Implementing augmentative and alternative communication (AAC) practices for people with acquired brain injury (ABI) requires a speech-language pathologist to delicately balance restoration goals with compensation strategies. The range of non-traditional communication tools gives us excellent options for setting up a system that allows clients to communicate in a variety of contexts. Matching a system to your client’s level of functioning, skills, preferences and needs can certainly present challenges.
I find the following aids and devices useful for supporting clients with ABI across a range of skills by promoting their quality-of-life needs, managing impaired cognitive skills and facilitating their continued engagement in meaningful life roles.
More on AAC:
Acquired brain injuries often result in some level of cognitive impairment, which can include deficits in orientation, attention, executive functioning and memory. Such cognitive deficits can impede a person’s social participation, family interactions and vocational success by fostering dependence on others for managing daily tasks. Introducing a system of assistive technology as a compensatory strategy early in treatment can significantly improve daily living activities.
I frequently use the tools listed below to address the cognitive needs of people with ABI.
- Orientation boards
- Day/night calendar clock
- Room identification and signage
Attention, organization and initiation
- Graphic organizers
- Visual schedules to promote a predictable routine
- Daily activity boards to keep clients informed about what to do and when
- Checklists to outline the steps required to complete a task
- Visual and written cues to focus or refocus attention
- Environmental cues—visual signs, calendars, audible alarms—to prompt the person to complete tasks
- Memory books and boxes
- Electronic memory aids, such as smartphones and personal data assistants
- Daily planners and organizers to track of appointments, to-do lists and other tasks.
- Audible alarms, timers and Television Assistance Prompting to remind the person of important events, like “take medicine,” at specified times
- Pill organizers, medication reminders and automatic dispenser systems to improve medication compliance
Both low- and high-tech functional communication systems give clients with ABI ways to communicate their wants and needs, choices, and decisions, and express relevant personal information. I focus intervention goals for selecting and using a system on increasing the consistency of appropriate responses and shaping them into meaningful communication.
Below is a list of these various AAC methods I’ve found useful in improving and compensating for impaired expression, discourse and social communication:
- Yes/no boards
- Talking mats for making requests
- Communication books with iconic symbols and remnants, such as family pictures, ticket stubs, maps and more
- Writing and alphabet boards
- Object choice boards
- Topic supplementation boards
- Low-tech picture boards with various selection sets
- Text-to-speech or dynamic display speech-generating devices
- Visual scene displays with personally relevant and contextualized images
While there is a wide range of options for remediating and compensating for cognitive-communication impairments related to acquired brain injury, AAC services involve more than just prescribing a device. SLPs teach clients and their communication partners ways to enrich their lives through engagement, empowerment and independence.
Successful AAC outcomes for people with ABI require careful consideration of the client’s social roles, age, and personal communications needs and goals. They will more likely enjoy activities and interventions that emphasize their competence and promote their self-esteem and self-satisfaction. I hope the resources listed above can help you tailor AAC intervention to facilitate intrinsic motivation and keep clients engaged in therapy.
Please share your tips or insights for matching and implementing augmentative and alternative communication systems to clients with acquired brain injury in the comments below.
Mandie Oslund, MS, CCC-SLP, is a speech-language pathologist specialized in the rehabilitation of acute communication and swallowing disorders of medically complex patients at University of Tennessee Medical Center in Knoxville. She is an affiliate of ASHA Special Interest Groups 2, Neurogenic Communication Disorders; and 13, Swallowing and Swallowing Disorders (Dysphagia). firstname.lastname@example.org