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Introduction to AAC

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

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Introduction to AAC

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  1. Introduction to AAC May 23, 2013

  2. 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)

  3. 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.

  4. What is AAC? • AAC is multimodal • It includes any residual speech or vocalizations, gestures, signs and aided communication • AAC is a system • It is an integrated group of components, including symbols, aids, strategies and techniques used by the individual to enhance communication

  5. AAC terminology/definitions • AAC device or aid • Aid/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 device • Dedicated communication device: an assistive communication device that is specifically designed for communication • Voice output communication aid (VOCA): device that has electronically produced voice or speech • Speech generating device

  6. AAC terminology/definitions • AAC symbol • Symbols 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 symbols • Symbol system: includes rules or logic for developing new symbols

  7. AAC terminology/definitions • Iconicity: visual relationship between symbol and its referent • Transparency: guess ability of a symbol in the absence of the referent • Translucency: degree to which individuals perceive the relationship between symbol and its referent • Opaque: little or no visual relationship to the referent • Arbitrary: random, subjective, illogical, subject individual will or judgment without restriction, contingent solely upon one’s discretion • Concrete/abstract: tangible or intangible nature of the referent and the ease with which a stimulus evokes an image

  8. 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)

  9. AAC definitions/terminology • Total communication: refers to the use of whatever means are appropriate to establish communication • Manual signs: refers to a natural sign language • Sign language: use of a natural sign language • American sign language: natural sign language used by the Deaf community in the U.S.

  10. 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

  11. Who uses AAC? • Congenital conditions • Severe intellectual disability • Cerebral palsy • Autism • Developmental apraxia • Acquired conditions • Amyotrophic Lateral Sclerosis (ALS) • Multiple Sclerosis (MS) • Traumatic Brain Injury (TBI) • Stroke/Aphasia • Spinal cord injury

  12. 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 speech • 529,000 of individuals under 15 years of age have problems using speech for communication • Similar 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 age • Increases to 4.2% for individuals 85 years and older

  13. What is it like to have a severe communication disorder?

  14. Purposes of communication interactions • Communication of needs/wants • Information transfer • Social closeness • Social etiquette • Communicate with oneself (internal dialogue)

  15. 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

  16. 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

  17. History of AAC • Scientific 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)

  18. History of AAC • Technology antecedents • Bell Telephone Labs worked on speech intelligibility and speech synthesis • Research 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 antecedents • Antibiotics and medical discoveries • Greater survival of individuals with accidents, falls, and gun shot words • Greater survivors of strokes and neurological conditions • Awareness of these individuals prompted need for legislature

  19. History of AAC • 1971 United Nations issued a declaration of general and specific rights of the mentally retarded • 1973 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 age • 1996 Medicaid started funding AAC devices for all individuals regardless of age • 2000 Medicare started funding AAC devices

  20. History of AAC • Organizations 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

  21. History of AAC • Assistive Communication Devices • Manual signs • Manual communication boards • Electronic systems • Portable systems • Symbol sets • Improvements in speed, durability, dependability and affordability • Communication aid manufacturers association (CAMA) • Assistive Technology Industry Association (ATIA) • Dissemination of information • Anecdotal reports, case histories, newsletters, etc. • Preparation of professionals – coursework on AAC • Development of organizations – ISAAC, USAAC, state chapters, SIG `1 • Research and journals – AAC, JSET, ISAAC bulletin, Augmentative Communication News, Perspectives. • Theories, models and taxonomies – controversial issues: inclusion, facilitated communication and team approach

  22. 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

  23. AAC model • Communication 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

  24. 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)

  25. 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.

  26. 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

  27. AAC Model • Sender, message, transmitter, communication environment, receiver and feedback • Communication environment which includes people, places and context • Transmission environment or signal channels is the propagating medium • AAC transmission processes and AAC interface components • Upper half typical scenario between two communicators in which the sender is using AAC • Sender forms an idea and generates coded neural impulses via cognitive and linguistic systems • Impulses pass through a monitor that detects errors and makes corrections

  28. AAC Model • Impulses drive any one of the transmitters (e.g., speech mechanism, hands and arms, face and other body parts) • Speech = speech mechanism • Hands and arms = manual signing or writing • Face = 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 achieved • Gets auditory feedback • Lower half the process is reversed

  29. AAC Model • Within 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.)

  30. 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

  31. AAC clinician responsibilities • See handout

  32. Communication bill of rights • See handout

  33. 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)

  34. At is only part of the answer • Operational 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

  35. 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

  36. 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

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