Transcript Day2.12.1.09TX

Aug
Comm
Evals
Simplified
(ACES) Tools & Resources
Using your toolkit
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Goal
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Learn the ACES module to assist in
your evaluation process
To define and finish your toolkit list
To learn more web-based resources
Your local reps and the ways they
assist
To leave with “next steps” for the
cases you came with
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Agenda
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Evaluation Examples: 3 types of
communicators
Work through your individuals with complex
communication needs (CCN)
– Use the ACES module and Evaluation Toolkit
– Feature matching
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AAC equipment
– Communication evaluation tools
– Website resources
– Meet your vendors
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Your turn
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Do case histories –
Yours & in group
– ACES module
Tools used
 Communicator skills
 Device features
 Next steps . . .
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Lunchtime – trial toolkits
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What was one idea yesterday that you
will implement?
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Evaluation software
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Tobii Communicator
Homepage
Choose 1 from each category
Try spelling
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Evaluation Examples
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3 types of communicators –who is yours?
– Emerging
– Context – dependent / situation dependent
– Independent
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What you will need:
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Emerging
No RELIABLE means of EXPRESSIVE
communication through SYMBOLIC language
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Have some functional non-verbal
communication (gestures, vocalizations,
other nonsymbolic communication)
Able to attend, even briefly, to individuals,
conversations, pictures, or symbols
Yes/no (acceptance/rejection) depicted with
body language; i.e. no reliable yes/no for
more complex communication
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Case history for LM;
Pertinent background
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Age: 4 years old
Diagnosis: Seizure disorder
Communication Diagnosis: Dysarthria
School setting: Attends university
preschool
Previous evaluation by AT team / school
– Did not address communication
components; recommendations for AT good
– other info wanted to expand on:
What doing? How doing it?
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LM continued
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Mother very involved – attend
workshop w/ team
Previous program set up for school;
several things tried at home
Reason for evaluation: mother wants
support for home program – and
wants to coordinate with school.
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Observations:
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Limited interests
Short attention span for most activities
Very active – did not sit for long
Needed constant attention for safety
due to balance
Mother felt she was a distraction - not
wanting to be there
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Toys mother brought (books with sound, IPOD)
Objects – monkey; ball, bubbles, etc.
Switch - Switch interface – toy
Single Message communicator
Computer (with touchscreen) w/ RJ Cooper Software
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Level: Emerging
Vision: not sure
Hearing: normal
Current
communication: facial,
body language,
vocalizations, some
eye contact, sign more
/ all done
(approximations)
Fine motor: gross
imitations of signs
Gross motor: poor
balance, constantly
moving
Switch access: best
with no wires
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Observations
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Use of objects recommended:
Starting to use; tried “monkey” for song
Cause – effect with toys: (magic frog / bubble machine)
– Played with switch cables – needed to cover up (wireless would
be better and attach switch to table)
– Reached for toy – needed to keep toy out of reach
– Not much attention
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Voice output – single message communicator – no
interest
Computer program / using CE software with
touchwindow
– Limited attention
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Chart – not appropriate
Instead use Communication Matrix –
Likes / Dislikes checklist
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Communication Matrix
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University of Washington
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likes_and_dislikes_checklist.doc
A checklist can be helpful when
searching for initial likes and dislikes
for an individual with "emerging"
communication skills.
Searches auditory, visual, kinesthetic,
tactile, tastes, textures, smells, etc.
Copyright (2002) Patricia Dowden, Ph.D., CCC-Sp; UW Speech & Hearing
Sciences
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Goals:
Communication Functions
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Make request – use objects
Make choices – touch; choice of 2
Continue – more; touch object
Stop – all done
Protest/reject – push away; head shake
Help – approach person; hand something to
person
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Questions? ? ?
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Case Study #2 - DZ
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Age 7
Diagnosis: Down’s Syndrome: Autistic
Communication Diagnosis: Dyspraxia
Reason for referral: Mother and SLP felt like he
could benefit from use of voice output; felt he
was “ready” due to new interest in computer
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Context- or PartnerDependent
Has SYMBOLIC communication that is RELIABLE but
limited to particular CONTEXTS or PARTNERS
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Rely on partners to provide limited response set
Need frequent instruction and cueing
Difficulty with initiation
May only be functional in particular settings
Wide range with regard to # of partners and # of
settings
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Pertinent Background
Info:
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Home schooled
Receiving private speech therapy
Previously tried verbal, gestures,
signs, PECS – not successful
Interest in computer; was using
computer and had started accessing it
with a mouse.
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Observations:
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Limited interests
Short attention span for most activities
Had cloth he carried much of the time
Brought items to session (his CD)
Limited communication functions
(currently completing Communication
Matrix & Likes / Dislikes form)
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Tools used
Single Switch – Switch Latch Timer – Battery operated toy (bubbles)
Single message communicator
Go Talk 4+ - 9+ - 20+
Computer with his software, RJ Cooper software, and communication
software (navigating pages)
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Observations
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Demonstrated ability to operate switch
(bubble machine). Used with switch latch
timer
Tried voice output devices (Go Talks)
Computer program / access: Moved mouse
to drag object from bottom of screen to
picture above it (example bone up to dog)
Enjoyed voice output – when paired with
high interest activity
Was very purposeful and accurate almost
immediately
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Video - DZ
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Level: Contextdependent
Vision: glasses
Hearing: normal
Current
communication: facial,
body language,
vocalizations, reach ,
some eye contact
Fine motor: use single
finger; tap
Gross motor: very
ambulatory
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Symbols
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Used 2 symbols: ball and computer
on 4 pictures device (Go Talk)
2” size (color with background
colored)
Progressed to 1” pictures on
20+ Go Talk
1” size (color with white background)
Concrete (ball) and abstract (more)
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Language representation
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Single meaning pictures
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Navigation page changes
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One page per situation
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Facilitator change
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Keyboard – not at this time
Voice / speech – digitized; high
interest – easier to understand
Type of device – digitized static
display; (Ruled out dynamic display:
lack of vocabulary needs; durability)
Device functions - NA
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Rate enhancement
- NA
Message formulation – single
message – or combine words into
routine phrase
Message display - NA
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Device types tried
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Static display (Go Talks)
– 9+ (2 inch); 20+ (1 inch)
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Dynamic display
– Not as easy to see; short visual attention
– Knocked on the floor
– Too sensitive; touched multiple places at
one time
– Could be used as
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Symbols: Pictures; digital
photos – people
Language representation:
single meaning pics;
Navigation: facilitator
change; few pages
needed for vocabulary
interest – up to 10 pgs
Keyboard: NA
Voice/speech: digitized
Type of device: digitized
Device functions: NA
Rate enhancement: NA
Message formulation:
single key messages38
Message display: NA
Other Factors
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Functions – WHY are they
communicating?
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X Attend to environment/others
X Express wants/needs
X Make requests / choices
X Continue/stop
X Request attention / help
X Protest
X Greet
Answer / ask questions
Direct actions of others
Initiate – maintain – end conversation
Make comments
Relate personal experiences/events
Repair communication breakdowns
Express novel thoughts / ideas
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Places – where are they
communicating?
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Home
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Communication partners
– who are they
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Mom
Dad (occasionally)
Speech therapist
Siblings
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Researching devices
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aacTechConnect.com
Free resources
– Simpler digitized
– Digitized
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aacTechConnect.com – possibilities
simpler digitized devices
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Digitized devices to consider
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Device Assistant Searchpick the symbols to use
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Helps you decide on type of device
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Answer the questions about features
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www.aacTechConnect.com
* Review simpler digitized devices
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Decision-making
Funding
Devices to consider
Trialing devices
Recommendations
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Accessories sheet (on CD)
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Report template (on CD)
the Communicator
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The Communicator –
Other Factors
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Decision-making
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Device decision-making
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SDT video SDT
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Other examples YG
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Used to promote verbal speech
– Severely apraxic 9 year old, bilinguqal girl
– Very little verbal speech – choose not to
speak
– Teach to imitate words as she selects themincluding sentences (highlighting)
– Helps to facilitate syntax
– Used to clarify speech
– Increases confidence and use of verbal
speech
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YG video
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Independent
(Generative)
Can communicate ANYTHING on ANY TOPIC
to ANYONE in ANY CONTEXT
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Locate, select, and convey messages on
their own
Can interact with familiar / unfamiliar
partners equally well
Can sequence symbols or letters to generate
novel messages
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Case Study #3 - MS
Independent communicator
 ALS
 Computer literate
 Current condition
 Verbal speech minimally adequate in a few
situations; changing quickly
 Physical access – severely limited- in
wheelchair – and unable to use hands on
keyboard / mouse
 Very computer literate – used to communicate
by email
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Toolkit
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Access
– Headpointing - fatigues
– Eye gaze – good
– Scanning – single / double switch – could do- much
slower
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Language Representation method
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Spelling
Word-based
Pre-stored messages
Conversation facilitation
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Free software (no voice)
– Point-N-Click
– Click-N-Type
– Etriloquist
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Word +
– EZ keys – rental (with voice)
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Outcome
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Trialed various systems – decided on Tobii
ATI (recommended by other therapist)
Not used for while
Not working – problems and no local
support
Insurance provided first system
Added Medicaid – should pick it up
Continued use of computer for written
communication (offered)
MDA funding
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2nd evaluation requested
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Called vendors
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3 in area
Patient request for 1
Short timeline too provide trials for all
EyeMax worked immediately
Company agreed to provide loaner during
funding process
– Waiting – using device independently with
grammar based text-boards
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TM
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27 year old autistic boy
Very good on internet browsing (Google King)
Need device for community
Previous evaluation-recommendations
Use of several communication systems (low &
high tech)
– WordPower – home use – slow down words – pace
himself
– Calendar – for all
– Device – for additional
spelling/conversation/community interactions
– Spelling system – character prediction – use of word68
prediction
TM - continued
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Program own device- Say It Sam
Communicator by Words +
– I will repeat the steps AFTER he does
them (100% proficient)
– Select his own vocabulary
– Where he wants to program it
– Chooses pictures
– Do not give him access all of the time
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TM video
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SR
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First met – device down – with
keyguard
Increase access by putting device up
improve access by 50%
Found software to replace keyguard
Highlights as she moves over it – used
to use screen to stabilize – now access
has improved
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SR video
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Questions? ? ?
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Your turn
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Decide on groups
- Emerging communicators
– Context – depending communicator
– Independent communicator
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Decide on 1 person the group will
focus on
Get out your worksheets:
Communicator / Device / Toolkit
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Pertinent Background Info
Age:
 Diagnosis
 Medical concerns
 Educational /residential setting:
 Behavioral (attention, continue/end
situation/activity; help, express desires/
needs, etc.)
 Other
Reason for evaluation:
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Communicator
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Device
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Other factors
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Functions – WHY are they
communicating?
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Attend to environment/others
Express wants/needs
Make requests / choices
Continue/stop
Request attention / help
Protest
Greet
Answer / ask questions
Direct actions of others
Initiate – maintain – end conversation
Make comments
Relate personal experiences/events
Repair communication breakdowns
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Other factors
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Where
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With whom?
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Device Selection Options
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Catalogues
– AAC TechConnect – contact
manufacturers
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Manufacturer websites
– Go to individual ones – AAC TechConnect
has list
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AAC TechConnect – free resources
– Pictures (thumbnails of 85+ devices)
– Free flyers
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Lite Tech Low Cost Chart
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Trialing equipment
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Vendors – local resources
Manufacturers
Loan equipment
Rental options
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Manufacturers Reps
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Companies:
– DynaVox Mayer-Johnson
– PRC
– Tobii ATI
– Saltillo
– Tellus
– Words +
– Zygo
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Funding
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www.aacfundinghelp.com
3rd party medical funding (Medicaid,
Medicare, Private Insurance)
Medicaid Available
Educational or Vocational
or Independent living
Private pay or donations
(Used equipment)
Work with your local device
representatives
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www.aacfundinghelp.com
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Explore programming of
the device
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Try the actual programming – see how
it feels
Communication partners need to feel
comfortable with the programming
Sales representatives can assist
Ask what support options include
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Accessories (list on CD)
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Carry bags
Keyguards
Access hardware (switches/head controlled
device, joystick, etc.)
Mounting systems/componants
Extra power (if required)
Internet/computer access
(hardware/software)
Environmental controls
Software to make overlays (for digitized
devices)
Others?
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Completing the
paperwork (on CD)
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Gather – Case History
Summarize – Assessment Summary
Write report - Report
Get quote / info from manufacturer
Complete funding paperwork (packets
from each company)
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Free templates
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CD
www.aac-rerc.org
Report Coach: aacfundinghelp.com
Dynavox – Funding Manager
Prentke-Romich: Funding Submission
Assistant
Templates on www.aactechconnect.com
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Questions? ? ?
Features
Access methods
Hands-on
Programming
Funding
Support
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Do you . . .
Have some new strategies
to try?
Have some things in your
closet you will dig out for
use?
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Our goals were . . .
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Explain the process of obtaining an AAC tool/device
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Describe tools/techniques used to determine the AAC
candidate’s skills
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Complete many of the components with templates
provided for gathering, compiling and reporting the
results.
Identify components on AAC devices such as common
features and categories of devices (i.e. dynamic display,
digitized, integrated, etc.)
Identify local resources and consultants for trials,
support, and funding assistance for AAC devices.
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Review your goals
How did we do?
Place a check mark by the ones you
accomplished.
What else to include next time? ? ?
 Please complete survey – we make changes
based on your input
 Testimonials – greatly appreciated and will
be posted on website
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THANK YOU
for helping others
get their voice
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www.aacTechConnect.com
866.4U.AAC.RX
[email protected]
www.aacTechConnect.com
866.4U.AAC.RX ( 866.482.2279)
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