Fast Facts: Dementia and Augmentative and Alternative Communication: Supporting conversations

By J. Murray, S. Dada and A. May

The purpose of this book is to offer medical, health, and social care professionals who work in acute, medical, long-term, or community care settings insights into the impact of dementia on an individual’s communication interactions and how augmentative and alternative communication (AAC) strategies could enhance these interactions. The first half of the text sets the scene for understanding the nature of dementia and its impact particularly on an individual’s social and emotional life and their language and communication; the second half introduces AAC and what it offers as a set of techniques to support and maintain conversational autonomy in those living with dementia. Table of Contents: • Section 1: The nature and impact of dementia • A description of dementia • Social and emotional impact of dementia • Language and cognitive-communication assessment and approaches to intervention • Section 2: Interventions mediated through augmentative and alternative communication • Augmentative and alternative communication (AAC) • Developing AAC interventions: A participatory assessment and intervention process • Communication partner AAC training and support • What everyone should know about dementia, AAC, and conversational partner training

• Language: English
• Publisher: S. Karger
• Release date: Aug 8, 2022
• ISBN: 9783318071627

Book preview

Introduction

Overview of the book

Dementia is a global health priority, as stated in the G20 summit declaration of July 2019. An estimated 50 million people worldwide have dementia, with nearly 60% living in low- and middle-income countries.¹,² Every year, there are nearly 10 million new instances of dementia diagnosis.³ The impact of the condition on the health and well-being of those living with dementia, including family members, is not fully understood. In particular, the economic, health, and social consequences require better understanding to support targeted and timely interventions.⁴

This book attempts to set out everyday interaction environments and considers how these impact those living with dementia and their conversational partners, especially family members, primary carers, and care staff. The book provides an overview of the current knowledge base of the dementias, their impact on social and emotional well-being, and progressive changes in language and cognitive abilities. A substantial feature of this text is the consideration of maintaining connectedness with those living with dementia through meaningful, co-constructed interactions, in particular those mediated through augmentative and alternative communication (AAC) techniques. Research suggests that there is limited knowledge across the international workforce regarding how techniques offered by AAC resources can enhance the communication dyad, which in turn reduces conversation partner distress and increases the quality of interactions between persons living with dementia and their primary conversational partners.

As advocated in the literature, an underlying premise of this text is the application of a person-centred intervention perspective to support and maintain communication participation in persons living with dementia.⁵ The concepts of a person-centred care approach refer to a person with dementia’s prerequisite right of inclusion in social relationships, autonomy in making choices, self-determination, and preferences that facilitate well-being.⁶ A person-centred approach recognises an individual’s strengths and remaining functional cognitive abilities, with prominence of the life story, heritage, culture, and past experiences of the person with dementia and other important individuals in their social environment. A person-centred method enables all practitioners to gain a deeper appreciation for the person ‘behind the dementia’, which may have the potential to enhance how the individual with dementia is viewed.⁷ This text will focus on the role of clinicians as they work to support meaningful communication outcomes during person-centred AAC interventions, including non-electronic (e.g., books with photographs) and electronic (e.g., tablet technologies) devices.⁸,⁹

The text is organised into 2 sections: (i) the nature and impact of dementia, and (ii) interventions mediated through AAC techniques.

Aims of the book

The purpose of this text is to offer medical, health, and social care professionals who work in acute, medical, long-term, or community care settings insights into the impact of dementia on an individual’s communication interactions and how AAC strategies could enhance these interactions.

This introduction summarises the content of the 2 sections and their chapters, indicating the learning objectives related to each chapter.

Section 1: The nature and impact of dementia. This section of the book sets the scene for understanding the nature of dementia and its impact particularly on an individual’s social and emotional life and their language and communication. Consideration of approaches to assessment and intervention are included.

Chapter 1 – A description of dementia. As a context for interpreting the relevance of intervention approaches, this chapter provides a description of the medical characteristics and progression of the dementias. This divides into a definition of dementia, a brief discussion of the risk factors for dementia, prevalence information, and descriptions of the key types of dementia with their differing characteristics. The chapter also provides a discussion of how dementia is diagnosed and what is understood about the course of the disease. By way of setting the scene for the remaining book content, the chapter concludes with a section on the impact of dementia on communication abilities.

Chapter learning objective: to understand the varying forms of dementia and begin to appreciate the impact these may have on professionals’ decision-making and the type of communication interactions they have with persons living with dementia.

Chapter 2 – Social and emotional impact of dementia. This chapter discusses the social and emotional impact of dementia from the perspective of both the person living with dementia and those around them. It departs from a biomedical conceptualisation of dementia as in Chapter 1 to highlight the significance of biopsychosocial elements of social and emotional well-being in those living with dementia. The chapter progresses to a discussion of the facilitators that may promote social and emotional well-being in persons with dementia and those closest to them.

Chapter learning objective: to gain an understanding of the social and emotional impact of dementia and ways to promote well-being of persons living with the condition through psychosocial interventions.

Chapter 3 – Language and cognitive-communication assessment and approaches to intervention. This chapter reviews currently recommended approaches to language and cognitive-communication assessment and associated interventions for clients with dementia. The content of the chapter is taken from the theoretical perspectives informing the clinician’s management decisions. Specifically, the content recognises the involvement of the speech and language therapist/pathologist (SLT/P) and the psychologist in the assessment and delivery of language and cognitive-communication interventions.

Chapter learning objective: to gain an understanding of the contributions of the SLT/P and the psychologist in the identification of language and cognitive-communication challenges for those living with dementia and the delivery of interventions that may ameliorate such challenges.

Section 2: Interventions mediated through augmentative and alternative communication. This section of the book sets the scene for understanding AAC and what it offers as a set of techniques to support and maintain conversational autonomy in those living with dementia. The section moves on to considering how such techniques could be the basis of conversation partner training, and concludes with a summary of key messages that all should understand about dementia and AAC. The text closes with a list of useful resources and a link to a freely downloadable poster summarising the key take-home messages.

Chapter 4 – Augmentative and alternative communication (AAC). This chapter defines AAC. It progresses to descriptions of the different types of AAC, contextualising them within the broader fields of assistive technology and, more recently, the artificial intelligence genre of technology-mediated interactions. It concludes with a section on supported communication to aid conversational flow.

Chapter learning objective: to gain an understanding of the breadth of AAC resources, tools, and techniques that aid supported conversation.

Chapter 5 – Developing AAC interventions: A participatory assessment and intervention process. This chapter presents an outline of the theoretical processes informing assessment, leading to the development of AAC interventions for individuals with dementia. This includes an overview of the assessment process as it is framed in relation to guiding principles of AAC management informed by research. The chapter retains an emphasis on a participatory process that involves the person living with dementia. This is grounded in a case example whereby a practical description of an assessment and intervention process is given. The text concludes with a summary of key AAC considerations during an intervention process.

Chapter learning objective: to gain a conceptual and practical understanding of a participatory assessment process for developing AAC interventions with and for persons with dementia.

Chapter 6 – Communication partner AAC training and support. This chapter commences with an overview of communication accommodation theory that defines how people position themselves within different types of interaction. These are used to explore and define the importance of communication partner training. The chapter considers how training programmes offer communication partners strategies for enhanced interaction with those living with dementia, concluding with where AAC techniques and resources fit within these programmes and strategies.

Chapter learning objective: to gain an understanding of communication partner training interventions aligned to social participation and person-centred communication outcomes that support those living with dementia and their key conversational partners.

Chapter 7 – What everyone should know about dementia, AAC, and conversational partner training. As a regular aspect of this textbook series, we conclude with a chapter on some key take-home messages. These messages are taken from across the entire text to enable us to draw together a summary of elements that inform, support, and drive positive change in interactions for those living with dementia and their primary conversational partners, be they family, medical professionals, or care staff. This chapter includes the important information that we regard as universal knowledge for all medical, health, and social care staff. This is irrespective of their varying cultural, linguistic, policy, system, or service provision contexts. Additionally, the text concludes with a summary of useful resources and contacts to support those living with dementia, their families, and the professional teams who support them.

We complete this chapter with a link to a freely downloadable poster summarising the key points that everyone should know about dementia and the value of AAC techniques in supporting meaningful conversations.

Chapter learning objective: to have knowledge of AAC techniques, tools, and resources that