Augmentative Communication Evaluations Simplified: ACES Tools & Resources Debby McBride, MS, CCC-SLP Presented by AAC TechConnect Inc. Lisa Bardach, MS, CCC-SLP Libby Rush, MS, CCC-SLP Tanya Curtis, MS, CCC-SLP 700+ participants in other workshops (contributions in content & resources)

To give people their VOICE Because we all have something to say! Purpose To give people their VOICE Because we all have something to say!

What role do you play in giving people their voice?

What does Augmentative/Alternative Communication mean to you?

What is augmentative /alternative (AAC) communication? Refers to the incorporation of techniques that can be used to help individuals with disabilities in general, as well as to very specialized technologies designed specifically for individuals with significant and severe disabilities. These techniques include, for example, the use of communication symbols, aids, strategies, skills, and devices designed to assist disabled individuals. (Sarah Blackstone; 1986) What is augmentative /alternative communication? ASHA??

AAC communication includes Nonverbal Vocalizations * Low-tech or no-tech * Lite-tech * High-tech

Goals include: Your goals for this workshop Write 3 ( on the back of your evaluation form) *

Goals include: Explain the process of obtaining an AAC tool/device Describe tools/techniques used to determine the AAC candidate’s skill Complete many of the components with templates provided for gathering, compiling and reporting the results. Identify components on AAC devices such as common features and categories of devices (i.e. dynamic display, digitized, integrated, etc.) Identify local resources and consultants for trials, support, and funding assistance for AAC devices.

Schedule Today – Tomorrow Looking at the “Communicator” Using a “Toolkit” for Evaluation Lunch Matching persons to devices / communication tools Trialing the toolkit Tomorrow Case studies – ours Case studeis - yours Decision-making process for appropriate devices Trialing the appropriate device(s) Using your local resources Funding

A Systematic Approach for AAC Evaluations ACES Module Augmentative Communication Evaluation Simplified

ACES Module examples The Person: Skills & Features to Consider for Assistive Technology The Person: Skills & Features to Consider for Assistive Technology Y/N response Method? Answers ?’s: Simple/Complex Follow Directions: Follows Conversation? Understands Humor? Receptive Language / Cognition Memory/new learning Attention Categorization/Assoc. Generalization Vision Skills Modifications W/in Functional Limits (WFL) Tactile Symbol modifications Glasses Auditory scan/fishing Color Cortically Blind Zoom magnification Contrast Font size: _____ Neglect/Field Cut Other: Y/N response Method? Answers ?’s: Simple/Complex Follow Directions: Follows Conversation? Understands Humor? Receptive Language / Cognition Memory/new learning Attention Categorization/Assoc. Generalization Vision Skills Modifications W/in Functional Limits (WFL) Tactile Symbol modifications Glasses Auditory scan/fishing Color Cortically Blind Zoom magnification Contrast Font size: _____ Neglect/Field Cut Other: words sentences complex pictures objects Current Communication Skills Facial/body language Speech Board / Book Point to/take/look at Gestures / Signs Device: Vocal / verbalizations Read: Recognize Write: words sentences complex pictures objects Current Communication Skills Facial/body language Speech Board / Book Point to/take/look at Gestures / Signs Device: Vocal / verbalizations Read: Recognize Write: WFL C P Volume Access C P HOH* Voice type/quality H/A* Headphones Deaf Silent Mode C = Communicator P = Partner Skills Hearing Modifications *HOH = Hard of Hearing *H/A = Hearing Aid WFL C P Volume Access C P HOH* Voice type/quality H/A* Headphones Deaf Silent Mode C = Communicator P = Partner Skills Hearing Modifications *HOH = Hard of Hearing *H/A = Hearing Aid Fine Motor Skills Points: Left/Right hand Finger/Knuckle Writes: Tremor: Gross Motor Ambulatory walker cane Paralysis/Plegia: Degenerative? Locked in? Weight/size restrictions: Wheelchair: manual/power Type of transfer: Limited (Describe): Balance Issues: Positioning: WFL Fine Motor Skills Points: Left/Right hand Finger/Knuckle Writes: Tremor: Gross Motor Ambulatory walker cane Paralysis/Plegia: Degenerative? Locked in? Weight/size restrictions: Wheelchair: manual/power Type of transfer: Limited (Describe): Balance Issues: Positioning: WFL Visual Auditory Linear Row Column Group Step Inverse Auto Zoom w/c Mount: Carry case other Trackball Mouse Joystick Headmouse Access Modifications (Mark access site) Direct select: pointer stylus Finger/Knuckle: Keyguard Size? Headpointer Eye Gaze Scanning # of switches: MorseCode Use w/c controls Switch Type Switch Mount Scanning Options Other: Visual Auditory Linear Row Column Group Step Inverse Auto Zoom w/c Mount: Carry case other Trackball Mouse Joystick Headmouse Access Modifications (Mark access site) Direct select: pointer stylus Finger/Knuckle: Keyguard Size? Headpointer Eye Gaze Scanning # of switches: MorseCode Use w/c controls Switch Type Switch Mount Scanning Options Other: Device Location/Positioning: Device Location/Positioning: ? Left, Midline, Right, High, Midpoint, Low ? Switch Circle switch site Left, Midline, Right, High, Midpoint, Low Switch Circle switch site L- L_ R- R_ L- L_ R- R_ Copyright © 2010 AAC TechConnect, Inc. Copyright © 2010 AAC TechConnect, Inc.

Tools and Resources you will leave with: ACES Module (handouts & on CD) Evaluation Toolkit List The Persons (form) AAC Device Features (form) Case History & Eval Summary (form) Device Decision Making (form) Resources on CD Handouts (including the above) AAC device flyers Templates (report, summary forms, etc.) Other resources (website lists, vendors lists, etc.) Websites: free resources

Challenges you have? Why… *

AAC Evaluations - Challenges Availability of systematic assessment protocols Acquire premade materials/resources (vocabulary, overlays, etc) Not organized / equipment available when needed / working when needed Training ??? Knowledge??? Experience??? Keeping up with technology Overwhelming ? ? ?

Process – Beginning to end Person Referral Gathering information Deciding on skills to assess Choosing the “toolkit items” used Evaluating the individual's skills (sensory, physical, language, communication functions/needs, etc.) Summarizing individual’s skills

Process continued Communication Tools / Devices Matching skills to communication tools (feature - matching) Voice / no voice Trialing communication tools / voice output devices Making recommendations Writing appropriate documentation Completing funding paperwork as needed Use of your equipment reps

Evaluation Who are they? What do they want to say? Where do they want to say it? How do they want to say it? What are their current skills? What technology can bridge the gap?

Feature Matching – Determine what the individual needs, then find the technology with the requisite features and match the technology to communicator. SDT

Level of communicator Emerging Context/Partner Dependent Independent

Emerging No RELIABLE means of EXPRESSIVE communication through SYMBOLIC language Have some functional non-verbal communication (gestures, vocalizations, other nonsymbolic communication) Able to attend, even briefly, to individuals, conversations, pictures, or symbols Yes/no (acceptance/rejection) depicted with body language; i.e. no reliable yes/no for more complex communication

Context- or Partner-Dependent Has SYMBOLIC communication that is RELIABLE but limited to particular CONTEXTS or PARTNERS Rely on partners to provide limited response set Need frequent instruction and cueing Difficulty with initiation May only be functional in particular settings Wide range with regard to # of partners and # of settings

Independent (Generative) Can communicate ANYTHING on ANY TOPIC to ANYONE in ANY CONTEXT Locate, select, and convey messages on their own Can interact with familiar / unfamiliar partners equally well Can sequence symbols or letters to generate novel messages

Access / modification Direct select: keyguard, pointer, stylus Headpointer / headmouse Eye gaze Joystick, mouse, trackball Morse code Scanning Wheelchair controls (caution)

Switch access Circle for location of switch Type of switch Mount / attachment How many switches?

Scanning options Auditory / visual Linear / row-column / group Step / inverse / auto Other

Who is your person?

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Evaluation - What’s in your toolkit? What do you currently use?

Toolkit List

Gathering your Toolkit Help you organize what you have - toolkit list Help you decide what to add to your resources Give you additional ideas for premade materials / resources Give you additional resources you can access: CD AAC TechConnect- web

The Evaluation Toolkit

The Evaluation Toolkit

Low-tech physical access components Keyguard Pointing light Partner Assisted Scanning Eye gaze PECS Positioning (motor – visual)

Miscellaneous items

Augmentative Resources

Switches & accessories Variety of switches Switch interface Switch mount

Array of Switches                                                                      

Switch Mounting System

TOOLKIT #1continued – “Lite – Tech” components Battery adaptor Array of Switches Switch Interface Switch activated devices (toy or fan or vibrating Pillow) . . . . . Switch Mounting system Battery adapter ?

Cause-effect items

Switch Activated Devices

Battery Adapter

Switch Interface

The Evaluation Toolkit

Voice output – does it make a difference ? ? ? Single message sequential communicator Multiple message communicators (progressive message key setups) Consider ones with levels

Simple voice output – w/ sequencing capabilities Single message communicators (Sequencers, Step-by-Step, etc.)

Single message communicators Replays one message at a time Recorded speech Some can do multiple messages (repeats different message each time you select it) Some can do different levels / situations

Progressive Communicator - Digitized device(s) Start simple – 2 pictures Add more pictures Has levels Direct select Recorded speech (voice) Uses overlays

Static Display Progressive Communicator

Simpler voice output devices Digitized Devices & Accessories

Others in your closet Macaw Message Mates ChatBox Others? Any of these?

Digitized Devices (examples only – not all inclusive)

The Evaluation Toolkit

Toolkit #3 - “Higher Tech” Laptop or tablet computer (convertible laptop optimal) Add communication software Emulate devices (large, medium, small) Accessories Touch Screen (not just with pen) Switch interface Make small, med. And large overlay

Laptop Computer, Touch Screen and AAC Software

I “stuff” (iPad, iPod, iTouch, etc.) . .. Droid, Slate, etc. . . . .

Communication Software Emulate the devices 3rd party software which does the following: Make various configuration of overlays Able to link them together to evaluate navigation Can do scanning of all types Spelling (word prediction) - optimal

Software for purchase Tobii Communicator (Tobii ATI) - $599 - SayIt! Sam Software (Words +)-$1395 Speaking Dynamically Pro (Mayer Johnson)- The Grid (Sensory software) Mind Express (Words+) others Boardmaker Plus (Mayer Johnson) Overboard (Gus)

Free manufacturer software/ demos you can get . . . Series 5 Semesterware (DynaVox) PASS software (Prentke Romich) SayIt! Sam (Words+) E Z Keys (Words+) Mind Express (Words + - coming) Others?

Questions?

What do you think you may What do you have? or What do you think you may need / want?

Time for lunch!

ACES Module: Your Tools & Resources Toolkit components: communication tools to have at your fingertips (in the bag) Premade evaluation materials / resources (in the book) Templates / resources to complete paperwork (on CD and on the web) Resources to make decisions on devices (On web)

Premade resources - ideas

Evaluation Materials/Resources Materials include: Objects Pictures Premade overlays / pages Low tech (communication boards) Lite tech (overlays for digitized devices) High tech (pages for dynamic display options)

Symbols Objects Photos COPPS Pictures Overlays Visual scenes Alphabet boards Make one example of each of these to show from the kit

Symbols and premade materials Make your own Purchase other resources Examples of Toolkit Notebook CD coming with PCS boards on it – Fall 2010

Pre-made pictures/overlays What do you use? We use . . . Examples include various sizes (size of message key and #’s of keys) Various communication functions Dynamic display (low tech example) Sizes example

Object-COPPS-Photo

TALKING MY WAY Talking My Wya

Object Symbol Resource

Photographs

PCS – Boardmaker (Mayer-Johnson)

SymbolStix - Symbolmate – News2U

Overboard by Gus

Attainment

The Test of Aided-Communication Performance (TASP) by Joan Bruno, Ph.D., CCC-SLP A tool for the assessment of symbol-based communication skills. Includes subtests on symbol size and number, grammatical encoding, categorization and syntactic performance. Results may help determine AAC intervention strategies and goals. Provides starting point for designing communication boards or selecting a page for an AAC device.

Alphabet boards Alphabet/Spelling Alphabet boards Keyboard arrangements ABC QWERTY Frequency of occurrence Grammar based boards

The Device: Features to Consider

Symbols Objects COPPS Photos Pictures Words Letters Media (video clips, etc.)

Language Representation Single meaning pictures Multi-meaning pictures (Unity) Alphabet / spelling Use of core words Visual scenes Phrase-based Grammar-based boards

Single meaning pictures

Semantic Compaction (Unity) Multi-meaning pictures Less key strokes (in sequencing) – faster Motor memory Icon prediction Activity row – picture prediction

Semantic Compaction-example

Visual scenes

Phrase Based

Premade vocabulary considerations Language representation Progression (easy to more complex) Individualizing Smaller vs. larger vocabulary needs Ease of navigation Ease of learning (for user and communication partners)

Grammar - Based / Core Words

Grammar Based Software WordPower (Most manufacturers) Picture Word Power Wordcore (PRC - Pics) Gateway (Dynavox - Pics & words) Tobii Communicator (Sono Key- words/Sono Lexis-pics) SpeechPro (Gus-words) AlphaCore (Dynavox-Pics & words) 93

Alphabet/spelling Keyboard arrangements ABC QWERTY Frequency of occurrence

Message formulation Single key messages Routine phrases Novel sentences Novel thoughts / ideas Spelling

Message formulation: Gateway - Unity – Picture WordPower –

Navigation / page changes Who is changing: facilitator or communicator (can limit access) Static display - # of pages Dynamic display - # of pages # of levels down

Message Key # of keys Size of keys Varies Actions required Click Zoom/enlarge Color changes Hold time Auditory “fishing” (technique)

Screen size Small (handheld size) Small – medium (Xpress, Springboard Lite, Alt-Chat) Medium Large Issues: visual, motor, navigation requirements (memory)

Message display Words Pictures Speak each word / sentence Speak on demand / punctuation Highlight each word as it speaks Silent mode

Rate enhancement Pre-store messages Prediction (word, letter, picture, symbol, character, phrase) ** Abbreviation – expansion Pre-made vocabulary options Grammar-based boards ** Word morphology (word endings, verb tenses, etc.)

102

103

Picture prediction – activity row

Refer to AAC Feature Chart for Voice/speech Device functions/access Keyboard Type of Device Devices to trial

Toolkit Time . . .

Handheld size

Small - intermediate

Medium size

Large size

Try it on . . .

Types of devices to consider Dynamic display Integrated systems Text – to – speech Digitized Simpler digitized Single message communicators

Dynamic Display Multiple pages “Navigate between pages” Variety of symbols available Both types of speech (digitized & synthesized) Possible to use generative language Offers more options for alternative access

Integrated System Multiple pages “Navigate between pages” Variety of symbols available Both types of speech (digitized & synthesized) Includes computer components

Digitized Simpler communication needs Recorded voice Use of pictures Multi lingual Most of them have: Paper overlays that are changed Also called “static display”

Digitized Devices (examples only – not all inclusive)

Text to Speech Mainly spelling (keyboard and some have scanning) Most have built-in keyboards Mostly synthesized speech, though few have digitized speech

Text-to-Speech (examples only – not all inclusive)

Let’s Review what we have so far: The Person (ACES Module) AAC Device Features (AAC Module) Toolkit List (AAC Module) Gather information (Case history & Summary Evaluation in ACES Module) Record evaluation results (form above & Assessment summary in Templates) Device Decision-Making (AAC Module) Device Assistant – 30 day trial from AAC TechConnect Write report (Templates) Funding (work with vendor)

Device Selection Which Device to Choose ? ? ? ? Low tech Lite tech High tech Combination

How do you proceed? . . . . . Know user’s skills . . . . .now what?

Device Selection Options Catalogues AAC TechConnect – contact manufacturers Manufacturer websites Go to individual ones – AAC TechConnect has list AAC TechConnect – free resources Pictures (thumbnails of 100+ devices) Free flyers

www.aacTechConnect.com Website which gives the following free information on ONE site What’s New Manufacturers Product information 126

Clinical Tools From AAC TechConnect The ACES Device Assistant – project of AAC-RERC The Resource for Lite Tech Low Cost AAC Chart (by Libby Rush & Mary Joan McClure)

132

Demo – AAC TechConnect Free trial

134

Clinical Online Tools from Lite Tech Low Cost Chart AAC TechConnect $14.95 (online with credit card) Device Assistant Free trial – 14 days Fee – for – service after that

Trialing equipment Loan equipment AT centers Vendors – local resources Manufacturers Rental options

Do you . . . Have some new strategies to try? Have some things in your closet you will dig out for use?

Questions? ? ?

Review goals Suggestions for next time? Please put on your eval form.

Did we: Explain the process of obtaining an AAC tool/device Describe tools/techniques used to determine the AAC candidate’s skills Complete many of the components with templates provided for gathering, compiling and reporting the results. Identify components on AAC devices such as common features and categories of devices (i.e. dynamic display, digitized, integrated, etc.) Identify local resources and consultants for trials, support, and funding assistance for AAC devices.

THANK YOU for helping others To get The best choice For the best voice

Debby McBride, MS, CCC-SLP 866.4U.AAC.RX info@aacTechConnect.com Contact us at: Debby McBride, MS, CCC-SLP 866.4U.AAC.RX info@aacTechConnect.com www.aacTechConnect.com 866/482-2279 or 303/674-8553