Aphasia rehabilitation can target augmentative and alternative communication

5.14 Aphasia rehabilitation can target augmentative and alternative communication, including:
• No-technology/low-technology AAC
• High-technology AAC.

References: Baxter et al., 2012: Systematic review of 65 studies (14 studies focused on aphasia); Garrett et al., 1989: Case study; Ho et al., 2005: Case series; Purdy & Wallace, 2016: Case series; Rayer et al., 2023: Scoping review of 16 studies (7 case studies, 4 singlesubject design studies, 5 group design);  Rose et al., 2013: Systematic review of 23 studies (4 group design, 19 SCED); Russo et al., 2017: Systematic review of 30 studies (22 observational studies, 8 case reports)); Taylor et al., 2019: Narrative review. 

NHMRC Levels of Evidence: No/low tech: IV; High tech: IV

Rationale: There is lower-level evidence supporting the use of some no/low-technology AAC strategies(Baxter et al., 2012; Garrett et al., 1989; Ho et al., 2005; Purdy & Wallace, 2016). Gesture treatments have the most and the highest levels of evidence (Rose et al., 2013). There is, however, no consensus on the use of no/low AAC in clinical practice.

High-technology AAC is a continuously developing field of research. There is some low-level evidence that high-technology AAC can enhance communicative abilities for some people with aphasia (Rayer et al., 2023; Russo et al., 2017). It is important to note that treatment success is variable, with AAC acceptance and effects on functional communication largely unclear (Rayer et al., 2023). AAC interventions therefore need to be individually tailored. Some factors that have been suggested as influencing AAC acceptance/use are cognitive factors (e.g., language impairment type and severity), personal factors (e.g., age, expectations of AAC), and environmental factors (e.g., availability of social support, clinician attitudes; Rayer et al., 2023; Taylor et al., 2019). More research is needed to clarify the role of each of these factors and how they might influence clinical decision-making (Taylor et al., 2019).

References:

1. Baxter, S., Enderby, P., Evans, P., & Judge, S. (2012). Interventions using high-technology communication devices: A state of the art review. Folia Phoniatrica et Logopaedica, 64(3), 137-144. DOI: 10.1159/000338250
2. Garret, K.L., Beukelman, D.R., & Low-Morrow, D. (1989). A comprehensive augmentative communication system for an adult with Broca’s aphasia. Augmentative and Alternative Communication, 5(1), 55-61. DOI: 10.1080/07434618912331274976
3. Ho, K.M., Weiss, S.J., Garrett, K.L., & Lloyd, L.L. (2005). The effect of remnant and pictographic books on the communicative interaction of individuals with global aphasia. Augmentative and Alternative Communication, 21(3), 218-232. DOI: 10.1080/07434610400016694
4. Purdy, M. & Wallace, S.E. (2016). Intensive multimodal communication treatment for people with chronic aphasia. Aphasiology, 30(10), 1071-1093. DOI: 10.1080/02687038.2015.1102855
5. Rayer, K., Chavers, T., Schlosser, R., & Koul, R. (2023). Efficacy of Speech Output Technologies in Interventions for Persons with Aphasia: A Scoping Review. Aphasiology, 37(11), 1861–1883. https://doi.org/10.1080/02687038.2022.2135366
6. Rose, M.L., Raymer, A.M., Lanyon, L.E., & Attard, M.C. (2013). A systematic review of gesture treatments for post-stroke aphasia. Aphasiology, 27(9). 1090-1127. DOI: 10.1080/02687038.2013.805726
7. Russo, M.J., Prodan, V., Meda, N.N., Carcavallo, L., Muracioli, A., Sabe, L., Bonamico, L., Allegri, R.F., & Olmos, L. (2017). High-technology augmentative communication for adults with post-stroke aphasia: A systematic review. Expert Review of Medical Devices, 14(5), 355-370, DOI: 10.1080/17434440.2017.1324291
8. Taylor, S., Wallace, S.J., & Wallace, S.E. (2019). High-technology augmentative and alternative communication in poststroke aphasia: A review of the factors that contribute to successful augmentative and alternative communication use. Perspectives of the ASHA Special Interest Groups, 4(3), 464-473, DOI: 10.1044/2019_PERS-SIG2-2018-0016