Alternative Communication Short Course Timeline

Strategies for People with Aphasia:

8:00 - 8:15 Introduction
Creating Goals That Matter 8:15 - 9:20 Assessment, Partner Dependent Strategies,
Partner Dependent Communicators
Joanne P. Lasker, Ph.D., CCC-SLP 9:20 - 9:40 Small Groups: Case Discussion and Goals
Florida State University, Tallahassee, FL
9:40 - 10:30 Technology Issues and Independent
Communicator Illustrations and Funding
Kathryn L. Garrett, Ph.D., CCC-SLP
10:30 - 10:45 Small Groups: Case Discussion and Goals
Duquesne University, Pittsburgh, PA
10:45 - 11:00 Summary and Questions
American Speech-Language-Hearing Association Convention
Boston, MA
1 2
November, 2007

Our Goals and Yours. . .

illustrate elements of assessment protocol

Implement evaluation strategies.

case examples to demonstrate how different communicator
types appear on assessment and how they employ various AAC
strategies in treatment

Identify and characterize communicators.

Identify appropriate treatment goals.

considerations regarding speech generating devices

Describe factors to consider when selecting devices for trials and
treatment.

Identify goals for particular device types.

funding issues

Identify resources and primary considerations.
3 then not used.
Introduction

Many people with chronic aphasia have unmet
communication and participation needs that may be
addressed through alternative or augmentative
communication options.

Determining which options are useful tools is a
complex issue.

related to capabilities and challenges of user

characteristics of partners and environment

features of AAC systems

challenges related to assessment and training

Many AAC systems and strategies are prescribed and
4

1

What is aphasia?

loss of ability to comprehend
and use language that results
in reduced ability. . .

to communicate or
understand information

to establish and

an impairment of the ability to maintain relationships
use or understand language,

to fulfill social roles in life
usually acquired as a result of
(Lasker, Garrett, & Fox, 2007)
stroke or head injury

(National Aphasia Association, 2007)
Augmentative and Alternative
Communication (AAC)

an area of clinical practice that attempts to
compensate for the impairment and disability
patterns of individuals with severe expressive
communication disorders

(ASHA, 1989)

refers to ways (other than speech) that are used to
send a message from one person to another

(ASHA, 2007)

5 6

Our Target Population Video Illustration

people with aphasia who have significant
What’s the problem here?
communication problems
What does this illustrate?

may be nonspeaking or limited over the long term

have participated in standard aphasia language
and motor speech-based treatments Video Neil

some are beginning to speak more

BUT are not able to meet daily communication
needs through speech alone

7 8

2
 Classification of Communicators with
Clinical Questions Aphasia (Garrett & Lasker, 2005)

How can clinicians determine which clients with
severe/chronic aphasia will benefit from use of
augmentative/alternative communication strategies?

How can clinicians determine which AAC

approaches will be successful with these clients?

How can clinicians design and implement

appropriate treatment goals for these clients?

9 10

Assessment Tools

AAC Assessment Protocol

for People with Aphasia

What steps do I take to assess

? people with aphasia who may
benefit from AAC strategies?
How do I develop treatment
goals from this information?

11 12

3
Assessment Tools (cont.) 5 Assessment Questions
unaided strategies

? partner-dependent strategies

What are some of
the more unusual external stored information
assessment 
tasks I would use
with a client with stored messages on device
aphasia to 
determine
whether he or formulate/generate messages with device
she can benefit
from AAC
intervention?
13 14

The point… Needs Assessment

MATCH communicators to an optimal
package of communication strategies and
“What would you like to be doing that you’re not doing?”
systems.
comparison to “pre-disease” self

multiple informants

conducted multiple times? ongoing?

needs/wants sometimes easier to identify than social role

fulfillment maintenance

clinician provides examples

encourage “imagined” situations

15 16

4
 Social Networks
Needs Assessment (Blackstone & Hunt Berg, 2003)

Sorting procedure for prioritizing user’s needs.

Circle of communication partners.
(Fox, Sohlberg, & Fried-Oken, 2001) 17 18
(Donham & Lasker, 2007)

Scanning, Visual Field, Print

Size, Attention Screen Standardized Assessments
“Point or circle the word “good” each time you
see it.” (Garrett & Lasker, 2005)
Western Aphasia Battery

(Kertesz, 1982)

Aphasia Quotient (1-100; 93.8 cutoff)

comprehension

• no field cut
fluency

repetition
• needed 16 pt font

naming
• ID’d 13/13 targets

Reading Comprehension Battery for Aphasia:
• 5 false positives Second Edition

(LaPointe & Horner, 1998)

Cognitive-Linguistic Quick Test

(Helm-Estabrooks, 2001)
http://aac.unl.edu19 20

5
 Modifed “PACE” Picture
Writing Assessment Description Task

provides information about
user’s ability to use unaided
modalities in communicative
situation

gesture, drawing, residual
speech

how much cueing or modeling
was required to convey
message succesfully?

stimulability

strategy use

21 22

Multimodal Communication Screening Task

for Persons with Aphasia - MCST-A
Data Collection (Garrett & Lasker, 2005)

sample communication book

contains pictures, words,

sentences, letters, map, story
sequences

clinician asks client to

communicate messages
using book and/or natural
strategies

videotaped administration

23
http://aac.unl.edu24

6
 Sample Scoring Page
Sample Stimulus Page MCST-A MCST-A

http://aac.unl.edu25 http://aac.unl.edu26

Scoring of MCST-A MCST-A Demonstration

clients permitted 3 attempts to communicate
“How would you tell me the state you live
message in?”

clinician’s cues are recorded and tabulated

response adequacy (+, +/-, -)

communication mode

Did she need cues? How many? What type?

# symbols used
What kind of communicator do you think she

ability to open and navigate through book might be?

# of client attempts

focus on type and number of cues required for
Transitional/Stored Message?
success
27 28

7
What Does the MCST-A Systems Trials for Partner-
Reveal? Dependent Strategies

Provides information about client’s:
Conduct trials of Partner Supported

ability to think to communicate with external system Techniques

ability to search through an array of symbolic picture
(Garrett & Lasker, 2005)
choices

Written Choice Conversation Strategy

ability to search through a limited categorical matrix

ability to combine symbols
Augmented Input Strategy

ability to combine modes of communication
Cued Question-Asking

ability to use external symbols in conversation or
Tagged Yes-No Responses
storytelling to truly convey a message

29 30

Written Choice Conversation Strategy

(Garrett & Beukelman 1992, 1995) Written Choice Conversation Strategy

Partner scaffolds conversation by. . .

providing topic choices

Asking open-ended conversational questions (sincere
questions)

Writing potential answers in the form of large print
word/phrase choices (usually vertical, indicate phrase with
bullet)

OR offering graphic scales

Asking the PWA to point to a choice/scale to communicate

Continuing the conversation by asking a follow-up question

31 32

8
 Augmented Input Techniques
Graphic Rating Scales (Beukelman & Garrett, 1998; Garrett & Beukelman, 1992)

Communication partner supports

comprehension of person with aphasia by:

supplementing spoken language with:

gesture

written key words

drawing

diagrams

33 34

Augmented Input Tagged Yes/No Questions

Partner: So you meet a lot of
acquaintances at the dogtrack
and at the bars?

PWA: [looks confused]

Partner: Oh, I’m sorry I was
going too fast.

Partner: [speaks while
writing/drawing] So you meet
a lot of people. . .

[writes and draws people]

at the dogtrack

[writes and draws dogtrack]. . .

and at the bars?

[writes and draws bottle and
glass]
35

Purpose: To facilitate patient’s reliable expression
of yes/no responses via gestures, head nods, or
verbal responses

Partners add a verbal and gestural “tag” to the ends
of their “yes/no” questions

“Did you ever serve in the military, YES [nod head up and
down, use rising intonation]….or NO [shake head side-to-
side, falling intonation]?

“Do you like maple syrup, YES [nod head up and down,
use rising intonation]….or NO [shake head side-to-side,
falling intonation]?
36

9
Illustration
Tips

Ask preference (“Do you like chocolate -
yes or no?) or autobiographical (“Were you
in the Army?”) questions first

vs. declarative information (test) questions
(“Is the sky blue?)

Pair with augmented input as needed
 Partner: “Richard, do you like omelettes…yes…or no?”
 Richard: [tries to gesture thumbs up, then points down, then
nods head ‘yes’ after pausing to work out the movement
sequence]
 Partner: “Yes?”
37 38
 Richard: Confirms ‘yes’ by nodding head up-and-down.

Cued Question-Asking Cued Question Asking

To avoid passive pattern of participation, cue
Can be a verbal, “and you?” or a gesture.
person with aphasia to ask questions of you
May require hand over hand assistance to cue
or other conversation partners. client to point to partner to ask a question.

May be incorporated into Written Choice
Can also use a visual remnant, notebook
Conversation Strategy.
pages, or a voice-output device to ask

For example, after a written choice based
exchange about the client’s weekend activities. question of a partner.

“So, John, do you want to know where I went this
weekend?”

“So ask me [clinician points/gestures/refers] …”
39 40

10
 How Did We Take Data on Partner-
? Dependent Strategies Trials?

JV’s sequentially
number or percent of successful communication turns

organized social
e.g. “The person with aphasia selected 1 of 4 written choices
communication accurately in conversation with the clinician.”
wallet. His target
e.g. “The person with aphasia shared reference during
behavior (cued): Augmented Input conversation by referring to written key
hand wallet to novel words/pictures and answered questions appropriately 2 out of 3
communication times.”
partners, then flip
how much cueing was required?
through it to ask
prestored questions,
how did communication partners of the person with aphasia
share information. employ these strategies after teaching?

did the person with aphasia enjoy the interaction?

John video
42

Emerging > Contextual Choice:

John
Dependent

62 years old, lives with wife
Communicators
10 years post large left
hemorrhagic CVA with
subsequent craniotomy

Standardized Testing:
How Assessment Results Lead to AAC WAB AQ .6/100
Treatment Goals BASA - 1st percentile

verbal expression limited to
John “wah wah” with varied
intonation and facial
Max expression

problems with attention,
limb apraxia, use of
2-dimensional symbols
43 44

11
Emerging > Contextual Choice
Profile AAC Treatment Goals
Assessment Tool Performance

transitioning from Emerging to Contextual Choice
communicator
Vision Screen severe right field cut
and neglect
Goals: The person with aphasia will. . .
Standardized Tests WAB AQ .6/100
consistently signal affirmation/agreement (head nod) during
choice-making activities for preferred items and rejection for non-
Writing Assessment no preferred activities.

Picture Description no

answer partner’s tagged “yes/no” questions with reliable
Multimodal Communication Screening Task no gestures, head nods, or verbal responses

Partner-Supported Strategies Augmented Input

Voice-Output Strategies no

45 46

AAC Treatment Outcomes Additional Goals

following treatment, can now:
Refer to tables in your handout on goals for

answer yes/no consistently partner-dependent communicators.

converse via partner dependent Written Choice
Emerging
Conversation Strategy
Contextual Choice

point to symbols to request favorite activities
Transitional - coming up
given partner setup and questions

point to items in the room to request
them

47 48

12
 Systems Trials for Independent
Assessment Protocol (cont.) Voice-Output Strategies

Prepare at least two representative types of
devices, if possible.

digitized device with static overlay (and perhaps
multiple levels)

synthesized device with dynamic screen

Develop appropriate scenarios and program
the vocabulary.

Conduct role-plays.

49 50

A Quick Review: Two Types of

How to “Do” a Role Play Speech Generating Devices

use a meaningful situation Devices That Enable
Formulation (Spelling)

i.e. hosting a granddaughter’s engagement party, buying
(dynamic/synthesized)
coffee, planning a trip, discussing car purchase

Have the capacity for a

script out the conversation line by line prior to the greater number of messages.
trial
Can produce messages

identify modalities that person with aphasia might use sound-by-sound with a
computer-generated voice.

program vocabulary
Multiple language formulation

try it with client several times options for user (words,
letters, icons, phrases,

take data on performance sentences).

success, cueing required
Can provide some users with
access to spelling.
Devices That Use Whole-
Phrase Retrieval
(static/digitized)

Someone records messages
by pushing the message
square and record button,
then speaking into the device.

Instant, “real” voice.

In most cases, little or no
formulation required by user.

Typically can’t create novel
messages/spell.

51 52

13
Some Digitized Devices with Static Display
Some Synthesized Devices

Tech/Speak
MessageMate
AMDI
Words+

Say-It! SAM Enkidu Portable Impact

Communicator DynaVox Systems
Words+
GoTalk
Attainment

Create the Scenario Scenario for Dynamic Display

Create a scenario appropriate for your client and
consumer transaction going beyond 5
program necessary vocabulary. prestored messages

Program a digitized device to handle buying a gift at
planning a trip, buying a car, having a “getting to
a toy store: know you” conversation

Sample Script:
“You are going to plan a vacation trip with a travel

I’d like to buy some toys for my daughters. agent who will book all of the arrangements. You will

Sheila is 12 and likes unicorns. use anything you can to communicate with the travel

Angela is 6 and loves “Dora the Explorer.” agent. You will need to arrange all of the details –

How much do those cost? where you are going, how you will get there, where

Do you have anything else? you will stay.”

Yes, I’ll take those!

55 56

14
Planning A Trip (page 1) Document User’s Behaviors
Device Features Client’s Behaviors

2nd page
attends to several screens

dynamic display
contains:
multiple messages per page
locates messages

numbers successfully

movement required between

days
navigates between pages
pages

changes features of the

weeks
return to operational pages device (speaking rate, voice)

months to change device features

turns device on/off

destination
store/retrieve messages
stores new text under picture

keyboard symbol
link

57 58

Videotape and Tally Max: You Decide

# successful turns (%)
66 years old

# initiations

2.5 year post left CVA

ability to combine items from systems

ability to integrate unaided strategies
severe expressive and

ability to switch levels manually receptive aphasia

ability to navigate from one level to another on a dynamic
retired military and
device
postal worker

ability to use categories to facilitate search for items

ability to resolve communication breakdowns
lives with wife
Contextual Choice?
Transitional?
59 Stored Message? 60

15
 Contextual Choice>Transitional Profile
Assessment Tool Performance
Max Assessment Examples
Vision Screen okay

Unaided Strategies
Standardized Tests WAB AQ 11.2/100
Picture Description Task
Partner Dependent

maximal, HOH assist
Writing Assessment only with HOH model Strategy Trials

Writing

perseverative, non-

successful with all
Picture Description maximal assistance communicative
Device Trial with Stored
for unaided gestures

MCST-A Max MCST-A Messages Max Transaction
Multimodal Communication Screening Task required multiple attempts
and cues;
average of 2.5 trials per message
transaction “in order”
successful at communicating attempt  transaction “out of order”
messages if on single page

average of 2.8 cues per attempt

No Spelling or Message
Partner-Supported Strategies Augmented Input
with max assist, able to convey
Written Choice single-hit messages in external
Generation Tasks
Voice-Output Strategies whole-phrase storage system
messages on static
display (but only “in
order”)
62

Will Max Benefit from

Overlay for TechTalk
a Voice-Output
Device?
Yes or No?
Independent Use?
With Cues?
Not at All?

63 64

16
AAC Treatment Goals AAC Treatment Outcomes

Goals: The person with aphasia will. . . .
On the cusp between Contextual Choice and

Tell simple stories on an SGD by activating sequential Transitional.
messages.
Ongoing challenges due to limited comprehension
and insight.

Answer predictable questions (e.g., autobiographical,
Uses unaided strategies (gesture, pantomime, drawing)
topical) by searching for, selecting, and pointing to pre- other than speech in conversation with clinician and other
stored messages on a simple SGD or notebook. aphasia group members.

Important partners have been trained in Augmented Input

Increase independent use of nonspeech strategies (e.g. and Written Choice.
gesture) to convey messages in conversation.

Continues to require considerable cues to use nonspeech
strategies.
65 66

Communication Type and Assessment Results:

Partner Dependent Tier
Additional Goals
Emerging Contextual
Can the person Choice
with aphasia. . .
John
Max
Refer to tables in your handout on goals for
partner-dependent communicators:
use unaided
maybe with
strategies (e.g.,
support
not yet
Emerging
gesture, facial)
use partner-
Contextual Choice
supported strategies yes yes

Transitional
use external stored with max assist;
message systems with max assist on a single page

access whole- only “in order” for

phrase messages on no transaction; only
voice-output device with support
generate messages
piece by piece no not yet
68

17
Partner Dependent Communicators:
Case Study Practice Summary of Group Activity

Find a group of people near
you.

Which case did you choose?

Select one of the cases in
What type of communicator was this person?
your packet:

Cases 1, 2, or 3
How could you tell?

Read and answer the
questions.
What sorts of goals did you create?

Refer to your Sample Goals
and Categories Checklist.

How would they perform some
of the activities we’ve been
describing?

What type of communicators
are they?

What sorts of goals would you
set? 69 70

Technology Features:
What Matters?
Independent
appearance
Communicators



size
pictures

hardware

Who can benefit from a communication
accessibility

portability
system that incorporates words, stored
voice quality
messages, and/or spelling?
volume

ease of use

Who needs a voice-output system?

effectiveness

is it worth it?
Ordering food at the deli counter with
a DynaMyte.
71 72

18
 Language Factors:
“Not the Device but How It’s Used” How Are Messages Stored and Retrieved?

dynamic screens can be useful for some, but not others

if the communicator has more than 8 pages of messages to Storage Retrieval
communicate, may be useful
letter by letter

various combinations

picture-based systems are the ones we see most often for
primarily spelling
people with aphasia of retrieval. . .

with word prediction

usually not systems that require sequencing of iconic symbols to
letters and phrases
access pieces of messages (words) or whole messages
by single words alone

words and phrases

synthesized systems are basically ways of retrieving more
text plus symbols or
messages [words, pictures, environments, letters] than pictures
words and pictures
available on a static display device with symbols
most common
words, phrases,
sentences

phrases/sentences

scenes and sentences

icons without words

visual scenes
73 74

Letter by Letter: More Devices with Prediction

Use word prediction strategies to Capabilities
supplement spelling.

Communicator types ‘t’ then ‘a.’

Computer generates “table”,
“take”, “taking”, “talk.”

Communicator hits key/clicks
to choose desired word.

Enkidu Portable
DynaMyte Impact Handheld
GUS Pocket PC DynaVox DynaVox
75 76

19
 Retrieval by Letters, Words, Pictures, Phrases
Sample Goals for a Letter-Based or
Picture-Based Prediction System Word Power Software
(Available on a variety of systems.)

Beginning Goal:

Done after family members’ names have been added to
prediction pool.

The client will select the first letters of family member’s
names and select the words in the prediction list 4 out of 5
times with minimal cueing.

More Advanced Goal:

In a conversation with an unfamiliar partner, Rod will
respond to specific questions about his job as an airport
manager by typing the first 2-3 letters of his answer and
selecting the best prediction option 3 out of 5 opportunities word and letter-based picture/word and letter-
with minimal cueing. retrieval with links based retrieval with links

77

Visual Scenes Display Goal for Visual Scenes System

In a conversation about
favorite movies, client will

photographic respond to partner’s
representations of questions and ask
connected actions questions of the partner
plus using preprogrammed
conversationally phrases, residual speech,
relevant phrases gestures on 10 occasions
and questions in conversation with an

topic choices stay unfamiliar partner with only
constant 1 communication
breakdown.

http://aac.unl.edu79 80

20
Picture Symbol-Based Additional Communicator
Retrieval: Sample Goal Examples

Stored Message

In a role-played
Communicators
transaction, the

Kelly
client will access the
appropriate page to
Generative Message
order coffee from
Rod
Starbucks and will
Specific Need
participate
Jan
successfully in 5 of 6
Enkidu Portable Impact
conversation
Symbol Base Main Page exchanges with the
DynaVox Systems clinician.
81 82

Would You Recommend

Stored Message: Kelly Stored Information System?
Kelly Stored Messages

42 years old
Assessment Tool Performance

6 months post L CVA
Vision Screen okay

WAB 34.8
Standardized Tests WAB 34.8

speech limited to “oh
Writing Assessment no
gosh” and “well”

accurate yes/no Picture Description gesture
pantomime
responses Multimodal Communication Screening Task phrase-based

previously employed navigation
as office worker Partner-Supported Strategies Written Choice

Voice-Output Strategies phrase-based or

83 word-based 84

21
Stored Message Treatment AAC Treatment Goals

Script-training.
The person with aphasia will. . .

Accessing stored messages to buy toys at
participate in selection and storage of specific vocabulary
FAO Schwarz. for a variety of communication situations.
Script Training
Kelly
practice accessing vocabulary during structured, scripted

What other goals might be appropriate for role playing situations (in therapy).
this young woman?

gradually use the system in more demanding situations,
such as returning an item to a store serviced by a clerk
with no knowledge of aphasia.

85 86

Generative Message Communicator:

AAC Treatment Outcomes Rod

Stored Message but working on improving
64 year-old, retired airport
formulation skills. manager

language formulation skills
9 years post L CVA

letter by letter, word-based
WAB AQ 55.4

familiarity with device
moderate aphasia and

operational skills (on/off, navigation) moderate-severe apraxia of

access [attention?] speech

programming for real-life situations
limited speech skills but

request is pending for voice-output device highly successful

phrase-based and word-based communicator with multiple

dynamic display modalities

good quality voice
87 88

22
 Rod – MCST-A Example
Generative Message Profile
“I want to buy some toys for my grandkids.”
Assessment Tool Performance
Vision Screen okay

Standardized Tests WAB AQ 55.4/100
initial unsuccessful speech attempt

Writing Assessment agrammatic with
successful search for appropriate page
spelling errors, but
communicative
independently accessed 3 symbols to convey
Picture Description Task gesture, tactile cues, message
writing

independently combined modalities
Multimodal Communication Screening Task symbol combinations
some spelling
speaks while pointing to symbol
Partner-Supported Strategies not needed
2 client attempts
phrase-based
adequacy score: +
Voice-Output Strategies word based
letter-based

AAC Treatment Goals AAC Outcomes RM

acquired and used a
Manager

Goals: Person with aphasia will. . .
portable, dynamic display

Establish topics prior to communicating complex device in his daily life
conversational information using tangible topic setters,
lived independently
topic cards (e.g., “I want to talk about…sports…family,
utilized both whole-phrases
etc.”), and verbal skills. and keyboard

Communicate in a variety of situations with familiar and
used first letter spelling
unfamiliar communication partners (e.g., with family and word-prediction
members and public places such as stores, banks,
continued work on speech
government offices, bars and social clubs, lectures). production for apraxia of
speech

Shift between accessing stored messages and creating

was still working on
novel messages to convey a complete idea. providing cues to partner to
control conversation
91
independent programming 92

23
Specific Need Communicator: Specific Need Communicator
Jan
Assessment Tool Performance

54 year old professor Vision Screen okay

4 years post L CVA Standardized Tests WAB AQ 79.1/100

WAB AQ 79.1, moderate
Writing Assessment excellent
anomic aphasia

did not use AAC as a Picture Description gesture, writing,
speech
primary communication
Multimodal Communication Screening Task symbol combinations
method navigation

required AAC for specific combined modalities
communication situations Partner-Supported Strategies not needed
that require specificity,
Voice-Output Strategies letter-based
clarity, and/or efficiency
93

Jan: MCST-A Example

“My sister is coming to visit me from Texas.”

navigation from calendar to map page

use of multiple locations on page to supplement
and augment her spoken productions

independent in use of strategies

independent combination of modalities

1 client attempt

adequacy score: +
AAC Goals and Outcomes

Specific Need Communicator

Goal: The person with aphasia. . .

Utilize SGD to communicate information
successfully during her graduate class.

client primarily used speech in daily life

for creating and delivering lectures, utilized EZ Keys
software on a computer system

combined speech and computer output delivery during
class lectures

continued work on refining computer skills and use of word-
prediction strategy
Jan and
NAFTA 96

24
 Billing Codes

Inpatient
AAC Funding
billable CPT codes

Outpatient

Insurance covers individual therapy
What procedures do I use to get funding
AAC evaluation, modifications, and treatment

? for SGDs for people with aphasia who

can benefit from voice-output systems?


available CPT codes
Group therapy (Elman, 2006) is also billable and fundable

Importance of goal/objective writing
 e.g., “Patient will answer functional conversational questions by
pointing to 1 of 4 partner-generated written phrase choices with
90% accuracy.”

Can include patient in construction of low tech systems
and programming of high tech systems to bill for a session.
97 98

Funding for SGDs

SGDs are attainable for people with aphasia.
Summary of Potential Goals

Medicare, Medicaid, Vocational Rehabilitation,and many
insurers will fund devices if application is submitted
Across Communicators
through a DME provider or if request is sent directly to
vendor.
Refer to Sample Goal

SLPs have the primary responsibility for this process.

Include reports, copies of insurance cards, vendor forms, ? Section of Your Handout
doctor’s prescription.

See www.aac-rerc.com for sample reports, FAQs, report
protocol, billing codes for device classes.

Also, see http://www.aacfundinghelp.com/ for information
and funding report template.

99 100

25
Communicator Type and Assessment Results:
Independent Tier Independent Communicators:
Case Study Practice
Can the person Stored Message Generative Specific Need
with aphasia. . . Kelly Rod Jan

Find a group of people near
use unaided you.
yes; uses first letter
strategies (e.g., yes yes writing
Select one of the cases in
gesture, facial)
your packet:
use partner-
Cases 4, 5, or 6
supported strategies yes yes yes but not needed

Read and answer the
use external stored best with “one- questions.
message systems symbol” yes yes but not needed
Refer to your Sample Goals
messages and Categories Checklist.
access whole-
How would they perform some
phrase messages best with “whole- yes and needed in
on voice-output
of the activities we’ve been
phrase” yes specific situations
describing?
device messages

What type of communicators
generate messages are they?
yes and needed in
piece by piece not yet yes specific situations
What sorts of goals would you
set? 102

Classification of Communicators with

Aphasia (Garrett & Lasker, 2005)
Summary and
Conclusions John

Max

So what does all of this mean for

? me in my daily practice with Kelly
people who have aphasia?
Rod

Jan

103 104

26
Take Home Points

AAC for people with aphasia involves “more than
just a talking box!”

an assessment protocol can be useful to determine
“type” of communicator with aphasia

match communicator with strategies

use a dynamic assessment process with data
collection to determine communicator potential for
success

consideration of cueing, support, and adequacy of
message

assessment will then lead to meaningful treatment
goals
105

treatment occurs in meaningful contexts

27