DYNAMIC AAC EVALUATION PROTOCOL – ADULT Acquired or Progressive Step I: Initial Client Information Personal Information Name of Person: Place of Residence: Address: Email: Date of Birth: Primary Medical Diagnosis: ICD-10 Code: Speech/Language Diagnosis: ICD-10 Code: Date of Onset/Referral: Home Telephone: Cell Phone: Advocate/Guardian: Address: Telephone: Cell Phone: Fax: Email: Physician Name: Physician Phone: Physician Fax: NPI #: Date of last visit: Address: Insurance Carrier: Insurance ID #: Insurance Sponsor: Medicaid #: Medicare #: Insurance Phone #: Assessment Information Date(s) of Evaluation Sessions: Evaluation Site(s): Evaluation Team Members and Roles: This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Gender: Pre-Assessment Activities Review the pre-assessment information prior to any formal on-site assessment activities. Pre-Assessment Form Sent Sent To: Address: pediatric | adult congenital | adult acquired Date Sent: Date Received Back: Additional Information Received: Telephone: speech therapy report occupational therapy physical therapy report educational report/IEP/support plan video/photographs other Assessment Interview Conduct an interview with available family/caregivers to confirm and/or clarify information from the pre-assessment form. Include the person who needs AAC. Complete any additional protocols, as needed. Record the interview. Confirm medical information: Confirm perceptual information: o hearing: o vision: o tactile/proprioceptive/motor: o information processing: Record current medications: Confirm history of speech therapy intervention: Confirm history of AAC system use: Confirm current status of AAC system use: AAC Needs Assessment (attach form): Additional protocols used: o o o o o o o o Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners. (Blackstone & Berg, Attainment Company) Aphasia Needs Assessment (Garrett and Beukelman) - attach Scanning/Visual Field/Print Size/Attention Screening Task (Garrett and Lasker) Multi-Modal Communication Screening Task for Persons with Aphasia (Garrett and Lasker) AAC-Aphasia Categories of Communicators Checklist (Garrett and Lasker) Quality of Communication Life Scale (Paul et al) Other: Other: This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Step II: Sensory and Motor Report (Pre-Assessment, Caregiver) Informal Assessment Formal Assessment Perceptual Skills for Use of an AAC System Vision Unaided and functional for AAC use Corrected (glasses/contacts) and functional for AAC use Functional use of AAC system required vision accommodations (check necessary accommodations) Concerns regarding functional visual processing (cortical visual skills) in absence of acuity difficulty Vision Accommodations Increased symbol size Auditory feedback Decreased visual clutter Increased font size Color Contrast Familiar Photographs Animation Positioned at: Other: Hearing Unaided and functional for AAC use Hearing Accommodations Increased volume Visual cues (display of message, highlight on activation) Headphones Dual display for communication Other: Hearing Aids L R Bilateral and functional for AAC use Modifications needs (with/without hearing aids) Motor Skills for Access of an AAC System 1. Positioning for Access Is the person appropriately positioned in his/her wheelchair (or regular/special chair) for maximum function to access an AAC system? NA | yes | no If NO, need to consult an expert in positioning (PT or OT) 2. Hand Use Control: Complete Functional Movement: Partial No Complete Partial No This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com 3. Head Use Control: Complete Functional Movement: Partial No Complete Partial No Motor Skills for Transportation of an AAC System 1. Current Means of Mobility (check): Walks independently Walks with assistances/aides Cane Quad cane Walker Manual wheelchair ( self-propelled or partner-dependent) Power wheelchair ( joystick head array sip and puff switch) *Is purchase of a power wheelchair anticipated in the near future? Yes | No Scooter 2. Anticipated Transportation of an AAC System Self-carried | Carried by others | Mounted on wheelchair | Attached to walker 3. If Self-Carry: Have the person self-carry various AAC systems and observe balance, strength, and mobility in transporting the system. Manual communication board | Tablet-iPad | Dedicated SGD | Computer 4. If mounting on a wheelchair: a. Brand of wheelchair: b. Tube width/size: c. Lap tray size: Step III: Speech and Language Status Report (Pre-Assessment, Caregiver) Informal Assessment Formal Assessment Formal Tests Administered and Results: This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Speech Intelligibility: _____ Non-speaking _____% intelligible with familiar listeners _____% intelligible with unfamiliar listeners 1. The person is aware when speech is not understood? yes | no | maybe | don’t know 2. The person is showing signs of communication frustration when depending on his/her speech to communicate? yes | no | maybe | don’t know Describe: 3. What strategies does the person use to help communication partners understand his/her speech? a. ☐ repeats b. ☐ slows down c. ☐ adds gestures/signs/pointing d. ☐ spells initial letters for misunderstood words e. ☐ uses a related word/concept f. ☐ other: Receptive Language Abilities No deficits in comprehension Subjective Comprehension Checklist Single words Phrases Sentences Conversation 1-step direction 2-step direction Multiple-step direction Yes/No questions Choice questions Wh-questions Symbols: Symbols, Photos, Line drawings, Written word(s) This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Expressive Language Abilities MCST-A Subtest Percentage Mode of of Success Communication (pic, gesture, etc) # of Attempts Successful Navigation (Y/N) Number/Type of Cues 1-symbol message Combining 2-3 Symbols Categorizing Using EnvironmentallyStored Phrases in context Storytelling Using a Descriptive Scene Sequence Story Retelling Using a Descriptive Scene Sequence Telling about Locations from a Map Spelling Overall Functions of Communication Observed/Reported: Requesting to meet wants and needs Refusing/Protesting Sharing information (specific news, labeling, responding, commenting, offering opinion (“like it”) Requesting information (“who’s that?” “what’s next?” “where?” “when are we done?”) Social etiquette (greetings, polite forms) Language Sample in Picture Description Task: This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Written Language Produces by handwriting N/A Letter Words (copying) Words (independently) Sentences Paragraphs Produces by typing N/A Letter Words (copying) Words (independently) Sentences Paragraphs Given single words (with or without symbols), produces N/A 2-3 word phrases Simple sentences Complex sentences Adaptations for Typing Standard keyboard Writing tool adapted QWERTY keyboard ABC keyboard Spelling on device Word prediction support Reading Functional Reading Comprehension Nothing Words only Sentences Paragraphs Reading Comprehension Level Intact Not intact Social & Strategic Communication Skills Communication Skill: Responds to the communication of others? Initiates communication with others? Stays on topic during conversations? Takes turns in a conversation? Attempts to repair communication breakdowns? Switches between communication strategies, as needed? Alternates message length/style based on communication partner and communication situation? YES NO Cognition Representational Skills The person understands the need and/or value of using an AAC system. immediately (describe): This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com limited, but teachable (describe): The person can use these ways to represent vocabulary: manual signs/gestures objects photographs of people, places, things pictures for words that are picture producers (e.g., house, car, apple, shoe) pictures for words that are NOT picture producers (e.g., safe, live, inside) printed letters printed words The person identifies pictures when: 1 picture means 1 thing (picture of a house = house) 1 picture means more than 1 thing (e.g., house = house, home, live, inside) 1 picture represents a semantic category (e.g., house = buildings) Learning: Demonstrated new learning during this evaluation (e.g., new techniques, devices)? yes | no Describe: Informal Assessment: Memory for tasks presented: Attention to tasks presented: within functional limits within functional limits partially limited partially limited severely limited severely limited Per Results, AAC-Aphasia Categories of Communication Checklist: Emerging Communicator Conversational Choice Communicator Transitional Communicator Stored Message Communicator Generative Communicator Specific Needs Communicator This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Quality of Communication Life Scale Score: _____________ Step IV: Current Communication Needs Environments: Check all the client participates in Home/Residence School Work Medical Facility Face-to-Face Telephone Community Support Group Other: Other: Partners: Check all partners with whom client interacts Immediate Family Extended Family Friends Peers Teachers Residential Staff Medical professionals Home health assistants/caregiver Individuals in community Other: Other: Other: Topics: Check all topics about which the client needs to communicate Activities of Daily Living (ADLs) Medical Needs Medical/Personal/Legal Decision-making Emergency needs/information Personal needs Personal information Other: Functions: Ask questions Respond to questions Social interaction (family and community) Social etiquette Resolve/prevent communication breakdowns Other: Summary and Prognosis: Choose one of the following This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Daily functional communication needs cannot be met using natural speech or lowtech/no-tech augmentative communication techniques OR Improvements in the quantity and intelligibility of client’s speech are unlikely, possible, expected at this time. At this time, verbal skills do not allow him/her to meet all of his/her daily communication needs nor do they allow him/her to continue to develop/ regain age-appropriate language skills. OR Client has a degenerative condition for which tradition speech/language therapy is not effective. His/her natural speech does not allow him/her to meet the majority of his/her daily communication needs. From Funding Manager, Tobii-Dynavox Prognosis for functional use of an augmentative communication system: Excellent Good Fair Step V: Hands-On Trials and Results Required Features Required features Language Message generation via spelling (language structure) Message generation via combinations of single words (language structure) Message generation via pre-stored messages (language use) Combination of message generation modes for quick communication and creation of novel messages (language use and language structure) Variety of symbols to represent words or concepts Ability to use digital photos to represent words or concepts Ability to use scenes to set the context for communication Word, character, and phrase prediction to speed rate of communication or decrease effort when spelling Other: Access Carrying case for protection while device is being transported and used This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Wheelchair mounting system for easy and safe access in all environments Desk mount for access at various tabletops Standard size keyboard for touch typing to optimize communication speed Keyboard to allow for exploration and literacy learning Keyboard to allow for spelling of novel messages Multiple keyboard layouts Adjustment of access settings (e.g. hold time, scanning speed) to best meet need Accessible via direct selection Accessible via eye gaze Accessible via mouse or mouse alternative (e.g. trackball, Head Mouse, Tracker) Accessible via joystick Accessible via one- or two- switch scanning Accessible via Morse code Accessible via multiple modes to accommodate for changes in condition over time Other: Device Characteristics Portability for use in multiple environments Durability to withstand daily use Battery power to allow for use throughout the day Voice output for communication in all environments Synthesized speech for production of novel messages Feedback (e.g. button click, message window highlight) to assist in message preparation/selection Dual display for interactions with hearing impaired individuals or in noisy environments Flexible font size and color for clearest visual presentation Flexible number and size of messages per page for optimal ease of use and comprehension Ability to save, retrieve, and edit longer files for use during story telling, speeches, and caregiver direction Other: Connections to the world Telephone access to allow for communication of emergency information Control of electronic appliances (e.g. lights, fan) for increased independence Email/texting capability for interaction with community (medical appointments, information, vocational interactions, etc) Internet accessibility for interaction with community (medical appointments, information, vocational interactions, etc) Other: This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Step VI: ASSESSMENT OF SPECIFIC EQUIPMENT AND TECHNIQUES- Use one form per device trialed (4 pgs). Fill in details, check items patient can accomplish, mark N/A for features not available on this device, and X for features not useable by this patient Device/Software/Materials: ______________________________________ Trial Specifics Length of trial: Considered but rejected without trial due to: Inability to meet required features Lack of symbols to represent language Lack of voice output Limited ability to meet comm needs Weight or size limiting portability Other: Small size not meeting physical or visual needs Trial during evaluation session: Additional info: Longer trial (>1 week) for ___________________ Techniques to elicit communication: Discussion Response to Questions Role play Functional Activity (snacks, activities, mobility) Play with motivating items (videos, toys, magazines, books) Other (describe): Care for AAC Independent System Transportation (carrying) Battery/Charger Maintenance Turn on/off Programming mods Volume Control Partner Assisted Size of Display: Hand-held (5”-7”) Extra large screen (1”) Tablet sized (10”) Size of Symbols: 2” Keyboard 1” Partner Dependent Large screen (12”) >3” This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Access Methods: (consider physical, sensory, behavioral and attention skills/needs) Direct Selection with Touch with touch enter delay, with (to decrease accidental activation or repetitive tapping) touch exit delay Keyguard Configuration: _____ # locations _____ touch indicator (thin borders between buttons) _____ keyguard (wider border between buttons) _____ touch guide (small openings, i.e. circles, with larger covered space between buttons) Movement Considerations ROM Accuracy Sufficient on Left Sufficient on Right Eye Tracking/Eye Gaze: Selection via: Blink Dwell Hold Time: _______ Seconds Zoom Highlight Border Highlight Audio Feedback Click: yes I no Calibration: both eyes left eye Sufficient Bilaterally Inversion Highlight right eye Joystick/Mouse: Selection via: Pause External Switch Fire (joystick only) Zoom Highlight Border Highlight Inversion Highlight Audio Feedback: voice selection _____________________________ Private Speaker Output Device Speaker Output at _________ volume Speed: ________________ Scanning: Scan Type: Automatic Scanning with Single Switch Single Switch with Dwell Select with _____ second hold to select 2-Switch (switch to move scan target + switch to select Scanning Cues: Zoom Highlight Border Highlight Inversion Highlight Audio Scan Cue: voice selection _____________________ Private Speaker Output Device Speaker Output at ______ volume This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Scan Pattern: Row/Column Column/Row Left/Right Left/Center/Right Six Zones Linear Top/Bottom Switches Trialed: Mechanical button style Mechanical pad style Switch Control Site on Body: Position of input (position of switch): Targeting Method Accuracy: Independent Partner Support Emerging Body Position Considerations: Access Trials: Size of buttons reliably accessed Number of buttons reliably accessed Size of screen Quadrants reliably accessed This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Cognitive Access Size of Symbols: Navigation: Keyboard 1” 2” Single page, no navigation >3” Can navigate – list pages:_____________ Navigation Support: Independent Verbal prompts Taught in context Repetition Hand over hand Visual cue- button shape, highlight Partner assisted navigation Type of symbol: Page Format: Object Grid Photograph Free form Symbol Word Spelling Scene Scan Pattern: Generative/Creative Word Based (e.g. Gateway, Word Power) Context Based (scenes or grids relating to particular settings) Activity Based (scenes or grids relating to specific activities ) Pragmatically Organized (fxn- ex: want something, greetings, something’s wrong) Quick Messages (yes/no, hi/bye, let me/you do it, more/all done, good/bad) Social and Control Messages (greetings, needs, feelings, questions) Number of symbols on page: 1 Message Unit: Word Mean 1 word Length of Utterance (MLU): Sentence 2-4 8-11 12-15 Phrase 40 60 >60 Letter 2 words 3-5 words using a carrier phrase only >3 words Ex: I want, I see, I go, I like independently combined on single page on single page with navigation to other pgs with navigation to other pgs Functions: Request Respond Social exchange Escape Comment Vocab expansion: Multiple levels Dynamic display Editing Functions: Close popup Rate: 20-30 Word prediction Delete Share info Reject Encoding Clear message Abbreviation expansion Pre-stored messages This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Trial 1: ________________________________________ Conclusion: Most appropriate device at this time Meets some needs, but will continue looking for the following reasons: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Trial 2: ________________________________________ Conclusion: Most appropriate device at this time Meets some needs, but will continue looking for the following reasons: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ Trial 3: ________________________________________ Conclusion: Most appropriate device at this time Meets some needs, but will continue looking for the following reasons: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Step VII: Post-Evaluation Recommendations and Follow-Up Planning (Summary and Recommendations) SGD AND ACCESSORIES RECOMMENDED Check recommended device and accessories: DEVICE Tobii Dynavox T7 Tobii Dynavox I-15 Saltillo NovaChat 8 Tobii Dynavox T10 Prentke Romich Accent 800 Saltillo NovaChat 10 Tobii Dynavox T15 Prentke Romich Accent 1000 Saltillo NovaChat 15 Tobii Dynavox I-12 Prentke Romich Accent 1200 Other: Tobii Dynavox Compass TalkRocketGo MyTalkTools Lingraphica SmallTalk Proloquo2Go VoisPal Scene Speak TouchChat SonoFlex Scene & Heard Image2talk Other: TABLET APPLICATIONS: TABLET APPLICATIONS (Picture-based): Pictello All About Me Storybook Talk’n Photos This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com SWITCH Mechanical Button Big Button Microlight Plate Switch Cap Switch Cup Switch Mini Cup Square Pad Pillow Trigger Switch Switch Joystick with Push Mini Joystick SCATIR Other: ACCESS ACCESSORY Extra Charger Head Mouse Tracker Headpointer Eye Gaze Camera:____________________ Keyguard/guide:______________________ Other: MOUNTING AND PORTABILITY Switch mount:_______________________ Tubing size:________________________” Other mounting placement:____________ Mount Brand:_______________________ SGD Mount:________________________ Tubing Size:________________________” Other mounting placement:____________ Mount Brand:_______________________ Standard Carrying Care Accessible Carrying Case Durable Carrying Case This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Treatment Plan and Follow Up INTERVENTION SCHEDULE Recommended Follow-Up: Consultation as Needed Limited number of follow-up treatment sessions after receipt of device: _____(#) Ongoing therapy with ______ minutes per session; ______ # of sessions per week Individual therapy recommended Group treatment recommended If follow up services are not available, a high tech speech-generating device is not recommended TREATMENT GOALS: Goals should be completed to determine areas of strength and need. Partners should be consulted regarding priority goals targeting increasing function and independence. This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com PATIENT/FAMILY SUPPORT OF SGD Responsible Parties Patient Family Caregiver (Name) __________ Manufacturer Therapist Rep (Name) (Name) ___________ __________ Therapy to address goals Initial Training Initial Customization (programming, vocab selection, intervention planning) Ongoing Training and Modification Maintenance of Device Warranty Maintenance Management NECESSARY FUNDING PAPERWORK Check when obtained Date Medicaid/Insurance Cards Copied Benefits Assignment Signed by Caregiver/Consumer Doctor’s Prescription AAC Evaluation Written Quote from Manufacturer This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com Other (Name) _________ Resources/References Consulted: "AAC Report Coach - AACFundingHelp." AAC Report Coach - AACFundingHelp. N.p., n.d. Web. 07 Sept. 2015. <http://aacfundinghelp.com/report_coach.html>. “Augmentative Communication Evaluation Summary,” Georgia Project for Assistive Technology, forms accessed on-line at http://www.atstar.org/docspdfs/gpat/AAC_Evaluation_Protocol.pdf Clarke, Vicki and Holly Schneider. “Dynamic AAC Goals Grid-2” Published by Tobii Dynavox on-line. 2015. Accessed at http://www.mydynavox.com/Content/resources/slpapp/Goals-Goals-Goals/the-dynamic- aac-goals-grid-2-dagg-2.pdf. The Funding Manager software, copyright 2008, Dynavox Technologies, Pittsburgh, PA This document has been adapted with written permission from: Gail Van Tatenhove, AAC Assessment.docx, 1998, updated 2000, 2013. www.vantatenhove.com and Vicki Clarke, Dynamic AAC Evaluation Protocol, 2015. www.mydynamictherapy.com