1. 1 Debby McBride Ligon, MS, CCC-SLP AAC for Persons With Complex Communication Needs Part 2: Physical Access To AAC Communication Tools

2. Goals: Discuss important issues about ACCESS Discuss physical considerations using the diagram for THE PERSON: SKILLS & FEATURES (handout) Review portions of AAC COMMUNICATOR PROFILE (website) Describe types of AAC modifications for access Discuss PROS and CONS of each Discuss case examples and demonstrate use of various AAC Tools with modifications including Low-tech, Lite-tech, iPad with AAC Apps, SGDs Case Study 2

3. 3

4. Communication is not "independent" if.. utterances can only be understood by some people, or... other people have to preprogram all vocabulary in a device, or... he cannot spell well enough to compose novel utterances, or... she is given no opportunity to communicate what she wants to say, or... his communication system doesn't match his motor skills making it difficult to control, or... her communication system doesn't match her communication needs, or... there are partners who influence communication through cueing, or... he has hidden vision impairments making it hard to see the symbols, or... she has a hidden hearing impairment making it difficult to hear what is said, or... he has been given insufficient training and time to learn to use his AAC system, or... she has no access to a communication system at times, or... he cannot see the display on his system in some light conditions, or... no one believes she has anything worth listening to....etc. 4

5. Build skills for communication 5

6. ABC: Access Before Communication 6

7. AAC Communicator Profile for Evaluations & Referrals On PPHC website In referral packet Can be used by itself for your own evaluations 7

8. From AAC Communicator Profile (website) 8

9. The Person: Skills & Features (diagram) on PPHC website 9

10. From the diagram: The Person: Skills & Features on PPHC website 10

11. From the diagram: The Person: Skills & Features on PPHC website 11

12. 12

13. AAC Tool Options Low-tech Light-tech iPads with AAC Apps Speech Generating Devices (SGDs) 13

14. Direct select & modifications Pointing with finger.... Touching with hand Keyguard (homemade vs. fits device) Stylus Finger modification (glove) Laptray 14

15. Direct select – Pros & Cons Pros Natural Modifications can help (ex. Dwell on SGDs and some iPad AAC Apps) Auditory Phishing Cons – physical challenges Limit access due to motor limitations (takes too much time and limited page layout) Better to use other access at times 15

16. Examples: Direct Select JG – Single Message Communicator iPad Access – GoTalk Now GoTalk 4 key Laptray AJ Finger access with keyguard (vision – various hands/fingers) on Mini-iPad Larger keys okay on iPad Use apps on iPad to increase single finger access 16

17. Keyguard 17 http://beyondadaptive.com/?s=keyg uards&post_type=any

18. http://www.laseredpics.biz/keyguards-for- ipads/?sort=featured&page=1 Lasered Pics - inexpensive $30 or less – premade or customized

19. Popular AAC Apps (pictures) 19

20. Headpointer Manual Speech Generating Devices (some tablets - new) 20

21. Head pointing – Pros & Cons Pros Form of direct access Can use head or mouth (manual) Inexpensive for manual Cons Manual is intrusive/socially undesirable More expensive doe technology version SGD/iPad access; requires good head control; difficult for CP and other neurological conditions 21

22. Examples: Headpointer SGDs - extra accessories required Tablet applications (for iPads and some SGDs) – extra accessories required 22

23. Eye Gaze Low-tech Speech Generating Devices (does NOT work with Tablets ) 23

24. Eye Gaze – Pros & Cons Pros Form of direct select Several input methods Dwell Dwell and select (with switch) Cons Head positioning and movement Device up in front - limits vision Recalibration required Expense (more than twice as much); 16K Last resort after other access methods (Medicare issues) Strong justification for needs (access, functions) 24

25. Eye Gaze: Examples CM Head / body positioning Limited interests/needs Explore use of low-tech JG Bored with simpler low-tech Constant head movement Awareness of how it could work Exploring several access methods Justify multiple access methods 25

26. Scanning Single switch Double switch Type of switch Position Modifications with mounts (positioning of switch and device ) Auditory Scanning Array 26

27. Type of scanning input Visual & auditory Visual only Auditory only (for visually impaired) 27

28. Scanning – Pros & Cons Pros Depending on person, can access more vocabulary than with other methods (i.e. direct select, eyegaze) Cons Is complex; switch access, switch/device positioning, type of scanning (auditory/visual) Difficult to learn Start with Partner Assisted Scanning 28

29. Examples CR Provided low-tech solution (YES/NO with hand signals for immediate needs in answer to YES/NO questions ) Needed to expand to selecting categories Behaviors - frustration Bad fit: issues that needed to be dealt with: Access – needed BluTooth – was inconsistent in operation Software match not good Hardware issues (2 times) Multiple hours spent with tech support / rep Patient aging out of “system” 29

30. Example (cont.) CR continued: High-tech needs Auditory scanning (blind – limited mobility) Needed portability Needed touchscreen access for switch Needed customized programming Provided with manufacturer input: larger device, incorrect switch access, software mismatch Had to be corrected (1.5 years; pursued Medicaid for new device; granted). 30

31. Scanning Examples (various patients) Single message communicator (says THIS ONE) or other signal (vocalization, thumbs up, eyes up, etc.) Partner Assisted Scanning Eye Gaze Board Communication Book Pictures on iPad / Tablet with cuing Auditory Scanning for recorded choices Training for switch access on single message communicator (using greetings / social scripts) 31

32. Scanning Examples (cont.) Use of iPad (tablet) in for multiple choices (providing the auditory and visual cues. … not the device)... More flexibility for timing, allowing for self-correction, etc. Use of iPad or SGD With earphone Public... Issues Voice output – more motivating Using technology – more motivating 32

33. 33

34. Hope you: > > >> Learned about some new resources... Have some fresh ideas... And New / different perspectives.... On ACCESS for AAC Communicators

35. 35 Including: Other AAC Training Sessions AAC Referral Packet Interest in AAC Team Participation Debby McBride Ligon aac@pediatrichomecare.com See PPHC website – under Employee Login for these and other AAC forms & resources