Handheld AAC Program for People with Aphasia. Marjorie Nicholas, PhD Krystal Peralta, MS

Transcription

1 Pocket C-Speak C Aphasia: Handheld AAC Program for People with Aphasia Marjorie Nicholas, PhD Krystal Peralta, MS

2 Goals of this seminar 1. Describe and demonstrate PCSA 2. Show videotapes of people with aphasia learning and using PCSA 3. Discuss factors relating to successful use of PCSA: Cognitive requirements- research results from CSA study Physical requirements/issues Social context issues

3 PCSA is based on C-Speak Aphasia Nicholas and Elliott (1998) CSA was created using Speaking Dynamically Pro and Boardmaker software (Mayer-Johnson Co.) Available as a special set of boards; need SDP/BM software bundle CD to operate it

4 Features of C-Speak C Aphasia and the pocket version Direct picture selection method Minimal reading/writing required Purposefully agrammatic Both single icon selection to create novel, more complex messages and Pre-programmed phrases for specific communication situations

5 C-Speak Aphasia Main Screen

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8 Pocket C-Speak Aphasia Software program created with PTP-Mobile program (Point-topictures mobile is available as a download from rjcooper.com) Works on several models of Pocket PCs (Dell, HP ipaqs, etc. that operate with Windows CE) Designed to be as close as possible to the laptop version of C-Speak Aphasia created with SDPro

9 PCSA MAIN Screen Telephone Autobiog. Topics Help People Actions Objects

10 Bill added to message display area PCSA People Screen Bill

11 cook added to message display area PCSA Actions Screen cook

12 food PCSA Object Subcategories Screen

13 spaghetti added to message display area PCSA Food Screen spaghetti Then, click on display area and device speaks the message

14 Questions about using handheld AAC such as PCSA Loudness of voice output- may need a set of mini-speakers (some come prepackaged with the device) Small size of buttons and text- may be an issue for some users- need a stylusthese get lost Cognitive requirements similar/identical to laptop version Is it really true that if it s more portable, it will be more functional?

15 C-Speak Aphasia Training Requires months of training to become a good user At first, focuses on dictated Subject- Verb-Object messages Progresses to responses to open-ended questions/conversations 3 training modules: Generative language Telephoning Assisted writing and ing

16 Pocket C-Speak C Aphasia Training: Mr. M Several years post onset Left MCA CVA Severe nonfluent aphasia; auditory comprehension fairly good; some deficits in cognitive testing of nonverbal executive functions Lives by himself in a retirement community with some services; family in the local area Training on PCSA for a few months (2x/weekly sessions) Note the contrast on the video- he does well with highly structured stimulus-response scripted task; then has difficulty in more real-life communicative context. Hyperlink to PCSA training session EP.mpg

17 Who will become effective users of alternative communication systems like this?

18 We need more evidence to show whether these approaches can be efficacious for people with severe aphasia

19 Using a computer to communicate: Effect of executive function impairments in people with severe aphasia. Marjorie Nicholas, Michele P. Sinotte, Nancy Helm-Estabrooks, Aphasiology, 2005.

20 Goals of the Study 1. Investigate whether functional communication could be improved via training on an alternate communication system (C-Speak Aphasia) 2. Find out who the good candidates are for such systems, by examining both cognitive and linguistic factors as they relate to response to training.

21 Hypotheses: 1. Some patients will improve functional communication via use of C-Speak Aphasia 2. Executive function skills will be important to good response 3. Severity of aphasia and specifics of the language impairment will be less important

22 Overall Design of the Study: Single Subject, Multiple Baseline, Repeated Measures Baseline testing of: - language and nonverbal cognitive skills - semantic categorical knowledge - functional communication probe tasks Off computer On computer Treatment begins: Module 1- Generative language Retest functional communication probe tasks every 3-4 weeks, each time Off computer On computer Treatment lasts approx. 6 to 12 months

23 Data from first 5 subjects have been analyzed and published * Currently 8 additional subjects also have been treated and data analysis is in progress. 3 of these subjects use PCSA * Nicholas, M., Sinotte, M.P., & Helm-Estabrooks, N. (2005). Using a computer to communicate: Effect of executive function impairments in people with severe aphasia. Aphasiology, 19, (10/11),

24 CSA Outcome Measures: Five Probe Tasks 1. Autobiographical questions: answering 7 questions: e.g. What is your address? 2. Picture descriptions: describe 5 simple photos, e.g. a man drinking coffee 3. Video event retelling: describe a video of a kitchen scene with mother, 2 kids, and cat 4. Telephone calls: making two short calls with specified information to be exchanged 5. Writing tasks: a birthday card and a grocery list, with some specified information

25 Example of data for scoring of video description task Off-computer: Um, gestures cutting, um, gestures falling, two, gestures flat hand to represent 2 children, gestures drinking, too dee, gestures drinking and eating, too dee On-computer: C: Marjorie cook knife eat cucumber lettuce. Girl eat grapes. Girl fall a little bit. Marjorie eat cookies milk girl. Girl go cat. Boy eat cookies milk.

26 RESPONSE TO TRAINING

27 Response to Training: Sample novel story

28 Performance on Probe Tasks: Answering Autobiographical Questions # Information Units Baseline Treatment Off- Computer On- Computer Able to communicate quite a lot at baseline On-computer scores only slightly higher 0 B1 B2 B

29 Performance on Probe Tasks Picture Descriptions # Information Units Baseline Treatment On-Computer Off-Computer 0 B1 B2 B On-computer scores much higher on this task than off-computer scores

30 Performance on Probe Tasks Telephone calls Baseline Treatment # Information Units On-Computer Off-Computer 0 B1 B2 B Again, on-computer scores are much higher than off-computer

31 Summary score differences (Across all 5 tasks) Mean probe score minus mean baseline score for the off-computer and on-computer probes. Offcomputer Subject Subject Subject Subject Subject Oncomputer

32 RESULTS SUMMARY Despite similar aphasia profiles, subjects responded quite differently to C-Speak training. Subject 1, with the most normal nonverbal CLQT scores has shown best response (Graphs) Subject 2, with good Symbol Cancellation and Design Generation scores on CLQT also has shown improvements on many probe tasks Subject 3, with the worst CLQT scores overall has NOT shown improvements on most probe tasks. Subject 4, with poor CLQT scores overall has NOT shown much improvement on probe tasks. Subject 5, at normal cut-off on 2 CLQT subtests (but not Design Generation) - performance variable; some benefits of using the computer started to emerge

33 Conclusions From the CSA research study Nonverbal cognitive measures, particularly executive function (EF) measures of creativity or cognitive flexibility such as Design Generation, may be able to predict who will respond favorably to training on systems like C- Speak Aphasia Recommend evaluations of EF be included as part of all assessments for treatment candidacy

34 Back to Pocket CSA Video sample: Mr. T Several years post onset L MCA CVA Severe nonfluent aphasia- no real words, only syllable stereotypy; relative preservation of auditory comprehension; relative preservation of nonverbal executive function skills Lives with wife Independent in most life activities Has been learning PCSA for several months Video shows combination of treatment tasks and conversation Hyperlink to PCSABO.mpg

35 Back to Pocket CSA Video sample: Mr. R Several years post onset L MCA CVA Severe nonfluent aphasia- stereotypy plus a developing corpus of words; moderate impairment of auditory comprehension; relative preservation of nonverbal executive function skills Lives with wife Independent in most life activities Video shows how PCSA augments conversation for some situations only Since repetition is relatively preserved, he can use the computer s output as a model for natural speech also. Hyperlink to PCSAconv.EG.mpg

36 Limitations specific to Pocket C-Speak C Aphasia and other similar handheld AAC systems for aphasia Cognitive issues related to flexibility, switching Assistant required to personalize boards- must learn how to do the editing Semantic issues related to knowledge of semantic categorization (how the boards are designed) Physical limitations of the device- battery/power limitations sound need for assistant who can link to desktop computer for downloads/back-ups of boards

37 Social Limitations specific to Pocket C-Speak C Aphasia and other similar handheld AAC systems for aphasia User and partner are looking at the device rather than at each other AS with any AAC device, using it tends to interfere with the feeling of a spontaneous, naturalistic, give and take interaction. This may be particularly true when there is some residual natural language capacity (as in the last sample)

38 Thank you! Questions?