Both as a practicing speech-language pathologist and in my role at DynaVox, I have heard the following questions, or variations on the following questions, many times.

“He can meet his basic needs, either by doing it himself or telling me.  He doesn’t need AAC, right?”

“I understand her when we are at home…and we are at home most of the time.  She doesn’t need AAC, right?”

The questions generally come from loving spouses or caregivers who really just want to make life easy for the person with a stroke or TBI.  They are leery of adding “one more thing” (in this case AAC) that they think might be difficult for the person to learn or use so they focus on the positive—the times that he or she can communicate successfully.  If they can make communication easy during those times, either by interpreting an attempt at communication or by providing something before it has to be requested, that should be good enough.  Right?

Well, consider this.  Situations change.  People change.  Sometimes all the items needed for everyday life just aren’t available.  Sometimes familiar communication partners aren’t around.  Sometimes we just want to shake things up a bit and try something new.  Sometimes we have to leave our comfort zone.  Sometimes we want to leave our comfort zone—even if it is just by reading a book or watching something on TV.

How does this relate to people with complex communication needs following a stroke or TBI?  Well, what happens when the gentleman who can meet his basic needs discovers that he has run out of coffee beans so he cannot make his own coffee?  What happens when he just decides he wants tea instead of coffee in the morning but there isn’t any in the cabinet?  What happens when his wife goes to visit a new grandchild and he needs to tell his son, who has come to stay with him, how to trim his mustache?

What happens when the man goes to the doctor and the doctor asks him a question?  What happens when his wife watches a show on TV that her husband has never seen and she wants to talk about it?

All of these questions point to a few basic ideas:

• Familiar communication partners might not always be available.  If they are not available, will the person with aphasia still able to communicate successfully?
• Relying on communication partners to interpret communication, or even prevent the need for communication by automatically providing for needs, does not allow for independence.  With all of the changes that occur following a stroke, finding ways to maintain some independence is very important.
• Communication is not always predictable.  When we are at home, we sometimes want to talk about things unrelated to home, like friends, community events, or movies.  When the number of potential communication topics increases, it can be harder for even the most familiar communication partners to understand.
• Finally, we all change.  Even in familiar settings, we might want a different beverage or a different hair style or a different magazine.  If attempts to communicate something different are misunderstood by communication partners, people with aphasia may “give up” and accept the status quo.  Think about how frustrating this would be for you.

AAC can be an important addition to the current means of communication for anyone who is not able to express everything he or she might want to.  It can support participation and independence in a variety of communication environments and with a variety of communication partners.