Augmentative and alternative communication


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  • Some people with disabilities may not be able to use speech as their main means of communication and may have to use special techniques. In many cases, the SLP is asked to operate in the role of case manager or team leader becausecommunication is frequently cited as a primary area of concern and one that influences all other aspects of daily living and life skills. SLP Specializes in AACNormally SLP initiates and coordinates with the team
  • Stephen hawking is a British theoretical physicist and author. At the age of 21 he was diagnosed with ALS and from 1974 he could not feed himself or get out of bed. As of 2012 he is almost completely paralysed and communicates thru speech generating device which is 1 form of AAC
  • Observe different devices used by tony
  • A word from a very famous individual in AAC. Whether in education setting, home or with in the community it is essential that individuals actually learn to communicate before they can get involve in the learning process
  • Without access to speech, these individuals are severely restricted in their communication and participation in all aspects of life – their educations affected, employment, relationship with family and in the community
  • Communication is the process of using a shared medium to share our ideas, thoughts, and feelings with other people and having those ideas, thoughts, and feelings understood by the people we aretalking with (during our first few months in Saudi)
  • Not known to developing countries and it varies from different countriesHigh prevalence of ASD and 30-50% of autistic children will remain in non verbal categories
  • International Society for AACAmerican speech language hearing associationAlmost everyone uses augmentative communication in the form of facial expression and gestures in addition to speech. Individuals with severe communicationdifficulties, however, may need to rely on augmentative and alternative communication (AAC) to meet their communication needsAugmentative and Alternative Communication or AAC refers to all forms of communication other than oral speech to express thoughts, ideas, needs, and wants. Some forms of AAC includes, body language, gestures, facial expression, sign language, word boards, books pictures, symbols and writing. It is something we all do everyday, such as making facial expressions when we're laughing or waving our hand to say hello. For some, AAC aids and devices are needed to help those who have speech or language problems. 
  • The individual’s full communication capabilities could include any residual speech or vacalizations, gestures, signs and aided communicationMultimodal approach – gestures, sign language, facial expression and writing. Communication is always a two way street where not just talking about sending out a message but also receiving a message. Many of our patients have difficulty understanding verbal communication examples are those with stroke (receptive aphasia) aside from language barrier, and autistic children
  • Aphasia – Receptive and expressive
  • Developmental disorders suchsOr AcquiredICU pt who are on trache but concious
  • They may need it to
  • AAC is under the umbrella of Assistive Technology
  • Augmentative communication includes a wide range of technology from no tech options such as use of manual sign language to high tech complex, computerized speech generating communication devicesUnaided or no tech – advantages are precisely unaided systems and thus wonderfully quick immediate and practical, you cant forget to take this system with youDisadvantages are gesture can only express things in the here and now while signs not everyone in the communication impaired person’s environment understand sign to any very advanced degree and it requires training for the pt and the family Low tech – Non-voice output aids or devicesMid – high tech - Voice Output Communication Aid (VOCA) or Speech generating device (SGD)Advantages of aided communication are the flexibility and richness of communication that can be achieved by creating or customizing vocabulary sets, employing sophisticated methods of storage and retrieval, and providing users with special means of accessing themDisadvantages are it requires some level of training or extensive training depends on how high tech the device is and maintenance as well
  • Minspeak system
  • As of 2012 almost 264 apps available in apple app store 52 are free and 15 of which are above $100. One of the reason why apple is pushing their product in education.A lot of Ots now a days use ipads as tool in their intervention
  • For someone to learn and use AAC effectively, it needs to be part of everyday life, not a task done occasionallyThis is not something automatic or accepted right awayThese individuals with communication problems needs to understand how important communication is especially those who are functioning at lower levelCommunicating is not an isolated series of one skill, it involves several skillsSpeaking involves not only getting your message across but also being able to listen and understand what others are saying (active listening) and observing the verbal and non verbal clues in order to monitor the effectiveness of your messageStake holders – Parents, families, friends, caregivers, SLP, OT, PT, Teachers Rehab engineers, computer programmers and AAC users
  • It not just what device are we going to use? Instead of What does the person needs the device for? What communication do they want to? What and who are they communicating with? What can we find to fit that.Though the device is important but AAC intervention is all about the systemIt’s not just the device it’s about coming up a system that meets that individual’s needs. The MESSAGE, NOT the medium is what matters for people who cannot use their own voiceIt’s the same as buying a new gadget you have to think of various features
  • Communication potential – is about the rate of progress or potential to improve of your pt. From a logistics standpoint You don’t what to remake something every time you turn around. If your pt is rapidly progressing you what to be prepared ahead of time. It is very important to look the rate of progress cognitively and communicatively. You have to think what kind of device to provide that does a lotAccess options is how a person selects the item or symbols he or she is looking for. Is he going to grab it or touch it? Is there a mobility issue? Is he going to point at it thru eyegaze. This is where OT and PT input comes in. You want your pt to access his or her devices in a best possible way. (video)Symbol systems – no standardized symbols. It’s based on their cognitive level symbolic understanding. What type of symbol your pt can identify. These where individualness comes inDisplay – How big is the display. Is it static or dynamic - static for low tech such as communication board and dynamic is for computer based devicesDevice output – digitized voice which is the voice recording or synthesized voice which is the computer generated voice (like siri) do they need bluetooth or do they need to email or infrared or remote control to control their invironmentPortability – is you pt ambulatory or does it need to be attached to a w/cCompatibility – windows or Mac Os, Apple iOS devices or Android, Support – do need upgrade or update
  • A mini movie which is available on youtube “Only God could hear us”
  • AAC is a last resort – if your thinking about it as a last resort you basically denying that child or person the ability to communicate and to develop communication It should be the first line of defense. Remember learning takes place thru communicationAAC hinders – Research has shown that it doesn’t hinders or stops speech development but it just supplements, enhance and support speech developmentIndividual must – there is no set of skills. We know that every individual communicating at some level it’s just a matter of coming up with a system that meets that individual needs and coming up with a system that is appropriate for that individual(baby cries) to drive home the messageSpeech- generating AAC – not necessary true. It’s a process, identifying what is the best for your pt is a process. Whether your pt is functioning at lower levelChildren have – The need for AAC should be identify as early as possible
  • AAC will only supplements, enhance and support their communication abilities to the point where they’re capable of or as their disability permits
  • Visual screening – your looking for ptosis, visual field deficit, diplopia, visual acuity problem and nystagmusPerception – spatial awareness, figure ground, agnosia (visual, auditory and somatosensory agnosia) Means of access – if the pt has mobility issueWriting and typing – specially for individuals who use their AAC device in any work related tasks such as emails or writing a book like stephen hawking)
  • 07:19
  • Augmentative and alternative communication

    2. 2. Stephen Hawking Tony Nicklinson
    3. 3. Overview 1 2 3 4. 4 5 6 • Communication • What is AAC? • Who uses AAC? • When does a person needs AAC? • Types of AAC • Myths about AAC • Role of OT in AAC
    5. 5. Communication and language Communication and language skills allow a person to…               Initiate, maintain, and terminate conversation Establish/maintain Interpersonal relationships Share ideas Express feelings Give information Ask questions Describe events Solve problems Direct others Entertain Show imagination Refuse Learn Function with greater independence
    6. 6. Communication • Communication requires that all parties have an area of communicative commonality. • There are auditory means, such as speaking, singing and sometimes tone of voice • Nonverbal, physical means, such as body language, sign language, paralanguage, touch, eye contact, or the use of writing
    7. 7. Facts Estimated 1 - 1.5% of total population in developed countries have such significant communication disabilities that they cannot rely on their natural speech to meet their daily communication needs
    8. 8. What is Augmentative and Alternative Communication? • AAC is a set of tools and strategies that an individual uses to solve everyday communicative challenges. - ISAAC • AAC involves attempts to study and when necessary compensate for temporary or permanent impairments, activity limitations, and participation restrictions of persons with severe disorders of speech-language production and/or comprehension, including spoken and written modes of communication - ASHA
    9. 9. Augmentative and Alternative Communication • AAC is a means to enhance overall communicative effectiveness • is to use the most effective communication possible that may require a multimodal approach in order to be able to communicate for different purposes in a variety of contexts • Natural Communication will always be encourage and remain an integral aspect of the total communication (multimodal) approach - ASHA
    10. 10. Disabilities Affecting Speech, Language, and Communication • Dysarthria is a disorder of motor speech control resulting from central or peripheral nervous system damage that causes weakness, slowness, and a lack of coordination of the muscles necessary for speech production.
    11. 11. Disabilities Affecting Speech, Language, and Communication • Apraxia is a disorder affecting the coordination of motor movements involved in producing speech caused by a central nervous system dysfunction. • Aphasia is a language disorder that occurs as a result of a cerebral vascular accident to Traumatic Brain Injury (TBI). It can affect both expression of spoken and written language, e.g. some people can forget names, places, or events. Others may lose the ability to understand spoken language.
    12. 12. Specific groups of AAC users • • • • • • • • • • • • • Cerebral palsy Intellectual impairment Autism Developmental dyspraxia Muscular dystrophy Traumatic brain injury Locked-in syndrome Amyotrophic lateral sclerosis Parkinson's disease Multiple sclerosis Dementia Deafness or hearing impairment Blind or visually impaired
    13. 13. When does a person need AAC? • To augment natural speech production • Provide a means for communication when other means are not available or diminished • To promote speech/language development • To address written communication or text needs when handwriting is impaired
    14. 14. Assistive Technology Augmentative Communication Continuum
    15. 15. AAC unaided and aided range of technology used as an intervention • No Tech Systems: does not require a power source or an external tool, and include facial expression, vocalizations, gestures, and sign languages and systems. • Low Tech Systems: defined as those that do not need batteries, electricity or electronics. These are often very simple communication boards or books, from which the user selects letters, words, phrases, pictures, and/or symbols to communicate a message • Mid – High Tech Systems: dedicated devices developed solely for AAC, or non-dedicated devices such as computers that run additional software to allow them to function as AAC devices.
    16. 16. Low Tech Devices
    17. 17. Mid Tech Devices
    18. 18. High Tech Devices
    19. 19. • AAC intervention is the process of enhancing and optimizing daily functional communication across all communicative contexts • This process takes time, as well as hours of work by the augmented communicator and the team of stake holders providing and supporting the needed intervention and follow-up activities and services
    20. 20. AAC Device Features • Generally, the selection of the most appropriate communication system is a process of matching the abilities and needs of the user to the features of the AAC device. That is the meaning of providing the best fit
    21. 21. The following features of the AAC device or system should be considered • • • • • • • • • • Communication potential Access options Symbol system(s) Display Device Output Portability Compatibility Dedicated or computer-based Durability and support Cost
    22. 22. Chris Klein
    23. 23. Myths about AAC • AAC is a last resort in speech language intervention • AAC hinders or stops further speech development • Individual must have a certain set of skills to be able to benefit from AAC • Speech-generating AAC devices are only for individual with intact cognition • Children have to be a certain age to be able to benefit from AAC
    24. 24. No piece of equipment in an of itself eliminates delay in language development or any communication problem
    25. 25. Role of OT in AAC • • • • • • Assesses visual screening Perception Hand-eye coordination Means of access Functional communication skills of writing and typing Also assessed in conjunction with PT are seating, positioning, and placement of the augmentative communication system
    26. 26. QUESTIONS?
    27. 27. Preferences • viders/
    28. 28. Stephen Hawking’s AAC Device