AAC- Yikes! You Want Me To Do What?

AAC- Yikes!
You Want Me
To Do What?
June Maranville MSP, CCC-SLP
Palmetto Language & Speech Center, LLC
Email: [email protected]
Website: www.plsclex.com
I don’t even know what I don’t
“The only disability in life is a bad attitude.” Scott Hamilton
ALL Individuals Can and Do
-National Joint Commission for the Communication Needs of Persons with
Severe Disabilities. (1992)
“If all my possessions were taken from me
with one exception, I would choose to keep
the power of communication, for by it I
would soon regain all the rest”
-Daniel Webster
We’ve come a long way, baby.
Who remembers…
O Cut and paste pictures from notebooks
O Hand coloring each picture
O Glue with no Velcro!
O No Boardmaker
O Contact paper instead of lamination
O Heavy-bulky systems that took weeks to
Present Day
Where are we now?
O Boardmaker
O Lamination
O Velcro
O Over 200 Apps for high-tech devices
O AAC App Comparison Chart (SCATP)
O http://www.sc.edu/scatp/apps.html
O Light weight, durable, intuitive systems
What has not changed?
O As professionals, practice due diligence
when choosing AAC for client.
Team Approach
Client and caregiver as active participants
Best fit- low/medium/high tech
Feature matching
O a process that involves matching the skills of
the AAC user with the features of the given
AAC systems.
What is Augmentative and
Alternative Communication
O “AAC involves attempts to study and when necessary
compensate for, temporarily or permanently, the
impairments, activity limitations, and participation
restrictions of individuals with severe disorders of speechlanguage production and/or comprehension. These may
include spoken and written modes of communication.”
(ASHA 2005)
AAC is the bridge that enables children with
severe communication difficulties to learn
higher-level language skills and to interact
with individuals outside the family.
~ Page and Quattlebaum (2012)
Handbook of Children with Special Healthcare Needs
The Goal of AAC
O Empower AAC user to
O express wants and needs
O exchange information
O develop social closeness with others
O engage in social etiquette routines.
O MULTIMODAL approach most effective in order to be
able to communicate for different purposes in a
variety of contexts. (ASHA, 1991)
Multimodal Communication
O Objects
O Signs
O Gestures
O Facial Expressions
O Pictures
O Speech
O Nurture residual speech
O Written Word
O Symbols
O Voice output devices
Feature Matching
O Which system is the best match to fit user’s
abilities, needs and skills?
O Dx does not determine need for specific device
O Consider:
O Current Skill Level
O ADLs and associated wants/needs
O Current Communication system/strategies
O Future Communication needs
O System growth with development and skills
O Degenerative/Deteriorating skills
Feature Matching Cont.
O Objective / Feature / Selection Criteria
O Shared symbol system
O Development of language system
O Construction of messages to interact with others
O Meaningful Vocabulary
O http://aac.unl.edu/vocabulary.html
O Access to communication symbols
O Access to communication device
~Page and Quattlebaum (2012)
Handbook of Children with Special Health Care Needs
Is it a good fit?
Would you ever get the gift box before you purchased the gift?
~ Dr. Carol Page
O No! ~ Let’s not do it with AAC either.
Evade “flavor of the month” devices based on marketing,
promotion and popularity.
AbleData: AAC products and features
Why Assess?
O Will use of AAC…
O Maximize client’s abilities and decrease
challenges of disabilities
O Help improve condition or prevent from getting
O Help person function in their environment
O Help improve independence
O How will team find the best fit?
O Is a formal assessment needed and required by
funding source?
O Is use of AAC a medical necessity?
Medical Necessity
O Medicare defines as
O “Service or supplies that are needed for the diagnosis
or treatment of medical condition and must meet best
practice standards.”
O Buzz words
O Correct deficits
O Ameliorate deficits - to make better or tolerable
O Palliate- to make less severe or unpleasant without
removing the cause.
O Letter of medical necessity and physician order with high-
tech AAC purchases
Who can assess formally?
O Licensed and credentialed in related field
O PT, OT, SLP, Rehab Engineer
O AT specialization certification
O Other Team members—as warranted
O Vision specialist
O Nurse
O Psychologist
O Educators
O Hearing specialist
Who pays for AAC?
Funding sources consider AAC dedicated communication devices
O Private Pay
O Babynet (0-3)
O IFSP Team, parents and professionals
O Schools (3-21) FAPE
O Private insurance- appeal if denied
O Medicaid
O Medicare
O Vocational Rehab
O Community
O Service organizations
O Church and local charities
Who really pays for AAC?
We all do!
Components of Successful
O Team Assimilation
O Medical Information
O History
O Functional Goals
O Technology that has been tried in the past
and results
O Clear communication among team members
O Trials with AAC
O Time is your best friend!
Assessment Help
O There are no standardized AT assessments.
O Ecological Inventory ~ Nalty and Quattlebaum (1998)
O Joy Zabala SETT Framework
O It’s not about technology or device
O It’s about matching
O The Student
O The Environment
O The Task
O The best Tool
O Communication Matrix
O Every Move Counts, Clicks and Chats
Trials with AAC
O Low-tech
O Examples:
boards, booklets.
O Can start immediately
O Boardmaker is your
O Backup system-as
needed if high-tech
device malfunctions
Trials with AAC
O Mid-tech
O Examples: BigMack, iTalk 2, Go talk series.
O Typically requires a battery to operate.
O Human voices recorded on device
Trials with AAC
O High-tech
O Examples: Dynavox, Prentke Romich,
Tobii- SGDs
O Increase vocabulary opportunities
O Digitized, synthesized speech
O iPads and Tablets
Purpose of Trials
O What works.
O What does not work.
O Show evidence of optimal fit for individual
communication need.
O System not to be used or recommended just
because only one tried, most popular, or
most promoted.
AAC Intervention
O If we’re using pictures do we call it
O AAC vs. other types of learning
Picture Identification vs.
Functional Communication
O Picture ID- END
O Receptive Skills and Knowledge
O Touch the “____”
O Teaching Format-Get response
O Match, sort, reinforce
O Academic Achievement
Picture Identification vs.
Functional Communication
O Functional AAC Communication- MEANS to
O Demonstrates desire to engage with
communication partner to share wants,
needs and ideas.
O Nurtures social interactions
O Empowers
O Beyond Requesting Powerpoint
Message Sets
O Vocabulary linked to social/emotional development
O Feelings
O Decrease behavioral problems with appropriate
vocabulary selection
O Vocabulary Selection
O Provides means to interact
O Motivating vocabulary imperative
O Consider user’s interest first
O Variety of word types
Core Vocabulary
Typical Peer 5-minute Conversation Sample
More than Nouns
Rich language experiences
Increase message set expansion
Generalizes across communication settings
Teaches rules of Syntax
Language to Literacy Expansion
O juice, want juice, no juice, more juice, write or
type juice –Page and Quattlebaum 2012
O Quick Hits/Urgent messages
O One Icon to represent message
O Example: “I need help” “I feel sick”
Prognostic Indicators
Extrinsic Factors
Skin in the game
Buy into use
Switch gears from basic needs to anticipating needs
Chain of cues
Model, model, model!
Enable vs. Empower
15x per day
Intrinsic Factors
Knowledge is power
User grasps that power is in communication
Active participant
Engage 15x per day using AAC device
Example: Music variety
Present and Possible Changes
Medical condition status
Plan implement ahead of time
Monitor and adjust to assess wants/needs
Dynamic and ever-changing process
~ Page and Quattlebaum (2012)
Parent/Caregiver Roles
O Active participants
O Ongoing programming
O Vocabulary selection
O Facilitate carryover of device to all settings
O Model use of device with motivating activity for user
O Troubleshoot problems
O Recognize when message sets changes needed
O Attend training
O Functional
O Motivating
O Means-End
O Efficient
O Effective
O Interactive
O All Environments
O At least 15 opportunities per day
O Update AAC system when change occurs
O Transition Strategies for Adolescents and Young
Adults Who Use AAC
O SC Assistive Technology Program
O Apps that make life easier
O Apps comparison chart.
O SC Equipment Distribution Program
O SC Vocational Rehabilitation
Resources Cont.
O CRS- Children's Rehab Services
O SCATP- Device Loan Program
O SC Independent Living Program
O CDR- Centers for Disabilities Resource Library
O Loaner programs through vendors.
O Key Technologies
O Dynavox
O Tobii
O Prentke Romich
Prize Time!
Q and A
Wrap it Up!
When you know better, you do better
~ Maya Angelou
O Use the resources
O Celebrate great resources in your backyard
O Don’t be afraid to ask for help
O Enjoy the journey and be inspired!
O Heart of the Ravens! Superbowl 2013 Champs!
O http://espn.go.com/video/clip?id=8815080
Works Cited
AAC and Speech Devices from PRC. N.p., n.d. Web. <http://www.prentrom.com/>.
"AAC Messaging and Vocabulary." AAC References. N.p., n.d. Web. <http://aac.unl.edu/vocabulary.html>.
"AbleData: Products." AbleData: Products. N.p., n.d. Web.
"Apps That Make Life Easier." Apps That Make Life Easier. South Carolina Assistive Technology Program, 7 Jan.
2013. Web.
ASHA. "Goal of AAC." (1991): n. pag. Print.
"Augmentative and Alternative Communication (AAC)." American Speech-Language-Hearing Association. N.p.,
2005. Web. <http://www.asha.org/public/speech/disorders/AAC/>.
"Beyond Requesting." Beyond Requesting. N.p., n.d. Web. <http://www.slideshare.net/slpwendy/beyondrequesting-presentation>.
CDR Library, School of Medicine Library, University of South Carolina. N.p., n.d. Web.
"Communication Assessment for Parents & Professionals." Communication Matrix. N.p., n.d. Web.
Bibliography Cont.
DynaVox: Communication Devices – Speech Devices. N.p., n.d. Web. <http://www.dynavoxtech.com/>.
"EMC, Inc. Home." EMC, Inc. Home. N.p., n.d. Web. <http://www.everymovecounts.net/>.
ESPN. ESPN Internet Ventures, n.d. Web. <http://espn.go.com/video/clip?id=8815080>.
"Independent Living." South Carolina Department of Social Services. N.p., n.d. Web.
Key Techonologies. N.p., n.d. Web. <http://www.gokeytech.com/>.
Nalty, L., and P. Quattlebaum. "A Practical Guide to Augmentative and Alternative Communication:
Assessment and Intervention Strategies." Greenville:Super Duper (1998): n. pag. Abstract. Severe
Communication Disorders (2012): 32. Print.
National Joint Commission for the Communication Needs of Persons with Severe Disabilities. Guide-lines for
Meeting the Communication Needs of Persons with Severe Disabilities (1992): n. pag. Print.
Page, C. A., and P. D. Quattlebaum. "Severe Communication Disorders." Ed. D. Hollar. Handbook of Children
with Special Health Care Needs (2012): 23-46. Print.
Bibliography Cont.
SCATP Device Loan Program. N.p., n.d. Web. <http://www.sc.edu/scatp/loan.htm>.
"SCATP." South Carolina Assistive Technology Program (SCATP). N.p., n.d. Web. <http://www.sc.edu/scatp/>.
"Sharing the SETT Framework." Joy Zabala SETT Framework. N.p., 2005. Web.
South Carolina Department of Health and Environmental Control. N.p., n.d. Web.
"South Carolina Equipment Distribution Program." SCEDP. N.p., n.d. Web. <http://www.scedp.org/>.
South Carolina Vocational Rehabilitation Department (SCVRD). N.p., n.d. Web.
Tobii Technology Global. N.p., n.d. Web. <http://www.tobii.com/>.
"Transition Strategies for Adolescents and Young Adults Who Use AAC." ASHA Online Store Details. N.p., n.d. Web.

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