Crossroads in aphasia rehabilitation

This thesis focusses on two types of aphasia rehabilitation, cognitive linguistic treatment (CLT) and AAC (Augmentative and Alternative Communication) training. In a study of the effect of nonlinguistic variables on the outcome of CLT, it was shown, that neuropsychological data contributed significantly to the prediction of verbal communicative ability after treatment. It is concluded that a neuropsychological assessment is needed in all aphasic patients before treatment is started. In a study of the efficacy of AAC in people with a severe aphasia, a computerised communication aid, TouchSpeak (TS), was developed and tested in 34 aphasic patients. 57 % of the participants used the device in everyday life scenarios and overall communicative abilities improved with TS training. The final chapter presents a new test for overall (verbal and nonverbal) communication in people with a severe aphasia. In a pilot group, patients with a severe aphasia showed large variation in overall scores. In addition, several communicative patterns could be described

Attitudes and concerns of doctors and nurses about using a translation application for in-hospital brief interactions with Korean patients

Background: New Zealand is becoming more ethnically diverse, with rising numbers of people with limited English language proficiency. Consequently, hospital interactions are increasing where patients have insufficient English to communicate adequately with doctors or nurses for appropriate, effective, and safe care. Translation technology is rapidly evolving, but evidence is limited regarding its usefulness to clinicians.Objective: To examine the acceptability to doctors and nurses of a translation application (app) used on a tablet, in brief interactions with Korean patients.Method: An app was developed to facilitate brief conversations between patients and clinicians as part of clinical care. We used the Technology Acceptance Model 2 to develop semi-structured interview questions for 15 junior and senior doctors and nurses in an urban hospital. Participants used the app to interact with the interviewer as part of a scenario. The interviews were analysed thematically.Results: The app was easy to use, learn to use, and to memorise for future use. It was considered useful for everyday brief interactions, urgent situations where there is no time to call an interpreter, and after hours, to augment the work of interpreters. Subject to perceived usefulness, there appears to be little need for social normalisation of a translation app, other than management support for the costs, maintenance, and implementation of the app for everyday use.  Conclusion: Guidelines are required for the use of a translation app by doctors and nurses to augment the interpreter role. A larger study and future research on the patient’s perspective are required.

Augmentative communication device design, implementation and evaluation

The ultimate aim of this thesis was to design and implement an advanced software based Augmentative Communication Device (ACD) , or Voice Output Communication Aid NOCA), for non-vocal Learning Disabled individuals by applying current psychological models, theories, and experimental techniques. By taking account of potential user's cognitive and linguistic abilities a symbol based device (Easy Speaker) was produced which outputs naturalistic digitised human speech and sound and makes use of a photorealistic symbol set. In order to increase the size of the available symbol set a hypermedia style dynamic screen approach was employed. The relevance of the hypermedia metaphor in relation to models of knowledge representation and language processing was explored.Laboratory based studies suggested that potential user's could learn to productively operate the software, became faster and more efficient over time when performing set conversational tasks. Studies with unimpaired individuals supported the notion that digitised speech was less cognitively demanding to decode, or listen to.With highly portable, touch based, PC compatible systems beginning to appear it is hoped that the otherwise silent will be able to use the software as their primary means of communication with the speaking world. Extensive field trials over a six month period with a prototype device and in collaboration with user's caregivers strongly suggested this might be the case.Off-device improvements were also noted suggesting that Easy Speaker, or similar software has the potential to be used as a communication training tool. Such training would be likely 10 improve overall communicative effectiveness.To conclude, a model for successful ACD development was proposed

A Formative Evaluation Of Augmentative And Alternative Communication Approaches To Promote Literacy In Young Children With Severe Speech And Physical Impairments

This thesis describes an educational intervention with three children with severe speech and physical impairments. The intervention focused on storybook reading experiences for early literacy development through the use of Augmentative and Alternative Communication technologies and methods. The review of literature focused on the main aspects relating to children with SSPI, and in particular on the difficulties they experience in developing emergent literacy skills. This review suggests the hypothesis that the use of AAC Techniques in storytelling achievement can provide emergent literacy experiences, which can promote the development of literacy in children with SSPI. In particular the study set out to enquire whether AAC techniques can be used to enhance participation with SSPI in storytelling activities, and whether such activities improve a pupil’s opportunities to become emergent readers. A six-month intervention was designed which included strategies proposed for increasing the children’s participation during storybook reading sessions, like repeated readings of the same story, abundant use of graphic symbols and access to AAC techniques. Qualitative data were gathered from the professionals at the Centre, and from the mothers. Storybook reading sessions with the teacher at school and with the mothers or significant other at home were videotaped, at the beginning and at the end of the intervention. Quantitative data were collected by videotape analysis. Communicative acts of children and adults were divided into communication categories, and their meaning was discussed as to form, use and content. One of the main conclusions of the study was that the use of stories promoting communication and language learning in storybook reading sessions can develop literacy skills if carried out in conjunction with AAC techniques, including graphic symbols and the technology to generate them. A second conclusion is that there is no automatic transfer of the improvement of communicative skills in the classroom to the interaction with the mothers

Some problems of designing for augmentative and alternative communication users: an enquiry through practical design activity

The submission is concerned with, and addresses, problems of designing for people with disabilities, with specific reference to people who are illiterate and cannot speak. People with such disabilities often depend on electronic AAC (Augmentative and Alternative Communication) devices for interpersonal communication. A central theme of the thesis, however, is that such products, and products intended for people with disabilities more generally, have characteristics that inadequately attend to users' needs. Through a combination of practical product development and literature reviews, the thesis demonstrates how improvements to AAC devices 'can be made through user-participatory, usercentred and more sensitive and perceptive design. Literature reviews in the following subjects are reported: AAC; the operational knowledge base for design and disability; user participatory design; and wearable computing. At the core of the thesis is the presentation and discussion of an empirical case study, carried out by the researcher, to design and develop the Portland Communication Aid (PCA). The PCA was conceived as an AAC product that would attempt to redress the inadequacies of predecessor devices. The design activity for the PCA is traced in the thesis, from initial concepts and development models through to a working prototype. Key ideas and essential principles of the design are illustrated. Throughout the work on the PCA, many problems associated with designing for people with severe communication disabilities were encountered. These problems, as with their resolutions, comprised matters of both designing (as an activity) and design (as product specification). The thesis contains comprehensive exposure and analysis of these problems and resolutions. In particular, the value of shaping meaning, metaphor, and other product semantics into devices intended for use by people with disabilities is explored. The study provides two substantive conclusions. First, that both the activity and the outcomes of Industrial Design have a valuable role in the empowerment and rehabilitation of AAC users. And second, that key principles have been identified that will enable designers to better identify, articulate and respond to the needs of people with communication disabilities (and the needs of people with disabilities more generally

Non-speaking children in schools for children with mental handicaps in the Pretoria area : a survey of communication and related problems

The prevalence of non-speaking children in special education is internationally estimated to be 3,5-6%. To date very little demographic data is available for nonspeaking children with regard to the prevalence, interaction needs and abilities. This is reflected in the lack of adequate planning for integration into society, economical self-sufficiency and full participation in the ordinary social life of the community. In South Africa statistical information for this population is practically non-existent. Available information is based on the medical model in which different etiologies are emphasized, often with little or no reference as to how the disability influences the functional communication of the individual in society. It is against this background that the present study proposed to investigate the prevalence of severe communication pathology in all registered schools for children with mental handicaps in the Pretoria area, m order to assess the current need for AAC intervention within these contexts. The present study is demographic in nature. Two questionnaires were developed and were completed by classroom teachers in conjunction with fieldworkers. All children in registered schools for children with mental handicaps between the ages of 3 - 12 years were included. The applicability of the questionnaires was tested by means of a pilot study prior to the main study. The first questionnaire was used to collect personal data from the 55 teachers who were included in the study. The second one was used to obtain information on the 412 children by discussing their abilities in all the different skill areas ( cognitive, motor, sensory, communication and social), functional reading, writing and mathematical abilities. In addition, the children's exposure to therapy (speech, occupational and physiotherapy) was described. Results indicate that the non-speaking children in schools for children with mental handicaps in the Pretoria area constitute a large population (38,3 % ) with heterogeneous characteristics and abilities. Furthermore it was noted that the nonspeaking children received considerably less therapy than the speaking children regardless of the fact that these children need intensive, specialized therapy and AAC services. It also shows that professionals (teachers and therapists) need knowledge and skill training in AAC strategies. This study was the first step in determining the prevalence and characteristics of non-speaking children in schools for children with mental handicaps in the Pretoria area. Information obtained from this survey can therefore be used as a basis from which to project and plan service delivery to this underserved population.Dissertation (MCommunication Pathology)--University of Pretoria, 1995.Speech-Language Pathology and AudiologyMCommunication PathologyUnrestricte

Comparisons of unilateral and bilateral cochlear implantation for children: spatial listening skills and quality of life

Recently, controversy in the care of severely-profoundly deaf children has centred on whether they should be provided with bilateral cochlear implants (two implants, one in each ear) rather than a unilateral cochlear implant (one implant in one ear). Potentially, implanting both ears rather than one could improve children’s spatial listening skills, meaning the ability to localise sources of sound (by comparing the intensity and timing of sounds arriving at the two ears) and to perceive speech in noise (by attending to whichever ear gives the better signal-to-noise ratio). The overall aim of the studies reported in this thesis was to assess whether bilateral implantation for children is more effective than unilateral implantation in improving spatial listening skills and quality of life. The first study measured the relationship between spatial listening skills and age in normally-hearing children. The second study compared the spatial listening skills of unilaterally- and bilaterally-implanted children. Whilst controlling for confounds, the bilateral group performed significantly better than the unilateral group on tests of sound-source localisation. Moreover, the bilateral group, but not the unilateral group, displayed improved speech perception when the source of a masking noise was moved from the front to either side of the head. Neither group of implanted children performed as well as normally-hearing children on tests of the ability to localise sources of sound and to perceive speech in noise. The third study measured the spatial listening skills of normally-hearing adults when listening to simulations of unilateral or bilateral implants. The differences in performance between simulations were similar to the differences in performance between groups of implanted children, which provides further evidence that the children's performance was primarily influenced by the number of implants they used rather than by confounds. The fourth study found that there was no significant difference between bilaterally- and unilaterally-implanted children in parental estimates of quality of life. The fifth study presented informants, who were not the parents of hearing-impaired children, with descriptions of a hypothetical child with unilateral or bilateral implants. The informants judged that the bilaterally-implanted child had a higher quality of life than the unilaterally-implanted child. These studies indicate that bilateral implantation for children is more effective than unilateral implantation in enabling spatial listening skills, but the extent of any gain in quality of life remains uncertain