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TBI Homepage |
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Speech-Language Pathologist
Communication Deficits of TBI Survivors
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| Cognitive-Communication |
 aMemory
aOrganization
aSequencing
aAttention
aInhibition
aOrientation |
aJudgement
aProblem
Solving
aExecutive
Functioning
aControl
of Impulsivity
aAbstract
Reasoning
aFlexibility
of Thought |
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Dysarthria....
wSpastic
wFlaccid
wAtaxic
wMixed |
aImprecise
articulation.....................
aAltered
voice quality
aPoor
control of vocalization
aDecreased
control of loudness
aHypernasality
or hyponasality |
aDysphagia
aDrooling
aFacial
asymmetry
aSpeak
in short phrases |
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| Apraxia........ |
aDifficulty
sequencing sounds in words despite ability to produce sounds in isolation
aNeurogenic
stuttering |
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| Aphasia.... |
aWord-finding
difficulties
aReduced
comprehension
aTelegraphic
speech
aGrammatical
errors
aReading
comprehension problems |
aPerseveration
aDecreased
writing ability
aPoor
oral reading
aPoor
repetition
aProduction
of jargon |
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Assessing
Communication Deficits for Augmentative and Assistive Communication (AAC)
The SLP is responsible for identifying
cognitive and language strengths and weaknesses to determine how they will
affect AAC selection and use (DeRuyter & Becker, 1988). Many
standardized assessments have been developed to measure speech and language
abilities of individuals with neurological impairments (e.g., stroke, TBI).
These tools can be used to gather information of functional speech, language,
and cognitive-communication abilities for AAC purposes (Fletcher, 1997).
Also, non-standardized evaluations are used to assess speech, language,
and cognitive-communication abilities (Tanchak & Sawyer, 1995).
| Ability |
Measures |
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| Reading |
Informal
measures |
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Matching pictures
to words and sentences |
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Formal measures |
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Woodcock Reading Mastery Tests-Revised |
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Metropolitan Reading Readiness
Test, Level II |
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Reading Comprehension Battery
for Aphasia (RCBA) |
Subtests:
aWord-Visual
aWord-Auditory
aWord-Semantic
aFunctional
Reading
aSentence-Picture
aParagraph-Picture |
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Boston Diagnostic Aphasia Examination
(BDAE) |
Subtests:
aSymbol
Discrimination
aWord
Recognition
aWord-Picture
Matching
aReading
Sentences and Paragraphs |
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| Spelling |
Informal
measures |
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aMatching
letters
aIdentification
of named letters
aSelecting
letters to complete spelling words |
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Formal measures |
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Wide Range Achievement Test |
Subtests:
Spelling |
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Peabody Individual Achievement Test |
Subtests:
Spelling |
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| Auditory Comprehension |
Informal
measures |
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aReliable
responses to yes/no questions
Ability to follow 1, 2, and 3 step commands |
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Formal
measures |
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BDAE |
Subtests:
aWord
Discrimination
aBody-Part
Identification |
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Detroit Tests of Learning Aptitude-2 |
Subtest:
aOral
Directions |
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| Speech Intelligibility |
Informal
measures |
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Intelligibility of single words
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Intelligibility of phrases,
sentences, conversation
aStimulability
for pacing or overarticulation strategies |
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Formal measures |
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Computerized Assessment of
Intelligibility of Dysarthric Speakers (CAIDS) |
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| Memory |
Informal
measures |
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aRecall
of time, place, self
aRecall
of objects and pictures |
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Formal measures |
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Rivermead Behavioural Memory
Test (RBMT) |
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| Vocabulary |
Informal
measures |
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aIdentification
of well known objects
aIdentification
of photographs
aIdentification
of colored drawings
aIdentification
of black and white line drawings |
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Formal measures |
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Peabody Picture Vocabulary
Test-Revised (PPVT-R) |
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Boehm Test of Basic Concepts |
| Pragmatics |
Informal
measures |
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aAbility
to initiate communication
aEye
contact
aUse
of gestures |
Beukelman & Mirenda, 1998,
pp. 209-12; Fletcher, 1997,pp. 490-4
Communication disorders dramatically change
over course of recovery. It is important to look at individual needs
to address natural speech recovery.
Implementing
Augmentative and Alternative Communication
The goal of implementing an augmentative and
alternative communication (AAC) system is to provide communication assistance
so that the TBI survivor is able to participate effectively in a rehabilitation
program and is able to communicate wants and needs (Beukelman & Mirenda,
1998). SLPs should provide a series of AAC systems as recovery progresses.
Severe Communication Impairments
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Stimulate consistent responses
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Require sufficient cognitive recovery to integrate
new learning and appreciate an alternative system as means of communication
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aTrain
family, staff, and frequent communication partners to assume responsibility
for communication and accept survivors mode of response
aFacilitate
a yes/no response (e.g., eye blink, head turn, chin up, thumb up/down,
writing, pointing, universal head shakes)
aSingle
switch used to teach cause and effect
aSingle
switch accessing used for communication or environmental control
aCommunication
boards, communication books, lap boards, and the like are implemented for
selecting limited picture symbols (1-4) for choice making via pointing,
scanning, and/or partner reliance |
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Moderate Communication Impairments
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Provide a means for patient to express basic
needs
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aCommunication
partners shift to communication facilitator by introducing topics, resolving
communication breakdowns, and creating motivating communication opportunities
aCompensate
for attention and memory impairments (e.g., daily planner, schedule books,
memory log)
aAlphabet
boards, pictures, word boards, yes/no techniques, eye gaze boards, scanning,
etc. utilized to support conversational interaction to fulfill wants and
needs and share information
aIncrease
number of pictures displayed on communication board
aEnvironmental
specific communication boards are used to promote interaction in various
environments with contextual support
aWritten
choice communication
aSingle
switches for call buttons, appliances, etc. for environmental control
aTrain
survivor to slow speech rate for greater intelligibility
aKeyguards
and hardware for mounting communication aids to desks or wheelchairs to
increase accessibility
aGradually
increase complexity of communication
aUse
of communication system to supplement poor speech indelibility
aUse
of speech output and/or printed output for alternative or augmentative
communication |
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Mild Communication Impairments
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Provide functional ways to interact with various
people in various settings
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aAugmented
writing systems
aPrepare
for long term communication system
aUtilize
AAC systems with orthographic symbol, including letters, words, and sentences)
aHigh
tech AAC devices
aTopic
identification using communication board
aSupplemented
speech using an alphabet board
aPortable
voice amplification system
aCompensatory
strategies for mild dysarthria
aCompensatory
strategies for executive functioning impairments (e.g., daily planners,
calendars, note taking, eliminate environmental distractions, break down
complex tasks) |
Beukelman & Mirenda, (1998),
pp. 508-514; Davies (1994), pp. 293-298; Jaffe, Mastrilli, Molitor, &
Volka, (1985), pp. 174-191
Treatment changes as the patient responds
more appropriately to the environment. Throughout recovery process,
utilization of multiple modalities (e.g., gesturing, writing, pictures,
drawing) will increase communicative effectiveness.
AAC
System and Device Products and Manufacturers
To access these web sites,
click on the blue diamond on the left.
| ABLEDATA |
Communications
Computers |
| ADAMLAB |
Mega Wolf
Whisper Wolf
Hawk
Black Hawk
Lynx |
| Canon |
Canon Communicator
Canon Communicator with Voice Output |
| Don
Johnston |
Ke:nx
Switches
Keyguard
Touch Window
Track Ball Guard
Co:Writer
ScanMate 4
Dial Scan |
| Innocomp |
Say It All
Say It Simply Plus
Scan It All
DECtalk |
| Mayer-Johnson |
Boardmaker |
| Prentke
Romich |
AlphaTalker
DeltaTalker
Liberator
Unity
Training Aid System
MIKE
Remote Head Master |
| Sentient
Systems Technology |
DigiVox
Dynavox |
| Theraproducts |
AAC
Communication
Oral Motor
Evaluations
Publications |
| Zygo |
Lightwriter
Talking Notebook Plus
Zygo Model 16-C Communication System
Switch Kit
Macaw |
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