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

1. Alternative Access:
Scanning & More!
Anne Davis, PCDA
Cynthia Heryanto, NAPA Center

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 different
competency levels
 Review of ready-made systems available

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. Planning Tools
 Communication Matrix – Charity Rowland
 AAC Profile – Linguisystems / Tracy Kovach
 Dynamic AAC Goal Grid & InterAACT Framework –
DynaVox Mayer-Johnson
 Functional Communication Profile - Linguisystems

6. 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

7. Alternative Access
Considerations
Take note of all body movements that are under volitional
control
 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-switch
scanning and typically puts the user in more control
Communication occurs all day, but no one will be seated in a
wheelchair with switch access all day
 A no-tech/partner-assisted scanning solution should always be
considered
And most importantly…

8. Remember fatigue!
Using an AAC system is hard work!
The benefit of using the system must
outweigh the effort.
The body of someone who requires alternative
access is already constantly working hard
just to maintain itself.

9. Auditory Scanning
Partner Assisted
 Dependent on partner
 Timing and accuracy less
critical
 Partner observation,
interpretation and social
responsiveness can improve
communicative success
Electronic
 Independent initiation
 Timing and accuracy
essential
 Auditory confusion
 Electronic consistency could
lead to more consistent
motor practice with better
establishment of motor
patterns

10. Choosing the Right Switch
 Motor movement
 Body Part
 Amount of force
 Targeting/Size
 Sensory feedback
**Downloadable handout from Enabling Devices

11. Other Equipment for
Switch Access
 Switch mount
 Switch interface

12. 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

13. Choosing a Language System
 How will the system grow with the client?
 As more language and competency are gained will
extensive programming be required to make language easily
accessible for scanning?
 Does the system have all of the features needed to allow for
successful 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 allow
for motor planning
 Dedicated system vs. iPad app

14. Partner-Assisted
Scanning Systems

15. Pragmatically Organized
Dynamic Display
“PODD is a way of organizing whole word and symbol
vocabulary in a communication book or speech generating
device 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 through
Inclusive Learning Technologies

16. Using a PODD for Auditory
Scanning
 Partner-Assisted Auditory Scanning
 Auditory Scanning to access a speech-generating
device
Goals of auditory scanning (Linda Burkhart, 2004)
Communicating as:
intelligibly, specifically, efficiently, independently and
socially as possible

17. 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 from
day-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-specific
messages that may be used in an errorless fashion for participation

18. Case Study:
Emergent Communicator
 8 years old, Dx of epilepsy and congenital disorder of
glycosylation, global hypotonia
 Has approximately 5-10 seizures per hour (typically
lasting 2-3 seconds), with alertness fluctuating based
on seizure activity day-to-day
 Primarily communicates through gestures and facial
expression interpreted by caregivers
 Communication isn’t consistently directed towards
others
 Working on developing communication initiation
through vocalization and beginning switch use for
requesting preferred items

19. EC: Case Study 2
 4 year old girl s/p cardiac arrest and resuscitation at 14
months with hypoxic brain injury resulting in 3 month
hospitalization, placement of pacemaker, tracheostomy,
and gastrostomy tube
 Severely limited movement, poor head and trunk
control
 Cortical visual impairment (later diagnosed with optic
nerve atrophy). Peripheral vision best

20. EC: Case Study 2 continued
 Presenting communication:
facial expression
affective vocalizations
changes in muscle tone
occasional word approximations during high affect play
(had a 10-15 word expressive vocabulary per report
prior to brain injury)

21. Switch Use in Assessment
 Positioning challenges
 Lots of equipment; No one solution for all situations
First Solutions:
foot switch
feather light switch attached to her right thigh
Communicative Activity:
calling her mother using a Big Mack switch

22. Recommended Goals
Following Assessment
 When adequately positioned with a mounted voice
output device, child will independently access a single
switch to initiate interaction with a familiar person a
minimum of five times per week in two different
communication environments (home, school, clinic)
during two out of three consecutive weeks.
 Child will spontaneously vocalize to gain attention and
initiate communication a minimum of five times per
week in three different communication environments
during two out of three consecutive weeks.

23. Recommended Goals
Following Assessment
 Child will choose between two enjoyable activities presented via
partner assisted auditory scanning by producing a consistent, pre-
determined movement to indicate yes or no in 2 out of 3
opportunities during 3 out of 4 consecutive sessions.
 Child will independently indicate yes and no using head or body
movements or an AAC device to affirm/ accept and deny/ refuse
with 80% accuracy during 2 out of 3 consecutive sessions.
 Child will demonstrate three movements that she can make
consistently on request with 70% accuracy in more than one
position to improve her ability to communicate through
spontaneous initiation and independent responses

24. Practicing Switch Use from a
DIR Perspective
Even before requesting:
establish a sense of trust, shared attention and
emotional attunement (DIR ® Milestone I)
develop a repertoire of shared pleasurable interactions
(DIR ® Milestone II)
Strategies: Singing songs together using a single
message VOCA, language routines and expectant
pause
Play routines that involved passive movement

25. Where do we go from here?
 Organized scanning system
 More options for playful use of language and social
interaction
 Needs a system that will enable her to start learning to
combine ideas and generate novel thoughts

26. Language Planning: Context
Dependent Communicator
 Understands general conversations and directions as well
as same-age peers
 Uses symbols and objects spontaneously to communicate
basic needs
 Beginning to combine 2 or more symbols to create longer
and more complex messages
 Large vocabulary means that row-column and/or quadrant
scanning may be necessary
 Communicate best in routines regarding familiar topics
 Developing literacy skills

27. CD Case Study 1
 9 years old, context-dependent communicator, diagnosed
with a progressive neurological disease (no formally known
diagnosis), CVI
 Had a clear yes/no, comprehension of conversations around
her, highly motivated by social interaction
 Had a Vanguard using Unity 45 Full, accessed with 2-head
switches, and row/column scanning with auditory cues
 Was having difficulty navigating within Unity; accessed
mainly fringe vocabulary in activity rows, and customized
context-specific pages

28. 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 auditory
cues signaling the content of each category
 Re-arrange vocabulary on 2nd hit screens to fit with word/phrase
type row categories
 Due to fatigue, needed a variety of language to be accessible
within very few hits
 Access to a complex partner-assisted scanning system due
to inability to access device when out of chair, and need for
frequent breaks from sitting up

30. Language Planning:
Independent Communicator
 Understands communication the same as same-age
peers
 Combines single words, spelling and phrases together
to communicate about a variety of subjects as others
would at his/her age
 Literacy and social skills on par with same-age peers
 Large vocabulary means that row-column and/or
quadrant scanning likely necessary

31. CD/IC Case Study
 16 years-old with cerebral palsy, WNL vision and hearing,
but reduced head control prevented ability to consistently
look 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 switch
placed around her wrist
 Extensive site word vocabulary, but not fully literate
 Previously used Unity sequenced, but went through
extended period of significant health decline and displayed
little interest in using AAC system post-illness

32. 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 to
get to a targeted word
 Organized vocabulary into category rows within content
pages to allow for row auditory cues relevant to content
contained in each row

34. What systems are out there
for scanners?
 Major dedicated devices all have the technical features
required to accommodate all scanning/alternative access
methods
 Not all have custom language sets designed with scanners in
mind, but are fully customizable
 Prentke Romich has a page-set for an 8 location setup likely
sufficient for a user between emergent and context-
dependent, and a word-based set for independent
communicators
 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 access
customizations available, and other features of iPad aren’t
integrated
* Insertion by SCAAC-N

35. Thanks for your time!