Pocket C

Pocket C
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Speak Aphasia:
Speak Aphasia:
Handheld AAC Program for
Handheld AAC Program for
People with Aphasia
People with Aphasia
Marjorie Nicholas, PhD
Marjorie Nicholas, PhD
Krystal
Krystal
Peralta, MS
Peralta, MS
Goals of this seminar
Goals of this seminar
1. Describe and demonstrate PCSA
2. Show videotapes of people with aphasia
learning and using PCSA
3. Discuss factors relating to successful use of
PCSA:
Cognitive requirements- research results
from CSA study
Physical requirements/issues
Social context issues
PCSA is based on
PCSA is based on
C
C
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Speak Aphasia
Speak Aphasia
Nicholas and Elliott (1998)
CSA was created using Speaking
Dynamically Pro and Boardmaker
software (Mayer-Johnson Co.)
Available as a special set of
boards; need SDP/BM software
bundle CD to operate it
Features of C
Features of C
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Speak Aphasia
Speak Aphasia
and the pocket version
and the pocket version
Direct picture selection method
Minimal reading/writing required
Purposefully agrammatic
Both single icon selection to create
novel, more complex messages
and
Pre-programmed phrases for
specific communication situations
C
C
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Speak Aphasia Main Screen
Speak Aphasia Main Screen
Pocket
Pocket
C
C
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Speak Aphasia
Speak Aphasia
Software program created with
PTP-Mobile program (Point-to-
pictures mobile is available as a
download from rjcooper.com)
Works on several models of Pocket
PCs (Dell, HP iPAQs, etc. that
operate with Windows CE)
Designed to be as close as possible
to the laptop version of C-Speak
Aphasia created with SDPro
PCSA MAIN Screen
PCSA MAIN Screen
Telephone
Autobiog.
People Actions
Objects
Topics
Help
PCSA People Screen
PCSA People Screen
Bill
Bill added to message display area
cook
cook added to message display area
PCSA Actions Screen
PCSA Actions Screen
PCSA Object Subcategories Screen
PCSA Object Subcategories Screen
food
spaghetti
spaghetti added to message display area
PCSA Food Screen
PCSA Food Screen
Then, click on display area and device speaks the message
Questions about using
Questions about using
handheld AAC such as PCSA
handheld AAC such as PCSA
Loudness of voice output- may need a
set of mini-speakers (some come
prepackaged with the device)
Small size of buttons and text- may be
an issue for some users- need a stylus-
these get lost
Cognitive requirements similar/identical
to laptop version
Is it really true that if its more
portable, it will be more functional?
C
C
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Speak Aphasia Training
Speak Aphasia Training
Requires months of training to become
a good user
At first, focuses on dictated Subject-
Verb-Object messages
Progresses to responses to open-ended
questions/conversations
3 training modules:
Generative language
Telephoning
Assisted writing and e-mailing
Pocket C
Pocket C
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Speak Aphasia
Speak Aphasia
Training: Mr. M
Training: Mr. M
Hyperlink to
PCSA training
session EP.mpg
Several years post onset Left MCA CVA
Severe nonfluent aphasia; auditory comprehension
fairly good; some deficits in cognitive testing of
nonverbal executive functions
Lives by himself in a retirement community with
some services; family in the local area
Training on PCSA for a few months (2x/weekly
sessions)
Note the contrast on the video- he does well with
highly structured stimulus-response scripted task;
then has difficulty in more real-life communicative
context.
Who will become effective
Who will become effective
users of alternative
users of alternative
communication systems
communication systems
like this?
like this?
We need more evidence to
We need more evidence to
show whether these
show whether these
approaches can be
approaches can be
efficacious for people with
efficacious for people with
severe aphasia
severe aphasia
Using a computer to
communicate: Effect of executive
function impairments in people
with severe aphasia.
Marjorie Nicholas, Michele P. Sinotte,
Nancy Helm-Estabrooks, Aphasiology, 2005.
Goals of the Study
Goals of the Study
1. Investigate whether functional
communication could be improved via
training on an alternate commun-
ication system (C-Speak Aphasia)
2. Find out who the good candidates are
for such systems, by examining both
cognitive and linguistic factors as they
relate to response to training.
Hypotheses:
Hypotheses:
1. Some patients will improve
functional communication via use
of C-Speak Aphasia
2.
2.
Executive function
Executive function skills will be
important to good response
3. Severity of aphasia and specifics
of the language impairment will
be less important
Overall Design of the Study: Single Subject,
Overall Design of the Study: Single Subject,
Multiple Baseline, Repeated Measures
Multiple Baseline, Repeated Measures
Baseline testing of:
- language and nonverbal cognitive skills
- semantic categorical knowledge
- functional communication probe tasks
Off computer
On computer
Treatment begins: Module 1- Generative
language
Retest functional communication probe tasks
every 3-4 weeks, each time
Off computer
On computer
Treatment lasts approx. 6 to 12 months
Data from first 5 subjects have been
Data from first 5 subjects have been
analyzed and published *
analyzed and published *
Currently 8 additional subjects also
Currently 8 additional subjects also
have been treated and data analysis
have been treated and data analysis
is in progress.
is in progress.
3 of these subjects use PCSA
3 of these subjects use PCSA
* Nicholas, M., Sinotte, M.P., & Helm-Estabrooks, N. (2005). Using a computer to
communicate: Effect of executive function impairments in people with severe
aphasia. Aphasiology, 19, (10/11), 1052-1065.
CSA Outcome Measures:
CSA Outcome Measures:
Five Probe Tasks
Five Probe Tasks
1. 1. Autobiographical questions Autobiographical questions: answering 7 questions: e.g.
What is your address?
2. 2. Picture descriptions Picture descriptions: describe 5 simple photos, e.g. a
man drinking coffee
3. 3. Video event retelling Video event retelling: describe a video of a kitchen scene
with mother, 2 kids, and cat
4. 4. Telephone calls Telephone calls: making two short calls with specified
information to be exchanged
5. 5. Writing tasks Writing tasks: a birthday card and a grocery list, with
some specified information
Example of data for scoring of
Example of data for scoring of
video description task
video description task
Off-computer:
Um, gestures cutting,
um, gestures falling,
two, gestures flat
hand to represent 2
children, gestures
drinking, too dee,
gestures drinking
and eating, too dee
On-computer:
C: Marjorie cook knife eat
cucumber lettuce. Girl
eat grapes. Girl fall a
little bit. Marjorie eat
cookies milk girl. Girl go
cat. Boy eat cookies milk.
RESPONSE TO
RESPONSE TO
TRAINING
TRAINING
Response to Training:
Response to Training:
Sample novel story
Sample novel story
Performance on Probe Tasks:
Performance on Probe Tasks:
Answering Autobiographical Questions
Answering Autobiographical Questions
Able to
communicate
quite a lot at
baseline
On-computer
scores only
slightly higher
0
2
4
6
8
10
12
14
16
B1 B2 B3 1 2 3 4 5
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Off-
Computer
On-
Computer
Baseline Treatment
Performance on Probe Tasks
Performance on Probe Tasks
Picture Descriptions
Picture Descriptions
On-computer scores much higher on this task than
off-computer scores
0
4
8
12
16
B1 B2 B3 1 2 3 4 5
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On-Computer
Off-Computer
Baseline Treatment
Performance on Probe Tasks
Performance on Probe Tasks
Telephone calls
Telephone calls
Again, on-computer scores are much higher than off-computer
0
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8
12
16
B1 B2 B3 1 2 3 4
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On-Computer
Off-Computer
Baseline Treatment
Summary score differences (Across all 5 tasks)
Mean probe score minus mean baseline score for the
off-computer and on-computer probes.
Off-
computer
On-
computer
Subject 1 -.03 39.7
Subject 2 2.8 27.7
Subject 3 3.2 13.1
Subject 4 13.8 13.4
Subject 5 7.2 16.8
RESULTS SUMMARY
RESULTS SUMMARY
Despite similar aphasia profiles, subjects
responded quite differently to C-Speak training.
Subject 1, with the most normal nonverbal
CLQT scores has shown best response (Graphs)
Subject 2, with good Symbol Cancellation and
Design Generation scores on CLQT also has
shown improvements on many probe tasks
Subject 3, with the worst CLQT scores overall has
NOT shown improvements on most probe
tasks.
Subject 4, with poor CLQT scores overall has NOT
shown much improvement on probe tasks.
Subject 5, at normal cut-off on 2 CLQT subtests
(but not Design Generation) - performance
variable; some benefits of using the computer
started to emerge
Conclusions From the CSA
Conclusions From the CSA
research study
research study
Nonverbal cognitive measures,
particularly executive function (EF)
measures of creativity or cognitive
flexibility such as Design Generation,
may be able to predict who will respond
favorably to training on systems like C-
Speak Aphasia
Recommend evaluations of EF be included
as part of all assessments for treatment
candidacy
Back to Pocket CSA
Back to Pocket CSA
Video sample: Mr. T
Several years post onset L MCA CVA
Severe nonfluent aphasia- no real words, only
syllable stereotypy; relative preservation of
auditory comprehension; relative preservation of
nonverbal executive function skills
Lives with wife
Independent in most life activities
Has been learning PCSA for several months
Video shows combination of treatment tasks and
conversation
Hyperlink to
PCSABO.mpg
Back to Pocket CSA
Back to Pocket CSA
Video sample: Mr. R
Several years post onset L MCA CVA
Severe nonfluent aphasia- stereotypy plus a
developing corpus of words; moderate impairment
of auditory comprehension; relative preservation of
nonverbal executive function skills
Lives with wife
Independent in most life activities
Video shows how PCSA augments conversation for
some situations only
Since repetition is relatively preserved, he can use
the computers output as a model for natural
speech also.
Hyperlink to
PCSAconv.EG.mpg
Limitations specific to
Limitations specific to
Pocket C
Pocket C
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Speak Aphasia and other similar
Speak Aphasia and other similar
handheld AAC systems for aphasia
handheld AAC systems for aphasia
Cognitive issues related to flexibility, switching
Assistant required to personalize boards- must
learn how to do the editing
Semantic issues related to knowledge of
semantic categorization (how the boards are
designed)
Physical limitations of the device-
battery/power limitations
sound
need for assistant who can link to desktop computer
for downloads/back-ups of boards
Social Limitations specific to
Social Limitations specific to
Pocket C
Pocket C
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Speak Aphasia and other similar
Speak Aphasia and other similar
handheld AAC systems for aphasia
handheld AAC systems for aphasia
User and partner are looking at the
device rather than at each other
AS with any AAC device, using it tends
to interfere with the feeling of a
spontaneous, naturalistic, give and take
interaction.
This may be particularly true when
there is some residual natural language
capacity (as in the last sample)
Thank you!
Thank you!
Questions?