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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
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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!
ALS Parkinson’s Huntington’s Progressive Supranuclear Palsy MS * CVA TBI Gullian Barre syndrome Progressive and Acute Disease
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 • mealtimes • emergencies • bed/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 speech • yes/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 speech • AAC for interactions • Tx 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 IJ K L M N O P Q RS T U V W X Y Znew 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