Unlocking Communication: Empowerment in Aphasia
by Ava Sheard
For most of her life, Deb was known as a wife, mother, grandmother, and friend. Her roles as an active community member and involved family woman made up large parts of her identity. After surviving an unexpected stroke, Deb had to add “person with aphasia” to her list of roles. At 52 years old, relearning how to communicate had a big effect on shaping Deb’s sense of self.
Early days after a stroke can feel overwhelming to patients and families because a conversation can quickly become difficult to understand, and draining for both communicators. In Deb’s case, having severe Broca’s aphasia resulted in her family struggling to understand her non-fluent speech. Before her stroke Deb’s social life felt natural and effortless, but eventually she started missing church meetings and stopped seeing friends. Even at home, she no longer felt confident communicating with the people she cared for the most. In a conversational world she felt silenced, and it took her a long time to adjust to her new normal. In the stressful time after receiving a diagnosis, speech-language pathologists (SLPs) alleviate the load by introducing new ways for patients and families to communicate, listen, and understand each other. SLPs can use new tools to remedy an old problem: how do we make communication accessible to all people?
More on Augmented Alternative Communication
Augmentative and Alternative Communication (AAC) are one of the tools in a speech-language pathologists tool kit. AAC is an exciting innovation because they can be personalized to fit the communication goals of each client. For the purposes of this article, “devices” will refer to all types of AAC such as tablets, drawings, communication, or picture books. In speech-language therapy, AAC devices help patients develop strategies to produce and interpret non-verbal communication.
Companies producing technological AAC devices serve multiple populations, including people with developmental disabilities, Autism Spectrum Disorder, traumatic brain injury, and aphasia!
Author Aside
Attending the 2023 American Speech, Language, Hearing Association (ASHA) convention, I was able to speak with representatives from the company Lingraphica to get an inside look at their tablets. They provided me with a walkthrough of a device designed for an older person. The AAC tablet displayed a personal profile catered to the client’s interests alongside talk, type, drawing, and media apps at his disposal. Users are also free to customize any personal information, photos, icons, and symbols that are unique to their identity or condition.
The case study on Deb[1] illustrates a recovery journey from both a clinical and client perspective. Originally, Deb wasn’t educated on AAC devices as an option. It wasn’t until her family took an honest survey on Deb’s progress that she realized she needed a change in her speech-language therapy services. It was recorded that, on average, “Prior to hospital discharge, only about 2% [of patients] receive AAC treatment."[2] Similarly, Deb was not introduced to AAC devices from an SLP, or open to this lifestyle change, until 3 years after her stroke incident.
Once it was clear that fluent speech was no longer a reality for Deb, rather than keep her life on pause any longer, she was introduced to an iPad and a new SLP that provided AAC support. She was reluctant at first, but her new speech therapy on the iPad offered writing, picture drawing, text, and a text-to-speech option. While she got more comfortable with the tablet, she also had the freedom to use communication books and other low-tech AAC options in her individual therapy sessions.
After only 6 weeks with her iPad, Deb felt comfortable enough going to a family party; something she hadn’t done in over 4 years. With the assistance of her AAC iPad, she began feeling confident about being social again. Her AAC devices allowed her to reclaim meaningful conversation, produce complex sentences, and go beyond requests and basic needs.
“The idea around AAC is making sure that our patients have communication that empowers them,” says Aimee Dietz, a current researcher and professor in communication sciences and disorders at Georgia State University who specializes in AAC and aphasia research.
I had the honor of interviewing Dietz about her contribution to Deb’s case study. Dietz emphasizes how AAC speech-language therapy is a “twopronged approach” that requires “train[ing] healthcare workers to know how to interact with people with aphasia, but also need[ing] AAC to help people with aphasia learn how to advocate for themselves.”
Living with aphasia means that SLPs and clients have to be open to finding creative solutions for communication challenges, even years later. In Deb’s case, AAC devices allowed her to take back a sense of identity and participation that felt out of her reach. With her iPad by her side, she returned to her church meetings, met with friends, and was excited to be with family again.
“AAC is just one additional tool that can help in the recovery process,” says Dietz. It’s important to remember that AAC is not compensating for language; it’s guiding assistance for it. She adds, “Even people [with aphasia] who can produce speech have better output when they use AAC.”
Wife, mother, grandmother, friend, person with aphasia, and now, AAC user. Like Deb, people with aphasia may lose some physical qualities of communication, but they deserve to narrate their own stories. With the support of AAC devices, we should strive to build pathways towards manageable and accessible communication for all people with aphasia. Empowering voices for today, tomorrow, and beyond.
[1] Dietz, A., McKelvey, M., Schmerbauch, M., Weissling, K. S., & Hux, K. (2023). Deb: Increasing Participation for a Person With Severe, Chronic Aphasia Using Augmentative and Alternative Communication. The Communication Disorders Casebook: Learning by Example, 364.
[2] Chabon, S. S., Cohn, E. R., & Lee-Wilkerson, D. (2023). The communication disorders casebook: Learning by example. Plural Publishing.
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