AAC unit 2

specific-need communicator

(aphasia) 1. AAC techniques used intermittently and only in specific communication situations 2. Communicate through gestures and speech 3. Interventions: develop strategies as needed for situations (e.g., using phone, grocery lists, written communication)

stored message communicator

(aphasia) 1. Independently locate stored messages in AAC system to supplement speech 2. Initiate without prompting in familiar situations 3. Have difficulty generating novel info for atypical topics; spelling and speech is limited 4. Interventions: develop inventory of messages/topics, assist in selection of messages, symbols, locations, set up environments for practice, evaluate effectiveness of strategies

generative message communicator

(aphasia) 1. Speakers and writers who can produce some novel information; do not have to rely on stored vocabulary; communicate using multiple modalities 2. Independent lifestyle 3. Generative comm. is fragmented or inconsistent, so need some degree of conversational or AAC intervention 4. Interventions: see strategies p. 488, need practice knowing when to use techniques particularly related to breakdowns (i.e., what strategies work in what situations), careful....high level AAC systems still may be too difficult

emerging communicator

(aphasia) a. Profound cog/comm disorder across modalities b. Little purposeful communication c. Difficulty recognizing symbols d. Difficulty with yes/no questions e. Augmented input (using photos, real objects, etc.) is helpful f. Intervention focuses on turn-taking, choice making, referential skills, signaling for agreement/rejection, training comm. partners

Transitional Communicators

(aphasia) a. Understand symbols and strategies b. h communication efforts and participation c. Can use notebooks or SGDs, particularly in familiar and/or structured situations d. Still need partner support in spontaneous communicative contexts e. Interventions include: initiate w/o cueing using prepared message or remnants, storytelling, practice skills in role play situations

Contextual Choice Communicator

(aphasia) a. Indicate needs by pointing b. Recognize visual symbols c. Aware of daily routines/schedules d. Follow predictable conversations (but unable to contribute independently) e. Partner assistance and augmented input is beneficial for participation and comprehension f. Intervention includes: topic reference, understanding graphic symbols, answering/asking questions (may be nonverbal) i. Written choice conversation, yes/no responses, asking questions gesturally to initiate, augmented input to alleviate confusion and communication breakdown

o Individual/family desire to work on speech o Difficulty accepting AAC alternatives o Use of medical model vs. participation model o Premature discontinuation of therapy o Poor match between AAC system and abilities o Limited availability of personalized messages o Lack of practice in contextual situations o Lack of available communication partners for support strategies o Inadequate support network to assist in message development and identification of comm. needs o Lack of comm. opportunities due to needs being met/anticipated by others

(aphasia) INTERVENTION CONSIDERATIONS—IMPACT ON SUCCESS

Accept/Reject Signals

1. Also important to have contingent interpretation and responsiveness to behaviors 2. Signals are often very subtle

facilitator

1. An individual who assumes or is assigned responsibility for supporting a person's communicative attempts 2. Must identify and respond to emerging communication signals of beginning communicators

cognitive/ linguistic skills- PD

1. Because occurs later in life, most have developed typical language skills a. So can spell and read at levels necessary to support most AAC interventions 2. Some have specific memory impairments and some complain of slowness in problems solving 3. Must consider whether or not cognitive limitations will interfere with AAC interventions

Physical Characteristics of Selection Set Displays- spacing and arrangement of items

1. Determined largely by visual & motor control capabilities of the individual a. e.g. some individuals may have blind spots b. e.g. some individuals have a stronger hand c. curved array: communication board designed to accommodate the motor control capabilities of a person using a headstick

person-centered planning

1. Emphasizes assisting supporters to focus on opportunities for people with severe disabilities to: a. Develop personal relationships b. Have positive roles in community life c. Increase their control of their own lives d. Develop the skills and abilities to achieve these goals

Sensory/Perceptual Skills- brainstem stroke

1. High brainstem stroke may affect cranial nerve nuclei controlling muscles of eye and eyelid movement 2. Middle or low brainstem stroke will not impair those muscles 3. Visual functioning may or may not be impaired 4. Hearing usually unimpaired 5. Tactile and position senses often damaged

Functional communication training; conversational repairs

1. Identify problem situations 2. Select two or more forms to teach as repairs 3. Teach repair strategies using graduated prompting procedures in naturally occurring routines and contexts 4. Encourage communication partners to respond appropriately 5. Monitor use of strategies

ready reader

1. Knows most letters and sounds they make 2. Identifies first letter of spoken word 3. Understands groups of letters make word 4. Identifies rhyming words 5. Understands sound blending for one-syllable words 6. Notices print in environment 7. Recognizes 5-20 sight words 8. Tries to make lines for print or copy letters

language skills- brainstem stroke

1. Language skills not impaired if doesn't affect cortical or subcortical structures

storybook reading strategies

1. Model use of AAC while reading text 2. Create/modify AAC to support text (see reading board) 3. Critical to provide for comments and requests (turn the page, what's that, boring) 4. Pause and wait expectantly for child to respond 5. Ask appropriate open-ended questions 6. Respond appropriately to communication attempts 7. Storybooks, storybooks, storybooks 8. Make print materials accessible: 9. Tabs for story books 10. Shelves where child can access 11. CD-ROM 12. Incorporate print in play activities 13. Adapt standard writing materials 14. Provide early access to computers 15. Encourage regular story-reading activities 16. Ensure access to AAC during literacy 17. Relate story info to real life experiences 18. Need to recognize how closely linked language and literacy are - language is the code 19. Need to learn more about how AAC symbols affect literacy development 20. Need to work on Phonological Awareness in modified ways - critical since typically don't speak much

cognitive skills- MS

1. More than half of individuals seem to display definite evidence of cognitive impairment 2. Subcortical dementia with a. Absence of aphasia b. Memory retrieval failure in presence of intact encoding and storage capability c. Impaired conceptual reasoning in context of near-normal intellect d. Slowed information-processing time e. Personality disturbances i. including apathy, depression, or euphoria

Physical Characteristics of Selection Set Displays- number of items

1. Most important: how many are required by the individual? 2. 1:1 correspondence of symbols to words 3. encoding strategies increase number of items

Activity Grid Displays

1. Most popular grid display strategy 2. Vocabulary is organized according to event schemes, routines, or activities 3. A.k.a. schematic grid layouts 4. Each display contains symbols for every type of vocabulary relevant to the activity or routine 5. These displays provide a way to participate while promoting language development and complex expressive output at the same time 6. Vocabulary items are typically organized according to semantic categories 7. These can be used in low-tech and electronic applications 8. Participation is enhanced when multiple activity displays are available 9. These can be used by individuals across the age range in community, school, and job settings 10. Major advantage is that displays can be created relatively quickly and can be used for multiple special events a. Enhances probability that specialized vocabulary items are available when needed 11. These also promote use of multiword linguistic structures and build a strong receptive language base

motor skills- MS

1. Motor capabilities vary 2. Careful motor assessment is important aspect of all AAC intervention 3. AAC teams can sometimes identify way to stabilize body part involved in access sufficiently so individual can make voluntary movements without excessive tremor 4. Other times, may need to attach switch to limb or hand 5. Specialized applications providing motion-filtering software have been developed 6. Motor control problems and visual impairments often combine to limit AAC options severely

motor skills- brainstem stroke

1. Motor control problems of limbs and speech mechanisms

Motor Skills- PD

1. Motor control problems that may influence AAC interventions are not well documented 2. AAC teams may need to consider several motor control problems a. Reduced range and speech of movement b. Reduce size of selection display c. Extensive tremors that are worse when at rest d. Stabilize hands on surface of communication board/device - keyguard e. Hyperkinesias (excessive movement) as side effect of medication i. May interfere with fine motor control

cognitive skills- brainstem stroke

1. No cognitive limitations if stroke involves only brainstem 2. If extends higher into brain or interference with oxygen supply to brain, variety of cognitive impairments may exist

Semantic-Syntactic Grid Displays

1. Organizes vocabulary items according to the parts of speech and their relationship within a syntactic framework a. Intended to facilitate language learning 2. Fitzgerald key is a commonly used strategy a. Organizes symbols from left to right into categories (who, doing, modifiers, etc), with frequently used phrases and letters clustered along the top or bottom of the display b. Order intended to facilitate word by word sentence construction from left to right 3. Symbols are usually color coded to allow easier visual access

VISTA (Vermont Interdependent Services Team Approach)

1. Picks up where COACH left off o Provides alternative ways for the student's educational support team to integrate related services in general education classrooms.

developing reader

1. Recognizes 100 words 2. Reads 1-2 original sentences 3. Decodes/sounds out non-sight words of 1 to 2 syllables 4. Spells out numerous words 5. Writes short sentences

beginning reader

1. Recognizes 50 sight words 2. Reads short predictable sentences (the dog runs) 3. Decodes/sounds out loud words, syllables 4. Tries to copy words 5. Tries to spell name and simple words

Sensory/Perceptual Skills- PD

1. Sensory disturbances usually do not interfere with AAC interventions

emergent reader

1. Shows interest in/listens to picture storybooks 2. "Reads" pictures, shows understanding of story while looking 3. Understands "turning the page" to continue 4. "Reads" tope to bottom, L to R, front to back 5. Understand print makes up story 6. Recognizes some letters and sounds 7. Recognizes labels (coke, McDonalds) 8. Recognizes own name 9. Tries to scribble

Parent/Facilitator Training Programs

1. Social-pragmatic-developmental intervention techniques: a. Optimize the person's behavior state (i.e., degree of alertness and responsiveness) b. Be person-oriented c. Recognize and interpret early communicative behaviors d. Promote interaction e. Model language 2. Van Dijk (1966) Technique a. A movement-based technique b. "learning through doing" enables people to: i. Acquire concepts ii. Form social relationships iii. Influence the environment as communicators

ALS

1. Speaking rate is a good predictor of the approaching decrease in speech intelligibility a. Speaking rate slows but intelligibility remains above 90% during early stages b. After rate decreases to about 120 words per minute, increasing number of individuals achieve speech intelligibility scores below 90% c. When rates decrease to 100 to 120 words per minute, most speakers have intelligibility cores below 90%

Taxonomic Grid Displays

1. Symbols are grouped according to super-ordinate categories a. People, places, feelings, foods, drinks, and action words 2. Has been used in AAC systems for older adults with aphasia and adolescents with cognitive disabilities 3. Research with typically developing children shows that they do not find this type of structure useful until sometime between age 6 and 7 a. Therefore, this strategy may not be appropriate for AAC users who are developmentally younger than age 6

Physical Characteristics of Selection Set Displays- orientation of display

1. The position of the display relative to the floor 2. depends on postural, visual, and motor control capabilities 3. table or wheelchair tray horizontal to the floor- provides arm & hand support and stabilization a. requires upright posture 4. 30-45 degree angle to floor allows individual to see the display clearly but avoids neck flexion required by horizontal display, still provides some stabilization 5. 45-90 degree angle used w/ light or optical pointers, careful not to obstruct vision for other people & activities

Verbal and light cues (ALS)

1. Used to encourage use of the symbols 2. Delivered in a least to most prompt hierarchy

sensory - perceptual skills- MS

1. Vision limitations are common a. 35% experience optic neuritis as first symptom 2. Many cannot use visual scanning arrays a. May require auditory scanning systems 3. Large print text is common requirement, along with synthetic speech feedback

Language Skills- MS

1. aphasia has occasionally been reported 2. 4 potential subgroups a. Pervasive language impairment (2%) b. Moderate to severe language impairment (13%) c. Mild to moderate language impairment (32%) d. Essentially typical language abilities (53%)

Physical Characteristics of Selection Set Displays- size

1. individual item size and overall display size 2. visual displays a. size of symbols determined by vision, motor access, type of symbols & number of symbols 3. auditory displays a. size of display determined by the individual's memory and ability to retain the organizational scheme 4. tactile displays a. size of selection set depends on tactile recognition capabilities

nonverbal juncture cues (ALS)

1. nonverbal signals performed by the facilitator that precede the highlighting of a symbol on the display 2. 2 functions a. Code the target symbol in nonverbal form b. Help individual anticipate symbol selection by providing a brief time delay where they might jump ahead and select the symbol spontaneously

Cognitive/Linguistic Skills (ALS)

1. usually retain their cognitive and linguistic functions as ALS progresses 2. able to understand and relate to world around them and formulate messages, like other adults 3. Cognitive changes do occur a. Between 40% and 50% experience some degree of dementia b. Cognitive deficits tend to be more distinct in those with dysarthria (bulbar involvement) and pseudobulbar palsy

o Nonverbal juncture cues o Verbal and light cues

2 types of cues used in ALS

o Stored Message Communicator o Generative Message Communicator o Specific-Need Communicator

3 levels of independent communicators (aphasia)

1. Emerging Communicator 2. Contextual Choice Communicator 3. Transitional Communicators

3 levels of partner-dependent communicators

1. Touch Cue 2. Verbal Cue 3. Pause 4. Verbal Feedback 5. Action

5 elements of scripted routines

1. Size: Adjust the number of items a student is expected to learn or complete 2. Time: Adjust the amount of time allotted for learning, task completion, or testing 3. Level of support: Adjust the amount of personal assistance or technology use 4. Input: Adjust how instruction is delivered 5. Output: Adjust how the student is expected to demonstrate learning 6. Difficulty: Adjust the skill level, problem type, or rules about how the learner approaches an activity 7. Participation:

7 ways to adapt curriculum

MAPs (Making Action Plans)

A collaborative planning process for action that brings together the key factors in a child's life

o Resistance toward need for AAC intervention because able to speak to some extent o Hearing limitations of listeners may be barrier to effective communication

AAC Constraints- PD

o Symptom patterns vary among individuals o Visual impairments are common and can make AAC interventions challenging o AAC interventions usually occur in conjunction with other efforts to compensate for multiple impairments

AAC constraints- MS

o enhance their strengths at each stage rather than to attempt to remediate their deficits o Materials and training should be provided to frequent communication partners o Intervention guidelines and strategies focus of the cognitive and communicative strengths: 1. Reduce memory demands: 2. Reduce Distractions: 3. Chunk information: 4. Provide information in alternating forms:

AAC intervention- dementia (7)

a. People with ALS require ongoing support from facilitators in order to use AAC systems b. Instruction in technical or other skills c. Facilitator support to select and modify stored messages d. May need facilitator to change motor control options and positioning of the system e. Facilitator may have to provide instruction in social use of the AAC system

ALS- facilitator support

a. Escape function behaviors i. Self-stimulatory behaviors (spinning objects, rocking) ii. Aggressive behaviors (tantrums, self-injury) b. Acceptance messages i. Hand flapping ii. Repetitively squealing c. FCT can be used to teach alternatives to inappropriate acceptance, rejection, and social interaction signals.

Accept/ Reject Signals; relationship to challenging behaviors (3)

o To enhance access in a classroom (aisle width, board height, table height, etc.)

Adapt the Educational Environment

PATH (Planning Alternative Tomorrows with Hope)

An in-depth, eight-step process for helping people assist a student by solving complex individual, family , or system problems through focused planning

o Advance Preparation o Use of Peer Instruction and Support o Selective Retention (stay past the age of 18 to meet specific academic goals)

Assist the Students to Manage Time Constraints (3)

1. To develop attention-seeking behaviors a. Respond to any intentional behavior that are i. Socially appropriate ii. Culturally appropriate iii. Apparently functioning to get attention b. Begin to limit response to the most desirable and frequent behaviors only, when: i. A repertoire of acceptable behaviors is established and used intentionally 2. Relationship to Problem Behavior a. Attention-getting signals often take the form of socially unacceptable (i.e., problem behaviors)

Attention-Seeking Signals for Social Interaction

1) Early Intervention- Begin when diagnosis is seriously considered (not necessarily confirmed) 2) Communication in a Social and Developmental Context 3) Speech Output- use has been debated but research has shown can help develop literacy & communication skills

Autism/PDD issues: (5)

35 years following onset

Average life expectancy in males with MS

1. Emphasis on AAC balance with: a. Motor development training b. Speech therapy c. Academic instruction 2. Meet immediate needs 3. Also invests in the future through a systematic motor or speech therapy program to train more complex skills 4. Encourage use of natural modes of communication (speech, gestures, and facial expressions) 5. Consider different techniques for different contexts, people, and messages

Balanced approach to intervention, CP (5)

1. Ask and answer questions on different topics 2. Give reports 3. Participate in instructional groups 4. Participate in a wide variety of social exchanges 5. Social environments that necessitate communication beyond requesting, rejecting, and identifying wants and needs

Broader range of communication needs in general education classroom: (5)

o Expert team o Best client-system match o Balanced Approach to Intervention

Cerebral palsy issues (3)

1. Physical environmental stuff 2. Academic workload issues 3. Creating active learners - need to stay up with vocab

Collaborative Teaming and Consensus Building- barriers (3)

1. Elements necessary to be included in the community 2. Ecological Inventory (similar to Participation Model) 3. Reduce opportunity barriers = not being supported to participate in functional, age-appropriate activities in a wide variety of settings 4. Communication Partners

Communication Opportunities for Adults (4)

1. Inclusive education with appropriate supports greatly increases the likelihood that students with disabilities will have numerous, daily opportunities for natural communication with a variety of partners. 2. MAPs, Circles of Friends, and PATH o Three related models used to facilitate social inclusion of school-age individuals with disabilities into general classrooms. o Useful to create inclusive neighborhoods, workplaces, and other settings as well. o Build communities for support and friendship development 3. Social Networks 4. COACH and VISTA

Communication Opportunities for School-Age Individuals

1. Creating Predictable Routines at Home and in the Preschool Classroom o Daily living routines 2. Adaptive Play

Communication Opportunities for Young Children (2)

o Residual speech o Gestures o Writing and/or drawing o AAC techniques

Communication for the aphasia patient includes use of all modalities:

o Most often partners are: 1. Family members 2. Paid communication partners 3. Other people with disabilities 4. These are acceptable, but should not be the only partners. o PATH and Social Networks o Person-Centered Planning

Communication partners for adults:

o Symptoms vary with level and extent of damage o Some with dysarthria communicate partial or complete messages through speech o Predominantly flaccid type of dysarthria o Others display spastic component in addition to flaccidity o Many are unable to speak because of severity of impairments

Communication symptoms - brainstem stroke

o Dysarthria results from weakness and spasticity o Bulbar involvement (dysarthria, Speech and swallowing 1st) o Spinal involvement- May retain normal or mildly dysarthric speech for considerable period of time o Timing of speech deterioration cannot be predicted accurately based on ALS type and months post-diagnosis alone o Most people with ALS experience a severe communication disorder during last months or years of their lives

Communication symptoms of ALS

o Dysarthria is most common communication problem associated with MS 1. But not universal characteristic of disease o Most individuals with MS do not require AAC systems

Communication symptoms- MS (3)

o Dysarthria is common o Speech symptoms o Speech disorders are not uniform o As PD progresses, many demonstrate combinations of these speech disorders o Clinical observations reveal a gradual process, with speech becoming increasingly difficult to understand

Communication symptoms- parkinsons

o Authorship: 1. Who is typing the messages? 2. Experiments have been unable to prove. o May simply not work for everyone 1. Some people become independent typists 2. Others continue to require facilitation 3. FC facilitators should receive appropriate training a. Also should address seating, positioning, and other support issues

Controversy over facilitated conversation; ways to circumvent

1) AAC as a Secondary Strategy o To support the child's attempts to communicate successfully o Until speech is adequate to meet ongoing communication needs 2) Multimodal Communication- low & high tech 3) Social Competence 4) Parent Support

DAS issues (4)

aphasia

Difficulty comprehending, creating ideas, retrieving words, formulating words/messages, reduced processing speed, decreased attention, memory and problem-solving skills

1. Assessment a. Vary little formal assessment because of difficulties staying awake or paying attention. b. Document systematic observations to identify changes in response patterns & functional movements. c. Over time, differentiation returns. i. Precursor to yes/no

Early stage (1-3) TBI, Assessment

2. Intervention a. Unable to speak in early stages b. Goal: emerge from coma & begin to respond consistently to simple commands, i.e. stimulation. c. Examples: Alternative access modes (switches), cause & effect awareness, limited number of symbols (1-4)

Early stage (1-3) TBI- Intervention

• Principle 1- Begin early, prepare AAC user for regular classroom experience • Principle 2-Hold student in the regular curriculum • Principle 3 - When students with disabilities are not successful in high school and college, it is usually because of their limited literacy skills and limited world knowledge base. • Principle 4 - Specialists must complement, not compete with, academic program

Educational inclusion- 4 basic principles

grid displays

Elements are typically individual symbols, text, or pictures arranged in various ways

o Access to a community-referenced support model which supports: o Access to learn the skills needed to participate in activities that are 1. Age appropriate 2. Functional 3. Taught in the actual community or vocational environments where they are needed 4. Taught with reference to the cues and corrections that are naturally available

Elements necessary to be included in the community, adults

Frontotemporal dementia

FTD/ALS occurs in 1% to 2% of individuals with ALS b. Profound personality changes and breakdowns in social conduct c. Fail on tests of executive function and exhibit poor abstraction, planning, and organization skills

(Frontotemporal lobar dementia syndrome)

FTLD

1. Potential communication partners may fail to recognize or make use of naturally occurring events related to communication 2. Partners may preempt communication by anticipating students' wants and needs 3. Students with disabilities may have limited repertoires of communicative behaviors, making it less likely that others will offer them opportunities to communication

Factors that may limit communication opportunities for school-age individuals (3)

o Select appropriate AAC modality o Identify nonpreferred items or activities across wide range of routines and contexts o Create need for rejecting, for example, by providing a nonpreferred item o Provide prompts to enable person to make the desired rejecting response o Remove the nonpreferred item or activity following the appropriate rejecting behavior

Five steps in teaching generalized rejecting

i. Designed to reduce problem behaviors by teaching functionally equivalent communication skills ii. Teaches alternative attention-getting behaviors

Functional Communication Training (FCT)

o Weakness causes flaccid dysarthria and sometimes anarthria (complete loss of speech) o Severe weakness often requires ventilator support through oral intubation or tracheotomy o Language and cognition usually unaffected

GBS- communication disorder (3)

o Stage 1: Deterioration Phase o Stage 2: Loss of Speech o Stage 3: Prolonged Speechlessness o Stage 4: Spontaneous Recovery of Speech communication breakdowns with AAC system o Stage 5: Long-Term Residual Motor Speech Disorder

GBS- intervention stages

independent communicators

Have cog/ling abilities to converse independently; good comprehension; self-select communication strategies and modalities; but....breakdowns still occur (aphasia)

o Observe a peer without disabilities engage in the activity o Write a step-by-step list of the skills required o Assess the target individual against the skill inventory to identify discrepancies o Design communication supports and instructional programs to teach needed skills

How do you create an ecological inventory for adults? (4)

o Consider the student's current levels of integration, educational and social participation, and support o Team should then discuss the integration, participation, and support goals for the next school year

Identify Current and Desired Participation and Support Patterns (2)

1. Is there alternating gaze between an object (i.e., goal) and a facilitator? 2. Is there body orientation to indicate that the signal is being directed toward a facilitator? 3. When a signal is produced, is there a pause before it is repeated that might indicate the communicator is awaiting a response from a facilitator? 4. When a signal is produced and the facilitator responds, does the signal terminate? Does the communicator show either satisfaction or dissatisfaction with the response? 5. When a signal is produced and the facilitator fails to respond, does the communicator persist by repeating or changing the signal? 6. Is the signal ritualized (i.e., the same every time) or does it have a conventional form (e.g., pointing, shaking head)?

Indicators of intentional communicative behavior

o Opportunity Factors o Problem Behavior

Intellectual disability issues: (2)

o Stage 1: No Detectable Speech Disorder o Stage 2: Obvious Speech Disorder with Intelligible Speech o Stage 3: Reduction in Speech Intelligibility o Stage 4: Residual Natural Speech and AAC o Stage 5: Loss of Useful Speech

Intervention Staging- ALS

o Stage 1: No Detectable Speech Disorder o Stage 2: Obvious Speech Disorder o Stage 3: Reduction in Speech Intelligibility o Stage 4: Natural Speech Supplemented with AAC o Stage 5: Loss of Useful Speech

Intervention stages- PD

• Phonology • Morphology • Semantics • Syntax • Pragmatics • Discourse • Reading Comprehension • Emergent Literacy

Language development characteristics (by linguistic component) in children using AAC. (8)

o Demonstrated delays o Needed for development of Phonological Awareness and decoding o Related to spelling development

Language development characteristics (by linguistic component) in children using AAC.: phonology

o More communication experiences with conversational discourse o Restricted experience with classroom discourse o Need discourse knowledge to support text comprehension and to participate in reading lessons o Also need to organize coherent composition in writing and to participate in writing activities

Language development characteristics (by linguistic component) in children using AAC: discourse

May have literacy materials in home like other kids, but have significantly less access and seldom involved in writing or drawing o Early intervention programs tend to ignore emergent literacy o Social interaction context of literacy often absent or diminished with AAC users o Adults dominate o Kids have few options for response

Language development characteristics (by linguistic component) in children using AAC: emergent literacy

o Demonstrated difficulties with production of morphemes o Needed to comprehend sophisticated meaning changes in text o Critical to conventional writers who communicate subtle meaning through text

Language development characteristics (by linguistic component) in children using AAC: morphology

o Impaired in AAC users, who are typically respondents with restricted range of speech acts o Related to understanding author's intention o Related to understanding classroom discourse o Related to understanding audience in writing, as well as to classroom participation in writing activities and in feedback to peers

Language development characteristics (by linguistic component) in children using AAC: pragmatics

o Silent reading comprehension o Word identification - need automatic and phonics/decoding o Whole text print processing - inner voice, eye movements, projecting prosody o Written language comprehension 1. Knowledge of text structures 2. Knowledge about topics or subtopics o Build or activate background knowledge before reading 1. Plan vocabulary selection and AAC systems 2. Focus on use, not just passive o After reading 1. Provide tasks that directly relate to purpose set prior to reading 2. Give feedback to build cognitive clarity about reading

Language development characteristics (by linguistic component) in children using AAC: reading comprehension

o Restricted experiences and background knowledge o Vocabulary deficits o Need both the comprehend text material o Need both to communicate during reading lessons o Critical to content generation in writing

Language development characteristics (by linguistic component) in children using AAC: semantics

o Often limited to 1 to 2 word utterances o Prevalence of single clauses, word order deviations, word omissions o Need to process range of sentences encountered in text o Needed to compose compound and complex sentences and to support cohesion between sentences

Language development characteristics (by linguistic component) in children using AAC: syntax

a. Patients who remain unable to speak at this stage usually have severe specific language or motor control disorders. b. Participation Model is used for assessment & intervention planning.

Late stage (6-8) TBI- Assessment

a. Traditional AAC techniques that resemble those used with other individuals who experience physical and cognitive impairments are often appropriate. b. Direct selection is common. c. Patients often retain the ability to read and spell. d. Avoid complex techniques & frequently changing devices.

Late stage (6-8) TBI- Intervention

o In males o If age at onset is greater than 35 years o If chronic, progressive pattern appears at onset o If cerebellar symptoms occur at initial presentation

MS prognosis is worse if

o Episodic memory (1st) o Semantic memory o Procedural memory is often best preserved of the memory domains o Typically, people with memory deficits due to dementia perform better when using recognition rather than recall memory

Memory strengths and deficits- dementia (4)

a. In this stage, individuals begin communicating comfort messages (hot, cold, etc.) & often experience agitation or poor awareness of communication deficits & therefore may initially reject AAC use. b. Goal of assessment in this stage is to identify residual capabilities that the individual w/ TBI can utilize to achieve communication goals.

Middle stage (4-5) TBI- Assessment

a. One or two goals b. Messages that relate to wants/needs & information sharing are most important. c. Usually non-electronic methods d. Communication partners important for structuring communication interactions at this stage.

Middle stage (4-5) TBI- Intervention

o Individuals with ALS adopt a range of lifestyle patterns 1. home-centered individuals a. movable or portable AAC systems may meet communication needs b. may also use AAC systems that require extensive facilitator support (eye pointing, lip reading)

Participation Patterns and Communication Needs (ALS)

1. Many are older and/or retired, so communication needs reflect social environments of their retirement 2. Range of physical impairments varies, so some require extensive physical assistance

Participation Patterns and Communication Needs- PD

o Medical and lifestyle issues influence needs o May require extensive personal and medical care o Usually aware of world around them and are able to exchange information and achieved social closeness through message formulations

Participation Patterns and Communication Needs- brainstem stroke

Partner-Dependent Communicators

Patients who rely on communication partners to assist with informational demands and provide communication choices

o Encourages teachers to set lesson goals and to design related activities that are inclusive from the outset o 3 basic principles: 1. To support recognition learning teachers should provide multiple, flexile methods of presentation 2. To support strategic learning, teachers should provide multiple, flexible methods of expression and apprenticeship 3. To support affective learning, teachers should provide multiple, flexible options for engagement

Principles of Universal Design to Design Lessons that include all Students (3)

COACH (Choosing Outcomes and Accommodations for Children)

Process in which family members and others are interviewed by a member of the educational team to identify a long-term vision for the student as well as annual educational goals.

Tri-Focus Framework - component 2 and 3

Provide supports to communication partners to better facilitate and support nonsymbolic communication

Leave-Taking

Rejection training-- for those who cooperate for a while then want to escape or terminate. 1. Message would be "want a break". 2. Have to learn to identify warning signs, behavioral antecedents. 3. Have to have signal available, and be provided with an opportunity to use it as soon as antecedent behaviors are produced. 4. Should be reinforced immediately with cessation of activity, building in a short delay later.

refusal

Rejection training-- rejection of object or activity completely. When prompted to sign no and client complies, object removed. Must be honored.

o Examples of problem behaviors: 1. Tantrums 2. Hitting 3. Screaming 4. Pushing 5. Various forms of self-injurious behavior o Problem behavior can be interpreted as communicative in nature and treated as such

Relationship Between Communication and Problem Behavior

o Initiate a topic o Maintain the topic by asking questions, answering questions, acknowledging others' contributions, and commenting o Repair communication breakdowns when they occur o Terminate the conversation appropriately

Requirements for conversational interactions: (4)

a. Pre-k or kindergarten so developmental support can be given b. 3rd & 4th for literacy skills c. Junior high to ensure enhanced versions & concepts are fluent before high school d. High school to complete academic requirements

Retention at different grades

o Shaping 1. Consistently interpret and respond to random behaviors as if they were intentional 2. Causes the individual to gradually learn to initiate them intentionally 3. Facilitators must respond differentially to intentional rather than unintentional behaviors in order to strengthen the former. ***read

Signaling for Communication (Distinguishing and Responding to Intentional and Nonintentional Signals for Communication)

• Both designed specifically for AAC applications • Both use total-immersion approaches to teaching individuals to understand and use graphic symbols • Purpose is to provide individuals with rich contextual models for combining symbols in flexible manner and opportunities to do so • Based on the premise that by observing graphic symbols being used by others, the learner can establish a mental image of how those can be combined and recombined to mediate communication during the activity • Intended to teach language in a very natural way

Similarities between aided language stimulation (ALS) and system for augmenting language (SAL). (5)

o Linguistic -- of environment and of code of system o Operational --technical skills to operate o Social - skills that relate to interpersonal dynamics, putting partners at ease, active participation and initiation, etc. o Strategic -- skills that make the most of what user has

Skills Related to Communicative Competence (4)

1. Identify daily activities in the order they occur. 2. Create symbols for daily activities. 3. Create a container for schedule. 4. Devise a system for identifying finished activities.

Steps for organizing a visual schedule (4)

1. Prompt individual to refer to schedule & id symbol for 1st activity. 2. Individual should discard symbol in predetermined manner once activity is completed. 3. Positive signs will indicate that person is making connection: using symbols appropriately, smiling/laughing when individual picks up preferred symbol.

Steps for using a visual schedule (4)

1. Withholding an item needed to complete or engage in an activity 2. Interrupting an ongoing activity to create an opportunity for requesting or protesting 3. Providing a wrong or incomplete item in response to a request 4. Delaying assistance

Strategies to overcome some limitations of communication opportunities for school-age individuals:

Circles of Friends

Support the development of friendships among classmates and peers

True- In a few rare cases, primary progressive aphasia appears to evolve to ALS

T/F Aphasia can be associated with ALS

true

T/F Between 75% and 95% of people with ALS are unable to speak by the time of their deaths

true

T/F In ALS, Motor control site for alternative access may need to be changed several times during progression of the individual's disease

true

T/F People with ALS usually demonstrate relatively high acceptance of AAC technology

true

T/F Specialists must complement, not compete with, academic program

True

T/F Typically simple print can be read by individuals with mild, moderate and occasionally sever dementia.

o Relationship to challenging behaviors 1. high motivation to communicate rejections, even more than requests 2. underlying aggression, tantrums, and self-injury o Teaching ways to communicate rejection acceptably should have positive behavioral consequences

Teaching Basic Rejecting

1. Identify frequent, meaningful opportunities to control environment. a. Deciding food & drinks b. Order in which to complete a task 2. Choice making formats -- motivating, natural, understandable. 3. Opportunities should be age appropriate

Teaching Choice Making (Elicited) (3)

a. Generalized requesting -- single, uniform symbol in different situations for different requests b. Client must first be able to gain attention of communication partner

Teaching Generalized and Explicit Requesting and Use of an Attention-Getting Signal (2)

1. socially unacceptable behaviors may be used by early communicators to initiate requests 2. "challenging" behaviors respond well to interventions in which alternative communicative behaviors are provided -- e.g., a. manual signs for please or want, b. showing a tangible symbol for want, c. operating a VOCA, or d. activating a microswitch with message that indicates "I want" or I'm bored" or ...whatever.

Teaching Requesting- Relationship to challenging behavior

1. Use a single, uniform symbol (WANT) to initiate requesting 2. Be sure WANT symbol is readily available 3. Identify a manual or aided attention-getting signal that will be taught.(e.g. tapping an arm, raising hand, ringing a bell, or activating a call buzzer) 4. If an aided call signal is selected, be sure it is accessible to the individual. 5. Use a physical prompt to teach the individual to use the signal to get a partner's attention. 6. When partner's attention has been gained, partner follows steps for teaching use of generic want symbols (p. 303). 7. Fade prompt used to teach the attention-getting signal. 8. Make attention-getting signal available to the individual as often as possible to encourage spontaneous requests.

Teaching use of Attention-getting signal to initiate requests (8)

a. Comprehension check b. Responding to spontaneous signals -- may initially occur at random but may be interpreted as meaning something else we give them intentionality. Be aware of attention seeking behavior and reward all that is socially and culturally acceptable. c. Teaching in routine contexts. Structured opportunities to practice behaviors in the context of naturally recurring routines. Four elements: touch cue, verbal cue, pause (10 seconds), Actions.

Techniques for teaching choice making (3)

• Identify Current and Desired Participation and Support Patterns • Develop a Student Profile • Develop Appropriate Individualized Education Programs • Use the Principles of Universal Design to Design Lessons that include all Students • Develop a Goal/Context Matrix • Identify Individualized Adaptations Needed for Participations • Adapt the Educational Environment • Managing the Academic Workload • Assist the Students to Manage Time Constraints

The Participation Model for Inclusion (9)

1. The Principle of Functional Equivalence a. Teach the individual an alternative behavior that serves the same function as the problem behavior 2. The Principle of Efficiency and Response Effectiveness a. People communicate in the most efficient and effective manner available to them at any given point in time b. If the new behavior is more difficult or less effective, the old behavior will persist 3. The Principle of Goodness-of-Fit a. Sometimes the most appropriate response to problem behavior is to create a better "fit" between the person and his/her environment. b. Usually requires altering relevant aspects of the environment

Three Principles of interventions (for both nonsymbolic and symbolic communication) for problem behavior:

Spontaneous signals for a. Getting attention b. Accepting c. Rejecting - Opposite of accepting signals

Three of the essential building blocks of communication are: o If not present, initial interventions should include strategies for developing these behaviors.

bulbar (Brain-Stem) ALS- motor skills

Usually able to control AAC devices that they can operate via direct selection using their hands or fingers - for some timeulbar (Brain-Stem) ALS- motor skills

Should be based on cognitive, language, sensory and motor capabilities of the client

What factors influence number of items on the display, size of icons, spacing/arrangement of icons, and orientation of the display? (4)

Collaborative Teaming and Consensus Building

Who's involved? Student and family members, SLP, regular education teacher, special education teacher, OT, PT, computer specialist, paraprofessional, educational administrators

The availability of genuine and motivating communication opportunities in inclusive settings is at least as important to the success of a communication intervention as the availability of an appropriate access system.

Why is providing communication opportunities important?

requesting, choice-making

_______ always involves a communication interaction between two people, while ________ does not. o Both occur on a continuum 1. The amount of partner support needed 2. The memory requirements involved

Requesting

_______ is one of the most basic & essential communication skills. 2. Instruction requires a systematic approach. 3. Behavior skill as well a. Beginning communicators may use socially inappropriate behaviors to ______

primary progressive aphasia

a distinct clinical condition characterized by a gradual progression of language impairment in the absence of more wide-spread cognitive and behavioral disturbances for a period of at least 2 years. • Mean age of onset: 60.5 years 2:1 ratio of men to women • is considered the 5th most common type of dementia • No known cause, although about ½ have a family history of dementia • 25% demonstrate symptoms of fluent aphasia, 60% non-fluent aphasia, 15% indeterminate symptoms • Initial symptoms vary but anomia (trouble thinking of specific words) is the most commonly reported language symptom. • Another common symptom is slow, hesitant speech with long pauses. • AAC intervention should aim to enhance both receptive and expressive language and should be introduced early, people should help in the design of their AAC strategy or device

operational competence

a. People with ALS require time and instruction in order to gain communicative competence with AAC system b. Able to select AAC system and learn to operate it while they can still use natural speech to meet at least their most basic communication needs c. Sound clinical management dictates early preparedness d. Exploration of AAC options should begin when speech has slowed to between 100 and 120 wpm and/or intelligibility is inconsistent in difficult listening situations

Choice-making arrays

a. Two preferred options b. One preferred and one non-preferred option c. One preferred option and one blank or distractor option. d. Other strategies: spacing, aligning, out of reach.

actions

actual steps in routine performed by facilitator. You don't need all four steps and cues, but you should think through scripted routine for play.

o Communication needs in real-life contexts o specific capabilities o Assess constraints o Consider TRIALS, especially with devices

aphasia assessment (4)

cueing hierarchies

are widely used to systematically increase or decrease cues or prompts for specific communicative behavior, contingent on performance of the behavior. (dementia)

facilitated communication

assumes communicative competence rather than impairments • Facilitators are encouraged to expect that their communication partners will produce meaningful & even complex communicative messages with the proper supports.

Mand-Model Technique

elicits requesting skills in those who have no such skills

Incidental Teaching

encourages initiation and builds more sophisticated comm. skills in those already communicating in response to verbal cues

preference

evident when individual indicates acceptance and rejection after he or she is offered options one at a time 1. Necessary 1st step to choice-making

shorter, less complex and less grammatical utterances. • Low-tech AAC strategies that focus primarily on choice making and scheduling should be introduced early in the course of the disease so that people with HD can learn to use them before cognitive impairments make new learning difficult. • People with HD may benefit from linguistic and cognitive supplementation strategies that support the procedural memory that underlies activities of daily living.

expressive language deficits, HD

natural consequences, choice making

get away from right and wrong -- need to learn natural consequence of choice that made, particularly if weren't paying attention. Don't correct kid for picking less preferred -- let them experience consequence. b. Begin w/ real items, then symbols

spinal ALS- motor skills

i. Usually experience extensive trunk and limb-related motor impairments by the time they need AAC ii. Usually require scanning communication system of some type

o Stage 1: No Detectable Speech Disorder o Stage 2: Detectable Speech Disorder o Stage 3: Obvious Speech Disturbances with Intelligible Speech o Stage 4: reduction in Speech Intelligibility o Stage 5: Loss of Most Useful Speech

intervention staging- MS

spaced retrieval (better than cueing)

involves learning to remember information by recalling it over increasingly longer durations of time. (dementia)

1. No response 2. Generalized response 3. Localized response 4. Confused-agitated 5. Confused, inappropriate, nonagitated 6. Confused-appropriate 7. Automatic-appropriate 8. Purposeful and appropriate

levels of cognitive functioning- TBI

o Emergent reader o Ready Reader o Beginning Reader o Developing Reader

levels of literacy (4)

gestural dictionaries

o A way of avoiding communication breakdowns o Lists descriptions of an individual's gestures, along with their meanings and suggestions for appropriate responses o Examples: 1. Wall poster in classroom or home 2. Alphabetized notebook with cross-referenced entries o Useful for all ages o Good when staff turnover is high

visual schedules

o AKA calendar system, schedule system or activity schedule o Represents each activity in the person's day w/ symbols; serves several purposes: 1. To introduce the individual to the concept of symbolization (one thing can stand for another) 2. To provide an overview of the sequence of activities across a day 3. To provide specific information about what will happen next in the day 4. To ease transitions from one activity to the next 5. To serve as one component of a behavioral support plan for individuals who have a high need for predictability.

Verbal Prompt-Free and Expectant Delay Procedures

o Aided symbols made available at appropriate moment o No prompt provided initially o Reward any move towards, contact with symbol.

visual scene displays

o Allows "hot spots" or key visual elements within a digitally stored picture to be programmed with appropriate messages on an SGD o Use w/ transitional communicators

Social Networks

o An inclusion tool designed for students who use AAC o Based on Circle of Friends model o Aimed at helping educational teams to collect and interpret information o Identify communication partners across 5 "circles" 1. Life partners 2. Good friends 3. Neighbors and acquaintances 4. People who are paid to interact with the individual using AAC 5. Unfamiliar partners with whom the individual interacts occasionally

graduated prompting (conversation)

o An instructional technique in which a facilitator provides increasingly directive cues to elicit a desired communicative response. o Instructional techniques that involve graduated prompting: 1. A-SIM 2. Structure practice 3. Conversational coaching o The idea is to predetermine the order of the prompts that will be provided in a least-to-most-intrusive hierarchy and then to fade them as quickly as possible

Conversational repairs

o Breakdowns may be cause by difficulties related to: 1. Message intelligibility or comprehensibility 2. Conversational timing 3. Partner unfamiliarity with AAC 4. Numerous other factors o Two Basic Types 1. Repetitions 2. Modifications

storybook reading

o Critical tool to facilitate literacy learning 1. Need to encourage joint participation 2. Should expose child to books at appropriate level and of interest, with predictable story line, large clear print, colorful illustrations, and rhyme and repetition

Adapted Strategic Instruction Model (A-SIM)

o Define the specific goal (i.e., target skill) to be taught to the person using AAC o Explain the skill to the person and why it is important o Demonstrate how to use the skill or have the person observe someone else applying the skill while saying "think-aloud" statements that explain when to use the skill o Ask the person or significant others (as appropriate) to think of a situation in which he might use the skill o Set up situations for the person using AAC to learn the skill, starting with less demanding situations and more to more demanding o Provide guided practice for the person to use the target skill in naturally occurring situations or role playing. o Evaluate progress regularly to measure the effects of instruction. o Conduct probes in novel settings to evaluate generalized effects of instruction.

Regulatory phrases

o Directions regarding positioning, effective use of AAC system, obtaining and securing conversational turns, and repairing conversational breakdown. o Blunt and direct may be better than long-winded but grammatically correct

visual scene displays

o Elements depicted are the events, persons, objects, and related actions that are actually part of the scene o Similar to activity displays because contain vocabulary words associated with specific activities or routines o Words are organized schematically, not semantically o Most appropriate for use with speech-generating devices that have dynamic screen displays o Easier for young, typically developing children to learn and use than activity displays or taxonomic displays o Can also be used in low-tech AAC systems, but less efficient

conversational coaching

o Facilitator provides physical, gestural, indirect verbal and direct verbal prompts to teach basic conversational structure, and then fades these. o Partners must be trained as well -- a kind of briefing. o Can do the same thing with play interactions between young AAC users and peers -- facilitators as active communicator and partner, modeling for other partners, then gradually fade out role of translator to peer

Active Social Participation

o Have friends, make choices about, and are involved in the social activities of their peer group, although they may not exert much direct influence over the social climate of the group or its interaction patterns. o Interact with classmate both inside and outside of school, although they may spend more time alone after school than do their socially influential counterparts.

No social participation

o Have limited or no access to peers without disability during school hours and thus have no opportunities to form friendships or make acquaintance with them

Introduction strategy, conversational training

o How to communicate with someone new, including explanation of method of communication -- use of intro strategy facilitates perception of communicative competence o For someone who uses AAC, an introductory message usually requires 3 components: 1. Basic information about who the person is 2. Information about the person's means of communication 3. Information about what the partner can do to facilitate the interaction

academic, social, & cross-curricular goals, instructional strategies and criteria for determining whether each goal has been met

o IEP should include:

Partner-focused questions

o If user initiates questions about partner's life, tend to be perceived as more communicatively competent. o Response-recode. Respond to a question, then ask a related question in return. The facilitator initially provides user with prompts -- verbal, verbal plus model, verbal, model and manual assistance. o Question -- do partners prefer more linguistically correct responses or short, to-the-point single words

full integration

o In the classroom the whole day (100% of the time) o Doing what everyone else does, when and where everyone else does it o NOTE: physically present doesn't mean actually participating

Nonobligatory turns

o Includes normal conversational things like comments -- "cool," "awesome," etc.-- basic interjections that keep the flow going. o Conversational Commenting is part of this -- phrases like "this is fun," "sounds good," "yuck." etc. o Users instructed in classroom to ensure practical applications.

MS

o Individuals are usually in educational programs or employed when first experience symptoms o Intermittent and gradual onset of symptoms doesn't usually require individuals to modify lifestyles immediately o Some with visual problems require technological assistance to read computer screens or detailed printed materials o Primary communication needs are conversational 1. But individuals may require assistance with writing as well

balanced literacy

o Integrates various modalities of literacy instruction o Explicit skill instruction & use of authentic texts o Responsibility is gradually shifted from teacher to students o software for emergent readers & writers that provides children who use AAC with access to storybook reading and to activities that foster 1. Phonemic awareness 2. Letter identification 3. Letter sounds 4. Phonics 5. Word recognition 6. Spelling

Talking Switch Techniques

o Method to introduce symbolic communication & provide limited context communication w/ voice output 1. E.g. BIGmack: single, short message 2. Single message cassettes o Person who records message should be same age & gender as client o Direct or remote activation (switch) o Esp. appropriate for beginning communicators learning to use microswitches

Interrupted Behavior Chains

o Milieu teaching based o Teaches elicited or self-initiated requesting in natural settings based on natural routines o Behavior chains o Good for those not motivated to initiate communication or with very limited response repertoires. o Have to identify what variables related to success, have person or facilitator carry out initial steps, interrupt chain in planned manner, and work to elicit desired response. This often generalizes well.

setup assistance

o Most students who use AAC require, at a minimum, setup assistance at the outset of an activity to change position or organize their work area in the classroom.

visual schedules

o Originally used w/ deaf/blind individuals 1. Now also w/ visual, developmental/cognitive, or multiple disabilities. o Effective across environments & age/ability ranges o Real objects, tangible symbols, photographs, line drawings, & wall displays

Active Educational Participation

o Participate in the same education activities as their peers and learn content related to academic subject areas such as language arts, math, science, and so forth. o However, the expected learning outcomes are not the same as those of their peers, and their progress is evaluated according to individualized goals or standards.

Involved Educational Participation

o Participate in the same educational activities as their peers o However, they are primarily expected to learn content in cross-curricular areas such as communication, social, and motor skills, rather than in academic subjects.

Competitive Educational Participation

o Participate in the same educational activities as their peers and are expected to meet the same educational/academic standards. o However, they may not complete the same amount of work in the same amount fo time with the same level of independence as their peers.

scripted routines

o Provide structured opportunities for beginning communicators to practice using attention-getting, acceptance, and rejection signals in the context of naturally occurring activities.

5 classes of MS

o Relapsing and remitting o Chronic progressive o Combined relapsing/remitting with chronic progression o Benign o Malignant

Influential Social Participation

o Socially influential students have friends that include their classmates without disabilities and assume leadership roles in their peer social groups.

no integration

o Some student with AAC systems may experience no integration during 1 or more years of their school careers. o Mandated not to occur, but it happens. o May be appropriate in short term - e.g., in classroom for short time with AAC specialist focusing on AAC systems, access, literacy, and integration.

full assistance

o Some students require full assistance in order to participate in general education classrooms o Independence nor the ability to be educationally competitive is an appropriate prerequisite to general classroom inclusion.

no support

o Some students who use AAC require no support in some activities- that is, they are able to position themselves appropriately, equip themselves with the necessary tools for participation and engage in the activity independently.

selective integration

o Spend part of each day in learning environments other than those that are typical for their classmates, such as resource rooms, special education classrooms, and so forth o Students may spend anywhere between 1% and 99% of their time in general education classrooms. o Allows for needed specialized services if carefully done

No Educational Participation (not appropriate)

o Students are integrated (i.e., physically present) in general education classrooms during the same activities as their peers but are passive and uninvolved for the majority of the time. o Other are integrated in general education classrooms but participate in substantially different educational activities than their peers and receive separate instruction delivered by paraprofessional or therapists o Pg. 402 gives a list of some things that provide appropriate educational participation

Involved Social Participation

o Students who are socially involved have smaller circles of friends without disabilities, exert less choice and influence in social situations, and are often passive participants or observers in social activities.

structured practice for conversational skills

o Teach how to produce variety of conversational messages o Then provide naturalistic cues and settings for use o Partner should provide expectant pauses, minimal prompts

COACH and VISTA

o Two related approaches for: 1. Developing individual education plans (IEPs) 2. Assisting educational teams to develop collaborations for implementing IEPs in inclusive classrooms

Initiation and Topic-setting strategies

o Visual Supports o Collections o Remnant Books o Topic-Setting Cards o Joke Cards o Conversation Displays o Dual Communication Boards o MiniBoards—topic specific o Talking Photo Album o Single message devices

choice-making

occurs when individual selects a preferred item or activity from two or more options, either independently or when someone else offers them. 1. Not always self-initiated 2. Doesn't always occur in comm. Context

Goal/Context Matrix

provides the teacher and other members of the AAC team with a "blueprint" that indicate which goals will be targeted for instruction in which subject areas or environments.

integration

refers to the amount of time each day a student is physically present in a general education classroom, (necessary but not sufficient component of inclusion)

requesting

requires two essential components: 1. Another person must be inclined to provide mediation or assistance if asked to do so. 2. The individual who attempts to gain access to a specific activity or item must be unable to do so w/out the assistance or mediation of another person.

organizational strategies

semantic-syntactic grid, taxonomic grid, activity grid and visual scene displays

1. Reduced pitch variability 2. Reduced overall loudness 3. Decreased use of all vocal parameters for achieving stress and emphasis 4. Imprecise articulation produced at variable rates 5. Harsh voice quality, sometimes breathy

speech symptoms- PD

o Early Stage: o Middle Stage: o Late Stage:

stages of intervention- PPA

o Stage 1: No Useful Speech o Stage 2: Reestablish Subsystem Control for Speech o Stage 3: Independent Use of Natural Speech o Stage 4: Maximizing Speech Naturalness and Efficiency o Stage 5: No Detectable Speech Disorder

stages of intervention- brainstem stroke

Time-Delay Procedure

teaches self-initiated requesting when individual has behavior but doesn't use unless prompted

AAC strategies- dementia

written choice techniques, communication notebooks or small wallets, and communication cards or labels

dementia

• A medical syndrome characterized by an acquired, chronic, cognitive impairment • Diagnosis requires that they cognitive impairments involve memory and at least one additional cognitive domain, such as language, attention, visuospatial function, praxia (movement), and executive or frontal love functions • Relative common syndrome, prevalence of 1% of the population for people 65 and almost 50% for people 90 or older • Alzheimer's disease (AD) is the most common form of dementia; affects 10% of people age 65 and most 50% of people 85 or older

System for Augmenting Language (SAL)

• A.k.a. augmented communication input • Similar to aided language stimulation, but 2 main differences o Use of speech-generating device o Techniques are much simpler than those used in aided language stimulation • Communication displays using graphic symbols with printed word gloss are made for the learner's device • Communication partners learn to activate symbols on the device to augment their speech input in naturally occurring interactions • Relies heavily on partners' cooperation and use of techniques on an ongoing basis o Therefore, variety of strategies are included to ensure positive perceptions and experiences

Multiple Sclerosis (MS)

• Acquired inflammatory disease of the white matter of the CNS • Lesions of MS result in multiple plaques that cause destruction of the myelin sheath

brainstem stroke

• Disrupt the circulation serving lower brain stem • Often cause severe dysarthria or anarthria • Damage to brainstem may result in inability or reduced ability to control muscles of face, mouth, and larynx • Severe damage may impair motor control of limbs as well

Aided Language Stimulation (ALS)

• Facilitator highlights symbols on the user's communication display as they interact and communicate verbally • Variety of unique instructional techniques are used to augment input and to encourage the use of the communication display o Goal is to provide speech and symbol input during activities • Incorporates a variety of techniques for eliciting communication using symbols and other AAC modes

Picture Exchange Communication System (PECS)

• For self-initiated requesting with aided symbols • Doesn't require prerequisite skills like eye contact, imitation, etc. • Originally designed for autistic persons, but works with other developmental disabilities. o Assess possible reinforcers o Person then learns to pick up specific symbol and hand to facilitator, who provides reward. o Physical and gestural, but no verbal, prompts at beginning. o Prompts faded, # of symbols increased. o Comprehension checks built in. o Sentence structure building can be added.

facilitated communication

• Involves the use of a keyboard communication device & physical support for the client. o Client is introduced to keyboard device gradually & initially prompted to touch correct keys in response to simple questions. o Errorless teaching & positive verbal feedback = successful interactions o Gradually questions become more complex o Then, individual is encouraged to initiate typing & carry on conversation w/out facilitation o Prompts & other supports are gradually faded

huntington's disease

• Is an inherited autosomal dominant degenerative disease (which means that if one parent has the disease the child has a 50-50 chance of inheriting it) • Symptoms typically appear in the 40s, with death occurring 15-17 years after onset, toward the end of the disease people are often unable to speak functionally. • Primary symptoms of HD include: chorea (involuntary, irregular spasmodic movements of the limbs or facial muscles), emotional disturbance and hyperkinetic dysarthria • Early cognitive changes include impaired attention, memory and cognitive functions with full dementia developing in some patients in later stages. • Language comprehension deficits include high-level processing difficulties with metaphoric or ambiguous sentences or sentences containing implied information or complex grammar.

Naturalistic teaching interventions (Milieu teaching)

• Naturalistic strategies for teaching functional language skills • Child initiates the teaching episode and consequences are functionally related to child's response • Approaches alike in that they use dispersed teaching trials in natural contexts and base teaching on individual's interests. • All three also require facilitator learning to identify potential communicative contexts throughout the day and employ set up strategies to create opportunities. • Set up strategies: o Placing item out of individual's reach; o Passively blocking access to desired item; o Intentionally giving individual inappropriate materials; and 4) presenting two or more options for choice.

Collaborative Teaming and Consensus Building

• Necessary to assess opportunity and access barriers o Team is critical o Need to work towards acknowledging shared responsibility o Access barriers are critical

Amyotrophic Lateral Sclerosis

• Progressive degenerative disease of unknown etiology involving the motor neurons of the brain and spinal cord • Primarily bulbar symptoms o More rapid course o Median survival of 2.2 years after appearance of initial symptoms

Guillain-Barre Syndrome (GBS)

• Results from progressive destruction and regeneration of myelin sheath of peripheral nerve axons • Paralysis progresses from lower extremities upward • Maximal paralysis occurs with 1 to 3 weeks of onset • Nerve function and associated muscle strength gradually return • Motor recovery begins with structures of head and face, and progresses inferiorly • About 80% recover completely with no residual impairments

locked- in syndrome

• Results in conscious quadriplegic state that limits individual's voluntary movement to vertical eye movements and eye blinks • Usual cause is basilar artery stroke, tumor or trauma to upper pons or midbrain • Low and high tech AAC strategies can be used

parkinsons

• Syndrome composed of cluster or motor symptoms including o Tremor at rest o Rigidity o Paucity (reduction in movement) o Impaired postural reflexes • Results from loss of dopaminergic neurons in basal ganglia and brain stem • Medical treatment has greatly altered natural course o But side effects of medication can interfere with use of AAC • Individual fluctuations in motor responses • Involuntary movements that interfere with functional activities and may cause emotional distress

yes/no

• These words can be used to answer a wide range of linguistically diverse questions o Requesting/rejecting - Do you want to go to the park? o Communication of preference - Do you like to go to the park? o Labeling - Is this the park? o Information Sharing - Have you ever been to the park?