Introduction to AAC May 23, 2013. What is AAC? Augmentative and alternative communication refers to an area of research, clinical and educational practice.

Introduction to AAC

May 23, 2013

What is AAC?

Augmentative and alternative communication refers to an area of research, clinical and educational practice.

Attempts to study and when necessary to compensate for temporary or permanent impairments, activity limitations, and participation restrictions of individuals with severe disorders of speech-language production and/or comprehension, including spoken and written modes of communication (ASHA, 2005, p.1)

What is AAC?

An augmentative and alternative communication (AAC) system is an integrated group of components, including the symbols, aids, strategies, and techniques used by individuals with severe speech and language disabilities to enhance communication. The system serves to supplement any gestural, spoken, and/or written communication abilities.

What is AAC?

AAC is multimodalIt includes any residual speech or vocalizations, gestures, signs and aided communication

AAC is a systemIt is an integrated group of components, including symbols, aids, strategies and techniques used by the individual to enhance communication

AAC terminology/definitions

AAC device or aidAid/device is a physical object or device used to transmit or receive messages (e.g., communication book, board, chart, mechanical or electronic device, computer)Assistive communication device: an electronic or non electronic aid or deviceDedicated communication device: an assistive communication device that is specifically designed for communicationVoice output communication aid (VOCA): device that has electronically produced voice or speechSpeech generating device

AAC terminology/definitions

AAC symbolSymbols are used for visual, auditory, and/or tactile representation of conventional concepts (gestures, objects, photographs, manual signs, picto-ideograhs, printed word, Braille, spoken words)Symbol: denotes any representation of a referent (idea, action, object, relationship)Symbol set: closed can be expanded but no specific rules for developing new symbolsSymbol system: includes rules or logic for developing new symbols

AAC terminology/definitions

Iconicity: visual relationship between symbol and its referentTransparency: guess ability of a symbol in the absence of the referentTranslucency: degree to which individuals perceive the relationship between symbol and its referentOpaque: little or no visual relationship to the referentArbitrary: random, subjective, illogical, subject individual will or judgment without restriction, contingent solely upon one’s discretionConcrete/abstract: tangible or intangible nature of the referent and the ease with which a stimulus evokes an image

AAC definitions/terminology

AAC strategies: Specific way of using aids, symbols and/or techniques more effectively for enhanced communication

AAC techniques:A method of transmitting messages (e.g., different scanning methods, encoding, signing, natural gesturing)

AAC definitions/terminology

Total communication: refers to the use of whatever means are appropriate to establish communicationManual signs: refers to a natural sign languageSign language: use of a natural sign languageAmerican sign language: natural sign language used by the Deaf community in the U.S.

Who uses AAC?

No typical AAC user

Individuals with severe communication disorders or those for whom gestures, speech and/or written communication is temporarily or permanently inadequate to meet all communication needs

May possess limited speech that is inadequate to meet their communication needs

Hearing is not a primary concern

Who uses AAC?

Congenital conditionsSevere intellectual disabilityCerebral palsyAutismDevelopmental apraxia

Acquired conditionsAmyotrophic Lateral Sclerosis (ALS)Multiple Sclerosis (MS)Traumatic Brain Injury (TBI)Stroke/AphasiaSpinal cord injury

Who uses AAC?

8-12 individuals 1,000 people (0.8-1.2%) in the general population experience severe communication impairments that require AAC (Beukelman & Ansel, 1995)1.3% of the entire U.S. population over 15 years of age have problems being understood while using speech529,000 of individuals under 15 years of age have problems using speech for communicationSimilar figures in Canada (200,000) and in the U.K.(800,000)0.12% in Australia and 0.06% in Hungary (does not include acquired disorders)0.2-0.6% of total school-age population worldwide has a severe speech impairment worldwide (Blackstone, 1990)Increases to 0.8% for individuals between 45 to 54 years of ageIncreases to 4.2% for individuals 85 years and older

What is it like to have a severe communication disorder?

Purposes of communication interactions

Communication of needs/wants

Information transfer

Social closeness

Social etiquette

Communicate with oneself (internal dialogue)

Features of communication competence

Portray a positive self-image

Show interest in others and draw them into interactions

Actively participate and take turns

Respond to others by commenting, negotiating and asking questions

Put partners at ease with an introductory message

Assistive technology versus AAC

AAC and AT non synonymous

AAC not a subset of AT

AT may be considered to be a part of AAC

History of AACScientific antecedents

Traditional speech therapy was not effective for individuals with severe communication disabilities

Clinician/educators developed new strategies that focused not on natural speech but on communication using other means

Research on the ability of chimpanzees to communicate with manual signs and symbols (Premack 1971, 1974)

Total communication in functional settings such as a residential facility for MRDD, university hospital school especially for the neurologically impaired

Little empirical data on AAC assessment and intervention until 1970s and early 1980s (AAC established in mid 1980s)

History of AAC

Technology antecedentsBell Telephone Labs worked on speech intelligibility and speech synthesisResearch in bioengineering and computers Control devices provided opportunity for communication to individuals with severe physical and communication disabilities (scanning and selection via a switch, head pointing using infrared head pointer) Morse code

Social antecedentsAntibiotics and medical discoveriesGreater survival of individuals with accidents, falls, and gun shot wordsGreater survivors of strokes and neurological conditionsAwareness of these individuals prompted need for legislature

History of AAC1971 United Nations issued a declaration of

general and specific rights of the mentally retarded1973 Federal legislature of section 504 of the

vocational rehabilitation (PL 93-142)1975 Education for all Handicapped

Children Act (EHA)1986 Education of the Handicapped Act (EHA),

amendments of 1986 (PL 94-457)1988 Technology assistance for individuals with

disability act (ADA) or tech act (PL 100 – 407)1990 Americans with Disability Act (PL 101 -336)1990 Individuals with Disabilities Education Act-IDEA

(PL 101-476)1994 IDEA amendment 1991 Medicaid started funding AAC devices in

Louisiana for children under 21 years of age1996 Medicaid started funding AAC devices for all

individuals regardless of age2000 Medicare started funding AAC devices

History of AACOrganizations like Arc helped to identify individuals who could benefit from AAC

Professionals (e.g., SLPs and Special Educators) recognized the benefits of AAC and helped engineer classrooms

Use of American Sign Language increased with use of Total Communication approaches

Public Figures and AAC user advocates

AAC modes and methods

Research

History of AAC

Assistive Communication DevicesManual signsManual communication boardsElectronic systemsPortable systemsSymbol sets

Improvements in speed, durability, dependability and affordabilityCommunication aid manufacturers association (CAMA)Assistive Technology Industry Association (ATIA)

Dissemination of informationAnecdotal reports, case histories, newsletters, etc.Preparation of professionals – coursework on AACDevelopment of organizations – ISAAC, USAAC, state chapters, SIG `1Research and journals – AAC, JSET, ISAAC bulletin, Augmentative Communication News, Perspectives.Theories, models and taxonomies – controversial issues: inclusion, facilitated communication and team approach

AAC Model

Purpose of models

Model is typically a construction based on one’s current understanding of how a particular phenomenon operates

Representation of theory

Communication is a complex phenomenon

AAC model proposed based on current knowledge

Modified and adjusted based on research

Model helps to

Conceptualize the integration of different fields that are involved in AAC

Develop better assessment and intervention strategies

AAC modelCommunication models

Source, message transmitter, signal channel, receiver and destination

Source = brain

Message transmitter = speech mechanism

Signal channel = sound waves with or without noise

Received and perceived by the listener’s ear

Destination = listener’s brain

AAC model

Fairbanks model included a feedback system

Sensor unit that compared the message sent to the intended message

Hearing mechanism, tactile and kinesthetic receptors of the speech mechanism

Berko, Wolvin and Wolvin (1977) added the idea of memory and past experiences used to govern the selection of language symbols to encode and decode the message

Sander’s model (1982) multi modal aspect of communication (facial expression, prosody, gestures, and movement)

AAC model

Communication model

2 individuals

Sender of the idea

Receiver of the idea

Message is transmitted within a communication environment which may have noise components (internal or external)

Feedback internal (auditory and kinesthetic) or external (linguistic and nonlinguistic)

Communication is multimodal

Speech , facial expression, pointing, gesturing, and writing, etc.

AAC model

AAC is intentional

Symbol-based

Rule-governed form of communication

Message transmitted from sender to receiver

Sent in a communication environment

Appropriate feedback

Interactive process

Usually takes place between an AAC user and a person without disabilities

AAC ModelSender, message, transmitter, communication environment, receiver and feedbackCommunication environment which includes people, places and contextTransmission environment or signal channels is the propagating mediumAAC transmission processes and AAC interface componentsUpper half typical scenario between two communicators in which the sender is using AACSender forms an idea and generates coded neural impulses via cognitive and linguistic systemsImpulses pass through a monitor that detects errors and makes corrections

AAC Model

Impulses drive any one of the transmitters (e.g., speech mechanism, hands and arms, face and other body parts)

Speech = speech mechanismHands and arms = manual signing or writingFace = facial expression Shoulders, legs, etc. = posture

The output message passes through the transmission environment (e.g., acoustic, visual signal)To the receptors (e.g., ears, eyes) of the receiver where sensory processing takes place and the message is sent to the neural processors where it is decoded Message is interpreted and meaning is finally achievedGets auditory feedbackLower half the process is reversed

AAC ModelWithin AAC transmission is housed

Means to represent

Means to select

Means to transmit

Symbols for AAC

Aided

Unaided

AAC model

User must formulate the message

Then choose the type of symbols (aided or unaided) to represent the message

Next the user must possess adequate control to select the symbols

Message is transmitted through some means (body parts, device, etc.)

AAC Model

Multimodal model

Degree of communication and miscommunication is directly related to the match or mismatch between sender and receiver

Communication is more effective and efficient when the sender and receiver are more closely matched on cognitive, culture and experience, linguistic competence, motivation and interest, and perceptual skills and abilities

Helps to determine the selection of different modes of communication

AAC clinician responsibilities

See handout

Communication bill of rights

See handout

AT is only part of the answer

Linguistic competence

Knowledge of receptive and expressive language skills of one’s native language

Knowledge of the linguistic code unique to one’s AAC system (e.g., drawings, words, signs, etc.)

Parents, communication specialists, friends, and other facilitators assist in mastering these skills

Ongoing opportunities for practicing in the natural environment

Receptive language training (joint use of system by user and facilitator)

At is only part of the answerOperational competence

Technical skills in operating the communication system

Training in operation and maintenance of the system

May not be the user but the family, teachers and/or other caregivers

May need training each year as facilitators change– Keep up with the vocabulary– Make overlays and displays– Protect the device against damage– Secure necessary repairs– Modify the system for tomorrow’s needs– Generally ensure day to day availability

AT is only part of the answer

Social competence

Knowledge of skills of social interaction

Initiating, maintaining, taking turns and terminating interaction using a variety of communication strategies and functions

Knowledge, judgment and skills in sociolinguistic and sociorelational aspects of communication

When to speak, when not to, what to talk about, with whom to talk about, with whom, where and in what manner

Provide opportunities to practice social competence skills within the natural environment

AT is only part of the answer

Strategic competence

Compensatory strategies used to deal with functional limitations associated with AAC use

Interacting with people unfamiliar with AAC

Resolving breakdowns

Compensating for a slow speaking rate

Appropriate assessment, intervention and mentoring strategies

Stakeholders are properly prepared and standards and guidelines of AAC practice are understood and implemented

Evidence based practice

Development of guidelines

Coaching or mentoring

AAC simply cannot do what typical communicators do

Quality of intervention, mentoring and coaching is variable