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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.
IIINNNDDDEEEPPPEEENNNDDDEEENNNTTT CCCOOOMMMMMMUUUNNNIIICCCAAATTTOOORRRSSS
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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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)
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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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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)
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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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1. Emerging (Basic Choice) Communicator cont.
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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Discussion!!!
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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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Dr. D. choosing a topic of discussion
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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]
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Steve’s wife, Diane, offering him choices about a wedding present
38Conversational 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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Video Neil with daughter OR Steve with his wife Diane
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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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Dr. D pointing to ask his wife a question
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John asking Sara for more info following HOH: now does spontaneously approximately 50% of the time
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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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Discussion!!!
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3. Transitional Communicator
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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
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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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“Look at me -- I’m communicating with no cues!”
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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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Some multimodal communication
“It was over…”
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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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Vanguard (PRC) with Minspeak software
++TIME =
Let’s get the mail now!
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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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Categories of Communicators Revisited
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Discussion
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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
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Stories about Specific Needs Communicators….
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Note…. The nature of AAC-type
interventions to meet specific needs is only limited by the team’s creativity!
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6. Specific Need Communicator cont.
Specific Strategies -- Partners: a. Identify specific situations and
specific messages b. Provide opportunities to use system
components
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Video – if time
Grace on telephone with husband
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Audience Participation Activity
Select a case packet Identify the “type” of
communicator Identify client
strategies Identify partner
strategies Select someone to
report on decisions