aac is a semantic prime ftiifor conversations in …...aac is a semantic prime ftiifor conversations...
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AAC is a semantic primef ti ifor conversations in moderate Alzheimer's diseasedisease
Melanie Fried-Oken, Ph.D., CCC/SpCharity Rowland, Ph.D.
Oregon Health & Science University Portland, OR
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The road to Montreal ISAAC (2004 – 2008)
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The driving crew to Montreal
– Melanie Fried-Oken (PI; speech-language pathologist)
– Charity Rowland (PI; psychologist)
– Jeon Small (RA; medical sociologist)
– Glory Baker (RA; public health student)
D l S h lt (RA i l d )– Darlene Schultz (RA; special educator)
– Carolyn Mills (RA; artist)
– Mayling Dixon (RA)Mayling Dixon (RA)
– Bret Fuller (Statistician)
– Barry Oken (neurologist)y ( g )
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2008 AAC and dementia chapter for clinicians
Michelle Bourgeois and Ellen Hickey: Dementia (chapter 8)
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REKNEW-AD
• Reclaiming• Expressive• Knowledge in• Elders• Elders• With -• Alzheimer’s disease
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A series of studies: 2004-2008
Do AAC tools improve the quantity or quality of conversation by individuals with moderateindividuals with moderate Alzheimer’s disease?
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Does symbol type make a difference?
• Between 3 studies reported, we examined personalized 16-symbol AAC b d ithboards with:
• Print aloneP i t + 2 D b l• Print + 2-D symbols
• Print + 3-D miniature objects• 2 D symbols alone• 2-D symbols alone• 3-D symbols alone• Control (no AAC)• Control (no AAC)
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Does voice output make a difference?Does voice output make a difference?
• Between 3 studies reported, we examined personalized 16-symbol AAC boards with:personalized 16-symbol AAC boards with:• Digitized speech output• No speech output• No speech output
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Board with 3-D symbols + print
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Board with 2-D symbols + print
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ASHA 2005: Pilot study
Single subject S g e subjectdesign: Voice output is distracting to one adult with severe AD
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Voice output distraction
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Setting off on the journey to large scale studieslarge scale studies
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Inclusion criteria
• Diagnosis of probable or possible AD by a board• Diagnosis of probable or possible AD by a board certified neurologist;
• Clinical Dementia Rating (CDR) = 1 or 2;• Mini Mental Status Examination (MMSE) = 8-18
within 6 months of enrollment in study (or we administer);
• Visual acuity better than 20/50 O.U. (as performed in the OADC);
• Hearing screening procedure performed to rule out• Hearing screening procedure performed to rule out adults with greater then 40dB hearing loss at screening frequencies (as performed in the OADC);E li h i l• English as primary language.
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Exclusion criteria
History of other neurologic or psychiatric illness (no CVA, reported alcohol abuse,illness (no CVA, reported alcohol abuse, traumatic brain damage, reported recent significant psychological orsignificant psychological or speech/language disorder).
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Participant demographics (N=41)
Gender 31 Females 10 Males
Age Mean = 74 yr Range = 50 94Age Mean = 74 yr. Range = 50-94
MMSE (0-30) Mean = 14 Range = 5-18
CDR (0-2) Mean = 1.47 Range = 1-2
FLCI (0-88) Mean = 67 Range = 27-85
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Method
1. Identify participant and randomly assign to condition for symbol type & voice output;y y
2. Determine participant’s preferred topic and vocabulary;
3. Develop communication device for condition;4. Conduct videotaped conversations with
participant for various conditions in theirparticipant for various conditions in their homes.
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Participant randomization to symbol type & voice output conditionsyp p
Input Mode
Print only 2-D +Print 3-D + Print
Output Mode symbols symbols
Voice output 5 6 3
N i t t 8 11 8No voice output 8 11 8
Total 13 17 11
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ISAAC 2006 (N=30)
Voice output distracts subjects with modAD andsubjects with modAD and depresses performance. (Fewer total # utterances and more 1-word utterances are produced with voice output)utterances are produced with voice output)
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ASHA 2007 (N=30)
AAC supports placed in front of persons with modAD does not affect conversation. No specific symbol type was beneficial; Att ti t b dAttention to board or physical reference to board was minimal or nonexistent for many subjects.
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“What does this mean?”
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Clinical message:AAC WITHOUT TRAINING IS NO AAC AT ALL!
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The race for significance begins
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Redefine dependent
Adjuststudy
Examine training
variablesdesignoptions
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Changes
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Addt i i
SPACED trainingcomponent:
RETRIEVAL TRAINING
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What is spaced retrieval?
•“A memory intervention that gives individuals practice at successfullyindividuals practice at successfully recalling information over progressively longer intervals of time.” (Jennifer Brush & Cameron Camp, 1998)
•Relies on classical conditioning and repetitive priming.
SpacedRetrieval=Semantic
•Used with elders with dementia to help remember compensatory strategies such as using a schedule,
ll i f l i d il
prime
swallowing safely, using a daily calendar, and using adaptive equipment.
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Adjust study design (N=11)
• Conditions varied within participants:– 1 primed experimental condition;– 2 control conditions (no AAC device):
• Standard control• Primed control
• 99 total conversations:• 99 total conversations:– 3 conversations/condition
9 ti / ti i t– 9 conversations/participant
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Add new dependent variables closely tied to semantic primestied to semantic primes
• Number of primed words used during conversation
• Number of utterances• Percent 1-word utterances• MLU in words• Type-token ratio• Number of references to AAC device
Used SALT software for transcription and analysis(Systematic Analysis of Language Transcripts, Miller & Chapman, 1986-2000)
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Control conversation: no AAC
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Primed conversation: AAC board
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Results: Subjects used the AAC device more when conversations were primed.
It works!
(References to AAC device during conversations ( f gquadrupled, as compared to untrained conversations)
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AAC combined with spaced retrieval exercise improved access to topical vocabulary.
(In AAC-supported conversations, subjects used significantly more primed words, as compared to control
diti )conditions.)
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Finish Line Message
• AAC improves conversation of adults with modADwith modAD• When training for semantic priming is addedadded• To account for attentional, perceptual, or memory impairments that interfere with performance.performance.
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REKNEW-PPA:Adults with Primary ProgressiveAphasiaISAAC-2008
AAC & dementia presentations:• N Alm et al• N. Alm, et al (Mon 15:30)•J. Murphy (Mon 16:05)
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• Layton Center for Aging and Alzheimer’s Disease Research, Portland, Oregon, USA
• NIH/NICHD/NCMRR award #1NIH/NICHD/NCMRR award #1 R21 HD47754-01A1
• DOE/NIDRR award• DOE/NIDRR award #H133G040176
Copy of presentation slides at:http://www.ohsu.edu/oidd/Presentations/reknew/reknew_ad.cfm