AAC Rehabilitation for Conversation in Dementia

该试点项目将确定辅助和替代交流（AAC）设备是否能改善中度痴呆症成年人的谈话。临床研究人员还没有对AAC设备对这一人群的有效性进行系统的调查，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)一般来说，使用AAC设备将改善中度痴呆症患者的谈话。(2)与AAC设备使用相关的会话增强源于对2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（打印标签、二维图片或三维对象）。AAC输出指的是 或者缺少具有符号的数字化语音。(3)中度痴呆患者语言障碍的严重程度与输入和输出模式相互作用。对于那些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，未经培训的护理人员会发现使用AAC设备可以改善与中度痴呆患者的功能对话。参与者是60名患有中度痴呆症的成年人，中度痴呆症的定义是CDR评分为2分，MMSE评分为5-15分，并在俄勒冈州阿尔茨海默病中心登记。FLCI是语言严重性的衡量标准。在研究1中，参与者进行5次有和没有AAC设备的对话，这些设备包含随机分配的输入和输出模式组合。参与者的表达行为是从录像带编码，以表征率和会话内容（资产阶级，2001年）。对于研究1（假设1-3），使用配对t检验评价了AAC器械使用的主要影响。使用回归模型分析了输入和输出模式的相对影响及其与语言严重性的关系。在研究2（假设4）中，熟悉的未经培训的护理人员与使用或不使用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R 01应用程序，以更精确地确定AAC的特征，这些特征在测量随时间推移的临床结局的纵向设计中增强了具有不同严重程度痴呆症的个体的功能性沟通。

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.