Augmentative and alternative communication

Augmentative and Alternative
Communication: Giving Voice
to Survivors of Brain Injury
Barbara Goodman, CCC-SLP
Heather Kriesman, BS

© 2012 Bancroft | All rights reserved

Technology


Definitions:
• Traumatic Brain Injury (TBI): an injury to
the brain caused by an external force after
birth (Brain Injury Association of America,
2012)


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).

Definitions
Types of Symbol Systems:
• Static Boards
– Point & Communicate
• Pull Off Boards
– PEC Boards
• Dynamic Speech Devices
– Dynavox, Prentke Romich & Tablets


Examples of Dynamic Speech Devices

Proloquo2go (iPad app.) Dynavox- Express


Definitions

Multimodality Communicator
• Is an individual who uses more than one
expressive communication strategy


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)


Functional Communication
Profile
• Functional Communication Profile-Revised
2003, authored by Larry Kleiman, CCC SLP
• http://www.linguisystems.com/sample1/4040.pdf


Functional Communication Profile-Revised
(FCT)


InterAACT

• http://www.dynavoxtech.com/interact/
continuum-of-communication/


InterAACT
• Communicative Ability Levels:
– Emergent
– Context Dependent
– Independent
• Multimodality Communicator


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


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


Assessment Results

Integrative picture of the whole individual,
relative strengths and AAC needs
• Trial
• Trial
• Trial


Selection of Devices

• SETT Framework
– Student (adult client)
– Environments
– Tasks
– Tools



• Results of assessment and SETT
• What currently works/doesn’t work
• What the user wants to use


• 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


• 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


• Vision issues, Physical disabilities
– Choose a system with larger buttons.
– May need to be mounted
– May need to be worn
– Consider scanning


• 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?



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


• 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.



• Trial
• Trial
• Trial



Writepad app DynaVox Prentke-Romich Saltillo


• What matches the users communication
needs, language level, physical abilities?
• What is the user comfortable with?
• Consider warranties
• Consider durability
• Consider customer service


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


Funding

• Order all accessories with device
• Purchases are for 5 years.
• Consider warranties
• Consider durability
• AAC, VOCA, medical necessity


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



• Programming needs to stay consistent with
users’ communication abilities and needs

• All need to be trained on programming and
users’ language level/needs


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



• Interactive learning
• Access or location and function
• Demonstrate
• Training is for everyone



• User Groups
• Client focused
• Family and client focused


Conclusion
• Integration of a comprehensive
communication assessment and selection
process, leads to a functional, independent
communicator.


Thank You!

Barbara Goodman: bgoodman@bnh.org
Heather Kriesman: hkriesman@bnh.org


Augmentative and alternative communication

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