AAC final

AAC is about what? not what?

language not about a device

AAC goal

autonomous communication

is there a standardized AAC assessment?

no

• Information gathering

• Formal Language Tests (adaptations)

• Informal Language Assessment (play, observation)

what should you consider in assessment?

• Consider low-tech and high-tech (no hierarchy)

• Access Methods (OT/PT/Rehab Engineer/ATP)

• ABC= Access Before Communication

• Hearing/Vision

• Fine Motor/Gross Motor/Positioning (OT/PT/Rehab Engineer/ATP)

• Language Systems

• Feature Matching

• Needs for Today and Tomorrow (5 year plan)

• Funding (academic vs medical/insurance)

what type of approach is AAC?

team, dynamic

who would you need to work with in assessment?

device consultants

other considerations for assessment

• Trial Periods/Rentals

  • justify you have made a decision and this person is fit for the device

• Templates from SGD companies

• Five-year plan is dependent on:

  • Developmental

  • Progressive Disorders (e.g., ALS)

Participation

• Endorsed by ASHA

• Based on the functional participation requirements of peers without disabilities who are the same age

• How do we remove barriers

• Looks at communication needs for today and in the future

candidacy

• Outdated model

• Based on prerequisites

• People were viewed as “too”

  • Too young, old, delayed…

• Gatekeepers of language/communication

• If you don’t have language or a reliable means of communication, how can you be “tested”

acquired

• Amyotrophic Lateral Sclerosis (ALS)

• Stroke/Aphasia

• Primary Progressive Aphasia (PPA)

• Dementia (Alzheimer’s)

• Traumatic Brain Injury

• Multiple Sclerosis

• Guillain-Barré Syndrome

• Parkinson’s Disease

developmental

Adults with developmental delays

rehabilitation/compensatory

acquired

habilitation

developmental

candidacy model

• Outdated model

• Based on prerequisites and what you can’t do

• People were viewed as “too” Too old, too young, too impaired

• Gatekeepers

• If you don’t have language or a reliable means of communication, how can you be “tested”

participation model

• Endorsed by ASHA

• Based on functional participation requirements of peers without disabilities who are the same age

• How do we remove barriers

• Looks at communication needs for today and in the future

2 types of Amyotrophic Lateral Sclerosis (ALS)

1. bulbar (brainstem)

2. spinal (limb)

bulbar (brainstem) ALS

• Speech and swallowing impacted early

• Dysarthria (slurred speech)

• May have intact limb movement*

spinal (limb) ALS

• Motor impairments in extremities*

• Mild dysarthria

both types of ALS…

• BOTH will eventually lose all ability to speak and move independently

• Extraocular muscles are usually unaffected*

• There might be some cognitive impairment or dementia

what is the typical cause of death of either type of ALS?

respiratory failure

life expectancy of ALS

2-5 years from time of diagnosis

Early Phase of ALS (monitor, prepare, support)

• Time of diagnosis

• Bulbar (brainstem)→Monitor speech rate, speech intelligibility

in the early phase of ALS, when should you initiate an AAC assessment?

Speaking rate of 125 wpm or speech intelligibility <90%

Early Phase of ALS: what do we do?

• Voice Banking/Message Banking

• Preserve communication as long as possible

• Amplification

• Speaking time for special occasions

• Smart Phone app

• Educate/Prepare

Middle Phase of ALS: Assess, recommend, implement

• Identify participation patterns and communication needs

  • (work, social, home, environment)

• Assess AAC needs (high/low tech)

• Help develop operational competence

• Partner support

Middle phase of Bulbar ALS

can still control AAC/technology

Middle phase of Spinal ALS

augmented writing system (work with OT, PT)

Late Phase of ALS: Adapt and accomodate

• Implementation of chosen AAC

• Assess changing needs and provide communication options (ongoing)

• Consider physical changes and adapt communication

Consider physical changes and adapt communication examples

• lying down more (work with OT/PT/ATP)

• what happens when they are out of their wheelchair? (OT/PT/ATP)

Language disorder that affects a person’s ability to communicate

Aphasia

Occur after a stroke, head injury, brain tumor

Aphasia

aphasia vs apraxia deficits

aphasia: Expressive and receptive deficits

apraxia: Impaired intelligibility

Brain disorder in which a person is unable to perform tasks or movements

Apraxia

Disrupts the sequential timing and coordination of articulatory movements

Apraxia

Neurodegenerative disease that causes gradual deterioration of language skills

Primary Progressive Aphasia

Aphasia, Apraxia, PPA recovery

• Recovery is on a continuum

• At each stage of recovery, there are different communication needs

• PPA will work on the opposite continuum

Aphasia, Apraxia, PPA: maximal support

signals for acceptance/rejection

Aphasia, Apraxia, PPA: transitional support

photos, visual scenes

Aphasia, Apraxia, PPA: specific/minimal support

a specific task (e.g., talking at a wedding)

“AAC will interfere with language recovery”

false

What is the role of AAC in Aphasia, Apraxia, PPA?

Caregivers/Communication partner to help co-create messages

__% of caregivers of Aphasia, Apraxia, PPA report any introduction to AAC within first 3 months

50%

What are we going to work on?

• NOT basic wants/needs, medical issues

• To remain socially relevant

• 9 general themes

9 general themes

1. Hobbies

2. Family

3. Travel

4. Work

5. Home/Places I’ve lived

6. Sports/Fitness

7. Religion

8. Animals

9. WWII

Social Media/Technology intervention→

share photos, tell a story can synchronous or asynchronous

Share photos intervention→

visual scenes (hi-tech), wallet of photos (low- tech)

Story Telling intervention→

visual scenes (hi/low tech options)

If someone can’t understand you→

gesture, write

Input/Comprehension intervention→

gesture, write keywords, draw, first letter/letter board (augmented input)

Written Choice intervention→

partner scanning

Pre-stored messages examples

hello, I have aphasia, please give me time

Guillain-Barré Syndrome tx:

short-term, low-tech options, yes/no, eye blinks

Parkinson’s Disease tx:

assistive technology (e.g., speech amplifier)

Multiple Sclerosis tx:

assistive technology, specific to the individual

Instructional Procedures

• Responsive Social Pragmatic Intervention

• AAC Modeling

• Explicit Instruction

• Milieu or Incidental Teaching

• Strategy Instruction

• Coaching

Responsive Social Pragmatic Intervention

• Respond to the child’s communicative attempts and modeling targeted skills

• Naturally occurring interactions in response to child’s interests

• Flexibly structured

AAC Modeling

• Aided language input+spoken output

• This is used across instructional approaches

Explicit Instruction

• Highly structured

• Based on principles of ABA

• Discrete trial training (DTT)/Requesting (mand)/Labeling (tact)

Milieu or Incidental Teaching

• Explicit teaching + Natural environment

• Manipulate the environment, target specific communication goals, utilize prompting techniques, respond to the individual's communicative attempt

• Milieu = a person’s social environment

Strategy Instruction

• Coaching

• Typically with those with acquired conditions

• Learning more advanced communication strategies and skills

• Modeling, demonstrations, coaching, prompting, explanations, discussions

• Used with those who have the metacognitive skills to analyze and talk about their communication

Coaching

• Explanations of targets and strategies

• Often used with caregivers

• Part of the ECI model

Common in classrooms

referential vs descriptive teaching

referential

Focus is on critical concepts and specific vocabulary

referential vs descriptive teaching

referential

Students answer questions with curriculum content words

referential vs descriptive teaching

referential

Close ended questions

referential vs descriptive teaching

referential

referential teaching

Traditional approach

AAC→ curriculum specific vocabulary programmed into the device

Question→correct response

however… referential teaching is

Developmentally appropriate. Not chronologically appropriate.

• Flexibility in language! (dev at 1-2 word stage but can expand to communicate so much)

• You’re not a programmer! You’re a skilled language therapist

Those words are used for a short time→

revolving vocabulary (not used in all contexts)

Teaches the concepts behind the context

referential vs descriptive teaching

descriptive

Use high-frequency, common words→core words

referential vs descriptive teaching

descriptive

Open-ended questions

referential vs descriptive teaching

descriptive

descriptive teaching example

HUNTING

• 1-word→food

• 2-word→ get food, food get

• 3-word→ go get food, go find food

Gail Van Tatenhove Descriptive Teaching videos

She uses the content specific words, and her learners describe it

Do AAC users ever get to learn and use the words Photosynthesis and igloo?

yes, we just need to see where they are on the tiers of vocabulary

tier 3

low-frequency words that are content specific

tier 2

robust, high-frequency words that students encounter across the content areas and topics. Often have multiple meanings and are referred to as academic vocab words

tier 1

basic, familiar words that commonly used by most students in everyday conversation

how to do prompts and cues

wait time→indirect (or less direct) verbal→gesture and/or direct verbal→ model

emergent AAC: hierarchy of learning needs

prompts and cues (need everything below first)

• natural and target feedback

• response to any AAC as meaningful

• interesting and engaging contexts

• modeling without explanation

• relationship and connection

what assumes there is something the AAC user is doing “wrong!?”

Most to Least prompting

They’re not getting it, so we must provide more prompts.

The responsibility is on them…

It’s not them… It’s you…or your activity…or your connection…

A potpourri of strategies

• Make it relevant to them (adults/peds)…this might seem obvious…but…lets talk about the word fart!

• Child centered…follow their lead…does not mean it’s a free for all…there is a difference between play and therapy

• Quit asking so many questions! If you do…don’t ask yes/no questions or closed ended questions

• WAIT

• Make things into comments…

• WAIT

• Make it functional (e.g., coins in a bank vs coins in a soda machine)

Beware of symbolated text (what is that?)

​Symbol Supported Text, sometimes called Symbolated Text, is the practice of adding picture symbols above or below each word or phrase in text based materials meant to be read. (It does not apply to symbols in AAC systems.)

what is making a big comeback right now?

spell to communicate

cases of abuse

facilitated communication

Other topics…Visual Impairment

VI teachers (TVI) & HOH/HUH…use with caution

organization framework of AAC

• special education (bigger umbrella- other services)

• department of AT (communication support, not every district will have this)

• speech and language department (will for sure have this)

• AAC specialist + SLPs

SELPA

Special Education Local Plan Agency

maintain/manages of IDEA, run differently depending on funding (can get sticky when families move states)

Guidelines from federal law that allows students to have services

IDEA

State law

Texas Education Agency (TEA)

Will be different representations of IDEA from each state

Assessment

• Referral

• Assessment Plan

• Conduct Assessment

• Report Results via IEP

• Device Recommendation

• Device Delivery

4 main parts of AAC treatment

1. Device awareness

2. Appropriate goals & implementation of goals

3. Team education & Collaboration

4. AAC Supports & Resources

assessment process

referral→ AP received→ complete assessment→ IEP meeting→ create/distribute AAC system

referral

• parent/guardian or school team referral

• assessment plan generated

AP recieved

• 60 day timeline starts

• AAC assessment begins

• IEP is scheduled

complete assessment

• team interviews

• direct assessments & indirect assessments

• AAC device trials & analysis (depends on what the district has available)

IEP meeting

• assessment report is reviewed

• recommendations are discussed

• parent/guardian consent or no consent

create/distribute AAC system

• if consent given, AAC system is built

• team trainings scheduled

• AAC system is distributed to student

AAC system awareness building

• student’s system and AAC history

• student’s awareness of their device

• teams awareness of student’s communication modality

kotter’s 8 step model is for…

cultivating credibility & change

1. Build coalition

2. Form a strategy to get device

3. Enlist your army

4. Enable action

5. Generate STG

6. Sustain acceleration

7. Institute change

8. Create a sense of urgency

our role: programming and trouble shooting

• personalizing (setting, classes)

• increasing motivation (restaurant they like, friend’s name)