1. Augmentative & Alternative Communication
Next Steps
(Assessment and Implementation)
Kathleen Post, MS-CCC/SLP
K. Post
AAC Linked Series for Infinitec

2. Welcome!
Plan for the day

3. IL State Standards Social Emotional Learning Listening and Speaking
Goal 2 - Use social-awareness and interpersonal skills to establish and maintain positive relationships.
Goal 3 - Demonstrate decision-making skills and responsible behaviors in personal, school, and community contexts.
Listening and Speaking
Goal 4: Listen and speak effectively in a variety of situations.
Plus more (reading, writing, etc.)! 3

4. Begin with the end in mind.
-Stephen Covey

5. What do we know? AAC - Augmentative & Alternative Communication Who
Goals
Martinsen & vonTetzchner, 1996
Paula defined three groups based on Martinsen & vonTetzchner, 1986
Alternate Language Group- little or no speech, difficulty in understanding language
Autism, severe cognitive impairment, auditory agnosia
Goal- to assist the understanding of langue, develop interaction skills and increase opportunities for expressive language.
Expressive Language Group- severe speech motor dysfunction
Cerebral Palsy, Severe Dysarthria, as age, gap increases between what can say and what understand
Goal- To provide means to express interests, needs, and comments and to provide opportunity to actively participate in the curriculum and to develop literacy skills.
Supportive Language Group- moderate motor speech dysfunction, problems with speech and language
Speech is poor, but typically do become intelligible speakers, Downs Syndrome, Apraxia, Severe oral-motor impairments, severe articulation disorders
Goal- provide a bridge for the development of speech and language and a means to enhance participation and communicative competence.
However, all children's need for augmentative communication is not the same. Martinsen & von Tetzchner (1996) identified three groups of children who require augmentative/ alternative communication. They called these the: alternative language group, expressive language group, and supportive language group. Each of these groups is very different and requires AAC for different reasons.
The Alternate Language Group is made up of children who use little or no speech to communicate and have a difficult time understanding spoken language. Children with Autism and severe cognitive impairment fall into this group, as do children with auditory agnosia (Problems recognizing sounds as meaningful linguistic elements.). Children in this group often use gesture as their primary means of understanding language. The primary goals of AAC with this group are to provide input to assist the student in the understanding of language, to develop interaction skills for that student and to increase the opportunities for expressive communication.
The Expressive Language Group includes students who have severe motor involvement, thus severe speech motor dysfunction. As they mature these children experience a widening gap between what they understand and what they are able to express using speech. Children with athetoid cerebral palsy and severe dysarthria of speech are examples . The main goal for AAC intervention with this group is to provide a means to express their interests, needs, and comments, provide opportunities to actively participate in the curriculum and focus on the development of literacy skills.
The Supportive Language Group includes students with moderate motor speech dysfunction. These children often have problems with both speech and language. Speech is poorly articulated during the birth through preschool years, although many of these children will become intelligible speakers. This group may include children with: Down syndrome, apraxia of speech, severe oral-motor impairments, severe articulation disorders and developmental delay. The primary goal of AAC intervention for this group is to provide a bridge for the development of speech and language and a means to enhance participation and increase communicative competence.

6. Alternative Language Group
Who
little to no speech & difficulty in understanding language (Autism, severe cognitive impairments, etc.)
Goal
assist in understanding language, develop interaction skills, increase opportunities for expressive language
Stand if you have kids in this group! Count numbers!
Video of Danny

7. Expressive Language Group
Who
severe speech motor dysfunction (CP, Dysarthria), widening gap between expressive and receptive language
Goal
provide means to express needs, interests, comment, actively participate, develop literacy skills, etc.
Stand if you have kids in this group! Count numbers!
Video of Kylie B

8. Supportive Language Group
Who
moderate motor speech dysfunction, problems with speech and language, speech is poor, but may develop more intelligibility (Downs, Apraxia, etc.)
Goal
provide a bridge for development of speech and language and a means to enhance participation and communicative competency
Stand if you have kids in this group! Count numbers!
Video of Kelly and Jack
Aided Language Stimulation can also be used when a student needs receptive vocabulary increased. Students in the Alternative Language Group especially benefit from an environment where communication partners use alternative language forms on a regular basis. So it is important to use Aided Language Stimulation, to provide picture schedules and to accompany spoken language with graphic symbols when communicating with a child in this group.
When a student uses an augmentative communication board or device (or even their own voice) to respond to communication, but rarely or never initiates communication, increase communication opportunities through Environmental Communication Teaching.-Environmental Communication Teaching (ECT) uses incidental teaching episodes that are short, positive and geared towards functional communication, not language training. There are three major components to ECT training: (1) Use of structural analysis and modifications, (2) use of cues, prompts, and descriptive feedback, and (3) use of AAC techniques and approaches (McCloskey & Fonner, 1999). Structural analysis and modifications specifically focus on knowledge of the different contexts for interaction, how the contexts are socially regulated, and how communicative functions are utilized within those contexts. Within the ECT training, cues, prompts, and feedback strategies are used to facilitate the initiation of communication interaction. These strategies are also utilized to encourage the use of age- and activity-appropriate communication. The prompt hierarchy listed below is employed when target students do not exhibit the level or amount of communication expected.

9. Assessment & Evaluation
How do we help?
Assessment & Evaluation
University of Oregon Teaching Effectiveness
Program defines assessment as:
Assessment is the process of gathering and discussing information from multiple and diverse sources in order to develop a deep understanding of what students know, understand, and can do with their knowledge as a result of their educational experiences; the process culminates when assessment results are used to improve subsequent learning.
Found on

10. Assessment and Evaluation
Evaluation can be defined as:
to draw conclusions from, judge,
compare and contrast, interpret,
decide.
In AAC, assessment and evaluation are used interchangeably, but perhaps they should be used together!

11. Augmentative Communication Assessment
Goal of AAC- Assist individuals with communication disorders to become communicatively competent to meet current needs and to prepare them for future needs.
Beukelman & Mirenda, 1998

12. Augmentative Communication Assessment
Purpose of AAC Assessment:
Determine which methods and tools will improve the exchange of information between the individual and others- communication!
Knowledge of individual
Assessment of the skills and needs of the individual in multiple areas affecting access to and understanding of communication (vision, motor, hearing, language, etc.)
Knowledge of AAC (not just devices, but also techniques and strategies)
Integrated with Evidence Based Practice
Includes research
Clinician’s expertise
Consumer’s values and preferences
Beukelman & Mirenda, 1998
Heling & Rush, 2009

13. Results of the AAC Assessment
To provide a plan for communication supports that includes:
Details of recommended non speech and/or speech generating systems
Recommendations for any changes to the environment to support communication (including training partners)
Recommendations for intervention to address or improve operational, linguistic, strategic and social competence

14. Team Approach
Who should participate?
Why?

15. Types of AAC Assessments
Candidacy models
Who needs AAC?
Replaced by Communication Needs models
Based candidacy on needs, not on impairments
Participation model
Assess and base AAC on functional participation requirements of peers
Feature-Based Assessment for Speech-Generating Devices (SGD)
Beukelman & Miranda, 1998

16. Plan to Assess and Evaluate
Identify and define areas of concern
Gather information related to concerns
Gather relevant information for various skill areas related to the use of Speech Generating Device (SGD)
Analyze information
Create a Feature List
Generate and prioritize potential solutions
Compare intervention options
Develop trial action plan
Conduct trials and collect data on effectiveness
Formulate recommendations
Document
Politano, 2009

17. State the Need or Goal Make sure that everyone is on the same page!
What do you hope to achieve by the end of this assessment and evaluation process?

18. Gather the Information
Survey family and team members or service providers regarding:
Current problems
Current communication behaviors or skills
Activity preferences
Any history of usage of communication supports
If there is conflict over whether the student needs AAC refer to an intelligibility test! Create your own or use The Quick Screener powerpoint
Need Case History Form

19. Gather the Information
What can I use?
Any case history form obtained or developed or customized for this purpose
WATI forms
Easter Seals DuPage forms
Infinitec Student Summary forms (handout)

20. Gather the Information
Sensory/Perceptual
Goal is to determine size, type, placement of symbols & identify language input & output options
Vision (Any standard assessment information and/or informal notations by team members)
Visual Acuity
Visual Field
Oculomotor Functioning
Light Sensitivity
Color Perception
Ask for ideas of how to assess this skill (what other tools can be used, such as Powerpoint, BoardMaker Plus, Device software)

21. Gather the Information
What can I use?
Formal or Informal testing materials may be:
TASP (Test of Aided-Communication Symbol Performance by Joan Bruno)
Created boards/electronic displays with differing symbol sizes and placements (eye gaze and direct selection)
Pogo Boards (
Speech Generating Device Page sets/tasks
DynaVox, Prentke Romich Company, Tobii, etc.

22. Test of Aided-Communication Symbol Performance (TASP)
Written by Joan Bruno, available from Mayer-Johnson,
A tool for the assessment of Mayer- Johnson 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
Show pages scanned in

23. Gather the Information
Sensory/Perceptual (cont’d)
Hearing (Standard Assessment)
If aided, where is sound best heard from?
Other sensory systems (tactile, olfactory, vestibular, gustatory) *
* If these are the targets for more in-depth investigation, use of Every Move Counts, Clicks and Chats is recommended as the assessment tool. Information from that tool can then be brought to the Feature Match outline for further determination.
Bring out Every Move Counts book.
Discuss kids with significant challenges for whom connecting with the environment is a major goal and there disabilities a major road block. Discuss the need to develop communication keys: Be able to separate themselves from the environment, Understand that these is something they can do to exchange information with someone, understand that there are things about which to communicate, and understand that there are people with whom to communicate.
Sternberg, L. 1980, Communication Programming Inventory. In Educating severely and profoundly handicapped studnets, Rockville, MD: Aspen
Every Move Counts is a unique blend of communication strategies with sensory integration techniques to better meet the needs of individuals with disabilities.
Studies by experts in SI have reported an increase in spontaneous language after vestibular stimulation. (Magrun, W.M., K. Ottenbacher, S. McCue, and R. Keefe. 1981, Effects of vestibular stimulation on speontaneous use of langauge in developmentally delayed children. The American Journal of Occupational Therapy 35(2):101-4.)
Process for Every Move Counts:
Identification Process (find activities to which the individual responds (hopefully in a positive manner)
Definition Process (a specific response is selected and contingencies are introduced--the occurance of a pleasurable event becomes dependent on the individual giving a more clearly defined response) Co-occurance!
Elicitation and Refinement Process (provide frequent opportunities for the individual to experience co-occurances between their response and the event).
Generalization and Expansion Process
Allows for individuals limitations rather than penalize for them, it does not require a specific response, but gives you a framework for interpreting the responses given.

24. Gather the Information
Motor Skills
Goal is to identify optimal seating, positioning, and motor technique for using AAC system
Work with other members of the interdisciplinary team, as necessary
Identify appropriate positioning
Identify selection method and technique (direct, scanning, encoding)
Where on the body (hands, head/voice, feet, arms/elbow, legs/knees, eye gaze)
Positioning has a direct impact on motor control, which is necessary for use of all AT
Determine direct selection via what? And then
Range
Target Size
Experience with Control Enhancers
If Scanning: determine visual, auditory or both? What type of switch access, describe, timing, method of highlighting, memory load of messages or cuing.

25. Definitions Direct Selection- Scanning-
Directly touching the item or target desired
Scanning-
Moving a highlight to a specific target
Linear, circular, row column, column row, group row column, etc.
Single switch automatic scanning, two switch step scanning, inverse scanning, etc.

26. Switch Data
Talk about How do you know it, How can you show it book from WATI site

27. Gather the Information
Motor Skills cont’d
What action will be used
How with the movement be used (direct select, head pointing, eye gaze, joystick, Morse code, scanning)
Considerations
Type, range, accuracy, consistency, strength, speed, etc.
Activation site: the minimum size of the targets, possible number of targets, spacing of targets, etc., will be determined by accuracy
Sensitivity: the amount of pressure or force needed to activate the target.

28. Gather the Information

29. Gather the Information
Questions to ask yourselves:
Can the method of access be used repeatedly without undue fatigue, discomfort or embarrassment?
What does the student like/tolerate?
Can this method be used across all environments or will there need to be other options for other situations/positions?

30. Gather the Information
What can I use?
Formal or Informal testing materials may be:
TASP (Test of Aided-Communication Symbol Performance by Joan Bruno)
Created boards/electronic displays with differing symbol sizes and placements (eye gaze and direct selection, scanning)
Pogo Boards (
Speech Generating Device Page sets/tasks
DynaVox, Prentke Romich Company, Tobii, etc.

31. Gather the Information
Cognition
Goal is to identify AAC techniques & strategies & select types of symbols
Modification of existing assessment instruments may be necessary along with the expertise to interpret results
Gain information on how the student perceives world and how they may use communication within their understanding.

32. Gather the Information
Cognition cont’d
Assess ability to categorize
Assess ability to use memory skills/motor patterns
What can I use?
Communication Matrix ( Every Move Counts-Clicks & Chats, Communication and Symbolic Behavior Scales by Wetherby and Prizant, TASP, other formal or informal tests and inventories.

33. Gather the Information
Language skills
Goal is to identify language skills for communication and comprehension.
Modification of existing assessment instruments may be necessary along with the expertise to interpret results
Vocabulary
Grammar
Discourse/Pragmatics
Literacy
(assess understanding if possible and survey needs)
Assess reading, spelling, and writing skills if present.
Can the student use letter cues, recognize words when offered, understand alphabetical arrangements, etc.

34. Gather the Information
What can I use?
Use word lists, use interview and observation inventories.
Use formal tests (TACL, CELF, SPELT)
Video an interaction opportunity, take a language sample! What topics initiated, continued, terminated? What types of words used, how frequently, etc.
Use formal or informal assessments regarding literacy levels, sight words, etc.

35. Gather the Information
Symbol Selection
Goal is to identify types of language representation
Modification of existing assessment instruments may be necessary along with the expertise to interpret results
Determine how an individual can communication with symbols & possible symbol types
Objects, Texture cues or symbols, Cut Out Photographs, Pictures, and Symbols, Photographs, Line Drawings (Color), Line Drawings (Black & White), Realistic (Color), Realistic (Black & White), Visual Scenes, Alphabet/Spelling
Talk about use of photos with BM symbols on them and then fading, etc. Pogo boards with different symbols, etc.

36. Gather the Information
What can I use?
TASP; Speech Generating Device Protocols; Metaphor Protocol by Gail VanTatenhove (
Informally created comparisons

37. Gather the Information
Use of Communication Partners & Environments
Note support or prompting help given by communication partners
Note needs for different environments
What can I use?
Informal observation/documentation, video clips, interview, Social Networks by Sarah Blackstone.

38. Social Networks

39. Analyze the Information
Determine a list of features needed based on performances, behaviors, needs gathered.
Input Features and Selection Methods
Access Method
Direct Selection-
Range/size, touch sensitivity or responsiveness, position, zoom
Scanning-
Number of choices, prompting (auditory/visual), zoom, highlighting, etc.

40. Analyze the Information
Input Features and Selection Methods (cont’d)
Display Design
Size of targets, number of targets, arrangement, contrast, etc.
Think about direct selection-- motor memory is important! Maybe do motor memory test?

41. Analyze the Information
Output Needs
Speech output
Type- digitized, synthesized, combination
Display output
Words/letters for partner/user reference
Activation marker
Environmental controls
Interface to computers, printers, phone systems

42. Analyze the Information
Message Characteristics
Whole sentences
Phrases
Words
Letters
Pictures
Ability to combine any of the above?
Rate Enhancement Strategies
Visual scenes, topical dictionaries, Unity, word prediction, abbreviation-expansion

43. Analyze the Information
Physical Characteristics
Size
Weight
Battery Life
Durability
Mounting
Transferability
Ease of setup
Visibility
Backup systems

44. Determine Options How do I do that?
Generate a list of systems that meet many or most of the needs list
How do I do that?
AAC TechConnect (trial)
Manufacturer Websites
Handouts from other sources
Own Experience
Talk about asking manufacturers representatives
Show some examples of charts

45. So many options!

46. Resources for Systems Comparison
AACtechConnect
My Dynamic Therapy
Closing the Gap
SETBC
ABLEDATA
Assistive Technology Exhibits (ATIA, CTG,CSUN etc)
Speech Generating Device manufacturers
Enabling Devices
Gus Communications Inc.
Dynavox Technologies
AMDI
Ablenet

47. Trials Where can I go? Obtain the top 3 systems for trial
State Assistive Technology Program- Lending Program,
Infinitec Coalition
Speech Generating Device Companies
Professional Loan
Local Representative
Device Rental
School Districts and Special Ed Cooperatives
Infinitec Website
ilTech website

48. Trials Set up systems for student
Vocabulary, access method, voice, positioning
Train staff that will be involved with student for trial
Try systems with student and note performance, behaviors
Length of trial may depend on student and equipment availability
Determine what is important to observe during the trial
Ease of access
Use of the system functionally (where and with whom and with what other supports)
Document performance

49. Trials Compare performances and data and discuss with team members
Determine next plan of action
Further trials
Procural of system and supports
Develop communication intervention plan
Determine responsibilities for ongoing training, troubleshooting, and updating

50. Where do I go to write the report/submit for purchase?
Report Templates and Funding Information
AAC-RERC
Assistive Technology Law Center, Inc.
Funding Sources
AAC Report Coach
Funding Assistance from Speech Generating Companies
Other processes within district or use of established forms from WATI or GPAT (

51. Activity Break into small groups
One person volunteers to present a student they work with (no real names please)
Work through the Assessment process with the group and determine:
What type of communicator?
What team members need to be involved?
Roles-responsibilities
What do you know as it relates to the Assessment process?
What information still needs to be collected, how?
Next steps..
Be prepared to share key points with group.

52. Contact Information
Kathleen Post, MS-CCC/SLP
Manager, Assistive Technology Department,
Easter Seals DuPage & Fox Valley Region
830 S. Addison,
Villa Park, IL 60181
Infinite member website:
Wiki site for AAC Linked Series: at