Updated: Jan 30
What is AAC?
People often think of the term Augmentative and Alternative Communication as referring to a high-tech device that talks for the person with communication difficulty but that’s not quite right. For sure, high-tech devices are types of AAC but the term really refers to any strategy, technique or device (low or high-tech) that can be used maximise the person’s communication skills.
What types of AAC are designed for aphasia?
It is important to note that many high-tech AAC apps and devices were not made with aphasia in mind. Instead they were made for individuals with physical or motor speech impairments rather than a language impairment. Such apps and devices often rely on strong categorisation skills and good grammar and syntax, which are usually impaired in aphasia.
Having impaired categorisation skills, grammar and syntax makes it immediately much harder to navigate and use such apps or devices. While you may know that an apple is a fruit and that you need to go into the ‘Food & Drink’ category and then the ‘Fruit’ subcategory to find it, that will not be at all obvious to many people with aphasia. Furthermore the understanding of symbols can be difficulty for individuals with aphasia as it not always apparent what word or concept is being represented.
Some apps and devices have been made for people with aphasia. Visual scene display apps, navigation rings, apps with personalisation and stored messages are all examples of AAC with aphasia in mind.
Visual Scene Display
Visual Scene Display apps allow you to add personal photos and hotspots. A hotspot is essentially “sound area” that can play a recorded messaged when selected and be used as a means of communication. A photo can have multiple “hotspots” that can be edited to add sound or written text labels. Scene Speak is one example.
A navigation ring book is essentially a ring-binder communication book with tabs to facilitate navigation. People find aphasia often find it much easier to find the page they need when this type of design is used.
Simple Grid-Based & Story-Telling Apps
Simple grid-based apps can be fully personalised for use as a talking photo album to support communication. Yes, they do have category-based grid but as the layout is simple and there are no sub-categories they are relatively easy for the person with aphasia to navigate. Click n’ Talk is one example.
Pictello allows you to make albums to tell a story. You can use the included text to speech voices, or make your own recordings. It could be used for making a life book or for helping the person with aphasia to talk about important life events.
All About Me also allows you to make a photo book album to which you can add personal photos, text and audio-recordings. The symbols on the homepage do look somewhat childish but they can be replaced by your own cover album photos.
Apps such as Clarocom that have in-built, editable stored messages can be useful for functional situations such as ordering a coffee in a restaurant. The person would aphasia would need to have sufficient reading skills to do so.
A System of Communication Tools & Strategies
While these tools are helpful, they can be limited in their usefulness. They may help the person with aphasia to communicate basic needs, wants, personal information and predictable things but they often won’t meet the person’s communication needs in an evolving conversation. Often the most effective AAC in aphasia is a system of tools and strategies rather than a single communication aid.
Text to speech apps
Text to speech apps with predictive text can be of great benefit to people with aphasia who have good spelling or who are able to spell some whole words or initial parts of words. There is a wide variety ranging from those that are lower-cost to those that are more expensive. Proloquo4text, Assistive Express Clarocom are all worth considering.
Communication is not only verbal. It is also drawing, writing, gesturing, body language. Multi-modal communication involves communicating through any of these modes. The person with aphasia will likely need specific training to effectively support their own communication by using one or more of these modes.
In sessions, you could start by showing the person with aphasia a picture (e.g. a person performing an action such as swimming or an object such as a teapot). Ask the person to show you how they would convey the message to you by drawing, writing or gesturing. Remember the intention is not to replace verbal output but rather to support it. If the person is able to say the word, that’s great but when a breakdown in communication occurs, having learned to use other modes will be of great benefit.
Aided Language Output
Aided language output is an evidence-based intervention that aims to help people with aphasia learn to use AAC faster. It involves the use of of augmentative tools by people who do not have aphasia. Writing down keywords, drawing, gesturing and using pictures as you talk supports the understanding of the person with aphasia. When you use tools to get your message in, those tools are in place to help the person with aphasia to get their message out.
A topic board is essentially a clarification tool. If the person with aphasia is having difficulty conveying their message, it helps if they can communicate the topic to their conversation partner. For example, if the person indicated they were talking about family, the conversation partner could then ask yes/no questions relating to family members to find out the intended message.
Written Choice Communication
Written Choice Communication supports the comprehension of the person with aphasia in addition to their ability to communicate. It is suitable for individuals who can read single words or phrases. It could be used to find out more about the person e.g. their hobbies and interests as well as a means of giving them a choice e.g. meal options for dinner.
Where did you grow up?
The Google Photos app is wonderful for organising photos and videos into albums by time, location and the people in them. The artificial intelligence in the app enables it to have face recognition and to identify objects,things and events in your photos e.g. cats, beaches, sunsets, boats, weddings. The app is then able to put your photos into albums grouped by place, thing, people etc. If you allow the app to add location to your photos it will do so automatically provided you have internet access on your device when out and about. Another great app for the same purpose is Moments. It has a similar but slightly different design.
Most people want to be able to communicate more than their basic needs and wants. We all like to share information with one another. It is an important part of our social interactions. The person with aphasia who takes photos of where they have been, what activities they have done, who they have seen during the week has a fantastic communication support tool on their smartphone/iPad/Android device. Self-captured photos can also be a wonderful tool to use in conversation therapy. What could be more motivating than talking about personal experiences and recent events?
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