AAC Rehabilitation for Conversation in Dementia

该试点项目将确定辅助和替代沟通（AAC）设备是否能改善中度痴呆成人的对话。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，操纵AAC设备的组件可能会改善痴呆症患者的对话。产生了四个假设。(1)使用AAC设备一般会改善中度痴呆患者的对话。(2)与AAC设备使用相关的对话增强来自于对两个特定AAC变量的操作：输入和输出模式。AAC输入是指AAC设备中的符号（印刷标签、二维图片或三维物体）。AAC输出是指存在

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.