Transcript Strategic Use in Context: AAC, Supported Conversation, and

Part III:
Assessment and Technique
Selection
173
A. Goals of Assessment
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Identify underlying linguistic, pragmatic
and cognitive-communication Skills
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With no context – true aphasia impairment
(standard aphasia tests)
With context – functional ability
Match client skills to appropriate strategies
Assess Communication Needs
Assess Desired Participation Level and
Activities
Utilize a Criterion Assessment
Strategy vs. Maximal Assessment
(example).
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B. Cognitive-Linguistic Factors in
AAC Strategy Selection
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First, analyze the demands of
everyday communication situations
What are…
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The cognitive-linguistic demands of
requesting a blanket (patient in
hospital):
The demands of talking about a movie
with a friend?
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In aphasia, it’s not
as simple as...
Substituting a novel symbol set:
* J
for an impaired language system:
(“Great, I have mail!)
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Aphasia disrupts the automaticity of
information processing and
language use in general
And now add...
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Additional Demands Posed by
AAC Strategies
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Physical Access (often nondominant limb)
Symbol Decoding and Encoding Skills
Message Encoding Skills
Working Memory
Operational Skills for Technology
Metacommunicative Ability
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To USE strategies in dynamic situations
To ID need to use alternative strategy
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AAC SYSTEMS are
Externalized
sets of procedures and
representations to aid
communication
- K. Garrett, ‘96
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We’re asking people with aphasia to
complete a METACOGNITIVE task when
using many AAC strategies– especially
those that don’t involve partner support
To think to TURN to an
alternative strategy in the
right situation and find the
right symbols to convey the
right message
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Aphasia =
disruption of the automaticity of the language/
communication process
+
AAC =
going outside of one’s own language system to
communicate
______________________________
Clinical Challenge = teaching people w/ aphasia to
use strategies effectively and naturally
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Cognitive-Linguistic Analysis of:
Access
Demands
Symbol
Skills
Memory
Demands
Metacognition
Demands
Call light
Y if limb
apraxia
No
Y–
min/mod
Y - min
Yes/No board
Y - min
Y
Y – min
Y - min
6-message
VOCA to
request/tell
story
Y - min
Y
Y - mod
Y - mod
Written
Choices
No
Y - min
Yes episodic
No
Multi-level
multisymbol
VOCA
Y - min
Y - mod
Max
Max
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What to do…???
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1) Match AAC strategies to
communicators, considering their abilities
(cognitive, language, motor, visual) and
needs. i.e.,
Don’t expect an emerging (basic
choice)communicator to initiate by pointing to a
symbol-based VOCA
 Don’t ask someone who fits the profile of
contextual choice communicator to combine
symbols to create a novel sentence
 Multimodal, generative communicators will need
strategies for spelling, drawing, using word
prediction, etc.
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2) Teach strategy use…
component by component
 by modeling strategy use during real
opportunities
 by embedding use of strategies within
real-life situations as you go
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More to come on
this approach to
communication
therapy in Part IV!
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For a more detailed discussion of the cognitivelinguistic demands inherent in AAC and
language-based communication activities, see…
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Garrett & Kimelman (2000). AAC & Aphasia:
Cognitive-linguistic considerations. In
Beukelman, Yorkston, & Reichle (Eds.) AAC for
Adults with Acquired Disabilities.
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C. Patient-based Capabilities
Assessment
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1. Categorical Assessment form (Garrett & Beukelman,
1992/1998; Garrett & Lasker revised 2004)
2. Multimodal Screening tool (Garrett & Lasker rev. 2004):
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symbol comprehension/association,
use of multiple levels
message complexity & symbol sequencing
categorization
spelling - first letter & whole word
3. Vision Screen
4. Standardized tools (RCBA, WAB subtests)
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Assess what you can't see – reading, comprehension
Look more carefully at decontextualized performance
5. System Trials (Lasker & Garrett, 2004)
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1. Categorical Assessment Form
(Garrett & Beukelman, 1992, 1998;
Garrett & Lasker revised 2004)
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See handout – Supplementary
Outline and Materials packet p. ___
Will be available on-line at
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http://aac.unl.edu
OR Beukelman & Mirenda (in press)
AAC Strategies text: Aphasia
Chapter (Brookes Publishing Co.)
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The goal:
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Differentiate between people who require:
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Partner support/prelinguistic
Partner support/emerging linguistic skills
and intentionality
Communicators who can learn to access
prestored messages
Self-initiated communicators
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Simple symbol systems
Complex symbol systems/Generative
communicators
Special adaptations for specific
environments
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2. Multimodal Communication
Screening Test: Score form
p. _____or on-line at http://aac.unl.edu
Appendix B. MULTIMODAL COMMUNICATION SCREENING TASK FOR PERSONS WITH APHASIA: SCORESHEET
(C) 1997, Kathryn L. Garrett
CLIENT NAME:
DATE:
EVALUATOR:
INSTRUCTIONS: Show the person with aphasia the booklet containing the symbolized choices. Explain that the pictures, letters, sentences and map
locations can all be used to communicate ideas. Provide examples if necessary. For each item, ask individual “How would you communicate
? You can use
this book or any other way you have to communicate.” Mark + if all concepts were communicated, +/- if some were communicated, and - if no items were
communicated. Circle concepts that were successfully conveyed. Record cues if provided. Substitute alternate concepts as appropriate.
Abstract
Target SymbolsMeaning?
A. IDENTIFICATION OF NOUNS BY NAME
1. Shoes
Mult. page
search needed?
Pic/word
NO
NO
2. Open Door
Pic/word
NO
YES (2)
3. Grandchild
4. Need to buy something
5. State of residence (“Nebraska”)
Pic/word
Pic/word
Map or 1st letter
YES
YES
NO
YES (3)
YES (3)
YES (5)
Pic/word
YES
NO
7. Open the window; it's too hot.
Pic/word
NO
8. I'm glad my grandkids are visiting
Pic/word
YES
YES (3)
Pic/word
Pic/word, map,
or 1st letter
Pic/word, map,
or1st letter
YES
YES (3)
YES
YES (6)
YES
YES (6)
B. 2-SYMBOL COMBINATIONS
6. I've been walking alot and I'm tired.
C. 3-SYMBOL COMBINATIONS
9. I want to buy some toys for my
grandchildren.
10. The kids are coming next week from
name of state or city.
11. I want to eat an expensive meal at
name of favorite restaurant tonight.
+/-
Cues Comments
YES (2)
D. PHRASE LISTS
“Pretend you’re at the drugstore//with your grandkids.” Find the page that
will help you do this. Then, tell me how you’d say...”
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Task 1: Symbol identification
sleep
s
h
oes
Q uickTim e™ and a
G r aphics decompr essor
ar e needed t o see t his pict ur e.
eat
l
ig
h
t
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Task 2: Categorization
Category A: Fruit
Category B:
Transportation
Category C:
C elebrations
Category D: Weather
Q uickTim e™ and a
TI FF ( Uncompressed) decompr essor
are needed t o see t his pict ur e.
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Task 3: Combine Concepts
Children
Calendar
Money
Toys
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Task 4: Locate phrases on an
environmentally-organized
vocabulary page
How’s school?
What do you want
for…..
How are……..
• your grades? A
B C+
• your frie nds?
• your sports?
• Do you do your
homework?
• What’s your
favorite class?
• Do you ha ve a…
boyfrie nd?
girlfriend?
 Your birthday?
 Chanukah/C hristmas?
 __________________
-------------------------------- Money $$$?
 A big gift?
 A toy?
 A hug?
 Socks!! Hah hah .
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Task 5: Communicate info
locations by pointing on a map
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Task 6: Communicate complex
information by locating and
sequencing symbols on
Multiple Levels (pages)
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Task 7: Storytelling
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Task 8: Spell to convey
novel information
A
F
K
P
V
B
G
L
Q
W
1 2
6 7
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C
H
M
R
X
D
I
N
S
Y
E
J
O
T
Z
3
8
4
9
5
0
U
Important to assess in communicators who have
potential ability to spell or write/i.e., generative
communicators
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Figure 16.11
Word Scanning/Cancellation Task for Vision Screening
Name:
Date:
Circle the word "good" each time you see it. Read left to right.
good
------------------------------------------------------------------------------
3. Vision
screening
breath
good
take
moth
home
good
bye
one
good
good
bee
shine
good
good
baby
house
shirt
good
see
nose
good
good
hope
fine
good
show
tired
pies
seem
good
-----------------------------------------------------------------------------good
table
shine
carpet
good
good
team
paste
good
glue
time
girl
gone
good
good
born
shout
socks
pick
tone
glow
glow
good
point
there
see
good
pass
-----------------------------------------------------------------------------good
paste
table
good
shine
glue
carpet
time
good
girl
good
gone
team
good
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4. Standardized tests
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To assess impairment in
decontextualized situations
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“Assess what you can’t see!”
Reading (e.g., RCBA, Discourse
Comprehension Test)
Auditory Comprehension (WAB, Token)
We’re beginning to use Cognitive Tests too
– we’ll let you know which ones are useful
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Cognitive-Linguistic Quick Test
Raven’s Progressive Coloured Matrices
Wisconsin Card Sort Test
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5. Systems Trials
(Lasker & Garrett, © 2004)
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Level A - Partner Dependent
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Task: Conversation
Topics:
1) Autobiographical Info
 2) Education about the Stroke
 3) Goals in Therapy
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Strategies:
Try written choice conversation
 Look at symbol skills
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Systems Trials
(Lasker & Garrett, © 2004)
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Level B - Single Message Users
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Task: Role Play
Topic: Requesting coffee/tea
Strategies:
Model single message VOCA use in simulated
role play with a ‘clerk’ -- “Small latte, please”
 Then ask communicator to try this with minimal
to no cues.
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Systems Trials
(Lasker & Garrett, © 2004)
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Level C - Stored Message Users - 1 level
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Task: Role Play
Topic: Getting a Haircut/Planning a Trip
Strategies:
Model VOCA use in simulated role play with a
‘clerk’ . Communicate multiple messages
(“haircut please”; shampoo; 1 inch”) from single
level.
 Then ask communicator to try this with minimal
to no cues.
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Systems Trials
(Lasker & Garrett, © 2004)
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Level D - Stored Message Users - 2-3 levels
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Task: Role Play
Topic: Getting a Haircut/Planning a Trip
Strategies:
Model VOCA use in simulated role play with a
‘clerk’ . Communicate multiple messages
(“haircut please”; shampoo; 1 inch”) from level
with basic messages and numbers level.
 Then ask communicator to try this with minimal
to no cues.
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Systems Trials
(Lasker & Garrett, © 2004)
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Level E - Generative Communicator - 2-3
levels + speech & gestures
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Task: Role Play
Topic: Getting a Haircut/Planning a Trip
Strategies:
Model integrated VOCA and speech/gesture use
in simulated role play with a ‘clerk’ .
Communicate multiple messages (“haircut
please”; shampoo; 1 inch”) from level with basic
messages and numbers level.
 Then ask communicator to try this with minimal
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to no cues.
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Systems Trials
(Lasker & Garrett, © 2004)
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Level F - Generative Communicator - Hi
tech multi-level system etc.
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Task: Role Play
Topic: Getting a Haircut/Planning a Trip
Strategies:
Model integrated VOCA and speech/gesture/
writing use in simulated role play with a ‘clerk’ .
Communicate multiple messages (“haircut
please”; shampoo; 1 inch”) from level with basic
messages and numbers level.
 Then ask communicator to try this with minimal
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to no cues.
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D. Partner Skills
Assessment
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1. Assess their literacy (informally)
2. Assess their vision and hearing skills
3. Assess their ability to anticipate
and provide opportunities (by
watching them interact, trying
strategies)
4. Assess presence of non-facilitative
communication skills
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Finishing sentences
Guessing too quickly
Asking just yes/no questions
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E. Communication Needs
and Context Assessment
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1. Needs assessment – see form p. ___
2. Identify Environments and
Potential Participation Activities
3. Topics
4. Messages and Vocabulary
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APHASIA NEEDS ASSESSMENT
(C) 1997, Kathryn L. Garrett & David R. Beukelman
CLIENT:
INTERVIEWER:
HOW ARE THINGS GOING FOR YOU?
HOW WELL ARE YOU COMMUNICATING?
Poorly
1
1
DATE:
2
So-So
3
4
Well
5
2
3
4
5
WHICH SITUATIONS GIVE YOU THE MOST TROUBLE•? (Mark with an X)
phone
conversations with family
discussions about personal business
conversing with friends
bank, pharmacy, travel agent, bus driver, etc.
restaurants
doctor
work
giving directions
understanding others
other:
DO YOU DO MOST OF THE COMMUNICATING
FOR YOURSELF?
1. NEEDS
ASSESSMENT
YES
NO
YES
NO
IF YOU ANSWERED “NO”, WHO DOES?
DO YOU USE ANY OTHER STRATEGIES
TO COMMUNICATE?
IF SO, WHAT STRATEGIES?
WHICH COMMUNICATION SKILLS WOULD
YOU MOST LIKE TO IMPROVE?
IN WHICH SITUATIONS?
HOW WELL DO YOU READ?
Poorly
1
2
So-So
3
4
Well
5
4
Well
5
WHAT KINDS OF THINGS WOULD YOU LIKE TO READ?
HOW WELL DO YOU WRITE?
Poorly
1
WHAT KINDS OF THINGS WOULD YOU LIKE TO WRITE?
2
So-So
3
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2.Topics/Vocabulary/Message
Inventory
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See materials from Garrett, K., &
Beukelman, D. (1992) AAC in the
Medical Setting. K. Yorkston, Ed.
Communication Skill Builders.
See phrases from new book by
Barbara Collier “See what we say –
messages for adults”. Brookes
Publishing company.
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Comment
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Nice to invite families to complete
this info gradually but steadily –
especially during acute/early phase
of recovery.
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