AAC Assessment Teens & Adultsc772064.r64.cf2.rackcdn.com/event/03800/03884/3228568-aac-hand… · AAC Assessment Strategies for Teens and Adults Sandra M. Grether, Ph.D.,CCC/SLP [email protected]

AAC Assessment Strategies for Teens and AdultsAAC Assessment Strategies for Teens and AdultsSandra M. Grether, Ph.D.,CCC/SLP

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Welcome to this SpeechPathology.com Live Expert e-Seminar!

Augmentative Communication: Assessment Strategies for Teens and Adults

Presented By:

Sandra Grether, Ph.D., CCC-SLP, ,

Moderated By:

Amy Hansen, M.A.,CCC-SLP, Managing Editor, SpeechPathology.com

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AAC Assessment Strategies for Teens and Adults

Sandra M. Grether, Ph.D.Cincinnati Children’s Hospital Medical Center

Developmental and Behavioral Pediatrics University of Cincinnati

What is NONVERBAL???

• What are the causes?

• Issues of language/cognitionlanguage/cognition

• Issues of motor/sensory

Impact of Diagnosis

Cognition/language

High Low

Motor SevereMotor Issues

Severe

Mild


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Communication Functions

Behavior Regulation • Requesting Objects

• Requesting q gActions

• Protesting


Social Interaction • Requesting Social Routines

• Showing Off• Telling Jokes• Telling Jokes• Greeting• Calling• Acknowledgement


Joint Attention• Commenting• Requesting

InformationInformation• Clarification

Wetherby, Cain, Yonklas, and Walker, 1988


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Ways to Communicate

• Eye Gaze• Facial Expression• Vocalization

• Pointing to: object, photograph, line drawing, and/or symbol

• Speech• Gestures/Sign

Language• Writing

symbol• Speech Generating

Device (SGD)• Cell phone

(calling/texting)

Goals of AAC to provide individuals with the

opportunity and capability to:

• Communicate messages so that they can interact in conversations

• Participate at home, in school, at work, and during recreational activities

• Learn their native language• Establish and maintain their social roles

(i.e. friend, student, spouse)• Meet their personal needs

Challenge• To help individuals “communicate”

effectively and to express novel ideas• To facilitate the attainment of socially

effective communication across environments

• To find communication tools that will facilitate the learning or relearning of language (including literacy skills)

• To communicate efficiently and QUICKLY in all situations.


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How Important is Performance?

• Language performance is what a person really knows about the language

• Different in different• Different in different contexts, when different modalities are used for input and output and when different levels of support are available from the environment

Nelson, 1992

• To be an effective communicator, an individual must have a system that allows flexible shifting among strategies, with the ability to call on a variety of linguistic, discourse, cognitive, and social interaction k llskills.

• An individual needs more than a limited set of knowledge and skills to communicate effectively

Nelson, 1992

Nelson’s Domain Model (1992)

• 4 linguistic rule systems - phonology (sound system), lexicon (words and their relationships), syntax (sentence structure), and morphology (meaningful units)3 pragmatic rule systems speech acts (the• 3 pragmatic rule systems - speech acts (the things a person does with language), conversation (the process of interacting with another person through language), and discourse (ways of constructing and organizing text - oral and written)


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Anthony

Communicative Competence

The goals of communicative competence are similar whether one uses natural

speech or augmented means to communicate.

Light, 1989

Factors Affecting Communicative Competence

• Intrinsic Factors to the individual who requires AAC – knowledge, judgment, skills, psychosocial factors

• Extrinsic Factors to the individual –environmental factors – communicative demands, external barriers and/or support

Light, 1989


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Model of Communicative Competence Intrinsic Factors

Factors• Knowledge,

Judgment, and kill

Specific Aspects• Linguistic• Operational• Socialskills

• Psychosocial factors

• Social• Strategic

• Motivation• Attitude toward AAC• Confidence• Resilience

Model of Communication Competence Extrinsic Factors

Factors• Communication

Demands

Specific Aspects• Social Roles• Interaction Goals

• Environmental Barriers and/or Supports

• Policy• Practice• Attitude• Knowledge• Skill

Intrinsic Factors Related Domains

• Linguistic• OperationalOperational• Social • Strategic


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Linguistic DomainSkills in the language(s) spoken by the

family and community• Receptive• Expressivep

Skills in the “language” code of the AAC system(s)

• Content (vocabulary)• Form (single words/messages)• Use (social/pragmatic)

Receptive Skills in Spoken Language

• Spoken language is primary language of input for individuals using AAC– Partners seldom augment their speechR ti l kill iti l t• Receptive language skills are critical to communicative competence

• Expressive difficulties may mask comprehension difficulties

• Goal for expressive language skills is to equal receptive language

Skills in “language code” of AAC system

• Learn to use AAC graphic symbols (including spelling) to represent vocabulary

• Learn how to combine symbols to express l idmore complex ideas

– Use determiners, conjunctions, prepositions

– Add morphological markers for tense, plurality, possession, comparatives

• Learn organization of system (pages/levels)


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Challenges in Developing Linguistic Competence Using AAC (Light, 1997)

• Asymmetry between language input & output– Language input via speech– Language output via multimodal AAC– Language output via multimodal AAC

• Communication partners need to model use of AAC system (i.e. strategies for finding vocabulary; use of spelling)

• Communication via AAC is typically multimodal - combine various “language codes” to express meaning

Assessment/Intervention Team• Individual with Complex

Communication Needs• Parent/Primary Caregivers/Spouse• Teachers/Teaching Assistants• Speech/Language Pathologist• Speech/Language Pathologist• Occupational Therapist• Physical Therapist• Administrators/Supervisors• Psychologists• Physician• Vocational Counselor/Caseworker

BARRIERS

COGNITIVE LANGUAGE

PROBE/ASSESSMENT

INFORMATION

LANGUAGE

AAC ASSESSMENT PROCESS

BACKGROUND INFORMATION

ENVIRONMENTAL ASSESSMENT

INVENTORY OPPORTUNITY

ISSUES

PEER/PARTNER

PARTICIPATION

SENSORY

POTENTIAL USER SKILLS

MOTOR

SELECTION OUTPUTENCODING

STRATEGIES

FEATURES SYSTEM MATCH COMMUNICATION NEEDS

OhioSAAC, 2/97

TRIAL PERIOD

PLAN FOR INTERVENTION

RECOMMEND SYSTEM

TECHNIQUES


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AAC Assessment Process

Define User skills• Cognitive• Language • Motor• Sensory

– Hearing– Vision

Potential User Skills - Language

Receptive and Expressive• Syntactic (grammar) skills• Semantic (vocabulary) skills( y)• Pragmatic (social) skills

Language Encoding is the most important feature match!!!!!

Environmental Assessment

IdentifyCommunicative:• demands• opportunities• opportunities• barriersPartners:• who• roles• training needs


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AAC Assessment –Language Encoding

• Why do you encode? To increase the rate of communication.

• Typical adult speakers with no speech Typical adult speakers with no speech disabilities converse at rates of 150 to 250 words per minute. Typical rate for messages selected and conveyed using speech generating devices is 2 to 25 words per minute.

AAC Assessment Language Encoding

Word Codes• Alpha (letter), Alphanumeric, Letter-

category, Numeric, MorseMessage Codes• Alpha (letter), Alphanumeric, Numeric,

Iconic (Unity/Minspeak; Gateway), Color Prediction• Message (word, linguistic),

phrase/sentence

Rate and Timing

• Linguistic cost – average number of selections needed to communicate

• Motor act index – number of keystrokes necessary to produce a messagenecessary to produce a message

• Search time – amount of time to locate a letter, word, or phrase

• Key press time – amount of time to activate a key or switch


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Rate and Timing

• Time/duration of message production –how long to produce a message

• Cognitive processing – time to decide which selections or acts are necessarywhich selections or acts are necessary

• Productivity & clarity indices – measures of which meanings may be encoded and how well are they encoded

Core versus Fringe Vocabulary

• Core - highly functional words and phrases typically beginning with items related to basic functional needs, brief social exchanges, and other information necessary across most environments

• Fringe - words are particularly content-rich, topic-related, and specific to particular individuals

Word Power(developed by Nancy Inman, M.A.T., CCC-SLP)


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CORE vocabulary

versus FRINGE

vocabulary!?!

User Profiles Emerging Communicator• No reliable method of symbolic expression • Limited to emerging communication

strategies• May use facial expressions, body

language, gestures, vocalizations, or other non-symbolic method of communication

• May also use a few rote signs or utterances or a very limited voice output communication device.

User Profiles

Context-dependent communicator• Reliable symbolic communication but

limited to specific contexts or partners• Some individuals can communicate only• Some individuals can communicate only

with highly familiar partners because speech is severely unintelligible

• Some only in limited contexts due to insufficient or inappropriate vocabulary


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User Profiles

Independent Communicator• Interact with both familiar and unfamiliar

partners about any topic in any context. • They are usually literate and have the

ability to communicate novel messages independently.

Static Screen versus

Dynamic Screen

What Features Are Needed?

Digitized (Recorded)versus

Synthesized (Can Spell Words)

Size(Portable versus Mounted)

AccessTouch

Keyguard HeadmouseEye Gaze

Scan with Switch (Visual and/or Auditory)


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AMDi Tech 8AMDi Tech 8http://www.amdi.net($395.00 to $970.00)

Tech Tech 3232

($445.00-$1190.00)

Tech 128Tech 128($995.00 -

$1240.00)

DynaVox V/VmaxDynaVox V/Vmaxhttp://www.dynavoxtech.http://www.dynavoxtech.comcom($7645.00/$8240.00)

DynaVox M3DynaVox M3

($3285.00) Xpress Xpress ($($75007500..0000))

Prentke Romich Company (PRC)Prentke Romich Company (PRC)http://www.prentrom.com

Vantage/Vanguard PlusVantage/Vanguard Plus($6895.00/$7195.00)

Vantage LiteVantage Lite($7295.00)


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Prentke Romich Company (PRC) Prentke Romich Company (PRC) http://www.prentrom.com

Springboard LiteSpringboard Lite($2495.00)

Eco Eco 1414

($($77957795..0000))

Tango ( was Tango ( was BlinkTwice)BlinkTwice)

http://www.dynavohttp://www.dynavoxtech.comxtech.com

($6899.00)

Tobii C8/C12 (was Tobii C8/C12 (was Assistive Technology)Assistive Technology)http://www.http://www.tobii.comtobii.com($7035.00)

Eye Gaze Technology• Tobii Eye Tracking• DynaVox Technologies

EyeMax ($7000.00)• Prentke Romich Company

– ECOpoint ($7250 00)ECOpoint ($7250.00)


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Pocket Commun XPocket Commun X5151by Gus Communicators by Gus Communicators http://www.gusinc.com ($2095.00)

Cyrano Communicatorhttp://www.cyranocommunicator.com($1199.00)

Apple iPod touch 8 GB (2nd Generation) and iPad (1.3) iTunes gift cards for Proloquo2Go Durable case with an integrated

Proloquo2Go Combo Pack ($650.00)http://www.proloquo2go.com/software only ($189.00)

speaker for quality sound - Black Carrying strap so the iPod touch is easily accessible Stylus for iPod touch Getting Started Resource Guide

DynaVox DynaWriteDynaVox DynaWritehttp://www.dynavoxtech.comhttp://www.dynavoxtech.com

($4995.00)($4995.00)

LightWriter SL40LightWriter SL40http://www tobii comhttp://www tobii comhttp://www.tobii.comhttp://www.tobii.com($6750.00)($6750.00)

The SpeakOut The SpeakOut (by Permobil)(by Permobil)http://www.frshttp://www.frs--solutions.comsolutions.com($3875.00)($3875.00)


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FUNDING!!!!

Why Is Funding Important?

• Families can’t buy SGDs on their own• Knowledge about funding options allows

proper assessment & treatment planning• Knowledge creates expectations about

outcomes clients can achieve through SLP treatment

Funding for AAC in the U.S.• Private Medical Insurance• Medicaid (ODHS)• Medicare• Tricare (formerly Champus)( y p )• Education• Rehabilitation Services Commission• BCMH• Family Resource Services• Philanthropic Organizations


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Medical Necessity for SGDs• Client has a severe communication

impairment• Unable to meet daily communication needs

using natural communication methods suchusing natural communication methods such as oral speech

• Unable to meet all daily communication needs using no or low tech AAC interventions.

Advocacy for SGD

Policy

VersusVersus

Practice

Understanding the Funding Source

• Know the rule• Submit appropriate documentation• Appeal unfavorable decisions

C ll• Call:– Assistive Technology Law Center 1-607-277-

7286; [email protected] (Lou Golinker, attorney)

– Ohio Legal Rights 1-800-282-9181– Neighborhood Legal Services www.nls.org


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Private Medical Insurance 1. Is the person “eligible”?2. Is the item or service “covered”?

(durable medical equipment, prosthesis, speech and language therapy)

3 Is the item or service “medically3. Is the item or service “medically necessary”?

4. Does the request meet any special eligibility or coverage rules that may apply?

All “YES” for Health Benefits Program to cover!!!

Funding for AAC

EDUCATION

Public Law 94-142• FREE Appropriate

Public Education –this law started it ALL!

IDEA: Individuals with Disabilities Education Act, 1997

Assistive Technology is defined as any item, piece of equipment, or product system,

h th i d i ll ff thwhether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

[IDEA 1990,(602a)]


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IDEA 1997 (Upheld in 2004) -Assistive Technology Service

• Evaluation• Purchasing, leasing, or otherwise providing• Selecting fitting customizing repairing• Selecting, fitting, customizing, repairing,

maintenance, etc.• Coordinating and using other therapies• Training

– student, family– professionals, service providers, etc...

Assistive Technology on the IEP

• It must be supported by the IEP team.• Annual goals and objectives• Supplementary aids and services• Related services

ReferencesBeukelman, R & Mirenda, P (2005). Augmentative &

Alternative Communication: Supporting Children & Adults with Complex Communication Needs. Baltimore: Paul H. Brookes Publishing Co.

Desch, LW, Gaebler-Spira D, & Council on Children with Disabilities (2008) Prescribing assistive-technologyDisabilities (2008). Prescribing assistive technology systems: focus on children with impaired communication. Pediatrics, 121, 1271-1280.

Light, JC (1989). Toward a definition of communicative competence for individuals using augmentative & alternative communication systems. Augmentative and Alternative Communication, 5, 137-143.


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Light, JC (1997). “Communication is the essence of human life”: Reflections on communicative competence. Augmentative and Alternative Communication, 13, 158-171.

Millar, DC, Light, JC, & Schlosser, RW (2006). The impact of augmentative and alternative communication intervention on the speech pproduction of individuals with developmental disabilities. Journal of Speech, Language, and Hearing Research. 49, 248-264.

Nelson, N (1992). Performance is the prize: Language competence ad performance among AAC users. Augmentative and Alternative Communication. 8, 3-18.

Soto, G. & Zangari, C. (2009). Practically Speaking: Language, Literacy, & Academic Development for Students with AAC Needs. Baltimore: Paul H. Brookes Publishing Co.

Wetherby A, Cain D, Yonclas D, & Walker V (1988). Analysis of intentional communication of normal children from the prelinguistic to the multi-wordchildren from the prelinguistic to the multi word stage. Journal of Speech and Hearing Research, 31, 240-252.

Documents

AAC Assessment Teens & Adultsc772064.r64.cf2.rackcdn.com/event/03800/03884/3228568-aac-hand… · AAC Assessment Strategies for Teens and Adults Sandra M. Grether, Ph.D.,CCC/SLP [email protected]