AAC Strategies and Tools for Persons With Dementia

Abstract

You have accessThe ASHA LeaderFeature1 Mar 2010AAC Strategies and Tools for Persons With Dementia Michelle Bourgeois, PhD, CCC-SLP Melanie Fried-Oken, andPhD, CCC-SLP Charity RowlandPhD Michelle Bourgeois Google Scholar , PhD, CCC-SLP, Melanie Fried-Oken Google Scholar , PhD, CCC-SLP and Charity Rowland Google Scholar , PhD https://doi.org/10.1044/leader.FTR1.15032010.8 SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In The basic goal of augmentative and alternative communication (AAC) is to help persons with communication impairments increase their participation in desired activities and create opportunities for social interaction through various modes of communication. AAC, especially high-tech computer-based and speech-generating devices, is most often used by individuals with severe oral-motor or expressive language impairments and is rarely considered for persons with dementia who continue to speak well into the late stages of their disease. Speech-language pathologists, however, have been using various forms of AAC to support communication participation of persons with dementia. Many non-electronic or low-tech communication approaches have been used successfully to support social interaction of persons with dementia. AAC, in the form of external aids that incorporate stimuli highly relevant to a person's daily life, may include memory wallets, notebooks, calendars, signs, color codes, timers, communication boards, labels, and other tangible visible symbols that provide cues for interaction. Persons with dementia use AAC successfully, and SLPs may want to demonstrate to patients and caregivers the effectiveness of these tools. Indicators of Dementia The diagnostic indicators of dementia are memory impairment and changes in other cognitive domains (language, abstract thinking, judgment, and executive function) that are sufficiently severe to cause impairment in social and occupational functioning (DSM-IV; American Psychiatric Association, 2000). The first symptoms of dementia are typically word-finding problems, comprehension deficits for abstract and complex conversation, and short-term memory problems that often interfere with conversational interactions. As the disease progresses, these memory deficits intensify and create related problems such as repetitive questions and limited verbal output, characterized as "empty speech." Over time spoken output is further eroded to echolalic, perseverative, and paraphasic speech, then to incoherent vocalizations, and finally to mutism (Bourgeois & Hickey, 2007; 2009). Areas of preserved ability—such as reading, writing, and pragmatic skills—that remain functional until the later stages of the disease can be recruited when planning therapeutic activities. Also, various memory processes that remain relatively intact until later stages can be harnessed for maintaining desired behaviors. For example, some forms of long-term memory (e.g., procedural, non-declarative, and episodic) and sensory memory have supported functional behaviors, such as conversation (Bourgeois et al., 1997; see Table 1 [PDF]). Strategies and Tools Two of the earliest examples of AAC tools targeting language expression and comprehension/memory support for persons with middle-stage dementia are memory wallets and books (Bourgeois, 1992). These visual cueing systems consisted of 10–30 pages, with each page featuring one declarative sentence and one picture illustration, that were used by clients to increase the number of factual statements made in conversations. Families provided pictures and anecdotes to include in the personalized albums; nursing assistants and activity personnel generated facts about daily living in the nursing home that could be used to resolve confusions and increase cooperation during care activities (Bourgeois et al., 2001). SLPs who designed memory books realized that the visual and physical characteristics of the aid could be modified to maintain function when the size of th