Post on 02-Oct-2020
AAC Evaluations-This is Not a TestSusan M. Todd, M.S., CCC-SLP
Lauren E. Vaughan, M.A., CCC-SLPKSHA 2019
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Susan M. Todd● Four years experience
completing AAC assessments across the lifespan
● Currently PhD student at the University of Kansas with AAC being primary area of emphasis
● Author and creator of AACtual Talk blog
Financial disclosures: Given free registration to conference for presenting. Employed as a GTA at University of KansasNo relevant non-financial disclosures. 2
Lauren E. Vaughan● Clinical outpatient pediatric SLP
with approximately 80% caseload of people who use AAC
● Two year ACTS grant scholar through the University of Kansas
● Member of ISAAC, USSAAC, and AAATE
Financial disclosures: Paid stipend for presenting. Employed by Heartspring Pediatrics.
No relevant non-financial disclosures to make. 3
Course Objectives1. Demonstrate understanding of completing AAC assessment
including a minimum of one low-tech and two speech generating systems
2. Compare one or more differences between conducting AAC evaluations in a single session versus over a period of several sessions
3. Demonstrate understanding of appropriate documentation for one complete AAC assessment.
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This is not a test.5
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Getting to know you● What setting do you work in? School, private clinic,
rehab, acute, home health, other?
● What is your experience with AAC assessments? Completed 0-5, 5-10, 10+
● What is your experience with AAC intervention? Once a week, two-three times per week, everyday?
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What is AAC?
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● AAC is a term used to describe a means for individuals who do not solely use verbal speech to communicate.
● AAC can be non-technology (i.e., sign language, texting, writing etc.), low-technology (i.e., core-fring communication books), and/or high-technology (i.e., speech generating devices).
AAC System Examples
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Non-Tech Low-Tech High-Tech
Low-Technology Examples● Core/Fringe Communication Book
● Eye Gaze Board
● Low Tech Word Power 60 Communication Board
● Picture Exchange Systems
● Tactile Board
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High-Technology Examples● Ablenet
https://www.ablenetinc.com/quicktalker-freestyle● Forbes AAC https://www.forbesaac.com/ ● iPad● Prentke Romich Company (PRC)
https://www.prentrom.com/ ● Saltillo https://saltillo.com/ ● Tobii-Dynavox https://www.tobiidynavox.com/en-us/
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Assessment Procedures
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Family-Centered AAC
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● Device (system) abandonment is a prevalent issue○ 39% of AAC systems introduced by SLPs were used for more than one
year (Johnson, Inglebret, Jones, & Ray, 2006)○ Several studies have indicated that lack of family involvement in the
decision making process as a contributing factor (Bailey, Parette, Stoner, Angell, & Carroll, 2006) (Light & Mcnaughton, 2015) (Moorcroft, Scarinci, & Meyer, 2019)
● “Support for AAC by communication partners was the second most important child-related factor, significantly more important that 14 other child characteristics. This suggests that professionals pay close attention to support in the child’s environment in making AAC device recommendations.” (Webb et al., 2019)
Communication Assessment
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● Demographic information (name, age, grade/occupation)
● Diagnosis○ Medical○ Speech and Language
■ Expressive & Receptive Language■ Articulation■ Literacy
● Therapy history● AAC history● Fine motor skills● Gross motor skills● Sensory status (Vision and hearing)
Relevant Case History Information
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Assessment Tools● Communication Matrix www.communicationmatrix.org ● Inventory of Potential Communicative Acts (IPCA)● Gail Van Tatenhove https://www.vantatenhove.com/resources● Augmentative and Alternative Communication Profile ● Communication Sample
○ May need to be videotaped in order to observe and document all communicative attempts
○ Surveys for parents, teachers, caregivers for intake of current communication
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Device Trials
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Maybe we should say “system trials”
● This process occurs for every person for whom AAC is being considered
● System trials should include: non-tech, low-tech, and high-tech options
● Low-tech options that are presented and used prior to evaluation should only be used for a short time or as a resource for back-up (from clinical experience)
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If low-tech options have been effective...
then high-tech options should be trialed for access to a more robust vocabulary.
If low-tech options have not been successful...
then the feature matched AAC assessment should continue with other options
(including high-tech).
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How do I “get” devices?● Contact the sales representatives for
AAC companies in your are○ Ask them to come to you and demo
systems - they will and do○ Ask how to receive device loaners○ Ask how their funding process
works○ The majority of information is on
the companies’ website
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Which devices to trial● Access method● Portability● Durability/compatibility of hardware
○ Volume○ Compatible with screen guards
● Compatibility of software○ Literacy○ Motor mapping○ Vision/Hearing
● Consideration of family/caregiver dynamics/desires
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Questions to Ask When Considering Systems
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Can the individual
read?
Can the individual use direct
access?
Does the individual
need a keyguard?
What is the individual’s
vision/hearingstatus?
Will the individual be carrying the
system?
What are the hardware
considerations?
Access Methods
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Types of Access● Direct
○ With modifications such as press-and-release time and screen guards
● Switch○ Different types of switches
● Eye-Gaze
Insurance companies may require that you document that direct/switch access are not
successful.27
Considerations with access methods
● Fatigue level
● Consistency of accuracy
● Functions of touch screen (e.g. do you have to scroll?)
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Multimodal Approaches
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More than just the back-up● Replicates what you and I do everyday
○ Multimodal approaches are important for families and individuals to create easy access to communication at all times
○ Moves away from the perspective if “having” to use a certain system
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Symbol Assessment
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What do I need to consider?● It is important to remember that this is
not an assessment to preclude a child from access to certain kinds of AAC
○ Research has shown that symbol iconicity may not be an important factor in word learning, especially with new vocabulary (Sevcik, Barton-Hulsey, Romski, & Hyatt Fonseca, 2018)
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Please Consider Vision● Is there a prescription for corrective
lenses?○ Yes
■ Does he/she wear the corrective lenses● Yes = Great● No = We need to modify
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Personalization
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Why is this important?● Families/caregivers are immediately responsible
for success of AAC systems
○ Personalization is important to create buy-in from both the user and the caregivers■ This goes beyond just adding preferred
nouns-think participation.
● Personalization is also part of the AAC evaluation when considering systems that would be successful in family unit
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● Success of system trials is heavily dependant on user’s interest in activities
○ Know what is intrinsically motivating for the child when selecting activities
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AAC Instruction
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For AAC to be successful, it cannot be isolated in a therapy
room without each stakeholder’s involvement in
decision-making.
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When providing education about AAC, make sure to give printed materials to parents to review later.
Format of an Assessment
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Single-Session Assessment
Might not beable to have preferred activity
Not alert every day
Warm-up time
Information quickly for curious parents
Accessible for families
Quick results
Multiple-Session Assessment
More information ever meeting
Change system between sessions
Trial systems for longer period of itmes
Plan sessions at different times
Relationship building
Process and come up with new ideas
Reseach
Opportunities for different settings
Single Session Multiple Sessions
Pro Con Pro Con
Communication Assessment
Device Trials
Access Methods
Multimodal Approaches
Symbol Assessment
Personalization
AAC instruction43
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Documentation
Sample Report
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Augmentative and Alternative Communication Evaluation Report
Client Name: Date: Evaluation Completed:DOB: Client Age:Parent/Caregiver/Facility: Evaluator:
Background Information● Age● Medical Diagnosis● Speech and Language Diagnosis● Projected impairment (degenerative, condition stable, improvement)● Severity of communication impairment ● Current therapy services● *Communication concerns and why an AAC system is needed
Speech and Language● Receptive Language Skills
○ Standardized Test, Clinical Observation, Caregiver Report● Expressive Language Skills
○ Standardized Test, Clinical Observation, Caregiver Report● Speech Intelligibility
○ Standardized Test, Clinical Observation, Caregiver Report● Social/Pragmatic Language Skills
○ Standardized Test, Clinical Observation, Caregiver Report● Literacy Skills
Sensory/Perceptual Skills● Vision● Hearing
Motor Accessibility● Fine Motor
○ Direct selection, switches, etc.● Gross Motor
○ Ambulatory, mounting system requirement
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Device TrialsThe following Augmentative and Alternative Communication Systems were trialed based on their vocabulary selection, language system, and portability.Include:﹡ Non Technology﹡ Low Technology﹡ High Technology
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Date Hardware Communication Software Grid Size Data
8/17/19 PRC PRiO Mini
LAMP Words for Life N/A Independent: “more” x3Prompted: “stop” x1
9/19/19 FRS Proslate 8”
Proloquo2Go 3x5
Summary● XX is in need of a consistent, effective, and functional communication
system.
● XX verbally cannot effectively express his/her wants, academic/vocational needs, feelings, and safety information.
● XX needs a speech generating AAC device that is portable combined with a large vocabulary.
● The following AAC systems did not meet XX’s communication needs.○ E.g., “the iPad did not provide a sufficient volume output level. XX
cannot yell for help in an emergency.”○ E.g., “the core/fringe book does not provide a robust vocabulary.”○ E.g., “XX encountered difficulties independently navigating through
page-sets through Proloquo2Go.”
● Data, clinical observations, and parent report indicate that XX was most successful with (state system). 48
Candidacy for a communication systemXX is a candidate for an AAC SGD:
1. XX does not produce verbal speech in an intelligible, functional, or efficient manner.
2. XX needs the ability to communicate with his/her caregivers, teachers/co-workers, and peers to meet medical, academic/vocational, and daily wants and needs.
3. XX consistenly demonstrates the effective use of an AAC SGD to request and comment on preferred activities.
4. XX needs a communication system that includes an advanced language system to promote expressive, receptive, and social/pragmatic language skills.
Feature-Skill MatchResults of clinical trials and caregiver report recommend the SGD have the following characteristics:
1. Direct selection2. Light-weight and portable3. Speech output at an appropriate loudness level4. Ability to have an advances language system5. Ability to be specifically individualized49
RecommendationsThe data and additional information collected throughout the evaluation indicate that XX is a successful (state AAC system) user. The following will need to be purchased in order to make a successful communication system for XX:
Treatment Plan Goals1. The SGD should be individualized through programming. Programming
specific vocabulary for XX will assist in motivating him/her to use the SGD to communicate and avoid device abandonment.
2. XX’s caregivers should be trained in how to use and program the SGD.3. The SGD should be implemented across all environments.
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Code Item Website
E2510 PRC PRiO Mini
Sample Goals1. XX will independently request/comment on/protest using the SGD a
minimum of 10 times per session.2. XX will independently answer personal safety questions (i.e., name,
address, and pertinent medical information) using the SGD with 90% accuracy.
3. XX will increase spontaneous use of core words by 10 words through clinical observation and caregiver report.
4. Caregivers will participate in 75% of sessions to obtain knowledge in use and programming of the SGD.
Speech-Language Pathologist Assurance of Financial Independence
Signatures with credentials
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Additional Resources for Documentation
● AAC-RERC○ https://aac-rerc.psu.edu/index.php/pages/show
/id/21
● Device Company Websites○ Funding specialists
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BibliographyBailey, R. L., Parette, J., Stoner, J. B., Angell, M. E., & Carroll, K. (2006). Family Members’ Perceptions of Augmentative and
Alternative Communication Device Use. Language, Speech, and Hearing Services in Schools, 37.
https://doi.org/10.1044/0161-1461(2006/006)
Dietz, A., Quach, W., Lund, S. K., & McKelvey, M. (2012). AAC Assessment and Clinical-Decision Making: The Impact of
Experience. Augmentative and Alternative Communication, 28(3), 148–159. https://doi.org/10.3109/07434618.2012.704521
Johnson, J. M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspectives of speech language pathologists regarding success
versus abandonment of AAC. Augmentative and Alternative Communication, 22(2), 85–99.
https://doi.org/10.1080/07434610500483588
Light, J., & Mcnaughton, D. (2015). Designing AAC Research and Intervention to Improve Outcomes for Individuals with
Complex Communication Needs. Augmentative and Alternative Communication, 31(2), 85–96.
https://doi.org/10.3109/07434618.2015.1036458
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Moorcroft, A., Scarinci, N., & Meyer, C. (2019). “I’ve had a love-hate, I mean mostly hate relationship with these PODD books”:
Parent perceptions of how they and their child contributed to AAC rejection and abandonment. Disability and
Rehabilitation: Assistive Technology, 1–11. https://doi.org/10.1080/17483107.2019.1632944
Sevcik, R. A., Barton-Hulsey, A., Romski, M., & Hyatt Fonseca, A. (2018). Visual-graphic symbol acquisition in school age
children with developmental and language delays. Augmentative and Alternative Communication, 34(4), 265–275.
https://doi.org/10.1080/07434618.2018.1522547
Webb, E. J. D., Meads, D., Lynch, Y., Randall, N., Judge, S., Goldbart, J., … Murray, J. (2019). What’s important in AAC
decision making for children? Evidence from a best-worst scaling survey. Augmentative and Alternative Communication,
35(2), 80–94. https://doi.org/10.1080/07434618.2018.1561750
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Questions?
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Thank you!Contact informationLauren - levaughanslp@gmail.com
Susan- toddsm@ku.eduaactualtalk@gmail.com