Augmentative and Alternative Communication (AAC) PDF

Augmentative and Alternative Communication (AAC) SPSC113 – Week 10 Kenny Ardouin [email protected] What is AAC? AAC includes all of the ways we share our ideas and feelings without talking. We may not realise how often we communicate without ta...

Augmentative and Alternative Communication (AAC) SPSC113 – Week 10 Kenny Ardouin [email protected] What is AAC? AAC includes all of the ways we share our ideas and feelings without talking. We may not realise how often we communicate without talking…but we all use some AAC throughout our lives. People with severe speech or language difficulties may need AAC to help them communicate most or all of the time. Some people may speak some words but use AAC for longer sentences or with people they don’t know well.  Gesture We all use some Writing forms of AAC all the time… Text messaging Email etc. Who may primarily use AAC for their everyday communication? People with development conditions such as cerebral palsy, RETT syndrome etc. People with autism People who are deaf People with intellectual disability People who have had a stroke or traumatic brain injury (TBI) People with a degenerative condition – e.g. Motor Neuron Disease, Huntington’s Disease, Parkinson’s etc. People who have undergone a laryngectomy People with locked-in syndrome No tech Sign language Gesture Head nodding yes/no 20 questions Partner Assisted Auditory Scanning Low tech Pen and paper Whiteboard Communication boards Communication books – e.g. PODD book Predominantly used for face-to- face communication Mid tech Voice amplifier Step-by-step / BIGmack switches GoTalk LightWriter Predominantly used for face-to- face communication High tech iPad with a communication app – e.g. TouchChat, Predictable, Speak for Yourself, LAMP Words for Life, Proloquo2Go etc. Computer or mobile phone with communication software Dedicated communication device – e.g GridPad High tech may include alternate access options such as: Switch scanning Head tracking Eye gaze Can be used for face-to-face and distance communication Key considerations when prescribing AAC (Light and McNaughton, 2014) What is the person’s receptive and expressive language ability? Linguistic competence What is their cultural background/languages/dialect? How will this person access the AAC system? Operational competence Are they able to independently programme/edit their AAC system? Social competence How are this person’s turn taking and dyadic skills? How might they problem solve a communication problem? Strategic competence (E.g. is there alternative vocab they might use? Pre-prepared messages and phrases? etc.) AAC Services in Aotearoa TalkLink Trust – conduct AAC assessment and apply for funding Employ SLTs, Occupational Therapists, and Technical Support staff Clients can be referred by an SLT, other clinician, school, ACC case manager, or self-referral To perform AAC assessment, a clinician must have Communicative Assistive Technology (CAT) accreditation Depending on the aetiology of a person’s communication difficulties, their AAC assessment and equipment will either by funded via Ministry of Health or ACC. Some specialist SLTs outside of TalkLink are CAT accredited and work closely with TalkLink to deliver AAC assessment SETT Framework Develop your own AAC System Imagine you wake up and find yourself in a country where nobody speaks English – how might you develop a way to communicate? You have one piece of paper and a pen You don’t have a mobile phone, access to translation services or an interpreter Let’s practice using low tech AAC Use one of the low tech options to communicate to the people around you what you are planning to do at the weekend. What can you do if you can’t point to the board? What do you observe? Is it easy/difficult? Let’s try high tech AAC 1. Using your mobile phone or other device, without speaking, communicate your plans for the summer 2. Imagine that the person you’re communicating with cannot read – how might you overcome this? 3. Imagine that you are not literate, how might you overcome this to get your message across? A note on Facilitated Communication (FC) A technique which involves a facilitator guiding the communicator’s hand to help them make selections on a communication device (also referred to as “hand-over-hand” Has been scientifically discredited – evidence shows that it is the facilitator’s communicative intent not the intended communicator’s that is expressed Yet, some people are still active proponents of FC ASHA Position Statement: Facilitated Communication (FC) (asha.org) The Diving Bell and the Butterfly (2007) Locked-in Syndrome Consider how Jean-Do communicates How would Jean-Do have felt? What assumptions did people make about him when he couldn’t speak? Some real-life examples of AAC use Mke - https://www.youtube.com/watch?v=zUW_f0dQNtY Geneva - https://www.youtube.com/watch?v=rL0kdDtQFzQ Motor Neuron Disease Motor Neurone Disease (MND) Affects about 1 in 15,000 people in NZ (>400 people nationwide) MND can affect adults at any age but most people are diagnosed above age 40, with the highest incidence occurring between 50-70. Life expectancy after diagnosis is 2-5 years. Early symptoms are mild and often dismissed – e.g. mild stumbling, difficulty holding objects, slurring of speech, muscle twitches, cramps, increased emotional lability etc. There is no test for MND – a diagnosis (by a neurologist) is reached by eliminating other possible conditions Types of MND Amyotrophic Lateral Sclerosis (ALS) – the most common type, affecting both upper and lower motor neurones. Usually, limb function is impacted first with the muscles of speech, swallowing, and breathing following. Progressive Bulbar Palsy (PBP) – second most common type of MND, also affecting both upper and lower motor neurones. PBP typically impacts the muscles of speech and swallowing first, with limb muscles being affected later. Rarer forms include Primary Lateral Sclerosis (PLS) affecting upper motor neurones only, causing weakness in lower limbs – some cases of PLS develop into ALS. 5-10% of MND is believed to be inherited via a genetic link Preserving identity using voice and phrase banking Voice banking vs Phrase Banking Phrase banking – recording a few (generally 50 or fewer) phrases for future use in a speech-generating device. Phrase banked phrases are replayed verbatim in the patient’s device Voice banking – involves recording a specific set of phrases (50 to 3,200) which are then used to create a synthesised voice that sounds similar to the patient’s voice  The earlier the better! Make the most of when their voice is strong – e.g. early in disease progression, and typically earlier in the day before they fatigue When and Record onto a dictaphone, mobile phone, voice memos on iPhone etc. how to Record in a quiet environment free of phrase bank background noise Create a separate file for each recording TalkLink will assist with inserting these recordings into the future device  Refer to TalkLink for assistance There are multiple voice banking options which are compared and evaluated here: https://talklink.org.nz/resources/voice-banking-2024 The most appropriate service will depend on client’s current speech ability and where voice banking sits in their priorities – it is much quicker (but less accurate) to How to voice record 50 phrases than 3,200 for example! TalkLink clients recording their voices: bank https://www.youtube.com/watch?v=bvl6rsqTiWA There is funding available to purchase voices for use in an AAC system Try for yourself: www.modeltalker.org; https://mov.acapela-group.com/, Apple Voice Banking New “I Will Always Be Me” e-book records voice during reading a book about MND: https://iwillalwaysbeme.com/ New with iOS 17 Personal Voice and Live Speech: https://www.youtube.com/watch?v=owBzKbpi NjE Type to Speak: https://support.apple.com/en- nz/guide/iphone/iphcf92d2d9b/ios A swathe of new speech accessibility features: https://www.apple.com/accessibility/speech/ New cognitive accessibility features: https://www.apple.com/accessibility/cognitive/ Communicating while on BiPAP/CPAP Many people with MND will use BiPAP/CPAP when they are experiencing reduced breath support If they are already using AAC, they can continue to use this while on BiPAP/CPAP If they are currently still communicating using speech, a HiSpeak voice amplifier which is specifically designed to connect to the BiPAP/CPAP mask to amplify sound may be recommended (contact TalkLink)  Almost all people with MND will experience dysphagia It may be one of the first symptoms – people Dysphagia in may seek medical treatment as they notice it MND becomes difficult to swallow and they experience unintended weight loss PEG/RIG insertion is often necessary to maintain nutrition