Transcript What is the best practice for the layout/design in

Alternative and Augmentative Communication
(AAC) EBP Group
Extravaganza Presentation 2011
What is the best practice for the layout/design
in augmentative and alternative communication
systems for people who have a communication
disability ?
An update
Background
 This CAT was completed as a review of the original
CAT compiled in 2005 by Speech Pathologists from
The Cerebral Palsy Alliance (formerly The Spastic
Centre) to appraise the evidence for:
 Design and layout of communication arrays
 Whether certain design principles were advantageous
for people who have communication disabilities.
In the beginning……
 Originally the idea for this CAT was to look into
research for PODDs (Pragmatically Organised
Dynamic Display) however limited evidence was
found to formulate a CAT.
 Our original question was
“How successful is the design of PODDs for individuals
with complex communication needs?”
What is a PODD?
Pragmatic – the way that we use language socially
Organisation – words and symbols arranged in a systematic way
Dynamic Display – changing pages.
PODD communication book : the words and symbols organised in a particular way.
Devised by Gayle Porter (Speech Pathologist with the Cerebral Palsy Education
Centre (CPEC) in Victoria)
 The aim of a PODD is to provide vocabulary (larger range):
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for continuous communication all the time
for a range of messages
across a range of topics
in multiple environments.
 They can have different formats, depending
on the individual physical, and communication
needs of the person i.e., direct access, partner assisted
eye gaze, coded access, speech generating device.
(http://www.novita.org.au/)
Video examples of children using PODDs
 http://www.youtube.com/watch?v=xv-b_GHonJM
 http://www.youtube.com/watch?v=TOvC9OoygaA&NR=1
However limited evidence was found to formulate a
CAT regarding PODDS….
So our next step…..
 We expanded the question to look at the layout /
design of AAC in general.
 Discovered that a CAT had been previously done in
2005 by CPA speech pathologists with a plan to be
reviewed in 2007.
 They concluded…. Insufficient high quality evidence to
guide clinicians regarding this question. “Clinicians
should be guided by their clinical experience and client
and family values…”
 We decided to review the original CAT.
 Importance of reviewing the original CAT given the
dynamic nature of AAC and how rapidly it changes
with new technology.
 On investigation we found that very little new
research has been conducted since the original CAT in
2005 and therefore we were unable to achieve our
original objective of reviewing how effective the new
AAC systems (high and low tech) are.
Factors to consider when designing an
AAC device
Layout:
 topic, place, colour, alphabet, size, dynamic or static
Other factors:
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individual’s age
literacy
personal preference
age of onset of disability
motor skills, positioning, accessibility
Method
Study Design/ Methodology of articles
retrieved
Level
Case series
Comparative study
Systematic review
Number Located
IV
3
III
4
I
1
Key findings
Colour
 Clinicians should incorporate colour in foreground of line
drawings when constructing visual displays.
 Targets that contain only background colour (e.g.,
Fitzgerald key) but no foreground colour make it slower
for younger children to locate the target.
 When creating AAC displays, results suggest symbols that
share colour should be placed together as the speed of
location/access increased e.g., Gail Van Tatenhove
 Use of colour may assist in segmentation of visual scene
to highlight contrasts between objects or to highlight
detail & as a means of cueing memory. This would
suggest that in a natural scene or schema, colour may aid
memory however this may not be true for a grid layout.
(from CPA CAT)
Example of Gail van Tatenhove’s core vocabulary
approach. www.vantatenhove.com
Symbol Organisation
 Adult participants required less time to sequence
symbols when they were a shorter distance apart.
 Symbols that are high frequency combinations should
be placed close together on the display.
User Preference
 When people have a choice in selecting preferred AAC
systems, this increases their motivation to use the system and
thus opportunities to learn communication competence
 Children value AAC technologies
 that serve to enhance their self-esteem and social image i.e.,
integrated systems such as something you can play with as
well as a communication system (e.g., iPAD, iPOD).
 That have a ‘high smile value’ i.e., should be fun. Light J.,&
Drager, K. (2007)
Age
 In young children.. generally have a preference
for personally relevant schematic layout.
(5 ways to group vocabulary - Taxonomic (categories),
schematic (event schema), semantic / syntactic, alphabetic,
idiosyncratic) ( from CPA CAT)
 Embedding language concepts within contextual
scenes maybe an effective approach for young
children learning dynamic display technology
Clinical bottom line
 Preference and motivation will greatly impact on the
outcomes of AAC competence.
 Colour aids with speed and accuracy of use – (e.g.,
Minspeak and core vocabulary)
 Highly used symbols should be grouped together.
Alternative and Augmentative Communication (AAC)
EBP Group
Extravaganza Presentation 2011
Is a high tech AAC system more effective
than a low tech AAC system for people
with ASD?
Taking EBP back to the workplace
Current best evidence
Clinical expertise
Client’s values
From: http://www.asha.org/members/ebp/default 10/23/08
Why this clinical question?
 Therapists are finding that a lot of
clients with ASD and their families are
interested in high tech devices such as
Proloquo2go on iPad/iTouch so we
wanted to look at the effectiveness of
both high and low tech AAC on people
with Autism
Taking EBP back to the workplace
Current best evidence
Clinical expertise
Client’s values
From: http://www.asha.org/members/ebp/default 10/23/08
http://www.foxnews.com/scitech/2011/03/09/can-apple-ipad-cure-autism/#ixzz1fd1ugwHt
Benefits of Low Tech AAC systems
Low cost
Easy to use
Easy to replicate
Easier to use in a number of settings
Easier to implement with those new to AAC
Easier to implement in acute settings (infection
control)
More widely recognised and used
Disadvantages of Low Tech AAC
 May have limited vocabulary
 Communicator needs to get the communication
partner’s attention first before sending message
 Communication partner needs to be able to see the
message. For example, seeing visuals in a dimly lit
room
 Communication partner needs to be trained in the use
of the low tech AAC, e.g., PECS
 General public may not recognise AAC as a means of
communicating (e.g. community request cards)
 Can be bulky and cumbersome (e.g. PODD)
Benefits of high Tech AAC systems
 May be able to store a large amount of vocabulary for
dynamic display devices
 Able to get feedback to the user, i.e. says the
word/sentence that you have pressed
 Reduces the communication partner’s burden
because the output is spoken language and provides
information in a mode that is familiar and non
threatening.
 Allows partners who are non literate to participate in
conversation (if device has voice output)
 Allows communication to happen at a distance
 Allows predictability
 More recognised in the ‘digital age’
Disadvantages of High Tech AAC
 Expensive (although it is getting more affordable now
with things like iPads)
 Takes a lot of time to program
 Some high tech AAC devices are heavy
 External factors such as battery life. For example, if
battery in High Tech AAC is gone they have no
communication method
 High tech devices are not as durable, e.g., dropping it
on ground
 Can’t be used in all settings (e.g. pool, at the beach)
Disadvantages of High Tech AAC
 Even though the speech is fairly intelligible, it still may
be difficult to hear in noisy environments by people
with hearing impairments, non-native English
speakers or those with reduced receptive language
abilities.
Taking EBP back to the workplace
Current best evidence
Clinical expertise
Client’s values
From: http://www.asha.org/members/ebp/default 10/23/08
Critically Appraised Papers
 45 identified articles referenced and sourced.
 14 were deemed relevant however only 10 were
accessible.
 4 articles subsequently CAPped and used for CAT as
remaining 8 did not directly relate to question on
closer scrutiny of paper
Schlosser et al (2001)
LEVEL
1
Objective:
To synthesise research regarding the potential benefits of speech output for persons with ASD
Results:
Several studies have compared PECS but no mention of speech output made
1.
Speech output devices as part of computer assisted treatment packages
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Packages had potential to teach reading and PA skills for stimulating verbal
expression & improving interactions of kids with ASD and their comm partners
2. Speech output from voice output devices (SGD)
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Contribution of SGD to effectiveness of treatment package unclear
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Promising results – speech output increased spontaneous utterances but poor design and small
3. Speech output as independent variable
sample size
Strengths and weaknesses
Further research since 2001
©
Schlosser et al (2001)
 Clinical bottom line
 There is a role for speech output devices for people
with ASD, however the benefits still remain unclear at
this time and more research into specific SGD’s is
needed
Schlosser et al (2007)
LEVEL
3a
Objective:
Use of Vantage Speech output device with voice on and off to determine benefits of voice
output
Results:
 Overall – non-speech goal did not increase in ¾ participants, however increase
by two fold in requesting skills in children with ASD using SGD
 ½ participants showed increase in vocal imitation skills using SGD vs. those that
were not exposed to use of SGD
Strengths and weaknesses
2 fold aim of paper – looking at requesting with high tech devices as well as
looking at changes in natural speech production as a result of intervention
Detailed information about how each participant met the criteria for the study
Difficult methodology to follow
Very strict participant criteria needed for study
Schlosser et al (2007)
 Clinical bottom line
Could not determine specifically if a high tech AAC
system is more effective than a low tech AAC system.
However – it is essential to look at the child / adult’s
preferences and ensure that these are taken into
account when prescribing a specific system
Sigafoos et al (2006)
Objective:
LEVEL
4
Comparison of PECS vs. VOCA system for requesting desired items
Results:
 In baseline no preference of PECS over VOCA vv
 All participants increase percentage of correct responses using both
systems (PECS & VOCA) [86-100%]
 Reported increase in speed in responding using VOCA
 1 of 3 participants preferred use of VOCA, other 2 participants preferred
PECS
 All 3 participants continued to use preferred AAC 6 months post study
Strengths and weaknesses
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Small number of participants
VOCA device not specified
No comprehensive follow-up
No generalisation data collected
Sigafoos et al (2006)
 Clinical bottom line
All participants in the study learnt to functionally use
PECS and Voice Output communication system with
comparable speed and proficiency. Child preference
appeared to be driving force in success of
administration of communication system
Trembath et al (2009)
Objective
 To measure and compare effectiveness of peer mediated teaching with
and without SGD, and to determine whether changes generalised.
Results
 Peer mediated naturalistic teaching with SGD resulted in more
communicative behaviours per minute than peer mediated naturalistic
teaching without SGD for 2 of the 3 subjects.
 All 3 subjects generalised slight increases in communicative
behaviours with peers during mealtime interactions.
Strengths and weaknesses
 Only 3 subjects - ? Ability to generalise results.
 Number of prompts provided by researcher not controlled – may have
influenced peers’ ability to implement interventions.
 Affect of factors such as different abilities of peers and different settings
 Only small number of generalisation probes taken due to time
constraints.
Trembath et al (2009)
 Clinical bottom line
Preliminary evidence for the effectiveness of combining
peer-mediated naturalistic teaching with the use of
SGDs for preschool-aged children with autism.
Take home message
 There is no absolute system that would suit every
client
 There are both advantages and disadvantages to both
a high and low tech AAC systems and on top of this
we also have to take in to account client abilities and
preferences as well as financial situation.
 It is best not to use a single mode of communication
but a combination of both high and low tech AAC to
ensure its use in a variety of environments with a
variety of communication partners
In 2012…
Meetings will take place at Cerebral Palsy Alliance –
Ryde .
3A Smalls Road, Ryde
1st meeting for 2012 – 15th February at 10 am
Please contact Natalie Alborés or Cecilia Rossi
[email protected]
[email protected]
References
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Chiang, H & Lin, Y. (2008). Expressive communication of children with autism. Journal of Autism &
Developmental Disorders 38(3), 538-45
Goldstein, H. (2002). Communication intervention for children with autism: a review of treatment efficacy.
Journal of Autism and Developmental Disorders, 32(5)
Johnston et al. (2003). The use of visual supports in teaching young children with ASD to initiate interactions
Augment Altern Commun. 2003 , 19, 86-103
Schlosser, RW. Blischak, DM (2001). Is there a role for Speech Output in Interventions for Person with
Autism. Focus on Autism and Other Developmental Disabilities; Fall 2001; 16, 3; 170-178
Schlosser, RW. Sigafoos, J. Luiselli, JK. Angermeier, K. Harasymowyz, U. Schooley, K. & Belfiore, PJ. (2007).
Effects of synthetic speech output on requesting and natural speech production in children with autism: A
preliminary study. Research in Autism Spectrum Disorders 1(2) 139-163
Sigafoos et al. (2009) A comparison of Picture Exchange and Speech Generating Devices- Acquisition,
preference and effects on social interaction Augment Altern Commun. 25(2):99-109.
Sigafoos, J. Drasgow, E. (2001). Conditional use of aided and unaided AAC: A review and clinical case
demonstration Focus on Autism and Other Developmental Disabilities 16(3) 152-161
Son,SH. Sigafoos, J., O'Reilly M. & Lancioni, GE. (2006). Comparing two types of augmentative and alternative
communication systems for children with autism. Pediatric Rehabilitation 9(4) 389-395
Thunberg, G., Ahlsen, E. & Sandberg AD. (2007). Children with autistic spectrum disorders and speech
generating devices: communication in different activities at home. Clinical Linguistics and Phonetics 21(6).
457-79
Trembath, D. Balandin, S. Togher, L. & Stancliffe, RJ. (2009). Peer-mediated teaching and augmentative and
alternative communication for preschool-aged children with autism. Journal of Intellectual and
Developmental Disability 34(2) 173-186