Introduction to Augmentative and Alternative Communication

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Questions and Answers

What does AAC primarily assist individuals with?

Developing their writing skills

Enhancing their understanding of mathematics

Improving their physical mobility

Communicating ideas and feelings without talking (correct)

Which group of people may benefit most from AAC?

People with developmental conditions and language difficulties (correct)

Those who are non-native speakers of a language

Individuals with high academic qualifications

Individuals with advanced technology skills

Which of the following is considered a high-tech AAC tool?

Communication app on an iPad (correct)

Sign language

Voice amplifier

Whiteboard

What is an example of a low-tech AAC method?

Communication boards Signup and view all the answers

Which factor is NOT considered when prescribing AAC?

The person’s visual acuity Signup and view all the answers

What type of AAC includes communication techniques like gestures and sign language?

No tech Signup and view all the answers

What is one of the primary uses for mid-tech AAC devices?

Predominantly for face-to-face communication Signup and view all the answers

What type of conditions might lead someone to rely on AAC for their communication needs?

Severe speech or language difficulties Signup and view all the answers

What is a requirement for a clinician to perform AAC assessment?

Communicative Assistive Technology (CAT) accreditation Signup and view all the answers

How might someone problem-solve a communication issue using AAC in a new country where they don’t speak the language?

By developing pre-prepared messages and phrases Signup and view all the answers

What type of funding may a person with communication difficulties receive for AAC services?

Funding through the Ministry of Health or ACC Signup and view all the answers

What is a key limitation of Facilitated Communication (FC)?

It relies on the facilitator's intent rather than the communicator's intent Signup and view all the answers

What emotion might Jean-Do experience due to his locked-in syndrome as described in 'The Diving Bell and the Butterfly'?

Frustration from being misunderstood Signup and view all the answers

Which of the following is a low-tech method to communicate plans for the weekend?

Sketching pictures to convey messages Signup and view all the answers

If confronting a non-literate person with a communication device, which strategy could be implemented?

Gesturing or showing images instead of text Signup and view all the answers

Who can refer clients to TalkLink Trust for AAC assessment?

SLTs, other clinicians, schools, ACC case managers or self-referral Signup and view all the answers

What is the typical life expectancy after a diagnosis of Motor Neuron Disease (MND)?

2-5 years Signup and view all the answers

Which type of MND primarily affects the muscles of speech and swallowing first?

Progressive Bulbar Palsy (PBP) Signup and view all the answers

What does voice banking involve?

Creating a synthesised voice that mimics a patient's voice Signup and view all the answers

At what age is MND most commonly diagnosed?

50-70 years Signup and view all the answers

What is the first noticeable symptom of Motor Neuron Disease (MND)?

Mild stumbling Signup and view all the answers

How many phrases are generally recorded in phrase banking?

50 or fewer phrases Signup and view all the answers

Which of the following is NOT a common type of MND?

Multiple System Atrophy (MSA) Signup and view all the answers

Which recording method can be used for storing voice banked phrases?

Dictaphone, mobile phone, or voice memos Signup and view all the answers

What is the recommended method for recording voices for voice banking?

Record in a quiet environment free of background noise. Signup and view all the answers

What is a quicker option for voice banking?

Recording 50 phrases quickly but with lower accuracy. Signup and view all the answers

What should people using AAC do while on BiPAP/CPAP?

Use a voice amplifier that connects to the BiPAP/CPAP mask. Signup and view all the answers

What is often necessary for maintaining nutrition in individuals with MND experiencing dysphagia?

PEG/RIG insertion to facilitate feeding. Signup and view all the answers

Which service can help with inserting recordings into future devices?

TalkLink. Signup and view all the answers

What resources are available for voice banking?

Various online platforms and tools. Signup and view all the answers

Which of the following is true regarding voice banking services?

The best service relies on individual speech abilities. Signup and view all the answers

What was introduced with iOS 17 that enhances speech accessibility?

Type to Speak feature. Signup and view all the answers

Study Notes

What is AAC?

AAC stands for Augmentative and Alternative Communication.
It encompasses all methods of sharing ideas and feelings without speaking.
Everyone uses AAC throughout their lives, even unknowingly.
People with severe speech or language difficulties often rely on AAC for most or all of their communication.
Some individuals use AAC for longer sentences or when communicating with unfamiliar people, even if they can speak some words.

Who Primarily Uses AAC?

People with developmental conditions including cerebral palsy, RETT syndrome, and autism.
Individuals who are deaf.
People with intellectual disabilities.
Those who have experienced a stroke or traumatic brain injury.
People with degenerative conditions like Motor Neuron Disease, Huntington's Disease, and Parkinson's.
Individuals who have undergone a laryngectomy.
Those with locked-in syndrome.

Types of AAC

No-Tech AAC: Sign language, gestures, head nodding, the "20 questions" game, and Partner Assisted Auditory Scanning.
Low-Tech AAC: Pen and paper, whiteboards, communication boards, communication books (e.g., PODD book). Primarily used in face-to-face communication.
Mid-Tech AAC: Voice amplifiers, step-by-step devices, switches, GoTalk, LightWriter. Primarily used in face-to-face communication.
High-Tech AAC: iPads with communication apps (TouchChat, Predictable, Speak for Yourself, LAMP Words for Life, Proloquo2Go), computers or mobile phones with communication software, dedicated communication devices (e.g., GridPad). Often involves alternative access methods like switch scanning, head tracking, and eye gaze. Enable both face-to-face and remote communication.

Key Considerations When Prescribing AAC

Linguistic Competence: Evaluate the person's receptive and expressive language capabilities.
Operational Competence: Determine their ability to access and independently program/edit the AAC system.
Social Competence: Assess their turn-taking and dyadic skills. Explore their communication problem-solving approaches.
Strategic Competence: Consider alternative vocabulary, prepared messages, and phrases they might utilize.

AAC Services in Aotearoa

TalkLink Trust: Provides AAC assessments and funding applications, employing SLTs, Occupational Therapists, and Technical Support staff.
Referral Sources: Clients can be referred by an SLT, other clinicians, schools, ACC case managers, or via self-referral.
Accreditation: AAC assessments require Communicative Assistive Technology (CAT) accreditation.
Funding: Depending on the cause of communication difficulties, AAC assessments and equipment are funded by the Ministry of Health or ACC.
Specialist SLTs: CAT-accredited SLTs outside TalkLink often collaborate to deliver AAC assessments.

SETT Framework

A framework to guide the selection, evaluation, and implementation of AAC for individuals.

Developing Your Own AAC System

Imagine waking up in a foreign country where no one speaks your language.
How would you communicate using a single piece of paper and pen without a phone, translation services, or an interpreter?

Facilitated Communication (FC)

A technique involving a facilitator guiding a communicator's hand for selections on a communication device (also known as "hand-over-hand").
Scientifically discredited: Evidence shows that the facilitator's communicative intent, not the intended communicator's, is expressed.
Some individuals still advocate for FC.

The Diving Bell and the Butterfly (2007)

A film about locked-in syndrome.
Observe how Jean-Do communicates.
Reflect on his feelings and the assumptions people made about him when he couldn't speak.

Real-Life Examples of AAC Use

Mke: (YouTube link provided)
Geneva: (YouTube link provided)

Motor Neuron Disease (MND)

Affects approximately 1 in 15,000 people in New Zealand, impacting over 400 people nationwide.
MND can strike individuals at any age, but most diagnoses occur after age 40, with the highest incidence between 50 and 70.
Average life expectancy after diagnosis is 2-5 years.
Early symptoms are often mild and dismissed: stumbling, difficulty holding objects, slurred speech, muscle twitches, cramps, increased emotional lability.
MND diagnosis is made by a neurologist through the elimination of other potential conditions.

Types of MND

Amyotrophic Lateral Sclerosis (ALS): The most common type, affecting both upper and lower motor neurons. Usually limb function is impacted first, followed by speech, swallowing, and breathing muscles.
Progressive Bulbar Palsy (PBP): The second most prevalent type. Impacts both upper and lower motor neurons. Typically affects speech and swallowing muscles first, with limb muscles affected later.
Rarer Forms: Primary Lateral Sclerosis (PLS) affecting only upper motor neurons causing lower limb weakness. Some cases develop into ALS.
Genetic Link: 5-10% of MND cases are believed to be inherited genetically.

Preserving Identity Through Voice and Phrase Banking

Voice banking: Records a specific set of phrases (50 to 3,200) used to create a synthesized voice that mimics the patient's voice.
Phrase banking: Records fewer phrases (typically 50 or fewer). These are replayed verbatim in the patient's device.

When and How to Phrase Bank

Early is Key: Start recording when their voice is strong; ideally early in disease progression and often during the day before fatigue sets in.
Recording Tips: Dictaphones, mobile phones, or iPhone voice memos can be used. Record in a quiet environment, free of background noise. Create a separate file for each recording.

How to Voice Bank:

TalkLink provides assistance.
Multiple voice banking options are listed and evaluated on the TalkLink website (link provided). The appropriate service depends on the client's current speech abilities and priorities.
There is funding available to purchase voices for use in AAC systems.
Try voice banking for yourself using www.modeltalker.org, https://mov.acapela-group.com/, or Apple Voice Banking.
The new "I Will Always Be Me" e-book records voice during reading about MND (link provided).

New iOS 17 Accessibility Features

Personal Voice and Live Speech: (YouTube link provided)
Type to Speak: (Apple support page link provided)
Speech Accessibility Features: (Apple page link provided)
Cognitive Accessibility Features: (Apple page link provided)

Communicating While on BiPAP/CPAP

Many individuals with MND may use BiPAP/CPAP for breathing support.
Those already using AAC can continue during BiPAP/CPAP use.
For those currently using speech, a HiSpeak voice amplifier designed to connect to the BiPAP/CPAP mask to amplify sound may be recommended. Contact TalkLink for details.

Dysphagia in MND

Almost all individuals with MND experience dysphagia (difficulty swallowing).
It may be one of the initial symptoms.
Medical treatment may be sought when swallowing becomes difficult and unintended weight loss occurs.
PEG/RIG insertions are often necessary to maintain adequate nutrition.

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Description

Discover the world of Augmentative and Alternative Communication (AAC) and its significance in facilitating communication for individuals with various speech and language challenges. This quiz explores what AAC is, the demographics that primarily use it, and the different types available, from no-tech to high-tech solutions.