“Speech is the most important thing we have. It makes us a person and not a thing. No one should ever have to be a thing.” -Dorene Individual who uses.

“Speech is the most important thing we have. It makes us a person and not a thing. No one should ever have to be a thing.”-Dorene Individual who uses AAC

Augmentative Communication-How Do Pediatric Occupational

and Physical Therapists Fit In?

Molly Shannon, OTR/L, ATP

Tammy Pereboom, PT, ATP

North Carolina Assistive Technology Program

www.ncatp.org

NCATP Overview

Federal and state funded Tech Act Program Free consumer consults if no funding source Fee based evaluations, trainings Interagency collaborations Loan Program Speech to Speech Dial 711, Overview/handout Work with all ages and all disabilities in many

western NC counties (depends upon age as to which counties, but about 12-22 counties overall)

Overview, Introductions

Molly and Tammy’s bios Course Objectives: definitions, OT/PT roles, AAC,

Assessment, Access, Mounting, Devices, Resources Agenda, Handouts Two Breaks, Restrooms Tours of AT center available in breaks, Devices available

for hands on Scott Chapman of Dynavox and Dawn Haynes from

Prentke Romich are here, thanks! Participant Introductions: name, where work, main

reason they are here today

Why Aren’t OTs and PTs Using AT or Helping with AAC? Lack of experience and/or confidence Too little time for additional training Little access to AT in particular settings No mentors Just don’t get it, no buy in yet or “ah-ha” moment or client Afraid to admit sometimes that we don’t know Lack of institutional or supervisor support Lack of resource information Fear of technology! Batteries to hard drive analogy. YOU ARE HERE! Thanks for coming!

Definitions of OT, PT and AT AOTA: OT is skilled treatment that helps individuals with

disabilities achieve independence in all facets of their lives. It gives people the “skills for living” necessary for independent and satisfying lives.

APTA: PT includes: Examining individuals with impairment, functional

limitation, and disability or other health related conditions in order to determine a diagnosis, prognosis, and intervention.

Alleviating impairment and functional limitation by designing, implementing, and modifying therapeutic interventions.

Preventing injury, impairment, functional limitation, and disability, including the promotion and maintenance of fitness, health, and quality of life in people of all ages.

Engaging in consultation, education, and research.

AT Definition from PL 100-407:

AT Device: Any item, piece of equipment or product system whether acquired commercially off-the-shelf, modified, or customized that is used to increase or improve functional capabilities of individuals with disabilities.

AT Service: Any service that directly assists an individual with a disability in the selection, acquisition, or use of an assistive technology device.

According to ASHA, augmentative and According to ASHA, augmentative and alternative communication (AAC) is an alternative communication (AAC) is an integrated group of symbols, aids, integrated group of symbols, aids, strategies, and techniques used by strategies, and techniques used by individuals to enhance communication. individuals to enhance communication.

AAC serves as part of a person’s AAC serves as part of a person’s communication system, supplementing communication system, supplementing gestural, spoken, and/or written gestural, spoken, and/or written communication abilities.communication abilities.

What is Augmentative and Alternative Communication (AAC)?

RESNA Certification for ATP

Now is only one certification for professionals and vendors

Used to be ATP and ATS We do have ATPs from wheelchair

companies in Charlotte Exam, ongoing continuing education,

training, ethics, etc. www.resna.org

What Augmentative and Alternative Communication (AAC) Does: Facilitate language development Provide a different form of

communication, enhancing the student’s present communication system

Increase independence Facilitate academic development and

classroom participation Offer opportunity for social interaction

AAC Does Not:

Inhibit spoken language

Interfere with classroom instruction

Create social barriers

AAC may involve: Low tech techniques, like picture schedules, Picture

Exchange Communication Systems (PECS), and communication boards or books. Students touch/point to or look at objects, picture symbols, words, or letters to communicate.

High Tech techniques/devices with voice output that provide students with a way to speak intelligibly. These approaches give the student the opportunity to use pictures, words, or letters to produce a single message,

“Please, turn on the fan.”

a few messages,

“I want a drink.” or “I am hungry.”

or many messages, some text based only and some with icon picture support (some with both!).

AAC Device Overview

Quick look at some low to high tech devices

No tech ideas: flip, boards Partner One and other less expensive one message devices:

Yes, Virginia there are more options than Big Macs!!! Tech 8 with ECU Tech 32 with levels Dynawrite Springboard Lite Dynavox V Eco 14 PASS Software for demo, nice option for training! Show Access

Hands on during breaks

A Beginning… I drew it, the letter A. There it was on the floor before me. I

looked up. I saw my mother’s face for a moment, tears on her cheeks. I had done it! It had started, the thing that was to give my mind it’s chance of expressing itself. That one letter, scrawled on the floor with a broken bit of yellow chalk gripped between my toes, was my road to a new world, my key to mental freedom.

Christy Brown, 1954 My Left Foot, movie and book

How can therapists not believe that we are a vital component of AAC delivery?

Communication is not only the essence of being human, but also a vital property of life. John A. Piece

“Molly or Tammy? Why Did You Stop Being an OT/PT?” WRONG!! We have never stopped being OTs and PTs. We are proud to be OTs and PTs!! Some in AT, not

so much! We are therapists that specialize in AT. AT professionals come from all backgrounds, but OT

and PT are logical choices. We have always done adaptive equipment and AT

is just the umbrella term for all of the equipment categories.

As do more AT, become more of a generalist and lines merge with professions.

If you want to know what it is like to be unable to speak, there is a way. Go to a party and don’t talk. Play mute. Use your hands if you wish, but don’t use paper and pencil. Paper and Pencil are not always handy for a mute person. Here is what you will find: people talking: talking behind, beside, around, over, under through, and even for you. But never with you. You are ignored until finally you feel like a piece of furniture.

Rick Creech Individual who uses AAC

Categories of AT: Today’s Focus is AAC But Access Overlaps All Areas of Course!

Computer Access Augmentative communication Activities of Daily Living Environmental Controls Seating, Mobility and Positioning

Assessment Assistance: AT assessment, $6 month for individuals, free 4 wk trial

at www.customtyping.com GREAT site. WATI free AT eval form (37 pages) and other materials

online, http://www.wati.org/content/supports/free/pdf/ASNAT4thEditionDec08.pdf 337 page guide to AT, Section 9/10 on seating and positioning. Great forms!

GPAT www.gpat.org FANTASTIC protocols, 14 page one on AAC and OT and PT “areas” are nice

SETT (Student, Environment, Task, Tools) Zabala, hard to find now, but many use. Forms similar in WATI above.

MSIPT (DeCoste 1996) Find still?

MSIPT, handout is an old form, but nice! Assessment form, hard to find anymore

Checklist for charting 3 observations with 3 different devices

M=movement S= site of control I=input method P=position of input T=targeting method

http://public.doe.k12.ga.us/DMGetDocument.aspx/AAC%20Evaluation%20Protocol.pdf?p=6CC6799F8C1371F64E4F53D91653586E66B5D054B9D6977ACF2448B2C7785534&Type=D

Suggested Team Roles: No One Person Can Wear All the Hats!

Language/Communication: SLP Programming of AAC: SLP, AT,

parent/consumer, or other with interest! OT/PT?

Curriculum Integration/Literacy: Teacher, AT/OT

Physical Access and Positioning: OT/PT, AT Linking and Computer: AT or other interested

staff, some parents/consumers Mounting: some would say PT only, but really

anybody willing to try!!!

OT/PT Role Typical Roles in AT Evaluation: Functional range of motion Strength Sensory Cognitive, depending upon team Coordination Reach Hand Strength and finger isolation or other isolated

access control Functional skill levels Posture, changes in position and environments

Assumption: Interdisciplinary Assessments

Best to have entire team’s input

Current assessments

Parent and consumer/client info vital

Copies of private or outside evaluations or reports helpful

Assessment: A Process, Not An Event

Assess to meet today’s needs, then tomorrow’s, and tomorrow’s and tomorrow’s…

Beukelman and Mirenda

Georgia Department of Education , GPAT: Principles of Assistive Technology Evaluations

•Smith (1993) points out that the Goal: Is not Which Device, Rather….

What (The child needs to be able to do)

Where (In what environment)

Why (For what specific purpose)

How (Possible ways to help the child accomplish described tasks in specific environments)

Then, which device combined with which services and which individual strategies= FEATURE MATCHING

AT Evaluation Considerations

Sensory Skills: hearing, vision acuity, perceptual/discrimination issues

Seating and Positioning: ambulatory issues vs. non-ambulatory

Individual Abilities Motor and Access, Direct Select vs. Switch vs.

Scanning Receptive and Expressive Communication

Communication Needs Language Functions Environments/Partners Tasks

Hierarchy of AT/AAC Access

KeyboardMouse TechnologyProportional JoystickSwitched Joystick4 switches3 switchesSingle switch scanning2 switchesSingle switch

Least Restrictive Access

Most Restrictive Access

Evaluation process, Direct Select? Most preferred method1. Direct Selection: Determine student’s gross and fine

motor abilities as related to accessing a system using direct selection, including Range of motion Position changes Move your object around the area in front of student, assess to

the right/left, top/bottom, midline/cross midline Have them touch, point or pick up items Fine motor control –how do they touch/point? Ability to achieve an isolated point, closed fist, hand, arm, etc. Strength and motor control 90/90/90 myth!

Access Evaluation, cont.

Delays in processing/motor recognition/initiation

Observe/measure how long takes to recognize direction, initiate motor movement and complete motor act

Ability to utilize adapted equipment for direct selection, if unable to access independently

Try handheld pointers, splints, t-bars, headpointers, etc. and repeat range and control observations

Direct Selection Access Evaluation, cont.

Determine degree of accuracy student can use to access targets of various sizes

Maximum range and number of targets student can access

Extent to which adaptations can be used to optimize accuracy, efficiency, and range of motion

Determine student’s ability to utilize alternate input devices for adapted direct selection (with AAC or computer based systems)

Mouse, Trackpad, Joystick/trackball, headpointing system

Eye Gaze vs. Head Control Access

Prentke Romich devices that are Plus have the Tracker infrared input

Can add on Head Mouse or Smart Nav to any device as access if correct cabling, USB, etc.

Magitek products nice too

Head/Mouth Based Access Demos

Head Mouse Others available Low tech options to remember is :

Mouthstick QuadJoy? Jouse for access, mouse/sip

and puff access

Eye Gaze Overview Dedicated computers or

AAC devices now Products: Eco 14

EcoPoint, EyeMax from Dynavox, Erica, Quick Glance, Tobii, LC Tech

Cost, high but less than

used to be! 4K-20 depending upon if buying AAC device or computer

Evaluations cost for true eye gaze systems

Demo of Head Based AAC access

ECO Eye Max?

If Cannot Direct Select, Assess for Switch Access Determine student’s ability to use single switch access

(using switch toys, music, w/ SLAT or Powerlink, motivating software with switch interface –no scanning at this point)

Identify activation sites student can use to activate one or more switches

Identify possible switch types Determine student’s ability to Activate a switch on command –how quickly, how easily Release a switch on command –how quickly, how easily Reactivate a switch –how quickly, how easily Hold and maintain closure on a switch –how easily Complete the above listed areas on a variety of

activation sites and switch styles

Hierarchy of Access Sites: Can Have Multiple Sites for Access

HandsHead/voice Arms/elbowLegs/kneesFeet

Switch Access Evaluation, cont. Determine student’s ability to use two switches for

potential dual switch/step scanning –two sites easily

Determine student’s ability to release and reactivate switch to continue use of communication system

Determine student’s ability to using scanning access for communication system use live voice scanning or partnered visual scanning with single message voice output device

Assess student’s ability to watch a visual cue, process and activate the switch when it is on a designated target (stand behind student if using an infrared pointer -start with one target, move to 2 –designate target, then go to choice 2-4)

www.tarheelreader.org

Spectrum of Switch Training and Use

Play, Exploration, Leisure Communication Movement: Cooper Car, power chairs Activities of daily living and Environmental

control (EADL) Education, Computer Pre-vocational and vocational

toys job

Top Tips for Switch Selection: Movement Issues: naturally occurring, volitional, social

and communication issues, motivation is key

Positioning and Environmental Concerns: team assessment helps, space constrictions, reflexes, mounting, different locales/times different access?

Performance Variables: Target size, Force,Timing, Accuracy, Efficiency, Durability, Safety and Fatigue

User Input: Interest and acceptance, Fun for younger users, Increases independence, Comfortable, Ease of use, Reliability, Cost issues

Professional or Family Support Pointers: Wait!, consider previous attempts, try it yourself!, ease and reliability of set-up by staff/families

1.Movement Issues

Observe naturally occurring movements Look for a volitional movement Don’t let it take away from communication

interactions Social considerations in different settings Motivating movements will often win out

2. Positioning and Environmental Concerns

Importance of prior team assessment Reflexes: ATNR, STNR Space restrictions Different access site and switches for

various settings, times of day 90/90/90 Mounting issues

3. Performance Variables

Target size Force Timing Accuracy Efficiency Durability Safety and Fatigue

4. User Input

Interest and acceptance Fun for younger users Increases independence Comfortable Ease of use Reliability Cost issues

5. Professional or Family Support Pointers

Wait, wait, wait for responses

Consider previous successful attempts

Try it yourself to see how it feels

Ease and reliability of set-up for caregivers is key

Categories of Switch Types

Pressure: push or lever Pneumatic: air sensitive such as Sip and

Puff Motion (mercury or infrared) or motoric

(pinch, grip, etc.) Photosensitive: Blink switch

More Switch Types

Physioelectric or sensitivity (muscle tension):P switch

Sound activated Remote or proximity: Cordless Big Red or

Untouchable Buddy/TASH Taction switches:attach to surface of item or

page of a book, but need Linkswitch Flexible Switches: Adaptivation, work with any

device and stick to surface

Switch Hands On Activity #1

Each small group gets a bag of goodies Within each bag there is:

a mount or some type of positioning device a switch low tech AAC, book or toy

You will put mount and switch or devices together (15 minutes) Brainstorm what kind of client could use Some bags require more problem solving than others! Extra materials on table if needed, tools, tape, Velcro, etc.

Every group will share briefly name of products and your ideas to group for show and tell. (15 minutes)

Ideas for Feature Matching with Switches: Varies with Clients! Cerebral Palsy: coordination is

key

Neuromuscular (ALS, MD, SMA): strength, ROM, fatigue

Spinal Cord Injuries: high level quads

DD/MR: bright, big, sturdy

Visual Impairments:

Pressure, rocker, wobble switches. Mounting!

Spec, light touch, blink, P switch, cup, microlite

Sip and puff, tongue, head controlled

Big Red, Bass, wobble, auditory

Texture switch, auditory feedback

Direct Selection vs. Scanning Direct Input Methods: hand, feet, pointers, mouthstick,

splints, eye gaze Direct Input Devices: keyboards and alternate keyboards,

eye gaze boards, low tech, onscreen keyboards, etc. Scanning is not direct selection and is most restrictive

access Be aware that the entire AAC device screen can be one

big switch! Nice option for many children. Linda Burkhart great resource for teaching various switch

skill progressions www.lburkhart.com/hand2sw4s.htm

Scanning: Techniques

Automatic: runs automatically number of times programmed to

Step: press to select and advance movement of cursor

Directed or Inverse: hold down switch until movement stops

Scanning: Patterns

Linear

Circular

Group Item: item, row, column, block

Customized

Switch Use Specific to AAC Devices

System specifics see manuals, websites, reps. Thanks Scott Chapman and Dawn Haynes!!!

Scanning Options: direction, type, speed, auditory

Setting scan patterns Assessment guide in Dynavox :ROM/targeting,

Scott demo Encoding: ex:, eyegaze boards, Minspeak and

morse. Very HIGH Tech info!

Visual and/or Auditory Scanning

Visual LED issues: one light in corner or entire message

outline Bi-modal Communication field importance

Auditory Entire web sites devoted to this method Cognitive and memory load Ironically often recommended for low functioning

clients

Regarding Scanning…

It should be emphasized that saying it can be done is not the same as saying it will be easy.

Stainback and Stainback

Stephen Hawking, from a

A Brief History of Time

“For a time after the tracheostomy operation the only way I could communicate was to spell out words letter by letter, by raising my eyebrows when someone pointed to the right letter on a spelling card. It is pretty difficult to carry on a conversation like that, let alone write a scientific paper.”

Mounting:

Lightweight Mounting Ideas

Usually holds 5 pounds or less Typically for switches or ECU devices and

lightweight AAC devices You typically use what you have and don’t

even know the ‘real’ name of it Many therapists make their own mounting

solutions from low tech materials

Slim Armstrong, $279 www.ablenetinc.com Versatile, strong, and easy to use. Easy positioning with ball joint. Telescoping arm stretches 20.5”. Support up to 5 pounds. Clamps to flat table surface or round wheelchair

frame. Five mix and match parts to create four different

systems. No tools needed!

Universal Switch Mounting System, $219

www.ablenetinc.com Heavy-duty system, friction knob. Holds up to 5 pounds. Many positions, arm adjusts and locks by turn of

lever. Ideal for assessment or computer stations. Includes large triangular mount for larger

switches. Ablenet: $219

TASH Mounting Arm

www.ablenetinc.com $252 Any TASH can attach

Also… Cling Arm $120

Mini Arm from RJ Cooper

www.rjcooper.com $99 The Mini-Arm is a variation on

the Articulating Arm.  Included is the great Super-Clamp so the Mini-Arm can be mounted to just about anything.  The Mini-Arm ranges from 4-11".  It comes with a 1" (for our Compact Switch) and 2.5" (for our Buddy Button) round plastic disk at the end, with Velcro, to mount switch.

Articulating Arm by RJ Cooper

$119 Three knobs to tighten,

versus one, and is not quite as strong as the Magic Arm. But it is less expensive, stronger, and much easier to use than some.

Magic Arm from RJ Cooper

$219 The base clamp attaches

securely to just about anything: wheelchair tubing, tables, the CooperCar rollbar, you name it! The dial at the elbow tightens all three joints: the one at the base, the elbow, and the switch end. And when it's tight, it REALLY holds everything in perfect place.

Mighty Mount, Ablenet/TASH, $170

Attaches to any surface: table, chair, wheelchair, bed.

Easy to position. Adjustable arm lengths, arm angle, and switch

angle (length 16”-24”) Best suited for Tash switches

Maxess Switch Trays and Mounts

www.inclusivetlc.com Trays, $59-79 Mounts, $32-42

Adapt-A-Tray

$685, plus http://

www.customsolutions.us/adaptatray/index.htm

The AdaptaTray is a new and unique upper body positioning system to assist individuals with physical disabilities to access equipment in their work and learning environment.

Dedicated AAC Mounts

So many available, we are showing representative or more popular ones

Some companies only recommend one or two vendors they prefer

Pricing is confusing This is a tricky area. Ask for help from vendors

and dealers Warranty and customer support is important

Folding mount/ Rigid Mount

Used for voice output communication aids, laptop computers, trays and communication boards.

Vertical and horizontal tube joined at right angle. Clamps onto wheelchair by Frame Clamp Assembly. Folding mount folds completely down beside

wheelchair. It may stick out from chair and hit wall when folded. Can be mounted on left or right of chair.

Rigid mount has no moving parts. It should be detached when mount is swung around beside wheelchair.

Folding and Rigid Mounts

Rigid mountFolding mount

Rear folding mount

Profiler Mount from CJT, $740 Is a new innovative design that makes

mounting to wheelchairs, walkers, hospital beds, stroller's and tables a breeze.

Can mount to square , oblong, and round tubing. You can use either vertical or horizontal tubing.

Can even be mounted to the inside of some chairs and brought out from the side and up.

It's lightweight and easy to adjust. Can move to the side with the single lift of

a lever. Can be used with most of the

communications devices on the market. Users have a choice of using any of the augmentative communication company's quick release, or C.J.T.'s device plate or C.J.T.'s new quick release system.

Benefits of Profiler

Easy to use. Installs in minutes not hours. Variety of angles and heights can be achieved within

seconds. Can change to clients new chair with minimum to no charge. Can hold up to 15 lbs. Nice looking. Light weight. Can swing away to the side. Can mount on the left or right side. Cost:

Profiler Lite from CJT The ProLite mounting system is specifically designed to

work with small and lightweight devices. Is simple to use and offers a variety of options. It's low profile makes it appealing to an individual while its

flexibility and durability accommodate real needs. Ordering the ProLite is simple. You choose one product code, giving you all the parts

you need to mount the ProLite to either the left or right side.

You can mount the ProLite to the base of the chair, the back, the arm, just find a small space and you can mount the system in minutes.

Profiler Lite, $265

Easy to assemble and disassemble. Mounts to both left and right side. Fully adjustable-Base turns 360 degrees. Mounts to square or round tubing. Lightweight. Works with most light weight devices. Max load 5lbs. Mounts to wheelchairs, hospital beds, walkers, IV poles and more. Come with device quick release. Mounts to vertical or horizontal tubing. Choice of length 9" to 16" or 16" to 21". Durable.

Freedom Table Mount, $475

Freestanding. Hands free support on any surface. Change angles, height, and rotate 360°. Locks into position. Quick release lever allows quick positioning for

use. Can be used with all AAC devices and most

notebook computers.

DAESSY Mounting System from DAEDALUS

http://www.daessy.com/dms/indexm.html

The DAESSY Mounting System is a component based system that allows for customization and limitless configurations to meet mounting needs.

Selecting a Mount handout: http://www.daessy.com/PDF/select.pdf

What are the Names of the Parts of my Daessy Wheelchair Mount? http://support.prentrom.com/article.php?id=325

The picture is the Daessy Wheelchair Folding Mount shown with the Standard PRC Quick Release Mount and 7/8" round frame clamp.  Frame clamps come in different hole shapes and sizes, so your clamp may look a bit different. 

Daessy Wheelchair Mount, cont. The Daessy bar comes in 2 different lengths called

offsets,  a 6"offset or a 12" offset.  A 12" offset adds inches to the Vertical Tube at both the bend section and to the length where the collar is attached. The shorter the offset, the closer the device will be to the person using it.

Mount ‘n Mover www.broadenedhorizons.com The Mount'n Mover system lets individuals choose

where and when their mount is positioned with devices, trays or laptops can be at-the-ready, not in-the-way.

2 easy to use knobs, one handed operation, customizable, holds up to 15 lbs. Cost from $800-1200ish

Mounting Worksheets… Dynavox: Handout “Mounting Worksheet”

http://dynavoxsys.custhelp.com/app/answers/detail/a_id/2218/kw/mounting/r_id/158 and additional questions for “Wheelchair Mount Ordering Basics” http://dynavoxsys.custhelp.com/app/answers/detail/a_id/4187/related/1/kw/mounting/r_id/158

DAESSY: 7 pages long http://www.daessy.com/PDF/select.pdf

Installation of DAESSY http://support.prentrom.com/article.php?id=330

How do I Determine the Proper Bar Length for my Mounting Kit? http://support.prentrom.com/article.php?id=799

Challenges in AAC Mounting: Michelle Lange, http://www.medrehabnetwork.com/art-

adee.cfm?artID=9042 Unusual tubing sizes Stroller frames are simply not strong

enough. Ultra lightweight manual wheelchairs Swing away mounts Transfers

More Challenges in AAC Mounts

Wheelchair and mounting companies are not always in sync with products, devices, and support

Tilt and/or recline systems Never mount these systems to moveable

parts.

More Challenges…

Overall width of the wheelchair and device.

Visual field and social issues. Multiple bases and environments. Pricing information, modular issues.

Frustrating to not know how much is going to cost!

Bottom Line with Mounting…

Someone has to put this mount on the chair! Believe me, your average caregiver just isn’t going to do it.

Who can or will help? Wheelchair vendors, AAC vendors, interested

therapists, Rehab Engineers, dads If you have to have an engineer mount the

device, then is that the mount you really want for that client?

10 things I wish my teacher knew about AAC (insert AT or therapist, parents, etc) ASHA and Callier Center, Dallas

1. I wish my teacher would joke with me. 2. I wish my teacher would learn how to work my communication device. 3. I wish my teacher would stop shouting at me like I can’t hear. 4. I wish my teacher would remember that I don’t always spell very well. 5. I wish my teacher wouldn’t have a heart attack when my device doesn’t work. 6. I wish my teacher would have more patience with me. 7. I wish my teacher wouldn’t hit my machine when it doesn’t work-that’s my mouth she’s hitting! 8. I wish my teacher would call on me for Share Day. 9. I wish my teacher would give me enough time to say what I’m thinking. 10. I wish I could walk and talk like my sister and brother.

Resources

Various AT, great site from OT Bridget http://www.customtyping.com/tutorials/at/switches/assessment.htm and http://www.customtyping.com/tutorials/at/switches/movement.htm Joint movement switch tutorial and same gal at http://www.customsolutions.us/

Great for AAC info! Tons! http://aac.unl.edu/yaack/toc.html

Dawn Haynes from Assistive Technology Works

Prentke Romich Company rep 540-337-4640 [email protected] www.prentrom.com Great online tech support and telephone

too from PRC

Scott Chapman, Dynavox

Lives in South Charlotte! Phone: 800-344-1778 ext.7937 [email protected] www.dynavoxtech.com Great online

support and tech support as well Training videos within some products

which is great.

Thanks for coming!

Molly Shannon www.ncatp.org Tammy Pereboom www.ncatp.org