SpeechPathology.com Phone: 800-242-5183

EdTheory Build Your Career 2018

Pearson's EBP Briefs: Which AAC Interface Design Facilitates Communicative Interactions for Persons With Nonfluent Aphasia?

Pearson's EBP Briefs: Which AAC Interface Design Facilitates Communicative Interactions for Persons With Nonfluent Aphasia?
Kris L. Brock, PhD, CCC-SLP
March 16, 2017

Clinical Scenario

Rico is a seasoned practitioner responsible for (a) providing services to individuals with acquired neurological communication disorders and (b) supervising student clinicians in a bustling urban outpatient rehabilitation center. Currently, Rico has several new clients on his  caseload with Broca’s aphasia which may eventually become  chronic in nature. Rico typically treats these patients using principles from Constraint Induced Language Therapy (Barthel, Meinzer, Djundja, & Rockstroh, 2008) and Social Participation Models (e.g., Simmons-Mackie, 2008). Last month, Rico started supervising two graduate student externs. The externs have been advocating for the inclusion of augmentative and alternative communication (AAC) strategies as a means to facilitate more difficult social interactions for their clients with aphasia. Rico remembers very little from his AAC course 15 years ago; however, he is concerned about substituting one language system (i.e., natural speech and language) with another language system (i.e., AAC). Moreover, Rico is concerned that AAC may facilitate learned nonuse of spoken language (Pulvermüller & Berthier, 2008). Rico’s students, Rochelle and Cristina, explained that AAC strategies for persons with aphasia (PWA) do not have to replace natural speech. In fact, they stated that data indicate that AAC intervention may enhance natural speech (Dietz, Weissling, Griffith, McKelvey, & Macke, 2014). Moreover, AAC can supplement natural speech when the clients’ words fail them in social contexts. 

Rico, realizing he wanted to incorporate new therapies into his repertoire to improve the communication of his patients, decided to take his students’ advice, however; he was unsure about the amount of time required to prepare and implement AAC intervention. Rather than incorporate AAC strategies with all of his clients, he conducted brief interviews with them to determine their level of interest in AAC intervention. Two clients were interested, but one of the caregivers stressed that she wanted her husband to “speak again” and not rely on photographs or graphic symbols to communicate.

Rico’s client, MB, is a 60-year-old male who was referred to the outpatient clinic secondary to surviving a left hemisphere ischemic stroke in August 2015. Results from the diagnostic imaging indicated an infarction volume of 50 cm  in the superior middle cerebral artery territory (i.e., Brodmann Area 44, Broca’s area). MB had right hemiparesis and used his left hand for daily living activities. Results from the Western Aphasia Battery–Revised (WAB–R; Kertesz, 2006) standardized assessment confirmed MB’s diagnosis of severe Broca’s aphasia (Aphasia Quotient 31.40). A dynamic assessment was conducted using principles from the Promoting Aphasics’ Communicative Effectiveness (PACE) intervention paradigm. The purpose of the PACE assessment was to determine how well MB performed in a barrier task using several communicative modalities. Specifically, he discussed several pictures with a partner who was blinded to the pictures’ content. Results revealed that MB’s spontaneous natural speech was comprised of approximately 10 words; however, he also used gestures, drawings, and writing to communicate. Finally, Rico conducted a modified activity, Participation Inventory (see Beukelman & Mirenda, 2013), to determine (a) where MB participated socially and (b) how much support was required. Rico noted that MB is a partner-dependent communicator, but he wants to participate with more independence at his local Italian Athletic Club. Given Rico’s limited experience with AAC intervention for PWA, he and his students searched  the AAC literature to develop a research question and an appropriate intervention program for MB. 

Kris L. Brock, PhD, CCC-SLP

Dr. Kris Brock, CCC-SLP is an Assistant Professor at California State University, Fullerton (CSUF) who specializes in neurogenic communication disorders and augmentative and alternative communication (AAC). His primary research interests concern the development of AAC interface designs that are more compatible with the cognitive-linguistic capabilities of persons with aphasia and children with autism. Additionally, he is interested in translational research that investigates the communicative competence (e.g., turn-taking and longer communicative interactions) of individuals using currently available AAC technologies.  Dr. Brock is also the Co-advisor of the CSUF National Student Speech-Language and Hearing Association chapter.  While traditional didactic lectures are an important component of learning, Dr. Brock understands that repeated practice, structured mentorship, and active learning in the field are better teaching techniques that develop clinical scientists capable of engaging in life-long learning.    

Related Courses

Best Practice for Assessment and Treatment of Bilingual Aphasia
Presented by Maria Muñoz, PhD, CCC-SLP
Course: #9759Level: Intermediate1.5 Hours
This course focuses on best practice in the assessment and treatment of bilingual aphasia by speech-language pathologists. Recommended practices are contrasted against common mistakes made by clinicians working with bilingual patients with aphasia. Implementation of best practices are modeled through case studies.

Behavioral Frameworks for Dementia Management
Presented by Mary Beth Mason, PhD, CCC-SLP, Robert W. Serianni, MS, CCC-SLP, FNAP
Course: #9473Level: Intermediate1 Hour
This course will focus on cognitive-communication intervention strategies for various dementia presentations and will provide a review of evidence-based treatment. Behavioral frameworks along with their rationales will be introduced and applied across several dementia types and mild, moderate and severe levels of impairment.

Dysphagia in Neurodegenerative Disease
Presented by Debra M. Suiter, PhD, CCC-SLP, BCS-S
Course: #9732Level: Intermediate1 Hour
Dysphagia is common in individuals with amyotrophic lateral sclerosis (ALS) and Parkinson’s disease. This course discusses the underlying pathophysiology and appropriate treatment programs for each disease, as well as use of alternate methods of nutrition/hydration.

Acceptance and Commitment Therapy: An Introduction for SLPs
Presented by William S. Evans, PhD, CCC-SLP
Course: #10771Level: Intermediate1 Hour
An introduction to Acceptance and Commitment Therapy (ACT), a modern evidence-based counseling approach, is provided in this course. Research support for ACT is discussed, and case studies to illustrate how ACT techniques can help patients and their families with the psychosocial consequences of living with communication disorders are presented.

Textbook: Achieving Communication Competence
Presented by Yvonne Gillette, PhD, ASHA Fellow
Course: #10517Level: Advanced15 Hours
Based on the textbook, Achieving Communication Competence, this course describes a three-step process to create an effective intervention plan for people with severe communication disabilities. Assessment of environmental factors and communication skills, implementation and modification of intervention plans, and progress reporting are discussed.

Our site uses cookies to improve your experience. By using our site, you agree to our Privacy Policy.