AAC

Four (five) purposes fulfilled by communicative interactions

1. communication of needs/wants

2. information transfer

3. social closeness

4. social etiquette

5. internal dialogue

total communication

• inclusive approach honoring the cultural and linguistic identity of deaf individuals - combats limitations of oralism

multimodal communication

• philosophy of supporting language acquisition for individuals with CCNs

• inclusive approach honoring differences in communication abilities - combats ableism

• multitude of modalities

Continuum of technology

1. no tech

2. low tech

3. mid tech

4. high tech

Transparency continuum for symbols

1. real object

2. photograph

3. line drawing

4. orthography

important aac system componenets/features

• output: digitized vs synthesized

• access method

• selection set/vocabulary

• display options

• portability features and accessories

• environmental controls

Visual scene displays (VSD)

• can be a stand alone product or built into a software platform

• includes static photograph to establish context with dynamic “hotspots” for language learning and communication

• useful for beginning communicators

• can be used to support literacy

What is the rule about aac for clinicians engaging in assessment?

practice within your scope of practice and competence

Which model is best practice?

participation model

• person centered

• meaningful communication and participation in ADLs, set equitable goals

• evaluate barriers and try to eliminate them

• reevaluate frequently to ensure participation

Entering into assessment we should….?

1. presume competence

2. presume potential

6 Non-negotiables for AAC eval

• earnest team-based approach

• skilled and professional team

• Individuals with CCNs must participate

• meaningful assessment based on individual’s experiences and CLD background

• sample behaviors in assessment must be sufficient to determine strengths and challenges

• the present is observable the future is unknown

What should the AAC eval team include?

• AAC user, family members/care partners, frequent communication partners

• professionals vary on individual’s needs

• SLP, OT, PT, ATP, audiologist, vision specialist, medical personnel, educational personnel

Types of AAC assessments

• norm referenced

• criterion referenced

• dynamic

what are the key components of AAC assessment?

• history/intake

• assessment of individual’s skills

• feature matching/system trials

what is included in history/intake part of assessment?

• interviews and questionnaires

• aac needs assessment

Areas assessed in skill assessment?

• sensory function

• natural speech

• language skills/symbols

• cognitive skills

• literacy skills

• physical/motor skills and access

What is assessed in sensory function?

Auditory

• input/output

vision

• size/type of symbols most appropriate

• best placement of device/symbols

• layout and highlighting

• nonreflective surfaces

• color perceptions and avoidance of clutter

Natural speech capability

Speech intelligibility

• maintenance throughout day

voice assessment

• usually perceptual, can get instrumental

fluency

What is assessed in language and symbols?

identify present modalities

receptive and expressive language

• content, form, use

prelinguistic skills

• joint attention/engagement, communicative initiation, play, turn-taking, gestures, symbolic communication

What is assessed in cognitive skills?

specific skills for AAC

• cause/effect

• attention, memory and word knowledge

• learning abilities/preferences

• software organization/navigation (linguistic, operational, environmentally, pragmatic)

What is assessed in literacy skills?

• print awareness

• phonemic/phonological awareness

• decoding

• word recognition

• reading comprehension

• writing/typing/spelling

What are assessed in motor skills?

• motor skills for unaided AAC

• mobility specifics

• seating and positioning

• access (direct selection or scanning)

What is done in featuring matching during system trials?

• assessment of individual skills

• continued trial of one or more systems may be the rec

• comparison trials and rule-outs are important piece of funding process

What are seven common AAC assessment tools?

• the communication matrix (early comm. skills)

• AAC communication profile

• dynamic AAC goals grid 3

• test of early communication and emerging language

• test of aided symbol performance

• assessment of phonological awareness and reading

• The multimodal communication screening test for persons with aphasia

DME funding process

• front and back of insurance card

• client info form

• SLP eval report

• equipment order form

• face-to-face encounter with physician

• signed physician’s prescription

• release/assignment of benefit form

• state Medicaid guidelines

• trial agreement

types of selection sets

• visual

• auditory

• tactile

What are the types of selection set displays?

Fixed displays

Dynamic displays

Hybrid displays

fixed displays

• no movement, all symbols stay in one location

dynamic displays

• computer/tablet screens

• change when activated

• often require learning of navigation

hybrid displays

have both fixed and dynamic components

• changes through lighting, brightness, color, font, symbols

• navigation through pages of vocab

• VSD “hotspots”

What are some physical characteristics?

Display size

• can impact number/size of symbols, weight and access workload

Spacing/arrangement of symbols

• handedness

• motor control

• visual field cut

Orientation

• position related to the floor

• mounting considerations

Types of direct selection methods

• physical contact

• pointing

• speech recognition

Types of direct activation strategies

• timed

• release

• filtered/averaged

Timed direct activation strategies

• most common

• ID item on screen and sustain contact or dwell for predetermined timeframe for tech to recognize selection

Release direct activation strategies

• tech doesn’t recognize selection until physical contact is broken

Filtered/averaged direct activation strategies

• tech forgives accidental selections and averages accumulated info over short timeframe to guess the selection

• good for those who struggle maintaining steady contact or dwell

What are some main features of indirect selection?

• most appropriate for those who can’t choose directly

• partner assisted scanning or tech configuration

• higher cognitive load

• typically slower rate

• timing must be personalized

What are indirect scanning patterns?

• circular

• linear

• group item

What are some selection control techniques?

• directed scanning

• automatic scanning

• step scanning

What is directed scanning?

• cursor begins when activated and selects with release

What is automatic scanning?

• continuous according to selected patterns

• can set # of cycles

What is step scanning?

• activate switch for every movement of cursor

• stall activation to select OR use second switch

What is feedback vs message output?

Feedback

• activation feedback: lets user know item has been selected

• message feedback: provides user with info about selection

• auditory, visual or tactile

Message output

• involves a communication partner and occurs after message contrusction

What are the different types of auditory message output?

• digitized speech

• synthesized/synthetic speech

What is digitized speech?

• natural speech that has been recorded/stored

• important for message banking

What is synthesized/synthetic speech?

• natural sounding, voices, representation of different genders, ages, CLD features, languages

• foundational to voice banking

What three steps needs to be planned for AAC intervention?

1. determine communication and participation needs

2. determining environmental supports and barriers

3. review assessment info regarding individual’s capabilities

What are the principles of AAC intervention?

1. Evidence based practice

2. plan intervention for the individual with CCNs, present needs and future needs

What are the types of intervention?

1. environmental adaptations

2. natural abilities

3. Use of AAC systems

What are essential components of AAC intervention?

1. selection and personalization of AAC systems to provide effective means of communication

2. instruction in the necessary strategies and skills needed to communicate

3. instruction of family members and other important communication partners

What are the instructional procedures - EBP Tx strategies?

• responsive social pragmatic intervnetion

• explicit instruction

• Milieu or incidental teaching

• strategy instruction

• coaching

What is responsive social pragmatic intervention?

• respond to all communicative attempts, fulfill intent, model target skill

• naturally occurring interactions

• model without expectation

• typically involves AAC modeling (total communication, system of augmented input, aided language stimulation, aided AAC modeling, natural aided language)

What is explicit instruction?

• ABA principles, not in natural environment

• highly structured, numerous trials, repeated opportunities for practice

• cognitive/academic skills > social communication skills

• tightly defined target behaviors/skills

• teaching conducted in small units that consist of stimulus, prompt, concrete response from learner, reinforcer

• corrective feedback provided for errors

• eventually avoid prompt dependency, get to generalization and maintenance

What is Milieu or incidental teaching?

• combined with explicit instruction to promote generalization

• manipulate natural environment to create communication opportunities

• target communication skill w/in natural context

• use prompting techniques to elicit target skills

• respond to communicative attempts

What is strategy instruction?

• more common for advanced communication goals

• can be adapted to teach comm partners to support AAC

• AAC user must understand explanations and discussions of goals

• teach strategy, explain importance, discuss when to use, provide opportunities, provide guided practice, eval progress

What is coaching?

• used for advanced communication goals

• may have pre established prompting hierarchy

• opportunities for practice, w/ feedback provided during interaction

What are the four pillars of communicative competence?

• linguistic

• social

• operational

• strategic

What is linguistic competence?

• comprehension and expression

• content (semantics) and form (syntax and morphology)

• literacy

• bilingual and multilingual environments

What intervention is commonly used in lingustic?

• RSPI

• milieu

• teaching

• explicit instruction

What treatments are used in linguistic comptence?

• shared reading

• focused stimulation through AAC modeling

• conversation-based intervention

What is social competence?

• choice of appropriate communication modality given the situation

• initiation, turn taking, choice making communicative functions

• communication complex wants/needs

• higher level - initiate and maintain interactions

• exchange information

What are examples of communication complex wants/needs? Higher level? exchange info?

Communication complex wants/needs

• personal care, health care interactions, emergencies

higher level - initiate and maintain interactions

• topic setting, past/future experiences, storytelling

exchange information

• explain/describe, deliver speech or presentation, self-advocate and report

What are intervention types used to address social competence?

• strategy instruction

• coaching

What is social competence?

bypasses limitations in other competency areas

• linguistic: ask partner to provide choices to overcome vocab understanding

• Operational: request assistance w/ navigation, preprogram messages

• Social: introduction strategies to teach partners, humor to retain rapport, regulatory messages to hold the floor or repair breakdown

What are common interventions addressing strategic competence?

• strategy instruction

• coaching

What is operational competence?

• promote accuracy and efficiency of AAC system use, reduces effort and faitgue

• cognitive developmental approach for building conceptual understanding of underlying operation

What are example skills targeted for aided aac systems in operational competence?

• adjust volume

• navigate

• select symbols

• accuracy with eye gaze

• learning to scan

• rate enhancement features

What interventions are used to address operational competence?

explicit instruction

strategy instruction

coaching

What is dynamic aac goals grid?

• helps SLPs collaborate with patients’ support team to assess progress and current communication abilities

• guides selection and tracking of appropriate AAC goals

What is best for vocab and personalization?

• ROBUST VOCAB

• do not use bottom up

• pre programmed is not ideal

• core vs fringe vocab

• client needs to be a part of selection and personalization as much as possible

What is functional communication traning?

• if client has challenging behaviors, SLP will have a role w/in the team that determines function of behavior and alternatives to replace it

What are the steps in functional communication training?

1. determine function of the behavior

2. determine replacement behavior

3. reinforce

Operational goal example

The user will independently charge their communication tablet every night and adjust the volume to 50% loudness for a noisy room by the end of the month

Linguistic goal example

The user will select three specific picture symbols on their device to create a three-word sentence ("I want juice") in four out of five tries

Strategic goal example

The user will point to a pre-programmed message that says "Wait, I am typing" when their communication partner tries to rush them

Social goal example

The user will look at a friend and wave to give a social greeting, then maintain eye contact for three conversational turns

How can we develop intentionality in pre-intentional communicators? How can we tell a behavior is intentional?

• intentionality develops by communication partners responding to unintentional communication

• intentionality is showed when behavior is persisted until goal is achieved, trying new way to achieve behavior, increasing intensity of behavior

What are intervention targets for pre intentional communicators?

• establish communicative intent

• increase moments of shared joy

• increase communicative initiation

What are intervention strategies for pre intentional?

• routines

• communication partners initiate interaction

• pause and wait

• look for individual to signal

• respond if behavior was intentional

• repeat

What does intentional but pre symbolic look like?

• consistent use of signals that are not yet symbolic

• communicate needs and wants through manipulating the behavior of others

• interact socially and develop social closeness

What are intervention targets for intentional but pre symbolic?

• acceptance vs rejection

• choice making

• requests for objects and activities

• teach individual how to take turns

• strengthening joint attention

Early symbolic communication

• first words around 10-14 months

• first 50 words - more content than function

• AAC symbols represented w/in the selection set

Intervention targets for early symbolic

• increasing semantic inventory

• expanding type of communicative function

individuals who are combining symbols

• 18-24 m

• complexity of communication increases

• syntax and morphology more important

• operational, social and strategic competencies come into focus

What are intervention strategies for symbolic communicators?

• teach vocab in meaningful context

• provide input w/ both speech and aac

• always respond to promote natural consequences

• provide explicit instruction if needed to teach vocab, vocab needs to generalize to meaningful activities

What should be done if AAC system is the problem?

• recheck feature matching and ensure it is robust

What should be done if the problem is with implementation?

• consider “communication autonomy”

• authentic comm and autonomy cannot develop through compliance

• autonomy promotes agency

What are implementation strategies important to focus on to be neurodiversity affirming?

• modeling without expectations

• use AAC system ourselves

• use AAC system within authentic interaction

• reduce contrived opportunities or activities

• reduce prompting

What should be done instead of prompting?

• focus on encouraging expression

• only target is autonomous comm

• create environment that values AAC

• authentic interactions, teach initiation, engage in conversation

What are the six phases of picture exchange communication system?

1. how to communicate

2. distance and persistence

3. picture discrimination

4. sentence structure

5. responsive requesting

6. commenting

What is pragmatic organization display?

• partner assisted scanning

• words grouped by how we use them in real life

• display changes based on what user selects

What are the factors that affect literacy development?

Intrinsic factors

• vision/hearing, motor skills, cognition, speech/language and world experiences

Extrinsic factors

• physical, social, language and cultural contexts

Instructional factors

• school experiences, differences in quantity and quality

What are the levels of literacy development?

1. emergent literacy

2. conventional literacy skills

What is developing in emergent literacy?

• language development

• print awareness

• storybook reading

• exposure to phonological/phonemic awareness, letter-sound correspondence

• emergent writing

What are interventions for emergent literacy?

• access to AAC during emergent literacy activities

• teaching interaction strategies to comm partners

• provide independent access to materials

• help to develop narrative skills

How can you optimize storybook reading for individuals who use AAC?

• access to comm modalities

• visual scenes

• appropriate interaction styles from comm partners

• independent access - adapted books, books on computer apps on tablets

How can you increase participation in storybook reading?

• let them choose the story

• have them point to words as you read

• talk about text as you read, relate to it

• give them a turn to read or a chance to request

• make a comm. board for the book

What are two main challenges in emergent literacy?

• children w/o disabilities get the chance to choose books and select the same book repeatedly

• With children who rely on AAC, parents and teachers dominate interaction and provide few opportunities for participation

What should be focused on when encouraging participation in storybook reading?

• focus on mechanics rather than comprehension/language and comm. development

What are the two stages of conventional literacy?

• learning to read and write

• reading and writing to learn