Updates on the Augmentative Communication Toolbox

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Brittney Holt
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1 Updates on the Augmentative Communication Toolbox Melanie Fried-Oken, Ph.D., CCC/Sp Director, Assistive Technology Program Professor, Neurology, Biomedical Engineering, ENT Oregon Health & Sciences University

2 In Honor of Dr. Hank Bersani

5 AAC as paddles Home Vocational setting Community (leisure and recreation) Health care and extended care settings

6 What paddles do you use? gestures writing speech

7 Objectives 1. Present information on current assistive technology related to communication; 2. Describe augmentative and alternative communication equipment and practice. 3. Discuss current issues.

8 WHAT IS AAC? Augmentative and Alternative Communication refers to any strategy, technique or tool that enhances, replaces, augments or supplements an individual s communication capabilities.

9 Augmentative Communication Approaches Speech Vocalization Gestures Eye gaze Body language Sign language Paper and pencil Communication books Communication boards and cards Speaking computers Talking typewriters Speech generating devices Mobile technology (ipads and apps)

10 WHO IS AN AAC USER? Anyone whose communication is adversely affected by an impairment in speech, language, cognition, and/or physical abilities.

11 This image cannot currently be displayed. Who is a candidate for AAC?

12 This image cannot currently be displayed. Anyone who can benefit from a strategy or tool to increase interaction. Breathing is the only prerequisite.

13 WHAT IS ASSISTIVE TECHNOLOGY? Devices, software, tools, and services that allow people who have physical and/or cognitive limitations to do tasks that would otherwise be significantly difficult for them to do. Rick Creech, Augmented speaker and Resources Coordinator, PA Department of Education

14 Tech Act: Technology-Related Assistance for Persons with Disabilities Act of 1998: Assistive technology is any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of people with disabilities [P.L , 29 U.S.C. 2201, 3(1)].

15 We all use A.T.

16 A.T. is a device or a service

17 A Device: Any item, piece of equipment, or system that increases, maintains, or improves the functional capabilities of people with disabilities. A.T. devices help people function longer and better.

18 A Service: Assistive Technology without training is not assistive. - Rick Creech, A.T. user and advocate

19 Who does AAC? Family and patient Speech-language pathologist Occupational therapist Physical therapist Medicine Nursing Social Services Prosthetics/Orthotics Vocational Rehabilitation Education Engineering Computer technology Audiology Vendor

20 AAC ASSESSMENT: Evaluation for Today and Tomorrow Diagnostic treatment Variable depending on LOS and payor Needs assessment Participation/opportunities assessment Team skills assessment

21 3 forms of AAC evaluation 1. Communication processes -Abilities and challenges 2. Communication needs Communication partners Communication locations Communication modes Message needs 3. Participation and social membership

22 Communication Processes What s wrong with the patient s communication and how can we fix it? Measure gaps in performance and adult expectations for speech, language and cognitive skills Problems with this assessment model: Does NOT address function Does not help the person participate in his/her environment.

23 Communication Needs Model

24 Communication Participation Model Goal is to support communication that will allow participation in daily activities Participation will develop and maintain social memberships

25 4 purposes of communication Express needs and wants Information exchange Social closeness Social etiquette

26 Opportunities Assessment Opportunity barriers: Policy Practices Attitudes Skills and knowledge of communication partners Access barriers and opps: Current communication Specific capabilities Motor skills, cognition, language, hearing

27 Assessment provides Strengths Challenges Environments AAC provides Features of an AAC system and all the paddles to help Unaided approaches Aided approaches

28 Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners

29 Circles of Communication partners 1. Family 2. Friends 3. Acquaintances 4. Paid workers 5. Unfamiliar partners

30 Type of partner Circle? Primary communication partner? Most skilled partner? Partner spends most time with? Favorite partner? Partner most willing to learn new communication skills? Person most willing to teach others how to communicate with individual?

31 Communication Partners: Pilot data The most skilled partners are not always the person s preferred partners Many individuals with complex communication needs do not spend most of their time with their most skilled partners Many partners thought to be most willing to learn are not being taught

32 Examples of how CCP section may be used in goal setting Circles not wellbalanced Some partners are not trained Increase interactions with peers in 2 nd and 3 rd circles peer buddy program. Increase opportunities in 3 rd and 5 th circles over baseline using simple AAC device Increase skills of (partner spends most time with) over baseline guided practice Increase # of partners who respond to gestures/signs gesture dictionary/training

33 Modes of Communication Facial expression/ body language Gestures/eye gaze Vocalizations Manual signs Speech Writing/drawing Nonelectronic communication aids Simple communication device Complex communication device Communication software Phone Other Defined in the SNs manual

34 Primary Modes Across Circles: Pilot Data Gestures Light tech Vocalizations Speech Sign High tech 1st Circle 2nd Circle 3rd Circle 4th Circle 5th Circle Gestures Vocalizations Speech Sign Light tech VOCA

36 Examples of how Modes section may be used in goal setting Only uses SGD in 4 th circle Wants to keep a diary. Gestures are not understood 1. Call parent 2x month using SGD 2. Use SGD to play Bingo in rec area 2x week Use communication book and remnant bag. Develop plan to ensure privacy. Target 2 gestures. Improve intelligibility with 2 people in 3rd circle.

37 Topics of conversation What does person talk about with partners in each circle? What would person MOST like to talk about with partners in each circle?

38 How does Topics section help with goal? Team doesn t know what person would most like to talk about. Topics with family are very different from topics with staff. Need more vocabulary Observe, discuss areas of interest and consider providing vocabulary accordingly Complete vocabulary inventories of favorite topics in both locations. Modify SGD and lowtech displays accordingly

39 Successful AAC for adults with developmental disabilities

speech output Digitized speech output Computers Dedicated versus

40 This image cannot currently be displayed. Electronic Devices Speech generating devices (SGDs) Synthesized speech output Digitized speech output Computers Dedicated versus integrated devices Mobile technology Adapted keyboards Touch screens Track balls and joysticks

41 Features of SGD to consider: Processor Interface or access method Language system (or symbolic representation used for concepts) Output

42 The processor: Integrated vs. dedicated device

43 The mobile technology explosion

44 Free Apps: Phrase Board (no speech), Tap To Talk (only one board loaded), small talk Aphasia series, Spubble Lite, Neo series, Sono Flex Lite, Locabulary Lite, My Talking Phone, Verbally Cheap Apps: SpeakIt, Imean, Verbal Victor, Tap Speak Button Expensive Apps: Proloquo2go, Touch Chat, Sounding Board, Sono Flex

45 Feature: How to layout the vocabulary Scene and Heard

46 Go Talk Now

48 TouchChat (Saltillo for Android)

49 Schedule apps

50 Photo album apps

51 Emergency Info app

52 ACCESS FEATURES: How will the person use the device? Megabee

53 Pointing: Direct Selection

54 Keyboard modifications

55 Keyboard labels

56 MOUSE OR TRACKBALL ACCESS

57 JOYSTICK CONTROL

58 Touch screen for AAC Be careful!!!

59 HEAD ACCESS

60 SINGLE SWITCH ACCESS

61 Brain- Computer Interface (BCI) Technology whereby a computer detects a selection made by a person who does not rely on neuromuscular activity. The technology uses the person s changes in brain electricity as the intended execution. Technology substitutes for the loss of typical neuromuscular outputs so that people can interact with their environments through brain signals rather than through muscle.

62 Wolpaw, et al (2002). Brain-computer interfaces for communication and control. Clinical Neurophysiology,

64 LANGUAGE REPRESENTATION: SYMBOLS AND SYSTEMS Pictures, photos, symbols Pre-made grids New message generation abilities Spelling (alphabet) options Ease of programming Ease of training Ease of learning

65 TouchChat with Symbol Stix Unity with Minsymbols Gateway with Picture Communication Symbols (Boardmaker)

66 Communication passports Orthography Spelling Typing Words & phrases

67 OUTPUT FEATURES

68 Attention Getting Devices Bicycle horns App with bells Battery Powered Doorbell

Telephone Options Ameriphone XL25s Amplified

through PUC TDAP: Telecommunication Device

69 Telephone Options Ameriphone XL25s Amplified Telephone with Outgoing Amplification product #: Speakerphone on smart phones Available through PUC TDAP: Telecommunication Device Access Program Speakerphone with SGD (available through PUC TDAP)

70 Hard copy print out Mayer-Johnson Writing with Symbols

71 LCD screens Saltillo Chat PC-M3 Assistive Technology, Inc LINK, Mercury

72 Digitized Speech Devices Go Talk family of devices

73 Speech Output Synthetic speech Dynavox VMax Saltillo NovaChat PRC ECO2 Lightwriter SL40

74 Talking computer Next Up Talker Many voices Download program from Internet for $99 Speaks out everything written on screen

75 Talking Typewriters DynaWrite Lightwriter SL40 Verbally app

76 Speech recognition Dragon-Naturally Speaking Must have consistent speech production Mild-moderate dysarthria is adequate for controlling computer with speech input.

77 Services: What can I do? Employment Education Advocacy Equipment

78 The Dilemma: What comes first? The AAAC or the job? Augmentative communication system Employment Opportunities Worksite Participation The vicious cycle Assistive Technology

79 Who are employed AAC users? Stephen Hawkings, physicist Michael Williams, author and journalist Andy Owens, Inventory specialist at Powell s Books India Ochs, Civil Rights Attorney

80 Supporting Successful Transitions for Individuals who use AAC Click Here to View the Webcast Webcast Description This presentation will provide information on major barriers and important supports to successful transitions for individuals who use AAC. Case examples provided by individuals who use AAC will be used to illustrate transition strategies that promote positive outcomes for individuals who use AAC. Participants in this seminar will be able to: Describe valued transition outcomes for individuals who use AAC. Identify major barriers to successful transitions for individuals who use AAC. Identify important supports to successful transitions for individuals who use AAC. Describe transition strategies that promote positive outcomes for individuals who use AAC. Additional Resources Augmentative Communication News: Transitions (April 2005) This issue focuses on the effects of transition periods in life on people who use AAC tools and strategies (pdf).

On-line activity for AAC users ACOLUG: Augmentative Communication On-Line Users Group Tracey Rackensperger (University of Georgia) ACOLUG is an international Listserv of people who use AAC and

81 On-line activity for AAC users ACOLUG: Augmentative Communication On-Line Users Group Tracey Rackensperger (University of Georgia) ACOLUG is an international Listserv of people who use AAC and families of young children who use AAC. It provides both a "virtual AAC community" and a link between individuals who use AAC and the RERC. Founded and sponsored by the Institute on Disabilities at Temple University, ACOLUG has become a virtual community for those who rely on AAC. ACOLUG s mission is to provide a forum for AAC users to connect, support, and learn from each other. ACOLUG is available 24 hours each day and 365 days each year. Line Users Group

82 Advocacy: ACCPC Augmentative Communication Community Partnerships Canada (ACCPC) is a Canadian, non-profit organization that promotes communication accessibility and community participation for people who have communication disabilities who may or may not use augmentative and alternative communication (AAC). ACCPC does Social innovation projects: communication access, inclusion, selfdetermination, abuse prevention and quality of life. ACCPC educates People who have communication disabilities about their rights and responsibilities People who work in justice and disability sectors Businesses and organizations ACCPC engages People with communication disabilities in all aspects of its projects Community organizations and government groups through collaboration and information sharing.

85 A Training Guide for Personal Attendants Working with Consumers who have Enhanced Communication Needs This DVD training program helps you teach others to better communicate with consumers who use augmentative and alternative communication (AAC) in their daily service routines.

86 Guidelines for communicating with people who use AAC You don't need special skills to communicate with a person who uses AAC Remember, a person who cannot speak does not necessarily have a hearing or cognitive problem. Make eye contact. Speak directly to the AAC user, not the person who is accompanying them Use everyday language. Do not speak loudly, slowly or in a condescending manner. Ask the person to show you how he/she communicates Yes. Ask the person to show you how he/she communicates No. Ask the person to show you how he/she communicates with AAC system. Give the person time to communicate. Using an AAC system takes more time than speaking. Do not feel you have to keep talking. It takes time to construct a message via AAC. Try to feel comfortable with the silences. If you are short on time and cannot communicate with the person be honest and make an appointment for when you do have the time.

87 If the person is using a display: Say each word selected out loud so that the AAC user knows you have the correct word. Do not interrupt when the AAC user is in the middle of conveying a message. If you are not sure if the AAC user is finished ask him/ her "Are you finished?" Say the words in the order that the AAC user gave them. Suggest what s/he might mean using all the words. Write down the words the person is communicating as it often helps in remembering long messages. If needed, ask the person if you can read about how they communicate and look for directions either on the front of the communication display or tray. If needed, ask the person if you can see another person communicating with them. If necessary, ask the person if he/she would like a familiar person to assist them in communicating with you. If the person is using a device: Ask the person where you should sit or stand. Some people who use devices prefer to prepare their message and then speak it out. Others prefer a communication partner to read their message as they are selecting the words.

Communication Access to Justice for People with Communication Disabilities Clients with communication disabilities have a right to: Use a variety of ways to communicate Have communication assistance

88 Communication Access to Justice for People with Communication Disabilities Clients with communication disabilities have a right to: Use a variety of ways to communicate Have communication assistance that ensures the accuracy and authorship of their messages Have their testimony recorded in ways that protect the integrity of their communication Receive information in ways they can understand and access

89 Don t be left in the middle of the lake without any paddles!

Getting Started with AAC

Getting Started with AAC P A R E N T G U I D E Many children have medical conditions that impact their ability to speak and learn language. But thanks to augmentative and alternative communication (AAC),