Monday, March 2, 2009

Augmentative/Alternative Communication

Almost every person with aphasia has some experience with an augmentative or alternative c0mmunication device, usually called an AAC device. The devices that I'm going to talk about now are the computerized devices. You may know these by their brand names--Dynavox, Mercury, Say-It!Sam, Lingraphica and others. While many therapists will recommend these devices to their patients with aphasia, my experience has shown me that not one of these persons who gets a device uses it consistently for a long period of time. There are two "benefits" that are sold to you when someone wants you to get a device--practice modules and computerized speaking. Therapists are usually bogged down by the insurance system, may not know what else to do with your case, and figure that an AAC device is the answer to help you out.Practice modules means that there is some part of the machine that you can use to practice speaking--maybe it speaks a sentence for you and you can mimic it eventually. You could also match words to their pictures and other tasks. Computerized speaking means that you will not speak, the machine will. I have found very few people with aphasia who like this option. Everyone I know wants to speak for themselves, and the public at large does not respond well or have patience for someone to use a device to speak. Frequently these devices are bulky (about the size of a laptop computer), which is not easy to carry around, find a place to put it, turn it on, and expect someone to wait while you do all of this. The smaller devices are hand-held, but unless you are able to use both of your hands/arms to hold it and choose things to say, it isn't helpful in the community. This obviously applies to a person who can walk around. A wheelchair mounted device may be more functional for someone in a wheelchair.Why am I telling you all this? I get tired of people with aphasia being told that this device will cure everything and be the best idea. There are alternative out there that your therapists may not be aware of, depending on the purpose of your device. These computerized devices run from $3500 to $15000, even if your insurance pays for it. I find that many of these devices are rarely used after purchase for several reasons. 1) The person with aphasia didn't really want to get it in the first place and the therapist just made it happen. 2)The person with aphasia did not realize that it was to be used to speak for them and does not want to do this 3)The training that has been received is minimal and no one can figure out how to operate it 4)It is too complicated to use 5)The person with aphasia finds it too large or heavy to lug around 6) Without the constant support of the therapist, the person with aphasia loses interest. Am I advocating that you don't get a device? Maybe. It's an individual decision, I just want you to be aware of what you are committing your (and your insurance's) money to. What are the practice alternatives? Stay tuned for the next segment.....

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