augmentative and alternative communication (aac) and traumatic brain injury (tbi) sla g304 kimberly...
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Augmentative and Alternative Communication (AAC) and
Traumatic Brain Injury (TBI)
SLA G304Kimberly M. Ho, PhD CCC-SLP
Shelley J. Weiss, MS CCC-SLP
Definition of TBI Sudden injury to a normal brain
that results in a cluster of deficits: Cognitive Linguistic Behavioral/psychological Physical
TBI Statistics Leading cause of death for people
under 45 1.5 million sustain TBI More than twice as many males as
females 80,000 to 90,000 experience long-
term or lifelong disability
Definition of TBI Degree of impairment associated
with size and type of lesion
Focal lesions
Diffuse lesions
Definition of TBI Frontal lobe damage most common
Executive function deficits
Memory deficits Anterograde Retrograde
Cognitive-Linguistic Deficits Frontal lobe lesions associated with
Disinhibition Reduced initiation Anxiety and disorganization Reduced flexibility Reduced comprehension Decreased ability to generalize
Rancho Los Amigos Scale of Cognitive Functioning – Revised (Hagen, 1997)
Scale of I-XEarly Stages of recovery (I-III)
I. No responseII. Generalized responseIII. Localized response
Maximal Assistance required
Ranchos Scale (cont’d)
Middle stages of recoveryIV. Confused-agitated
Maximal assistance
V. Confused,-inappropriate-non-agitated
Maximal assistance
VI. Confused-appropriateModerate assistance
Ranchos Scale (cont’d)
Late stages of recoveryVII. Automatic-appropriate
Minimal assistance for daily living skills
VIII. Purposeful and appropriateStand-By assistance
IX. Purposeful and appropriateStand-By assistance on request
X. Purposeful and appropriateModified independent
Definition of AAC Augmentative communication
Strategies in combination with natural speech or writing
Alternative communication Strategies that replace natural speech or
writing
Clinical examples
Symbols and Techniques Aided communication
• Electronic aids• Nonelectronic aids
Unaided communication
Criteria-based Assessment Observe current level of function
Observe changes over time More effective than norm-referenced Sensitive to change over time Time efficient
Criteria-Based Assessment Skills Assessment
Communication needs inventory
Opportunities and constraints
Feature matching
Representation Assessment
Symbol type Acoustic Graphic
• Remnants• Photographs• Line drawings• Traditional orthography (TO)
Manual Tactile
TBI Intervention Protocol Avoid new learning tasks
Tap into residual world knowledge
Keep physical access demands to a minimum
Intervention (Cont’d) Train functional communication
Effectiveness of message productionEfficiency Effort
Structured environment Errorless learning Repetitive practice