AAC- Yikes!
You Want Me
To Do What?
June Maranville MSP, CCC-SLP
Palmetto Language & Speech Center, LLC
Email: plsc@plsclex.com
Website: www.plsclex.com
I don’t even know what I don’t
know
“The only disability in life is a bad attitude.” Scott Hamilton
ALL Individuals Can and Do
Communicate!
-National Joint Commission for the Communication Needs of Persons with
Severe Disabilities. (1992)
“If all my possessions were taken from me
with one exception, I would choose to keep
the power of communication, for by it I
would soon regain all the rest”
-Daniel Webster
We’ve come a long way, baby.
Who remembers…
O Cut and paste pictures from notebooks
O Hand coloring each picture
O Glue with no Velcro!
O No Boardmaker
O Contact paper instead of lamination
O Heavy-bulky systems that took weeks to
program
Present Day
Where are we now?
O Boardmaker
O Lamination
O Velcro
O Over 200 Apps for high-tech devices
O AAC App Comparison Chart (SCATP)
O http://www.sc.edu/scatp/apps.html
O Light weight, durable, intuitive systems
What has not changed?
O As professionals, practice due diligence
O
O
O
O
when choosing AAC for client.
Team Approach
Client and caregiver as active participants
Best fit- low/medium/high tech
Feature matching
O a process that involves matching the skills of
the AAC user with the features of the given
AAC systems.
What is Augmentative and
Alternative Communication
(AAC)?
O “AAC involves attempts to study and when necessary
compensate for, temporarily or permanently, the
impairments, activity limitations, and participation
restrictions of individuals with severe disorders of speechlanguage production and/or comprehension. These may
include spoken and written modes of communication.”
(ASHA 2005)
AAC is the bridge that enables children with
severe communication difficulties to learn
higher-level language skills and to interact
with individuals outside the family.
~ Page and Quattlebaum (2012)
Handbook of Children with Special Healthcare Needs
The Goal of AAC
O Empower AAC user to
O express wants and needs
O exchange information
O develop social closeness with others
O engage in social etiquette routines.
O MULTIMODAL approach most effective in order to be
able to communicate for different purposes in a
variety of contexts. (ASHA, 1991)
Multimodal Communication
O Objects
O Signs
O Gestures
O Facial Expressions
O Pictures
O Speech
O Nurture residual speech
O Written Word
O Symbols
O Voice output devices
Feature Matching
O Which system is the best match to fit user’s
abilities, needs and skills?
O Dx does not determine need for specific device
O Consider:
O Current Skill Level
O ADLs and associated wants/needs
O Current Communication system/strategies
O Future Communication needs
O System growth with development and skills
O Degenerative/Deteriorating skills
Feature Matching Cont.
O Objective / Feature / Selection Criteria
O Shared symbol system
O Development of language system
O Construction of messages to interact with others
O Meaningful Vocabulary
O http://aac.unl.edu/vocabulary.html
O Access to communication symbols
O Access to communication device
~Page and Quattlebaum (2012)
Handbook of Children with Special Health Care Needs
Is it a good fit?
Would you ever get the gift box before you purchased the gift?
~ Dr. Carol Page
O No! ~ Let’s not do it with AAC either.
O
O
Evade “flavor of the month” devices based on marketing,
promotion and popularity.
O
AbleData: AAC products and features
http://www.abledata.com/abledata.cfm?pageid=19327&ksectionid=19327
Why Assess?
O Will use of AAC…
O Maximize client’s abilities and decrease
challenges of disabilities
O Help improve condition or prevent from getting
worse.
O Help person function in their environment
O Help improve independence
O How will team find the best fit?
O Is a formal assessment needed and required by
funding source?
O Is use of AAC a medical necessity?
Medical Necessity
O Medicare defines as
O “Service or supplies that are needed for the diagnosis
or treatment of medical condition and must meet best
practice standards.”
O Buzz words
O Correct deficits
O Ameliorate deficits - to make better or tolerable
O Palliate- to make less severe or unpleasant without
removing the cause.
O Letter of medical necessity and physician order with high-
tech AAC purchases
Who can assess formally?
O Licensed and credentialed in related field
O PT, OT, SLP, Rehab Engineer
O AT specialization certification
O Other Team members—as warranted
O Vision specialist
O Nurse
O Psychologist
O Educators
O Hearing specialist
Who pays for AAC?
Funding sources consider AAC dedicated communication devices
O Private Pay
O Babynet (0-3)
O IFSP Team, parents and professionals
O Schools (3-21) FAPE
O Private insurance- appeal if denied
O CRS
O Medicaid
O Medicare
O VA
O Vocational Rehab
O Community
O Service organizations
O Church and local charities
Who really pays for AAC?
We all do!
Components of Successful
Assessment
O Team Assimilation
O Medical Information
O History
O Functional Goals
O Technology that has been tried in the past
and results
O Clear communication among team members
O Trials with AAC
O Time is your best friend!
Assessment Help
O There are no standardized AT assessments.
O Ecological Inventory ~ Nalty and Quattlebaum (1998)
O Joy Zabala SETT Framework
O It’s not about technology or device
O It’s about matching
O The Student
O The Environment
O The Task
O The best Tool
O Communication Matrix
O Every Move Counts, Clicks and Chats
Trials with AAC
O Low-tech
O Examples:
Communication
boards, booklets.
O Can start immediately
O Boardmaker is your
friend!
O Backup system-as
needed if high-tech
device malfunctions
Trials with AAC
O Mid-tech
O Examples: BigMack, iTalk 2, Go talk series.
O Typically requires a battery to operate.
O Human voices recorded on device
Trials with AAC
O High-tech
O Examples: Dynavox, Prentke Romich,
Tobii- SGDs
O Increase vocabulary opportunities
O Digitized, synthesized speech
O iPads and Tablets
Purpose of Trials
O What works.
O What does not work.
O Show evidence of optimal fit for individual
communication need.
O System not to be used or recommended just
because only one tried, most popular, or
most promoted.
AAC Intervention
O If we’re using pictures do we call it
AAC?
O AAC vs. other types of learning
activities
Picture Identification vs.
Functional Communication
O Picture ID- END
O Receptive Skills and Knowledge
O Touch the “____”
O Teaching Format-Get response
O Match, sort, reinforce
O Academic Achievement
Picture Identification vs.
Functional Communication
O Functional AAC Communication- MEANS to
END
O Demonstrates desire to engage with
communication partner to share wants,
needs and ideas.
O Nurtures social interactions
O Empowers
O Beyond Requesting Powerpoint
Message Sets
O Vocabulary linked to social/emotional development
O Feelings
O Decrease behavioral problems with appropriate
vocabulary selection
O Vocabulary Selection
O Provides means to interact
O Motivating vocabulary imperative
O Consider user’s interest first
O Variety of word types
Core Vocabulary
http://aac.unl.edu/vocabulary.html
Typical Peer 5-minute Conversation Sample
More than Nouns
Rich language experiences
Increase message set expansion
Generalizes across communication settings
Teaches rules of Syntax
Language to Literacy Expansion
O juice, want juice, no juice, more juice, write or
type juice –Page and Quattlebaum 2012
O Quick Hits/Urgent messages
O One Icon to represent message
O
O
O
O
O
O
O
O Example: “I need help” “I feel sick”
Prognostic Indicators
O
Extrinsic Factors
O
O
O
O
O
O
O
O
O
Skin in the game
Buy into use
Switch gears from basic needs to anticipating needs
Co-treating
Chain of cues
Model, model, model!
Enable vs. Empower
15x per day
Intrinsic Factors
O
O
O
Knowledge is power
User grasps that power is in communication
Motivation
O
O
Active participant
Engage 15x per day using AAC device
O
O
Example: Music variety
Present and Possible Changes
O
O
O
O
Medical condition status
Plan implement ahead of time
Monitor and adjust to assess wants/needs
Dynamic and ever-changing process
O
~ Page and Quattlebaum (2012)
Parent/Caregiver Roles
O Active participants
O Ongoing programming
O Vocabulary selection
O Facilitate carryover of device to all settings
O Model use of device with motivating activity for user
O Troubleshoot problems
O Recognize when message sets changes needed
O Attend training
Carryover
O Functional
O Motivating
O Means-End
O Efficient
O Effective
O Interactive
O All Environments
O At least 15 opportunities per day
O Update AAC system when change occurs
O Transition Strategies for Adolescents and Young
Adults Who Use AAC
Resources
O SC Assistive Technology Program
O Apps that make life easier
O Apps comparison chart.
O SC Equipment Distribution Program
O SC Vocational Rehabilitation
Resources Cont.
O CRS- Children's Rehab Services
O SCATP- Device Loan Program
O SC Independent Living Program
O CDR- Centers for Disabilities Resource Library
O Loaner programs through vendors.
O Key Technologies
O Dynavox
O Tobii
O Prentke Romich
Prize Time!
Q and A
Wrap it Up!
When you know better, you do better
~ Maya Angelou
O Use the resources
O Celebrate great resources in your backyard
O Don’t be afraid to ask for help
O Enjoy the journey and be inspired!
O Heart of the Ravens! Superbowl 2013 Champs!
O http://espn.go.com/video/clip?id=8815080
Bibliography
Works Cited
AAC and Speech Devices from PRC. N.p., n.d. Web. <http://www.prentrom.com/>.
"AAC Messaging and Vocabulary." AAC References. N.p., n.d. Web. <http://aac.unl.edu/vocabulary.html>.
"AbleData: Products." AbleData: Products. N.p., n.d. Web.
<http://www.abledata.com/abledata.cfm?pageid=19327>.
"Apps That Make Life Easier." Apps That Make Life Easier. South Carolina Assistive Technology Program, 7 Jan.
2013. Web.
ASHA. "Goal of AAC." (1991): n. pag. Print.
"Augmentative and Alternative Communication (AAC)." American Speech-Language-Hearing Association. N.p.,
2005. Web. <http://www.asha.org/public/speech/disorders/AAC/>.
"Beyond Requesting." Beyond Requesting. N.p., n.d. Web. <http://www.slideshare.net/slpwendy/beyondrequesting-presentation>.
CDR Library, School of Medicine Library, University of South Carolina. N.p., n.d. Web.
<http://uscm.med.sc.edu/cdr/>.
"Communication Assessment for Parents & Professionals." Communication Matrix. N.p., n.d. Web.
Bibliography Cont.
DynaVox: Communication Devices – Speech Devices. N.p., n.d. Web. <http://www.dynavoxtech.com/>.
"EMC, Inc. Home." EMC, Inc. Home. N.p., n.d. Web. <http://www.everymovecounts.net/>.
ESPN. ESPN Internet Ventures, n.d. Web. <http://espn.go.com/video/clip?id=8815080>.
"Independent Living." South Carolina Department of Social Services. N.p., n.d. Web.
<http://www.state.sc.us/dss/independent/index.html>.
Key Techonologies. N.p., n.d. Web. <http://www.gokeytech.com/>.
Nalty, L., and P. Quattlebaum. "A Practical Guide to Augmentative and Alternative Communication:
Assessment and Intervention Strategies." Greenville:Super Duper (1998): n. pag. Abstract. Severe
Communication Disorders (2012): 32. Print.
National Joint Commission for the Communication Needs of Persons with Severe Disabilities. Guide-lines for
Meeting the Communication Needs of Persons with Severe Disabilities (1992): n. pag. Print.
Page, C. A., and P. D. Quattlebaum. "Severe Communication Disorders." Ed. D. Hollar. Handbook of Children
with Special Health Care Needs (2012): 23-46. Print.
Bibliography Cont.
SCATP Device Loan Program. N.p., n.d. Web. <http://www.sc.edu/scatp/loan.htm>.
"SCATP." South Carolina Assistive Technology Program (SCATP). N.p., n.d. Web. <http://www.sc.edu/scatp/>.
"Sharing the SETT Framework." Joy Zabala SETT Framework. N.p., 2005. Web.
South Carolina Department of Health and Environmental Control. N.p., n.d. Web.
<http://www.scdhec.gov/health/region5/crs.htm>.
"South Carolina Equipment Distribution Program." SCEDP. N.p., n.d. Web. <http://www.scedp.org/>.
South Carolina Vocational Rehabilitation Department (SCVRD). N.p., n.d. Web.
<http://scvrd.net/common/index.php>.
Tobii Technology Global. N.p., n.d. Web. <http://www.tobii.com/>.
"Transition Strategies for Adolescents and Young Adults Who Use AAC." ASHA Online Store Details. N.p., n.d. Web.
<http://www.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsdetails>.