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Augmentative & Alternative Communication AAC Overview  What is AAC? AAC refers to an area of research, clinical, and educational practice. AAC involves attempts to study and when necessary compensate for temporary or permanent impairments, activity limitation, and participation restrictions of pe...

Augmentative & Alternative Communication AAC Overview  What is AAC? AAC refers to an area of research, clinical, and educational practice. AAC involves attempts to study and when necessary compensate for temporary or permanent impairments, activity limitation, and participation restrictions of persons with severe disorders of speech-language production and/or comprehension, including spoken and written modes of communication. American Speech-Language-Hearing Association. (2005). Roles and responsibilities of speech-language pathologists with respect to augmentative and alternative communication: Position statement [Position Statement]. Available from www.asha.org/policy What is AAC? A system, not a single entity. It involves an ongoing program of decision-making that considers – individuals, – their method of communicating, – and the effectiveness of that communication with a variety of listeners, as well as – environmental variables that foster or impede communication. The Two A’s of AAC Augmentative – adds to natural speech Alternative – instead of natural speech  AAC: What is the Point? NOT to find a technological solution to a communication difficulty… …but to effectively serve as a by-pass of body parts that are not working due to illness, injury, or disability. Effect on Natural Speech Research has shown that using AAC does not stop individuals from using or continuing to develop natural speech – it actually increases it. – Millar, Light, & Schlosser, 2006; Schlosser & Wendt, 2008 Who Uses AAC? American Speech-Language-Hearing Association (ASHA), as well as the National Joint Committee (NJC) for the Communication Needs of Persons with Severe Disabilities supports the idea that all people have a basic right to use communication as a means of affecting how they live. Zero exclusion policy for AAC as long as there is a discrepancy between communication needs and abilities.  The AAC Team Speech-language pathologist Physical therapist Occupational therapist Vision therapist Teacher Parents/spouse/children Psychologist Behavior consultant Employer Social worker Case manager  Who Uses AAC? Congenital/ Acquired developmental causes impairments – Intellectual disability – Amyotrophic lateral – Cerebral palsy sclerosis – Autism – Traumatic brain injury – Childhood apraxia of speech – Stroke – Genetic disorders – Spinal cord injury – Multiple sclerosis  Purposes of Communication (Light, 1988) 1. Communicate needs/wants 2. Information transfer 3. Social closeness 4. Social etiquette Most communication interactions have multiple functional goals.  Types of AAC Systems Unaided requires no external device/item – signs (e.g., AmerInd, ASL, Signed Exact English). – gestures – facial expressions Aided requires external device/item for communication. – actual objects – pictures – line drawings – orthography  Types of AAC Systems The types or forms of AAC can be broadly organized into two categories (1) unaided and (2) aided. The choice of AAC is determined by the person’s needs, abilities and communication environment. Effective AAC system: Has high intelligibility Is comprehensible Is efficient  Types of AAC Systems Unaided communication is sometimes referred to as ‘no-tech’ AAC because there is no technological support required. The person uses whatever is available to them using their own body. This may include sign language, gestures, eye gaze, facial expressions, and tone of voice.  Types of AAC Systems The use of aided AAC involves some form of external device to support communication. Aided AAC devices can be classified according to the general categories of (1) low technology and (2) high technology. Types of AAC Systems: Aided (low- tech) Types of AAC Systems : Aided (high-tech) Speech-Generating Device (SGD)  Types of AAC Systems : Aided (high-tech) Dedicated system A dedicated system is one that has been created exclusively for communication—the only thing it does is speak. Open system An open system is one that is multifunctional (e.g., tablet or hand-held device). Not only does the system speak but also has all the features and functions of a regular computer (e-mail, word processing, web surfing). Components of AAC An AAC system is an integrated group of components that are used by individuals to enhance communication. This includes: 1. Symbols 2. Aids 3. Strategies 4. Techniques Symbols Something that stands for or represents something else. The symbol could use visual, auditory, and/or tactile representation of conventional concepts. 24 Symbols & Iconicity Continuum  Iconicity Transparent – visually resemble the referent (shape, motion, function) – highly guessable Translucent – relationship perceived – not readily guessable Opaque – no symbol-referent relationship, may be arbitrary PILL Grab a sheet of paper and a writing implement. Write numbers down the side (1-13). Don’t forgot your open and creative mind! Symbol-guessing activity Aids A device (electronic or not) that is used to transmit or receive messages. – a choice selection between two photographs affixed to a sheet of paper – a communication book – a single message recorded on a single switch-activated device – relatively complex technologic presentations of numerous symbols that can be combined to convey an infinite variety of meanings.  Strategies The ways in which messages can be conveyed most effectively and efficiently. Strategies may: –Enhance message timing, –Assist grammatical formulation of messages, and/or –Enhance communication rate.  Techniques The ways that messages can be transmitted. Direct selection: choosing desired symbols without intermediate steps; a one-to-one relationship between the motor act and the resultant selection touch (pointing) with finger, toe, headstick/pointer eye gaze or head mouse pick up and exchange voice input Indirect selection: involves multiple steps to choose desired symbols scanning coded access (e.g., Morse code) AAC: Length of Use Temporary – for patients with temporary loss of communication abilities tracheostomy tube post-surgery intubation Permanent dysarthria aphasia apraxia Assessment History, interview No standardized tests exist to fully evaluate candidacy for AAC, but need to determine both current and future capabilities: – cognition – physical ability – vision – hearing – language – speech Assessment Trials with various systems. Feature matching – AAC systems are selected based on relationships between an individual’s capabilities and communication needs in relation to various features of the system. Treatment Goals Operational competence – learning how to use the system; using the AAC system. Linguistic competence – An adequate level of mastery of language for communication. Communicative competence – ability to functionally communicate within the natural environment and to adequately meet daily communication needs. Treatment May need to train how to use access method. Determining which symbol set is appropriate. Determining the vocabulary for the system. Determining the most efficient and effective layout of the system. Treatment Functional –make choice –yes/no –communicate basic physical needs/emotional status –communicate self-care or medical needs –use a basic spoken vocabulary and short phrases –engage in social communication with family & friends –engage in communicative interactions in the community –utilize conversational language skills –talk on the telephone –respond to emergencies Treatment Best way to teach a system is to use it during communication or functional activities. Augmented communicator needs to learn how to use chosen system. People close to augmented communicator need to learn how to use the chosen system. – One of these very familiar listeners (or the augmented communicator, if appropriate) should also learn troubleshooting for the system.