Assistive Technology Roundtable
Augmentative and Alternative Communication:
The Basics
April 23, 2014
Beaver Valley
Intermediate Unit
Get Ready!
• Welcome to the BVIU!
• Help yourselves to coffee
and donuts.
• Follow along on your
laptop or tablet.
• Open your internet
browser.
2
Join Me!
• Now, load today’s presentation so you can
follow along.
• Go to the BVIU website at
http://www.bviu.org/Page/654.
• You’ll find the link in the right hand column,
titled “Roundtable Day 3 presentation”.
3
Today’s Objectives
• What is AAC?
• Examine belief statements regarding the use of
AAC; bust the myths.
• Review best practices, basic DO’s and DON’T’s,
for using AAC.
• Review funding options for AT and AAC.
• Introduction to a range of assistive technology
tools for communication.
4
Joining Us Today. . .
• From Augmentative Communication
Consultants, Inc.; 10:30
• Millie Telega, CEO
• [email protected]
• 1-800-982-2248
5
Joining Us Today. . .
• From New Horizon School, the AAC Evaluation
Team
• Maureen Burns, SLP; [email protected]
• Kim McCabe, CCC-SLP; [email protected]
• Tammy Mihalow, SLP; [email protected]
• 724-728-3730
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Fates Worse Than Death
• With a neighbor, list health impairments that
you would consider to be worse than death.
• Elderly adults
1.
2.
3.
• College students
1.
2.
3.
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"AAC Myths Revealed." DynaVox. N.p., n.d. Web. 27 Mar. 2014.
Quality of Life
• These groups also identified “interacting with
family and friends” as the most valued activity
influencing the quality of life.
• Followed by:
– Involvement with work/school
– Religion/politics, recreation/sports
– Intellectual and artistic pursuits
– Helping others
– Good health
– Cognitive functioning
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"AAC Myths Revealed." DynaVox. N.p., n.d. Web. 27 Mar. 2014.
Communication
• The act or process of using words, sounds,
signs, symbols, or behaviors to express or
exchange information or to express your
ideas, thoughts, feelings, etc., to someone
else
• Four purposes of human communication
–
–
–
–
"AAC Myths Revealed." DynaVox. N.p., n.d. Web. 27 Mar. 2014.
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What is meant by expressive and
receptive language?
Receptive- more than just what you hear, it’s
what you
.
Expressive- more than just what you say, it’s
you say it.
– Word choice, word order, word endings, tone,
gestures
– Also different when writing
"What Are Expressive and Receptive Language Skills?" Dynavox, AAC 101. N.p., Sept. 2009. Web. 27 Mar. 2014
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Characteristics of AAC Users
• All age groups
• Significant expressive language impairment
• Impairment interferes with or prevents the
development or use of oral language
• Due to congenital or acquired disabilities
– Autism, CP, sensory impairments, ID, stroke, TBI,
apraxia, ALS, MS, spinal injuries
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A–A-C
Augmentative and Alternative Communication:
• Refers to tools and techniques used to
supplement communication for people who
have difficulty communicating through speech
or writing.
• Includes unaided techniques (pointing,
gestures), light technology (communication
books and boards), and high tech (voice
output devices and computers).
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A-A-C
Communicating without speaking
13
A-A-C
• Augmentative- in addition to
• Alternative- instead of
• Symbols- stand for something else
"What Is a Symbol?" Dynavox, AAC 101. N.p., June 2008. Web. 27 Mar. 2014.
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Symbols
cludangle
S - P - O - O - N
DOG
"What Is a Symbol?" Dynavox, AAC 101. N.p., June 2008. Web. 27 Mar. 2014.
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Benefits of AAC
• Can give a voice to those who have had
difficulty communicating throughout their
lives.
• Can give a voice BACK
to those suffering from
stroke, head injury,
MS, ALS, and more.
• Can increase
and
in home, community, and work.
levels
"Challenges of AAC." Dynavox, AAC 101. N.p., June 2008. Web. 27 Mar. 2014.
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Benefits of AAC
• Provides a means of expressing wants, needs,
and ideas.
• Decreases
and
.
• Can help build
communication and
language skills.
• Can increase interaction with family,
friends and school.
"What Is AAC and Who Can Use It?" Dynavox, AAC 101. N.p., Sept. 2009. Web. 27 Mar. 2014.
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Challenges of AAC
• Takes time to learn system
well.
• Tool or device must always be
available.
• Often requires communication
partners.
• Changes and updates must be
made to vocabulary.
• Successful use of AAC depends
on the person.
"Challenges of AAC." Dynavox, AAC 101. N.p., June 2008. Web. 27 Mar. 2014.
18
What are the types of AAC systems?
• Unaided communication systems – rely on
the user's body to convey messages. Examples
include
,
,
and/or
.
19
What are the types of AAC systems?
• Aided communication systems – require the use of tools or
equipment in addition to the user's body. Aided
communication methods can range from paper and pencil to
communication books or boards to devices that produce voice
output (speech generating devices or SGD's)and/or written
output. Electronic communication aids allow the user to use
picture symbols, letters, and/or words and phrases to create
messages. Some devices can be programmed to produce
different spoken languages.
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AAC in Action
• http://youtu.be/R8VuA8yVBv8
21
An individual
can be too
cognitively
impaired to
benefit from
AAC.
22
• Certain language skills appear in the absence
of expected cognitive skills; infants.
• Assuming incompetence leads to reduced
opportunities and segregation.
• The least dangerous assumption is a powerful
tool.
• Low tech solutions have been more readily
used. High tech SGDs may have prerequisites
that should be matched to skills.
23
Carly’s Voice
24
AAC is only used by people
who cannot communicate
verbally…
25
• AAC can be used by a wide variety of
communicators. We all augment our verbal
communication with gestures, facial
expressions and so forth.
• AAC is useful for children with delayed speech
development, and is becoming more
commonly used with people who are learning
a second language.
26
The goal of
communication
is to express
wants and
needs…
27
• For most people, in most situations, expressing
wants and needs is secondary to social expression.
• One way to think of this is to put yourself into the
position of the person who uses AAC. If you could
only say three things, would they be “I need to go
to the toilet”, “I’m hungry”, and “I’m thirsty”, or
would they be “Hi, how are you”, “Can we talk?”,
and “I love you”?
• This is not to say that being able to control your
environment is not important, but it may not be
the most important (or motivating) thing.
28
• Get ready for a game!
• Form a group of 5-7 people.
• Three players will use different
communication boards and cannot use their
voice.
– Basic needs
– Go Fish Core
– 12 Core Words
29
Using AAC will delay
speech development…
30
• Studies show that the use of AAC
actually improves speech development
where possible (Silverman 1995), and it
can be argued that it improves language
development in all cases.
• It should be noted that even the most
sophisticated voice output
communication aid cannot be as
efficient or smooth as good speech.
31
We should wait to use
AAC until a person is
ready for it…
32
• Anybody can use AAC. We do not wait to
communicate verbally with a typical child
until they are ready to talk; rather, we
surround them with a wealth of language.
• The same can be said for a child who uses
AAC. We should not wait to introduce other
methods of communication until they are
ready to use them; rather we should
surround them with a wealth of language
(verbal, gestural or symbolically based).
33
“…breathing is the only prerequisite
that is relevant to communication.
Breathing equals life, and life equals
communication. It is that simple.”
-Mirenda, 1993
34
AAC Considerations for a Young Child
• Communication Needs
•
•
•
•
35
We should
not
overwhelm
somebody
with access to
too many
symbols…
36
• We should provide more symbols than a child can
use at one time.
• If we look at typically developing children, they
have access to all the sounds of their language by
6 months of age. They use them appropriately
when they are able to.
• The same can be said for someone
communicating with symbols. If a child is not
provided with any more symbols than they have
‘mastery’ of, then they have no opportunity to
practice new symbols in a natural progression.
37
Somebody
who has a
VOCA should
use it all the
time…
38
• Voice output communication aids are often vital
components of a person’s AAC system. It is true
that they should have access to their device all
the time (or almost all the time). But, there are
times when it is not practical or necessary! (For
example, using a VOCA in the bath is not usually a
good idea.)
• Communication is in its nature multi-modal; for
example, there are many people who use VOCAs
in most situations, but not at home with their
family.
39
An AAC
system
should be a
goal for all
people who
are
nonverbal…
40
• The ‘goal’ is to have functional
communication. An AAC system may be
a useful tool towards that end.
• This distinction, while subtle, can help
tremendously towards setting
appropriate goals for a student.
41
‘Getting AAC Users
COMMUNICATING
regardless of AAC system used
(no tech, low tech, high tech)
or skill level!...’
Many thanks to Lauren Enders, ATC, Bucks County
42
DON’T
• Expect a user to know how to
communicate without direct
models and instruction!
• Expect sentences right away!!
• MODEL, MODEL MODEL!!!
DO
• Model expected communication
behaviors BEFORE expecting to see
those behaviors from the user!!
• Provide Aided Language Input!
43
Normal Language Development
• One goal of AAC intervention is to provide the child with
normal language learning experiences, while gradually
building up his/her vocabulary.
• Normal language learning benchmarks are the best tools
we currently have to determining how to direct the
language learning experiences of children learning and
expressing language through AAC strategies.
• The long-range plan is to end up with a useful vocabulary
of approximately 300+ core words on the child’s
communication device.
‘Normal Language Development, Generative
Language and AAC’ by Gail Van Tatenhove
44
Augmented Language Input
“Aided language input (stimulation) is
when a verbal communication partner
highlights symbols on the user’s
communication display as he or she
interacts and communicates verbally
with the user.”
(Goossens’ et al., 1992)
45
Principles of Modeling
• Modeling takes time, Time, TIME!
• Modeling takes practice, Practice, PRACTICE!
(And a high level of comfort with vocabulary!)
• Always pair with speech
• Model SLOWLY enough for the student to observe
vocab selections and word combinations
• Model maximum language possible without
overwhelming the student
– 1-2 words beyond student output level
– Base models upon target vocabulary in the lesson
46
When can I expect the student to use
the words I have modeled?
• How many models given before students
started to use the words?
Range = 20 – 100, Average = 47!
• How many models before students started to
use language structure?
Question Phrase: Range = 25-150, Average = 92
Noun Phrase: Range = 75-175, Average = 103
Data from PDE Conference presentation by Gail Van Tatenhove, 2013.
47
DON’T •Over prompt!
DO
•Follow a prompt
hierarchy!
48
DON’T •RE-PROMPT too
quickly!
DO
• WAIT 10-20 seconds (with
and expectant look)
before re-prompting!
• COUNT 1-2-3…in your
head!
49
Modeling within a Prompt Hierarchy
(prompt only as much as the student needs to respond!)
• Focus your attention on student. Pause.
• Ask an OPEN ENDED question. Pause expectantly.
– “What would you like to do next?”
• Give a partial prompt then pause expectantly.
– “Should we move to morning meeting or finish our art
project?”
• Request a response then pause expectantly
– “Tell me move or finish ”
Prompt Hierarchy from:
• Present a full model. Pause Expectantly.
Environmental
Communication Training,
– “I want finish work”
Dr. George Karlan
When student responds, reflect what you heard and then
model something they could add!
50
DON’T
• Don’t provide ONLY Nouns
• Focus on vocabulary that
won’t be functional/used
tomorrow!!
• Provide CORE WORDS!!
DO
•Nouns, verbs and
describing words!
51
Core
vocabulary
is a
statistical
concept
related to
overall
word
frequency.
The most frequently occurring words (core
words) = 80% of the actual words spoken
This 80% of the words we use daily come
from a set of fewer than 350 - 400 words
The 50 most frequently occurring words
account for 40-50 % of total words said,
while the 100 most frequently occurring =
60% of what is said
The most frequently occurring words for
speakers is also true for users of AAC
(when given access to these words in their
AAC system)
53
Core Words – Top 60!
Again
All
All done
All gone
Away
Bad
Big
Busy
Come
Different
Do
Don’t
Down
Drink
Eat
feel
get
go
good
happy
he
help
here
I
in
it
like
little
make
me
mine
more
my
not
now
off
on
out
play
put
question
ready
sad
she
some
stop
tell
that
there
thing
this
turn
up
want
what
where
who
why
you
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Partner Activity
55
Core Board – First 50
(remake of core board from Pixon Project with BM symbols)
56
Let’s take a closer look at Core…
(thank you Sally and Laureen from Pioneer)
Can I dress up
I want to be a princess called
Sophia
Where is the top
There is the top
Does this look like a Sophia dress
Okay
This one doesn't have any pants
How do you know that it doesn't
Can you put this on me
I want you to put this on me
I want to find something else
This is my dress-up bag
Which way is left
This way or that way
Which way is right
Which way is in the middle
39 core words out of
84 total = 46% core
Verbal students - Oral Language Samples
Look
Play playground
Slides and wagons
I going to have fun at playground Miss Laureen
Is that yours Miss Laureen
Miss Laureen what's that
I'm drinking milk
I want to do the boy
That's you
It's funny
Not me
Not my mom birthday
I'm not going
24 core words out of
47 total = 51% core
57
Let’s take a closer look at Core…
(thank you Sally and Laureen from Pioneer)
Student using a Voice Output Communication Aid:
•
•
•
•
•
•
•
•
•
•
I play with mom and dad with my cousins game
I can't wait for week on Saturday my family coming to
up on Saturday my house on
Saturday
I want cake my birthday
Not me
Cris bridge is back to my school
I'm going to Dave and Busters Saturday
I going to Kennywood
I am watch (look) Monster High to on tv to watch (look)
fight on I am see vampire and werewolf is to monster high
school.
My family coming to up on Saturday 2:00
58
THE POWER OF CORE VOCABULARY!
59
DON’T
DO
•Teach only requesting
• Teach all language
functions including
directing, commenting,
requesting assistance,
rejecting, etc…
60
Pragmatic Language
http://www.aaclanguagelab.com/materials/AACPragmaticsChart.pdf
61
DON’T •MOVE SYMBOLS!
DO
• KEEP icon placement
consistent
• Keep repeated icons in the
same location on each
page/screen
62
DON’T
DO
•Stop all ‘babbling’
(exploring, button
pressing)
•ALLOW user time to
explore and learn the
system
63
DON’T
DO
• Remove the device
• Keep the AAC system in
their desk, cubby or
backpack!
•MAKE AAC available at
all times!
64
DON’T •DO ALL THE TALKING!!
DO
•PRESUME
COMPETENCE!!
65
Access to appropriate tools
+
Good intervention
+
Opportunities for massed and
repeated practice
=
REAL COMMUNICATION (and learning!!)
AAC Language Lab
66
Don’t Forget
• When considering AAC, you must check the
appropriate considerations.
Communication
Assistive Technology
Others
67
Including AAC in the IEP
• AAC tools, like other AT equipment, should be
described in general, non-specific terms in the
“Supplementary Aids/Services; Modifications;
Accommodations” section when the student
has access to the equipment on a long-term
basis.
• DO NOT NAME SPECIFIC TOOLS OR DEVICES.
68
Including AAC in the IEP
Examples of how to describe AAC equipment
without naming it:
– Single message device (NOT BIGmack)
– Portable device with touchscreen capability (NOT
iPad)
– Speech generating device with keyguard (NOT Eco2,
Accent 1200)
– Communication system including communication
book, topic boards, choice boards (NOT Pixon Project
Kit board)
69
Including AAC in the IEP
Why should you not name the device?
– There are times when the device is not available
(due to breakage, battery drainage, being left at
home, or simply not being an effective tool in a
certain setting).
– If you name the device and don’t use it at certain
times, you are out of compliance whenever the
device is not in use.
70
Requesting an AAC Evaluation
• Start with a call to Jeff Huchko, 724-774-7800.
• Complete paperwork. Available on IU site.
–
–
–
–
–
Permission to evaluate
Permission to videotape
Information from Parent
Information from SLP
Information from regular
or special educator
printable
electronic
• Take short video of child in school and/or at
home. Send to AT Team, New Horizon School.
• Set date for observation and evaluation.
• Be there! Invite parents, too.
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Resources
•
•
•
•
•
•
•
The Pixon Project Kit: A Language
Development Curriculum, Gail
VanTatenhove, MS, CCC-SLP, Semantic
Compaction Systems, October, 2009.
Prentke Romich Company,
www.AACLanguageLab.com
AAC Connecting Young Kids, (yAACk)
www.aac.unl.edu/yaack/toc/html
Dynavox,
http://www.dynavoxtech.com
Semantic Compaction Systems,
www.minspeak.com.
PrAACtical AAC: Supports for Language
and Learning, www.praacticalaac.org
American Speech Language and
Hearing Association, www.asha.org
Bibliography
• "AAC Myths Revelaed." DynaVox.
N.p., n.d. Web. 27 Mar. 2014.
• "Challenges of AAC." Dynavox, AAC
101. N.p., June 2008. Web. 27 Mar.
2014.
• Van Tatenhove, Gail M. "AAC in the
IEP." Gail Van Tatenhove. Web. 5 Apr.
2014.
• "What Are Expressive and Receptive
Language Skills?" Dynavox, AAC 101.
N.p., Sept. 2009. Web. 27 Mar. 2014.
• "What Is a Symbol?" Dynavox, AAC
101. N.p., June 2008. Web. 27 Mar.
2014.
• "What Is AAC and Who Can Use It?"
Dynavox, AAC 101. N.p., Sept. 2009.
Web. 27 Mar. 2014.
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