1 AugCommEvalsSimplified (ACES) Tools & Resources Using your toolkit

2 Goal Learn the ACES module to assist in your evaluation process Learn the ACES module to assist in your evaluation process To define and finish your toolkit list To define and finish your toolkit list To learn more web-based resources To learn more web-based resources Your local reps and the ways they assist Your local reps and the ways they assist To leave with “next steps” for the cases you came with To leave with “next steps” for the cases you came with

3 Agenda Evaluation Examples: 3 types of communicators Evaluation Examples: 3 types of communicators Work through your individuals with complex communication needs (CCN) Work through your individuals with complex communication needs (CCN) –Use the ACES module and Evaluation Toolkit –Feature matching AAC equipment AAC equipment –Communication evaluation tools –Website resources –Meet your vendors

4 Your turn Do case histories – Do case histories – Yours & in group Yours & in group –ACES module Tools used Tools used Communicator skills Communicator skills Device features Device features Next steps... Next steps... Lunchtime – trial toolkits

5 What was one idea yesterday that you will implement? What was one idea yesterday that you will implement?

6 Evaluation software Tobii Communicator Tobii Communicator Homepage Homepage Choose 1 from each category Choose 1 from each category Try spelling

7 Evaluation Examples 3 types of communicators –who is yours? 3 types of communicators –who is yours? –Emerging –Context – dependent / situation dependent –Independent

8 What you will need:

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

10 Case history for LM; Pertinent background Age: 4 years old Age: 4 years old Diagnosis: Seizure disorder Diagnosis: Seizure disorder Communication Diagnosis: Dysarthria School setting: Attends university preschool School setting: Attends university preschool Previous evaluation by AT team / school Previous evaluation by AT team / school –Did not address communication components; recommendations for AT good – other info wanted to expand on: What doing? How doing it? What doing? How doing it?

11 LM continued Mother very involved – attend workshop w/ team Mother very involved – attend workshop w/ team Previous program set up for school; several things tried at home Previous program set up for school; several things tried at home Reason for evaluation: mother wants support for home program – and wants to coordinate with school. Reason for evaluation: mother wants support for home program – and wants to coordinate with school.

12 Observations: Limited interests Limited interests Short attention span for most activities Short attention span for most activities Very active – did not sit for long Very active – did not sit for long Needed constant attention for safety due to balance Needed constant attention for safety due to balance Mother felt she was a distraction - not wanting to be there Mother felt she was a distraction - not wanting to be there

13 Toys mother brought (books with sound, IPOD) Objects – monkey; ball, bubbles, etc. Switch - Switch interface – toy Single Message communicator Computer (with touchscreen) w/ RJ Cooper Software

14 Level: Emerging Vision: not sure Hearing: normal Current communication: facial, body language, vocalizations, some eye contact, sign more / all done (approximations) Fine motor: gross imitations of signs Gross motor: poor balance, constantly moving Switch access: best with no wires

15 Observations Use of objects recommended: Use of objects recommended: Starting to use; tried “monkey” for song Starting to use; tried “monkey” for song Cause – effect with toys: (magic frog / bubble machine) Cause – effect with toys: (magic frog / bubble machine) –Played with switch cables – needed to cover up (wireless would be better and attach switch to table) –Reached for toy – needed to keep toy out of reach –Not much attention Voice output – single message communicator – no interest Voice output – single message communicator – no interest Computer program / using CE software with touchwindow Computer program / using CE software with touchwindow –Limited attention

16 Chart – not appropriate Instead use Communication Matrix – Likes / Dislikes checklist

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18 Communication Matrix Communication Matrix

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20 University of Washington University of Washington likes_and_dislikes_checklist.doc likes_and_dislikes_checklist.doc likes_and_dislikes_checklist.doc A checklist can be helpful when searching for initial likes and dislikes for an individual with "emerging" communication skills. A checklist can be helpful when searching for initial likes and dislikes for an individual with "emerging" communication skills. Searches auditory, visual, kinesthetic, tactile, tastes, textures, smells, etc. Searches auditory, visual, kinesthetic, tactile, tastes, textures, smells, etc. Copyright (2002) Patricia Dowden, Ph.D., CCC-Sp; UW Speech & Hearing Sciences Copyright (2002) Patricia Dowden, Ph.D., CCC-Sp; UW Speech & Hearing Sciences

21 Goals: Communication Functions Make request – use objects Make request – use objects Make choices – touch; choice of 2 Make choices – touch; choice of 2 Continue – more; touch object Continue – more; touch object Stop – all done Stop – all done Protest/reject – push away; head shake Protest/reject – push away; head shake Help – approach person; hand something to person Help – approach person; hand something to person

22 Questions? ? ?

23 Case Study #2 - DZ Age 7 Age 7 Diagnosis: Down’s Syndrome: Autistic Diagnosis: Down’s Syndrome: Autistic Communication Diagnosis: Dyspraxia Communication Diagnosis: Dyspraxia Reason for referral: Mother and SLP felt like he could benefit from use of voice output; felt he was “ready” due to new interest in computer

24 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 Rely on partners to provide limited response set Need frequent instruction and cueing Need frequent instruction and cueing Difficulty with initiation Difficulty with initiation May only be functional in particular settings May only be functional in particular settings Wide range with regard to # of partners and # of settings Wide range with regard to # of partners and # of settings

25 Pertinent Background Info: Home schooled Home schooled Receiving private speech therapy Receiving private speech therapy Previously tried verbal, gestures, signs, PECS – not successful Previously tried verbal, gestures, signs, PECS – not successful Interest in computer; was using computer and had started accessing it with a mouse. Interest in computer; was using computer and had started accessing it with a mouse.

26 Observations: Limited interests Limited interests Short attention span for most activities Short attention span for most activities Had cloth he carried much of the time Had cloth he carried much of the time Brought items to session (his CD) Brought items to session (his CD) Limited communication functions Limited communication functions (currently completing Communication Matrix & Likes / Dislikes form)

27 Tools used Single Switch – Switch Latch Timer – Battery operated toy (bubbles) Single message communicator Go Talk Computer with his software, RJ Cooper software, and communication software (navigating pages)

28 Observations Demonstrated ability to operate switch (bubble machine). Used with switch latch timer Demonstrated ability to operate switch (bubble machine). Used with switch latch timer Tried voice output devices (Go Talks) Tried voice output devices (Go Talks) Computer program / access: Moved mouse to drag object from bottom of screen to picture above it (example bone up to dog) Computer program / access: Moved mouse to drag object from bottom of screen to picture above it (example bone up to dog) Enjoyed voice output – when paired with high interest activity Enjoyed voice output – when paired with high interest activity Was very purposeful and accurate almost immediately Was very purposeful and accurate almost immediately

29 Video - DZ Video - DZ

30 Level: Context- dependent Vision: glasses Hearing: normal Current communication: facial, body language, vocalizations, reach, some eye contact Fine motor: use single finger; tap Gross motor: very ambulatory

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32 Symbols Used 2 symbols: ball and computer on 4 pictures device (Go Talk) Used 2 symbols: ball and computer on 4 pictures device (Go Talk) 2” size (color with background colored) 2” size (color with background colored) Progressed to 1” pictures on Progressed to 1” pictures on 20+ Go Talk 1” size (color with white background) 1” size (color with white background) Concrete (ball) and abstract (more) Concrete (ball) and abstract (more)

33 Language representation Single meaning pictures Single meaning pictures

34 Navigation page changes One page per situation One page per situation Facilitator change Facilitator change

35 Keyboard – not at this time Voice / speech – digitized; high interest – easier to understand Type of device – digitized static display; (Ruled out dynamic display: lack of vocabulary needs; durability) Device functions - NA

36 Rate enhancement - NA Message formulation – single message – or combine words into routine phrase Message display - NA

37 Device types tried Static display (Go Talks) Static display (Go Talks) – 9+ (2 inch); 20+ (1 inch) Dynamic display Dynamic display –Not as easy to see; short visual attention –Knocked on the floor –Too sensitive; touched multiple places at one time –Could be used as

38 Symbols: Pictures; digital photos – people Language representation: single meaning pics; Navigation: facilitator change; few pages needed for vocabulary interest – up to 10 pgs Keyboard: NA Voice/speech: digitized Type of device: digitized Device functions: NA Rate enhancement: NA Message formulation: single key messages Message display: NA

39 Other Factors

40 Functions – WHY are they communicating? X Attend to environment/others X Attend to environment/others X Express wants/needs X Express wants/needs X Make requests / choices X Make requests / choices X Continue/stop X Continue/stop X Request attention / help X Request attention / help X Protest X Protest X Greet X Greet Answer / ask questions Answer / ask questions Direct actions of others Direct actions of others Initiate – maintain – end conversation Initiate – maintain – end conversation Make comments Make comments Relate personal experiences/events Relate personal experiences/events Repair communication breakdowns Repair communication breakdowns Express novel thoughts / ideas Express novel thoughts / ideas

41 Places – where are they communicating? Home Home

42 Communication partners – who are they Mom Mom Dad (occasionally) Dad (occasionally) Speech therapist Speech therapist Siblings Siblings

43 Researching devices aacTechConnect.com aacTechConnect.com Free resources Free resources –Simpler digitized –Digitized

44 aacTechConnect.com – possibilities simpler digitized devices

45 Digitized devices to consider

46 Device Assistant Search- pick the symbols to use

47 Helps you decide on type of device

48 Answer the questions about features

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52 * Review simpler digitized devices

53 Decision-making Funding Devices to consider Trialing devices Recommendations

54 Accessories sheet (on CD)

55 Report template (on CD) the Communicator

56 The Communicator – Other Factors

57 Decision-making

58 Device decision-making

59 SDT videoSDT video SDT SDT videoSDT

60 Other examples YG Used to promote verbal speech Used to promote verbal speech –Severely apraxic 9 year old, bilinguqal girl –Very little verbal speech – choose not to speak –Teach to imitate words as she selects them- including sentences (highlighting) –Helps to facilitate syntax –Used to clarify speech –Increases confidence and use of verbal speech

61 YG video YG video

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

63 Case Study #3 - MS Independent communicator ALS ALS Computer literate Computer literate Current condition Current condition Verbal speech minimally adequate in a few situations; changing quickly Verbal speech minimally adequate in a few situations; changing quickly Physical access – severely limited- in wheelchair – and unable to use hands on keyboard / mouse Physical access – severely limited- in wheelchair – and unable to use hands on keyboard / mouse Very computer literate – used to communicate by Very computer literate – used to communicate by

64 Toolkit Access Access –Headpointing - fatigues –Eye gaze – good –Scanning – single / double switch – could do- much slower Language Representation method Language Representation method –Spelling –Word-based –Pre-stored messages –Conversation facilitation

65 Free software (no voice) Free software (no voice) –Point-N-Click –Click-N-Type –Etriloquist Word + Word + –EZ keys – rental (with voice)

66 Outcome Trialed various systems – decided on Tobii ATI (recommended by other therapist) Trialed various systems – decided on Tobii ATI (recommended by other therapist) Not used for while Not used for while Not working – problems and no local support Not working – problems and no local support Insurance provided first system Insurance provided first system Added Medicaid – should pick it up Added Medicaid – should pick it up Continued use of computer for written communication (offered) Continued use of computer for written communication (offered) MDA funding MDA funding

67 2 nd evaluation requested Called vendors Called vendors – 3 in area – Patient request for 1 – Short timeline too provide trials for all – EyeMax worked immediately – Company agreed to provide loaner during funding process –Waiting – using device independently with grammar based text-boards

68 TM 27 year old autistic boy 27 year old autistic boy Very good on internet browsing (Google King) Very good on internet browsing (Google King) Need device for community Need device for community Previous evaluation-recommendations Previous evaluation-recommendations Use of several communication systems (low & high tech) Use of several communication systems (low & high tech) –WordPower – home use – slow down words – pace himself –Calendar – for all –Device – for additional spelling/conversation/community interactions –Spelling system – character prediction – use of word prediction

69 TM - continued Program own device- Say It Sam Communicator by Words + Program own device- Say It Sam Communicator by Words + –I will repeat the steps AFTER he does them (100% proficient) –Select his own vocabulary –Where he wants to program it –Chooses pictures –Do not give him access all of the time

70 TM video TM video

71 SR First met – device down – with keyguard First met – device down – with keyguard Increase access by putting device up Increase access by putting device up improve access by 50% improve access by 50% Found software to replace keyguard Found software to replace keyguard Highlights as she moves over it – used to use screen to stabilize – now access has improved Highlights as she moves over it – used to use screen to stabilize – now access has improved

72 SR video SR video

73 Questions? ? ?

74 Your turn Decide on groups Decide on groups - Emerging communicators –Context – depending communicator –Independent communicator Decide on 1 person the group will focus on Decide on 1 person the group will focus on Get out your worksheets: Communicator / Device / Toolkit Get out your worksheets: Communicator / Device / Toolkit

75 Pertinent Background Info Age: Age: Diagnosis Diagnosis Medical concerns Medical concerns Educational /residential setting: Educational /residential setting: Behavioral (attention, continue/end situation/activity; help, express desires/ needs, etc.) Behavioral (attention, continue/end situation/activity; help, express desires/ needs, etc.) Other Other Reason for evaluation:

76 Communicator

77 Device

78 Other factors

79 Functions – WHY are they communicating? Attend to environment/others Attend to environment/others Express wants/needs Express wants/needs Make requests / choices Make requests / choices Continue/stop Continue/stop Request attention / help Request attention / help Protest Protest Greet Greet Answer / ask questions Answer / ask questions Direct actions of others Direct actions of others Initiate – maintain – end conversation Initiate – maintain – end conversation Make comments Make comments Relate personal experiences/events Relate personal experiences/events Repair communication breakdowns Repair communication breakdowns Express novel thoughts / ideas Express novel thoughts / ideas

80 Other factors Where Where With whom? With whom?

81 Device Selection Options Catalogues Catalogues –AAC TechConnect – contact manufacturers Manufacturer websites Manufacturer websites –Go to individual ones – AAC TechConnect has list AAC TechConnect – free resources AAC TechConnect – free resources –Pictures (thumbnails of 85+ devices) –Free flyers

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83 Lite Tech Low Cost Chart

84 Trialing equipment Vendors – local resources Vendors – local resources Manufacturers Manufacturers Loan equipment Loan equipment Rental options Rental options

85 Manufacturers Reps Companies: Companies: –DynaVox Mayer-Johnson –PRC –Tobii ATI –Saltillo –Tellus –Words + –Zygo

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

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88 Explore programming of the device Try the actual programming – see how it feels Try the actual programming – see how it feels Communication partners need to feel comfortable with the programming Communication partners need to feel comfortable with the programming Sales representatives can assist Sales representatives can assist Ask what support options include Ask what support options include

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

90 Completing the paperwork (on CD) Gather – Case History Gather – Case History Summarize – Assessment Summary Summarize – Assessment Summary Write report - Report Write report - Report Get quote / info from manufacturer Get quote / info from manufacturer Complete funding paperwork (packets from each company) Complete funding paperwork (packets from each company)

91 Free templates CD CD CD Report Coach: aacfundinghelp.com Report Coach: aacfundinghelp.comaacfundinghelp.com Dynavox – Funding Manager Dynavox – Funding Manager Prentke-Romich: Funding Submission Assistant Prentke-Romich: Funding Submission Assistant Templates on Templates on

92 Questions? ? ? Features Access methods Hands-onProgrammingFundingSupport

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

94 Our goals were... Explain the process of obtaining an AAC tool/device Explain the process of obtaining an AAC tool/device Describe tools/techniques used to determine the AAC candidate’s skills 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. 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 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. Identify local resources and consultants for trials, support, and funding assistance for AAC devices.

95 Review your goals How did we do? Place a check mark by the ones you accomplished. What else to include next time? ? ? Please complete survey – we make changes based on your input Please complete survey – we make changes based on your input Testimonials – greatly appreciated and will be posted on website Testimonials – greatly appreciated and will be posted on website

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98 THANK YOU for helping others for helping others get their voice

U.AAC.RX U.AAC.RX ( )