2. Arrangements for the module
week 1 (23-27 Jan 23)
Day of week time activity Delivery Method
Monday
(23/01/23)
12pm-3pm Live lecture slide Face-to-Face
Tuesday
(24/01/23)
8am-11am Quiz on work covered thus far
Live lecture
Q&A session
Face-to-Face
Wednesday
(25/01/23)
1pm-4pm Live lecture
Q&A session
Face-to-Face
Thursday
(26/01/23)
8am-11am Quiz on work covered thus far
Live lecture
Q&A session
Face-to-Face
3. Arrangements for the module
week 2 (30-03 Feb 23)
Day of week time activity Delivery Method
Monday
(30/01/23)
9h30am-11am Short Test Face-to-Face
Tuesday
(31/01/23)
3pm-5pm Live Online lectures
Q&A session
BB ultra
Wednesday
(01/02/23)
09am-11am Recorded presentations (group) BB Ultra
Thursday
(02/02/23)
3pm-5pm Live Online lectures
Q&A session
BB ultra
4. Arrangements for the module
Week 3 (13-17 Feb 23)
Day of week time activity Delivery Method
Wednesday
(15/02/23)
08h30-11am Revision sessions Face-to-Face
Thursday
(16/02/23)
08h30-11am Individual Support sessions Face-to-Face/Online
Friday
(17/02/23)
9am-12pm MSLB041 SEMESTER TEST
(120 Marks)
Face-to-Face
5.
6. Aim of the AAC module
Provide review of the scientific foundation for the
knowledge and skills required for treating clients
requiring AAC
SLTs – implement evidence-based practices (EBP)
Integrate best and current research evidence
With relevant stakeholder perspectives
And clinical or educational expertise
7. Learning Objectives:
Discuss the background to AAC – (what is
AAC?)
Discuss the different kinds of systems
Explain communication competence
Describe who uses AAC
Goals and aims of AAC
9. Goal Review and Discussion
Why are you here?
THEN….
What is AAC?
What do you know about AAC?
https://youtu.be/zmsdLzQW5G0
10. Discussion
Have you ever tried to communicate with an
adult who could not understand or speak
effectively and did not have an AAC device?
What would you do to make the person
communicate more easily?
11. Introduction
Augmentative and alternative communication
(AAC) refers to
ways (other than speech) that are used to send a
message from one person to another.’’
We all use augmentative techniques to
communicate (facial expressions, gestures etc.)
12. What Exactly is AAC?
Definition of AAC:
“…..An area of research, as well as a set of clinical, and educational
practice involving 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.”
Augmentative and Alternative
Special Interest Division 12, ASHA
13. Terminology
Speech
Relies on vocal production and auditory comprehension
Relies of five primary sub-sections:
Phonation, articulation, resonance, respiration and prosody
Communication
Transmission of meaningful information from one person to another
Messages conveyed – different types of symbols that represent ideas,
entities and events in the world
Language
Combination of symbols governed by set of rules (language).
Rules correspond to three dimensions of language (content, form,
and use)
Refers to phonologic, morphologic and syntactic rules
Concerned by sequencing of sounds or traditional orthography to
create words
Sequence words to create phrases and sentences
14. “The closest simile as to how people treat non-speech
people is how they treat pet dogs….think about that for
a minute. How much difference is there? People take
good care of pet dogs, They give them love, food, warm
homes, attention when they are not busy. And people
don’t expect much out of their pet dogs. Just affections
and obedience. This is the sad part. People just don’t
expect much from non-speech people”
• Personal communication via voice
synthesizer, Ricky Creech, AAC user
15. What is AAC? Definition
Attempts to study temporary or permanently
compensate for: (remember the ICF!)
Impairments
Activity limitations
Participation restrictions
Individuals with severe disorders of speech-
language productions and/or comprehension
(spoken and written)
16. Three general areas of AAC – (impairment)
People with disabilitieswho may benefit from AAC
Processes such as messages, symbols, alternative access, assessment,
and intervention
Procedures developed to serve individuals with developmental disabilities
who require AAC systems – e.g. assessment & intervention
Begin to look at “who uses AAC systems”
17. How do you communicate with an AAC
user?
Important: - not to be prejudiced
Your attitude towards the AAC – can become a barrier
Let the AAC user know when you understand him – also
when you do not understand him
Allow sufficient time to transfer the message, and do not
guess what the message is until he is finished
Communication can be enhanced if questions are asked to
clarify issues
Do not pretend to understand – ask for clarification
In case of a misunderstanding between you and the AAC user,
obtain help from a third person
Train the AAC user to regularly repeat what he has said. He
must learn to convey the message in different ways and to
provide additional guidelines
18. AAC is a system
AAC is a system – not single entity
Ongoing programme of decision making
that considers:
Individuals
Methods of communicating
Effectiveness of that communication
19. AAC: A system
AAC system - primary
components
Symbols
Aids
Strategies
Techniques
20. AAC system: symbols(1)
Types of symbols: (graphic, auditory, gestural, texture/tactile)
Unaided (signs, manual gestures, facial expressions)
Aided”: need for prosthetic support
Actual objects
Pictures
Line drawings
Traditional orthography
Iconicity: visual similarities between symbol and its referent
Iconicity facilitates symbol learning and interpretation
Transparent (drink) – easily guessed
Translucent – not easy but once learnt is easy
Opaque – abstract – not easy to understand (e.g. emotions)
21. AAC system: Aids(2)
Aids: refers to devices
(electronic or non-electronic)
used to transfer messages
Range from simple devices (two photographs) to
complex technologic presentations of numerous
symbols that can be combined to convey infinite
meanings
22. AAC system: Strategies (3)
Strategies: ways symbols can be conveyed most
effectively and efficiently
Purposes of strategies:
To enhance message timing
To assist grammatical formulation of messages
To enhance communication rate e.g. :
letter / word prediction,
semantic compactions (encoding technique that involves
sequencing icons to create an infinite number of
messages)
23. AAC system includes: techniques
(4)
Techniques: Ways in which
messages can be transmitted
Indirect: Scanning
Each item is presented sequentially
(visually, auditory, tactually)
Direct: (e.g pointing)
24. AAC system: temporary vs
permanent
Temporary: E.g. ICU (pre-operative,
post-operative)
Permanent: a communication
board or an I-Pad user, longterm
25. AAC system: Augmentative or
Alternative Communication
Primary purpose of AAC:
supplementing or augmenting the effectiveness of existing
methods of communication
May be effective and efficient for some partners in certain
situations
Individual with CP – easily understood by familiar partners – not with
strangers
Alternative: primary and only means of communication
Depends on the cause of the disorder
E.g. early ALS – augmentative
Later stages of ALS – alternative means of communication
26. AAC system: Multi-modal
communication
AAC – not specific methods of communication
User will not adopt a single method of communication
AAC system: consists of multiple modes of communication
used in combination to meet daily communication
demands
Any one method may be called for – depends on
circumstances
27. AAC system: impact on Challenging
behaviour
Challenging behaviour: nonconventional, socially
inappropriate and perhaps harmful (self or others) behaviours
to make needs known
In this case: AAC = alternative method
Situations that require AAC as alternative method:
Socially unacceptable
Undesired reflex or movement patterns
Idiosyncratic - only minimal number of conversational partners can
interpret and respond correctly to the behaviour
Is potential harmful to the individual
Is relatively inefficient
28. Summary: AAC
AAC: An inclusive term for any system that facilitates
communication with:
techniques,
strategies,
aids,
Symbols,
to support and individual’s expressive communication
29. AAC is……
A system of multiple components / modes for
communication that include:
Symbols (objects, pictures, graphics, gesture, etc.)
Aids (electronic and non‐electronic device)
Techniques (the way the message is transmitted)
Strategies (most effective method of conveying
message)
30. AAC population: Who Uses AAC?
AAC Users include:
Individuals with many different types of
communication disorders
Children and adults
Developmental and acquired disorders
Temporary and permanent users
31. AAC Population
0.8% - 1.2% USA population: severe communication
impairments
45% of SLPs serve clients with AAC needs
50.3% - hospitals
45% - schools
43% - non-residential health care
38% - residential health care
32. ‘Reasons for AAC’
Congenital disorders:
CP
Autism
Mental retardation
Developmental apraxia of speech
Acquired disorders
Stroke
Traumatic brain injury
Amyotrophic lateral sclerosis (ALS)
TBI
AAC candidates: Permanent or temporary – depending on etiology
and goals of AAC programme
34. Who uses AAC?
There is no typical person who uses AAC.
Some from all age groups, socio-economic groups,
and ethnic and racial backgrounds.
Common ground:
all require adaptive assistance for speaking and/or writing
because their gestural, spoken, and/or written
communication is temporarily or permanently inadequate
to meet all of their communication needs
(Beukelman & Mirenda, 2013)
36. Different kinds of AAC systems
1.Different kinds of
AAC systems
•Aided
•Unaided
•Multi-component
•Use of assistive devices
37. AAC SYSTEMS
Unaided systems Aided systems
Non-linguistic
features
Linguistic
features
Tangible, illustrations, orthographic symbol
systems, objects, photos, line drawings,
orthography
Dedicated systems Non-dedicated
systems
•Low tech
Systems
e.g.
Communi-
cation
Board, PECS,
Commu. books
High tech
Systems
e.g. computerized devices
TobiiDyanvox,
Apple i-pad
Systems
that are not
for specifically
used for AAC
Apple I-phone/
I-pad, Computer
Digital
Speech output
Synthetic
Speech output
•Vocalizations
•General gestures
e.g. ‘yes/no’
Head shake
Natural/cultural
Gestures
Pointing
•Pantomime
•Natural speech
(e.g. English)
•Sign language
e.g. SASL
•Alphabet-based
Symbols e.g.
Finger spelling
Language e.g.
•Signed English
40. Aided systems
Tangible, pictorial &
orthographic symbol
sets/systems
Objects-photographs-
line drawings-print
Low technology
e.g. communication
boards,
communication vests
High technology
Digital speech output
Synthesised speech
output
40
41. Types of Systems
Non-speaking systems
Low-tech voice output systems
High-tech voice-output systems
42. Non-speaking systems
Object systems
Natural gestures
Sign language
Pictographic symbol systems
Bliss symbols
Minspeak systems
Rebus symbols
Picsyms
Picture communication systems
Morse code
Picture exchange systems
Eye-gaze/blink systems
45. Low-tech voice output systems
Recorded single-message systems
Recorded magnetic strip cards
Multi location voice output devices
Voice-amplification systems
Text-to-speech systems
46. High-tech voice-output systems
Static or dynamic display
Digitized or synthesized speech
output
Direct or indirect access modes
47.
48.
49. Access modes
Direct access
Indirect access
Linear scanning: left to right for 6-8 location
Step scanning:
Row-column
Linear scanning
Selection of a switch
Intentional and consistent movements
Size or timing of the movement
The feedback (clicks / visual / tactile sensations)
Positioning of the switch
53. Why is AAC an important option for
my client?
Goal of AAC Intervention:
“To enable individuals to efficiently and effectively engage in a
variety of communication interactions and participate in
activities of their choice”.
Beukelman and Mirenda, 2005
This may or may not involve a communication device
54. Aim of AAC
To maximize potential for communication
◦ Communicate messages so that they can interact in
conversations
◦ Participate at home, in school, at work, and in
recreational activities
◦ Learn their native language
◦ Establish and maintain their social roles (friend,
student, spouse, employee, employer)
◦ To meet their personal needs
To live as independently as possible
To have the best possible quality of life
55. Aims: cont.
•This implies that we have to
•Increase their functioning and independence
•Support of AAC users
•Expect more from them
•Give them greater self-fulfillment
•More control over their environment
56. The aim of AAC-cont.
1. The ultimate goal of AAC intervention is ACCESS TO
and the LEARNING OF LANGUAGE, not mastery of
technology.
2. LANGUAGE THAT GETS YOU TO YOUR GOAL
3. TEACHING STRATEGIES THAT MOVE YOU TOWARD
YOUR GOAL
4. SUPPORT NETWORKS THAT SUPPORT THE GOAL
5. Address CHALLENGES TO MEETING THE GOAL
56
58. Purposes of communication interactions
1. Communication of needs/wants
2. Information transfer
3. Social closeness
4. Social etiquette
5. Communication with oneself/internal dialogue
58
59. 1. Communication of needs/wants
Goal is to regulate the behaviour of the listener
toward an action-oriented response
Content of the message is important
Vocabulary is relatively predictable
Accuracy & rate of message production are critical
Predominate many communication systems
59
60. 2. Information transfer
Some messages complex & difficult to convey
Content of the message is important
Messages novel (not predictable)
Allow speaker to discuss a wide variety of topics
Accuracy & rate of message production critical
60
61. 3. Social closeness
Goal relates to:
Establishing
Maintaining or
Developing personal relationships
Content of message is less important than
interaction itself
Rate, accuracy & content of message &
Independence of person communication are
secondary to feelings achieved thru interaction
(connectedness & intimacy)
61
62. 4. Social etiquette
Goal is to conform to social
conventions of politeness
Vocabulary predictable
Rate, accuracy & communicative
independence are important
factors for success
62
63. 5.Internal dialogue
Helps to stay organised on a day-to- day basis
List
Calendar entries
Daily to-do lists/schedules
Diaries/journals
Future objectives
63
65. What competent communicators are able
to do?
Portray a positive self-image to their communication
partners
Show interest in others & draw others into
interactions
Actively participate & take turns in a symmetrical
fashion
Be responsive to their communication partners
Put their partners at ease with their AAC system e.g.;
introductory strategy, humor & predictable, readable
non-verbal signals
65
67. Linguistic competence
Receptive & expressive language
skills
Knowledge of linguistic code (line
drawings, words, signs etc)
Parents, friends, & facilitators
important in helping AAC user to
learn tasks
67
68. Operational competence
Technical skills needed to
operate the AAC system
accurately & efficiently
Training on operational &
maintenance aspects of
device/system
68
73. Disadvantages (Musselwhite & St. Louis,1988)
1. AAC systems not typical systems of comm & may
not be reinforced by natural speakers
2. Reluctance from comm partners as they may feel it
represents giving up on vocal lang.
3. Comm. Partners may be unable to receive or
understand the message
4. Comm. Partners may be unwilling to take the time
necessary to receive message or converse
5. AAC systems may not be affordable
Training of significant others
73
74. Advantages (Musselwhite & St. Louis,1988)
1. AAC systems may provide 2 simultaneous inputs (Auditory
& Visual)
2. AAC systems do not inhibit development of vocal language
3. AAC systems may serve various purposes relative to vocal
language
Interim comm system
Speech/language facilitation
Supplement to vocal language
Primary communication system
4. AAC systems are typically more static
5. More amenable to physical prompting
74
75. Principles of AAC
Assessment must always take a team
approach
Person being assessed is “captain of the team”
Multi-modal/ multi-sensory
communication
Multi-component communication
76. Multi-component communication
Question:
will AAC not inhibit speech development – rather rely on AAC device and
not develop speech?
AAC systems should be part of a multi-modal approach to
communication
Children use their verbal skills to communicate part of their message
Use AAC for the portions of speech that are not sufficiently intelligible
AAC augments speech rather than replace the development of
speech
77. Principles of AAC assessment
Numerous areas of an individual’ s needs
must be determined to provide the most
appropriate and functional communication
system
The principles of AAC systems are built around
The physical usability of the systems
Various types of symbolic representation that will
meet the individual’s individual needs
78. Multi-modal approach
AAC systems should be part of a multi-modal
approach to communication
Children use their verbal skills to communicate part of their
message
Use AAC for the portions of speech that are not sufficiently
intelligible
Parents should be made aware that AAC augment
speech rather than replace the development of
speech
79. Multi-modal approach (cont.)
People with severe disabilities –
Rely on:
specialized gestures,
sign language
Communication aids:
Charts, bracelets, language boards
Object represented by pictures, drawings, letters,
words, symbols, or any combination thereof
80. Discussion:
Disorders that commonly involve AAC
◦ Each group prepare to discuss the following (table format for each disorder):
What it is? (aetiology)
Symptoms?
How can the population benefit from AAC treatment approaches?
1. Cerebral Palsy
2. Degenerative neuro-motor diseases (ALS, Parkinson’s)
3. Aphasia
4. Mental Retardation
5. Traumatic Brain Injury
6. Apraxia
7. Autism
81. Conclusive remarks
AAC is a multi-disciplinary field
Involves electronic and non-electronic systems
Includes three areas of information
People (teams, individuals with specific disabilities)
Processes (e.g. assessment, intervention)
Procedures (signing, scanning, pointing)
Who benefits from AAC?
Children: variety of severe physical and communication -
Begin fairly early!
Communication impairments may benefit from AAC - Adults
: congenital or acquired disabilities
82. NB: for next Quiz
Refer to Myths about AAC -
AAC A way of thinking
https://journals.lww.com/iycjournal/Fulltext/2005/07000/Aug
mentative_Communication_and_Early_Intervention_.2.aspx
