Assistive Device Treatments
There are multiple options regarding augmentative and alternative communication (AAC) devices for those individuals with Parkinson's disease. Depending on the progressive nature of the disease and the communication needs of the individual, high-tech or low-tech aided AAC devices can be suggested for use from the speech language pathologist (SLP). Low-tech devices include simple or paper-based aids such as alphabet board, pacing board, picture chart, and amplifier. High-tech devices are battery or electronic aids with voice output such as Big Mack, Lightwriter, or an iPad with a communication app (i.e. TouchChat). It usually is difficult to implement the idea of a device as most people with PD are able to speak to some extent, so this can lead to them not being accepting of the use of a device to assist them. Also, many of the individuals with PD are older adults, which may make using an AAC device difficult at first but also their friends and spouses might have hearing impairments which can impact effective communication with a device. The process of knowing when to implement a device for an individual with Parkinson's disease is difficult. The following is a five stage model for knowing when AAC intervention is needed and to what extent.
Five Stage Model for AAC Intervention
L. Armstrong et al. (2000) discussed a five-stage model incorporating deterioration of speech and the possible AAC intervention for individuals with Parkinson's Disease.
The Assessment for Augmentative and Alternative Communication Devices
The SLP will need to take into consideration:
Five Stage Model for AAC Intervention
L. Armstrong et al. (2000) discussed a five-stage model incorporating deterioration of speech and the possible AAC intervention for individuals with Parkinson's Disease.
- Stage 1 corresponds with no detectable speech disorder with AAC intervention by providing information of possible use for the future.
- Stage 2 is the presence of a speech disorder that is characterized by reduction in volume and therapy intervention is needed. AAC intervention is more likely and will consist of a portable speech amplification system and possible telephone adaptations.
- Stage 3 is a reduction in speech intelligibility characterized by imprecise consonant production, reduced volume, voice breathiness, and alterations in rate (such as rushed speech). The AAC intervention might consist of some type of speaking rate control: an alphabet board to have the patient point to the first letter of each word in the message, amplification, topic displays, and remnant books.
- Stage 4 is a loss of functional natural speech. An AAC device would be necessary such as a pacing board, alphabet boards, portable typing system such as Lightwriter.
- Stage 5 is a severe speech disorder with no natural speech. This stage can be difficult to introduce an AAC device due to possible motor control and cognitive impairments.
The Assessment for Augmentative and Alternative Communication Devices
The SLP will need to take into consideration:
- Positioning and how the individual is seated- once evaluation is completed this will be important in choosing a device
- Cognitive abilities such as the possible onset of dementia which can occur, specific memory impairments, and some slowness in problem solving have been reported for individuals during assessment of AAC.
- Motor control- assessing hand/arm control, head control to not interfere with their vision, foot/leg control, range and accuracy of movement
- Assessing the severity of tremors and rigidity of the individual pertaining to fine motor skills. This can impact the range of motion, and speed of movement to access a device.
- Knowing the medications the individual might be on and any symptoms related to the medications that could impact cognitive abilities or motor abilities
- Reduced self-awareness or self-monitoring of speech intelligibility
Characteristics of AAC Devices for use in Parkinson's Disease
The following are possible AAC devices that can be used with individuals with PD:
The following are possible AAC devices that can be used with individuals with PD:
- Dynamic device such as an iPad can be beneficial for individuals with PD to utilize
- Reduced size of the selection display for those individuals with difficulties with range of motion or reduced speed of movement
- The icons can consist of words and symbols
- Digitized speech that uses their own voice that is prerecorded before the disease progresses to the point where the individual cannot produce speech any further or their voice becomes severely impaired (this will limit the amount of vocabulary on the device)
- Synthesized voice output if not able to record their own voice for speech output and will provide an infinite amount of vocabulary.
- Direct selection with timed activation- dwell activation will allow the user to identify the item they want and push the icon for a predetermined period of time to make the selection. This requires less motor control and fewer frequency of motor movements which can help prevent or lessen the individual feeling fatigued.
- Key-guard might be necessary for those individuals who have tremors that are worse when they are at rest which might cause the individual to select an item involuntary.
- Space between icons is needed and will be beneficial for those individuals who have hyperkinesia as a result of the medication they are taking to help prevent excessive movement from tapping another item on the display screen.
- Indirect scanning on the device will be beneficial for the individuals with severe Parkinson's disease.
- Device should be compatible with group scanning (as long as cognitive level permits) when a switch is needed to make a selection.
- The ability for automatic scanning with the use of a large switch if needed as the disease progresses.
Other Assistive Devices:
o Biofeedback
o Portable delayed auditory feedback (DAF) device
o Computer-generated pacing procedures
o Finger tapping while speaking is the paced alphabet board technique
o Portable delayed auditory feedback (DAF) device
o Computer-generated pacing procedures
o Finger tapping while speaking is the paced alphabet board technique
Family Education and Involvement
Family education is very important in the implementation of an AAC device for an individual with Parkinson's disease. If the individual with Parkinson's disease is receiving speech therapy, practice is very important outside of the actual therapy sessions, especially if an AAC device is being implemented. The individual with PD is having to learn how to navigate and use the communication device, but the communication partner (family) also will have to learn how to communicate with a person using an AAC device. Communication partners need to encourage their loved ones to actively use the device. Family members can assist in speech therapy sessions and at home, to monitor and help remind the individual to take in a deep breath and to slow down their speech to help increase their intelligibility while using their AAC. The more information the family has regarding PD, the better the outcome for their loved one, especially if there is an augmentative and alternative communication (AAC) device that has been introduced.