Augmentative and alternative communication

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Augmentative and alternative communication

  1. 1. Augmentative and Alternative Communication: Giving Voice to Survivors of Brain Injury Barbara Goodman, CCC-SLP Heather Kriesman, BS© 2012 Bancroft | All rights reserved
  2. 2. Technology© 2012 Bancroft | All rights reserved
  3. 3. Definitions: • Traumatic Brain Injury (TBI): an injury to the brain caused by an external force after birth (Brain Injury Association of America, 2012)© 2012 Bancroft | All rights reserved
  4. 4. Definitions• Augmentative & Alternative Communication (AAC) – Any approach designed to support, enhance or supplements the communication of individuals who are not independent verbal communicators in all situations (Nicolosi, Harryman & Kresheck, 1989).
  5. 5. Definitions Types of Symbol Systems: • Static Boards – Point & Communicate • Pull Off Boards – PEC Boards • Dynamic Speech Devices – Dynavox, Prentke Romich & Tablets© 2012 Bancroft | All rights reserved
  6. 6. Examples of Dynamic Speech DevicesProloquo2go (iPad app.) Dynavox- Express© 2012 Bancroft | All rights reserved
  7. 7. Definitions Multimodality Communicator • Is an individual who uses more than one expressive communication strategy© 2012 Bancroft | All rights reserved
  8. 8. Assessment • Formal Testing & Informal Measures – Functional Communication Profile-Revised (FCT), 2003, Larry Kleiman – InterAACT Framework and Dynamic Goal Grid (Dynavox, 2011) – Mayo Portland Asaptability Inventoryy-4 (MPAI- 4Lezak, Malec)© 2012 Bancroft | All rights reserved
  9. 9. Functional Communication Profile • Functional Communication Profile-Revised 2003, authored by Larry Kleiman, CCC SLP • http://www.linguisystems.com/sample1/4040.pdf© 2012 Bancroft | All rights reserved
  10. 10. Functional Communication Profile-Revised (FCT)© 2012 Bancroft | All rights reserved
  11. 11. InterAACT • http://www.dynavoxtech.com/interact/ continuum-of-communication/© 2012 Bancroft | All rights reserved
  12. 12. InterAACT • Communicative Ability Levels: – Emergent – Context Dependent – Independent • Multimodality Communicator© 2012 Bancroft | All rights reserved
  13. 13. Assessment Communicative Competencies • Linguistic- vocabulary and sentence structure • Operational- care/maintenance of device • Social- how language is used • Strategic- know how and when to communicate© 2012 Bancroft | All rights reserved
  14. 14. Assessment Mayo Portland Adaptability Inventory- 4 (MPAI-4) • Abilities- includes mobility, vision, communication, memory – Adjustment-includes fatigue, anxiety, depression, impaired self- awareness – Participation-initiation, social and leisure activities, employment – Pre-Existing and Associated Conditions-pre morbid issues that may impact rehabilitation© 2012 Bancroft | All rights reserved
  15. 15. Assessment Results Integrative picture of the whole individual, relative strengths and AAC needs • Trial • Trial • Trial© 2012 Bancroft | All rights reserved
  16. 16. Selection of Devices • SETT Framework – Student (adult client) – Environments – Tasks – Tools© 2012 Bancroft | All rights reserved
  17. 17. Selection of Devices • Results of assessment and SETT • What currently works/doesn’t work • What the user wants to use© 2012 Bancroft | All rights reserved
  18. 18. Selection of Devices • If the user can read and write -Choose a text to speech device -word and phrase prediction -pre-stored messages • If the user has difficulty reading or writing -Choose an icon based system -Can be photos, icons, drawing© 2012 Bancroft | All rights reserved
  19. 19. Selection of Devices • If the user has word finding and memory problems – A subject or scene based communication system may help – Limit the number of pages one has to navigate© 2012 Bancroft | All rights reserved
  20. 20. Selection of Devices • Vision issues, Physical disabilities – Choose a system with larger buttons. – May need to be mounted – May need to be worn – Consider scanning© 2012 Bancroft | All rights reserved
  21. 21. Selection of Devices • What does the user want to say? – Convey information? – Tell stories? – Answer questions? – Order for themselves? • What does the user need to say? – Participate? – Answer questions? – Convey information?© 2012 Bancroft | All rights reserved
  22. 22. Selection of Devices What currently works? • Paper/pencil, gestures, sign, email, text, VOCA, combination • What is he using that doesn’t work? – Poor handwriting, poor articulation • People stick with what is easy and familiar© 2012 Bancroft | All rights reserved
  23. 23. Selection of Devices • Results of assessment will guide the decision making process, but the deciding factor has to be the user. • Appropriate choices will provide communication independence. • Incorrect decisions will lead to system abandonment.© 2012 Bancroft | All rights reserved
  24. 24. Selection of Devices • Trial • Trial • Trial© 2012 Bancroft | All rights reserved
  25. 25. Selection of Devices Writepad app DynaVox Prentke-Romich Saltillo© 2012 Bancroft | All rights reserved
  26. 26. Selection of Devices • What matches the users communication needs, language level, physical abilities? • What is the user comfortable with? • Consider warranties • Consider durability • Consider customer service© 2012 Bancroft | All rights reserved
  27. 27. Funding • Medicaid, Major Medical, TBI fund, VA, Private Charities, DVR and DDD fund dedicated communication devices. -SLP and or AAC report/ letter of medical necessity -doctor’s script -Assignment of Benefits form -insurance cards -company funding paperwork -insurance denial http://www.state.nj.us/humanservices/dds/document/resourse© 2012 Bancroft | All rights reserved
  28. 28. Funding • Order all accessories with device • Purchases are for 5 years. • Consider warranties • Consider durability • AAC, VOCA, medical necessity© 2012 Bancroft | All rights reserved
  29. 29. Implementing and Maintaining AAC • Less than 10% of adult AAC users and less than 25% of family members and caregivers of AAC users report receiving professional support to effectively implement AAC. • Close to 20% of the professionals and close to 30% of the family members and caregivers consider the professional supporting the AAC user not or only slightly knowledgeable on AAC. • Family members and caregivers report that only 20% of the AAC users in their care use AAC for the full range of communication functions, such as starting and changing a conversation. Results of 2012 survey from U of San Diego and California State U http://www.assistiveware.com/taking-pulse-augmentative-and-alternative- communication-ios© 2012 Bancroft | All rights reserved
  30. 30. Implementing and Maintaining AAC • Programming needs to stay consistent with users’ communication abilities and needs • All need to be trained on programming and users’ language level/needs© 2012 Bancroft | All rights reserved
  31. 31. Implementing and Maintaining AAC Regardless of choice, the device/tool must • fit with the user’s skill level • communicate what the user wants to say • be easy for the user to use • be what the user wants to use© 2012 Bancroft | All rights reserved
  32. 32. Implementing and Maintaining AAC • Interactive learning • Access or location and function • Demonstrate • Training is for everyone© 2012 Bancroft | All rights reserved
  33. 33. Implementing and Maintaining AAC • User Groups • Client focused • Family and client focused© 2012 Bancroft | All rights reserved
  34. 34. Conclusion • Integration of a comprehensive communication assessment and selection process, leads to a functional, independent communicator.© 2012 Bancroft | All rights reserved
  35. 35. Thank You! Barbara Goodman: bgoodman@bnh.org Heather Kriesman: hkriesman@bnh.org© 2012 Bancroft | All rights reserved

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