Augmentative Communication for Older Adults
Challenges and Considerations
Caryn F. Melvin PhD CCC-SLP
“Words are, of course, the most powerful drug used by mankind” Rudyard Kipling
Issues on the Plus Side
Seasoned language users Seasoned, effective communicators Understand the power of communication
Motivation Problem solving ability Educated World knowledge Cognition ?
Challenges and Considerations
Remembering normal communication Change in social role Change in family dynamics Grieving Financial worries Self esteem Have observed others with impairments Other health issues
Measuring and Evaluating the Communication Difficulty Impairment Functional limitations Disability
Common Adult Disease Processes Requiring Augmentative Communication
ALS* MS* Parkinson Disease* B-Stem CVA Severe Aphasia Others (SCI, GBS,
TBI)
Progressive or Acute Disease?
It impacts more than just management!
Progressive and Acute Disease
ALS Parkinson’s Huntington’s Progressive
Supranuclear Palsy MS *
CVA TBI Gullian Barre
syndrome
Progressive Disease and AAC
ALS Parkinson Disease PSP MS
Do not always have expressive deficits Huntington’s Disease
No Detectable Disorder
Obtain base line information/scores Answer questions Provide education re: disease
As warranted Provide info re: options for communication Avoid details re: end stage of the disease
Unless asked directly Use phrases like;
If you should need this___ Some people experience____
Obvious Disorder/Intelligible
Minimize environmental interference Reduce rate Confirm topics Confirm listener understanding Voice amplification
For Parkinson and PSP Possible AAC assessment/intervention
In specific situations
Reduced Intelligibility
Complete AAC assessment If not already done
Prosthetic Aids Palatal lift, alphabet board etc
Reduce breath groups Compensatory strategies* Maintaining communication opportunities* Support group
If warranted
Loss of Useful Speech
Total reliance on AAC Develop yes/no system for
mealtimesemergenciesbed/times of excessive fatigue
Eyegaze boards
AAC with Non Progressive Disorders Working backwards TBI
Cognitive deficits CVA
Language disorders, Apraxia B Stem CVA
Cognitive and lang. Skills generally OK
No Useful Speech
No useful speechyes/no system
If no recovery beyond this stage; initial choice making
eye gazing or blinking
pointing head or hands
multipurpose electronic AAC device may need scanning due to fatigue
No Useful Speech
Re-establishing subsystem control for speechAAC for interactionsTx focuses on
increasing respiratory support improving phonatory and velopharyngeal control strengthening oral motor musculature coordinating actions of all subsystems
Return of Speech
Independent use of natural speech Compensatory strategies to increase intelligibility Alphabet board supplementation AAC for writing?
Maximizing speech naturalness work on appropriate breath groups and stress
patterns No detectable speech disorder
Rare
Multimodal Systems
Natural speech Gestures High tech
Voice output devices
Low tech Alphabet boards Picture/word books
Writing
Compensatory Strategies For All AAC Users Establish breakdown and resolution
strategies Quiet environment Face your listener Adequate lighting Try natural speech but know when to
switch to AAC
Maintaining Communication Opportunities for All Users Topic setter cards Alphabet board supplementation Remnant books/memory books Loop tapes/single message tapes Miniboards High Tech for specific situations
Writing, telephone, strangers
Topic Setter Cards
Family TV shows Outings Church “Stories” Any hobby or interest
Single Loop Technology
Go Talk button records one 10 second message
Big Mack
Big Step by Step
A B C D E F G H I
J K L M N O P Q R
S T U V W X Y Z
new word 1 2 3 4 5 6 7 8 9 10
“Almost” Final Thoughts
Stakeholders Empowerment Perceived success Vs failure with AAC
“Good communication is as stimulating as black coffee, and just as hard to sleep after.” Anne Morrow Lindbergh