)

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John learning to choose between 4 symbolic (photo) representations of favorite activities

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Specific Strategies -- Partner: 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

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Video of John Activity: xxxxxx Data derived from a 12 month tx

period 1X week individual tx 1X week group tx

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Changes in Number of Behaviors from Communication Interview (modified from Schuler, Peck, Willard, & Theimer, 1989):

54%58%

18%26%

0%11%

0%10%20%30%40%50%60%70%80%90%

100%

% of Communication

Signals/Total Opportunities

Preintentional Intentionaland Symbolic

PreTx

PostTx

Percentage of preintentional, intentional, and intentional/symbolic communication behaviors (total # behaviors rated = 14; total # of ratings = 159; 82% intrarater reliability)

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Changes in target communication behaviors

Pre-Treatment

Post-Treatment

Answers Tagged Y/NQuestions 10% 70%-100%

Answers WrittenChoice Questions 0% 85%

Requests ContextualObjects (from routine)By pointing topictures or Dynavoxsymbols

0% 83%

References othersprior tocommunicating

Max cues 75% min.cues

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2. Contextual Choice Communicator

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Characteristics: Show a desire to communicate, but often

can’t initiate request, questions or comments

Emerging symbolic communication skills – but extremely limited use for communication 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.

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Often have poor auditory comprehension skills as well Better comprehension in contextual

situations But often nod as if understanding (but

don’t!) Have difficulty following

conversational topic shifts

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Characteristics cont.: 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

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Treatment Focus: 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…)

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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

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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: 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...

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

example

Friend: “Can you give me advice on what to make for the school bake sale tomorrow?”

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: [Points to brownies]

Continued…

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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 so-so one? [writes a rating scale on the page]

Bad So-So Good

-------|--------|----------|---------|---------|-

1 2 3 4 5

PWA: [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]

35Conversational Question: “Where have you traveled?”

While drawing … say and point to locations: “Right here in Nebraska? Up to Minnesota to fish? California, where it’s warm…?

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Goals of Written Choice Technique

Increase PWA’s participation in meaningful social conversations

Establish social closeness Can also use for communication of

Functional needs and wants E.g., * Aspirin? * Milk of Magnesia?

Functional information transfer E.g., Your daughter lives….

* Pennsylvania?

* New York?

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Written Choice Conversation – Garrett 1993 Dissertation Research

Data – Three participants with severe aphasia 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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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?”)

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Followup study: Lasker, Hux, Garrett, Moncrief, & Eischeid (1997)

3 participants 3 modes of presentation

Auditory-visual choices Auditory only Visual placement only

Outcomes: each person differed in terms of BEST mode of presentation

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The point... Assess whether your client benefits

from: Presenting choices through all

modalities Needs auditory choices only Needs a visual reference point only

Regardless, it works!

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Audience Participation Activity

Try written choice technique Option A: 1 volunteer on overhead Option B: with each other

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. The second strategy for PWA

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

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 up-and-

down.

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d. Visually attend to partner’s presentation of augmented

input; indicate via head nods, yes/no

responses, or vocalizations whether message was understood

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The communication partner has a significant role with the contextual choice communicator…

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Specific Strategies -- Partner:

a. Implement Written Choice Strategy Identify interesting conversational topics Learn to generate consecutive,

meaningful, conversational questions Learn to generate potential/possible

answers in the form of choices or scales

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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)?”

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Specific Strategies -- Partner cont.:

c. Utilized “augmented comprehension” strategies when PWA doesn’t appear to understand incoming auditory messages.

Write down: 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

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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: 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…. 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

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are needed to see this picture.

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Characteristics 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

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Treatment Focus Assist PWA to transition to self-

initiated 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)

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Specific Strategies -- PWA 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

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Violet learning to signal for assistance

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e. Answer predictable questions (e.g., autobiographical, topical) by searching for, selecting and pointing to pre-stored messages on a simple VOCA

I was in the Korean War The NAVY

We never got hit 2 years only

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Fred answers conversational questions about farming given scripted support, min cues, and clinician-selected vocabulary on VOCA





Video Clip

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f. Hand a potential communication partner a tangible topic setter to initiate a conversation

Game ticketArticle from a newspaperCigar from grandchild’s birthSequentially-organized

conversational starter book

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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

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Constructed Topic Setter

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Steve pointing to topic setter to converse about plane crash



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Graphic Context Study: ResultsGarrett & Huth, 2002

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)

Instructional implications…. Video if time

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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

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My name is George

I’m from Omaha, Nebraska

My wife’s name is Laura.

I worked in theStockyards

What time is it?T.V.

Coffee Please

Storytelling content vs. needs/requests

Storytelling Needs

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Jeff telling a “fish story”Video Illustration



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A Quick Review: Types of Voice Output Communication Aids (VOCAs)

Synthesized Speech Devices

Large capacity devices Program sound-by-

sound -- 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

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Examples of Digitized Message VOCAs -- 4 to 32 message spaces per level

Go Talk (Attainment Company) Tech Speak (Assistive Technology, Inc.) Cheap Talk (Great Talking Box Co.) Message Mate (Words+) Black Hawk (Adamlab) DynaMyte (Dynavox, Inc.)

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Tech Talk 32 -- AMDi

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Cheap Talk (Great Talking Box Company)

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ss. Synthesized Speech VOCAs: Dynavox Series 4 and

Dynamyte

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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).”

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INDEPENDENT COMMUNICATORS

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4. Stored Message Communicator



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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

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Often uses natural communication modalities to communicate specific information Gestures First letter spelling, number writing, air-

writing, 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

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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

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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

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Bus Page

Drop me off at the:

* VA Hospital

* Vet’s club

* Duquesne Clinic

* Kaufmann’s downtown

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?

Environmentally- organized vocabulary

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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

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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

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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

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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

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5. Generative Communicator

“go anywhere -- say anything”



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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, air-writing, drawing, stereotypic phrases, intonation, some semantically specific words or short phrases)

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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

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Specific Strategies - PWA:

a. Initiate introduction of self AND communication strategies

Mike J: Broca’s-type aphasia (AQ = 47/100)

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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

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c. Establish topics prior to communicating complex conversational information Tangible topic setters Verbally Topic card

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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

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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

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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)

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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”.

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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.

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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

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j. Spell/write partial or complete words/phrases to generate novel messages

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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

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l. Utilize specific, metacommunicative communication strategies to resolve communication breakdowns in conversationa. 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

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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

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Multimodal System Examples and Components

1. Multi-modal Communication Notebook

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Cover & Explanation Card.

* * * *

Can obtain pre-made cards from the (U.S.) National Aphasia Association (NAA)

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Bus Page

Drop me off at the:

* VA Hospital

* Vet’s club

* Duquesne Clinic

* Kaufmann’s downtown

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?

Environmentally- organized vocabulary

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Timeline to Organize Autobiographical Storytelling

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Preconstructed outline map to communicate familiar place names (vs. say “North Platte”)

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Sample of natural drawing & writing – paper & pen

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“It was over…”

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Slide with breakdown phrases

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Modality Instruction Card

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Video – Mike J. Comprehensive Communicator

Pre-intervention (with wife) Post Intervention (with Marcie)

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Mike J’s Comprehensive Communicator Data

Garrett, Beukelman & Low (1989)

Measure Pre-AAC Post AAC

# Turns 51 88

# Initiations 12 42

% Initiations 24% 47%Ave # Turns Per Breakdown Sequence

15 4

% of Turns spent on resolving Communication Breakdowns

46% 11%

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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.

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Multilevel, high tech AAC Device - Dynavox

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C-Speak Aphasia(Nicholas & Elliot – available through Mayer

Johnson. Computer-based software – combine with Speaking Dynamically software)

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Talk Boards(Dundee University – available through Mayer

Johnson. Also requires Speaking Dynamically Pro)

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Other “brands”: Talking Screen (words+): install on

laptop Lingraphica (now marketed as a

language training tool – similar to C-Speak Aphasia)

Chat PC Portable Impact

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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?

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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

Communicator types S + L computer generates slow, slam, slick, slide Communicator hits key to choose desired word

Spelling assistance/spell checker Resources

Article by Hux (see reference list) Don Johnston – Mfr. Of Co: Writer

Video – Dr. A – if time

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Enkidu Portable Impact Devices with

Spelling/Prediction/Phrases

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Specific Strategies - Clinicians/ Partners: a. Assist in compiling vocabulary b. Interpret and guess at

appropriate moments in conversations

c. Encourage PWA to try another modality

d. Encourage use of conversational control strategies

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6. Specific Need Communicators

“I can communicate just fine except when…..”

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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

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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

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Treatment Focus: Develop highly specific AAC mini-

interventions to increase participation in important life activities: family rituals/activities communicating needs in the community writing supports telephone assists

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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

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GROCERY LIST

We need to buy: Day:

FOOD CLEANING SUPPLIES

•Bath Soap

Drinks •Soft Soap

•Beer •Toilet Paper

•Milk •Ajax

•Coffee •Bleach

•Tea •Scouring Pads

•Juice •Paper Towels

-OJ

-Grapefruit

• Soda COSMETICS

-Pepsi •Shampoo

-Coke •Deodorant

-7-up •Bandaids

•Shaving Cream

BASICS

•Bread • Rice

•Cheese • Macaroni

•Margarine • Spaghetti Noodles

•Ketchup • Spaghetti Sauce

•Mustard • Lettuce

•Mayonnaise • Onions

•Salt • Pepper

MEATS

•Hamburger •Tuna

•Chicken Breast •Ribeye

•Bacon •Delmonico's

Groceries Request List – Mary’s story

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Numbers page with printed out numerical words to assist an individual with severe semantic paraphasias (especially for numbers) to communicate numerical info by telephone

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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_______________________________

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List of Word and Phrase Choices

Jan Feb March April May June

July Aug Sept Oct Nov 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

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2. (Names of family members/friends go here)

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3. Hello! Hi! Howdy! Greetings!

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4. ...are you? ...is it going? ...is your family?

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5. fine OK pretty good terrific a little tired

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Elaine’s letter copied onto script

Elaine’s letter using script as a reference

138

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

139

Note…. The nature of AAC-type

interventions to meet specific needs is only limited by the team’s creativity!

34 Part II: Specific AAC-Based Communication Strategies for People with Severe Aphasia.

Documents

Transcript of 34 Part II: Specific AAC-Based Communication Strategies for People with Severe Aphasia.