Transcript Managing Changing AAC systems

Managing
Changing AAC
systems
Nuffield Orthopaedic Centre
Oxford
June 2016
Claire Hartley BSc (hons) MSc RCSLT HCPC
Highly Specialist Speech and Language Therapist
 22 years experience in the field of complex disability and AAC
 Nearly 14 years at Treloar School and College
2
Treloar School and College
Non-maintained special school for 2 to 19 year old students with physical
disabilities and complex needs
Specialist College for 16 to 25 year old students with physical disabilities
and complex needs
Provision:
– Education
– Care
– Therapy
– Medical support
– Independence training
3
Current AAC Needs
97 students in the school (including nursery)
70 students in the college
61 students in the school use some form of AAC
32 students in the college use some form of AAC
– Wide range of systems used – low and high tech
– PCS symbols
– Makaton
4
Questions?
What might necessitate a change in
AAC systems?
How do we manage this change?
Goal: To ensure that our students have the most
functional efficient and effective method of
communication across all environments
5
Factors that might necessitate change
Deterioration of Skills
Educational Needs
Change in Environment
Developing Literacy Skills
Behaviour
Changing Technology –
More Options
Increasing Vocabulary
Needs
Family Aspirations / Needs
Access
Support Staff Skills and
Experience
Future Needs
Broken / unreliable systems
6
Case Study 1 - James
7
Managing changing systems – Low Tech
Joined Treloar School in June 2013 aged 16 years (now 18)
Diagnosis:
– Athetoid CP with Dystonic Movements and Osgood Schlatters Disease
– Epilepsy
– Gastrostomy
– No Verbal Speech
– Very Short Attention Span
– Reception Level Skills
8
Managing changing systems – Low Tech
2010 (Aged 13 years) – Seen by ACE
- Recommended eye pointing colour coded book and E Tran
Frame
2013 Arrival at Treloar School aged 16 years (now 18)
- No communication book
- Yes/No response – vocalisation or reaching out
- Concerns over shoulder dislocation
- High levels of frustration
9
Managing Changing Systems – Low Tech
Therapist recommendations:
– Eye pointing to yes/no symbols due to shoulder dislocation and exertion
– Eye pointing to symbols in book (opposed to physical pointing)
– Use of 4 symbol per page eye pointing communication book
– Use of visual timetable
10
Managing change of systems – Low Tech
Observations:
- Fleeting eye gaze (interpretation difficult and multiple confirmation
requests required)
– Desire to physically point to symbols
– Frustration leading to staff reverting to ‘old method’
– Need to prevent physical injury to shoulders
– Questions over portability
11
Managing changing systems – Low Tech
Intervention and change:
– Conversation with James regarding preferred method of access
– Discussion with staff to understand their views
– To provide James with a more physical yes/no response
– Encouraged previously used vocal ‘yes’
– Worked with physiotherapist to improve head shake for ‘no’ and to
assign movement with meaning
– Engaged staff support
– Mounted communication book on chair
12
Managing changing systems – Low tech
Outcome:
- Able to use vocal ‘yes’ and physical shake of head for ‘no’
– ‘No’ requires reinforcement (…but happier)
– Communication book is used regularly (personalised to James)
– Eye pointing continues to be short but improving due to use of high tech
– Continues to need quiet environment with limited distractions
Presentation title Date
13
Case Study 2 - Felix
14
Managing Changing systems – High Tech
Joined Treloar School in June 2010 aged 8 years (now 13)
Diagnosis:
– Dystonic Cerebral palsy (all 4 limbs)
– Short Sighted (glasses to correct)
– Mild/Moderate sensory-neural hearing loss
– Problems coping with sensory stimulation
– Spasms, discomfort, pain
– Gastrostomy – requires venting
– Requires SSA and physiotherapy support at all times
– Requires regular re positioning - use of Acheeva Bed
15
Managing changing systems – High Tech
AAC:
– My Tobii CEye – purchased by parents
– Arrived once Felix started at Treloar School
– No low tech
16
Managing changing systems – High Tech
Observations:
– High tone
– Spasm (head turns to the right - requiring support to see the screen)
–Tobii being used for photos and fun but not communication
– Parental expectations
– Relying on communication partner to interpret when using
communication book and use of yes/no questions
– But Felix continued to be very motivated to use Tobii despite
difficulties
Presentation title Date
17
Managing changing systems – High Tech
Intervention and Change:
– Introduced auditory scanning with facilitated switch access to reduce
the need for vision and head positioning
– Used ‘yes’ response (sticking out tongue)
– Set up access to both eye gaze and auditory scanning so could switch
between the two
– Able to use when change of position needed – e.g. Acheeva Bed
Presentation title Date
18
Managing changing systems – High Tech
Outcome:
–Tone immediately reduced with increased effectiveness
– Improved ability to select more symbols in timed period compared to
eye gaze
– Developed his previous 6 symbol programme
– Using in classroom environment to access lessons
– Able to communicate needs/ideas
– Good understanding of programme and where to find vocabulary
– Switching between pages and linking ideas
– Increased use at home
Presentation title Date
19
Managing changing systems – High Tech
Future:
– To trial new auditory scanning programme – more vocabulary
– VOCA - Tellus with Mind Express and My Access
– Independent access - trial of switch activated by tongue
– Auditory communication book based on programme to ensure
consistency
Presentation title Date
20
Case Study 3 - Daniel
21
Managing changing systems – High Tech
Joined Treloar School in September 2015 aged 12 years (now 13)
Diagnosis:
– Dystonic Cerebral palsy (all 4 limbs)
– Long Sighted (glasses to correct and has a right divergent squint)
AAC:
– Unity 60 on Vantage Lite with keyguard
– 2012 changed programme from Word Power 45 to Unity to enable
increased access to vocabulary
22
Managing changing systems – High Tech
–Observations:
– Competent user of programme
– Good understanding of single word vocabulary
– Comprehension around 3 ICW
– Vantage unreliable – charging
– Struggling with sentence building – despite lots of input
23
Managing changing systems – High Tech
Intervention to date:
–Trial of Accent (800 and 1000) – plus another trial arranged
–Trial of Easy Chat – to promote sentence building
– Mounting of Vantage Lite in midline so can drive power chair
– Assessment for mounting device on walker – awaiting funding
24
Questions?
Where do we go from here?
Is a change of programme needed?
25
Summary
Managing change is a constant element of our work
AAC systems are developing and evolving all the time
Students grow and develop and we have to meet their needs
Importance of time and ability to trial new systems
Multidisciplinary teams/support is essential
Importance of family support and supporting families
Transition / Future Plans
26
Thank you
www.treloar.org.uk
Treloar’s • Holybourne Alton Hampshire GU34 4GL
T 01420 547 400 • E [email protected]
Charity number.1092857