IATP Statewide Conference 2019

Discover the Possibilities

Augmentative and Alternative Communication (AAC)

Evaluation

“ For people without disabilities, technology makes things easier. For people with disabilities, technology makes things possible.”

IBM training manual 1991

AAC Evaluation

The AAC assessment assumes that the communication disorder is chronic and natural language is not likely to occur. Therefore the focus on the assessment shifts to designing an AAC system that will provide for the highest level of generative communication that can be achieved.

Rush-Hellig ASHA presentation

Who uses AAC?Over 2 million people in the United States have severe communication

impairments which affect their ability to speak.

AAC Populations

• Autism spectrum disorder

• Cerebral palsy

• Developmental disabilities

• Intellectual disabilities

• Developmental apraxia of speech

• Genetic disorders

• Acquired disabilities-TBI

Components of AAC Assessment Process

• Preparation-Questionnaires, Records

• AAC student Considerations

• Sensory/Perceptual

• Positioning/Access

• Communication/Cognitive/Literacy

• Communication Partners/Environment

• System Selection-Feature matching

• AAC report/funding reportRush-Hellig, ASHA presentation

Sensory/Perceptual

Vision-

• Visual acuity

• Visual field

• Light sensitivity

• Color Perception

• CVI-Cortical Vision Impairment

Incidence-48-75% of children with developmental disabilities and/or Cerebral Palsy have vision problems and 75-90% with severe/profound disabilities.

Hearing-• Standard Assessment/ Auditory Processing

Student with Cerebral Palsy who had significant visual acuity issues and needed large target speech buttons with an easy motor plan

Access

What part of the body and what action will be used to activate the device?

Hierarchy of Anatomic Sites

Hands

Head

Feet

Arms/Elbows

Legs/Knees

Mounting/Portability of the device

Communication/Cognition/Linguistic

Review assessments

Communication Continuum

• Emergent- does not have a reliable means of expressive language through symbolic language.

• Context Dependent-symbolic communication is reliable, but limited to certain contexts or partners.

• Independent- not limited to what they can talk about or whom they can talk to. The ability to communicate to anyone in any context.

Feature Matching

• Layout-number of symbols

• Symbol Type

• Symbol Size

• Presentation-Static/Dynamic

• Access Method

• Output-synthesized/digital speech

• Mounting/Portability

• Ease of set up/training support

• Durability

IATP-AAC Evaluation Process

• AT/AAC school based evaluation

• Funded through ISBE grant

• AAC Packet sent to school team-

SLP, OT, PT, teacher, etc.

• AAC evaluation is scheduled when complete packet is received

No Tech Devices

Developing yes and no response with larger size icons

Low Tech Devices

Mid Tech Devices

High Tech Devices•Tobii-Dynavox: Indi, I-110, SC dedicated iPad, I-Series (I-12+, I-15+), EyeGaze

•Prentke Romich Company (PRC): Accent (800, 1000, 1400), Essence PRO, Words for Life (WFL) Communication App, NuEye Tracking System, NuPoint Headtracking System, Prio dedicated iPad with LAMP-WFL communication App.

•Saltillo: NOVA chat (5, 8, 10, 12), Touch Chat Express dedicated iPad

•Pro-Slate: dedicated iPad with Communication Apps, Winslate Eye gaze system, voice pod

High Tech Devices cont.

Develop the AAC evaluation plan

• no, low, mid, or high tech device

• Access site (isolated finger, hand, head, etc.)

• Switches

• Device activities (child’s interests)

• Vocabulary lay out of devices

-vocabulary sets

-hide/show speech buttons

Device Access

•You can have the best language system in the world but if a child cannot access it, it doesn’t matter.

•If a child has access issues, work with the team to determine how the child can quickly and efficiently access a device.

•Assessment of Learning Process (ALP)

Wilds, Clarke, & Nilsson 2017

How do children use AAC Systems?

Direct Selection: Includes pointing with a body part or eyes.

Indirect Selection: This would involve the use of a device that scans.

Direct Access-Touch

Indirect access with switch scanning

Two switches-using core scanner

Eye Gaze Access

Determining the Best AAC Fit

• Low, mid, and/or high tech devices

• Number of symbols

• Symbol type

• Best Access option

• Vocabulary organization-word, phrase, scenes, combinations

• Language growth potential

• Language options (i.e. Spanish)

• Ease of use/training support

AAC Evaluation Summary

Access Evaluation

• Direct Selection

Example: consistent use of right index finger with inconsistent activation of target symbols in all locations of the screen

• Adapted Direct Selection

Example: ball grip with stylus

Georgia Project for Assistive Technology

AAC evaluation

Indirect Access/Switch

• Switch type (jelly bean, candy corn, etc.)

• Scanning switch access

• Auditory/visual or both

• Automatic, step scan, etc.

• Scan pattern-linear, row/column

Head Access with a Switch

Symbol Evaluation

• Formal evaluation

TASP Test of Aided Communication Symbol Performance

• Informal evaluation

AAC evaluation “Genie” App.

• Symbol types-Boardmaker, Symbol Stix, Unity, Widget, Photos, tangible objects, etc.

• Use of symbolic representation

Evaluate-Vocabulary Usage

Communication intent:• Gain attention• Express wants and needs• Request reoccurrence “more” • Indicate finish “all done” • Express choices• Make comments• Express greetings/farewells• Responds to questions• Reject

Evaluate: Symbol Accommodations for Vision needs

• Large symbol size

• Spacing between symbols

• High contrast

• Grid separating symbols

• Key guard

• Tangible symbol system

No to Low Tech AAC evaluation

• Cause/Effect toys/Apps

Help Kidz Learn Apps-Inclusive Technology

• Choice Making devices

• Tangible Objects/Prox Talker

• Partner Assisted Scanning

• Big Mack-develop “core” words

• PODD-Pragmatic Organization of Dynamic Display

Cause/Effect Switch ActivationAssessment of Learning Process (ALP) for AAC access- Stage 1 beginning to activate, recognizing movement is causing an effect.

Partner Assisted Scanning

Dedicated device funding options

School District

IL Medicaid

Private Insurance

Alternate funding resources

Grants

Costs of high tech devices/iPads/

Communication Apps

Device funding process

• Data collection during 4-5+ week device trial

• Submit funding packet-AAC evaluation, trial addendum, certificate of medical necessity by the physician, and assignment of benefits so device company can bill insurance company

What does IATP have to offer?

• Four Full Time Speech Pathologists/AAC evaluators who assess school age children in Illinois K-12th grade (free assessment funded through ISBE)

• Free Assistive Tech evaluations in the schools

• Demo floor

• Loan library

• Reutilization program

• And more….

Thank you!