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Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC

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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 – PowerPoint PPT presentation

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Title: Cognitive-Linguistic Profiles of Aphasic Communicators Who Use AAC


1
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-Heari
ng Association Convention November 22,
2003 Chicago, IL
2
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?

3
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

4
Cognition and Aphasia
  • Aspects of cognition related to aphasia may
    include (Purdy, 2001 Hinckley, 2002)
  • attention
  • memory
  • executive function skills
  • resource allocation
  • pragmatics

5
Demands of AAC Techniques
  • Think to initiate communication through external
    means -- outside of the communicators 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

6
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

7
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.

8
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.

9
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 individuals
    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

10
Testable Hypothesis
  • Certain measures of cognition may serve as
    reasonable predictors of an individuals ability
    to use an AAC system to communicate meaningfully.

11
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

12
Proposed Test Battery
  • Western Aphasia Battery (Kertesz, 1982)
  • Ravens Coloured Progressive Matrices (Raven,
    Raven, Court, 1998)
  • Cognitive-Linguistic Quick Test (Helm-Estabrooks,
    2001)
  • Wisconsin Card Sort Task (Kongs, Thompson,
    Iverson, 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)

13
One ComparisonWAB Writing Task
14
Clients Written Responses
MH
JK
RM
15
The Multimodal Communication Screening
Video Clip
16
(No Transcript)
17
Ravens Coloured Progressive Matrices
18
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)

19
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

20
Trailmaking taskoops not this
21
Trail Making Example
22
Wisconsin Card Sort Test
  • sort cards by
  • number
  • shape
  • color
  • rules change after 10 correct sorts

23
WCST Example
24
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.

25
Categories of AAC Use
26
Categories (cont.)
27
D. Case Studies
28
On to Pennsylvania folks!
29
JV -- Emerging Communicator
  • WAB AQ - .6/100
  • BASA -- 2nd ile for people with global aphasia
  • Ravens -- 0/36
  • CLQT -- N/A
  • Technology Attitudes
  • Minimal experience
  • Interested in trying technology
  • Required specific training to use symbols to
    request
  • Max assist to locate symbolized messages

30
AA RC -- Contextual Choice Communicators
  • WAB AQ 9.2
  • Reading 11/100
  • Writing 10.5/100
  • Ravens 15/36
  • CLQT
  • Symbol Trails 1/10
  • Design Memory 2/6
  • Mazes 0/8
  • Design Generation 6/13
  • Technology Attitudes
  • Minimal to some computer experience
  • Willing to learn to operate simple AAC systems
  • Less willing to use in real-life

31
SA - Transitional Communicator
  • WAB AQ 93.4
  • Reading 80/100
  • Writing 71/100
  • Praxis 55/60
  • Block Design 7/9
  • Calculation 24/24
  • Ravens 16/20
  • Moderate dysarthria
  • Technology Attitudes
  • Moderate computer experience
  • Interested in Palmtop PC-type device because of
    social acceptability

32
GW--Deferred Technology User
  • WAB 35
  • Brocas profile
  • 1 year post onset
  • Lawyer
  • Computer experience
  • Technology Attitudes --
  • No interest in learning to use AAC at present

33
Florida AAC/Aphasia Clients
34
Client MH
  • 52-year old woman
  • left CVA in March, 2001
  • 2 years post
  • 14 years of education
  • right hemiparesis
  • lives with mother who is in frail health
  • completed assessment phase of project before
    relocation
  • diagnosed with moderate receptive and severe
    expressive aphasia
  • limited speech therapy

35
MH - Results
36
MH - Results
37
MH AAC Trials
38
MH Strengths Challenges
  • Challenges
  • emotional issues
  • frustration
  • sadness
  • anxiety
  • social isolation
  • impaired auditory comprehension
  • impaired executive skills
  • severity of speech deficit
  • Strengths
  • reading
  • writing
  • motivation

39
MH Current Status
  • relocated after assessment
  • currently not receiving any services
  • SLP attempting to contact an area SLP to continue
    intervention and device trial

40
Client JK
  • 53-year-old tenured geography professor
  • earned doctorate
  • left CVA in 3/2001
  • 8 months post at first visit
  • employed by university for 21 years (since 1982)
  • lives with husband (also a professor) and young
    daughter (5 years old)
  • diagnosed with moderate expressive aphasia and
    mild receptive aphasia

41
JK - Results
42
JK - Results
43
JK AAC Trials
44
Student Evaluations First Teaching Experience
After Stroke
  • It was very interesting to see how Dr. Kodras
    put her sentences together and got her point
    across to the class.
  • Topic ---- instructor ---- extremely well versed
    ---- passionate about topic ---- makes all
    difference ----- instructor ----- exceptional.
  • I could see that living with aphasia does not
    mean that you have to stop living.

45
JK Strengths and Challenges
  • Challenges
  • communication needs
  • impaired executive skills
  • Strengths
  • reading
  • writing
  • motivation
  • education?
  • familiarity with technology
  • family support

46
JK Current Status
  • Participating in intervention to utilize a
    combination of EZ Keys and Key Word Teaching to
    lecture to her graduate classes.
  • Continues to use EZ Keys to prepare lectures.
  • Continues to negotiate support from department.

47
Client RM
  • 62-year-old
  • education 14 years
  • retired airport manager
  • left CVA occurred 1995
  • diagnosed with moderate aphasia and
    moderate-severe apraxia of speech

48
RM - Results
49
RM - Results
50
RM AAC Trials
51
Message Behaviors
52
Device Usage - Press Behaviors
  • I like a cheeseburger and coke please.

53
RM Challenges and Strengths
  • Challenges
  • poor spelling
  • unable to use word-based pages on device
    effectively
  • resistant to change of relatively inefficient
    layout of device
  • automaticity?
  • familiarity?
  • Strengths
  • positive attitude about everything
  • multimodal to the extreme
  • willing to use device in public, on phone, as
    email tool

54
RM Current Status
  • increase and enhance facilitative behaviors on
    device
  • category-based word search
  • word by word formulation
  • decrease non-facilitative behaviors
  • inappropriate topic setting
  • device navigation
  • participating in motor-based learning study to
    increase speech output
  • acts as ambassador and community educator

55
E. Summing Up
  • What did we learn?

56
Salient Subtests on CLQT
57
Categories of AAC Use
JV
AA and RC
58
Categories (cont.)
MH and SA
RM and JK
59
E. Summary What did we learn?
  • Clinician judgment (via AAC trials)
    differentiated independent from partner-dependent
    communicators.
  • Test results verified these judgments.
  • Potential suspects for determining outcome
    likely a complex picture. . .
  • AQs
  • expressive writing task
  • attitude toward AAC system
  • cognitive tasks on CLQT

60
As always
  • Further research is warranted
  • Your comments are appreciated
  • Handouts give us one week to post them on the
    ASHA website
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