Most of us know someone who had a stroke, has dementia, or is challenged by Parkinson’s disease and has problems with communication. Often, these people cannot participate in activities as they used to and feel less satisfied with their daily lives. Luckily, there is a range of communication technologies available today to support people with speech and language impairments, enabling richer opportunities for social interaction.
The most common communication impairments in older adults are aphasia, dementia and dysarthria. Aphasia is a condition involving damage to the language centers of the brain, typically caused by stroke. People with aphasia struggle to process language, despite having normal intellectual functioning. They may have difficulty retrieving words, combining words into sentences and understanding others; most experience similar challenges with reading and writing.
Dementia may result in a variety of cognitive changes, including aphasia, memory problems, difficulty with planning, sequencing and organizing facts, or changes in behavior and personality—all of which can adversely affect communication.
Dysarthria is a motor speech disorder that makes a person’s speech sound uncoordinated, imprecise or slurred. It can be caused by stroke or by neurological diseases such as Parkinson’s disease.
Technology that Can Help
There are many communication technologies that may be helpful to older adults with communication and cognitive impairments, several of which already exist in our homes and communities. They range from high-tech options like dedicated speech-generating devices and portable computers that can speak messages aloud in any language, to low-tech and no-tech options, such as talking picture albums and printed communication boards. We all keep “to do” lists or grocery lists, we have photo albums with family pictures and we even listen to directions spoken to us in our cars by GPS. These can all serve as tools to support people with communication challenges, too. Such supports and technologies are known as augmentative and alternative communication (AAC), and fall within the medical category of assistive technology for communication. They provide an alternative means of communication, as in the case of a person with dysarthria who uses a “talking typewriter” to discuss this week’s sports news with you. They may also serve to augment a person’s existing communication methods—a person with aphasia may draw a picture, or a person with dementia may point to a photo in her photo album to tell you about her son’s recent wedding.
Mobile Devices and AAC Apps
The recent boom in tablet and smartphone technology has provided many new AAC options, with a rapidly growing selection of apps for communication and memory support. Devices such as the iPad are relatively affordable, universally available, portable and fun; and AAC apps are often free, inexpensive and easy to install. There are a wide variety of apps to meet the needs of people with communication impairments. If a person can’t remember names, she can use an app with words and pictures for people, places, items or activities that have been conveniently categorized. If a person’s speech is difficult to understand, there are apps permitting them to type in words and speak them out with a variety of male, female and children’s voices—even the voice of someone they know! The app will remember phrases the person has typed previously and offer them for quick communication the next time they’re needed. Finally, when memory difficulties interfere with daily life, there are apps that provide built-in picture or word-based calendars and reminder tools (for example, medication reminders). Plus mobile devices are handy for many other uses—eBooks, photos, games, movies, music, and the Internet. Introduction to and use of these apps should increase enjoyment, familiarity and comfort for older consumers.
But Which Technology Is Right?
Communication technology should be matched to the unique abilities and needs of each individual. Ideally, communication strategies will capitalize on the user’s previous experiences and interests. Those with limited comfort and familiarity with technology may benefit from simplified user interfaces and screen layouts, or may prefer to use low-tech or no-tech communication aids. Regardless of the type of communication system in use, all technologies should be personalized and adapted for the user. Written or spoken cues may make a communication device easier to use; and larger font sizes, louder voices or simpler sentences may make a communication app easier to read and understand. People with physical disabilities may benefit from alternative access methods such as pointing with a stylus instead of a finger, or controlling a computer with head or eye movements.
The Role of the Caregiver and the Environment
Caregivers and loved ones are an important part of any communication system. They can provide valuable information about a person’s abilities and interests to guide the selection and customization of an appropriate system, and can help create an environment that will support successful communication interactions. You can’t communicate to yourself, so the role of family members and caregivers is essential. Caregivers may require training on how to be a good conversation partner to someone using communication technology, and on how to provide cues and support as needed; how to operate and change the language in a device; and how to troubleshoot the equipment.
Evidence-based Practice and Communication Technology
The body of research on the use of communication technology among older adults is growing, and should inform decisions on technology and treatment selection. For example, our research found that AAC devices with voice output do not improve conversation when used by people with moderate Alzheimer’s disease. We presented communication boards that spoke words to older adults with moderate dementia, and expected the boards to help them talk about familiar topics. But the speaking machines appeared to distract people, and led to fewer words spoken. We also found that someone needs to teach the person how to use the speaking device over time, and continue reminding him or her of how to use it. Learning to use a new form of communication, whether it’s technology or a communication book, takes time and patience. Clearly, AAC for older adults is not a one-size-fits-all proposition. A person’s individual strengths and deficits, the level of support they have at home and in the community, as well as evidence from current research should be taken into account.
Incorporating AAC into Healthcare for Older Adults
Communication technology can be easily purchased off the shelf (such as the iPad or talking photo album) or can be prescribed by a physician and speech-language pathologist (such as a speech generating device from an AAC manufacturer). Equipment prescribed by a healthcare team is considered “durable medical equipment” and can be funded by Medicare and third-party payers. In both cases, it benefits the person with communication challenges to consult a speech-language pathologist who is familiar with the range of technologies and has the clinical skills to conduct a comprehensive evaluation to match the features of the communication technology to the personal characteristics of each potential user. Also, specialized treatment should accompany any device purchase, for both the person with communication challenges and their family or care providers. As one of our colleagues reminds us, “Assistive technology without training is not assistive.”
Communication and information technology has the potential to enhance the daily participation of older adults in their communities. It provides tools that could substantially reduce social isolation; it allows individuals to retain or regain a higher level of independence and control over their lives; and it keeps people intellectually active. The challenge is to find the best communication technology to fit individual needs and to learn how to integrate these new tools into daily routines.
Melanie Fried-Oken, Ph.D., CCC/SP is a professor of neurology and a speech language pathologist at Oregon Health and Science University (OHSU), Portland, Ore.; Aimee R. Mooney, M.S. CCC/SP, is adjunct faculty in cognitive rehabilitation and a researcher at OHSU, and a speech language pathologist; Glory Noethe, MPH, is a research coordinator at OHSU; and Betts Peters, M.S. CCC/SP, is a research associate at OHSU with REKNEW (Reclaiming Expressive Knowledge in Elders With communication impairments) and a speech language pathologist.
This article was brought to you by the editorial committee of ASA’s Network on Environments, Services and Technologies for Maximizing Independence (NEST).
There’s a swelling social movement to encourage all of us to discuss and document our preferences for care as the end of life approaches. To... Read More