Transcript Augmentative Communication Evaluations Simplified

AAC for Persons With
Complex Communication Needs
Part 2: Physical Access To
AAC Communication Tools
Debby McBride Ligon, MS, CCC-SLP
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Goals:
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Discuss important issues about ACCESS
Discuss physical considerations using the diagram for THE PERSON:
SKILLS & FEATURES (handout)
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Review portions of AAC COMMUNICATOR PROFILE (website)
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Describe types of AAC modifications for access
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Discuss PROS and CONS of each
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Discuss case examples and demonstrate use of various AAC Tools
with modifications including Low-tech, Lite-tech, iPad with AAC
Apps, SGDs
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Communication is not "independent" if..
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utterances can only be understood by some people, or...
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other people have to preprogram all vocabulary in a device, or...
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he cannot spell well enough to compose novel utterances, or...
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she is given no opportunity to communicate what she wants to say,
or...
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his communication system doesn't match his motor skills making it
difficult to control, or...
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her communication system doesn't match her communication
needs, or...
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there are partners who influence communication through cueing, or...
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he has hidden vision impairments making it hard to see the symbols,
or...
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she has a hidden hearing impairment making it difficult to hear what
is said, or...
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he has been given insufficient training and time to learn to use his
AAC system, or...
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she has no access to a communication system at times, or...
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he cannot see the display on his system in some light conditions, or...
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no one believes she has anything worth listening to....etc.
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Build skills for communication
Attention
Access
Interaction
Symbols
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ABC:
Access Before Communication
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AAC Communicator Profile
for Evaluations & Referrals
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On PPHC website
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In referral packet
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Can be used by itself for your own
evaluations
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From AAC Communicator Profile (website)
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The Person: Skills & Features
(diagram) on PPHC website
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From the diagram: The Person:
Skills & Features on PPHC website
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From the diagram: The Person:
Skills & Features on PPHC website
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AAC Tool Options
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Low-tech
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Light-tech
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iPads with AAC Apps
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Speech Generating Devices
(SGDs)
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Direct select & modifications
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Pointing with finger . . . . Touching with
hand
Keyguard (homemade vs. fits device)
Stylus
Finger modification (glove)
Laptray
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Direct select – Pros & Cons
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Pros
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Natural
Modifications can help (ex. Dwell on SGDs
and some iPad AAC Apps)
Auditory Phishing
Cons – physical challenges
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Limit access due to motor limitations (takes
too much time and limited page layout)
Better to use other access at times
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Examples: Direct Select
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JG –
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Single Message Communicator
iPad Access – GoTalk Now
GoTalk 4 key
Laptray
AJ
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Finger access with keyguard (vision – various
hands/fingers) on Mini-iPad
Larger keys okay on iPad
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Use apps on iPad to increase single finger access
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Keyguard
http://beyondadaptive.com/?s=keyg
uards&post_type=any
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Lasered Pics - inexpensive $30 or less –
premade or customized
http://www.laseredpics.biz/keyguards-foripads/?sort=featured&page=1
Popular AAC Apps (pictures)
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Headpointer
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Manual
Speech Generating Devices (some
tablets - new)
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Head pointing – Pros & Cons
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Pros
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Form of direct access
Can use head or mouth (manual)
Inexpensive for manual
Cons
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Manual is intrusive/socially undesirable
More expensive doe technology version
SGD/iPad access; requires good head control; difficult
for CP and other neurological conditions
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Examples: Headpointer
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SGDs - extra accessories required
Tablet applications (for iPads and some
SGDs) – extra accessories required
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Eye Gaze
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Low-tech
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Speech Generating Devices
(does NOT work with Tablets)
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Eye Gaze – Pros & Cons
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Pros
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Form of direct select
Several input methods
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Dwell
Dwell and select (with switch)
Cons
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Head positioning and movement
Device up in front - limits vision
Recalibration required
Expense (more than twice as much); 16K
Last resort after other access methods (Medicare issues)
Strong justification for needs (access, functions)
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Eye Gaze: Examples
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CM
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Head / body positioning
Limited interests/needs
Explore use of low-tech
JG
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Bored with simpler low-tech
Constant head movement
Awareness of how it could work
Exploring several access methods
Justify multiple access methods
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Scanning
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Single switch
Double switch
Type of switch
Position
Modifications with mounts (positioning
of switch and device )
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Type of scanning input
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Visual & auditory
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Visual only
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Auditory only (for visually impaired)
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Scanning – Pros & Cons
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Pros
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Depending on person, can access more
vocabulary than with other methods (i.e.
direct select, eyegaze)
Cons
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Is complex; switch access, switch/device
positioning, type of scanning
(auditory/visual)
Difficult to learn
Start with Partner Assisted Scanning
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Examples
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CR
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Provided low-tech solution (YES/NO with hand
signals for immediate needs in answer to YES/NO
questions )
Needed to expand to selecting categories
Behaviors - frustration
Bad fit: issues that needed to be dealt with:
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Access – needed BluTooth – was inconsistent in operation
Software match not good
Hardware issues (2 times)
Multiple hours spent with tech support / rep
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Patient aging out of “system”
Example (cont.)
CR continued:
High-tech needs
 Auditory scanning (blind – limited mobility)
 Needed portability
 Needed touchscreen access for switch
 Needed customized programming
 Provided with manufacturer input: larger device,
incorrect switch access, software mismatch
 Had to be corrected (1.5 years; pursued Medicaid for
new device; granted).
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Scanning Examples
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(various patients)
Single message communicator (says THIS
ONE) or other signal (vocalization, thumbs up,
eyes up, etc.)
 Partner Assisted Scanning
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Eye Gaze Board
Communication Book
Pictures on iPad / Tablet with cuing
Auditory Scanning for recorded choices
Training for switch access on single
message communicator (using greetings / social
scripts)
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Scanning Examples (cont.)
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Use of iPad (tablet) in for multiple choices
(providing the auditory and visual cues . …
not the device) . .. More flexibility for
timing, allowing for self-correction, etc.
Use of iPad or SGD
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With earphone
Public . . . Issues
Voice output – more motivating
Using technology – more motivating
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Hope you: > > >>
 Learned about some new resources . . .
 Have some fresh ideas . . .
And
 New / different perspectives . . . .
On ACCESS for AAC Communicators
See PPHC website – under Employee Login
for these and other
AAC forms & resources
Including:
Other AAC Training Sessions
AAC Referral Packet
Interest in AAC Team Participation
Debby McBride Ligon
[email protected]
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