AAC Processing Support for Spoken Language in Aphasia

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DESCRIPTION (provided by applicant): The PC-based Communication System (CS) was developed for adults with acquired aphasia. It acts as a "processing prosthesis" by taking spoken message creation off-line and minimizing demands for fast retrieval and working memory. Used as an AAC device, the CS has been shown to enhance aphasics' fluency and grammatical expression in narrative production tasks. Used as a therapy tool, it resulted in improved unaided production after independent practice in the home. This proposal will extend the functionality of the CS by making it possible for the user to transfer CS-generated messages appropriate to specific situations onto a hand-held computer, which can be deployed in situ to supplement or cue language production in real-world, real-time, communication. The intention is to create an AAC device that will not only enable the transfer of information appropriate to these situations, but also will allow the user to demonstrate his or her intellectual competence, which may be obscured by the language disability. An experiment is proposed to evaluate whether and how the enhanced system (CS plus handheld: CS-HH) benefits aphasics' communication of messages prepared in anticipation of simulated service encounters (e.g., a medical examination). The experiment will compare a group trained to use CS-HH in these simulated encounters with a second, closely matched group, that is trained to use conventional verbal and nonverbal strategies to compensate for their spoken language deficits (the control group). Experimental and control groups will be compared on a total of five service encounters: three that subjects train for in therapist-led sessions, and two that they prepare for without therapist involvement (the generalization test). The prediction is that the experimental group will use the CS-HH to communicate more effectively both in the encounters they train for and in those they prepare themselves. A second study will use qualitative techniques (focus groups, semistructured interviews) to explore patients' assessment of their communicative competence in service- and other encounters, and their attitudes toward communication aids, both technological and conventional (e.g., picture books, gestures). It is predicted that after using the CS-HH in simulated service encounters, patients will view themselves as more effective communicators than they did at the start and will be positively disposed to using this AAC device in the future.