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