AAC Final
What are some considerations when an individual has difficulties in activation with direct selection?
Can they access by: Physical Contact, Physical Pressure or Depression, Pointing (No Contact), Speech Recognition Adaptation considerations: Keyguards, Adapted keyboard, Alternative mice for computers
How can we build intentionality in communication?
Establish routines focused on motivating activities Initiate the interaction Pause and wait expectantly Watch carefully for a signal Respond immediately to the signal "as if it were intentional: Repeat this sequence
True or False: Research on voice output devices has suggested that implementing AAC may delay speech development.
False
True or False: The Communication Matrix is a good resource to use for ANY population at ANY cognitive level to determine the appropriate AAC system.
False
True or False: The goal of AAC intervention is to find a technological solution for communication issues.
False
True or False: When assessing individuals with disabilities for AAC, it is the ethical responsibility of the speech-language pathologist to allow for vendor-driven AAC evaluations.
False
Name a resource provided for feature matching.
Feature Matching Communication Applications Chart
What is the difference between augmentative and alternative communication?
Augmentative means to add to someone's speech Alternative means to be used instead of speech
What are indicators of Intentional Communication?
Eye gaze Facial or head orientating Vocalization Facial expressions Physical actions Body posturing
Medicaid guidelines...trial information, what gets paid for?
The billable unit includes time spent meeting with the multidisciplinary team, administering any supplemental instruments, tests and tools, and writing an evaluation report. View or print the billable augmented communication device evaluation codes and descriptions.
Discrete Trial Training (DTT)
-Teaching technique that comes from ABA -Breaks down skills into small, "discrete" components. Systematically, the trainer teaches these skills one by one. Along the way, trainers use tangible reinforcements for desired behavior. (Autismspeaks.org) -For example if you are teaching a child colors, you may start with teaching the color red. You would ask the child to point to red and then reward the behavior. She would then move on to teaching yellow by itself, reinforce that skill, and then ask about both colors and so on.
List the four purposes that communicative interactions fulfill.
1. Expressions of needs and wants 2. Information transfer 3. Social closeness 4. Social etiquette
List at least 6 possible members of an AAC team and identify what members MUST be included according to Arkansas Medicaid Guidelines.
1. SLP 2. PT 3. OT 4. Family 5. Social worker 6. Teacher 7. Individual with complex communication needs
Explicit instruction is founded on the priniciples of Applied Behavioral Analysis. This highly structured therapeutic approach is comprised of 4-5 small teaching units. List those units. One of the units is only provided if the individual produces an error.
1. Stimulus 2. Prompt 3. Correct response 4. A reinforcer 5. Corrective feedback is given if the individual produces an error
What are the characteristics of preintentional communicators?
1. They do not yet understand that they can impact others by communicating 2. They do not yet understand cause-and-effect relationships 3. Their behaviors are reflexive 4. Once they recognize the relationship between their behaviors and the effects on caregivers, they begin to use behaviors intentionally to communicate 5. The transition from preintentional to intentional happens around 9 months in typical development
What are the 7 questions (feature matching) that need to be answered alongside the data you get from a comprehensive, functional communication assessment?
1. Who needs to be involved in the AAC Team to assist with feature selection? 2. What does the individual need and want to communicate? How does he/she communicate these needs and wants right now? 3. Where, when and with whom does he/she need/want to communicate? (contexts) 4. What are the next steps in language development for this communicator? The next, next steps? 5. What are the communicator's, family's, and team's preferences and skills? 6. What support is needed to access an AAC tool if motor limitations are present? 7. What support is needed to access an AAC tool if vision limitations are present.
According to Arkansas Medicaid guidelines, how many devices and language systems should be presented during an AAC evaluation? What is the rationale?
3 - to determine which device best suits the patient and which device the patient will possibly have more success with. To rule out devices that will not adequately benefit the patient for functional communication.
What is the general ratio of core to fringe vocabulary you want to consider for your AAC device users?
4:1
How many individuals likely benefit from AAC?
97 million worldwide 5 million Americans
What is the Least Dangerous Assumption as it applies to individuals with severe disabilities?
Always assume people can do something (hear, understand, speak, etc.)
Treatment Techniques
Aided language stimulation Structured teaching Discrete trial training LAMP Total Communication Milieu Therapy i. Incidental Teaching ii. Time Delay iii. Mand-Model Procedures
What is the difference between aided and unaided modes of communication? Provide examples of each in your answer.
Aided: requires some form of equipment or technology (low-tech communication boards, PECS, high-tech computer based SGD, mobile tech with ACC apps) Unaided: does not require any external equipment or technology (vocalizations, gestures, signs, eye blinking)
What is the Communication Bill of Rights? Name 5 out of 15 specific communication rights that all people have relative to their daily interaction.
All people with a disability of any extent or severity have a basic right to affect, through communication, the conditions of their existence. To participate fully in communication interactions, each person has fundamental communication rights such as: 1. The right to interact socially, maintain social closeness, and build relationships 2. The right to request desired objects, actions, events, and people 3. The right to refuse or reject undesired objects, actions, events, or choices 4. The right to express personal preferences and feelings 5. The right to make choices from meaningful alternatives 6. The right to make comments and share opinions 7. The right to be informed about people and events in one's life 8. The right to access interventions and supports that improve communication 9. The right to be treated with dignity and addressed with respect and courtesy
What are encoding techniques and why are they important?
Combining one, two, three, or more symbols (e.g., alphabet, number, iconic codes) on a fixed display. Why are they important? Increase that rate of communication by reducing the number of selections required to communicate a word or message and provide access to a greater number of vocabulary items using a relatively small number of representations. Can encode sentences or words. Decrease cognitive/motoric/linguistic demands
ASHA notes two broad categories of users that may require temporary or permanent need for AAC. Please list those two categories and provide at least 3 examples under each category.
Congenital disabilities: CP, CAS, Developmental disability, genetic disorders, ID Acquired disabilities: CVA, TBI, ALS, PPA, apraxia, disability following surgery
Explain the difference between Core and Fringe Vocabulary.
Core: Relatively common words and relatively frequently used by a variety of individuals in different situations. Includes large number of function words (it, that, is, the). Small number of content words that occur relatively frequently (go, want, more). Fringe: Words used in fewer situations and at a particular time (mountain, road, hole). More specific to subject or individual. Represents approximately 20% of our vocabulary. Not made of general words and not used in many different situations. Consist or lower frequency words - mostly nouns that tend to be context specific.
What are conventional gestures?
Culture bound emblems that do not translate across different cultures
What should happen during a trial of a device?
During trial rounds, you do not have to show proficiency Identifies priority context(s) for the trial Sets up the AAC support for the individual's use within this context (i.e., appropriate vocabulary, representation, organization, layout, access technique, and output) Introduces the AAC system to the individual and communication partners (e.g., family, educational staff, personal care attendant) Provides instruction in the operational skills to use the system Provides instruction in functional implementation for communication Provides opportunities for practice and use over a period of time Collects data to determine the impact of the system
Intervention for Early Symbolic Communication
Develop a robust vocabulary: -Start with fringe -Initial vocabulary should be selected in response to the needs, interests, experiences, partners, and environments of the individual -Early vocabulary should reflect the people, objects, actions, descriptors, and social words used in the immediate environments Select appropriate representations: Aided or unaided
Intervention with individuals who are intentional but presymbolic
Develop clear signals to express needs and wants and regulate the behavior of others (e.g., signals to express acceptance and rejection, communicate choices, and request objects or activities) Take turns consistently in social interactions and develop social closeness Demonstrate joint attention (i.e., shift attention between the partner and the shared activity).
What are types of access techniques?
Direct Selection Scanning [Direct (inverse) scanning, Automatic (Regular or Interrupted) Scanning, Step scanning] Switches Synthesized speech
Who authored the SETT Framework?
Dr. Joy Zabala
The acronym DME as it pertains to AAC devices stands for:
Durable medical equipment
Where can you get loaner devices from?
EasterSeals iCan
What are the types of SGD displays and give definitions
Fixed displays: Organize displays into levels. Visual or auditory selection sets that incorporate levels in their design and operation Dynamic displays: entire display changes. Click one button and new page comes up (click on volleyball and then you can click related specific topics) Hybrid fixed and dynamic display: part is fixed and part is dynamic
According to Arkansas Medicaid guidelines, how long should a trial last, what should be included in the trial, and what does the client need to demonstrate during the trial? What needs to happen if the individual does not have good success during the trial period? Does the trial period need to be documented in the AAC report?
Four-week trial period that includes extensive experience with the requested system. Data must be collected during the trial period and document that the client can successfully use the recommended SGD device. If the client cannot demonstrate successful use of the recommended SGD device, subsequent trial periods with different devices shall occur until a device is identified that the client can successfully use. Information about the trial period must be documented in the evaluation report.
1. What are physical characteristics of AAC displays that we need to consider when looking at systems?
Number of representations Size of representations and display Spacing and arrangement of representations Orientation of the display
Milieu Therapy: i. Incidental Teaching ii. Time Delay iii. Mand-Model Procedures
Incidental Teaching: -Set of principles that incorporate explicit teaching to natural contexts. -Manipulating the arrangement of the natural environment. -Targeting specific communication goals within naturally occurring contexts. -Utilizing prompting techniques to elicit the target skills. Time Delay: -Communication partner asks a question, models a symbol, or places a desired item in view and then provides an extended wait accompanied by an expectant facial expression and eye contact. Mand-Model Procedures: -Engage the client with a preferred item or activity, the communication partner asks a question (ex: "What do you want?"). If the client doesn't respond with the target skill, the partner models the desired response. For example, a parent points to a doll while a child is playing with it and asks, "What's that?"; if the child does not respond or responds incorrectly, the parent models the sign "doll".
LAMP
Language Acquisition through Motor Planning Proposes that words on the AAC technology are learned by repeating a consistent motor movement.
What is the most critical domain in the development of communicative competence?
Language skills: To develop communicative competence, individuals need to learn skills in the spoken language of the family and community, including both comprehension and expressive skills
Linguistic, Strategic, Social, Operational Domains-what do these mean and how would you incorporate them in therapy (goals)?
Linguistic → receptive/expressive skills in native language, broader community, as well as skills in the language code of the AAC system Understand and respond appropriately (using her AAC system) to simple why questions asked by her teachers in English at school and by her parents in Korean at home Operational → technical skills needed to operate aided AAC systems or to produce unaided modes Touch a preferred object to communicate a choice between two objects offered by her teacher, aide, parents, or sister Social → sociolinguistic (pragmatics) as well as sociorelational skills Request information from his parents and grandparents and build his vocabulary by asking WHAT'S THAT? using his AAC technology Strategic → compensatory strategies that may be used to overcome environmental barriers or limitations in linguistic, operational, and/or social skills Select the symbol for SOMETHING ELSE when he is communicating a novel message to his parents, teacher, or aide and he does not have the required vocabulary to do so
List the four areas of Communicative Competence and provide a definition of each.
Linguistic: receptive/expressive skills in native language, broader community, language code of AAC Operational: technical skills needed to operate aided AAC systems or to produce unaided modes Social: Sociolinguistic (pragmatics), sociorelational skills Strategic: compensatory strategies that may be used to overcome environmental barriers or limitations in linguistic, operational, and/or social skills
Which of the following is a practice that involves manipulating and/or arranging stimuli in a child's natural environment to create a setting that encourages the child to engage in targeted communication?
Milieu Teaching
Medicaid AAC eval guidelines
Multidisciplinary team that must be led by a speech-language pathologist licensed by the Arkansas Board of Examiners for Speech-Language Pathology and Audiology who has a Certification of Clinical Competence from the American Speech-Language and Hearing Association. The team must include an occupational therapist licensed by the Arkansas State Medical Board. The team must include a physical therapist if it is determined there is a need for assistance in the evaluation as it relates to the positioning and seating in utilizing specific SGD equipment; The speech-language pathologist, occupational therapist, and physical therapist must have documented and verifiable training and experience in the use and evaluation of SGD equipment, including without limitation knowledge concerning the SGD equipment's use and working capabilities, mounting and training requirements, warranties, and maintenance. The team may include any other practitioners or individuals determined necessary to perform a complete evaluation, including without limitation educators, parents, behavior analysts, and vocational rehabilitation counselors, as appropriate; and Team members must disclose any financial relationship they have with SGD device manufacturers and must certify that their recommendations are based on a comprehensive evaluation and preferred practice patterns and are not due to any financial or personal incentive. Must evaluate at least three (3) SGD systems from different manufacturers and product lines using an interdisciplinary approach incorporating the goals, objectives, skills, and knowledge of various disciplines. The recommended SGD is prior authorized for purchase only after the client has completed a minimum of a four-week trial period that includes extensive experience with the requested system. Data must be collected during the trial period and document that the client can successfully use the recommended SGD device. If the client cannot demonstrate successful use of the recommended SGD device, subsequent trial periods with different devices shall occur until a device is identified that the client can successfully use. Information about the trial period must be documented in the evaluation report. After the team has completed the evaluation, the evaluation report must be submitted to the selected prosthetics provider. The evaluation report must include the following: The medical necessity for the SGD and pertinent background information; Information about the client's current speech-language and communication abilities over the last year; Limitations of the client's current communication abilities, a list of the systems and devices the client currently uses, and the client's current communication needs; Information on the client's sensory functioning, including vision and hearing, as related to the SGD; Information regarding the client's postural and motor abilities. The report must include optimal access/selection technique needed for independent use of SGD; A description of the functional placement of the SGD (such as mounting devices, carrying cases, and straps); An indication of the client's ability to use various graphic and auditory symbol forms; Information on vocabulary storage and rate enhancement techniques considered and the justification for those deemed most appropriate; A summary of the client's required device features and delineate features of devices presented; A specific recommendation for an SGD system, including a description of the SGD system, all components and accessories, and justification of why the recommended SGD system is more appropriate than the others; Information about the trial period documenting that the client could successfully use the recommended device, including at a minimum: Length of trial; Frequency of use of SGD; Environments, activities, and communication partners involved; Access method(s) used; Portability of the SGD; Symbolic language system and rate enhancement used; Number of symbols and layout of overlay used; Sample of language expressed; Client's level of independence (prompting strategies) using the SGD and expressing various language functions; and A summary of baseline and end of trial data. An initial treatment plan for implementing use of the device, which must identify: Who will be responsible for delivering and programming the SGD; Who will develop initial goals and objectives for functional use of SGD; and Who will train the client's team members and communication partners in the proper use, programming, care, and maintenance of the SGD. The signature of the speech-language pathologist and all other professionals directly involved in the evaluation on both the evaluation report and a non-conflict disclosure stating that they do not have financial relationship or other affiliation with a SGD manufacturer. Medically necessary evaluations for SGDs are covered once every three (3) years. The billable unit includes time spent meeting with the multidisciplinary team, administering any supplemental instruments, tests and tools, and writing an evaluation report. View or print the billable augmented communication device evaluation codes and descriptions.
List the three main evaluation types/approaches that can be used to assess a person's capabilities. Provide what approach/approaches are best to use for an AAC evaluation and why.
Norm Referenced: Not the best to use because it is not a comprehensive assessment of performance. Seldom provide sufficient information to guide treatment plan. Criterion Referenced: Can help develop capability profile that can then be used with feature matching. Dynamic Assessment: Best option. Test-teach-retest format. Can help individuals with no prior experience with AAC symbols or access techniques
What are the Phases of PECS?
Phase 1- How to communicate Phase 2- distance and persistence (travel) Phase 3- Picture discrimination Phase 4- sentence structure Phase 5- responding to "what do you want?" Phase 6- commenting
What are intervention considerations with those with ASD? What are types of interventions that we can implement?
Promoting social communication: AAC interventions emphasize skills to build social interactions, not just the expression of needs and wants; Many AAC interventions designed for beginning communicators with ASD focus primarily on teaching requests for preferred objects or activities (also known as mands), to the neglect of goals to promote social interaction and information exchange (e.g., commenting, asking questions).; Intervention with individuals with ASD should focus on learning to engage in sustained social interactions; To learn the pragmatic aspects of communication, intervention should focus on communication skills in the context of naturally occurring routines related to meaningful activities in daily life; Intervention with individuals with ASD involves repeated trials to provide practice.; The focus of AAC intervention should always be the acquisition of skills to promote social interactions with varied partners in the real world Providing intervention across the lifespan: Research has shown that it is critical to start intervention programs for children with ASD as early as possible to optimize outcomes; AAC intervention should be considered for all infants and toddlers who are at risk for ASD or other developmental disability; There is currently a significant lack of services for adolescents and adults with ASD, especially those that require AAC. Types of intervention (evidence based intervention): Highly structured behavioral approaches, such as discrete trial teaching; Incidental teaching, such as enhanced milieu teaching; Naturalistic developmental behavioral interventions such as JASPER (Joint Attention, Symbolic Play, Engagement, and Regulation; Early Start Denver Model Most of these approaches have been adapted to incorporate AAC supports
Key Considerations for AAC intervention for those with Down Syndrome...
Providing early intervention: Processes of communication and language development begin at birth, it is important to intervene with infants with Down syndrome and their families as early as possible. It is important that early intervention involves family-centered services whereby practitioners develop a partnership with families and work collaboratively to solve problems and make decisions. Partners may have limited expectations for infants and toddlers with Down syndrome to communicate, and, as a result, they may provide few opportunities for them to do so, unintentionally limiting their language learning. Setting appropriate expectations: Opportunity barriers: Too often, individuals with Down syndrome experience low expectations in society The low expectations of others may limit their opportunities for learning, thus compounding the effect of their disability. Least Dangerous Assumption: It is important to eliminate these opportunity barriers by setting appropriately high expectations for individuals with Down syndrome and ensuring that they have the supports required (including AAC) to learn
Creating a goal to select the symbol for SOMETHING ELSE when one is communicating a novel message to parents, teacher, or aide and does not have the required vocabulary to do so is an example of a goal in the
Strategic domain
What therapy approach/approaches is frequently used with adults with acquired disabilities?
Rehabilitation: acquired disabilities - help relearn something Habilitation: developmental disabilities to develop competence for the first time
What are 4 different AAC device companies that are used in Arkansas?
Saltillo PRC Tobiidynavox Ablenet?? Adaptive switch labs??
Structured teaching
Structured instruction that is needed when natural cues are not sufficient to support skill acquisition Founded on the principles of applied behavioral analysis Highly structured and is characterized by numerous instructional trials to provide repeated opportunities for practice and tightly defined target behaviors or skills. Teaching occurs in small teaching units referred to as "trials" -Stimulus -Prompt -A Correct Response -A reinforcer -**Corrective feedback is given if the individual produces an error
SETT
Student: Strengths; Barriers; Motivators; What do we need to learn about this student Environment: Previous AT; Current AT; Physical Environment; Staff Support Tasks: Specific tasks that the student is having difficulty; What is the current expectation?; What would success look like for this student?; What is this student unable to do that their peers are able to do? Tools: Is it expected that the student will not be able to make reasonable progress toward educational goals without assistive technology devices and services?; If yes, describe what a useful system of supports, devices, and services for the student would be like if there were such a system of TOOLS.; Brainstorm specific Tools that could be included in a system that addresses student needs; Select the most promising Tools for trials in natural environments; Plan the specifics of the trial (expected changes, when/how tools will be used, cues, etc.)
The Social Networks is primarily a communication inventory for individuals with complex communication needs that focuses on communication:
The communication partners with whom the individual is likely to communicate. Starting with an inner circle (family, life partners), then 2- friends, 3- acquaintances, 4-professionals, 5- unfamiliar people. Usually indicates that they have a very limited social network
What is feature matching? What are the 2 main goals of it?
The process of determining what features are needed by the AAC user and then selecting tools that have those features for trials. Main goals: to use the skills and needs of the communicator and his/her family to identify key features needed in an AAC system and to match the key features identified to the tools and strategies available on the market.
When considering icons to use with an AAC system, an opaque icon refers to symbols that are:
The symbols do not visually resemble their referents, and are not obvious, but often abstract
In the article, Robust Receptive Vocabulary Instruction for Students With Significant Cognitive Disabilities Who Use AAC, the author described 3 levels of vocabulary. List the 3 levels and provide a description of each.
Tier 1: common words that most children who use natural speech to communicate will learn through everyday interactions in meaningful contexts and without the need for explicit instruction (e.g., more, go, cup) Tier 2: important targets for vocabulary instruction for students with SCD and CCN because understanding these words can help them across oral and written language tasks Tier 3: domain specific and rare; may be of perceived importance for a single academic lesson or unit, but they do not tend to be useful to students with SCD and CCN beyond those fleeting instructional lessons (e.g., aorta, circumference)
What are the classifications of iconicity?
Transparent - Symbols are readily guessable in the absence of the referent, such as a photograph or written word. Opaque - Symbols are not readily guessable even when the meaning of the symbol is known, such as an individualized gesture Translucent symbols lie between transparent and opaque symbols. The meaning of the referent may not be obvious, but the relationship between symbol and referent is more obvious when additional information is provided
True or False: An AAC evaluation must involve multiple phases.
True
True or False: Assistive technology is an item, piece of equipment, software program, or product system that is used to increase, maintain, or improve functional capabilities or persons with disabilities.
True
True or False: It is considered inappropriate practice to restrict communication services based on achieving either cognitive or language milestones.
True
True or False: One of the most compelling findings of the 2010 National Joint Committee for the Communication Needs of Persons with Severe Disabilities report, was that individuals with severe disabilities can learn a broad range of expressive or interactive communication when provided systematic intervention.
True
True or False: There are no prerequisites for Augmentative/Alternative Communication.
True
AAC considerations for those with cerebral palsy...
Using a team approach: AAC interventions require the expertise of a team of professionals from a number of disciplines, perhaps more so than with any other developmental disability. AAC intervention must be balanced with the range of interventions targeting other needs The time and effort devoted to each of these interventions must be determined by the needs and skills of the individual and the priorities identified by the individual and family. Ensuring Access: Individuals with cerebral palsy may have limited access to learning experiences and social interactions What is an important first step? the team must address positioning and seating adaptations on an individual basis to ensure safety, maximize stability, and optimize function Look at motor acts that are accurate, efficient, and minimally fatiguing Beginning Activities: Access to adaptive play Stabilizing toys Keep them within reach Switch-activated toys Gloves with Velcro to help them grasp
What is the purpose of the Modified Fitzgerald color coding system?
Utilizing a color-coded display design to increase communication efficiency and understanding of linguistic categories
Total Communication
When speech and signs are combined as input
How should we address challenging behaviors in our intervention?
Why do you think these individuals may have challenging behaviors?: Lack of preferred and functional places to go; Lack of people to be with; Lack of things to do; Lack of ways to communicate Historically, behaviors were managed by: Institutionalization; Medication; Punishment Intervention should focus on: Positive behavior supports to prevent challenging behaviors (e.g., visual schedules to support transitions); Strategies for teaching socially appropriate, functional communication skills as alternatives.
Which of the following is NOT one of the main vendors for augmentative/alternative communication devices in Arkansas?
a. PRC b. Saltillo c. Tobiidynavox d. d
SETT Framework
students, environment, tasks, and tools - four areas that guide teams seeking to identify supports and services for students with disabilities
Explicit Instruction
teaching method that is highly structured and is characterized by numerous instructional trials to provide repeated opportunities for practice and tightly defined target behaviors or skills
1. What is assistive technology? Give examples
the use of any equipment, tool, or strategy to improve functional daily living in individuals with disabilities or limitations Examples: Manual signs, Gestures, Speech generating devices
