Transcript Chapter 15: Complex Communication Needs and AAC

Chapter 15:
Complex Communication
Needs and AAC
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.1
Focus Questions
•
•
•
•
What are complex communication needs?
What is AAC?
How is AAC classified?
What are the defining characteristics of
common causes of complex
communication needs?
• How are complex communication needs
and AAC systems identified?
• How are complex communication needs
treated with AAC?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.2
Introduction
• Complex communication needs result from
significant speech, language, and/or
cognitive impairments
• The individual can no longer communicate
in conventional ways
• Area of clinical practice that supports and
meets these needs is augmentative and
alternative communication (AAC)
• Use symbols, aids, strategies, and
techniques to improve success and
effectiveness of communication
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.3
Case Study #1: Sara
• 3-year old born at 30 weeks, diagnosed with
atethoid cerebral palsy, severe dysarthria, and a
mild-moderate receptive and expressive
language delay
• No formal symbolic means of communicating at
this time; only communicates with close family
and teacher
• Significant motor impairment but can sometimes
point her index finger
• Mother worries that Sara and her twin sister
Susan will not be able to play together if she
cannot find some help
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.4
Case Study #1 Questions
• What valuable information could the AAC
team learn from Sara’s twin sister, Susan,
during an AAC assessment?
• From the information that is provided, what
type of communicator (emerging, contextdependent, independent) is Sara now?
How do you know?
• What questions do you have about Sara’s
communication abilities?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.5
Case Study #2: Jan
• 14-year old eighth grader with moderate
intellectual disability and moderate speech,
language, and cognitive delay
• Communicates with gestures, speech, and a
communication book
• Difficulty communicating with unfamiliar partners
at school and in community
• Expressed interest in joining the bowling club at
school, but mother is concerned she will not be
able to communicate with the new people
• School SLP referred Jan to school district’s
assistive technology team for comprehensive
AAC assessment
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.6
Case Study #2 Questions
• What benefits might Jan see if she
participates in a comprehensive AAC
assessment?
• What type of communicator (emerging,
context-dependent, independent) is Jan
now? What if she had access to an AAC
system with training?
• What barriers might prevent Jan from
participating in bowling or other activities
at school?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.7
Case Study #3: Steve
• 28-year old suffered from brain stem stroke 3
years ago resulting in a locked-in syndrome
– profound dysarthria with no speech output
• Communicates with eye gaze, eye gaze board,
head pointer, and dependent scanning on
alphabet board
• Interested in getting an AAC system to provide
more independence
• Currently managing his auto repair garage and
attending college majoring in computer
information systems
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.8
Case Study #3 Questions
• How might Steve’s previous hobby interest
in computers help in exploring AAC
options?
• What features would be important for
Steve to have in an AAC system?
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.9
I. What are Complex
Communication Needs?
• When individuals cannot meet their daily
communication needs through the current
method of communication
• Result from variety of physical, sensory,
and environmental causes which restrict
independent functioning in society
• Needs can occur in all forms of
communication, in any environment, and
with a variety of communication partners
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.10
Purposes of Communication
•
•
•
•
Fulfill needs and wants
Information transfer
Social closeness
Social etiquette
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.11
Terminology
• International Society of Augmentative and
Alternative Communication (ISAAC)
• Previous terms: severe communication
disorders or severe communication
impairments
• Currently preferred term:
– complex communication needs
– focus on identifying what is important for each
person to meet his/her own goals of
communication
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.12
Prevalence and Incidence
• 8 to 12 out of every 1000 Americans are
unable to meet their communication needs
• Approximately 2 million people currently
have complex communication needs
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.13
II. What is AAC?
• Set of procedures and processes by which
an individual’s communication skills can
be maximized for functional and effective
communication
• Also refers to the field or area of clinical,
educational, and research practice
• Can either be augmentative or provide an
alternative method of communication
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.14
III. How is AAC Classified?
• AAC system is an integrated group of
components consisting of four elements:
• Symbol
• Aid
• Strategy
• Technique
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.15
A. Symbol
• Something that stands for or represents
something else
• Four types:
– Acoustic: sounds or tones
• Morse code
– Graphic: printed symbols usually in paper,
boards, and/or computer screens
• BoardmakerTM
– Manual: produced using the body
• Gestures, signs
– Tactile: physically manipulated objects
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.16
Variations among Symbols
• Static and Dynamic:
– Static: do not require movement or change to
understand meaning
– Dynamic: require movement or change
• Iconicity and Opaqueness:
– Iconic: symbol closely resembles what it refers to
– Opaque: symbol has little resemblance to what it refers
to
• Aided and Unaided
– Aided: requires device or accessory external to one’s
body to transmit message
– Unaided: requires only body
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.17
B. Aid
• Aid: type of assistive device that
supplements or replaces natural speech
and/or writing
• Can support comprehension as well
• Can be either electronic (e.g., voice output
communication aid) or non-electronic (e.g.,
communication picture book)
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.18
C. Strategy
• Process or plan of action that is used to
improve a person’s performance when
communicating
• Examples: setting the topic before
initiating a conversation, having an index
card available for unfamiliar
communication partners
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.19
D. Technique
• An approach or method of selecting
messages or accessing messages on a
display
• Fixed vs. dynamic displays
• Direct selection techniques
• Indirect selection techniques
– Scanning
– Directed scanning
– Coded access
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.20
IV. Defining Characteristics of
Common Causes of Complex
Communication Needs
• Developmental causes (examples)
–
–
–
–
Intellectual disability
Cerebral palsy
Autism
Developmental apraxia of speech
• Acquired causes (examples)
– Traumatic head injury
– Stroke
– Degenerative diseases
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.21
V. How are Complex
Communication Needs and AAC
Systems Identified?
• The assessment team is a
multidisciplinary group of professionals
• Speech-language pathologist is usually
the “team leader”
• Assessment can take place in schools,
clinics, and hospitals
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.22
The Assessment Process
• Referral: made by anyone who can identify
unmet communication needs
• Common referral sources:
– parents
– SLPs
– teachers
– counselors
– nurses
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.23
Comprehensive Assessment
• Case history
– Determine background information
• Interview
– Gather information about communication
skills and goals
• Identification of communication needs
– Determine which needs are not being met and
if person is participating in all the same
communication activities as their same-age
peers
– Looks at presence of opportunity barriers or
access barriers
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.24
• Identification of communication skills
– Using formal and informal assessment tools,
looks at oral motor skills, hearing acuity,
receptive and expressive language skills,
speech production, and cognitive skills
• Identification of vision and motor skills
– Determine visual acuity and fine and gross
motor skills to determine what type, size, and
array of symbols may be used
• Identification of communication partners
and environments
– Circle of Friends paradigm
– Determine common communication
environments
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.25
• Identify features of AAC systems to meet
communication needs
– Determine which specific features of an AAC
system will meet identified needs
• Recommendations
– Team recommends a specific AAC system,
usually for a trial period first
• Funding
– Funding for AAC system is usually sought
through insurance companies, school
districts, private donations, or grants
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.26
VI. How are Complex
Communication Needs Treated?
• Access to treatment is a right not a
privilege
• Treatment must occur in “real-world”
contexts
• Team must work to plan a treatment that:
– Meets unmet communication needs
– Increases communicative competence
– Increases participation in society
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.27
A. Meet Unmet Communication
Needs
• Short-term treatment goals emphasize
learning how to use the AAC system
• Ongoing assessment is necessary to best
meet the needs of the individual
• Crucial to consider the cultural background
of the individual when planning treatment
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.28
B. Communication Competence
• Intrinsic and extrinsic factors impact the attainment
of communicative competence
• Three groups of communicators:
– Emerging communication: no reliable method of
symbolic expression – AAC focuses on establishing this
– Context-dependent communication: reliable symbolic
communication, but few partners and environments –
AAC focuses on maximizing independence and
increase use of AAC strategies
– Independent communication: usually literate and
effective communicators – AAC focuses on increasing
number of communication options available
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.29
Communication Partners
• Very important to a successful treatment
program
• Traits of a good communication partner:
– Patient
– Interested and comfortable with all methods of
communication
– Tries to understand impaired speech
– Makes an effort to interpret sign/gestures
– Repeats and confirms messages
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
15.30
C. Increase Participation in
Society
• Social roles: roles each person has in society
– determines demands the person using AAC will face
• Each social role has a communication role that
must be met
• AAC team must identify current and desired
social and communication roles
• Successful communication is when an individual
with complex communication needs can
participate in any aspect of society desired
Justice
Communication Sciences and Disorders: An Introduction
Copyright ©2006 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.