ive-Linguistic Profiles of Aphasic Communicators Who Use AAC Joanne P. Lasker, Ph.D. Florida State University Kathryn L. Garrett, Ph.D. Duquesne University Presentation at the American Speech-Language-Hearing Association Convention November 22, 2003 Chicago, IL
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Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC
Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC. Joanne P. Lasker, Ph.D. Florida State University Kathryn L. Garrett, Ph.D. Duquesne University. Presentation at the American Speech-Language-Hearing Association Convention November 22, 2003 Chicago, IL. - PowerPoint PPT Presentation
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Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC
Joanne P. Lasker, Ph.D.
Florida State University
Kathryn L. Garrett, Ph.D.
Duquesne University
Presentation at the American Speech-Language-Hearing Association ConventionNovember 22, 2003
Chicago, IL
A. Statement of the Problem
Many people with severe aphasia have unmet communication needs.
Which individuals with chronic aphasia will benefit from augmentative and alternative communication strategies (AAC)?
Which type/class of AAC strategies? Are there systematic ways of assessing this
issue? Is there a “profile” of an effective AAC
communicator?
B. Cognitive-Linguistic Considerations in AAC
definition of aphasia “Language” or “symbolic deficits” across
modalities Intermittency of processing (Brookshire, 1978;
McNeil, 1983) more recently we have seen attention to
possible cognitive aspects of aphasia
Cognition and Aphasia
Aspects of cognition related to aphasia may include: (Purdy, 2001; Hinckley, 2002) attention memory executive function skills resource allocation pragmatics
Demands of AAC Techniques
Think to initiate communication through external means -- “outside” of the communicator’s own head and language system (Garrett & Kimelman, 2000)
Verbal memory for messages Spatial memory for message location Symbol translation skills -- from icons to meanings Executive function skills -- to judge which method of
communication best fits the situation Attention and perseverance to complete the
message transaction
Resource Allocation to balance the cognitive demands of using a novel form of
communication… …with the pragmatic demands of speaking to a
communication partner And the linguistic demands of encoding messages And any other stressors in the communication environment
Balancing Noise Multiple speakers Multiple topics Interruptions Communication breakdowns
Challenges with AAC and Aphasia Limited information is available re: who is and
is not successful.
“Matching” AAC approaches to skills/needs of communicator involves many variables.
Limited knowledge is available about how to effectively train people with aphasia to use AAC in real-life situations.
Still More Challenges
People with aphasia tend to be isolated, and therefore have limited social opportunities to communicate.
Message pools selected for AAC systems may not be appropriate or meaningful for adults with aphasia.
Negative or ambivalent attitudes toward technology may be held by adults with aphasia and/or communication partners.
Recent Research Helm-Estabrooks (2002) described a case study of a
person with aphasia who used a high tech AAC system (C-Speak Aphasia; Nicholas & Elliot).
Her analysis of the individual’s cognitive-linguistic profile revealed: mild-moderate aphasia as measured by the WAB relatively strong cognitive skills on specific subtests of
the Cognitive-Linguistic Quick Test (Helm-Estabrooks, 2001) Trail Making Design Generation Mazes
Testable Hypothesis
Certain measures of cognition may serve as reasonable predictors of an individual’s ability to use an AAC system to communicate meaningfully.
C. Our Purpose/Design
Case study approach. generate a cognitive-linguistic and behavioral
profile of successful AAC users with aphasia Independent Communicators Partner Dependent Communicators Nonusers
aid in assessment and intervention planning
Proposed Test Battery Western Aphasia Battery (Kertesz, 1982) Raven’s Coloured Progressive Matrices (Raven, Raven, &
Heaton, 2000) Multimodal Communication Screening Task (Garrett, 1998) The Assistive Technology Device Predisposition Assessment
Consumer Form (adapted from Scherer & McKee, 1989 by Lasker & Bedrosian, 2000; under revision)
Categorical Assessment of Communicators with Aphasia (Garrett & Beukelman, 1998; under revision)
One Comparison:WAB Writing Task
Client’s Written Responses
MHJK
RM
The Multimodal Communication Screening
QuickTime™ and aYUV420 codec decompressor
are needed to see this picture.Video Clip
MULTIMODAL COMMUNICATION SCREENING TASK FOR PERSONS WITH APHASIA: SCORESHEET (C) 1997, Kathryn L. Garrett see http:// www.aac.unl .edu for pictoral stimuli that accompany this score sheet
CLIENT NAME: DATE: EVALUATOR: INSTRUCTIONS: Show the person with aphasia the booklet containing the symbolized choices. Explain that the pictures, letters, sentences and maplocations can all be used to communicate ideas. Provide examples if necessary. For each item, ask individual “How would you communicate ? You can usethis book or any other way you have to communicate.” Mark + if all concepts were communicated, +/- if some were communicated, and - if no items werecommunicated . Circle concepts that were successfully conveyed. Record cues if provided. Substitute alternate concepts as appropriate.
Abstract Mult. page Target Symbols Meaning? search needed? +/- Cues Comments A. IDENTIFICATION OF NOUNS BY NAME 1. Shoes Pic/word NO NO 2. Open Door Pic/word NO YES (2) 3. Grandchild Pic/word YES YES (3) 4. Need to buy something Pic/word YES YES (3) 5. State of residence (“Nebraska”) Map or 1st letter NO YES (5)
B. 2-SYMBOL COMBINATIONS 6. I've been walking alot and I'm tired. Pic/word YES NO 7. Open the window; it's too hot. Pic/word NO YES (2) 8. I'm glad my grandkids are visiting Pic/word YES YES (3)
C. 3-SYMBOL COMBINATIONS9. I want to buy some toys for my
grandchildren. Pic/word YES YES (3) 10.The kids are coming next week from Pic/word, map,
name of state or city. or 1st letter YES YES (6) 11.I want to eat an expensive meal at Pic/word, map,
name of favorite restaurant tonight. or1st letter YES YES (6)
D. PHRASE LISTS“Pretend you’re at the drugstore//with your grandkids.” F ind the page thatwill help you do this. Then, tell me how you’d say...”
12. I need more aspirin and shampoo. Phrase list NO NO 13.Please fill my prescription for 2 refills
and write down your instructions for me. Phrase list NO NO 14. Tell me about school. How is your ? Phrase list NO NO
15.Do you do your homework? Are your grades good? Phrase list YES YES (2) SUMMARY & INTERPRETATION: Can this person intentionally locate info on multiple pages? Combine concepts? Use symbols abstractly? Use writtenwords, maps, or the 1st letter of a word? Use other modalities? Answer and initiate questions?
Raven’s Coloured Progressive Matrices
Cognitive-Linguistic Quick Test (Helm-Estabrooks, 2001)
criterion-referenced test relative skills in the areas
of: attention memory language executive function visuospatial skills
does require verbal skills for some tasks (e.g., story retelling)
CLQT – Tasks and Composites
Personal Facts Symbol Cancellation Confrontation Naming Clock Drawing Story Retelling Symbol Trails Generative Naming Design Memory Mazes Design Generation
Yield composite scores: attention memory executive function language visuospatial skills
Trailmaking task…oops …not this…
Trail Making Example
Wisconsin Card Sort Test
sort cards by: number shape color
rules change after 10 correct sorts
WCST Example
Sample questions from the “Technology Predisposition Survey”
I will benefit from using this AAC system. This AAC system will help me achieve a goal that I
have. I will feel comfortable using this AAC system in
public. This AAC system will improve the quality of my life. I will feel comfortable using this AAC system around
my family.
Categories of AAC Use
Partner-Dependent Communicators
Emerging Communicators
Contextual Choice Communicators
Augmented Input Communicators
Categories (cont.)
Independent Communicators
Transitional Communicators
Stored Message Communicators
Generative Communicators
D. Case Studies
On to Pennsylvania folks!
QuickTime™ and aTIFF (Uncompressed) decompressor
are needed to see this picture.
JV -- Emerging Communicator WAB AQ - .6/100 BASA -- 2nd %ile for people
with global aphasia Raven’s -- 0/36 CLQT -- N/A Technology Attitudes