0743-4618/89/0501/0055$2.

00/0
AAC Augmentative and Alternative Communication
Copyright 1989 by Williams & Wilkins

A Comprehensive Augmentative Communication

System for an Adult with Brocas Aphasia
Kathryn L. Garrett, David R. Beukelman, and Deanna Low-Morrow

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Madonna Centers Rehabilitation Hospital, Lincoln, Nebraska [K. L. G.], University of Nebraska, Lincoln [D. R. B.], and Meyer Childrens Rehabilitation Institute,
Omaha, Nebraska [D. R. B., D. L-M.]

A multimodality augmentative communication system was developed for a 74-year-old man with
Brocas aphasia. System development began with an assessment of the subjects communication
competencies and needs. Decisions were made regarding which modes of communication could
be capitalized on without additional instruction, and which modes could be enhanced via augmentation in order to successfully transmit messages. A multimodal communication system consisting
of natural speech, gestures, writing, drawing a first letter spelling alphabet card, a thematic word
dictionary, breakdown clues, and control phrases was eventually developed. The tangible
components of the system were consolidated into a small portable notebook. Issues regarding
instruction in system use, interaction, and vocabulary selection were addressed. Data collected
by videotaping interaction with unfamiliar speakers revealed that fewer communication breakdowns were present in the augmented condition than in the unaugmented condition, indicating
greater efficiency of message transmission.
KEY WORDS: aphasia, augmentative communication, multimodal communication

Successful comprehensive augmentative and alternative communication (AAC) systems for adults with
aphasia have not been widely reported in the literature
to date (Beukelman & Garrett, 1988). In the past, much
research in the area of aphasia has focused on describing the complex of neurologic and linguistic deficits
associated with the aphasia syndrome, and devising
treatment techniques that focused on strengthening
deficit areas. More recently, the literature pertaining to
adult aphasia has begun to describe the communicative
competencies demonstrated by these individuals (Holland, 1982; Ulatowska & Bond, 1983). For instance,
Wilcox (1983) suggested that if pragmatic competence
(the ability to convey and receive both verbal and
nonverbal messages) as well as linguistic competence
is considered, then many individuals with aphasia can
be considered communicatively competent. This focus
on competence opens the door for AAC approaches to
communication for the individual who is unable to effectively generate messages through deficient modalities,
particularly if traditional intervention has failed to improve spoken, written, or gestural communication skills
to functional levels to meet all communication needs.
The multimodal nature of AAC approaches (Vanderheiden & Yoder, 1986) is also well suited to the adult with
aphasia, as their intermittent processing patterns require an array of strategies to ensure communicative
success (Beukelman & Garrett, 1988).
The following case study discusses the development
of an augmentative communication system for an adult
with Brocas aphasia who also demonstrated communicative awareness and competencies, although his

attempts at communication were often frustrated by

the lack of complete understanding on the part of his
listeners. The AAC techniques focused on competencies and attempted to increase the efficiency of the
communicative process by providing a package of
augmentative approaches and techniques.

Case Description
Mike was a 74-year-old male with Brocas aphasia
as a result of two cerebrovascular accidents sustained
in 1977 and 1981. Mike lived with his wife, daughter,
and granddaughter in a rural farmhouse, and led an
active lifestyle that consisted of going to the racetrack,
eating in restaurants, shopping, and so forth. He traveled to most of these destinations independently via
taxicab and bus. Mike had been receiving traditional
speech and language therapy at the University of Nebraska Speech and Hearing Clinic for approximately 3
years. The focus of therapy had been on the remediation of expressive language deficits as well as on the
improvement of reading skills.
At the time of his referral to the Barkley Augmentative
Communication Center, Mike continued to demonstrate
severe expressive language deficits that were characterized by the following: production of nonspecific, telegraphic utterances, repeated attempts to achieve oral
targets for words (oral apraxia), phonemic paraphasias,
occasional semantic paraphasias, and frequent word
recall difficulties.
He also demonstrated a mild receptive language
deficit which was compounded by the presence of a
55

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56

Garrett, Beukelman, and Low-Morrow

moderate sensorineural hearing loss for high frequencies bilaterally. An aphasia quotient of 34.6 (100 possible) was obtained with the Western Aphasia Battery
(Kertesz, 1982) in October 1987. A complete listing of
subtest scores is contained in Table 1.
An assessment of Mikes communicative competencies revealed the following: an awareness of his environment and principles of interpersonal communication,
a strongly evidenced intent to communicate, speech
that conveyed this intent approximately 20% of the
time, supplementary nonformalized gestures, single
word and phrase reading skills, attempts to graphically
spell short words or write common abbreviations, an
ability to roughly sketch maps, and frequent attempts
to use or point to objects or information in the environment (e.g., looking up names in the phone book) in
order to communicate a specific message. Further
probing revealed inconsistent first letter spelling skills
when using an alphabet card during naming tasks.
In spite of his ability to convey messages to familiar
listeners using well established topics, each exchange
required his partner to make repeated attempts to
decode the message. Thus, communication was a
lengthy, inefficient process even under ideal conditions.
With unfamiliar partners who did not have knowledge
of the subjects communicative strategies or personal
background, conversations were characterized by multiple conversational breakdowns and incomplete message resolutions. On the basis of the observations
regarding his deficits, competencies, and conversational effectiveness, the following course of intervention
was followed.
Intervention

Needs Assessment
The intervention was driven by an initial needs assessment (Beukelman, Yorkston, & Dowden, 1985)
that revealed the complex communication needs of the
subject. As indicated earlier, this gentleman continued
to participate in many activities. In regard to the physical
characteristics of a potential augmentative technique,
portability appeared to be a key prerequisite due to the

many environments in which he communicated. When

conducting an inventory of the subjects message
needs, he appeared to require a comprehensive communication system that would allow him to communicate a wide variety of messages to any conceivable
partner in the multiple environments. He thus needed
to be able to communicate unique information in order
to provide pertinent content for the changing messages, as well as more predictable information such as
that contained in standard social greetings and messages related to consistent conversational themes
(e.g., sports, family, horse races).

Early Trial Interventions

Given the basic information obtained from the needs
assessment, as well as our initial observations regarding the subjects competencies, the actual intervention
approach remained unclear due to our lack of experience with other AAC options for individuals with
aphasia. A brief trial period with an electronic communication system, the Touch Talker with Express
software was conducted initially. The electronic system offered more intelligible spoken output as well as
a relatively large message storage capacity. It was
hypothesized that Mikes direct selection skills, single
word reading skills, and knowledge of symbolic communication would make him a good candidate for this
system. In addition, he demonstrated an immediate
understanding of the concept of leveling, or alternate
message storage within the same selection area. The
2-week trial revealed that this system did not meet the
subjects needs for the following reasons: restriction of
messages due to the finite vocabulary set, and the lack
of portability due to his need to use a cane when
ambulating. In addition, Mike made no use of the visual
display monitor or synthesized speech feedback/output
options. He preferred to show the actual overlay to his
conversational partner as opposed to utilizing the auditory output to convey the message; in addition, he
often vocalized the message after seeing the word in
print (i.e., the printed word on the overlay cued his
recall and/or word production ability).

Components of the AAC System

TABLE 1: Subjects Test Data from Western Aphasia Battery
(Kertesr, 1992)
Subtest
I. Spontaneous speech
Content

Results

6 (Correct response to 4 of 6
items)
Fluency
4 (Halting, telegraphic speech)
II. Auditory verbal comprehension 60/60
Auditory word recognition
53/60
Sequential commands
51/60
Ill. Repetition
26/100
IV. Naming
31/60
Word fluency
8/20
Sentence completion
5/10
Responsive speech
6/10
Aphasia quotient: 34.6/100

Several alternative communication strategies were

then developed simultaneously in order to better address Mikes communication needs. The multiple components were designed to interface more directly with
a larger number of his residual capabilities.
1. Word Dictionary. Due to Mikes ability to use
written words to cue his verbal output, a word dictionary was constructed. A more exhaustive inventory of
the subjects favorite conversational themes was compiled over the course of several months: family, foods
and restaurants, sports, personal history, places, personal care items, phone numbers, and words referring
Touch Talker with Express Software by Prentke-Romich Company,
1022 Heyl Road, Wooster, OH 44691, USA.

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Case Study: AAC & Aphasia

to the time domain (e.g., month, oclock). Words pertaining to each of these themes were also identified,
and Mike acted as an editor during the final decisionmaking process. Two types of storage systems for the
words were tried in order to determine which would be
a more effective accessing method for the subject. In
the first method, all of the words were arranged according to their first letter, as in an actual dictionary.
The second method, arranging the words topically,
appeared to be more beneficial. In addition to selecting
words more rapidly, Mike also recalled points related
to each topic when the appropriate words were arranged in clusters.
2. Alphabet Card. Second, Mikes ability to use an
alphabet card to cue the message receiver with the first
letter of the word was assessed (Figure 1). Mike demonstrated that he was able to use the alphabet card
during structured tasks (e.g., pointing to the first letter
of a word given to him auditorily) with approximately
40% accuracy. During spontaneous naming tasks, he
recalled and pointed to the first letter of the word
approximately 30% of the time. Interestingly, once the
first letter had been located, this often cued him to say
the desired word correctly. Errors or an inability to
indicate the first letter appeared to be due to several
factors that occurred and co-occurred intermittently: an
inability to retrieve the entire word, an inability to retrieve the first letter, or an inability to process the
information presented to him.
Once first letter cueing had been identified as a viable
communication option for Mike, a period of instruction
was initiated. For 1 month, he participated in structured
word recall tasks that required him to point to the first
letter of proper names. Familiar items, such as the
names of sports teams, were used initially. When the
subject demonstrated some success with this task, he
was then asked to recall the first letter of common
nouns such as food names. Finally, he was encouraged
to use the technique in conversation. Mike initially required specific instructions to use the alphabet board
during conversational breakdowns, but eventually demonstrated an ability to use the technique independently.
The alphabet card was particularly effective when
Mikes spoken productions were unintelligible due to a
phonemic paraphasia. In these cases, the partner received both a word approximation and first letter cue.
This usually was sufficient to deduce the intended word.
Occasionally, Mike would also search for the first letter
as a means of cueing himself in situations when he
could not recall the word, which indicated that whole
A

word recall did not always precede first letter retrieval

for him. Mike quickly learned that this alphabet card
cueing technique was the technique of choice when the
desired word was not contained on the word dictionary;
in other words, it was most useful for communicating
unique information.
3. New Information Pocket. A new information
pocket was also included in Mikes communication
system. This paper pocket was introduced to him as a
means of carrying pieces of current information, such
as newspaper clippings, which he often carried with
him from home. This technique has been used successfully by the authors with elementary age nonspeaking children as a means of communicating unique information that had occurred in the childs home environment. Articles or mementos from the race track also
enabled Mike to convey an impression regarding a
unique current experience or memory of his past, which
in turn led to a more information-rich interaction with
the clinicians.
4. Breakdown Resolution Clues. A card containing
clues was also included in Mikes communication
system (Figure 2). These clues consisted of phrases
that would guide the partner through a structured form
of 20 questions in order to arrive at the desired piece
of information. For instance, Mike would point to a
phrase that said the target word was one of the following: person, place, thing, and so forth.
5. Conversational Control Strategies. While Mike was
judged to be fairly competent in the area of conversaCLUES

ITS A:

PERSON
PLACE
EVENT
THING
TIME

ILL DESCRIBE IT:

COLOR
SIZE
WHAT ITS MADE OF
WHAT IT DOES
SOMETHING ELSE

Figure 2. Clue phrases in communication book.

DIRECTIONS

GUESS THE WORD

ASK ME QUESTIONS

Figure 1. Alphabet/first letter spelling card (adapted from Beukelman

et al., 1985).

IM CHANGING TOPIC
WE WILL STOP

Figure 3. Control phrases in communication notebook.

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58

Garrett, Beukelman, and Low-Morrow

tional savvy and pragmatics, it was noted that he

had some difficulty judging when a topic was exhausted
and should be terminated. In the case of breakdowns,
he was particularly unable to judge the worth of a piece
of information to the overall conversation, and often
had to be instructed to move on to another point. In
addition, Mike occasionally shifted to new topics without alerting his conversational partner. To address
these issues, conversational control phrases were also
added to the inside back cover in order to manage
some of the interactional aspects of conversation (Figure 3).
6. Natural Communication Modalities. Mike was also
encouraged to use his other natural communication
modalities more extensively. He was given no additional
training in the use of formalized sign, due to his ability
to express himself fairly effectively with natural gestures. However, he was told that gesturing was a valid
means of communicating, and that it could be used
when other modalities failed or when gestural communication would convey the message more efficiently
than other means (e.g., greetings).
Writing and drawing were also encouraged. Previously, Mike had written on available scraps of paper. A
notepad was provided for him and he was encouraged
to write words, abbreviations, or sketch diagrams when
necessary.
Finally, Mike was encouraged to continue communicating with natural speech whenever possible. However, he was also asked to monitor the effectiveness
of his verbal output. If he perceived that his speech
was ineffective in delivering the message, he was encouraged to try other communication options.

System Consolidation
A subsequent decision was made to combine all of
the above usable communication skills into one consolidated communication system. This selection of a
multimodal system was compatible with Mikes present
strategies and skills, and also corresponded with
known information regarding the multimodal nature of
nonimpaired communication (Davis & Wilcox, 1985).
The alphabet card, writing paper, and the thematic word
dictionary were included in a 4" 8" notebook binder.
The word dictionary was arranged with identifying tabs
for each theme. The alphabet card was taped to the
inside cover for easy access. A card with identifying
information and instructions for the partner concerning
the subjects means of communication was taped to
the outside front cover (Figure 4). The card, containing
breakdown resolution clues and the conversational
control phrases, was taped to the inside back cover of
the notebook. A bus schedule was also included in the
notebook due to its frequent use by Mike. Natural
speech and gestures were incorporated with the tangible communication components during the training
phase.

Instruction in System Use and Interaction Management

Once a consolidated communication system was
established, Mike revealed that he had some difficulty

MIKE J.
STREET ADDRESS
LINCOLN, NE ZIP
(PHONE)
HELLO.
MY NAME IS MIKE J.
I HAVE HAD A STROKE.
THIS IS NOT A WALLET.
IT HELPS ME COMMUNICATE.
I WILL SHOW YOU WHAT I NEED OR WOULD LIKE TO SAY BY POINTING
TO THE WORDS IN THE BOOK.
IF THE WORD I WANT IS NOT IN THE BOOK, I WILL TRY TO POINT TO
THE FIRST LETTER OF THE WORD.
I WILL ALSO POINT TO SOME DEFINITIONS IF WE NEED EXTRA HELP.
THANK YOU FOR HELPING ME.

Figure 4. Communication book instructions.

choosing the most efficient mode of communication in

an ongoing conversation, particularly to resolve breakdowns. An analysis of his communication patterns revealed that he tended to repeat his communication
attempts for up to seven or eight conversation turns
without changing to an alternate modality or technique.
This recycling through unsuccessful techniques caused
most conversational partners to give up in their efforts
to interpret his message, which resulted in frustration
for both individuals. Further experimentation revealed
that the subject was most likely to initiate a topic or
convey a message through speech on the first attempt.
He was most easily directed to use a natural communication modality (gestures or writing) if his attempt to
communicate via speech failed. These three techniques
were thus established as his first level of communication strategies.
Mike was then instructed to use his alphabet card or
word notebook if the first level of strategies were
unsuccessful. He required some cueing initially to use
these second level strategies. In addition, supplementary instructions were required in order to encourage
him to use the alphabet card for unique information
and/or to supplement speech distorted by paraphasic
errors, and to use the word dictionary when the information related to the previously stored words and
topics.
Finally, Mike was encouraged to use the third tier of
strategies, the clues or the control phrases, if communication via the natural modalities, thematic word dictionary, or first letter alphabet card was unsuccessful.
Thus, this third level of strategies was, in essence, the
level used for breakdown repair. In regard to the latter
technique, the subject initially needed to be alerted that
he was having difficulty conversationally. The use of
the phrases was then modeled by the clinician. However, after several months of instruction, the patient
demonstrated an ability to independently shift, introduce, or terminate the topic by alerting his partner
through the use of the phrases.

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Case Study: AAC & Aphasia

All of the above strategies were graphically represented on a large chart, which was color coded and
clearly labeled. This chart was kept in full view during
therapy sessions, and was used as a reference whenever necessary. Figure 5 is a schematic representation
of the instructional chart.
In addition to instruction in both efficient use of the
separate system components (e.g., first letter card
instruction) and multimodality system use, the subject
also participated in a series of role-playing activities
designed to simulate entire conversational sequences.
That is, he was encouraged to introduce himself and
his system, using the cover card to fully explain how
he communicated. Then he was encouraged to use the
previously learned techniques to either obtain or convey
information in an efficient yet socially satisfying manner.
Finally, he was asked to monitor the course of the
conversation and decide when specific topics and/or
the entire interaction had been exhausted, using either
natural communication techniques or the control
phrases to manage these aspects of conversation. A
series of community outings to promote use of the
system in actual environments was also planned, although they had not been completed at the time of
publication.
Use of the System in Structured Situations
Development and instruction in use of the system
required approximately 7 to 8 months of twice-weekly
therapy sessions in addition to the time required to
actually construct the notebook. The options for measuring the success of the intervention included assessing
the subject and/or his partners satisfaction with the
system, and assessing frequency of use in other environments, and dyadic measures. Due to the lack of

59

data at any level of the intervention process, the number

of breakdown sequences, percentage of conversational
turns per breakdown sequence, percentage of communication acts, and the number and percentage of
conversational initiations were targeted as appropriate
dyadic measures.

The Interaction Task

The preliminary data were obtained by videotaping a
conversation between Mike and an unfamiliar Masters
level student speech-language pathologist before and
after implementation of the augmentative communication system. The partners were simply instructed to
get to know each other. All conversational turns from
a 6 min segment within the respective conversations
were then transcribed from the tape and coded according to standard definitions developed by the authors for
the determination of turn boundaries, communication
acts, and conversational role (initiations, responses,
etc.) (see Appendix A). The communication act definitions were based on a protocol developed by Wilcox
and Davis (1977) for their analysis of the speech acts
of aphasic adults in individual and group settings, which
in turn was derived from the earlier work of Searle
(1969). The term communication acts is used instead
of speech acts in this study due to the importance of
coding nonspoken modes of communication.

Reliability
The first and third author re-rated each of the variables for 20% of the conversational turns using a
segment of tape approximately 1 min into the conversation. Interrater reliability for the coding of conversa:
tional turns was 90% and 80% for the communication

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Garrett, Beukelman, and Low-Morrow

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acts. lntrarater reliability was calculated to be 90% for

conversational turns and 80% for communication acts.
Results and Discussion
Data for the following variables are presented in
Tables 2 to 5: total number of conversation turns,
number of breakdown sequences and frequency of
turns per sequence, percentage of communication acts,
and number and percentage of conversational initiations.
The preceding data suggest that the augmented
conversation was characterized by a 65% increase in
the number of total turns per partner during the same
unit of time. This data may be correlated with the
information continued in Table 3--a decreased number
of turns was required to resolve communication breakTABLE 2: Total Number of Conversational Turns (from 6
Minute Segment)
Subject

Partner

Total

51
88

39
77

100
165

Preaugmentative
Postaugmentative

TABLE 3: Total Number of Breakdown Sequences and

Frequency and Percent of Turns per Breakdown Sequence
Preaugmentative Postaugmentative
Condition
Condition
Number of breakdown
sequences
Average number of
turns per breakdown sequence
Range of number of
turns per breakdown sequence
Percentage of total
turns used in breakdown sequence

15

9-23

3-8

46%

11%

TABLE 4: Percentage of Communication Acts (after Searle,

1969)
Postaugmentative

Preaugmentative
Subject

Partner

Subject

Partner

Rep (37%)
Asn (31%)
Aff (29%)
Que (2%)
Req (0%)
Rei (0%)
Cla (0%)

Aff (35%)
Cla (29%)
Asn (22%)
Que (10%)
Req (4%)
Rei (0%)
Rep (0%)

Asn (60%)
Aff (31%)
Cla (3%)
Que (2%)
Rep (2%)
Req (1%)
Rei (0%)

Aff (43%)
Que (22%)
Asn (19%)
Cla (8%)
Rep (4%)
Req (3%)
Rei (0%)

Key: Req. request; Rei, reinforcement; Asn. assertion; Cla, request for clarification; Aff.
affirmation; Rep, repair; Que, question. (Refer to Appendix A for definition?.).

TABLE 5: Number and Percentage of Conversational Initiations

(see Appendix A for definition)
Subject

Preaugmentative
Postaugmentative

Partner

No.

No.

12
42

24%
47%

31
39

63%
50%

Note: Percentage of initiations was derived by dividing the number

of initiations by the subjects or partners own total turns.

downs. Almost one-half of the conversational turns

during the preaugmented conversation were used to
resolve breakdowns in message transmission. While
only three breakdown sequences were recorded in the
preaugmented conversation, an average of 15 turns
per sequence was required to resolve each breakdown.
In contrast, while more breakdown sequences occurred
during the augmented conversation (7), on the average
only four turns were necessary to resolve the miscommunication. Only 11% of the total conversational turns
were used to resolve breakdowns in the postaugmentative condition.
In addition, the data provided in Table 4 reveal that
the relative frequency of the subjects information-providing turns (assertions) approximately doubled during
the augmented conversation. While data on information
transfer was not gathered, it does appear that when
fewer turns were required to resolve breakdowns, more
information was generated by Mike, which possibly
increased the amount of information received by his
partner.
Finally, the data in Table 5 revealed that the number
of Mikes conversational initiations increased (from 24%
to 47%) during the second condition.
These data indicate that the nature of the two conversations differed greatly. The preaugmented conversation appeared to be relatively inefficient, in that much
of the communicative effort was spent on resolving
breakdowns in message transmission. In contrast, the
augmented conversation allowed greater efficiency of
communication. The increase in the number of assertions, or information-containing statements, perhaps
resulted in an increase in information transfer during
the second condition, though this assumption was not
measured directly. In addition, Mikes role in the second
conversation clearly changed from that of respondent
to one of more equal partnership. While systematic
data were not collected to document subject and partner satisfaction, Mike reported that the AAC system
allowed him to initiate conversations more easily in the
community and to resolve communication breakdowns
more efficiently.
While interventions for other individuals with acquired
language disorders may differ from the one described
above, several of the following principles may apply to
other candidates for comprehensive AAC systems:
1. An emphasis on residual capabilities and communicative competency may provide the foundation for
the development of a feasible AAC system.
2. The development of multimodality communication
systems that include the use of natural communication
skills as well as alternative forms of communication,
may meet more communication needs than single technique systems, particularly for adults with neurological
impairment.
3. The relative needs of the individual for a means of
conveying unique as well as predictable information
should be addressed.
4. Instruction in use of individual system techniques,
use of multiple communication modalities, interaction,
and system use in the community, may be crucial to

Case Study: AAC & Aphasia

the success of any one intervention. The effectiveness
of various instruction techniques has yet to be systematically investigated with this population.
This case study illustrated a sequential problemsolving approach used to design an AAC system for an
adult with aphasia. Clearly, many of the variables that
combine to form a successful intervention have yet to
be identified, much less carefully investigated. The very
issue of defining success begs more study and discussion. Reports of other AAC interventions for this
unique and varied population are clearly indicated.

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Acknowledgments
This manuscript was prepared with partial support
from the Barkley Memorial Trust and Grant No.
G008530093 from the U.S. Department of Education,
Division of Personnel Preparation. It is based in part on
a presentation at the October 16-18, 1987 conference,
sponsored by ASHF, CAMA, and ISAAC, held in Denver, Colorado.
Address reprint requests to: Kathryn L. Garrett, Madonna Centers Department of Communication Disorders, 2200 South 52nd Street Lincoln, NE 68506, USA.

61

REFERENCES
Beukelman, D., & Garrett, K. (1988). Augmentative and alternative
communication for adults with acquired severe communication
disorders. Augmentative and Alternative Communication, 4, 104121.
Beukelman, D., Yorkston, K., & Dowden, P. (1985). Communication
Augmentation: A Casebook of Clinical Management. San Diego,
CA: College Hill Press.
Davis, G., & Wilcox, M. (1985). Adult Aphasia Rehabilitation: Applied
Pragmatics. San Diego, CA: College-Hill Press.
Holland, A. (1982). Observing functional communication of aphasic
adults. Journal of Speech and Hearing Disorders, 47, 50-56.
Kertesz, A. (1982). Western Aphasia Battery. New York: Grune &
Stratton, Inc.
Searle, J. (1969). Speech Acts. Cambridge: Cambridge University
Press.
Ulatowska, H., & Bond, S. (1983). Aphasia: Discourse considerations.
Topics in Lanauage Disorders, 3, 21-34.
Vanderheiden, G., & Yoder, D. (1986). Chapter 1: Overview. In S.
Blackstone (Ed.), Augmentative Communication: An Introduction.
Rockville, MD: ASHA.
Wilcox, J. (1983). Aphasia: Pragmatic considerations. Topics in Language Disorders, 3, 35-48.
Wilcox, M., & Davis, G. (1977). Speech act analysis of aphasic
communication in individual and group settings. In R. Brookshire
(Ed.). Clinical Aphasiology: Conference Proceedings 1977. Minneapolis: BRK Publishers.

APPENDIX A

CODING PROTOCOL AND DEFINITIONS

Turn Boundary Criteria:
1. Communication acts occur >1 set apart
2. The communication act changes in definition (e.g., from assertions to requests)
Communication Acts (after Searle, 1969; Wilcox & Davis, 1977):
Request: The leading partner is requesting an action or item of the receiving partner.
Assertion: The leading partner is attempting to convey a proposition to the receiving partner that he/she believes is true. Allows the
communicator to provide information or make comments.
Affirmation: The receiving partner acknowledges receipt of the information conveyed in the preceding turn. A confirmation or
interpretation of the message.
Question: The leading partner requests information from the receiving partner.
Reinforcement: The receiving partner provides feedback to the leading partner regarding how well he communicated in his preceding turn.
Does not pertain directly to the content of the preceding turn.
Request for:
Clarification: The receiving partner provides feedback to the leading partner regarding how well he communicated in his preceding turn.
Does not pertain directly to the content of the preceding turn.
Repair: Follows a request for clarification. The leading partner once again attempts to transmit the same message through the
same or alternative communication modes.
Initiations:
Due to the difficulty in differentiating true initiations from parallel comments, the following categorical definition was applied:
Initiations consist of the following speech acts: Requests, Questions, Requests for Clarification, and all Assertions that are not responses to
Requests and Questions.

Information on AAC Courses

To assist members in identifying augmentative and alternative communication (AAC) courses, ISAAC has published
information on summer courses and seminars in the February 1989 issue of The ISAAC Bulletin. An updated list will be
published in the May issue, and periodically thereafter. Therefore the editor is requesting that individuals teaching courses
send basic information including: (1) title of course, (2) credit (semester, quarter, or term units), (3) instructor, (4) university
or college and mailing address for additional information, (5) when the course is offered, and (6) a course description of up
to 150 words. This information should be sent in duplicate typed double-spaced copy to Barbara J. Nail, Editor, The
ISAAC Bulletin, Special Education, SCC-E, Purdue University, West Lafayette, Indiana 47907, U.S.A.