SHS 473 Midterm

AAC

Augmentative and Alternative Communication

Augmentative Communication

supports (augments) speech

- speech and AAC

Alternative communication

replaces speech

- Only AAC

Four purposes of communication

1. Communicating wants and needs

2. Transferring information

3. Expressing social closeness

4. Expressing social etiquette

Communication wants and needs (purpose of communication)

Goal: Regulate the behavior of the listener towards an action-oriented response

- asking for food or help

Transferring Information (purpose of communication)

Goal: Share information

- give directions, how to ask someone to prom, etc.

Expressing Social Closeness (purpose of communication)

Goal: establishing, maintaining, and/or developing personal relationships

- content is less important than the interaction itself

Expressing social etiquette (purpose of communication)

Goal: conforming to social conventions of politeness

- hello, goodbye, etc.

Who needs AAC?

- Developmental disabilities (ASD, CP)

- Acquired disabilities (TBI, spinal cord)

- Progressive neurological conditions (ALS, MS, Parkinsons)

- Temporary conditions (ventilator)

Who can benefit from AAC?

People who are unable to meet their daily communication needs through speech alone

- in all contexts with all communication partners

- in some contexts

- with some communication partners

- at certain times of the day

- temporarily

- part time AAC users

Unaided AAC

Any system that does not require an external object

- Only requires what is on your body

Unaided AAC

- voice and speech

- sign systems (ASL) and languages

- gestures, body language, facial expressions

Advantages of unaided AAC systems

- No financial barriers

- options for vocabulary (depending on the system)

- mobile

- available all of the time

- range of expression

Disadvantages of unaided AAC systems

- difficult to communicate with partners you are not familiar with

- cannot explain/hard to communicate

- not universal

- requires motor movements

- can be limiting

Aided AAC

requires objects

Types of Aided AAC

low tech, high tech, mid tech (simple digitized systems

Low-tech aided AAC

- not computer based

- no battery

Ex:

- communication boards and books

- letter boards

- symbol card systems

- visual schedules

- pen and paper

Advantages of low-tech systems

- cost effective

- easily accessible

- easy to understand

- more vocabulary options

Disadvantages of low-tech systems

- simple communication

- motor abilities may limit

- pieces can get lost

- no voice output

- time demand of creating new vocabulary

High-tech aided AAC

- Computer based

- has a battery

- may or may not also give visual output on screen

- dynamic or static displays

Ex:

- speech generating device

- produce spoken or written output by speech synthesizers, digitized speech, and/or printers

Advantages of high-tech aided AAC systems

- easy to understand

- voice output

- easy to add new vocabulary

- can keep up with language development

Disadvantages of high-tech aided AAC systems

- difficult for child to use

- expensive

- hard to obtain

- have to bring this with you everywhere

- training required

- constant programming

- charging

- partners have to be familiar

- can break easily

- technology issues

Dynamic displays

touch the screen and it moves

Static displays

touch the screen and it stays how it is

Mid-tech aided AAC systems

- simple digitized systems

- use simple technology and recorded speech

Ex: button that makes noise

Multimodal communication

the simultaneous use of both verbal and nonverbal aspects of communication

Ex: using speech and a device

Communicative Competence

the ability to efficiently and effectively transmit messages in all interactions based on individual interests, circumstances, and abilities

4 Communicative Competencies (Light, 1989)

1. Linguistic

2. Operational

3. Social

4. Strategic

Linguistic Competence

about receptive and expressive language skills and the linguistic code of the AAC system

- related to language

- people with limited speech need to understand the language of their partners and speak the code of their system

- need to know where to find the words on their device

Operational Competence

about the technical skills needed to operate the AAC system

it includes:

- designing layouts and displays

- protecting the device

- repairing the device

- updating vocabulary to meet communication needs

*partners take on a lot of the responsibility

Social Competence

- about initiating, maintaining, developing, and ending interactions

It includes:

- giving and taking turns

- communicating to request/reject

- engaging in different coherent and cohesive interactions

Strategic Competence

- describes the strategies people with CCN use to manage the limitations of AAC

It includes

- resolving communication breakdowns (by confirming/denying messages)

- compensating for slow speaking rates

What else does communicative competence also depend on?

Psychosocial factors (intrinsic) and environmental factors (extrinsic)

Psychosocial factors (intrinsic)

motivation, attitude, confidence, resilience

- may require intervention to foster these as protective factors

Environmental factors (extrinsic)

environment, communication partners, policy, practice, attitude, skill, knowledge barriers

Feature Matching

For each priority context, determine client's system requirements based on his/her needs and skills

- Matching features of the AAC system to the needs and skills of the individual

- NOT fitting the individual to the system

Feature Matching: Representation

- Symbols: how to represent language

- symbols always represent something else

- the "something else" is called the referent (the symbols all mean something else)

- symbols should have a consistent meaning --> everyone understands it

- can represent a range of emotions, ideas, objects, etc.

Iconicity

an association that an individual forms between a symbol and its referent

- is a continuum from transparent to opaque

Transparent (most iconic - easy to understand) --> translucent (in between) --> Opaque (least iconic - hard to understand)

More iconic =

easier to understand

the _____, _______, or _____ of the _______ is obvious that the meaning of transparent symbols can be guessed in the absence of the _______

shape, motion, or function

referent, referent

________ symbols might have an obvious relationship to their referents, but the relationship becomes obvious after the viewer knows the meaning

translucent

_________ symbols have no obvious relationship to their referent

opaque

The meaning of any given symbol is mediated by factors that are __________ to the viewer

intrinsic

Ex: generation, age, gender, culture, language, etc.

people prefer _________ symbols

personalized!

Unaided symbols

do not require external objects

- speech, vocalizations, gestures, signs

* referent that is consistent

Aided symbols

require external objects

Ex: 2D and 3D tangible symbols

3D symbols

real objects, miniature objects, partial objects, other tangible symbols

2D symbols

photographs, line drawings, orthography

Feature Matching: Organization

Organization of language concepts in physical space of AAC technologies

- design layout

- display type

- grouping of symbols

Traditional grid displays

organize symbols in rows and columns

VSD

visual scene display

Visual Scene Display (VSD)

pictures or photographs that organize symbols into specific contexts

- highly personalized

- contain extensive context to support understanding

- support conversation and social interaction, learning, and general communication activities like play, storytelling, and participation

- must contain a person

Hybrid displays

combine traditional grid displays with VSDs

Organization: Type of Display

Static/Fixed

a display in which the symbols or items on the board or overlay are "fixed" in a particular location

Organization: Type of Display

Dynamic

a display in which the symbols or items available on the board or overlay change depending on user input

Organization: Type of Display

Traditional Orthographic

Systems that use traditional orthography (usually letters) as a means of input and output

Organization: Grouping of Symbols

1. Physical characteristics

2. cognitive organization

Cognitive Organization

the organization of symbols within the display

Cognitive organization: Schematic organizations

- organized by context

*EX: Superbowl --> many vocabulary words that relate to this specific thing.

* win, touchdown, team, football, yay, halftime, etc.

Cognitive organization: Taxonomic organizations

- organized by category

*EX: 4 box screen that says: play, sports, school, and home.

*Select "sports" - it would then show the words football, baseball, soccer, and swim.

- If talking about the Superbowl, you hit football and then you will be taken to a screen that has many vocabulary words relating to that.

Cognitive organization: Semantic-syntactic organizations

- organized by word order (to support sentence structure)

* EX: If we are thinking about football, when making a sentence, you will have pronouns, then verbs, then nouns, and adjectives that relate.

* The columns are organized in a particular way to make creating a sentence easy

Cognitive organization: Alphabetic organization

organized by alphabet/letter

Cognitive organization: Idiosyncratic organizations

Organized by the individual

Feature Matching: Selection

Access method

- physical means by which the user controls the communication system

Feature Matching: Output/Feedback

any auditory or tactile response from the system

The Participation Model

provides a framework for AAC assessment and intervention

allows teams to gather the information they need to plan interventions for people with limited speech and their families

What does the Participation Model do?

- identifies communication needs

- assesses skills

- identifies partner interaction strategies that support communication and environmental barriers that impede it

Valid

means the assessment measures what it is supposed to measure

Reliable

means the results are consistent

AAC assessment

allows teams to gathers information they need to plan interventions for people with limited speech and families

- must be valid and reliable

Communication Needs Assessment

determines the AAC system

- unmet communication needs determine contexts and skills that are priorities for intervention

Purposes of a communication needs assessment

1. Determine the type of input the person with CNN needs to understand

2. Determine with whom, when, where, why, about what, and how the person with CNN needs to communicate

3. Describe communication patterns and identify unmet communication needs

4. Review unmet communication needs and identify priorities for intervention

Procedures for completing a communication needs assessment

- interviews

- social networks

- communication need surveys and/or ecological inventories

Procedures for communication needs assessment: Interviews

planning an interview- draft your interview questions

the purposes of a communication needs assessment - what questions with you ask a person with CNN and/or their family to determine their communication needs

Ex: who they communicate with? what can they not communicate?

Procedures for communication needs assessment: Social Networks

- life partners

- close friends and relatives

- acquaintances

- paid workers

- unfamiliar communication partners

center the family in their system: a framework to promote family centered AAC services

- family and ecological systems

= microsystem, mesosystem, exosystem, macrosystem, chronosystem

Procedures for communication needs assessment: Communication needs surveys and/or ecological inventories

ecological inventories are systematic observations -- observe the person with limited speech across environments and consider both communication obligations and opportunities compared to peers without disabilities

Ecological inventories

- observe and/or record the person with CCN and review notes/videos

- observe peers without disabilities participating in the same activity

- write a step by step list of the required communication skills

- assess the skills of the person with CCN against

Techniques to determine priorities for intervention

- interviews

- talking mats (give a topic and tell them to say what they like doing and do not like doing)

- rating scales

- observation of affect (to figure out what they are interested in)

- offer choices

Communication skills assessment

describes a person's skills across sensory-perceptual skills, motor skills, receptive language, expressive communication, symbol representation, literacy, and cognitive organization

what does a communication skills assessment require?

requires professionals with knowledge and skills across disciplines

Purposes of a communication skills assessment

- identify sensory-perceptual limitations that might affect intervention

- assess the person's comprehension of spoken language

- determine the effect of augmented input to support comprehension (as needed)

- determine the person's current expressive communication skills

- determine the person's symbol representation skills

- assess the person's cognitive organization

- determine functional positioning and describe motor skills related to the use of aided and unaided communication

- determine appropriate access to aided communication systems (as needed)

Procedures of a communication skills assessment :sensory-perceptual skills

- assess vision skills to determine access to systems and strategies

- Visual acuity - how clear is their close up and distance vision

- Visual field - might only see one side, visual field cut (something in the brain)

- assess students' hearing skills to determine access to systems and strategies

- assess students motor skills to determine access to systems and strategies

Procedures of a communication skills assessment: comprehension of spoken language

- "point to tree"

- standardized assessments like the Receptive One-Word Picture Vocabulary Test often need to be adapted - they will not be scored against the norming sample but instead used to describe receptive language skills (ex: receptive vocabulary or comprehension)

- conduct systematic observations of receptive language performance in daily interactions (like understanding prepositions, in and on

- implement informal, criterion-referenced assessment tasks (ex: put batman on the box)

- complete dynamic assessment of the effect(s) of augmented input

Procedures of a communication skills assessment: Expressive communication

- systematic observations of interactions

- inform eliciting contexts to describe specific skills

Ex: does he understand the words "go, stop, and crash"

* Materials for eliciting contexts (understanding and use of 2-word utterances)

Goals of an expressive communication assessment

- identify turn-taking patterns

- initiating/response patterns

- range and frequency of communicative functions

- range and frequency of the person's modes of communication and the effectiveness

- efficiency and appropriateness of each mode

- the content and form of communicative messages

Test-Teach-Retest Model

Test: place objects in a crash, ask, "what happened"

Teach: model using the communication board and say "the ambulance crashed"

Retest: place objects in a crash, ask, "what happened"

Procedures of a communication skills assessment: Symbol representation

- Identify concepts the person understands

- Identify concepts of interest to the client (will relate more to her functional communication; motivational factor; can be gathered in interviews with family, teachers, and other people in her life)

- Choose a range of concepts for testing (objects, people, descriptors, actions, locatives, questions, social words)

- Choose appropriate symbols to represent concepts (type of symbol should be appropriate, and specific representation should be appropriate)

Goal of a symbol representation assessment

identify types of symbols that the client understands as representation of concepts

Tasks to assess symbol representation

- Receptive language

- Yes/no tasks ("Is this a...")

- Visual matching tasks

- Question/answer tasks

- Request format

- Use dynamic assessment across tasks

*test, teach, retest - and record everything

Tasks to assess symbol representation: Receptive language

Say "Show me ______" (understand instructions, spoken words/vocab)

Ex: Show me cookie monster. There are two different characters

Tasks to assess symbol representation: Yes/no tasks

Present one symbol and ask, "Is this _______?"

- Provide two or more symbols with the referent and say, "Match it"

Ex: Show a picture of chocolate milk and ask "is this chocolate milk?"

Tasks to assess symbol representation: Visual Matching tasks

Provide two or more symbols with the referent and say "match it"

Most transparent: give them an apple and a strawberry and the actual object

Less transparent: Give line drawings of an apple and banana and ask them to match to the object apple

Opaque: show an apple and ask them to match the picture of the apple to the written word "apple"

Tasks to assess symbol representation: Question/answer task, Request

- say "what's mom doing?"

- Request: say "what do you want?" or "whats next?"

Ex: have them choose between two items - broccoli or goldfish

Goal of cognitive organization

Identify appropriate organization of symbols within aided systems

- schematic organizations

- taxonomic organizations

- semantic-syntactic organizations

- alphabetic organizations

- idiosyncratic organizations

Procedures to assess cognitive organization

- sorting tasks (how does he categorize things together)

- pairing tasks

- trial system use and evaluation (trial different organization systems)

Purposes of a communication partners/environment assessment?

- identify the partner interaction

Two types of communication barriers the Participation Model identifies:

- Opportunity barriers

- Access barriers

Opportunity barriers

imposed by people other than the person with CCN and cant be resolved by providing an AAC system and intervention

Access barriers

related to factors that are intrinsic to the person with CCN

5 types of opportunity barriers

1. Policy

2. Practice

3. Knowledge

4. Skill

5. Attitude