Augmentative Communication Evaluations Simplified: ACES Tools & Resources Debby McBride, MS, CCC-SLP Presented by AAC TechConnect Inc. Lisa Bardach, MS, CCC-SLP Tanya Curtis, MS, CCC-SLP Libby Rush, MS, CCC-SLP (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 – Looking at the “Communicator” Using a “Toolkit” for Evaluation Lunch Matching them to the devices / communication tools Decision-making process for appropriate devices Trialing the appropriate device(s) Using your local resources Local reps and distributors Local loan banks Local resources Funding CEU certificates

A Systematic Approach for AAC Evaluations ACES Module Augmentative Communication Evaluation Simplified Toolkit List Forms for summarizing evaluation information Individual skills Device Features

ACES Module examples

Tools and Resources you will leave with: ACES Module (handouts & on CD) A Toolkit List The Communicator Device Features Other Considerations Resources on CD Handouts (including the above) AAC device flyers Templates Other resources 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

The Communicator

The Communicator

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

Vision Modifications Vision modifications Tactile Auditory cueing Zoom Symbol modifications Other

Hearing modifications Volume access Voice type/quality Headphones Other (including communication partners) Silent mode

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

Current communication Facial/body language Point to / take / look at Gestures / signs Vocal / verbalizations Board / book Device Other

Fine motor Fine motor Points Writes Limited hand / finger use (describe)

Gross motor Ambulatory Wheelchair Walker Cane Walk only with assistance Mounting / carry case needs

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?

Video Questions ? ? ? ? ?

break

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 Toolkit #1: Low-to Lite-tech Tools Toolkit #2: Digitized devices Toolkit #3: Computer & accessories to emulate variety of communication devices (evaluation ONLY) Objects Pictstures Dusty pics

Let look at some examples TOOLKIT #1 – “Lite – Tech” components

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

Switch Computer Application RJ Cooper Linda Burkhart Marblesoft/Simtech Judy Lynn

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.)

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?

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

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) - optimul

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

Free software/ demos Manufacturers (some examples) Series 5 Semesterware (DynaVox) PASS software (Prentke Romich) SayIt! Sam (Words+) EZ keys (Words+) Overboard (GUS)

Point-N-Click Click-N-Type Etriloquist

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 m( in the book) Templates / resources to complete paperwork (on CD and on the web) Resources to make decisions on devices ( On web)

Premade resource

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

No-tech 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 Evaluation Assistant

Pre-made pics/overlays What do you 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

PCS – Boardmaker (Mayer-Johnson)

SymbolStix

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

Examples from Medical book For Medical settings – check with AAC TechConnect for more info

Premade Resources?

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)

The Device: Features to Consider

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

Language Representation Single meaning pictures Semantic Compaction Alphabet / spelling Visual scenes Phrase-based Grammar-based boards

Single meaning pictures

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

Semantic Compaction

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

Visual scenes

Phrase Based

Grammar - Based

Navigation / page changes Facilitator/communicator changes pages Number of pages required (few-many) Static display # of pages Dynamic display navigation skills

Keyboard options Built – in keyboard (integrated) Onscreen keyboard – W+ Plug-in keyboard (external) Convertible-style tablet

Voice / speech Synthesized (synthetic) Digitized Other language needed Pre-recorded Spelling

Type of device Dynamic display (small/med/large) Integrated (dynamic display as computer) Text-to-speech (attached keyboard) Digitized (static display with overlays)

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

Dynamic Display (examples only – not all inclusive)

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

Integrated Systems (examples only – not all inclusive)

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)

Device functions / access Use access to on / off User access to volume User access to programming ECU’s Internet access / browsing Computer applications Camera Phone Text messaging Email Printer

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.)

Picture prediction – activity row

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

Single meaning pictures

Core vocabulary

Message button # of keys per page Size of keys Need for variety (progressive)

Message feedback Action Click (auditory) Color changes (visual) Zoom / enlarge (visual)

Button / selection method features Touch enter / exit Hold time Direct select Headpointing Eyegaze Auditory “fishing” Scanning

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

Screen size / size of device Small – handheld size Small – medium 7” screen Medium - 8.4” screen Large – 10.4” + screen (mounted?)

Handheld size

Small - intermediate

Medium size

Large size

Try it on . . .

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

Grammar Based Software WordPower (Most manufacturers) Picture Word Power Wordcore (PRC) InterAAACT (Dynavox) SpeechPro (Gus) AlphaCore (Dynavox) d

Quick fires

ACES Module (templates provided ) Gather information (Case history) Record evaluation results (Assessment summary) Device decision-making (Device assistant) Write report (report) Funding (work with vendor)

Pre-Assessment Preparation Obtaining previous reports, evaluations and supplemental information (on CD) Case History Intake

Evaluation Notes Form to provide consistent means of recording information during the evaluation session Use of form helps to promote an organized method for keeping work records Mechanism to measure progress Assessment Summary Intake form with notes * * * * * *

Video

Device Selection Which Device to Choose ? ? ? ?

Additional Features to know Accessories required (list on CD) Medicare version required (Insurance) website: www.aacfundinghelp.com (web list on CD) Cost Size / weight Etc.

Decision-making Alphabet / Spelling Pictures / spelling Keyboard (Text to speech) And/or onscreen keyboard (Dynamic display - tablet style) Pictures / spelling Dynamic display Pictures / spelling with computer components Integrated systems

Decision-making continued Pictures only – Static display (digitized) vs Dynamic display vs integrated system Number of pictures Number of pages Types of pictures Changing levels (user vs. facilitator) Ease of programming

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

Single Message

No tech Use as primary communication Secondary communication Backup communication Evaluate benefits of voice output Individual Communication partners Motivation

Decision-Making & Supporting Documentation

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

Funding www.aacfundinghelp.com 3rd party medical funding (Medicaid, Medicare, Private Insurance) Medicaid Available Educational or Vocational or Independent living Private pay or donations (Used equipment) Work with your local device representatives

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

www.aacTechConnect.com Low cost information resources Lite Tech Low Cost Chart AAC TechConnect $14.95 (online with credit card) Device Assistant Free trial – 14 days Fee – for – service after that

Lite Tech Low Cost Chart

Device Assistant – free info

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

Explore Programming of the device Try the actual programming – see how it feels Edit button; make page; link pages Communication partners need to feel comfortable with the programming Sales representatives can assist Ask what support options include (including on-line support)

Accessories (on CD) Carry bags Keyguards Access hardware (switches/head controlled device, joystick, etc.) Mounting systems/components Extra power (if required) Internet/computer access (hardware/software) Environmental controls Software to make overlays (for digitized devices) Others?

Completing the paperwork Gather Summarize Write report Get quote / info from manufacturer Complete funding paperwork (packets or online resources from each company)

Free templates & Paperwork Assistant CD www.aac-rerc.org Report Coach: aacfundinghelp.com Dynavox – Funding Manager PRC – Funding Submission Assistant Templates on www.aactechconnect.com

Paperwork Assistant from AAC TechConnect (coming in Fall)

Knowledge about best practices Evidence-based practice refers to an approach in which current, high-quality research evidence is integrated with practitioner expertise and client preferences and values into the process of making clinical decisions. Web list I & web list II To download handouts, go to www.aacTechConnect.com go to EVENTS - see materials listed there

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