The Effect of Voice Output on AAC-Supported Conversations of Persons with Alzheimer’s Disease

Abstract

The purpose of this study was to determine whether the presence or absence of digitized 1–2 word voice output on a direct selection, customized augmentative and alternative communication (AAC) device would affect the impoverished conversations of persons with dementia. Thirty adults with moderate Alzheimer’s disease participated in two personally relevant conversations with an AAC device. For 12 of the participants the AAC device included voice output. The AAC device was the Flexiboard™ containing 16 messages needed to discuss a favorite autobiographical topic chosen by the participant and his/her family caregivers. Ten-minute conversations were videotaped in participants’ residences and analyzed for four conversational measures related to the participants’ communicative behavior. Results show that AAC devices with digitized voice output depress conversational performance and distract participants with moderate Alzheimer’s disease as compared to similar devices without voice output. There were significantly more 1-word utterances and fewer total utterances when AAC devices included voice output, and the rate of topic elaborations/initiations was significantly lower when voice output was present. Discussion about the novelty of voice output for this population of elders and the need to train elders to use this technology is provided.

A comparison of syntax, semantics, and pragmatics in spoken language among residents with Alzheimer's disease in managed-care facilities

“…During the course of the disease, individuals lose cognitivecommunication skills in predictable ways [3]. This decline in language facility can result in decreased social interaction and life satisfaction for persons with AD and their caregivers.…”

AAC to Support Conversation in Persons with Moderate Alzheimer’s Disease

“…The one statistically significant effect, related to the presence of voice output, was not anticipated and is discussed in detail in Fried-Oken et al (2009). Voice output, a feature embedded in the AAC devices used by half of the participants, appeared to distract participants and depress performance.…”

“…The discovery that voice output does not facilitate and may even impede conversation for this population is an important one for intervention (Fried-Oken et al, 2009). Remember that the participants were not dysarthric or nonspeakers, so that voice output did not serve as an expressive communication mode.…”

“…As we collected data on the first 30 participants, we observed that voice output seemed to have an unexpected negative effect on conversational success (Fried-Oken et al, 2009). It was at this point that we elected to analyze the data; results from these first 30 participants constitute Pilot Experiment 1.…”

How Can We Develop AAC for Dementia?

“…Elsewhere it was reported that verbal conversation could be improved with AAC communication boards if relevant training was first given to participants [16]. High-tech AAC can be problematic however; it was found [15] for example that pre-programmed digital voice output in devices proved distracting to participants with moderate dementia and reduced their conversational performance compared to devices without digital voice output. Fried-Oken et al [17] also reviewed AAC-supported communication for patients with neurodegenerative disease, including Alzheimer's disease (AD), observing that "Communication supports, including high-tech, low-tech, and no-tech approaches, should be tailored to the specific needs and abilities of each person, and should be modified throughout disease progression".…”