Augmentative Alternative Communication PDF

AUGMENTATIVE ALTERNATIVE COMMUNICATION IRUM NAWAZ M.Sc (Clinical Psy), M.S (SLP/T), Pg.D (Teaching Methodology) PECS Certified, DHA Accreditation ID 1620/18 [email protected] FACULTY OF...

AUGMENTATIVE ALTERNATIVE COMMUNICATION IRUM NAWAZ M.Sc (Clinical Psy), M.S (SLP/T), Pg.D (Teaching Methodology) PECS Certified, DHA Accreditation ID 1620/18 [email protected] FACULTY OF REHABILITATION AND ALLIED HEALTH SCIENCES  Emerging An "Emerging" communicator does not have a RELIABLE method of EXPRESSIVE communication through SYMBOLIC language  Emerging  RELIABLE communication means that the individual is able to communicate what he/she intends (plan) to communicate; there are no accidental selections that result in unintended messages. Reliability is crucial to independence.  EXPRESSIVE communication is emphasized because this model is based on OBSERVABLE communication behaviors: how an individual uses symbolic language. It is not based on how well he or she understands language, something that may or may not be known for emerging communicators.  SYMBOLIC LANGUAGE does NOT mean just using visual symbols. Instead, it means using something to REPRESENT or SYMBOLIZE a concept, idea or thought.  For example, sounds symbolize meaning in our speech while letters and words represent meaning in our writing, and in AAC we use symbols you can hear, see or feel. Symbolic language permits us to talk beyond the "here and now" about things in another time or place.  In contrast, non-symbolic communication is limited to the "here and now," for example, using pointing and gestures to respond to what one sees, hears or feels in the immediate environment.  Emerging non-symbolic communication strategies such as gestures, body language, facial expressions and familiar partners to figure out what is meant by these signals. perhaps a way to signal "acceptance" (e.g. a smile, or reaching for something) and "rejection" (e.g. head turn away, pushing away, etc.), but the individual does not have a reliable method of answering other yes/no questions. trials of AAC strategies or devices may or may not be happening, but performance is still inconsistent.  Emerging Pre- or early symbolic level, non-literate, pre- intentional Are very reliant (dependent) on communication partner and structured context May be at cause –effect / early choice making level May have severe to profound developmental delay/mental handicap/intellectual disability Are often motorically involved or severe autistic or severe sensory (vision, hearing) impairment. What might limit someone to only "emerging" communication skills? System doesn't match motor capabilities Hidden hearing impairment Hidden vision impairment Low expectations of other people Lack of opportunities to communicate Lack of AAC services Belief in unreliable methods of communication  Case Study A 65-year-old man had a CVA six months ago, resulting in severe aphasia and apraxia of speech. When the SLP first met him, he had very garbled speech and confused yes and no in his replies to questions. He also had significant right-side hemiplegia. He had no reliable method of communicating beyond the here and now, no symbolic communication. He is an re-"emerging" communicator, because he has only non-symbolic methods of communication.  Context Dependent A "Context-Dependent" Communicator has SYMBOLIC COMMUNICATION that is RELIABLE, but it is limited to particular CONTEXTS or PARTNERS  Context-Dependent  SYMBOLIC COMMUNICATION: "symbolic" communication does NOT mean the use of visual symbols. It means any communication in which something (e.g. a word, sign, picture, etc.) represents a concept or meaning. For example, sounds symbolize meaning in our speech while letters and words represent meaning in our writing, and in AAC we use symbols you can hear, see or feel. Symbolic language permits us to talk beyond the "here and now" about things in another time or place.  RELIABLE: means that the individual is able to communicate what he/she intends to communicate, not accidentally push another key or convey a message that was not intended.  LIMITED CONTEXTS: this means that the individual is only able to talk about certain topics and/or only able to communicate in certain settings or activities, e.g. snack time, circle time (for kids) or in speech therapy (for adults).  LIMITED PARTNERS: this means that the individual is able to communicate only with some people in daily life, e.g. with mom (for kids) or a spouse (adults).  Context-Dependent AAC techniques with vocabulary chosen by others, for example: symbol displays word boards communication books communication devices OR AAC strategies that are effective only with familiar partners, for example severely unintelligible speech strategies that require learning by the partner (e.g. eye-gaze, partner assisted scanning, etc.) devices with output that is not useful with strangers (e.g. devices with poorly intelligible speech output or screens that are unreadable outdoors). http://bridgeschool.org/transition/multimodal/partner_assist_scan.php  Context-Dependent Are pre-literate or early literate Are intentional symbol users with reliable symbolic communication skills Rely on context-dependent communication strategies May have a moderate intellectual disability or have highly unintelligible motor speech skills (apraxia) or more typical development but delayed speech May have motor impairments  What might keep someone from advancing to "independent"? Limited spelling ability Vocabulary - for only particular contexts Vocabulary - not personal or useful Limited experience with new partners Limited opportunity to practice communication in natural contexts Hidden hearing impairment Hidden vision impairment Mismatch of device and motor control Fear of AAC techniques Low expectations of other people Lack of opportunities to communicate Lack of AAC services  Case Study A 69-year-old male who was a mechanical engineer until he had a severe CVA in 1999. Following this stroke, he had moderate non-fluent aphasia with apraxia of speech, coupled with limb apraxia and right hemiparesis. Hearing testing showed a high frequency hearing loss, but amplification was not recommended. He was able to use a combination of communication methods to supplement his speech, including: gestures, writing/drawing, and a communication notebook. He demonstrated that he had reliable symbolic communication, but he was dependent on the vocabulary provided by others and his best listeners had to be taught to attend to multiple modalities. He was a context-dependent communicator, but his effective communication was limited to a few partners in fairly narrow contexts.  Independent Independent Communicators are not limited in what they can talk about or whom they can talk to. They can communicate with both familiar and unfamiliar partners. And if they don't have the right vocabulary preprogrammed, then they can use spelling to communicate exactly what they  Basically, Independent Communicators have… The ability to communicate anything on any topic to anyone in any context.  Communication Is Not Independent If…….  Utterances can only be understood by some people  Other people have to preprogram all vocabulary in a system  He/she cannot spell well enough to compose novel utterances  He/she is given no opportunity to communicate what he/she wants to say  Her/his communication system doesn't match her/his motor skills making it difficult to control  Her/his communication system doesn't match her/his communication needs  There are partners who influence communication through cueing  He/she has hidden vision impairments making it hard to see the symbols  He/she has a hidden hearing impairment making it difficult to hear what is said  He/she has been given insufficient training and time to learn to use AAC system  He/she Adapted has no from UW Augcomm access to a communication system at times at http://depts.washington.edu/augcomm/03_cimodel/commind1_intro.htm  Case Study A 59-year-old woman with cerebral palsy has dysarthria and significant motor impairments. She participates in all aspects of her daily life and is also a public advocate for people with disabilities, lobbying the state legislature about employment, health care and housing issues. She uses a number of communication modalities. With familiar partners, she relies primarily on her speech, plus some limited signs and gestures. Unfamiliar listeners typically cannot understand her speech, so she uses a Pathfinder. However, she is not a proficient speller; she only acquired 2nd grade spelling ability, not quite what is needed for communicative independence. Because she cannot spell very well, she is a context- dependent communicator. She can communicate anything she wants through her speech, but ONLY to her husband, the only person who can understand her really well. With unfamiliar people, she is limited to vocabulary that has been preprogrammed by others.  Case Study Young child with severe spastic-athetoid cerebral palsy with essentially no volitional control over his hands, arms, head, legs, feet, or eyes. Communication is limited to facial expressions and body postures, but even those movements are full of non-volitional movements. His family is able to read a smile for "acceptance" and a frown for "rejection“, but the rest of the team cannot distinguish these signals from non-volitional grimaces of the face. He is an "emerging" communicator, because he has only non-symbolic methods of communication and has no reliable method of symbolic language. What should we do to help him become more than a emerging communicator? Thank You!