AAC Rehabilitation for Conversation in Dementia

这一试点项目将确定增强和替代交流(AAC)设备是否能改善中度痴呆症成年人的对话。临床研究人员尚未对AAC设备对这一人群的有效性进行系统调查，即操纵AAC设备的组件，以改善痴呆症患者的对话。本文提出了四个假设。(1)一般来说，接触AAC设备将改善中度痴呆症患者的对话。(2)与AAC设备使用相关的会话的增强是通过操作两个特定的AAC变量来实现的：输入和输出模式。AAC输入是指AAC设备中的符号(打印的标签、二维图片或三维对象)。AAC输出是指存在 或者没有带有符号的数字化语音。(3)中度痴呆者语言障碍的严重程度与输入输出方式存在交互作用。对于有严重语言障碍的人来说，更具体的语音输出输入模式将更好地改善对话。(4)熟悉的、未经培训的照顾者会发现，使用AAC设备可以改善与中度痴呆症患者的功能对话。参与者是60名患有中度痴呆症的成年人，根据CDR评分为2，MMSE在5-15之间，并在俄勒冈州阿尔茨海默病中心登记。语言严重程度指数是衡量语言严重程度的标准。在研究1中，参与者在使用和不使用AAC设备的情况下进行了5次对话，这些设备包含随机分配的输入和输出模式的组合。参与者的表达行为是从录像带中编码的，以表征语速和对话内容(布尔乔亚，2001)。对于研究1(假设1-3)，使用AAC设备的主要效果使用配对t检验来评估。使用回归模型分析了输入和输出模式的相对影响以及它们与语言严重程度的关系。在研究2(假设4)中，熟悉的未经培训的照顾者与使用或不使用AAC设备的受试者进行对话，并对对话的功能结果进行评级。结果 将用于生成R01应用程序，以更准确地确定AAC的功能，这些功能在纵向设计中增强了不同严重程度痴呆症患者的功能沟通，以衡量随时间推移的临床结果。

This pilot project will determine whether Augmentative and Alternative Communication (AAC) devices improve the conversation of adults with moderate dementia. Clinical researchers have not conducted a systematic investigation of the effectiveness of AAC devices for this population, manipulating the components of AAC devices that might improve conversation for persons with dementia. Four hypotheses are generated. (1) Access to AAC devices in general will improve the conversations of individuals with moderate dementia. (2) The enhancement of conversation associated with AAC device use results from manipulation of 2 specific AAC variables: input and output mode. AAC input refers to the symbols in AAC devices (printed labels, 2-dimensional pictures, or 3-dimensional objects). AAC output refers to the presence or absence of digitized speech with the symbols. (3) The severity of language impairment displayed by persons with moderate dementia interacts with input and output mode. The more concrete input modes with voice output will improve conversation more for those with severe language impairment. (4) Familiar, untrained caregivers will find that the use of AAC devices improves functional conversation with individuals with moderate dementia. Participants are 60 adults with moderate dementia as defined by a CDR score of 2, MMSE between 5-15, and enrollment in the Oregon Alzheimer's Disease Center. The FLCI is the language severity measure. In Study 1, participants engage in 5 conversations with and without AAC devices that incorporate randomly assigned combinations of input and output mode. Participants' expressive behaviors are coded from videotapes to characterize rate and conversational content (Bourgeois, 2001). For Study 1 (Hypotheses 1-3), the main effect of AAC device use is evaluated using paired t-tests. The relative effects of input and output modes and their relationships to language severity are analyzed using a regression model. In Study 2 (Hypothesis 4), familiar untrained caregivers engage in conversations with subjects with or without an AAC device and rate the functional outcome of the conversations. Results will be used to generate an R01 application to determine more precisely the features of AAC that enhance functional communication for individuals with different severity levels of dementia in a longitudinal design measuring clinical outcomes over time.