Man-with-i-series

Aphasia/Stroke

Aphasia affects your ability to speak and understand what others say. It can also affect your ability to read and write. It happens when you are no longer able to understand or use language. Aphasia is a common problem after a stroke and around one third of stroke survivors has it.

Aphasia is the medical term for full loss of language. Dysphasia is the medical term for partial loss of language. The word aphasia is now commonly used to describe both conditions. Some people may refer to aphasia as dysphasia.

Assessing Comprehension

When implementing an AAC system, it is critical to pitch it at the right level.   All too often the assessed level of comprehension does not match the actual level.  This can lead to frustration and an unwillingness to adopt or persevere with a communication system.  If the person with aphasia thinks the system is too childlike or, conversely, is confused by the complexity of the system, this will only lead to early abandonment.  It is also extremely important to recognize the fluctuation in cognitive ability and the rehabilitation process – comprehension in aphasia is variable and evolving.

An accurate assessment of comprehension leads to agreement between health professionals and families on the strategy for communication.  Successful AAC and language rehabilitation will be more readily achieved if we have, what we call, “buy-in” from all parties. Research shows that health professionals often underestimate comprehension whereas spouses and family members often underestimate the difficulties in comprehension faced by the person with aphasia.

Regardless of the research, it is of key importance that we seek agreement, a commitment to use and persevere with a system, and that we periodically reassess the level of communication being offered to the person with aphasia.

At Tobii Dynavox we offer a number of tools that help with the assessment of comprehension;

  1. Boardmaker Online – Multiple choice templates
  2. Gaze Viewer – Live eye tracking response and eye tracking reports.

The Stroke and Brain Injury app (part of the Compass Communication system) offers levels of complexity built into the software.  There is no complex programming required by the therapy team or the family members.  Just scale up and down through the levels until you have the right match.

Expressing Wants and Needs

“I want cup of tea” is, perhaps, the most common message we see when AAC systems are demonstrated to family members for the first time.  It makes sense, right?  The person with aphasia drinks tea, so they would want to ask for it?

The answer is “almost right.”  It is of paramount importance that people with aphasia are reintroduced to the words and messages that they use in daily life.  However, expressing wants and needs is far more than requesting.   In most cases the person with aphasia would probably be the person offering a cup of tea, and if they wanted one, they would get up and make it.

When we consider the communication needs of a person with aphasia, we should surround them with words and phrases of communication scenarios in the “here and now.”  If we focus on drinks for example, this allows the person to gradually expand their vocabulary to, sugar, 2 lumps, spoon, too hot, earl grey, lapsang souchong etc.

At Tobii Dynavox, we have a clinical team of 12 speech and language pathologists/therapists who have created situation based communication modules inside our software.  This allows the team around the person with aphasia (including the person themselves) to select a wide range of topics, immediately accessing the social phrases around the situation, a glossary of topic specific words, and other tools.

Motivation to Interact

Getting language and AAC right is important for the person with aphasia, but it is equally important that we create a solution that involves the spouse and other family members, friends and work colleagues.  We need to make it extremely simple for the second person in the conversation to get involved and direct the conversation when required. We call this modeling.

Regardless of the communication scenario, we want it to be as simple as possible to find the word or phrase needed right then and there. 

As an example, lets discuss the weather.  Rather than rely on each individual to think of what to say and then create a visual, we should provide a rich array of messages that can be explored and added to the functional vocabulary of the AAC user. 

It is also important that the images we choose to represent meaning are relevant to those using the system.  

The joint attention of a team around the communication scenario is often achieved through two other methods

Typing together

Typing together is great for word play and word recognition. Often the person with aphasia can recognize the word they want but cannot initiateWorking on a keyboard together with letter prediction and symbol word prediction is a great way to keep someone involved on a keyboard and on the pathway to regaining functional literacy.

Drawing together

Using a whiteboard drawing app is a great way to involve gesturing in the communication process.  Importing a photo and drawing around areas of interest drives conversation and joint attention.

Regaining Functional Literacy

Aphasia can often affect reading and writing skills. These are often regarded as being of high importance to families of the AAC user. 

Exposure to a keyboard and spoken or written word is an important part of the overall AAC solution.

Typing together is great for word play and word recognition. Often the person with aphasia can recognize the word they want but cannot initiateWorking on a keyboard together with letter prediction and symbol word prediction is a great way to keep someone involved on a keyboard and on the pathway to regaining functional literacy.

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