AAC- Yikes! You Want Me To Do What?

June Maranville MSP, CCC-SLPPalmetto Language & Speech Center, LLC

Email: plsc@plsclex.comWebsite: www.plsclex.com

I don’t even know what I don’t know

“The only disability in life is a bad attitude.” - Scott Hamilton

ALL Individuals Can and Do

Communicate! -National Joint Commission for the Communication Needs of

Persons with Severe Disabilities. (1992)

“If all my possessions were taken from me with one exception, I would

choose to keep the power of communication, for by it I would

soon regain all the rest” -Daniel Webster

We’ve come a long way, baby.

Who remembers…O Cut and paste pictures from

notebooksO Hand coloring each pictureO Glue with no Velcro!O No BoardmakerO Contact paper instead of laminationO Heavy-bulky systems that took

weeks to program

Present Day

Where are we now?O BoardmakerO LaminationO VelcroO Over 200 Apps for high-tech devices

O AAC App Comparison Chart (SCATP)O http://www.sc.edu/scatp/apps.html

O Light weight, durable, intuitive systems

What has not changed?O As professionals, practice due

diligence when choosing AAC for client.

O Team ApproachO Client and caregiver as active

participantsO Best fit- low/medium/high techO Feature matching

O a process that involves matching the skills of the AAC user with the features of the given AAC systems.

What is Augmentative and Alternative Communication (AAC)?

O “AAC involves attempts to study and when necessary compensate for, temporarily or permanently, the impairments, activity limitations, and participation restrictions of individuals with severe disorders of speech-language production and/or comprehension. These may include spoken and written modes of communication.”

(ASHA 2005)

AAC is the bridge that enables children with severe communication difficulties to learn higher-level language skills and to interact with individuals outside the family.

~ Page and Quattlebaum (2012)

Handbook of Children with Special Healthcare Needs

The Goal of AACO Empower AAC user to

O express wants and needsO exchange informationO develop social closeness with others O engage in social etiquette routines.

O MULTIMODAL approach most effective in order to be able to communicate for different purposes in a variety of contexts. (ASHA, 1991)

Multimodal Communication

O ObjectsO SignsO GesturesO Facial ExpressionsO Pictures

O SpeechO Nurture residual

speech

O Written WordO Symbols O Voice output

devices

Feature MatchingO Which system is the best match to fit

user’s abilities, needs and skills?O Dx does not determine need for specific

deviceO Consider:

O Current Skill LevelO ADLs and associated wants/needsO Current Communication

system/strategiesO Future Communication needs

O System growth with development and skills

O Degenerative/Deteriorating skills

Feature Matching Cont.

O Objective / Feature / Selection CriteriaO Shared symbol systemO Development of language systemO Construction of messages to interact with

othersO Meaningful Vocabulary

O http://aac.unl.edu/vocabulary.html O Access to communication symbolsO Access to communication device

~Page and Quattlebaum (2012) Handbook of Children with Special Health

Care Needs

Is it a good fit?

O Would you ever get the gift box before you purchased the gift?

~ Dr. Carol Page O No! ~ Let’s not do it with AAC either. O Evade “flavor of the month” devices based on marketing,

promotion and popularity.

O AbleData: AAC products and features http://www.abledata.com/abledata.cfm?

pageid=19327&ksectionid=19327

Why Assess?O Will use of AAC…

O Maximize client’s abilities and decrease challenges of disabilities

O Help improve condition or prevent from getting worse.

O Help person function in their environmentO Help improve independence

O How will team find the best fit?O Is a formal assessment needed and

required by funding source? O Is use of AAC a medical necessity?

Medical Necessity

O Medicare defines asO “Service or supplies that are needed for the

diagnosis or treatment of medical condition and must meet best practice standards.”

O Buzz wordsO Correct deficitsO Ameliorate deficits - to make better or

tolerableO Palliate- to make less severe or unpleasant

without removing the cause.

O Letter of medical necessity and physician order with high-tech AAC purchases

Who can assess formally?O Licensed and credentialed in related field

O PT, OT, SLP, Rehab EngineerO AT specialization certificationO Other Team members—as warranted

O Vision specialistO NurseO PsychologistO EducatorsO Hearing specialist

Who pays for AAC?Funding sources consider AAC dedicated communication devices

O Private PayO Babynet (0-3)

O IFSP Team, parents and professionalsO Schools (3-21) FAPEO Private insurance- appeal if deniedO CRSO MedicaidO MedicareO VAO Vocational RehabO Community

O Service organizationsO Church and local charities

Who really pays for AAC?

We all do!

Components of Successful Assessment

O Team Assimilation O Medical InformationO HistoryO Functional GoalsO Technology that has been tried in the

past and resultsO Clear communication among team

membersO Trials with AACO Time is your best friend!

Assessment HelpO There are no standardized AT

assessments.O Ecological Inventory ~ Nalty and

Quattlebaum (1998)O Joy Zabala SETT Framework

O It’s not about technology or device O It’s about matching

O The Student O The Environment O The TaskO The best Tool

O Communication MatrixO Every Move Counts, Clicks and Chats

Trials with AACO Low-tech

O Examples: Communication boards, booklets.

O Can start immediately

O Boardmaker is your friend!

O Backup system-as needed if high-tech device malfunctions

Trials with AACO Mid-tech

O Examples: BigMack, iTalk 2, Go talk series.

O Typically requires a battery to operate.

O Human voices recorded on device

Trials with AACO High-tech

O Examples: Dynavox, Prentke Romich, Tobii- SGDs

O Increase vocabulary opportunitiesO Digitized, synthesized speechO iPads and Tablets

Purpose of Trials O What works. O What does not work.O Show evidence of optimal fit for

individual communication need.O System not to be used or

recommended just because only one tried, most popular, or most promoted.

AAC Intervention

O If we’re using pictures do we call it AAC?

OAAC vs. other types of learning activities

Picture Identification vs. Functional

CommunicationO Picture ID- END

O Receptive Skills and KnowledgeO Touch the “____”

O Teaching Format-Get responseO Match, sort, reinforceO Academic Achievement

Picture Identification vs. Functional

CommunicationO Functional AAC Communication-

MEANS to ENDO Demonstrates desire to engage with

communication partner to share wants, needs and ideas.

O Nurtures social interactionsO EmpowersO Beyond Requesting Powerpoint

Message SetsO Vocabulary linked to social/emotional

development O FeelingsO Decrease behavioral problems with

appropriate vocabulary selection O Vocabulary Selection

O Provides means to interactO Motivating vocabulary imperativeO Consider user’s interest firstO Variety of word types

Core Vocabularyhttp://aac.unl.edu/vocabulary.html

O Typical Peer 5-minute Conversation SampleO More than NounsO Rich language experiencesO Increase message set expansionO Generalizes across communication settings O Teaches rules of SyntaxO Language to Literacy Expansion

O juice, want juice, no juice, more juice, write or type juice –Page and Quattlebaum 2012

O Quick Hits/Urgent messagesO One Icon to represent message

O Example: “I need help” “I feel sick”

Prognostic IndicatorsO Extrinsic Factors

O Skin in the gameO Buy into useO Switch gears from basic needs to anticipating needsO Co-treatingO Chain of cuesO Model, model, model!O Enable vs. EmpowerO 15x per day

O Intrinsic FactorsO Knowledge is powerO User grasps that power is in communicationO Motivation

O Example: Music varietyO Active participantO Engage 15x per day using AAC device

O Present and Possible ChangesO Medical condition statusO Plan implement ahead of timeO Monitor and adjust to assess wants/needsO Dynamic and ever-changing process

O ~ Page and Quattlebaum (2012)

Parent/Caregiver RolesO Active participantsO Ongoing programmingO Vocabulary selectionO Facilitate carryover of device to all settingsO Model use of device with motivating activity

for userO Troubleshoot problemsO Recognize when message sets changes

neededO Attend training

CarryoverO FunctionalO MotivatingO Means-EndO EfficientO EffectiveO InteractiveO All EnvironmentsO At least 15 opportunities per dayO Update AAC system when change occursO Transition Strategies for Adolescents and You

ng Adults Who Use AAC

ResourcesO SC Assistive Technology Program

O Apps that make life easierO Apps comparison chart.

O SC Equipment Distribution ProgramO SC Vocational Rehabilitation

Resources Cont.O CRS- Children's Rehab Services O SCATP- Device Loan ProgramO SC Independent Living ProgramO CDR- Centers for Disabilities Resource Librar

yO Loaner programs through vendors.

O Key Technologies O DynavoxO TobiiO Prentke Romich

Prize Time!Q and A

Wrap it Up!When you know better, you do better

~ Maya Angelou

O Use the resourcesO Celebrate great resources in your

backyardO Don’t be afraid to ask for helpO Enjoy the journey and be inspired!O Heart of the Ravens! Superbowl 2013

Champs!O http://espn.go.com/video/clip?id=881

5080

BibliographyWorks Cited

AAC and Speech Devices from PRC. N.p., n.d. Web. <http://www.prentrom.com/>.

"AAC Messaging and Vocabulary." AAC References. N.p., n.d. Web. <http://aac.unl.edu/vocabulary.html>.

"AbleData: Products." AbleData: Products. N.p., n.d. Web. <http://www.abledata.com/abledata.cfm?pageid=19327>.

"Apps That Make Life Easier." Apps That Make Life Easier. South Carolina Assistive Technology Program, 7 Jan. 2013. Web.

ASHA. "Goal of AAC." (1991): n. pag. Print.

"Augmentative and Alternative Communication (AAC)." American Speech-Language-Hearing Association. N.p., 2005. Web. <http://www.asha.org/public/speech/disorders/AAC/>.

"Beyond Requesting." Beyond Requesting. N.p., n.d. Web. <http://www.slideshare.net/slpwendy/beyond-requesting-presentation>.

CDR Library, School of Medicine Library, University of South Carolina. N.p., n.d. Web. <http://uscm.med.sc.edu/cdr/>.

"Communication Assessment for Parents & Professionals." Communication Matrix. N.p., n.d. Web.

Bibliography Cont.

DynaVox: Communication Devices – Speech Devices. N.p., n.d. Web. <http://www.dynavoxtech.com/>.

"EMC, Inc. Home." EMC, Inc. Home. N.p., n.d. Web. <http://www.everymovecounts.net/>.

ESPN. ESPN Internet Ventures, n.d. Web. <http://espn.go.com/video/clip?id=8815080>.

"Independent Living." South Carolina Department of Social Services. N.p., n.d. Web. <http://www.state.sc.us/dss/independent/index.html>.

Key Techonologies. N.p., n.d. Web. <http://www.gokeytech.com/>.

Nalty, L., and P. Quattlebaum. "A Practical Guide to Augmentative and Alternative Communication: Assessment and Intervention Strategies." Greenville:Super Duper (1998): n. pag. Abstract. Severe Communication Disorders (2012): 32. Print.

National Joint Commission for the Communication Needs of Persons with Severe Disabilities. Guide-lines for Meeting the Communication Needs of Persons with Severe Disabilities (1992): n. pag. Print.

Page, C. A., and P. D. Quattlebaum. "Severe Communication Disorders." Ed. D. Hollar. Handbook of Children with Special Health Care Needs (2012): 23-46. Print.

Bibliography Cont.SCATP Device Loan Program. N.p., n.d. Web. <http://www.sc.edu/scatp/loan.htm>.

"SCATP." South Carolina Assistive Technology Program (SCATP). N.p., n.d. Web. <http://www.sc.edu/scatp/>.

"Sharing the SETT Framework." Joy Zabala SETT Framework. N.p., 2005. Web.

South Carolina Department of Health and Environmental Control. N.p., n.d. Web. <http://www.scdhec.gov/health/region5/crs.htm>.

"South Carolina Equipment Distribution Program." SCEDP. N.p., n.d. Web. <http://www.scedp.org/>.

South Carolina Vocational Rehabilitation Department (SCVRD). N.p., n.d. Web. <http://scvrd.net/common/index.php>.

Tobii Technology Global. N.p., n.d. Web. <http://www.tobii.com/>.

"Transition Strategies for Adolescents and Young Adults Who Use AAC." ASHA Online Store Details. N.p., n.d. Web. <http://www.asha.org/eweb/OLSDynamicPage.aspx?Webcode=olsdetails>.