Post on 20-Feb-2018
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AAC INTERVENTION 1Liora Ballin, PhD
Johanna Korkalainen, Cerebral Palsy Alliance
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O!line
" Re#ie$ assess%en!, &oal se!!in& an' in!er#en!ion
" Decision %akin& in !hera(y
" )oal se!!in&
"Aban'on%en! o* AAC" Challen&es in learnin& !o se AAC
" O#erco%in& barriers
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CLINICAL REA+ONIN) PROCE++IT- AAC. A++E++/ENT 0 )OAL
+ETTIN) I/PLE/ENTATION
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Process
PLANNING
INTERVENTIONEVALUATE
ASSESSM
ENT
GOAL
SETTING
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PLANNIN)
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Plannin&
" In#ol#e%en! o* collabora!i#e !ea% an' !ea% roles
"A''ress barriers an' challen&es 2
" Consi'er &oal li%i!in& *ac!ors.
ID 3a%ily circ%s!ances an' a#ailabili!y in or'er !o
" 4se o* AAC in na!ral en#iron%en!s
" Pro#i'in& %o!i#a!in& o((or!ni!ies
" 4se o* %o'ellin& !echni5es
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" The sccess o* AAC 'e(en's on !he s((or! !ea%6" Lack o* &oo' s((or! lea's !o AAC aban'on%en!6
" 4n'ers!an' !he (r(ose o* !he sys!e%
" 4n'ers!an' ho$ !he in'i#i'al ses !he sys!e%
" Encora&e an' %o'el !he se o* !he sys!e%
" Re#ie$ an' ('a!e !he sys!e%
Role o* !he +((or! Tea%
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Pr(ose o* !he sys!e%
Clari*y !he crren! (r(ose o* !he sys!e%" E6&6 To re5es!7 &ree!7 co%%en! 0 co%bina!ion
" To a&%en! nclear s(eech
Realis!ic n'ers!an'in& o* *!re &oals7 (o!en!ial" I! %ay !ake years o* (rac!ise *or !he 'e#ice !o
beco%e !he (erson8s 9#oice:
" 4n'ers!an'in& o* ho$ !he crren! &oals bil'
!o$ar's &rea!er (o!en!ial
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E;(ec!a!ions
Es!ablish realis!ic e;(ec!a!ion o*" !he !i%e i! !akes !o learn !he &oals an' learn !he se o* !he
sys!e%
" ho$ !he chil' is crren!ly able !o se !he 'e#ice
" !he a%on! o* s((or! an' co%%i!%en! !ha! is re5ire' *ro%e#eryone
" ho$ !he se o* an AAC sys!e% can slo$er an' see%in&ly i%(e'e
con#ersa!ion
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E;(ec!a!ions o* AAC
"AAC s!akehol'ers, incl'in& *a%ily %e%bers an' en'
sers o* !he !echnolo&y, #ie$ !he (ro#ision o* AAC as a
sol!ion !o !he co%%nica!ion 'i**icl!ies o* (eo(le $i!h
CCN ??>@
" Bailey e! al6 ??@ s!'ie' *a%ily %e%bers8 (erce(!ions
o* +)D se" Paren!s $ere 'isa((oin!e' $i!h ho$ li!!le co%%nica!ion chan&e'
*ollo$in& (ro#ision o* an +)D an' !he li%i!e' resorces an's((or!s !hey $ere able !o access !o bil' AAC skills
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On&oin& s((or!" In!ro'ce !he s((lier" De%ons!ra!e ho$ !o se
!he $ebsi!es7 3As
" Dis!rib!e in!er#en!ion hors
!o incl'e s((or!
" Ne$ re*erral *or *r!her s((or!
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+4PPORTIN) PER+ON
CENTERED PLANNIN)
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" Ensre !ha! !he (erson $i!h CCN is incl'e' a! all s!a&es
o* !he AAC assess%en!, %ana&e%en! 'ecisions, an'
in!er#en!ion
" 3or (eo(le $i!h CCN, !here is a nee' !o !hink care*lly
abo! ho$ (ar!ici(a!ion in (erson cen!re' (lannin& is
or&anise'
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-o$ !o s((or! (ar!ici(a!ion in (lannin&
" Pro#i'e in!eri% co%%nica!ion s((or!s
" Pro#i'in& in*or%a!ion in *or%a!s !ha! are accessible
" Co%%nica!ion s((or!s %ay incl'e." AAC*rien'ly8 in*or%a!ion shee!s an' consen! *or%s
" In*or%a!ion 'is(lays
" +che'les
" 4se o* a((ro(ria!e (ho!o&ra(hs, (ic!o&ra(hs or o!her sy%bolic or
nonsy%bolic *or%s o* co%%nica!ion" Talkin& /a!s
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Incl'in& (eo(le $i!h ID in 'ecision %akin&
" The +((or!e' Decision /akin& 3ra%e$ork ?1?@ hel(s !o (ro#i'e an obec!i#e $ay !o s((or! !he
(erson $i!h in!ellec!al 'isabili!y
" ha!e#er is kno$n abo! !he (erson8s (re*erences an'
co%%nica!ion is !aken in!o accon! an' re#ie$e' !o
allo$ *or chan&es in 'ecisions, as circ%s!ances can an'
$ill chan&e o#er !i%e
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AAC BARRIER+
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Barriers !ha! rela!e !o !he in'i#i'al sin& !heAAC sys!e%6
" The in'i#i'al8s skillsF co&ni!i#e skills, co%%nica!ion skills,(hysical abili!y, li!eracy abili!y #ision, hearin&
" A!!i!'esF !he in'i#i'al8s a!!i!'e !o$ar's !he AAC sys!e%
e6&6 ne&a!i#e a!!i!'e7 *ear7 e%barrass%en!
" Resorce li%i!a!ionsF li%i!a!ions o* !he ac!al AAC sys!e%
e6&6 A%on!7 !y(e o* #ocablary
Barriers !o AAC 0 Access
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Barriers !ha! rela!e !o !he en#iron%en! or !hes((or! !ea%" Policies !ha! i%(ac! on AAC se, e6&6 no se o* elec!ronic 'e#ices in
hos(i!als
" Prac!ices, (roce're or con#ic!ions, e6&6 no AAC se 'rin& %eal !i%es" +kill !o o(era!e !he AAC, e6&6 ('a!in&7 (ro&ra%%in&
" +kill !o i%(le%en! !he sys!e%, e6&6 $here an' ho$ !o se !he sys!e%
" A!!i!'es an' belie*s o* o!hers !o$ar's AAC
" Kno$le'&e7 n'ers!an'in& o* !he se o*
AAC, e6&6 i!s (r(ose
Barriers !oAAC 0 O((or!ni!y
-o'&e ??G@, /r(hy e! al
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Lack o* kno$le'&e7 n'ers!an'in&.
"AAC is a 9las! resor!: in s(eechlan&a&e in!er#en!ion
"AAC hin'ers s(eech 'e#elo(%en!" Peo(le %s! ha#e a cer!ain se! o* skills !o be able !o
bene*i! *ro% AAC
" +)Ds are only *or chil'ren $i!h in!ac! co&ni!ion
" Chil'ren shol' be o* cer!ain a&e !o be able !o bene*i!
*ro% AAC" Ro%ski an' +e#cik ??@
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9Or %ain co%%nica!ion &oal is *or !he (erson !o
!alk:
"AAC in!er#en!ions $ill no! inhibi! s(eech an'
co%%nica!ion 'e#elo(%en! ??F +chlosser = en'!, >??@" a sys!e%a!ic re#ie$ $i!h %e!aanalysis
"AAC (ro%o!es lan&a&e learnin& ??@
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9Nobo'y else $ill se !he AAC sys!e%, so $e 'on8!
$an! i!:
" I* co%%nica!ion (ar!ners an' en#iron%en!s 'o no!
s((or! !he se o* AAC, !here $ill be a 'ecrease'
likelihoo' o* sccess
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AAC ABANDON/ENT
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AAC aban'on%en!
" The !er% abandonmentis se' in 'i**eren! $ays in !he AAC li!era!re
??@
" Dis!in&ish be!$een !hose $ho a((ro(ria!ely 'iscon!ine sin& AAC
once !hey no lon&er nee' i! $i!h !hose $ho con!ine !o nee' AAC, b!
'o no! se i! ??@
" They se !he !er% abandonment!o re*er !o 9ina((ro(ria!e
'iscon!inance o* $ha! (ro*essionals *eel is an a((ro(ria!e AAC
sys!e%: ??, (6 H@
" There are hi&h ra!es o* aban'on%en! e#en a%on& !hose $i!h access
!o sys!e%s" Varie!y o* reasons *or aban'on%en! e6&6 lack o* s((or!, lack o*
!rainin&, lack o* kno$le'&e, 'i**icl!y !robleshoo!in& !echnical isses,
o((or!ni!y an' access barriers
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De#ice aban'on%en!
" Varie!y o* reasons *or aban'on%en! e6&6 lack o* s((or!,
lack o* !rainin&, lack o* kno$le'&e, 'i**icl!y
!robleshoo!in& !echnical isses, o((or!ni!y an' access
barriers
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AAC 4se $i!h (eo(le $i!h CP
AAC is o*!en no!se' by (eo(le
$i!h si&ni*ican!
co%%nica!ion
'i**icl!ies
+(eech is %os!co%%only se'
by (eo(le $i!h
si&ni*ican!
co%%nica!ioni%(air%en!sLo$ !ech AAC
sys!e%s are %os!
co%%on 1 An'ersen e! al >?1?, > -i%%el%ann e! al, >?1>, Cockerill e! al, >?1, No#ak e! al, >?1
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De#elo(%en!s in AAC
" Ra(i' 'e#elo(%en!s ha#e been !akin& (lace in AAC
!echnolo&y o#er recen! years
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/ains!rea% !echnolo&y
" 4se o* iPa's has increase' %ore !han se o* o!her AT
" 9/ains!rea%: no! 'i**eren! or in'ica!i#e o* a 'isabili!y
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)OAL +ETTIN)
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Example handout from package
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Example handout from package
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Co%(e!ence )oals
Lin&is!ic co%(e!ence" Lan&a&e (rinci(les
O(era!ional co%(e!ence" Technical skills !o o(era!e !he sys!e%
+ocial co%(e!ence" Con#ersa!ion roles
+!ra!e&ic co%(e!ence" +!ra!e&ies *or co%%nica!ion break'o$ns
Janice Li&h!, 1HH
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PLANNING
INTERVENTIONEVALUATE
ASSESSM
ENT
GOAL
SETTING
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" Re*lec!s clien!s = !hera(is!8s (riori!ies
" I%(ro#es clari!yo* &oals
" 3acili!a!es clien! (roble% sol#in&
" Es!ablishes realis!ic e;(ec!a!ions o*
in!er#en!ion
Ottenbacher & Cusick, 1993Forbes, 1998
"Es!ablishes realis!ic &oals
")oals are in'i#i'alise'
"Res(onsi#e !o chan&e
"No! bon' by any !rea!%en!
a((roache'
Person Cen!ere' )oal +e!!in&
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T6J Kiresk = R6E6 +her%an
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essels e! al, 1HHH
" E**ec!i#eness in %easrin& chan&e $i!h assis!i#e
!echnolo&y
" +bec!i#e %easre o* !he i%(ac! !ha! (roble%s ha#e on
'aily li*e6
" Pro#i'es %easres be*ore an' a*!er !he se o* assis!i#e
!echnolo&y6
In'i#i'ally Priori!ise' Proble% Assess%en!
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")oal *or !he se o* !he co%%nica!ion sys!e%6 ha! is !he clien! sin& !he sys!e% *or here is !he clien! sin& !he sys!e%
-o$ is !he clien! accessin&7 sin& !he sys!e%
-o$ o*!en is !he clien! sin& !he sys!e%
ho $ill s((or! !he se o* !he sys!e%
"I'en!i*y !he %e%bers an' !he roles o* !he s((or!!ea%6
"Deci'e on !he re#ie$ (rocess
Ti%e *ra%e -o$ 'o yo kno$ i* !he sys!e% has been sccess*l
)oals 0 lon& !er% an' shor! !er%
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IPPA Assessment Form
! " # $
No!i%(or!an! a!
all
No! soi%(or!an!
+o%e$ha!i%(or!an!
i!ei%(or!an!
/os!i%(or!an!
! " # $
No! 'i**icl!ya! all
Li!!le'i**icl!y
i!e so%e'i**icl!y
A lo! o*'i**icl!y
Too %ch'i**icl!y !o(er*or% !heac!i#i!y a! all
Please descr%&e the pro&lem'
(o) do *ou rate the %mportance of th%s pro&lem+
(o) do *ou rate the le,el of d%ff%cult* *ou ha,e )%th th%s pro&lem %n
e,er*da* l%fe+
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Implementat%on phase
" De#ice access
" Plan in!o ac!ion
" Plan re#ie$
"
/akin& chan&es
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E,aluat%on phase
" On&oin&
" Re#ie$ &oals
" E#ala!e ac!i#i!ies
"
E#ala!e roles" E#ala!e s!ra!e&ies
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C-ALLEN)E+ INLEARNIN) TO 4+E AAC
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Challen&es
" Peo(le *ace challen&es in learnin& !o se AAC
!echnolo&ies" ??GF /cNa&h!on, e! al6, >??F Perry, e! al6,
>??>F Rackens(er&er, e! al6, >??F +%i!h = Connolly, >??@
" Rackens(er&er e! al6 ??@ re(or!e' challen&es !o AAClearnin& *ro% !he (ers(ec!i#e o* (eo(le $ho se an +)D
!o co%%nica!e
" They i'en!i*ie' challen&es, sch as
" 'i**icl!ies accessin& ins!rc!ion an' s((or!" ser#ices *ro% +LPs an' o!her AAC (ro*essionals $ho 'o no! ha#e
!he !rainin& or e;(erience !o !each +)D se
" ins**icien! o((or!ni!ies !o (rac!ise
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Di**icl!y accessin& !rainin&
" Peo(le ne$ !o an +)D can e;(erience 'i**icl!y ob!ainin& !he
!hera(y ser#ices re5ire' $i!h !he s**icien! *re5ency !o
s((or! learnin&
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Pro*essionals $i!ho! AAC !rainin&
" +LPs %ay no! ha#e !he kno$le'&e, !rainin&, an' e;(erience !o
!each ne$ learners ho$ !o se !he #arie!y o* +)Ds a#ailable
??@
" Clinicians ha#e re(or!e' lo$ le#els o* e;(er!ise in AAC an'
li%i!e' !rainin& ??@" Johnson e! al6 ??@ sr#eye' >G +LPs in !he 46+6 abo! AAC sys!e%
se an' aban'on%en!
" The a!hors concl'e' !ha! lack o* !rainin& an' s((or! in AAC sys!e%s
$ere key *ac!ors in 'e#ice aban'on%en!
" In'i#i'als $ho re5ire AAC an' !heir co%%nica!ion (ar!ners
also re(or! a lack o* !raine' (ro*essionals in !he AAC *iel'
??F Rackens(er&er, e! al6, >??@" Paren!s hi&hli&h!e' li%i!e' e;(erience o* +LPs ??@
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Prac!ice o((or!ni!ies
" Co%(e!ence in AAC !akes !i%e an' (rac!ice
" Peo(le learnin& !o se AAC 'o no! al$ays ha#e !heir AAC
a#ailable
" Lack o((or!ni!ies !o a((ly an' (rac!ise skills in %any
e#ery'ay en#iron%en!s ??@
" Research $i!h schoola&e sers o* +)Ds s&&es!e' !ha!
'e#ices are o*!en inaccessible in !he classroo%
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Co%%nica!ion (ar!ner skill
" Ty(ically, co%%nica!ion (ar!ners con!rol in!erac!ions
sin& #erbal an' (hysical 'irec!i#es an' 'o no! (ro#i'e
(eo(le learnin& AAC $i!h co%%nica!ion o((or!ni!ies?11F Pennin&!on, e! al6,
>??@" Co%%nica!ion (ar!ners.
" ask close'en'e' 5es!ions
" !ake !he %aori!y o* con#ersa!ional !rns
" en&a&e in %essa&e cocons!rc!ion
" These s!ra!e&ies 'ecrease !he %essa&e len&!h o* (eo(le
sin& AAC an' can (ro%o!e 'e(en'ency
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In(!o!(! assy%e!ry
" /o'ellin& o* AAC sys!e% se is no! co%%only (er*or%e'
by s(eakin& (ar!ners ??@" The resl! is !ha! (eo(le learnin& AAC 'o no! o*!en recei#e in(! in
!he co%%nica!ion %o'e !ha! !hey are e;(ec!e' !o se ?11@
" I* (ar!ners 'o %o'el AAC se, !y(ically con!en! $or's are
(ro#i'e' in !he ai'e' %o'ali!y ??@
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Access !o (osi!i#e (eer %o'els
" Peo(le learnin& AAC rarely see !he sys!e% !hey se bein&
se' by so%eone %ore co%(e!en! !han !he%sel#es
" Lo$ le#els o* con!ac! a%on& (eo(le $ho se AAC %ean
!ha! !hose ne$ !o AAC %i&h! recei#e ina'e5a!e
%o'ellin& o* co%(e!en! +)D se ??@
" Peo(le $ho se AAC col' bene*i! *ro% !he s((or! an'
encora&e%en! o* a'l!s $ho also se AAC e**ec!i#ely
an' $ho ha#e o#erco%e challen&es an' achie#e'sccess ??G@
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" Kno$le'&e o* barriers is i%(or!an! in or'er !o (ro#i'e
*ocs !o in!er#en!ions
" ha! 'oes !his %ean *or clinical (rac!ice
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AAC I/PLE/ENTATION
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I%(le%en!a!ion consi'era!ions
" In!er#en!ion s!ra!e&ies !eachin& s!ra!e&ies incl'in&
lan&a&e s!i%la!ion, (eer learnin&, e;(lora!ion
" Pro%(!in& *ee'back !y(es an' *re5ency
" /o'e o* s((or! one on one #s #ia corres(on'ence6
ha! is !he *re5ency
" Doc%en! !he (lan an' share $i!h !he !ea%
" Pyra%i'al !rainin&
" Lan&a&e s!i%la!ion !echni5es
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Crea!e an AAC en#iron%en!" /o'el !he se o* AAC
" Crea!e n%eros o((or!ni!ies !o se %l!i%o'al AAC
" Consis!en! lan&a&e
Assis! !he (erson !o se !heir AAC sys!e%" Physical an' #erbal (ro%(!in&
" )i#e !he (erson *ll a!!en!ion
" )i#e clear ins!rc!ions abo! 9here an' no$:
Co%%nica!ion En#iron%en!
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" 9+abo!a&e: si!a!ions
" +(ecial cha!s $i!h (eers an' s!a**
" +(ecial !asks $here !he se o* AAC is re5ire'
" Role (lay !o (rac!ise ro!ines
I'en!i*y o((or!ni!ies a! yor $ork(lace $here
AAC col' be encora&e'6
Prac!ise I'eas
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Prac!ise Ins!rc!ions e;a%(le
Clear n'ers!an'in& o* ho$ !o se !he sys!e% in 'i**eren!
con!e;! $i!h 'i**eren! !ea% %e%ber
Act%,%t* Place Team mem&er
Tell ne$s a! ne$s!i%e Pro&ra% ne$san' (ho!os *ro%!he $eeken'
+chool /% an' sel*
Play !rains Na%e !he coloran' sie o* !hecarria&es
)ran'%a8s hose )ran'(aren!s
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/y o$n 'e#ice
Personalise !he 'e#ice" Personal an' ni5e only !o !he ser
" Na%es, (ho!os, #i'eos
3n" Ty(ically 'e#elo(in& chil'ren ha#e *n
Chil'ren $i!h AAC 9(rac!ise co%%nica!ion:6
" A&e a((ro(ria!e okes an' s!ories
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" Kno$s co%%nica!ion sys!e%
" 4ses !he co%%nica!ion sys!e%
" Lis!ens
" )i#es !i%e an' a!!en!ion
" 4ses lo!s o* 'i**eren! s!ra!e&ies
" Is a$are o* *a!i&e
Co%%nica!ion Par!ner
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Re*erences" Co(e OQKane, J6, = )ol'bar!, J6
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" Reichle, J6, Bekel%an, D6 R6, = Li&h!, J6 C6 ??>@6 -emplary practices for beginning
communicators: /mplications for C. 0altimore, 1D: %aul !. 0rookes %ublishing Co." Pennin&!on L, )ol'bar! J, /arshall J ??@ +(eech an' lan&a&e !hera(y !o i%(ro#e !he
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