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Speech and Augmentative/Alternative Communication (AAC) in ALS

presented by John Costello, MA, CCC-SLP and Meghan O'Brien, MS, CCC-SLP

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Disclosure Statement:

The ALS Association Alabama Chapter receives compensation for this course.

Financial: John Costello received an honorarium for participating in project (ALS Association, Alabama Chapter). He is a full-time, salaried employee at Boston Children's Hospital. There is no other financial interest beyond the production of this course.

Nonfinancial: John Costello collaborated in the creation of www.mymessagebanking.com. My Message Banking™ was created in collaboration with Tobii Dynavox with initial funding from the Prize for Life grant. The content of this lecture was developed from the clinical practice and innovations of the ALS Augmentative Communication Program at Boston Children's Hospital. He has no competing nonfinancial interests or relationships with regard to the content presented in this course.

Financial: Meghan O'Brien received an honorarium for participating in project (ALS Association, Alabama Chapter). She is a full-time, salaried employee at Boston Children's Hospital. There is no other financial interest beyond the production of this course.

Nonfinancial: Meghan O'Brien has no competing nonfinancial interests or relationships with regard to the content presented in this course. The content of this lecture was developed from the clinical practice and innovations of the ALS Augmentative Communication Program at Boston Children's Hospital. 

Satisfactory completion requirements: All disciplines must complete learning assessments to be awarded credit, no minimum score required unless otherwise specified within the course.

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Video Runtime: 78 Minutes; Learning Assessment Time: 52 Minutes

This course addresses ongoing evaluation and management of communication challenges secondary to amyotrophic lateral sclerosis (ALS). Following course completion, clinicians will describe systems and strategies to support communication intelligibility for individuals with ALS. The intended audience is speech-language pathologists (working in inpatient, outpatient, rehabilitation, home health, and long-term care facilities) with no or limited experience working with people with ALS. SLPs will define and describe the impact of dysarthria/anarthria resulting from ALS on the speech subsystems and learn strategies for intervention associated with improving intelligibility of speech and conserving energy. Strategies for voice preservation (message banking(TM) and voice banking) will be addressed. Providers will learn about evaluation and implementation of high-tech speech-generating technologies, quick-access communication strategies, and options for emergency alerting. Finally, time will be spent in discussing strategies for training communication partners.

Please be sure to check out the other courses in this series:

Meet Your Instructors

John Costello, MA, CCC-SLP

John Costello has been a speech-language pathologist at Boston Children's Hospital for 36 years where he directs the Augmentative Communication Program and the ALS Augmentative Communication Program. He founded the first dedicated inpatient AAC service in an acute and intensive care hospital where he developed the Message Banking Process, initially for children in the ICU…

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Meghan O'Brien, MS, CCC-SLP

Meghan O'Brien, MS, CCC-SLP, is a speech-language pathologist in the Augmentative Communication Program and ALS Augmentative Communication Program at Boston Children's Hospital. She has specialized in augmentative/alternative communication (AAC) for 14 years. She is an adjunct instructor in the Department of Communication Sciences and Disorders at the MGH Institute of Health Professions in Boston, Massachusetts.…

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Chapters & Learning Objectives

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Download the learning objectives for Speech and Augmentative/Alternative Communication (AAC) in ALS.

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1. Motor Speech and ALS

This chapter addresses clinical heterogeneity, progression, and implications of dysarthria secondary to ALS. Clinicians will learn strategies for motor speech evaluation and differential diagnosis, including cranial nerve examination and auditory-perceptual speech evaluation.

2. Speech Intelligibility and Energy Conservation

This chapter addresses goals related to motor speech and energy conservation in ALS. Time is spent in discussion regarding compensatory strategies and strategies to enhance intelligibility of speech. Additionally, voice amplification is introduced as a mechanism for increased volume and energy conservation.

3. Voice Preservation

This chapter introduces the processes of voice banking, message banking™, and double-dipping to allow for voice preservation. These processes allow for integration into speech-generating technologies, as needed.

4. High-Tech AAC Evaluation and Implementation

Speech-generating technology evaluation is explained as a dynamic, ongoing process including PT/OT to address physical access needs. Critical features to consider during evaluation are highlighted, and importance of an evidence-based trial to ensure goodness of fit is emphasized.

5. Quick-Access Communication Strategies and Emergency Alerting

Systems and strategies to call for attention and to address communication needs if or when a high-tech system is not available or practical are addressed. The importance of system personalization and customization is emphasized.

6. Communication Partner Training

It is critical that the burden for modifying communication strategies does not fall entirely on the person with ALS. Suggestions for communication ground rules for maintaining privacy and dignity are offered, and solutions for maximizing communication success are discussed.

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