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Article Excerpt
Recent advances using AAC strategies and systems have increased functional communication skills of people with chronic aphasia. This single subject multiple baseline study investigated the use of one such system--a contextual picture-based system (Visual Scene Display) in an AAC device--by a subject with chronic nonfluent aphasia. Results documented successful use of the Visual Scene Display interface by the participant to communicate two stories to multiple unfamiliar communication partners. The researchers documented successful navigation of the AAC system by the person with aphasia while simultaneously documenting his reduced production of distracting communicative behaviors and improved quality of communicative interactions.
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Aphasia is an impairment of the ability to manipulate symbols that results from acquired brain injury, most commonly cerebrovascular accidents (McNeil, 1988). Because language is a sophisticated symbol system used in multiple aspects of daily life, one of the most prominent characteristics of people with aphasia is language impairment. The effect this impairment has on communicative interactions depends on the severity of the aphasia and the nature and extent of a person's participation in social networks.
Traditionally, aphasia intervention has focused, at least in the initial stages, on attempts to restore language functions. However, because restoration attempts may be only partially successful, 40% of people with aphasia have chronic language impairments severe enough to prevent them from regaining functional communication abilities despite the efforts of speech-language pathologists and other rehabilitation professionals (Helm-Estabrooks, 1984). As a result, supplements to reliance on residual natural speech that incorporate augmentative and alternative communication (AAC) strategies may be beneficial (Beukelman & Mirenda, 2005). Such AAC strategies include using communication books, photographs, remnants, gestures, writing, and drawing. High-technology strategies may also be appropriate (Garrett & Lasker, 2005); however, questions persist about how well people with aphasia can learn and use high-tech AAC options in communicative situations. In this research, the ability of a person with chronic, severe aphasia to learn and use a new, high-tech AAC interface during multiple interactions with naive communication partners was investigated.
Introducing AAC strategies, techniques, and devices would seemingly provide an opportunity for people with severe chronic aphasia to maximize their use of residual language skills in combination with their relatively preserved intellectual, visual-spatial, and memory functions (Fox & Fried-Oken, 1996). This apparent match has prompted several researchers to try different AAC approaches with people with aphasia. For example, Beck and Fritz (1998) trained persons with severe chronic aphasia to associate iconic symbols with concrete concepts, but the participants had difficulty making associations between symbols and abstract concepts. Other researchers have successfully taught people with aphasia to associate meanings with photographs (Fox, Sohlberg, & Fried-Oken, 2001), Blissymbols (Funnell & Allport, 1989; Koul & Harding, 1998), and iconographic symbols (Thorburn, Newhoff, & Rubin, 1995) for communication purposes inside structured therapy environments.
Despite this moderate success, several obstacles to using AAC with people with aphasia still exist, one of which stems from the timing of speech-language pathologists' introduction of AAC options (Lasker & Beukelman, 1999). Anecdotal information suggests that many speech-language pathologists do not introduce AAC materials to people with aphasia who are in the acute stage of recovery. This tendency may reflect a belief that AAC strategies are appropriate only after attempts to restore natural speech and language behaviors prove futile. The result is that people with aphasia who are slow at regaining natural speech and language functions may not have exposure to AAC systems or strategies until just prior to discharge from acute care hospitals or rehabilitation facilities, thus resulting in insufficient time to practice using the materials and techniques while receiving support from rehabilitation professionals.
Another obstacle to the successful implementation of AAC with people with aphasia concerns attempts to substitute one symbol system for another. Because aphasia affects a person's manipulation of symbol systems (McNeil, 1988), people with aphasia tend to have comparable struggles when attempting to formulate messages through spoken, written, or gestured forms; likewise, they have comparable struggles when attempting to understand messages presented auditorially or visuographically. Despite this, some researchers have attempted to teach people with aphasia to use high-tech AAC systems that basically serve to substitute an alternative symbol system for conventional language. For example, C-VIC (Computerized Visual Input Communication) (Steele, Kleczewska, Carlson, & Weinrich, 1992) is a system in which a person with aphasia uses icon-graphic symbols representing lexical items to compose subject-verb-object messages; TalksBac (as cited in Waller, Dennis, Brodie, & Cairns, 1998) is a Macintosh computer-based AAC system that provides predictive access to a stored database of sentences and stories along with synthesized speech output. Not surprisingly, researchers investigating the use of such systems have reported only isolated examples of success, and those examples reference people with aphasia who have had extensive training and who have only demonstrated use of the systems in controlled therapy settings (Steele et al., 1992; Waller et al., 1998)
An alternative approach to designing AAC systems to support the communication of people with aphasia involves using contextually rich photographs relating to experienced events and familiar people and places. Organizing and grouping multiple contextually rich photographs about specific life experiences into Visual Scene Displays is an emerging intervention strategy for people with severe, chronic aphasia that does not rely on linguistic or linguistic-like processes of stringing symbols together to generate messages. Instead, the Visual Scene Display provides depiction of an event occurring in its natural environment, thus establishing the context for a conversational interaction and providing a person with aphasia and his or her communication partner with information to support multiple communicative exchanges.
One benefit of using contextually rich photographs to organize an AAC system concerns the amount of information conveyed. Specifically, the amount of information conveyed through a single contextually rich picture contrasts sharply with that conveyed by a static portrait. For example, consider the plethora of informational content provided by a picture of a grandchild kicking a soccer ball to one of several teammates in the midst of a game compared to the severely limited informational content provided by a still portrait of the same grandchild against...
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