9B: Augmentative and Alternative Communication

Augmentative and Alternative Communication

An area of clinical practice that provides communication interventions for people who have complex communication needs or little or no functional speech

• for people who don’t have a way to express themselves

Augmentative communication _________ or ____________ speech and/or language

supplements or enhances

Alternative communication ___________ or __________ speech and/or language

substitutes or replaces

Assistive technology

to perform functions that would otherwise be too difficult

Goals of AAC

• Assist with daily communication needs

  • Say what you want to say, when you want to say it, as quickly as possible

• Facilitate development of speech/language

• Facilitate return of speech/language

Symbols to create messages

• bliss symbols

• coloured pictures

• objects

Two ways to access symbols

Direct selection

• Accessing symbols with a finger or pointing device

• Accessing symbols with another body part

Indirect selection

• Alternate method for accessing symbols (eg. eye gaze)

Who uses AAC?

• Developmental disabilities

• Acquired disabilities

AAC System Types

• AAC systems and techniques may be used alone or in combination

• AAC users may use multiple systems and techniques

• Systems can be unaided or aided

aided vs unaided?

• Choice determined by needs, abilities and communication environment

• Often a combination of both to ensure optimal (multimodal) communication

• Decided on what specific needs the child has

Ideal AAC system is (3 things):

• highly intelligible

• comprehensible

• efficient

Unaided communication systems

• Rely on user's body to convey messages

• No external equipment

• e.g., gestures, body language, sign language

*Anything you can do with your body is an unaided AAC system

Aided communication systems

• Require use of tools or equipment in addition to user's body

• more complex communication

• Wide range of methods, both electronic and non-electronic (i.e., can be low-tech or high-tech)

  • e.g., paper and pencil, communication books/boards, speech generating devices, written output

Low tech aided communication

• May or may not uses power

• Simple to develop or program

• few moving parts

  • eg. pictures in a book, pointing to icons

high tech aided communication systems

• Uses power

• Sophisticated programming, usually computer-based

• Many are speech-generating devices

• super customizable (unlimited vocab)

• Can be dedicated or open

  • need special training to be able to prescribe and program high-tech systems

  • not just any SLP can use one

  • AAC clinics have long wait lists

AAC switches

• Many devices include an electronic switch (or multiple switches)

• The switch activates symbol scanning movement and can then be used to select an item/message

• some people can use both eye gaze and switches

• e.g.,

  • Push (button - needs enough muscle force)

  • Touch (light touch pad - good for people with no muscle)

  • Sound controlled (humming)

  • EEG-activated

AAC assessment

• cannot do it by yourself

• Requires team approach (team varies by case)!

  • e.g., Family, SLP, OT, PT, rehabilitation engineer, teacher, audiologist, psychologist, etc.

• Ongoing

  • Trial approaches (e.g., aided, unaided)

  • Longer term due to changing needs

  • peoples communication changes over time

    • eg. a 4 year old will need different communication than a 28 year old

Goal is to determine:

• Current abilities and needs in language, literacy, mobility, physical access, hearing, and vision

• Current and future language development and communication needs

• Communication goals across environments and communication partners

• The most appropriate AAC system

• The most appropriate therapy program

AAC assessment considerations

• Test may need to be adapted (people have different needs and functions… this invalidates tests however)

• Time consuming and ongoing (assessments are VERY time consuming and resource heavy)

• Team-based

• Focused on communicative function

• Emphasis on communication partners and environments

AAC intervention

To support the AAC user in communicating effectively

• Training in the use of aided/unaided AAC

• Involves family/caregivers

• In naturalistic contexts to promote generalization

• Focused on communicative effectiveness

• Supporting independent communication

Participation Model (Beukelman & Light, 2020)

• Functional intervention

• Goal: easy communication with peers through communication opportunities and access

• Based on the person’s participation requirements (participation inventory)

Communicative Competency Model (Light, 1989)

Goal: to help individuals develop functional operational, strategic, linguistic, and social skills

• Operational competence (making sure they can operate ACC by themselves)

• Strategic competence (symbols, facial expressions and complex messages)

• Linguistic competence (making sure they can from sentences and be literate)

• Social competence (function in social settings)

Examples of AAC implementation and intervention approaches

• Provide direct instruction in use of system – e.g., picture meaning, picture location, access strategies.

• Practice in multiple environments with multiple partners

• Develop routines and scripts for predictable scenarios and activities

• Train communication partners

• Incorporate language and literacy instruction

Cultural considerations

• selection of AAC type, symbols, and interaction style must consider the client’s cultural perspective

• must integrate family’s values, beliefs, interaction styles, etc.

• find out what the individual whats to get out of their AAC