In aphasia, the sequence of neurological steps required to communicate may be

interrupted at any point—when comprehending what others say, creating ideas, retrieving
words and sentence structures, or executing the motor movements to speak.
Comprehension and manipulation of symbols (words, letters, sounds, numbers, pictures)
is inaccurate or slow, which in turn impacts many activities that are ubiquitous
for people in industrialized cultures: reading, writing, computing, e-mailing, using
electronic devices and ATMs, listening in crowded or noisy venues, placing an order
for tangible goods, asking and answering questions in face-to-face situations as well
as by telephone, and more. Some people with aphasia demonstrate relatively intact
intellectual ability; others demonstrate reductions in processing speed, attention,
memory, executive functions, and/or problem solving that cannot be completely explained
by the loss of language (Christensen & Wright, 2010; Erickson, Goldinger, &
LaPointe, 1996; Helm-Estabrooks, 2002; Murray, Holland, & Beeson, 1997; Nicholas,
Sinotte, & Helm-Estabrooks, 2011; Wright & Shisler, 2005).
Many people with aphasia continue to improve their communication, cognition,
and language skills for months and years following onset (Jungblut, Suchanek, & Gerhard, 2009; Rijntjes,
2006). However, many never communicate as efficiently or
effectively as before the onset of aphasia. Language that once was swift, automatic,
unconscious, and attuned to the dynamic challenges of communicating with others
often remains awkward and effortful, even for those who regain natural speech.
Even more urgently, up to 40% of all people with aphasia will experience chronic, severe
language impairments across modalities (Collins, 1986; Helm-Estabrooks, 1984;
Kurland et al., 2004; Martin et al., 2009). (supprting)

Unfortunately, this essential training phase for generative AAC communicators

may not receive enough attention in a multimodal intervention. Other common

reasons that generative AAC communicators do not use their AAC systems effectively

include the following: 1) the vocabulary and content of the AAC materials

provided do not match specific opportunities in real-life communication situations;

2) important communication partners are not willing to accept augmented modes

of communication; 3) teaching and training in naturalistic situations did not occur;

4) communication devices may be too large and unwieldy, or too small to be appropriate

for the vision skills of the individual; and 5) the individual’s social networks

(Blackstone & Hunt Berg, 2003a, 2003b) have become so limited that the individual

has few opportunities to communicate

Written choice  metode yg lebih ke memberikan petunjuk dibanding free recall sehingga dpt
memfasilitas respon pada afasia kronik parah dan/atau global. Hanya membantu jika terdapat
kemampuan membaca dan processing auditorik yg tersisa. Afasia global mungkin tidak
memdaaptkan keuntungan dari terapi ini

Lasker et al  afasia wernicke yang parah, akurasi lebih bagus jika menggunakan written choice
standar dibandingkan dg hanya auditorik atau hanya visual. Pada afasia ekspresif parah dan reseprif
moderate dan pada afasia broca, akurasi standard tidak berbeda dibandingkan dg hanya auditorik
atau hanya visula

Kagan (2001)  lebih bagus jika berinteraksi dg partner yg terlatih. Kemampuan partner
berhubungan signifikan dg transfer informasi.

Beberapa penelitian sudah mengkonfirmasi bahwa individu dengan afasia kronik parah dapat
menggunakan simbol, piktograph dan gambar dengan garis.

Garet et al efektivitas penggunaan sistem komunikasi multimodal (kamus kata, kartu alfabet,
kantong komunikasi, komunikasi natural) pada individu dg afasia broca. Hasilnya lebih banyak
pergantian percakapan, inisiasi percakapan dan lebih sedikit breakdown komunikasi.

Ho et al  orang dg afasia global lebih sukses berinteraksi jika menggunakan simbol. Lebih banyak
menginisiasi topik dan penyampaian pesan yang sukses lebih sering dan efek positif lebih banyak jika
memiliki akses ke buku komunikasi

Walaupun kemapuan pemahaman tulisan da materi pantonim sering tergangu dg afasia,

kemampuan pwa untuk memahami dan memganalisa bahan grafis serupa dg orang tanpa afasia. Hal
ini karena hemisfer kanan sangat terlibat dalam memdapatkan, mengingat gambar ikonik.
Penggunaan simbol grafis relatif lebih muah dibanging vahasa natural

Walaupun tipe dan keparahan afasia mempengaruhi kemampuan seseorang untuk menggunakan
AAC, secara umum AAC device yang menampilkan pesan relevan personal dan sederhana dan
bergantung pada memori merupakan yang paling sukses dipelajari dan paling fungsional digunakan.
Kriteria kunci penggunaan fungsional alat adalah flesibeilias untuk penggunaan di rumah serta
komunitas. Partner komunikasi yang suportif berperan dalam merencanakan konten dan pengaturan
konten yang diprogram serta menerima, membantu dan mendorong penggunaan AAC

Letmetalk
Clinical experience (Lasker & Garrett, 2006) suggests that the MCST-A effectively
distinguishes between communicators who require partner support to indicate
choices and stored-message AAC communicators who can independently search
through the booklet to locate symbols. Data on the amount and type of cuing can help
determine whether the communicator falls into the category of partner dependent
(i.e., consistently requires cues to locate a symbolized message) or independent (i.e.,
needs no cues or minimal cues to locate symbols to convey a message). It is also relatively
easy to identify generative AAC communicators. Clinicians can ask the person
with aphasia to communicate a complex message (e.g., “How would you communicate
that your grandchildren are going to Disney World next month if they have
enough money?”) and then observe if the person can successfully communicate this
idea by pointing to a logical sequence of pictures, words, letters, or locations on the map. In addition, observing
this diagnostic activity may assist some family members
to better understand why a clinician may suggest low-tech instead of high-tech options
for an individual with aphasia.