What is AAC?
What is its purpose? Does AAC have to replace speech altogether?
What may AAC consist of?
- AAC refers to any system, device or method that IMPROVES the ABILITY of a person with a communication impairment to communicate effectively
- AAC is used as an ALTERNATIVE OR to SUPPLEMENT existing communication skills (rather than replace speech all together).
- AAC systems can include voice / sounds, facial expressions, body movements, natural gestures, signing systems, object symbols, photos, pictures, text and electronic devices / computer based systems
What does every AAC system need?
- Sufficient VOCABULARY to interact – for a full range of communication functions – to combine symbols into sentences – in a range of activities
- Vocabulary and features for the FUTURE
- SELECTION TECHNIQUES which are not too physically taxing or limiting to promote meaningful communication
What is the Participation Model?
The Participation Model provides a systematic process for conducting AAC ASSESSMENTS and designing INTERVENTIONS based on the functional participation requirements of peers without disabilities of the same chronological age as the person with CCN.
The model takes into account the individual, their activities, and context when choosing an AAC system.
Is AAC a dynamic or static process? Explain.
AAC interventions are usually ongoing, long-term processes because the individuals who require them usually are unable to speak and/or write due to physical, cognitive, language, and/or sensory impairments that persist over time.
Nevertheless, the communication needs and capabilities of people who rely on AAC often change. Some people experience an expanding world with increased opportunities, whereas others become less able to participate as they age or as their impairments become more severe.
Thus, AAC assessment and intervention is a dynamic process and usually consists of four general phases.
What are opportunity barriers? What are the five types?
Opportunity barriers are those imposed by others, which cannot be eliminated by providing an AAC system
- Policy
- Practice
- Knowledge
- Skill
- Attitudes
Describe policy barriers, using two examples.
Legislation or policies (of schools, residential homes, workplaces etc.) that prevent the full participation of those with CCN.
E.g. many educational districts have policies that separate children with disabilities into separate classrooms from normally abled peers.
E.g. hospital policies that prevent the use of electronic equipment (including high tech AAC devices).
Describe and give an example of a practice barrier
Procedures or conventions that have become common in a family, school, or workplace but are not actual policies.
E.g. some schools restrict the use of government-founded AAC equipment (iPads etc.) outside school - and therefore prevent students from taking home their AAC device.
E.g. in therapy - therapists forcing the patient to (for example) write their name using a pencil, even if they are physically incapable (with cerebral palsy etc).
I.e. a “textbook rule” that wasn’t to be broken.
Describe and give an example of a knowledge barrier
Lack of information on the part of a FACILITATOR or another person (NOT the person with CCN) that results in limited opportunities for participation.
E.g. Lack of knowledge about AAC intervention options, technologies, and instructional strategies often presents tremendous barriers to effective participation by individuals with CCN.
Describe and give an example of a skill barrier
A skill barrier occurs when, despite even extensive knowledge, facilitators have difficulty with the actual implementation of an AAC technique or strategy.
Numerous technical and interaction skills are often necessary to assist someone to become a competent communicator. It is important to assess the “hands-on” skill level of individuals who will be responsible for various aspects of the AAC intervention, in order to identify skill deficiencies and design interventions to reduce these barriers to communicative competence.
Describe and give an example of an attitude barrier
The attitudes and beliefs held by an individual who is in some way involved with the AAC implementation.
Parents, co-workers, peers, and the general public all may hold negative or restrictive attitudes.
E.g. some people believe that AAC discourages speech development, and therefore should not be used.
What are access barriers? What are the three aspects that must be assessed?
Access barriers pertain to the capabilities, attitudes, and resource limitations of individuals who communicate through AAC, rather than to societal or support system limitations.
During assessment, and in the implementation of AAC,
- An an individual’s current communication
- Their potential to use and/or increase the ability to use natural speech
- Potential to use environmental adaptations
should all be assessed.
What must be considered when assessing an individual’s current communication?
Everyone communicates in some fashion.
Determine the effectiveness and the nature of the individual’s current communication system (operational and social competence - e.g. assessment should include nonverbal pragmatic skills, writing, etc.).
The current communication system may consist of only vocalisations, gestures, some words, or the use of an AAC device.
Once the AAC team has assessed a person’s current communication system and how it is used, they can then begin to examine the potential of various solutions to existing communication barriers.
What must be considered when assessing an individual’s potential to use/increase speech?
How can the effectiveness of speech in communication interaction be measured?
Topic of debate: does AAC discourage speech development? Should AAC be used to “replace” speech altogether?
Evidence shows that AAC does NOT impede speech development - rather, existing research suggests that AAC may enhance speech development in children with Autism.
Most individuals with CCN demonstrate at least some ability to communicate using speech—that is, they are not 100% unable to vocalize or speak.
Can be measured on the Meaningful Use of Speech Scale.
What must be considered when assessing the potential for environmental adaptations?
Environmental adaptations = altering physical spaces, locations, or structures, in order to provide simple solutions to communication opportunity and/or access barriers.
E.g. in the classroom, school staff can raise or lower desks and tables, create a vertical work surface with a slanted board, or cut out counter- tops to accommodate wheelchairs or AAC devices.
E.g. in a family home, furniture rearrangements and/or renovations to widen door frames or lower countertops may be necessary to accommodate the needs of a resident with newly acquired disabilities.
Which three assessments determine an individual’s ability to use AAC systems or devices in order to reduce access barriers?
- Operational requirements profile
- Constraints profile
- Capability profile
What factors are involved in determining the operational requirements profile?
It is necessary to identify which of the many AAC options (i.e. low tech v. high tech) may be appropriate.
AAC team must be aware of the operational requirements of each specific AAC technique.
- Display requirements (number of items, size, layout)
- Selection techniques (sensory-motor interface between the individual and the device).
- The output of the device (if applicable) may require certain user skills/abilities.
What is a Constraints Profile?
What are the four areas of constraints?
The factors that may also influence the selection of an AAC system and strategies for instruction.
- Individual and family preferences
- Preferences and attitudes of other communication partners
- Communication partner and facilitator skills and abilities 4. Funding
What are some features of AAC that the individual’s family is likely to have a preference for?
1) System portability, durability, and appearance (i.e., cosmetic appeal)
2) The quality and intelligibility of speech output in Speech Generating Devices
3) the “naturalness” of the communication exchange achieved through the system.
In particular, children with CCN and their family members may be especially sensitive to these issues out of concern that the AAC device not make the child look or sound any more different from typically developing peers than necessary.
What are some features of AAC that the individual’s OTHER communication partners are likely to have a preference for?
- To support the development of positive attitudes toward AAC, the AAC team should: provide adults with INFORMATION about AAC, and provide children with the opportunity to ROLE-PLAY using AAC techniques.
- Some evidence suggests that electronic devices are perceived more positively than low-tech displays by adolescents and adults.
- There is also evidence to suggest that either AAC option is strongly preferred over poorly intelligible speech.
- Finally, this research shows that efficiency with regard to the RATE of communication is an important consideration for unfamiliar communication partners regardless of age, and that strategies in this regard are critical, regardless of the type of AAC device that is used.
Skills and abilities of communication partners and facilitators
- Imperative that communication partners are able to understand the messages conveyed through the AAC communication system. E.g. difficulty understanding signs or poor speech synthesis.
- Must consider the age and literacy skills of the communication partners.
- If facilitators do not have the skills to operate, program, and maintain the devices, then abandonment is likely.
- AAC team may need to provide extensive training for intervention techniques (e.g. style of questions asked, ways to facilitate grammar intervention).
- Conversational partners need to have good social and strategic competence in order to provide good models
Funding…
The amount of funding provided by the government for AAC intervention (especially for high tech devices etc.) will have an impact on the affordability of AAC (and therefore have influence over the type of AAC system chosen).
