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van de Sandt-Koenderman, M.W.M.E. (2004). High-tech AAC and aphasia: Widening horizons? Aphasiology, 18 (3), 245-263.
The article reviews the state of the art both in low-tech and in high-tech AAC applications for aphasia. AAC training is considered to be an intervention at the levels of activity and participation according to the World and Health Organization (WHO, 2001) classification. It is claimed that the field of AAC for aphasia is relatively young and that the literature on AAC strategies is limited. Factors influencing the success of low-tech (i.e., writing, gestures, drawing, and communication books) AAC in aphasia include: type of aphasia, cognitive abilities, communicative abilities and needs, motivation, training and communicative environment. High-tech AAC designed for aphasia includes: devices aiding word finding (i.e.,”Multicue”), devices aiding sentence construction (i.e., “Computerizes Visual Communication - C-VIC”; “Lingraphica”), devices aiding conversation (i.e., “Talkbac”, “Personal Communication Assistant for Dysphasic People – PCAD”). Although the use of high-tech communication aids in aphasia rehabilitations is restricted, few studies in the literature have shown several advantages in communication skills, and the use of high-tech AAC by people with aphasia is promising in the field of communication disorders. More research is needed to explore the benefits of new technologies and use them to improve individuals with aphasia quality of life by enhancing participation.
Jacobs, B., Drew, R., Ogletree, B.T., Pierce, K. (2004). Augmentative and Alternative Communication (AAC) for adults with severe aphasia: where we stand and how we can go further. Disability and Rehabilitation, 26 (21/22), 1231-1240.
The article purpose is to make a review of the literature to the application of AAC with adults with severe aphasia. Several studies were reviewed and findings suggested positive AAC treatment effects in individuals with severe aphasia. However, positive effects took place mostly in control environments, but not in everyday settings. Some research questions were brought up: “Could it be that researchers and practitioners have failed to extend and support training in real world contexts?”(p.1237). Another issue commented was about the acceptance of AAC by users and those around them. The authors concluded that AAC application with persons with severe aphasia is essential and that training studies including easy of system/device use, vocabulary selections and user knowledge must be done to control for system and users variables that might impact findings. Furthermore, training should design to the extending of communicative use in natural occurring environments.
HO, K. M., Weiss, S.J., Garrett, K. L., Lloyd, L. L. (2005). The Effect of Remnant and Pictographic Books on the Communicative Interaction of Individuals with Global Aphasia. Augmentative and Alternative communication, 21(3), 218-232.
Knowing that people with global aphasia have difficulty comprehending or using external symbols during conversations, the present study was designed to determined whether participants with global aphasia were more successful at initiating and maintaining social interaction with conversation partners when remnants, pictographic symbols, or no symbols were available. Remnant is characterized as an actual object or photograph showing recent or past events. For example: tickets for a recently game, photographs of a vacation spot, a favorite restaurant menu, letter, maps, etc. Two participants with global aphasia were tested across three conversational conditions: baseline (no symbols), pictographic topic symbols, and remnants. Results indicated that participants with aphasia initiated more topics, used more pointing, and had fewer communication breakdowns in both of the symbol conditions supporting the use of communication books for individuals with global aphasia.
Linebarger, M.C., Schwartz, M.F. (2005). AAC for Hypothesis Testing and Treatment of Aphasic Language Production: Lessons from a “Processing Prosthesis.” Aphasiology, 19(10/11), 930-942.
In this article, the author reviewed data from three published studies of the “processing prosthesis” (CS), a communication system designed to provide processing support on spoken language to be produced. The system links spoken words or phrases recoded by the user with visual icons with can be moved around on the screen, replayed, and build up into sentenced and narratives. These studies provided indirect support approach to AAC technology and its implication for treatment of aphasic disorders. Lessons learned for the CS studies include: CS allowed aphasic users to create more structure utterance on the system they were able to use in their unaided conversations because CS allowed the users to assemble and integrate into a sentence more material then would be possible under normal conditions. Moreover, it allowed users to replay segments they have recorded. They replay of words helped in overcoming word retrieval blocks. In conclusion, the CS provided an enlarged language production workspace where many individual with aphasia were able to assemble more elaborated structures than they could produce without processing support.
van de Sandt-Koenderman, M.W.M.E., Wiegers, J., Wielaert, S.M., Duivencoorden, H.J., Ribbers, G.M. (2007). High-Tech AAC and Severe Aphasia: Candidacy for TouchSpeak (TS). Aphasiology, 21(5), 459-474.
The study focused on exploring factors associated with the functional use of TouchSpeak (TS) in people with severe aphasia. A retrospective analysis was done on the data of a group of 30 patients who had received TS training to evaluate the role of age, gender, aphasia type, time post onset, memory, executive functioning, semantic processing, and overall communicative skills. The TouchSpeak training was aimed at functional use of the central hierarchical vocabulary in everyday life. Four levels of treatment outcome were defined: No functional use of TS, dependent use of TS, independent use of TS, and extensive use of TS. Differences between outcome groups were tested with univariate ANOVA for continuous data, and chi-square test for categorical data. ANCOVAs were used to investigate the role of communication, linguistic, and cognitive variables. Seven participants were classified as extensive users of TS, five were independent TS users, and five were partner dependent. There was no functional use of TS in 13 cases. Extensive users were younger then other outcome groups; however, there was an effect of semantic processing independent of this age effect. Furthermore, the no-users group scored significantly lower on semantics than all the other groups. The authors pointed out that few patients with severe aphasia may be expected to become independent users of high-tech AAC and prospective studies are needed to support the predictive value of semantic processing for high-tech AAC use.
van de Sandt-Koenderman, M.W.M.E., Wiegers, J., Wielaert, S.M., Duivencoorden, H.J., Ribbers, G.M. (2007). A Computerized Communication Aid in Severe Aphasia: An Exploratory Study. Disability and Rehabilitation, 29(22), 1701-1709.
The study investigated the functional benefits of TouchSpeak (TS), a computerized high-tech aid that aims directly at functional use in daily life. In order to evaluate the long-term effect of the aid, the participants were interviewed three years after completion of the TS training. Participants included 17 individuals with aphasia. The majority of the participants were classified as having global aphasia. There were two separated phase of treatment: Phase I focused on operating and mastering a standard hierarchical vocabulary; the ability to navigate was evaluated after 6 weeks of navigation training. Phase II targeted the use of individually-tailored hierarchical vocabulary to support everyday life communication. The overall communication ability, the ability to navigate, and contributions of TS to quality of communication were assessed. Results showed that the overall communication ability improved, as tested in untrained scenarios, and the quality of communication with TS was rated higher that without TS. In conclusion, patients with a severe global aphasia were able to master vocabulary in the TS software, and to use in daily life for specific communication situations. Thus, aphasic communication can be supported effectively by TS.
Bartlett, M.R., Fink, R.B., Schwartz, M.F., & Linebarger, M. (2007). Informativeness Ratings of Messages Created on an AAC Processing Prosthesis. Aphasiology. 21(5), 475-498.
The SentenceShaper (SSR) is a computer program that supports spoken language production in aphasia by recording and storing the fragments that the user speaks into the microphone, making them available for playback. Bartlett et al. (2007) used the SentenceShaper (SSR) first to demonstrate aided effects in “functional narratives” conveying hypothetical real-life situations from a list person perspective. Second, to submit aided and spontaneous speech samples to listeners judgments of informativeness, and third to produce preliminary evidence on topic-specific carryover from SentenceShaper. Five individuals with chronic aphasia created narrative sentences on two topics under three conditions: Unaided (U), Aided (SSR), and Post-SSR Unaided (Post-U). The 30 samples (5 participants, 2 topics, 3 conditions) were judged for informativeness by graduate students in speech-language pathology using a rating method called Direct Magnitude Estimation (DME). After statistical analyzes through repeated measures ANOVA, the results showed a main effect of Condition for four of the five participants. Planned contrasts indicated that the aided effect (SSR>U) was significant in each of these cases. For two individuals was also topic-specific carryover (Post-U >U). The authors concluded that listeners judged functional narratives generated on SentenceShaper to be more informative than comparable narratives spoken spontaneously.
Lasker, J.P., & Garret, K.L. (2006). Using the Multimodal Communication Screening Test for Persons with Aphasia (MCST-A) to Guide the Selection of Alternative Communication Strategies for People with Aphasia. Aphasiology. 20(2/3/4), 217-232.
Lasker and Garret (2006) pointed out that individuals with severe communication problems associated with aphasia are often unable to meet their daily communication needs through speech alone. For this type of population, augmentative and alternative communication strategies might offer opportunities for improved communication effectiveness. Furthermore, the author commented that it is always a challenge to determine if individuals can learn to use alternative communication strategies independently or if they will require assistance from conversational partners to participate in meaningful communication interactions. For this reason, the authors above developed an assessment tool called the “Multimodal Communication Screening Task for Persons with Aphasia” (MCST –A) envisioning to help clinicians differentiate those aphasic individuals who would benefit most from partner communication strategies such as written choice conversation, partner-presented symbol choices, and tagged yes/no questions, and those aphasic individuals who could learn to use AAC systems, such as digitized speech devices that store messages, to communicate independently. A study was done comparing MCST-A scores to profiles of actual communication strategy using four individuals with severe aphasia. The individuals were asked to locate pictorial, textual, or graphic symbols from an eight-page stimulus manual to communicate simple needs and complex concepts, complete simple categories, tell and retell stories, or use partial spelling to convey novel information. Accuracy of responses and the amount and type of cueing required to complete each task were tailed for each individual. Results showed a correspondence between MCST-A test scores and patterns of communication strategy use. The two individuals who received the lowest responses accuracy scores and the highest cueing scores on the MCST-A were primarily dependent on partner-supported communication strategies in their daily lives. The two individuals with the lowest cueing scores and highest responses accuracy scores had learned to use complex AAC devices to communicate independently. The study concludes that the MCST-A is a valuable tool that may guide clinician in identifying the most appropriate AAC strategies for individuals with aphasia.
Kraat, A.W. (1990). Augmentative and Alternative Communication: Does it Have a Future in Aphasic Rehabilitation?. Aphasiology. 4(4). pp. 321-338.
Kraat (1990) examined the results of multiple studies published during the late 1960s through 1980s in which researchers endeavor to teach non-speech modes of communication to individuals with aphasia. Kraat’s review showed that the results of studies during this time were encouraging in that individuals with severe aphasia could learn alternative means (e.g., signs, symbolic gestures and written words) of expression and comprehension, suggesting this way that AAC techniques have an important role in aphasia. Moreover, Kraat’s review of new technology in the early 80s suggested encouraging results. To be exact, individuals with severe aphasia acquired non-speech communication symbols and mastered the technical operation of AAC devices.
Albright, E., Purves, B. (2008). Exploring SentenceShapeTM: Treatment and agumentative possibilities. Aphasiology, 22 (7-8), 741-752.
Integrating principles from both impaired-based and social models of aphasia, Albright and Purves (2008) explored how an individual with nonfluent aphasia makes use of SentenceShaper’sTM rehabilitation and augmentative potential. The authors evaluated changes in narrative production both with and after using the program, in order to understand whether the program in fact support sentence production for this individual. They also evaluated the ways in which this participant chose to use the program to support her everyday communication. The study was conducted over a 4-month period and comprised two components: The first component was designed to evaluated changes in participant’s narrative production after regular use over 12 weeks of SentenceShaper. The second component used a qualitative case study approach, first to further develop understanding of participant as a communicator, and then to explore how she used the program to support her everyday communication. Results showed an improvement in the participant’s morphosyntactic production in several areas. Also, the proportion of sentences that were well formed increased following use of SentenceShaper. However, measures of informativeness, efficiency, and narrative structure remained relatively unchanged. Changes in participant’s everyday communication associated with using SentenceShaper included increased use of e-mail and conversation with prerecorded messages. However, neither she nor her mother readily accepted the use of the program to augment communication in everyday life. The authors concluded that the SentenceShaperTM can contribute both to language remediation and to augmentation of communication in everyday life.
Jokel, R., Cupit, J. Rochon, E., Leonard, C. (2009). Relearning lost vocabulary in nonfluent progressive aphasia with MossTalk Words®. Aphasiology, 23(7), 175-191.
MossTalk Words® is a computer program for individual with receptive and expressive language impairments. The program system comprises a large array of words with corresponding pictures and cues (both spoken and written). There are three modules in the program: 1. Core-vocabulary module; 2. Multiple choice matching module, and cue naming module. In the MossTalk Words®, users can access either pre-programmed exercises or prepare custom-made tailored to the needs of individual participants. Jokel et al. (2009) investigated MossTalk Words® treatment-specific effects, maintenance, and generalization diagnosed with two individual with nonfluent progressive aphasia (NPA). Sessions occur two to three times a week. Treatment involved that presentation of a picture on the computer screen and the participants were required to name it. Baselines were established before treatment using three lists of words. Success in treatment was measured by probing list naming every second session. A score of 80% accuracy over two consecutive probes or participation in 12 sessions would lead to the presentation of the next list. Each participant was tested on all items immediately after therapy, and again 1 month later. Results indicated that both participants improved their naming skills with MossTalk Words®. In addition, each participant maintained some of the therapeutic gains on the trained items and showed some generalization to a sentence production 1 month port treatment. The authors concluded that both participants with primary progressive aphasia benefited from a computer-bases treatment for anomia. The results suggested that MossTalk Words® may be a promising therapy approach for patients who suffer from aphasia
