This is the second article of a three-part series on AAC and aphasia created from an interview with the co-authors of the AAC vocabulary Communication Journey: Aphasia. Special thanks to Lois Turner, Anne MacCallum, and Sarah Douglas for their kindness and dedication in helping individuals with aphasia find their voice.
Communication is a significant part of life. In addition to expressing wants and needs, communication helps maintain relationships and allows engagement in meaningful activities. An acquired language impairment like aphasia doesn’t take away the need for communication. Individuals with limited functional speech need support so that they can communicate in whatever way is possible for them. Building an augmentative and alternative communication (AAC) system, made up of both high-tech and lite-tech tools and strategies, can help someone experience the benefits of communication again.
No matter what the degree of severity of aphasia, or the type of aphasia, a high-tech AAC vocabulary like Communication Journey: Aphasia can be part of someone’s comprehensive communication system. For those with little residual speech, it can be their primary voice by providing vocabulary and phrases. For others, it can augment limited speech with visual supports and other supportive communication tools such as the advocacy pages, visual scene displays, and maps.
The role of a speech therapist or speech-language pathologist (SLP) is to assess and treat communication disability. Their end goal is to find ways to improve someone’s communication to the best of their ability across caregivers and the environment. On the first visit with a client who has aphasia, an SLP observes and assesses interactions, the use of gestures, language comprehension, as well as reading and writing skills. Then they determine how well the client can use an AAC device. Can they see the icons? Can they change pages to access additional words and phrases? Assessment includes all routes of communication. All aspects of recovery are supported as much as possible during the hospital stay, and then home needs are considered.
An AAC solution, whether lite-tech paper boards or high-tech AAC vocabulary like Communication Journey: Aphasia, can start right away at the hospital and continue at home. “It’s best for the client to maintain the same AAC vocabulary throughout to avoid confusion,” said MacCallum.
Treatment plans vary based on each person’s unique symptoms, needs, and goals. Some individuals may participate in speech therapy to work on recovering verbal speech, strengthening language comprehension, or implementing AAC. The SLP is looking for ways to increase their client’s capacity to express and comprehend however possible. An individual’s daily communication system is made up of several different modalities. “Assistive technology is just one tool,” said Turner. “A person also communicates using gestures, body movements, facial expressions, and paper-based, or lite-tech systems.”
AAC makes communication possible again by teaching someone a different way to use language. “It assists individuals with communication functions that have been damaged by a stroke or traumatic brain injury,” said MacCallum. “AAC supports residual language, and it helps them find new ways to express their ideas.” Every person’s experience is different. The exact damage can’t be fully known sometimes; the recovery and losses can’t necessarily be predicted.
AAC offers hope after a significant health situation by:
An AAC vocabulary like Communication Journey: Aphasia is a communication ramp with several different strategy support options. Highly customizable for each person, it allows them to participate in their daily life however they choose. And it grows and changes with them!
Below are images of conversation support pages in English, Spanish, and French.
Learn more about the strategies and page sets available in Communication Journey: Aphasia in the user guide.
James experienced a stroke and has profoundly expressive aphasia. Though his verbal speech was limited, he can read and is very adept at technology. He often Googles topics in conversations around him. He copies text from the internet and pastes it into his app and has it speak for him. James is motivated to use words based on his interest. The level of complexity within AAC and the vocabulary file is often based on each individual person’s interest.
Studies show that poststroke depression (Berg et al., 2003) and social isolation after aphasia onset (Hilari & Northcott, 2006; Vickers, 2010) may negatively affect improvement/recovery from aphasia. AAC can help with mental health and social connection.
It’s important for the AAC team to be mindful of emotional wellbeing for individuals with aphasia. “I don't think that there is a disability group with a greater need for mental health support than people that have communication disabilities and who are less able to access it,” noted MacCallum. A communication partner may want to add a sensitive discussion page to the customized Communication Journey: Aphasia file to help gauge mood or start the conversation. Buttons could be programmed to say, “Let's talk about X” or “Can we talk about Y?”
“The fact that they have some piece of technology or AAC to help them start those conversations or even to hint at it allows them to reach out,” said Douglas.
“The way verbal people talk about feelings is nuanced,” added MacCallum. “The vocabulary can be customized to have conversations around sensitive topics like mood, caregiver abuse, capacity assessment, or issues with family members.”
AAC gives a voice to someone who is nonspeaking which can decrease fear and other overwhelming feelings. Customizing their vocabulary to include their personal relationships, environments, core needs, and interests will help them feel connected to themselves and the world around them. “They can participate in what matters to them if they have the right words,” said Turner. Patience and support from the AAC team matters as well. Include the device in your conversations to help normalize it. Encourage the use of the AAC solution so the communicator can grow in their competency and independence.
Read more about what family and friends can do to support someone with aphasia.
Communication Journey: Aphasia can be customized for someone who is bilingual. Symbols for two languages can be added to the same icon. Duplicate pages in both languages can be created. There are a variety of synthesized voices available in select languages, or you can create your own voice through The Voice Keeper™ or Apple® Personal Voice.
Communication Journey: Aphasia is currently available in English, Spanish, and Canadian French through the TouchChat app on your personal iOS device or on a fundable NovaChat® or Via® communication device.
Additional languages may be customized on your own. “I know an SLP who created a Cantonese file in the vocabulary,” said Turner. “The SLP recorded his voice for them to use.”
For more support with customizable features like profile switching, connect with your local PRC-Saltillo consultant and problem solve together.
Communication Journey: Aphasia was born out of a desire to help more individuals find their voice faster and more efficiently with AAC. Before Communication Journey: Aphasia released, SLPs working with individuals who had a stroke or trauma brain injury, were using lite-tech communication books or customizing high-tech AAC files for each patient. There wasn’t enough time on their full caseloads to keep up with that approach. They believed there was a better way. A group of SLPs in British Columbia working exclusively with clients who have aphasia came together to brainstorm what sets of pages and vocabulary made the most sense and how it could be organized.
Learn more about the development of Communication Journey: Aphasia and how it’s designed to help individuals experience meaningful communication and independence.