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!

Progressive and Acute Disease

ALS Parkinson’s Huntington’s Progressive

Supranuclear Palsy MS *

CVA TBI Gullian Barre

syndrome

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

mealtimesemergenciesbed/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 speechyes/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 speechAAC for interactionsTx 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 I

J K L M N O P Q R

S T U V W X Y Z

new 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