Revisiting the Role of Augmentative and Alternative Communication in Aphasia Rehabilitation

Purpose — The purpose of this article is to revisit the role of augmentative and alternative communication (AAC) in post stroke aphasia rehabilitation. The authors’ intent is to provide a viewpoint that expands the use of AAC in post stroke aphasia rehabilitation. Specifically, we seek to clarify the role of AAC in restorative and participation approaches to aphasia rehabilitation while also considering the role of AAC in a comprehensive treatment plan. The authors support their viewpoint with citations from both the historic and contemporary literature on aphasia rehabilitation. Conclusions — A thought-provoking viewpoint on the role of AAC in post stroke aphasia rehabilitation is proposed. More specifically, the versatility of AAC strategies is reviewed, with an emphasis on how AAC can be used to empower people with aphasia to fully participate and engage in life activities with increased independence. Moreover, we argue that AAC can be viewed as a dual-purpose tool that can simultaneously serve to drive inter-systemic reorganization resulting in some improved language performance—and perhaps restoration of language function—while offering a communication alternative during inevitable anomic events

Supporting Narrative Retells for People With Aphasia Using Augmentative and Alternative Communication: Photographs or Line Drawings? Text or No Text?

Purpose: The purpose of this study was to examine how the interface design of an augmentative and alternative communication (AAC) device influences the communication behaviors of people with aphasia during a narrative retell task. Method: A case-series design was used. Four narratives were created on an AAC device with combinations of personally relevant (PR) photographs, line drawings (LDs), and text for each participant. The narrative retells were analyzed to describe the expressive modality units (EMUs) used, trouble sources experienced, and whether trouble sources were repaired. The researchers also explored the participants’ perceived helpfulness of the interface features. Results: The participants primarily used spoken EMUs to retell their narratives. They relied on PR photographs more frequently than LDs; however, they reported both picture types to be equally helpful. Text was frequently used and reported as helpful by all 4 people with aphasia. Participants experienced similar rates of trouble sources across conditions; however, they displayed unique trends for successful repairs of trouble sources. onclusion: For narrative retells, LDs may serve as an effective visual support when PR photographs are unavailable. Individual assessment is necessary to determine the optimum combination of supports in AAC systems for people with aphasia

Supporting Narrative Retells for People with Aphasia using AAC: Photographs or Line Drawings? Text or No Text?

People with aphasia (PWAs) have demonstrated the ability to learn augmentative and alternative communication (AAC) devices that employ traditional grid layouts to enhance their communication; however, the process is typically lengthy and yields limited generalization (Fox & Fried-Oken, 2001; Koul & Harding, 1998). In response, researchers have begun to investigate the use of visual scene displays (VSDs) to support the communication interactions of PWAs by capitalizing on their relatively intact episodic memory (Beukelman, Dietz, McKelvey, Hux, & Weissling, in press; Dietz, Beukelman, & McKelvey, 2006a; Dietz, McKelvey, Beukelman, Weissling, & Hux, 2006b; McKelvey, Dietz, Hux, Weissling, & Beukelman, 2007). High-technology VSDs may include various combinations of photographs, text boxes and speak buttons (see Figure 1); however, the specific elements of VSDs that best support the communication of PWAs is unknown. Therefore, the purpose of this investigation was to compare the impact of personally relevant (PR) photographs and line drawings (LDs) as well as the presence of text on four AAC interfaces, on the communication of PWAs during a personal narrative retell task

Supporting Narrative Retells for People with Aphasia using AAC: Photographs or Line Drawings? Text or No Text?

People with aphasia (PWAs) have demonstrated the ability to learn augmentative and alternative communication (AAC) devices that employ traditional grid layouts to enhance their communication; however, the process is typically lengthy and yields limited generalization (Fox & Fried-Oken, 2001; Koul & Harding, 1998). In response, researchers have begun to investigate the use of visual scene displays (VSDs) to support the communication interactions of PWAs by capitalizing on their relatively intact episodic memory (Beukelman, Dietz, McKelvey, Hux, & Weissling, in press; Dietz, Beukelman, & McKelvey, 2006a; Dietz, McKelvey, Beukelman, Weissling, & Hux, 2006b; McKelvey, Dietz, Hux, Weissling, & Beukelman, 2007). High-technology VSDs may include various combinations of photographs, text boxes and speak buttons (see Figure 1); however, the specific elements of VSDs that best support the communication of PWAs is unknown. Therefore, the purpose of this investigation was to compare the impact of personally relevant (PR) photographs and line drawings (LDs) as well as the presence of text on four AAC interfaces, on the communication of PWAs during a personal narrative retell task

Moderate-severe, chronic aphasia: An exploration of the changes in social roles

This study explored the changes in social roles following a stroke from the perspective of three people living with moderate-severe, chronic aphasia. The researchers conducted semi-structured interviews with two family members/friends of the people with aphasia. Next, the researchers transcribed the interviews and analyzed them for emergent themes. The researchers used these themes to develop questions and conduct semi-structured interviews with the participants with aphasia—using augmented communication strategies as necessary—to validate, or negate the findings. Although results confirm that a change in social roles is present, some discrepancies exist between family/friends and the people with aphasia

The Effect of Visuographic Context on the Auditory Comprehension of People with Chronic Aphasia

The purpose of the research was to determine what types of images best support the auditory comprehension of people with aphasia when listening to stories. Twenty-one people with chronic aphasia listened to four stories, one in each of four conditions (e.g., Isolated Photographs, High Context Drawings with embedded Photographs, High Context Photographs, and No Visuographic Support). The researchers measured auditory comprehension by determining participants’ accuracy in responding to 15 multiple choice questions related to each story. Results showed no significant differences in accuracy across the four visual graphic conditions. Clinical implications and future research are discussed

Augmented input: The effect of visuographic supports on the auditory comprehension of people with chronic aphasia

Background: Augmented input (AI), or the use of visuographic images and linguistic supports, is a strategy for facilitating the auditory comprehension of people with chronic aphasia. To date, researchers have not systematically evaluated the effects of various types of AI strategies on auditory comprehension. Aims: The purpose of the study was to perform an initial evaluation of the changes in auditory comprehension accuracy experienced by people with aphasia when they received one type of AI. Specifically, the authors examined the effect four types of non-personalized visuographic image conditions on the comprehension of people with aphasia when listening to narratives. Methods & Procedures: A total of 21 people with chronic aphasia listened to four stories, one in each of four conditions (i.e., no-context photographs, low-context drawings with embedded no-context photographs, high-context photographs, and no visuographic support). Auditory comprehension was measured by assessing participants’ accuracy in responding to 15 multiple- choice sentence completion statements related to each story. Outcomes & Results: Results showed no significant differences in response accuracy across the four visuographic conditions. Conclusions: The type of visuographic image provided as AI in this study did not influence participants’ response accuracy for sentence completion comprehension tasks. However, the authors only examined non-personalized visuographic images as a type of AI support. Future researchers should systematically examine the benefits provided to people with aphasia by other types of visuographic and linguistic AI supports

Augmented input: The effect of visuographic supports on the auditory comprehension of people with chronic aphasia

Background: Augmented input (AI), or the use of visuographic images and linguistic supports, is a strategy for facilitating the auditory comprehension of people with chronic aphasia. To date, researchers have not systematically evaluated the effects of various types of AI strategies on auditory comprehension. Aims: The purpose of the study was to perform an initial evaluation of the changes in auditory comprehension accuracy experienced by people with aphasia when they received one type of AI. Specifically, the authors examined the effect four types of non-personalized visuographic image conditions on the comprehension of people with aphasia when listening to narratives. Methods & Procedures: A total of 21 people with chronic aphasia listened to four stories, one in each of four conditions (i.e., no-context photographs, low-context drawings with embedded no-context photographs, high-context photographs, and no visuographic support). Auditory comprehension was measured by assessing participants’ accuracy in responding to 15 multiple- choice sentence completion statements related to each story. Outcomes & Results: Results showed no significant differences in response accuracy across the four visuographic conditions. Conclusions: The type of visuographic image provided as AI in this study did not influence participants’ response accuracy for sentence completion comprehension tasks. However, the authors only examined non-personalized visuographic images as a type of AI support. Future researchers should systematically examine the benefits provided to people with aphasia by other types of visuographic and linguistic AI supports

Personalizing AAC for People with Aphasia: The Role of Text and Pictures

Over time, and with intensive instruction, people with aphasia (PWAs) can learn to use grid-based, categorically organized, high-technology AAC layouts during structured tasks (e.g., Hough & Johnson, 2009). In an effort to reduce the training intensity required to teach PWAs to use AAC; researchers developed visual scene displays (VSDs), designed to complement the residual cognitive and linguistic abilities of PWAs by tapping their intact episodic memory. VSD interfaces incorporate personally relevant (PR) photos, text, and speech output (Dietz, McKelvey, & Beukelman, 2006; Weissling & Beukelman, 2006). VSDs appear to facilitate improved communication success (e.g., McKelvey, Dietz, Hux, Weissling, & Beukelman, 2007) as well as relatively efficient learning of system navigation with less instruction than reported for traditional grid layouts (McKelvey et al., 2007; Wallace & Hux, 2012). Figure 1 contrasts VSD and grid interfaces. The success of VSDs is frequently attributed to the PR photographs; however, investigators have not examined the impact of the various VSD elements on communication behaviors. Therefore, the purpose of this study was to examine the influence of PR photographs and the presence of text on a VSD interface on the communication behaviors of PWAs during a narrative retell task

Personalizing AAC for People with Aphasia: The Role of Text and Pictures

Over time, and with intensive instruction, people with aphasia (PWAs) can learn to use grid-based, categorically organized, high-technology AAC layouts during structured tasks (e.g., Hough & Johnson, 2009). In an effort to reduce the training intensity required to teach PWAs to use AAC; researchers developed visual scene displays (VSDs), designed to complement the residual cognitive and linguistic abilities of PWAs by tapping their intact episodic memory. VSD interfaces incorporate personally relevant (PR) photos, text, and speech output (Dietz, McKelvey, & Beukelman, 2006; Weissling & Beukelman, 2006). VSDs appear to facilitate improved communication success (e.g., McKelvey, Dietz, Hux, Weissling, & Beukelman, 2007) as well as relatively efficient learning of system navigation with less instruction than reported for traditional grid layouts (McKelvey et al., 2007; Wallace & Hux, 2012). Figure 1 contrasts VSD and grid interfaces. The success of VSDs is frequently attributed to the PR photographs; however, investigators have not examined the impact of the various VSD elements on communication behaviors. Therefore, the purpose of this study was to examine the influence of PR photographs and the presence of text on a VSD interface on the communication behaviors of PWAs during a narrative retell task