Chapter 14 Flashcards
Amyotrophic Lateral Sclerosis (ALS)
ALS is a progressive, degenerative disease of unknown etiology
Involves the motor neurons of the brain and spinal cord
Communication Symptoms ALS
Speech symptoms differ among individuals
80%-95% are unable to speak by the time of their death
Cognitive changes do occur in some people with ALS
Aphasia may occasionally be associated with ALS
A Model for AAC Intervention - ALS
3-phase intervention model
Early phase – monitor, prepare, support; initial diagnosis through referral for an AAC assessment
Middle phase – assess, recommend, implement; time from referral for AAC assessment until AAC strategies are selected, purchased, and initial instruction is completed
Late phase – adapt, accommodate; time after initial AAC intervention until the individual’s death
Early Phase ALS
- Monitor speech performance –
Use objective measures to monitor speaking rate and intelligibility - Make timely AAC referral -
Refer when speaking rate reaches 125 words/minute
For a small percentage severe dysarthria reduces speech intelligibility prior to significant rate reduction and it is recommended that referral for an AAC assessment be made when sentence intelligibility drops below 90% regardless of rate - Preserve natural speech effectiveness –
amplify residual speech and allocate time for social or informational exchanges - Educate about AAC –
Info about natural speech deterioration, timing of AAC assessment, low- and hig-tech AAC options, and technology purchases (funding)
Middle Phase ALS
ID participation patterns and needs - Assess portability, telephone and internet access, aids to daily living
Current and anticipated capabilities –
Bulbar ALS – will typically be able to control AAC technology, carry and operate with direct selection, and then move towards head/eye tracking access
Spinal ALS – need for augmented writing system often precedes need for augmented conversational system; usually require mounted system with head/eye tracking access
Assess constraints – attitudes of family members and friends, availability of facilitators, funding
Evaluate intervention outcomes – to know which direction to go in, to meet funding requirements, to set precedent for a center or agency
Social and personal care supports
Selecting low- and high-tech AAC options
Late Phase ALS
Adapt and Accommodate
Consider acceptance of mechanical ventilation
Within last few weeks of life people with ALS depend ore on low-tech options
Multiple Sclerosis
Most common neurological condition of young and middle-age adults
Of unknown cause
Acquired, inflammatory, demyelinating disease of the central nervous system
Symptom patterns vary
Prognosis is worse:
- In males than females
- If the age at onset is greater than 35 years
- If a chronic, progressive pattern appears at onset
Communication Symptoms MS
Dysarthria is most common but is not universal
Relatively small number of individuals with MS require AAC systems
Early, Middle, and Late Phase Interventions MS
Early – may require supports like font enlargement, TTS, modified keyboard access (Ease of Access Center), memory and organizational supports
Middle – alphabet supplementation (ID first letter)
Late – AAC interventions are very personalized, depending on need and capabilities of person; primary communication needs of many people with MS are conversational and care related; some may require assistance with writing
Assess Prior to AAC Intervention MS
Cognitive Skills – memory retrieval impairment, impaired conceptual reasoning, slowed information-processing time
Language Skills – aphasia occasionally reported (1%-3%), difficulty with word finding and changes in verbal or written organization
Sensory/Perceptual Skills – loss of vision presents problems in the context of AAC interventions and require auditory scanning options with speech feedback
Motor Skills – vary, common to have tremor, may need to stabilize body part to support access
Guillain-Barre’ Syndrome
Results from progressive destruction and subsequent regeneration of the myelin sheath of peripheral nerve axons
Paralysis progresses from the lower extremities upward, maximal paralysis usually occurs within 1-3 weeks of onset
Nerve function and associated muscle strength gradually return as the myelin sheath slowly regenerates
Communication Disorders GB
Weakness causes flaccid dysarthria and may cause anarthria
Early Phase GB
Deterioration Phase/Loss of Speech
After a few weeks, those who require AAC intervention are usually unable to speak and receive respiratory support from a ventilator
Intervention starts with low-tech - establishing yes/no followed by eye-pointing/linking, creation of communication boards with social and health-related messages as well as letters and numbers
Middle Phase GB
Prolonged Speechlessness, Spontaneous Recovery of Speech
Time frame varies (weeks/months)
Continue using low-tech but may opt for higher tech, scanning with eye control (funding? Borrow program?)
As speech returns may use a ventilator and a tracheostomy tube for breathing; some use an oral-type electrolarynx with a head switch
May use AAC to set topic then use residual speech
May use AAC as a repair strategy
Late Phase GB
Long-Term Residual Motor Speech Disorder
For a small population, speech interventions to maximize the effectiveness of their natural speech are appropriate
Parkinson’s Disease
Syndrome composed of a cluster of motor symptoms that include tremor at rest, rigidity, paucity, and impaired postural reflexes
PD results from a loss of dopaminergic neurons in the basal ganglia and the brainstem
Onset is insidious (gradual but with harmful effects)
Medication is greatly changing the lifestyles of people with PD
During the time when AAC intervention is needed, symptoms may be difficult to manage with medication
Communication Symptoms PD
Dysarthria is common
Reduced pitch variability, reduced overall loudness (AT for that), decreased use of all vocal parameters for achieving stress and emphasis
Imprecise articulation and produced at variable rates
Harsh and often breathy voice quality
Speech disorder are not uniform
For numerous reasons speech becomes increasingly more difficult to understand
AAC techniques are typically used with natural speech
Early, Middle, and Late Phase Intervention PD
Early
AAC supports are usually not necessary
May require assistance for computer control, internet usage, and recreation
Near the end of this phase, people with PD often complete instruction in the Lee Silverman Voice Treatment (distance tx)
Middle
AT and AAC supports may be necessary to supplement natural speech
Delayed auditory feedback (iPad) helps control speaking rate
Portable vocal amplifiers (Chattervox, Mini Voice Amp)
Late
Use AAC to resolve communication breakdowns, communicate in adverse situations, or for most of their messages
Choose technology with speech synthesis output accessed through letter-by-letter spelling
Participation Patterns and Communication Needs PD
People with PD typically need communication for the social environments of their retirement
People with PD may require extensive physical assistance, and this influences access to AAC
Assess Prior to AAC Intervention PD
Cognitive/Linguistic Skills – are typically literate, unsure about presence of dementia, may require help compensating for learning or memory difficulties
Sensory/Perceptual Skills – usually N/A
Motor Skills – motor control problems may influence AAC interventions
Reduced range and speech of movement – reduce size of selection display (on alphabet board)
May require keyguard
Brainstem Stroke
Strokes that disrupt the circulation serving the lower brainstem often cause severe dysarthria or anarthria
Severe damage to the brainstem may impair motor control of the limbs as well as of the face and mouth
Communication Symptoms Brainstem Stroke
Vary based on level and extent of damage
Some people are dysarthric but can communicate partial or complete messages through speech
Usually flaccid type of dysarthria but may have spastic component
Nearly all require AAC initially
Participation Patterns and Communication Needs Brainstem Stroke
Medical and lifestyle issues as well as the extent of their communication disorders influence communication needs
Usually unable to work and are cared for at home, others may be in independent living centers nursing homes
Early Phase Brainstem Stroke
Begins as soon as the referral is received
Goal is to develop a functional yes/no response and the ability to access a call system
Share information among all communication partners
Later in the early phase, may introduce low-tech techniques
Consider eye-linking, eye-gaze, or partner-assisted scanning strategies
Dependent on accuracy of individual, willingness and capability of communication partners
