Alternative Access:Scanning & More!Anne Davis, PCDACynthia Heryanto, NAPA Center
Areas for Discussion When is alternative access necessary? Guidelines for assessment High-tech, low-tech, no-tech, or a...
Where do you start?Language First! What intents are communicated? What methods are used to communicate? Who are the com...
Planning Tools Communication Matrix – Charity Rowland AAC Profile – Linguisystems / Tracy Kovach Dynamic AAC Goal Grid ...
Alternative Access is needed…now what? Switch Considerations 1 or 2 switches? high-tech or low-tech? Partner-assisted ...
Alternative AccessConsiderationsTake note of all body movements that are under volitionalcontrol If they can move it on p...
Remember fatigue!Using an AAC system is hard work!The benefit of using the system mustoutweigh the effort.The body of some...
Auditory ScanningPartner Assisted Dependent on partner Timing and accuracy lesscritical Partner observation,interpretat...
Choosing the Right Switch Motor movement Body Part Amount of force Targeting/Size Sensory feedback**Downloadable hand...
Other Equipment forSwitch Access Switch mount Switch interface
Feature Matching Auditory, Visual, Zoom Scanning Support for private speaker or change in voice for cue vs.speech output...
Choosing a Language System How will the system grow with the client? As more language and competency are gained willexte...
Partner-AssistedScanning Systems
Pragmatically OrganizedDynamic Display“PODD is a way of organizing whole word and symbolvocabulary in a communication book...
Using a PODD for AuditoryScanning Partner-Assisted Auditory Scanning Auditory Scanning to access a speech-generatingdevi...
Language Planning:Emergent Communicator Uses facial expression, body language, gestures, and/or behaviors(either socially...
Case Study:Emergent Communicator 8 years old, Dx of epilepsy and congenital disorder ofglycosylation, global hypotonia H...
EC: Case Study 2 4 year old girl s/p cardiac arrest and resuscitation at 14months with hypoxic brain injury resulting in ...
EC: Case Study 2 continued Presenting communication:facial expressionaffective vocalizationschanges in muscle toneoccasio...
Switch Use in Assessment Positioning challenges Lots of equipment; No one solution for all situationsFirst Solutions:foo...
Recommended GoalsFollowing Assessment When adequately positioned with a mounted voiceoutput device, child will independen...
Recommended GoalsFollowing Assessment Child will choose between two enjoyable activities presented viapartner assisted au...
Practicing Switch Use from aDIR PerspectiveEven before requesting:establish a sense of trust, shared attention andemotiona...
Where do we go from here? Organized scanning system More options for playful use of language and socialinteraction Need...
Language Planning: ContextDependent Communicator Understands general conversations and directions as wellas same-age peer...
CD Case Study 1 9 years old, context-dependent communicator, diagnosedwith a progressive neurological disease (no formall...
CD Case Study 1 cont. Features for language system modification Auditory scanning Row/column scanning with auditory cue...
Language Planning:Independent Communicator Understands communication the same as same-agepeers Combines single words, sp...
CD/IC Case Study 16 years-old with cerebral palsy, WNL vision and hearing,but reduced head control prevented ability to c...
CD/IC Case Study cont. Designed language system with input from L Used partner-assisted scanning to choose desired,highl...
What systems are out therefor scanners? Major dedicated devices all have the technical featuresrequired to accommodate al...
Thanks for your time!
Alternative Access - Davis, Heryanto
Alternative Access - Davis, Heryanto
Alternative Access - Davis, Heryanto
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Alternative Access - Davis, Heryanto

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For communicators who cannot touch a screen, augmentative and alternative communication (AAC) may require alternative access, such as switch scanning, eye gaze, or part

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  • George story about being stressed sitting up in chair, spending most time at home on the floor
  • PAAS is potentially less objective. Ideas can come from both the partner and the individualCognitive load is heavy
  • Story of Cameron getting distracted by click feedbackGeorge needing something to accommodate head turn, but something flexible so he wouldn’t get hurt when body tensed in atnr
  • Discuss need for practice with switches to achieve motor/operational competencyHelpkidzlearn website, computer software (choose & tell), Linda Burkhart classroom suite activitiesiPad apps: choose with caution depending on switch interface
  • Consideration for operational and strategic competence is significant with this population
  • Pass around PODD and flip-book
  • PODDs can have different formats, depending on the individual physical, sensory and communication needs of the person who will use it.
  • - In addition to requesting, also use step-by-step to share an “app of the day” with people around clinic to address social commUse single-message VOCA to call out for attention she has limited communicative intents
  • Anne’s case AGY
  • Open shut with bus tentRoll overWash your hands
  • Tell story of Sophia & Lueza’s story buttons that were programmable to act as sequenced messenger once activated… on iPad would have to go to a different app to get that functionality (go from tapspeak choice to tapspeak button)
  • Alternative Access - Davis, Heryanto

    1. 1. Alternative Access:Scanning & More!Anne Davis, PCDACynthia Heryanto, NAPA Center
    2. 2. Areas for Discussion When is alternative access necessary? Guidelines for assessment High-tech, low-tech, no-tech, or a combination? Design of language systems for AAC users at differentcompetency levels Review of ready-made systems available
    3. 3. Where do you start?Language First! What intents are communicated? What methods are used to communicate? Who are the communication partners?…Technology Second Gross and fine motor Sensory system Seating and positioning
    4. 4. Planning Tools Communication Matrix – Charity Rowland AAC Profile – Linguisystems / Tracy Kovach Dynamic AAC Goal Grid & InterAACT Framework –DynaVox Mayer-Johnson Functional Communication Profile - Linguisystems
    5. 5. Alternative Access is needed…now what? Switch Considerations 1 or 2 switches? high-tech or low-tech? Partner-assisted Options PODD system? E-tran? Eye Gaze
    6. 6. Alternative AccessConsiderationsTake note of all body movements that are under volitionalcontrol If they can move it on purpose, there is likely a switch for it!2 switches are better than 1 Step-scanning is cognitively less demanding than single-switchscanning and typically puts the user in more controlCommunication occurs all day, but no one will be seated in awheelchair with switch access all day A no-tech/partner-assisted scanning solution should always beconsideredAnd most importantly…
    7. 7. Remember fatigue!Using an AAC system is hard work!The benefit of using the system mustoutweigh the effort.The body of someone who requires alternativeaccess is already constantly working hardjust to maintain itself.
    8. 8. Auditory ScanningPartner Assisted Dependent on partner Timing and accuracy lesscritical Partner observation,interpretation and socialresponsiveness can improvecommunicative successElectronic Independent initiation Timing and accuracyessential Auditory confusion Electronic consistency couldlead to more consistentmotor practice with betterestablishment of motorpatterns
    9. 9. Choosing the Right Switch Motor movement Body Part Amount of force Targeting/Size Sensory feedback**Downloadable handout from Enabling Devices
    10. 10. Other Equipment forSwitch Access Switch mount Switch interface
    11. 11. Feature Matching Auditory, Visual, Zoom Scanning Support for private speaker or change in voice for cue vs.speech output with auditory scan Linear, Row/Column, Quadrant Step, Inverse, Autoscan
    12. 12. Choosing a Language System How will the system grow with the client? As more language and competency are gained willextensive programming be required to make language easilyaccessible for scanning? Does the system have all of the features needed to allow forsuccessful access to the language in the system? Pages with consistent & predictable formatting Start of scan can be set to default to first item of page to allowfor motor planning Dedicated system vs. iPad app
    13. 13. Partner-AssistedScanning Systems
    14. 14. Pragmatically OrganizedDynamic Display“PODD is a way of organizing whole word and symbolvocabulary in a communication book or speech generatingdevice to provide immersion and modeling for learning. 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.”Developed by Gayle Porter. Templates available throughInclusive Learning Technologies
    15. 15. Using a PODD for AuditoryScanning Partner-Assisted Auditory Scanning Auditory Scanning to access a speech-generatingdeviceGoals of auditory scanning (Linda Burkhart, 2004)Communicating as:intelligibly, specifically, efficiently, independently andsocially as possible
    16. 16. Language Planning:Emergent Communicator Uses facial expression, body language, gestures, and/or behaviors(either socially appropriate or challenging) to communicate May be starting to use clear and simple symbols to make choices May show some variability in both understanding and expression fromday-to-day or activity-to-activity Relies on communication partner to be a successful communicator Any switch scanning will be Linear May use pages on device that have preprogrammed context-specificmessages that may be used in an errorless fashion for participation
    17. 17. Case Study:Emergent Communicator 8 years old, Dx of epilepsy and congenital disorder ofglycosylation, global hypotonia Has approximately 5-10 seizures per hour (typicallylasting 2-3 seconds), with alertness fluctuating basedon seizure activity day-to-day Primarily communicates through gestures and facialexpression interpreted by caregivers Communication isn’t consistently directed towardsothers Working on developing communication initiationthrough vocalization and beginning switch use forrequesting preferred items
    18. 18. EC: Case Study 2 4 year old girl s/p cardiac arrest and resuscitation at 14months with hypoxic brain injury resulting in 3 monthhospitalization, placement of pacemaker, tracheostomy,and gastrostomy tube Severely limited movement, poor head and trunkcontrol Cortical visual impairment (later diagnosed with opticnerve atrophy). Peripheral vision best
    19. 19. EC: Case Study 2 continued Presenting communication:facial expressionaffective vocalizationschanges in muscle toneoccasional word approximations during high affect play(had a 10-15 word expressive vocabulary per reportprior to brain injury)
    20. 20. Switch Use in Assessment Positioning challenges Lots of equipment; No one solution for all situationsFirst Solutions:foot switchfeather light switch attached to her right thighCommunicative Activity:calling her mother using a Big Mack switch
    21. 21. Recommended GoalsFollowing Assessment When adequately positioned with a mounted voiceoutput device, child will independently access a singleswitch to initiate interaction with a familiar person aminimum of five times per week in two differentcommunication environments (home, school, clinic)during two out of three consecutive weeks. Child will spontaneously vocalize to gain attention andinitiate communication a minimum of five times perweek in three different communication environmentsduring two out of three consecutive weeks.
    22. 22. Recommended GoalsFollowing Assessment Child will choose between two enjoyable activities presented viapartner assisted auditory scanning by producing a consistent, pre-determined movement to indicate yes or no in 2 out of 3opportunities during 3 out of 4 consecutive sessions. Child will independently indicate yes and no using head or bodymovements or an AAC device to affirm/ accept and deny/ refusewith 80% accuracy during 2 out of 3 consecutive sessions. Child will demonstrate three movements that she can makeconsistently on request with 70% accuracy in more than oneposition to improve her ability to communicate throughspontaneous initiation and independent responses
    23. 23. Practicing Switch Use from aDIR PerspectiveEven before requesting:establish a sense of trust, shared attention andemotional attunement (DIR ® Milestone I)develop a repertoire of shared pleasurable interactions(DIR ® Milestone II)Strategies: Singing songs together using a singlemessage VOCA, language routines and expectantpausePlay routines that involved passive movement
    24. 24. Where do we go from here? Organized scanning system More options for playful use of language and socialinteraction Needs a system that will enable her to start learning tocombine ideas and generate novel thoughts
    25. 25. Language Planning: ContextDependent Communicator Understands general conversations and directions as wellas same-age peers Uses symbols and objects spontaneously to communicatebasic needs Beginning to combine 2 or more symbols to create longerand more complex messages Large vocabulary means that row-column and/or quadrantscanning may be necessary Communicate best in routines regarding familiar topics Developing literacy skills
    26. 26. CD Case Study 1 9 years old, context-dependent communicator, diagnosedwith a progressive neurological disease (no formally knowndiagnosis), CVI Had a clear yes/no, comprehension of conversations aroundher, highly motivated by social interaction Had a Vanguard using Unity 45 Full, accessed with 2-headswitches, and row/column scanning with auditory cues Was having difficulty navigating within Unity; accessedmainly fringe vocabulary in activity rows, and customizedcontext-specific pages
    27. 27. CD Case Study 1 cont. Features for language system modification Auditory scanning Row/column scanning with auditory cues Re-arrange core icons into new rows by category with auditorycues signaling the content of each category Re-arrange vocabulary on 2nd hit screens to fit with word/phrasetype row categories Due to fatigue, needed a variety of language to be accessiblewithin very few hits Access to a complex partner-assisted scanning system dueto inability to access device when out of chair, and need forfrequent breaks from sitting up
    28. 28. Language Planning:Independent Communicator Understands communication the same as same-agepeers Combines single words, spelling and phrases togetherto communicate about a variety of subjects as otherswould at his/her age Literacy and social skills on par with same-age peers Large vocabulary means that row-column and/orquadrant scanning likely necessary
    29. 29. CD/IC Case Study 16 years-old with cerebral palsy, WNL vision and hearing,but reduced head control prevented ability to consistentlylook at screen, making auditory scanning necessary Used Vantage Lite with 84-button custom set-up with 1-switch auto-scan in row/column scanning Accessed device by pulling arm up to activate string switchplaced around her wrist Extensive site word vocabulary, but not fully literate Previously used Unity sequenced, but went throughextended period of significant health decline and displayedlittle interest in using AAC system post-illness
    30. 30. CD/IC Case Study cont. Designed language system with input from L Used partner-assisted scanning to choose desired,highly-motivating vocabulary Arranged vocabulary to allow for minimum selections toget to a targeted word Organized vocabulary into category rows within contentpages to allow for row auditory cues relevant to contentcontained in each row
    31. 31. What systems are out therefor scanners? Major dedicated devices all have the technical featuresrequired to accommodate all scanning/alternative accessmethods Not all have custom language sets designed with scanners inmind, but are fully customizable Prentke Romich has a page-set for an 8 location setup likelysufficient for a user between emergent and context-dependent, and a word-based set for independentcommunicators iPad AAC apps with scanning: SoundingBoard, GoTalk Now,TapSpeak Choice, TalkBoard, Alexicom, Proloquo2Go(version 3.0)* Consider these apps with caution as there are far fewer accesscustomizations available, and other features of iPad aren’tintegrated* Insertion by SCAAC-N
    32. 32. Thanks for your time!

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