Transcript Best Laid Plans - University of South Carolina

The Best Laid Plans
Can Work: Selecting
the Best AAC System
Sarah Scarborough, MA, CCC-SLP
Speech and Hearing Center
University of South Carolina
Carol O’Day, PhD, CCC-SLP
South Carolina Assistive Technology Program
Center for Disability Resources
University of South Carolina School of Medicine
Training Objectives
Participants will:
identify basic components of an AAC
evaluation.
list four different types of symbol systems.
describe characteristics of functional
communication messages
Keep in mind...
The equipment, software, ideas and
examples presented today represent a
starting place and are not specific
recommendations or endorsements. The
suggested intervention techniques should
be implemented only after careful
consideration and under ongoing
consultation from a qualified SpeechLanguage Pathologist.
Alternative/Augmentative
Communication
or “Visual Supports”
a definition…
…a device or method that helps
persons with speech and/or hearing
disabilities communicate.
Use a Multimodality Approach
AAC can be used with individuals who
are verbal, limited verbally, or
nonverbal.
Teach and encourage use of many
forms of AAC.
Continue to address verbal skills, if
appropriate, as you teach AAC skills.
Prerequisites
for the Use of
AAC
NONE!
Kangas & Lloyd, 1988
Beukelman & Mirenda, 1998
AAC Assessment
Before Evaluation: Review case history/
referral.
If you are already working with the child
you can complete the case history.
If this child is new to you, then you may
want to re-think your usual case history
questions.
AAC Case History Questions…
Handedness for: ___ Writing ___Throwing ___ Eating
Method of Transportation:
Walks: ___ independently___ with assistance
Wheelchair: ____ independently ___ with assistance
Other positioning information:
___________________________________________
Adaptive equipment used or required (e.g. head rest,
switch):_______________________________________
Describe any hearing impairment:
__________________________________________
Hearing aid required? : ____ Yes ____ No
Describe any visual impairment:
____________________________________________
Corrective lenses required?: ____ Yes ____ No
More Case History Questions
List four activities that occupy the child for most of
each day.
Name the people the child communicates with each
day (e.g., friends, siblings, teachers, medical
personnel, etc).
What are the child’s ‘favorite’ treats, rewards,
activities?
What types of augmentative and alternative
communication systems have been tried by the child
in the past?
What was good about the systems?
What was bad about the systems?
Why isn’t a system being used now?
Questions to Ask
Communication Partners
TIME
ACTIVITY
INTERACTION
(Describe gestures,
sounds, speech ,
signs, or any other
signals used)
Performing the Augmentative
Communication Evaluation
Begin with a standard speech language
evaluation…
Assess language level.
Assess pragmatics.
Assess speech, oral motor, voice,
fluency.
Screen hearing.
How to Assess Language
Whenever possible use standardized
assessments…
- Boehm Test of Basic Concepts-3
• kindergarten-2nd grade
- Peabody Picture Vocabulary Test-4
• age 2.6 through 90 years
More Language Assessments
Nonspeech Test by Mary Blake Huer
FCP-R Functional Communication
Profile - Revised
by Larry I. Kleiman
Language Assessment continued
Very often tests or
subtests that
require pointing
response only
can be adapted
for use with
children with
deficits in the
areas of access.
A
B
C
D
Speech Assessments
There are several tests of speech, e.g.,
Goldman-Fristoe Test of Articulation-2 or
the Arizona Articulation Proficiency
Scale: Revised.
Some children need specialty speech
assessments, e.g., Frenchay Dysarthria
Assessment or Apraxia Profile.
Once you complete the Speech
Language evaluation,
determine the child’s best
method of symbolization…
Continuum of AAC Symbols
Continuum:
- gestures (easiest)
- signs
- objects
- objects with pictures
and words
- photos, pictures and words
- text (most difficult)
Language Activities Resource Kit
Language Activities
Resource Kit - Second
Edition (LARK-2), Pro-Ed
Richard A. Dressler.
Western Aphasia
Battery (WAB),
Ali-Med
Andrew Kertesz, M.D.
Using Pictures/Graphics to
Communicate
Test of Aided Communication Symbol
Performance (TASP) by Mayer-Johnson
- Assesses symbolic skills.
- Guides communication board design.
- Includes subtests for
symbol size and number,
grammatical encoding,
categorization and
syntactic performance.
Using Pictures/Graphics to
Communicate
EvaluWare Software helps identify the
best computer access methods and
ideal AAC setups for users with special
needs.
Motor/access skills.
Looking skills.
Listening skills.
Other related skills.
Adaptivation Object Cards
Homemade
Symbol Assessment Kit
Using Pictures/Graphics to
Communicate
Picture Master Language Software
Picture Master Board Designer
- Does not
come with
animated
files or
speech
functions.
AAC Symbols
How do you know when you have
chosen the correct AAC symbol set?
- the child is able to meet functional
communication goals.
- the child can communicate basic
wants and needs.
Why Objects Work
Concrete (low cognitive demand)
Static or permanent (low memory demand)
Iconic (close obvious relationship to referent)
Easy to manipulate
Allow tactile discrimination
Support expressive and receptive
communication
Elizabeth Rush, MA, CCC-SLP, CPM
Mary Joan McClure, MS, CCC-SLP
Why Objects May Not Work
Object identification is not communication.
Miniature objects are not understood well
by some (individuals who are visually
impaired or autistic).
Non-motivating objects used.
Difficult to find objects to represent verbs,
adjectives, modifiers, etc.
Using Objects to Communicate
May need to use the actual object at first.
Use a duplicate object (symbol) as soon as
possible.
Begin exchange system.
Mount object on board or voice output device.
Introduce second, but different object symbol
(change color, size or texture of object).
Elizabeth Rush, MA, CCC-SLP, CPM
Mary Joan McClure, MS, CCC-SLP
Using Pictures/Graphics to
Communicate
Pictures and graphics have varying levels
of iconicity.
Size, background color, and number do
matter.
Once you determine child’s
best method of symbolization
Determine how many symbols he/she
can handle at one time.
What type of layout does he/she scan/
reach best?
Does he/she prefer sound/voicing
feedback?
How best to access this system?
Switch, type, point, etc.
Back to the AAC Assessment…
Summarize Your Findings:
- Symbol Preference
- Optimal target/text size
- Optimal number of targets
(words/pictures/objects)
- Recommended layout
- Best method of access
Use the AAC assessment
summary plus your evaluation
of the child’s language/speech
skills and prognosis to
determine the best
augmentative/alternative
communication system.
Considerations:
Look at the child’s language age:
- How many words does a child of a
similar age with age appropriate
communication skills use?
18 months
According to Nicolosi and Collins,
children with language ages of 18
months have a vocabulary of 10-20
words and at 24 months their
vocabulary increases to 200 words.
2-3 years
According to Nicolosi and Collins, from
2 years to 2 ½ years expressive
vocabulary ranges from 200-300 words
and from 2 ½ to 3 years receptive
vocabulary increases from 400 words to
800 words with an expressive
vocabulary of 900 words at 3 years.
3-4 years
According to Nicolosi and Collins, from
3 to 4 years receptive vocabulary is up
to 1500 words and expressive
vocabulary ranges from 900 to 1500
words.
Call for help!
Once you have summarized the results:
- Discuss findings with your school
district’s assistive technology team or
- Contact Carol O’Day (803-935-5301,
[email protected]) to discuss the AAC
system that best meets the
cognitive/language/access needs of
your child or to borrow AAC
devices.
- Or both!
Writing the report
You’ve done the work…
Now write it up!
Elements of an AAC
Evaluation Report:
Demographic information.
Current communication impairment.
Daily communication needs.
Functional communication goals.
Rationale for device selection.
Treatment plan.
Functional benefit of upgrade (if needed).
SLP assurance of financial independence
and signature.
See this website for more details:
http://www.aac-rerc.com/pages/medicare/MCAppProtocol.htm
Basic Considerations of
AAC Devices
Size
Weight
Display size
Battery life
Access method
Does the device
meet current and future needs and
expectations?
Other Considerations…
Compare what you want for the child
with other devices/systems you decided
against.
What was best about your choice?
Making a treatment plan
Consider message selection.
Communication environments &
partners.
Message Selection
Requesting wants and needs
Making choices
Confirming or denying
Rejecting and protesting
Gaining attention
Providing greetings, farewells, social
niceties
Expressing feelings
Making comments
Asking for information or help
Telling jokes
Connecting with peers
Asking questions
Message Selection
Message Selection:
- If neurological and physical potential
for speech exists, a preference will be
shown towards speech.
- Speech is easy and highly accepted .
(Burkhart, 1993, p. 38)
- Children will tend to use the least restrictive
mode of communication.
Message Selection
Message Selection:
- Avoid starting with messages that are
abstract in nature (ie. “yes” and no”).
- Avoid programming messages that can be
gestured or spoken (ie. “yes” and “no”).
- Avoid messages regarding functions that the
child has not mastered (ie. “bathroom”).
Message Selection
Core Vocabulary:
- A few hundred words that make up
approximately 80% of what a person says.
- Dolch words (see “Unique Websites”).
- “Total communication” is the combination of
general core vocabulary and extended
vocabulary.
- Combine general core vocabulary and
personal core vocabulary for fastest
communication.
AAC Institute
Message Selection
Use single-word messages
whenever possible because they
allow for generative language and
utterance expansion.
(Anderson & Baker, 2004)
Message Selection
Why single-word messages can be
more efficient:
- Communicating using single-word messages
allows more flexibility than sentence messages.
- Generating a message using single-word messages is
easier overall than communicating through sentence
messages.
- Single-word messages can be used across
environments.
- Sentence messages rarely reflect speaker
intentionality.
- Language acquisition takes place when single-word
messages are combined to make multi-word
messages.
Message Selection
Effectively programming sentences:
- Use sentences for messages that are
used repeatedly.
- Use sentences as a complement to, not as a
replacement for, single-word messages.
May consider messages such as,
“I want to say something that’s not
on my device" or "Please ask
yes-or-no questions."
Message Selection
When should you start encouraging
generative language skills?
May not have to wait until
developmental language norms are
reached with AAC to begin teaching
generative language.
Message Selection
Change messages as your child’s
interests and wants and needs
change.
Include peer-level language.
Where Do We Start?
Start with success!
- The first level of intervention
should be the highest level of
child’s performance and then
add next small degree of
difficulty.
- The number of symbols
provided should be within skill
range.
- Include highly-motivating
messages.
Where Do We Start?
Just get started!
- You don’t need to wait for the
person to demonstrate
receptive skills to begin on
expressive skills.
Helpful Websites
www.closingthegap.com
http://www.theschoolbell.com/Links/Dolch/Dolch.html
www.Lburkhart.com and http://www.lburkhart.com/handcvi.htm
www.Do2Learn.com
www.wati.org
www.tinsnips.org
http://trainland.tripod.com/pecs.htm
http://www.ataccess.org/resources/atk12/default.html
www.aacintervention.com
www.outersound.com/cafiero
www.speakingofspeech.com
www.mayer-johnson.com
www.silverliningmm.com
www.difflearn.com
http://aac.unl.edu:16080/yaack/d5.html#d5b
http://www.learningmagicinc.com/
www.designtolearn.com
www.kidsdomain.com
www.adaptedstories.com
www.priorywoods.middlesbrough.sch.uk
www.bbc.co.uk/cbeebies/funandgames/
www.edmark.com
www.kidsmartearlylearning.org
www.literacycenter.net
www.laureatelearning.com
www.accessingenuity.com
www.ronn.com/kidstuff1.html
http://www.fctd.info/
http://www.projectparticipate.org/handouts/Tipscaregive.pdf
http://www.projectparticipate.org
http://www.sc.edu/scatp
http://www.imaginesymbols.com
http://www.freedigitalphotos.net
http://aacfundinghelp.com/funding_programs.html
http://www.aac-rerc.com/pages/medicare/MCAppProtocol.htm
http://letsplay.buffalo.edu/index.html
Primary References
American Speech-Language-Hearing Association. (1997). Maximizing the
Provision of Appropriate Technology Services and Devices for
Students in Schools. Technical Report.
Beukelman, D., & Mirenda, P. (1998). Augmentative and Alternative
Communication, Management of Severe Communication Disorders
in Children & Adults (2nd. ed.). Baltimore, MD: Paul H. Brookes
Publishing.
Brodin-Lennon, D. & Rinehart, C. (2002). Songs to Communicate. Solana
Beach, CA: Mayer-Johnson, Inc.
Browder, D., Flowers, C., & Wakeman, S.Y. (2006). Level of symbolic
communication classification for students with significant cognitive
disabilities. Manuscript submitted for publication.
Burkhart, L. (1993). Total communication in the early childhood classroom.
Baltimore, MD.
Donnellan, A. (1984). The criterion of the least dangerous assumption.
Behavioral Disorders, 9, 141-150.
Downing, J.E. (2005). Teaching communication skills to students with severe
disabilities ( 2nd ed.). Baltimore, MD: Paul H. Brookes Publishing
Company, Inc.
Primary References
Glennen, S., & DeCoste, D. (1997). The Handbook of Augmentative and
Alternative Communication. San Diego: Singular Publishing Group.
Goosens’, C., Crain, S., & Elder, P. (1994). Communication Displays for
Engineered Preschool Environments. Solana Beach, CA: MayerJohnson.
Kangas, K., & Lloyd, L. (1988). Early cognitive skills as prerequisites to
augmentative and alternative communication use: What are we
waiting for? Augmentative and Alternative Communication, 4, 211221.
King-DeBaun, P. & Musselwhite, C. (2002). Presentations given at Closing
the Gap 2002, Minneapolis, MN.
King-DeBaun, P. (1993). StoryTime Just for Fun! Stories, Symbols,
and Emergent Literacy Activities for Young Children. Park City,
UT: Creative Communicating.
Millar, D., Light, J. & Schlosser, R. (2004). The impact of Augmentative and
Alternative Communication on speech development: A best evidence
research review. Manuscript submitted for publication.
Primary References
Light, J. (1989b). Toward a definition of communication competence for
individuals using augmentative and alternative communication systems.
Augmentative and Alternative Communication, 5, 137-144.
Light, J. & Binger, C. (1998). Building communicative competence with
individuals who use augmentative and alternative communication.
Baltimore: Paul H. Brookes Publishing Co., Inc.
Quattlebaum, P. & Nalty, L. (1998). A Practical Guide to Augmentative and
Alternative Communication: Assessment and Intervention Strategies.
Greenville, SC. Super Duper Publications.
Rouse, C. (2002). Ideas for Using Classroom Materials to Teach
Academics to Nonverbal Children and More! Solano Beach:
Mayer-Johnson,Inc.
Silverman, F. (1995). Communication for the speechless (3rd ed.). Needham
Heights, MA: Allyn & Bacon.
For more information or to borrow
AT equipment, contact the
South Carolina
Assistive Technology Program
803-935-5263
www.sc.edu/scatp
With special thanks to Mary Alice Bechtler