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Augmentative Communication with Cerebral Palsy

Margaret Fish, MS, CCC-SLP

February 16, 2004



I have a 17-year old student with Cerebral Palsy on my caseload who has received articulation therapy for 15 years. His speech is 50% intelligible in conversational speech. He has difficulties producing multi-syllable words which require anterior-posterio


Speech problems associated with cerebral palsy are associated with poor respiratory control as a result of muscular weakness, laryngeal and velopharyngeal dysfunction, and articulation disorders that result from imprecise movement of the oral-facial structures. The incidence of dysarthria varies in relation to the type and degree of motor impairment. Other communication disorders (e.g., hearing loss, language delay or disorder) may also be associated with cerebral palsy.

It is difficult to make a prognosis for change for any individual, particularly an individual who has a developmental disability. I find it most useful to counsel parents of children who have severe communication disorders about the purpose of augmentative communication. I explain that augmentative communication SUPPLEMENTS existing forms of communication, and that augmentative communication helps the individual communicate more effectively and efficiently. I further explain that improvement of oral speech skills continue to be a goal of therapy; however, additional forms of communication (i.e., light-tech and/or high-tech augmentative communication devices, symbols) will be learned to help the individual AND the listener be better communicators.

Parents often have misconceptions about augmentative communication (e.g., Oral speech and language skills will no longer be a part of the therapy program. Communication ''aids'' or devices will supplant existing oral communication skills. Machines will make the user ''lazy'', and that s/he will rely totally on the machine to communicate.). Because of the misconceptions, parents may be reluctant to agree to having their child learn additional forms of communication. To reduce some of these myths, I draw parallels between augmentative communication used by typical communicators and individuals with communication disorders. That is, I explain that many people use taped voice messages to relay information (e.g., answer phones); that business men and women use templates for written messages that are frequently sent; and that drivers relay on road signs with picture symbols to convey meanings. Augmentative communication devices can have taped voice messages to convey information (e.g., ''Hello. How are you today?''); that a template with course-specific vocabulary (e.g., science: beaker, burner, observation) can be developed and used to complete class and homework assignments; and that picture symbols can be used to convey a single-word or complete-sentence (e.g., a black & white picture of a burner means to place the beaker on the burner and heat the substance).

Parent and client counseling are important to any therapeutic process. It is particularly important when therapy introduces new and unfamiliar techniques, methods, or devices. A conference where you can give a thorough explanation about the individual's therapy history, discuss treatment methods and their purposes, and allow ample time for discussion about these topics may be an appropriate next step in this client's therapy program.

Dr. Paula S. Currie has been a speech-language pathologist for more than 25 years. She is the Head of the Department of Communication Sciences & Disorders at Southeastern Louisiana Univesity. She can be reached at pcurrie@selu.edu.

margaret fish

Margaret Fish, MS, CCC-SLP

Margaret is a speech-language pathologist working in private practice in Highland Park, Illinois, with over 30 years experience as a pediatric SLP. Her primary professional interests are in the areas of children’s speech sound disorders, language disorders, and social language development. Margaret is the author of the book, Here’s How to Treat Childhood Apraxia of Speech, now in its Second Edition. She is a frequently invited speaker at local, state, and national workshops. Her workshops and writing focus on providing practical, evidence-based ideas to support clinicians working with children with CAS. Margaret serves on the Professional Advisory Board for the Childhood Apraxia of Speech Association of North America (CASANA) and is a topic area advisor for the SpeechPathology.com Advisory Board.

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