Speech-Generating Devices for Adults with Aphasia
Aphasia is the medical term used to refer to a communication disorder that occurs as a result of injury or damage to the part of the brain that processes language. The medical condition is common in the elderly, especially those with cases of a stroke. Patients diagnosed with aphasia find it difficult to comprehend and use words. Aphasia however does not affect the patient’s intelligence, but rather how they share the knowledge they possess. Often times, people with the condition have a hard time talking because they are unable to find the right words to express what they are thinking. They also find it difficult to follow conversations and even reading and writing.
Aphasia is divided into different types with each category having effects that range from mild to severe. Patients who have mild aphasia find it easier to communicate but only simple conversations as complex words or discussion may be too much to comprehend. Those with severe aphasia on the other hand are unable to communicate and while they may speak a few words, they are unable to engage in a conversation in any way.
The advancement in technology has led to the development of communication devices, systems and tools that can be used to support and even replace speech through what is known as augmentative and alternative communication (AAC). The tools assist people with difficulty in communicating and speech. Aphasia patients however require more than picture boards and talking boxes because. ACC was recently described as “a set of procedures and processes by which an individual’s communication skills can be maximized for functional and effective communication” by ASHA. Its implications and strategies are however not applicable to everyone, especially in cases where patients have severe aphasia. Furthermore, clinically based systems have been developed to describe the communication behaviour of individuals diagnosed with aphasia such that SLPs have a better understanding of what AAC strategies are likely to yield the best result in treatment intervention.
Various AAC device configurations are currently being used but none has managed to give enough or significant communication to everyone diagnosed with communication disabilities and impairments. The SLP are responsible for conducting evaluations to determine the key components of the type of technology needed to meet a specific user’s needs. The follow-up processes and systematic evaluationssystematic and objective evaluation acts as safeguards that ensure that devices are not abandoned or underutilized. The SLPs reference rely on very specific clinical indicators that are distinct and useful in helping to match the categories to an individual’s profile in accordance with their cognitive, physical and motor skills.
AAC-based intervention plays a significant role as they assist people with serious cases of aphasia to improve skills and evolve from depending on their partners to depending on themselves. Although there is no way to ensure that the patients will evolve to become independent communicators, the strategies are very helpful in promoting then likelihood of positive occurrences in the development process. The patients will however still need support that is personalized and designed in such a way that it will help the patients to evolve and improve as they adapt to their condition. Giving the ACC tool to patients however is just the beginning of the process. The patients will require training and assistance on how to use the tool and also on how to develop a new vocabulary. Patients are able to express themselves, but they cannot do so because of Aphasia. The tool makes it easier to evolve from having a desire to communicate to actually expressing oneself. Demonstrations will be helpful in helping the patients to visualize how tools can be used to develop various ideas, and to teach the patient that it is acceptable to communicate in that specific way. The visuals about the proper way to use the system is helpful to both clients diagnosed with aphasia and also their caregivers and family members. Family members also need help in finding a better way to communicate with patients with aphasia. The difficulty in finding a proper image or way to communicate the message further makes it harder for the patient who has to understand. AAC can therefore ease the communication and help the messenger be better at communicating.
Patients can be trained to access portions of messages stored in low-tech, picture or board format and this can greatly improve their communication skills. Patients can also be trained to express themselves using short messages such as assisting for help with something. A simple phrase like “could you help me with that?” can act as the first stage to train the clients how to express themselves. Patients can also be helped using catch phrases that are easy to remember. A statement like “Please give me a minute to answer, I have aphasia” can be very helpful as it acts as the point of origin for the patient. Since the medical condition makes it difficult for the patient to formulate words or sentences, having a ready response bring composure and the [patient can use it as a basis of reference.
The tool is helpful for family members and caregivers as well. Those responsible for looking after the patient can also learn the best approaches to use in order to make the communication process more effective. The individuals trying to engage with the patient with aphasia could use short sentences that are also direct to the point. Using select words as part of the vocabulary helps to reinstate them as ideal for communication and in so doing, encourage the patient to incorporate them during communication.
Other than direct speech, there are other approaches that can be used to help improve communication with patients diagnosed with aphasia. Family members and friends can come together to form communication groups aimed at helping the patient. For patients having a difficulty in expressing themselves, the exposure from a communication group can act as a basis of reference for the patient. Engaging with different people, even through the act of simply observing can help trigger memory and also help formulate a pattern that the patient can recognize and use to break the barrier preventing him from formulating a sentence.
Role playing on the other hand can help the patient put into practice what has been learnt. Other than encouraging communication, there is need to create a platform where the patient can actually practice what is sought by the AAC. Role playing can be an effective tool as it creates made up scenarios that imitate real life occurrences. Patients can be trained on how to go about basic communications such as asking for directions, exchanging greetings, buying goods and simple pleasantries like hello. The real-life scenario created through role play has an advantage in that it is direct to the point and actually pushes the patient to communicate. Instead of just learning how to communicate, the patient is given a chance to communicate and gain experience on how to go about handling such occurrences in the real world.
The relationship between the caregiver and the patient with Aphasia greatly affects the success of the ACC intervention systems used. In treatments that employ the use of SDG, the relationship between the caregiver and the patient helps in selecting the most ideal image or graphical symbol used to trigger the patient’s memory. For its to be successful, the caregiver must possess a basic understanding of the patient on a personal level so as to derive the most significant symbol. The is therefore a need for cooperation between the patient, family and friends, caregivers and any individual involved in the treatment process.
The chances for success are therefore determined by the approach taken by the caregiver when introducing the treatment method to the patient. When introducing new topics, the clinician can start by finding ways to get along and communicate with the patient’s family, friends and caregivers. This helps to collect information on the state of the patient and also determine the treatment approach to take by developing a graphic symbol to use. After this, the clinician can develop an SDG that will be used to store the message that is being communicated. The SDG could be tagged with a favourite catch phrase or slogan that resonates well with the patient. Those assisting with the communication are informed about the SDG and what message it communicates. Using the image therefore acts as a buffer and further encourages the patient to communicate.
The cognitive demands used should be minimal because the person with aphasia does not need to look through complex arrays when looking for symbols. The clinician should always take note that the level of understanding for the patient is hindered by the condition. Information must therefore be structured using phrases that re short, easy to remember and are direct to the point. When dealing with clients who have difficulty answering yes/no questions, tagged questions can be used. The approach would be to pose a yes/no question and then add a tag at the end. An example would be, “Do you have children, yes, or no?” The reason behind this strategy is how the clinician implement the tag “yes or no?”. effectiveness can be enhanced if the clinician is to speak slowly and augment their speech with gestures like head nod for yes and shaking it for no. the important thing about the approach is that it encourages participation and encourages the patient to communicate.
Augmentative and alternative communication (AAC) devices have added advantages in that they are readily available and therefore user friendly and user friendly. The devices are customized to meet the needs of each patient regardless of their background. Patients have a huge variety to choose from with three being the most common. The first category is the single which represents pictures and are considered to be the simplest of the devices. While they may require literacy, the patient only needs to understand the pictures and this can easily be taught. The alphabet-based systems fall into the second category and they are slightly more advanced and require some form of literacy. The last category is the semantic compaction and they involve short series and therefore require training.
Successful implementation of AAC requires communication partner instruction. When establishing evidence-based practice (EBP), implementation features are crucial, and this is for both classroom staff and families at home. How communication is taught is therefore an important factor on how well EBP is provided. It is important to not that patients diagnosed with aphasia will require a different approach when teaching compared to their caregivers. The same systems cannot be used for the patient and the family members because the patient requires more attention. Finding a balance ensures that family members are well updated on how to help the patient manage their condition without disrupting any progress made with the caregiver.
Various findings from previous research reveal that use of multiple training elements has a high likelihood of resulting in optimal learner outcomes. It is also correct to assume that strategy description, strategy demonstration, verbal practice and controlled practice can be used. Coaching is however overlooked as trainers rely on research that proposes that the use of targeted strategies in the natural environment can increase to about ninety-five percent. Coaching here involves entering the patient’s natural environment like their home and observing the caregiver and other members of the family and then compiling a report of the findings. It is a collaborative process that requires the researcher to develop a partnership with the subject under study.
The method is often provided to clients that require help in developing skills in accessing the communication equipment. It also helps the patients to learn the vocabulary used and trains them on how to use their communication system in the critical care environment. Family members and caregivers are taught about the operational care requirements, how to be supportive and also what is needed in order to overcome any barriers that may come in between communication between the individual and the Aphasia patient. The AAC team on the other hand monitors and reviews the use of the communication equipment. The control allows the AAC to make changes to the system with reference to feedback collected from the patient or members of the family and the caregivers. Family members also help the patient to improve vocabulary content through the exchange of communication.
Clients categorized as communication vulnerable are provided with a voice that assists them to communicate with their family, friends, and members of the healthcare team. AAC in the ICU department for example has helped patients to track and report their symptoms, seek information and other activities that aid in their care. By improving the quality of stay for instance, patients that require intensive care are safer and have a higher chance of making positive progress. Patients also get to communicate with their family members on sensitive issues such as how they wish to spend their last days and even what should be done after passing. In addition, professionals in the healthcare industry are lessened the burden of bearing the stress of not being able to communicate with a patient under one’s care. It is therefore a tool that improves the level of medical care offered and also the quality of care while one is being treated.
The silver lining is that patients diagnosed with aphasia have a chance to improve regardless of whether the diagnosis occurred after a few months or years. Since the condition affects the patient’s ability to communicate, the goal is just to provide a tool rather than teach the individual how to communicate. The patients already know how to communicate, the tools just help them to bypass the restrictions brought about by the condition. Since the condition does not prevent the patient from learning how to communicate, speech has been discovered to be faster and more efficient as a communication tool. In addition, research has demonstrated that speech tends to be successful when supported with an ACC system. In cases where the is difficulty in clarity, then ACC can be used to add clarity and give the patient a more positive experience.
About 2 million people in the United States and 1% of the British population rely on digital adaptive alternative communication methods, voice communication output devices and speech generating devices. The figure is made up of People with ALS, Parkinson’s disease, Brain stem stroke, traumatic brain injury and disabilities that make communication difficult or impossible without the speech generating devices. The devices are of great importance as they help patients with limited speech to express themselves successfully by relying on whatever means are available to them. Through AAC, people with person with limited speech can expand their vocabulary and find it easier to communicate far more than they were able to without ACC.
