1. Chapter 15: Complex Communication Needs and AAC Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

2. Focus Questions What are complex communication needs? What is AAC? How is AAC classified? What are the defining characteristics of common causes of complex communication needs? How are complex communication needs and AAC systems identified? How are complex communication needs treated with AAC? 15.1 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

3. Introduction Complex communication needs result from significant speech, language, and/or cognitive impairments The individual can no longer communicate in conventional ways Area of clinical practice that supports and meets these needs is augmentative and alternative communication (AAC) Use symbols, aids, strategies, and techniques to improve success and effectiveness of communication 15.2 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

4. Case Study #1: Sara 3-year old born at 30 weeks, diagnosed with atethoid cerebral palsy, severe dysarthria, and a mild-moderate receptive and expressive language delay No formal symbolic means of communicating at this time; only communicates with close family and teacher Significant motor impairment but can sometimes point her index finger Mother worries that Sara and her twin sister Susan will not be able to play together if she cannot find some help 15.3 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

5. Case Study #1 Questions What valuable information could the AAC team learn from Saras twin sister, Susan, during an AAC assessment? From the information that is provided, what type of communicator (emerging, context- dependent, independent) is Sara now? How do you know? What questions do you have about Saras communication abilities? 15.4 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

6. Case Study #2: Jan 14-year old eighth grader with moderate intellectual disability and moderate speech, language, and cognitive delay Communicates with gestures, speech, and a communication book Difficulty communicating with unfamiliar partners at school and in community Expressed interest in joining the bowling club at school, but mother is concerned she will not be able to communicate with the new people School SLP referred Jan to school districts assistive technology team for comprehensive AAC assessment 15.5 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

7. Case Study #2 Questions What benefits might Jan see if she participates in a comprehensive AAC assessment? What type of communicator (emerging, context-dependent, independent) is Jan now? What if she had access to an AAC system with training? What barriers might prevent Jan from participating in bowling or other activities at school? 15.6 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

8. Case Study #3: Steve 28-year old suffered from brain stem stroke 3 years ago resulting in a locked-in syndrome –profound dysarthria with no speech output Communicates with eye gaze, eye gaze board, head pointer, and dependent scanning on alphabet board Interested in getting an AAC system to provide more independence Currently managing his auto repair garage and attending college majoring in computer information systems 15.7 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

9. Case Study #3 Questions How might Steves previous hobby interest in computers help in exploring AAC options? What features would be important for Steve to have in an AAC system? 15.8 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

10. I. What are Complex Communication Needs? When individuals cannot meet their daily communication needs through the current method of communication Result from variety of physical, sensory, and environmental causes which restrict independent functioning in society Needs can occur in all forms of communication, in any environment, and with a variety of communication partners 15.9 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

11. Purposes of Communication Fulfill needs and wants Information transfer Social closeness Social etiquette 15.10 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

12. Terminology International Society of Augmentative and Alternative Communication (ISAAC) Previous terms: severe communication disorders or severe communication impairments Currently preferred term: –complex communication needs –focus on identifying what is important for each person to meet his/her own goals of communication 15.11 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

13. Prevalence and Incidence 8 to 12 out of every 1000 Americans are unable to meet their communication needs Approximately 2 million people currently have complex communication needs 15.12 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

14. II. What is AAC? Set of procedures and processes by which an individuals communication skills can be maximized for functional and effective communication Also refers to the field or area of clinical, educational, and research practice Can either be augmentative or provide an alternative method of communication 15.13 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

15. III. How is AAC Classified? AAC system is an integrated group of components consisting of four elements: Symbol Aid Strategy Technique 15.14 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

16. A. Symbol Something that stands for or represents something else Four types: –Acoustic: sounds or tones Morse code –Graphic: printed symbols usually in paper, boards, and/or computer screens Boardmaker TM –Manual: produced using the body Gestures, signs –Tactile: physically manipulated objects 15.15 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

17. Variations among Symbols Static and Dynamic: –Static: do not require movement or change to understand meaning –Dynamic: require movement or change Iconicity and Opaqueness: –Iconic: symbol closely resembles what it refers to –Opaque: symbol has little resemblance to what it refers to Aided and Unaided –Aided: requires device or accessory external to ones body to transmit message –Unaided: requires only body 15.16 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

18. B. Aid Aid: type of assistive device that supplements or replaces natural speech and/or writing Can support comprehension as well Can be either electronic (e.g., voice output communication aid) or non-electronic (e.g., communication picture book) 15.17 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

19. C. Strategy Process or plan of action that is used to improve a persons performance when communicating Examples: setting the topic before initiating a conversation, having an index card available for unfamiliar communication partners 15.18 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

20. D. Technique An approach or method of selecting messages or accessing messages on a display Fixed vs. dynamic displays Direct selection techniques Indirect selection techniques –Scanning –Directed scanning –Coded access 15.19 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

21. IV. Defining Characteristics of Common Causes of Complex Communication Needs Developmental causes (examples) –Intellectual disability –Cerebral palsy –Autism –Developmental apraxia of speech Acquired causes (examples) –Traumatic head injury –Stroke –Degenerative diseases 15.20 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

22. V. How are Complex Communication Needs and AAC Systems Identified? The assessment team is a multidisciplinary group of professionals Speech-language pathologist is usually the team leader Assessment can take place in schools, clinics, and hospitals 15.21 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

23. The Assessment Process Referral: made by anyone who can identify unmet communication needs Common referral sources: –parents –SLPs –teachers –counselors –nurses 15.22 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

24. Comprehensive Assessment Case history –Determine background information Interview –Gather information about communication skills and goals Identification of communication needs –Determine which needs are not being met and if person is participating in all the same communication activities as their same-age peers –Looks at presence of opportunity barriers or access barriers 15.23 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

25. Identification of communication skills –Using formal and informal assessment tools, looks at oral motor skills, hearing acuity, receptive and expressive language skills, speech production, and cognitive skills Identification of vision and motor skills –Determine visual acuity and fine and gross motor skills to determine what type, size, and array of symbols may be used Identification of communication partners and environments –Circle of Friends paradigm –Determine common communication environments 15.24 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

26. Identify features of AAC systems to meet communication needs –Determine which specific features of an AAC system will meet identified needs Recommendations –Team recommends a specific AAC system, usually for a trial period first Funding –Funding for AAC system is usually sought through insurance companies, school districts, private donations, or grants 15.25 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

27. VI. How are Complex Communication Needs Treated? Access to treatment is a right not a privilege Treatment must occur in real-world contexts Team must work to plan a treatment that: –Meets unmet communication needs –Increases communicative competence –Increases participation in society 15.26 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

28. A. Meet Unmet Communication Needs Short-term treatment goals emphasize learning how to use the AAC system Ongoing assessment is necessary to best meet the needs of the individual Crucial to consider the cultural background of the individual when planning treatment 15.27 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

29. B. Communication Competence Intrinsic and extrinsic factors impact the attainment of communicative competence Three groups of communicators: –Emerging communication: no reliable method of symbolic expression – AAC focuses on establishing this –Context-dependent communication: reliable symbolic communication, but few partners and environments – AAC focuses on maximizing independence and increase use of AAC strategies –Independent communication: usually literate and effective communicators – AAC focuses on increasing number of communication options available 15.28 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

30. Communication Partners Very important to a successful treatment program Traits of a good communication partner: –Patient –Interested and comfortable with all methods of communication –Tries to understand impaired speech –Makes an effort to interpret sign/gestures –Repeats and confirms messages 15.29 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.

31. C. Increase Participation in Society Social roles: roles each person has in society –determines demands the person using AAC will face Each social role has a communication role that must be met AAC team must identify current and desired social and communication roles Successful communication is when an individual with complex communication needs can participate in any aspect of society desired 15.30 Justice Communication Sciences and Disorders: An Introduction Copyright ©2006 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.