Caregiver Training in an AAC Intervention for Severe Aphasia

Initial interventions for individuals with severe aphasia usually focus on increasing comprehension and verbal expression with the eventual goal of restoring functional communication. However, many individuals with severe aphasia do not achieve sufficient language capacity for successful, functional communication. Recently, compensatory strategies including augmentative and alternative communication (AAC) have been implemented with this population (Beukelman, Fager, Ball & Dietz, 2007; Henry, 2010; McKelvey, Hux, Dietz & Beukelman, 2010). The American Speech-Language-Hearing Association (2005) supplement, entitled 'Knowledge and skills needed by speech-language pathologists providing services to individuals with cognitive-communication disorders,' indicates that speech-language pathologists should know about and apply computerized and other technologies when working with individuals with cognitive-communication disorders. Among the important areas to be addressed are helping clients develop functional skills, compensatory strategies, and support systems. AAC AND APHASIA There is a limited body of research focusing on AAC use by individuals with dementia, aphasia, and the geriatric population in general (Beukelman, Ball & Fager, 2008; Crema, 2009). AAC strategies that did not include a speech-generating device, such as written choice communication, have been implemented for individuals with severe aphasia (Lasker, Hux, Garrett, Moncrief & Eischied, 1997). This approach used communication partners to provide written word choices to support the individual's responses to questions. Cress and King (1999) reported improvements in communication skills for two individuals with primary progressive aphasia following facilitator-trained use of picture communication boards. More recently, AAC research has investigated the use of more sophisticated technology, using speech-generating devices. Lasker and Bedrosian (2001) described improved communicative effectiveness in an individual with acquired aphasia, using a voice output augmentative communication system. Lund & Light (2006) have emphasized the increasing need to facilitate utilization of AAC by individuals with aphasia and the importance of documentation to establish best practices for individuals with complex communication needs. CONSIDERATIONS FOR AAC USE AND APHASIA The linguistic deficits typically associated with aphasia can be compounded by deficits in attention, working memory and exexcutive functioning (Purdy & Dietz, 2010). These deficits may also present challenges to effective AAC usage. There have been reported improvements in the cognitive and language skills of individuals with chronic non-fluent aphasia following a period of AAC usage (Johnson, Strauss Hough, King, Vos & Jeffs, 2008). Ho, Weiss, Garrett and Lloyd (2005) investigated the efficacy of the use of communication books for individuals with global aphasia. Their results indicated that more effective communication occurred when the participants used real objects and photographs to convey their messages, as compared with graphic symbols. Individuals with aphasia frequently experience problems interpreting symbols such as line drawings or written words, and they struggle to combine words and symbols to formulate messages (Fox, Sohlberg & Fried-Oken, 2001; McKelvey et al., 2010). In a recent study, data analysis from eight adults with aphasia identified their preference for using personally relevant photographs to represent words on an AAC device (McKelvey et al., 2010). The authors cited ease of recognition and the meaningful, motivational and naturalistic aspects of using these types of stimuli as possible reasons for the participant's preferences. Personal photographs are also an accepted vehicle for individuals to maintain and support social relationships with friends and family. In addition, principles of visual cognitive science suggest that when individuals using AAC view personally relevant photographs, they process the essential content as a whole, rather than in fragmented bits (Wilkinson & Jagaroo, 2004). …