Man-with-i-series

Aphasia/Stroke

Aphasia/Dysphasia affects your ability to speak and understand what others say. It can also affect your ability to read and write. It happens when you are no longer able to understand or use language. Aphasia is a common problem after a stroke and around one third of stroke survivors has it.

Aphasia is the medical term for full loss of language. Dysphasia is the medical term for partial loss of language. The word aphasia is now commonly used to describe both conditions. Some people may refer to aphasia as dysphasia.

Assessing Comprehension

When implementing an Augmentative and Alternative Communication (AAC) system, it is critical to identify the right ability level.  All too often the assessed level of comprehension does not match the actual level.  This can lead to frustration and an unwillingness to adopt or persevere with a communication system.  If the person with aphasia thinks the system is too childlike or, conversely, is confused by the complexity of the system, this will only lead to early abandonment.  It is also extremely important to recognize the fluctuation in cognitive ability and the rehabilitation process – comprehension in aphasia is variable and evolving.

An accurate assessment of comprehension leads to agreement between health professionals and families on the right communication strategy.  Successful AAC and language rehabilitation is easier to achieve with buy-in from all parties. Research shows that health professionals often underestimate comprehension whereas spouses and family members often underestimate the difficulties in comprehension faced by the person with aphasia.

Regardless of the research, it is of key importance that to seek agreement, a commitment to use and persevere with a system, and to periodically reassess the level of communication being offered to the person with aphasia.

At Tobii Dynavox we offer a number of tools that help with the assessment of comprehension in individuals with aphasia;

  1. Boardmaker Online – Multiple choice templates
  2. Gaze Viewer – Live eye tracking response and eye tracking reports.

The Stroke and Brain Injury app (part of our Compass Communication system) offers levels of complexity built into the software.  There is no complex programming required by the therapy team or the family members - just the ability to scale up and down through the levels until you have the right match.

Expressing Wants and Needs

“I want cup of tea” is, perhaps, the most common message we see when AAC systems are demonstrated to family members for the first time. It makes sense, right? The person with aphasia drinks tea, so they would want to ask for it.

The answer is “almost right.” It is of paramount importance that people with aphasia are reintroduced to the words and messages that they use in daily life.  However, expressing wants and needs is far more than requesting. In most cases the person with aphasia would probably be the person offering a cup of tea, and if they wanted one, they would get up and make it.

When considering the communication needs of a person with aphasia, they should be surrounded with words and phrases of communication scenarios in the here and now.  If we focus on drinks for example, this allows the person to gradually expand their vocabulary to: sugar, 2 lumps, spoon, too hot, earl grey, lapsang souchong etc.

At Tobii Dynavox, we have a clinical team of speech and language pathologists/therapists who have created situation-based communication modules within our software. This allows the person with aphasia and their support team to select a wide range of topics, immediately accessing the social phrases around the situation, a glossary of topic-specific words and other tools.

Motivation to Interact

Getting language and AAC right is important for the person with aphasia, but it is equally important to create a solution that involves the spouse and other family members, friends and work colleagues. It needs to be extremely simple for the second person in the conversation to get involved and direct the conversation when required. This is called modeling.

Regardless of the communication scenario, it should be as simple as possible to find the word or phrase needed right then and there. 

As an example, lets discuss the weather. Rather than rely on each individual to think of what to say and then create a visual, there should be a rich array of messages that can be explored and added to the functional vocabulary of the person using the augentative and alternative communication (AAC) device.

It is also important that the images we choose to represent meaning are relevant to those using the system.  

The joint attention of a team around the communication scenario is often achieved through two other methods:

Typing together

Typing together is great for word play and word recognition. Often the person with aphasia can recognize the word they want but cannot initiateWorking on a keyboard together with letter prediction and symbol word prediction is a great way to keep someone involved on a keyboard and on the pathway to regaining functional literacy.

Drawing together

Using a whiteboard drawing app is a great way to involve gesturing in the communication process. Importing a photo and drawing around areas of interest drives conversation and joint attention.

Regaining Functional Literacy

Aphasia can often affect reading and writing skills. These are often regarded as being of high importance to families of those using AAC.

Exposure to a keyboard and to spoken or written words is an important part of the overall AAC solution.

Typing together is great for word play and word recognition. Often the person with aphasia can recognize the word they want but cannot initiateWorking on a keyboard together with letter prediction and symbol word prediction is a great way to keep someone involved on a keyboard and on the pathway to regaining functional literacy.

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