Creating opportunities for AAC use: All day every day

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Workshop in Benalla, Victoria

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  • Cases – Otterbox defender, dropped from balcony onto concrete, fell off travelling car. Heavy reliable case. Adds weight. iBallz 4 rubber balls and trapeze adds little weight. Cushions no matter how it falls. Speakers – iadapter, xmini can be daisy chained, Bluetooth options iPad Mounts – wheelchair, stands geekslp has reviewed a lot of them, link on spec web Stands
  • Creating opportunities for AAC use: All day every day

    1. 1. Creating Opportunities for AAC Use: All Day, Every Day
    2. 2. Charlene CullenInclusive Technology ConsultantSpeech Pathologist
    3. 3. Tell me about...• What you have communicated so far today• How you communicated• Why did you communicate?
    4. 4. Communication helps us to• Chat• Get what we need and want• Enhance our lives • We can.. greet, comment, make requests, protest/reject, give opinions, answer questions and more!
    5. 5. AAC• People with complex communication needs use augmentative or alternative communication (AAC) strategies
    6. 6. What is AAC?
    7. 7. Augmentative and Alternative Communication (AAC)• Augmentative Communication uses other forms of communication (e.g. pictures, gestures, signing) with speech• Alternative Communication uses other forms of communication instead of speech
    8. 8. What AAC strategies have you used?
    9. 9. Unaided and Aided AAC• Unaided AAC: All techniques that do not require any physical aids• Aided AAC: Techniques where some type of physical object or device is used. Aided AAC is often divided into high technology or low/light technology systems.(Speech Pathology Australia AAC Position Paper 2004)
    10. 10. Unaided AAC
    11. 11. Aided AAC• Messages (words, phrases, sentences) are symbolically represented as photographs, line drawings, tangible objects or letters/words.
    12. 12. Low/Light Tech AAC
    13. 13. High Tech AAC• Custom Speech Generating Devices• Mainstream Technology • iPod touch/iPad • Android Phones/Tablets • Laptops
    14. 14. AAC Myths and Legends• Will stop someone from developing speech• Low tech before High tech• Has a little speech so doesn’t need AAC• Too cognitively impaired• Will fix all communication difficulties• No need, as person can express basic needs
    15. 15. AAC Myths and Legends - Resources• DynaVox Implementation Toolkit http://www.dynavoxtech.com/implementation-toolkit/l• Romski, M.A. & Sevcik, R.A. (2005). Augmentative communication and early intervention: Myths and realities. Infants & Young Children, 18:3, 174-185.• YAACK http://aac.unl.edu/yaack/
    16. 16. AAC Myths and Legends - Resources
    17. 17. So how do we introduce AAC?
    18. 18. Good practice approaches• Aided Language Displays (ALDs)• Engineering the Environment• PODD• Core Vocabulary• CHAT Now
    19. 19. Aided Language Displays
    20. 20. Aided Language Displays• Use a teaching method called Aided Language Stimulation• Requires modelling language using aided symbols• Individuals learn to communicate in the way they experience the system of communication being used
    21. 21. Let’s have a look
    22. 22. Aided Language Displays• No one would dispute the fact that it would be very difficult to become a fluent speaker of French, if your instructor seldom used French in your presence.• Likewise, it is difficult for a nonspeaker to become a proficient AAC user if other people never model interactive use of their system during all aspects of the day.
    23. 23. Aided Language Displays• Prospective users must be provided with frequent examples of interactive, generative use to acquire any semblance of proficiency.
    24. 24. Have a go!
    25. 25. Aided Language Displays• Aided Language Displays are NOT choice making boards.• Choice making boards supplement ALDs.• E.g. during lunch time there is a choice board for foods followed by lunch conversation board
    26. 26. Lunchtime ALD
    27. 27. Aided Language Displays• If an individual is to gain proficiency in using their aided AAC systems, others must begin to use the AAC system to communicate with them.
    28. 28. Creating ALDs
    29. 29. Choosing activities for ALDs• What happens across the day?• How frequently does it occur?• What activities are motivating?
    30. 30. Aided Language Displays• If you cannot use a communication system or display throughout an interaction then how can you provide modelling?• If you cannot use it, is it designed well?
    31. 31. Choosing messages for ALDs• Should enable you to keep a running commentary of an activity.• Should always be messages that the user could “say”.• 16 - 36 messages per activity• Write them down and rank them
    32. 32. Food preparation – word based 1. Let me 13. Careful 25. Burn 2. More 14. Finished 26. Hurry 3. Get 15. Turn on 27. Set the timer 4. Open 16. Turn off 28. Cold 5. Put in 17. Hot 29. Cook 6. Stir 18. Look 30. Cut 7. No, don’t 19. Smell 31. Where 8. Yuck 20. Pour 32. What? 9. Uh oh 21. Make 33. When? 10. Taste 22. Spill 34. Please 11. Take out 23. Bowl 35. Spread 12. Good 24. Spoon 36. Close
    33. 33. Food preparation – Phrase/Sentence based 1. Let me 13. It’s hot 25. It’s done 2. Put it in 14. This is fun 26. Turn it off 3. Open it 15. Tastes yummy 27. Wanna save it for later 4. Turn it on 16. Not done yet 28. It’s your turn 5. Need some more 17. I know how 29. Help me please 6. No, don’t! 18. Take it out 30. Smells good 7. It’s yuckie 19. That’s too much 31. My mum makes this 8. Uh ohhh 20. I think it’s burning 32. It’s all gone 9. Be careful! 21. That’s my favourite 33. What a mess! 10. You forgot! 22. It’s not your turn 34. It’s cold 11. Is it done yet? 23. Can I take some home 35. Close it 12. That’s enough 24. Don’t forget 36. Gotta clean up
    34. 34. Words or phrases on ALDs?• Cognitive level of the user• Language goals• Selection technique• Time dependent nature of the activity
    35. 35. Have a go!• Choose a motivating high frequency activity• Fold paper to 4 x 3 grid• Design an ALD• Remember to include vocabulary such as names, actions, positions, requests, commands....
    36. 36. Software for making ALDs• Online: • http://connectability.ca/visuals-engine/ • http://mrsriley.com/home• Boardmaker Software Family• Matrix Maker
    37. 37. www.boardmakershare.com
    38. 38. Selection Technique• Finger point, Fist point, Eye point, Head pointer, Scanning• Must not be too physically taxing• Can work on a new technique in other activities while an easy technique is used for communication
    39. 39. ALD format• 9 cell, 12 cell, 16 cell, 32 cell, 36 cell etc• Matrix or horse shoe
    40. 40. Meaningful learning• Often we teach in stimulus response activities eg. Find the shoes, find pants• Need to teach in contexts that allow the adult to see symbols being used • repeatedly • interactively • and generatively during meaningful activity
    41. 41. Meaningful learning• By modelling how to use a display to initiate and maintain communication, you show the adult how to initiate and maintain – not just respond!
    42. 42. Meaningful Learning• May help to “script” activities• Needs to occur at least 80% of the time• Slow and a few concepts to begin with, gradually increasing in speed and complexity.
    43. 43. Engineering the Environment• Storage • Must be stored in close proximity to where they are needed • Must be stored in a way that helps with quick access and set-up • E.g. on back of bookshelf, on walls, cupboard doors, on tables, inside the recipe folder, on kitchen pin up board
    44. 44. Engineering the Environment
    45. 45. Engineering the Environment
    46. 46. Pragmatics• Pragmatics – social use of language• Using language for different purposes, such as greeting, informing, demanding, promising, requesting• Changing language according to the needs of the listener• Following conversational rules www.asha.org
    47. 47. Pragmatics• Need to ensure AAC users have access to and know how to use a range of pragmatic skills• Dewart and Summers “Pragmatics Profile” (1998)• http://wwwedit.wmin.ac.uk/psychology/pp/
    48. 48. PODD• PODDs have been developed over the past 15 years by Gayle Porter, a speech pathologist with the Cerebral Palsy Education Centre (CPEC) in Victoria. Each PODD format has been shaped by the experiences of both children with Complex Communication Needs (CCN), and their communication partners.
    49. 49. PODD• PODD is a way of organising whole word and symbol vocabulary in a communication book or speech generating device to provide immersion and modelling for learning.
    50. 50. PODD• The aim of a PODD is to provide vocabulary: • for continuous communication all the time • for a range of messages • across a range of topics • in multiple environments.
    51. 51. PODD• PODDs can have different formats, depending on the individual physical, sensory and communication needs of the person who will use it.
    52. 52. Let’s have a look....
    53. 53. Core Vocabulary• Using common English words on an AAC display to enable a user to construct their own sentences.• Approach used in lots of high tech systems but not used as much in low tech due to difficulty of arranging vocabulary for access.
    54. 54. Core Vocabulary• FRINGE VOCAB • CORE VOCAB• Low frequency words • High frequency words• Only useful in one or • Can be combined to two situations get your message• Often related to a across in lots of specific topic different situations
    55. 55. Core Vocabulary
    56. 56. Core Vocabulary•WordPower 24 in TouchChat, AAC App
    57. 57. Core Vocab to supplement ALDS• From the Disability Services Commission WA http://www.boardmakershare.com/Activity/969086/Core-Vocabulary-Display
    58. 58. Speak for Yourself• Uses core vocabulary• 13,000 words and only up to 2 key presses• Gives user enough language so that language development isn’t held back• Allows enough language for good modelling throughout the day
    59. 59. CHAT-Now• General interactive multi-level
    60. 60. Technology
    61. 61. High Tech and Light Tech• Both are just tools• Both need good vocabulary design and good modelling to ensure success• High Tech can be less forgiving but can offer more access options• Some students more motivated by high tech and some don’t like it!!• Most people need both – for different situations
    62. 62. Speech Generating Devices• DYNAMIC DISPLAY • STATIC DISPLAY
    63. 63. Static Display• May be more durable• Generally cheaper• Often run off AA or AAA batteries• Overlay based - require Boardmaker or other tool• Need to work out system for storing and changing overlays• Need to ensure vocabulary is updated• Harder to maintain in many ways
    64. 64. Dynamic Display• May be more durable• Usually rechargeable• Tools for generating pages in device – and sometimes in free software too• Can change vocabulary on the spot• Can change pages and levels easily• Generally offer a wider range of access options
    65. 65. Access Options• For a user who need alternative access, SGDs can offer: • Large range of access options • Flexibility • Complete control over device and other software
    66. 66. Mobile devices
    67. 67. What’s a good app?Many AAC apps don’t reflect good practice• 20% AAC apps are category based apps• Some don’t include speech• Some app manuals advise use of the app a couple times per week until competence improves
    68. 68. Apps for AAChttp://www.spectronicsinoz.com/article/iphoneipad-apps
    69. 69. Apps for AAC• Tap Speak Sequence• Tap Speak Choice• Scene & Heard• Touch Chat HD• Verbally• Predictable• RIDBC Auslan Tutor
    70. 70. AccessBlue2 Bluetooth Switch Switchbox Switch4Apps By Ablenet by Therapy Box by Pretorian
    71. 71. Access
    72. 72. Accessories
    73. 73. Let’s have a look
    74. 74. Have a look! Think about: • Vocabulary • Ease of programming? • Access options • Portability and size • Try programming a message • Who might benefit from using it? • What situations could you use it for?
    75. 75. InterAACtion Manual and CD• resource is for people who live or work with adults who have communication impairment• Ideas for age-appropriate communication ideas• Templates and steps to develop your own communication aids
    76. 76. Communication about the individual• About Me Books/Communication Passports• Personal Communication Dictionary
    77. 77. About Me Books• Also known as Communication Passports• For support people• Gives information about how the person likes to be supported during daily routines• Useful for exchanging information about an AAC User between others• Often not a tool used by the AAC user directly
    78. 78. Communication Passports• Template available from CALL Centre Scotland• www.communicationpassports.org.uk• iPhone App coming soon• Also from SCOPE UK at http://www.scope.org.uk/help-and-information/publica
    79. 79. Apps to create Passports• Pictello, Creative Book Builder, Click n’ Talk, Story Patch• Encourage AAC User to participate in creating the book• Model using it multiple times• Keep low tech back ups too!
    80. 80. Personal Communication Dictionary• A Personal communication dictionary records and suggests meanings for the unique gestures, body language, facial expressions, and vocalisations of people who appear not to have any formal method of communication
    81. 81. Personal Communication Dictionary
    82. 82. Additional AAC options• Community Request Cards• Chat Book/ Personal Storytelling• Small Talk• Social Scripts
    83. 83. Community Request Cards• to request a service or object• only need to have a “passing” behaviour• Use large print for easy reading for communication partner and symbol for person who uses AAC• Must be self explanatory• Specific to person and situation
    84. 84. Community Request Card apps• Most of them can be used this way if they are editable• TapSpeak Button, TapSpeak Sequence and Scene & Heard etc
    85. 85. Social Communication• Social communication is a BIG part of our day.• We use different forms of social communication – small talk, storytelling, greetings, wrap ups and farewells.
    86. 86. Social Communication• Social communication is more than 50% of our daily conversation.• Light (1998) found that reasons for communication between adults were (in ranked order) • Social closeness • Social etiquette • Information transfer • Wants and Needs
    87. 87. Small Talk
    88. 88. Small Talk• A type of conversational exchange used for initiating and maintaining conversational interaction.• Some conversation never progresses beyond small talk e.g. at a cocktail party.
    89. 89. Small Talk• Small talk is used as a transition between the greeting and information sharing stage, especially when people don’t know each other well or don’t possess a lot of shared information.• Small talk is often the first step towards social closeness.• There are even websites to teach you how to small talk
    90. 90. AAC Users and Small Talk• Many AAC users use little or no small talk• This can be because • They don’t have access to small talk in their communication system • They don’t see the need for it • They think it is a waste of time.• Light and Binger (1998) found that AAC users were seen as more intelligent, valued and competent communication partners if they used small talk.
    91. 91. Generic Small Talk Generic Specific• people can use with a variety Small Talk Small Talk of different conversational How is your How is your partners because it doesn’t family? wife? refer to specific shared What’s What are information. happening? you doing?• Particularly effective for many Don’t you Nice AAC users as it has many look nice! haircut. She’s She’s a different uses. great. great teacher.
    92. 92. Generic Small Talk• researchers looked at the frequency and types of generic small talk used by speakers of various ages without disabilities. • 3 – 5 year olds - 48% of all utterances at both home and pre- school/school were generic small talk • 20 – 30 year olds - 39% of all utterances were generic small talk • 65 – 74 year olds – 31% of all utterances were generic small talk • 75 – 85 year olds – 26% of all utterances were generic small talk
    93. 93. Generic Small Talk• Most of the age groups used continuers as the most common form of small talk eg. Really? Yeah? Great! Cool!• Some words were specific to certain age groups e.g. “bummer” used only by the 25 – 35 year olds• Differences also based on friendship groups, geographical location, interests and life experiences.
    94. 94. Small Talk and Mealtimes• Balandin and Iacono (2000) tried to script the content-specific vocabulary needed for mealtimes for an adult in the workplace• In this situation, the only predictable thing was small talk (and often sports after the weekend!)
    95. 95. Adult Generic Small Talk Try it out…
    96. 96. Adult Generic Small Talk
    97. 97. George’s Small Talk
    98. 98. George’s Small Talk• Young man with athetoid cerebral palsy• Attends a day centre for adults• Uses a device but only uses the spelling page• Controls communication device with a head switch
    99. 99. George’s Small Talk• Over 20 other people with disabilities and 6 staff attended George’s centre, most of whom talked• George rarely used his device during the day• Staff requested a review of his device because he didn’t “ever” use it
    100. 100. George’s Small Talk• A speech pathology student observed him in two sessions. He “used” his device constantly but only spoke with it twice• She observed that by the time he had formulated a message the conversation had moved on and he erased and moved onto a new message• A two pronged approach was used • A conversational topic was established before each group e.g. “What are your favourite films?” and then George could compose messages in advance • A small talk page was programmed and George practiced using this in one-to-one and then small group conversation
    101. 101. George’s Small Talk• At the end of 8 weeks the same speech pathology student observed George in the same two sessions• George used his device 46 times - 5 of these were topic setters, 41 were small talk continuers• Several other people in the centre commented spontaneously that “George was much cleverer than they thought” or that “They enjoyed talking to George much more”
    102. 102. Fat Cat Snappy Chat• One of a series of apps• Addresses areas of weakness in AAC systems or that AAC users don’t use• Small Talk in Snappy Chat• Communication Breakdown in Chat Repair• Useful in combination with other systems not stand alone
    103. 103. Sequenced Social Scripts
    104. 104. Sequenced Social Scripts• Sequenced social scripts can really help a user to • Get a feel for the anatomy of a conversation • Develop turntaking skills • Learn to interact with a variety of partners • Enjoy successful interactions
    105. 105. What are Social Scripts?• support individuals in learning to claim, start, and maintain turns in a conversation• Also called Participation Scripts• Much of the information in this section is taken from “Can We Chat? Co-Planned Sequenced Social Scripts: A Make It / Take It Book of Ideas and Adaptations” by Caroline Musselwhite and Linda Burkhart
    106. 106. What are Social Scripts?• Social Scripts are interactions such as joke- telling, sharing life stories and general conversations• They help persons using AAC move beyond wants and needs to using real communication for conversational purposes• Often give developing communicators a sense of the power of communication
    107. 107. Anatomy of a social script• Attention getters• Starters• Maintainers, holders and interjections• Turn transfers• Closings
    108. 108. Attention Getters• These are the phrases that start an interaction and make sure that someone is ready to listen• Creative attention getters can motivate a listener to be interested in hearing more• They can also change perceptions of others about the person who is using the script, by conveying, humor, age appropriateness, and initiative• AND they can be very motivating to use!
    109. 109. Hey, you guysWaz upDudeYoHellooCome hereLet’s talk
    110. 110. Starters• Once attention is gained, starters set the stage for what the person will be talking about• Setting the context further prepares the listener and allows the person to take charge of the conversation• Like attention getters, creative starters pique the interest of the listener and often get a natural response that encourages the person to go on and tell the story, complete the joke, etc.
    111. 111. Guess what I did?I have a secret!Wait till you hear what I heard!You won’t believe thisDid you see the game?I’ve got something to show youWanna hear a joke?
    112. 112. Maintainers, Holders and Interjections• Phrases such as "Shall I give you a hint?", "You know what happened next", "You will never believe what she said after that“ etc.• Allow the person to add interest to the basic story line while maintaining control of the conversation• They also prompt the listener to make comments and naturally encourage the person to tell the rest of the story
    113. 113. It was so funnyGuess what happened next?Wanna hint?I hate that!Can you guess?I’ll give you a clueIt was so embarrassingAnd then it got even worse
    114. 114. Turn Transfers• After the person has communicated his story, or sometimes in the middle of a longer story, turn transfers invite the listener to comment or give their opinion• They give the person the power of turning the conversation over to a partner, without ending the conversation
    115. 115. What do you think?Isn’t it amazing?Can you believe it?You won’t tell anyone will you?How about you?Is that amazing or what?What did you see?
    116. 116. Closings• Closings allow the person to take the initiative of ending the conversation• It helps the listener and also avoids that awkward feeling of “well is that all?”• Again the person’s personality and humor comes through in the choice of closings used• Often several closings in sequence are appropriate, because people typically take several turns when finishing a conversion
    117. 117. Nice chatting with youEnough about thatWhat have you been up to?Catch you laterCan you find someone else for me to tellabout this?Hasta la vista baby
    118. 118. TapSpeak Sequence• Opportunity for quick errorless communication • Jokes • News • Cheering at sports events • Gossip • Messages • Interviews etc.
    119. 119. Have a go!• In pairs pick a topic e.g. Joke, prank, gossip, message• Generate a sequenced social script• Find another pair and try your script out
    120. 120. Personal Storytelling• As we get older the percentage of small talk decreases and the percentage of storytelling increases• Older adults, in particular, use stories to entertain, teach and establish social closeness with their peers
    121. 121. AAC and Storytelling• Storytelling with AAC systems has become practical and possible with improved technology• However, we must be careful that the stories are ones which the person would choose to tell• Storytelling is very personal and must be individualized
    122. 122. Alexicom Elements Story Maker• We build social closeness through storytelling• We use stories to identify people we might want to be friends with• This app allows storytelling on the fly – easy to add pages as you go between
    123. 123. Michael’s Storytelling• Michael is a young teenage boy• Lives with his Mum, Dad and brother in Perth• He has intellectual disability• He uses gestures, words, sounds, facial expression and a Maestro for communication
    124. 124. The Royal Show
    125. 125. The Royal Show• 1 We went to the Royal Show• 2 I like to go up the Ferris Wheel• 3 I petted the baby animals• 5 The Katich family came with us too• 6 Daddy & I went on the bumper cars• 7 We watched some people chop wood• 8 Mummy bought us some fairy floss• 9 Fireworks• 10 Money• 11 We had to buy some tickets• 12 We had something to eat
    126. 126. Sarah’s Storytelling
    127. 127. Sarah’s Storytelling• In her forties she was in a motor vehicle accident and is now a quadriplegic• She has a good understanding of spoken English but very limited expressive communication, including very little facial expression• She has control of a single switch with her left thumb, but tends to fatigue quickly, although her stamina is increasing• She has a multi-level communication book which she accesses with eye pointing
    128. 128. Sarah’s Storytelling• She has a range of in-house care staff who tend to stay around for between 5 months and 3 years• Many of these staff assume she doesn’t understand what is said to her because she doesn’t give body language feedback
    129. 129. Sarah’s Chat Book Inside this book are some of my photos. The writing tells you about them. The questions are things I am interested inabout you. Please read out the writing and the questions and we can find out about each other together - but be warned - it might take more than one visit! Sarah
    130. 130. This is the first decent photo of me - sitting at the piano when I was 11 like a good girl! You won’t see that often. •Did you learn an instrument? If so, what was it?
    131. 131. •Me and my cat in 1955. I’m the one on the right.•Did you have a pet as a child. If so, what was it? •What was its name?
    132. 132. •The wedding day - myself and Pete.
    133. 133. •Peter loved sailing. This was a fantastic day. It would have been sometime in 1984. •Have you ever been sailing? Do you like it?
    134. 134. •On the 12th of July 1985, Pete and I were hit by a car as we were walking to a restaurant for dinner •My life completely changed after that. Pete died as a result of the accident and I am now severely physically disabled•Pete and I had over six wonderful years together. I still miss him very much as you can imagine•Luckily, I have many great friends and they, and my own determination, have helped me to keep going
    135. 135. Sarah’s Chat Book• Sarah’s chat book has completely changed the way staff see her• Each new staff member sits down and goes through the book with her over a few different sessions• They realise how interested Sarah is in them and they gossip with her more and it gives them topics to talk about that they think will interest her
    136. 136. Other Resources• Practical AAC http://sites.google.com/site/praacticalaac/• AAC Rerc http://aac-rerc.psu.edu/• Delicious http://www.delicious.com/chacullen/AAC• Twitter #aacapps #augcomm #TweetAAC #assitivetech #SLPeeps• Facebook Augmentative Communication Resources and Help Assistive Technology• http://www.scopevic.org.au/index.php/site/resources/communicationaids
    137. 137. W ant to learn m ore?
    138. 138. Spectronics Free Emailed Update Service!www.spectronicsinoz.com
    139. 139. Spectronics Online Training Services! www.spectronicsinoz.com/onlinetraining

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