Developing AAC Systems & Assessing Communication Support Technologies

Working in inter-professional teams, Bridge School staff use the Participation Model (Beukelman & Mirenda, 2013) to guide the process of AAC system development and assess appropriate communication tools for each student. Students with SSPI and CCN learn to use a range of communication support technologies to meet daily communication needs. Taken together, these tools, and the strategies for how and when to use them across interactions, make up an individual’s AAC System.

The team assesses current functional participation relative to typical participation patterns of same-aged peers, as well as current barriers to communication and full participation in school activities. This includes an assessment of the student’s motor, linguistic, literacy, and sensory/perceptual skills and levels of current functioning in the school environment. (See section on Assessment: Documenting Present Levels of Performance, setting goals, and monitoring progress.) We consider a variety of communication support technologies and then test these possible tools and strategies in different situations to determine if they are effective at meeting specific communication needs. We teach the student to use those tools and strategies within classroom activities and meaningful social interactions. The team identifies the best times to provide multiple practice opportunities across the student’s day, and trains important communication partners and facilitators. We establish processes for monitoring progress and evaluating outcomes. Selection of communication support technologies and teaching strategies are modified as needed until effective communication tools/strategies are identified. If a commercially-available device is deemed an appropriate tool to meet the student’s current communication needs and increase effective participation, we work together with families to proceed with the funding and procurement process. This assessment process is repeated as the team identifies additional unmet communication needs and opportunities to maximize participation.

The Bridge School’s assessment process for communication support technologies. The communication needs of the student inform the selection/creation/procurement of AACsystem components, rather than a particular device or tool leading the assessment process.

We view AAC system development as a dynamic, ongoing process. AAC systems are continually evolving to meet a student’s changing needs and abilities. An AACsystem is unique to each student and may include some or all of the following communication support technologies:

No-technology

Gestures
Manual signs
Spoken words
Non-word vocalizations
Eye contact
Eye gaze
Proximity cues

Low-technology

Object-based symbol sets
Picture symbols
Communication boards or books
Photo albums
Remnants from personal experiences
ABC boards for spelling out messages
Communication books or boards organized for partner-assisted auditory scanning (PAAS)

Voice-output Technologies

Recordable digitized speech devices, single messages or sequenced messages (Step-by-Step Communicator, Talking Brix, etc.)
Multi-level, multi-message digitized speech devices (GoTalk, SuperTalker, TechTalk, etc.)
Complex speech-generating devices (Tobii Dynavox I-Series+, PRC Accent, Saltillo NOVA Chat, etc.)

Mainstream Technologies

Laptop or desktop computer
Mainstream software and apps (MS Office, Google Chrome, iTunes, etc.)
Social media platforms (Facebook, Instagram, Twitter, etc.)
Blogging
Video conferencing
Mobile phone (including texting, media sharing, etc.)
Landline phone
Tablet or other mobile device
Remote controls
Media player (iPod, etc.)
Video games
Digital camera, video camera
Toys
Household appliances

Other Assistive Technologies

Independent mobility device (support walker, power wheelchair, etc.)
Computer interface devices (switch interface, mouse emulator, joystick, etc.)
Alternate keyboard
Capability switches
Mounting hardware
Specialized software (screen readers, talking word processors, etc.)

Example

Communication need, based on barriers

Student needs a way to participate in social games and exchanges at recess with same-aged peers by: choosing peers to engage with, gaining peers’ attention, communicating directly with peers (gain attention, ask to play, communicate during activity, etc.)
Student is positioned in walker with single switch access (no way to safely mount SGD).

Current participation

Instructional Assistant (IA) asks student where/with whom they want to play (IA gives choices and student responds with yes/no gestures).
IA helps student move towards location or peer group, asks peers if student can join in play.
IA continues to facilitate the interaction and “translate” student’s non-verbal cues throughout the interaction.

Communication support technologies to try

Low-tech board with choices of favorite playground activities and peers, to use with partner-assisted auditory scanning (PAAS).
Seek OT support to help student navigate playground terrain more independently.
Teach student to use proximity cues, vocalization, and/or an attention-getting message programmed into Step-by-Step (SBS) mounted on walker to gain peers’ attention.
Teach student to use pre-programmed message in SBS to ask “wanna play?” or “can I play?” (or similar message of student’s choosing).

Practice opportunities

Role play with familiar partners at Bridge School first.
Daily practice opportunities at morning recess.
Once routine is established at school, ask parents about opportunities at playdates, playgrounds, etc.

Partner training

Train IA on PAAS procedure if necessary.
OT trains IA on ways to support independent mobility on the playground.
Train playground peers on student’s communication modes: how to ask student yes/no questions and how student answers, how to program student’s SBS with messages to support participation in group games, etc.
Train parents on support strategies (PAAS, programming SBS, etc.)

Progress and outcomes

Has student’s participation and communication in this context changed following the introduction of communication tools and strategies?
Which tools and strategies have worked to meet the identified communication need?
Was partner training successful?
How have student and partners reacted to the communication support technologies being trialed?

Funding & Procurement

In the United States, funding models for communication support technologies, including speech-generating devices (SGDs), is locally regulated by individual states and school districts. As mainstream technologies become a more essential part of users’ AAC systems, funding models are increasingly in flux and laws are changing rapidly. Funding sources may include primary medical insurance, Medicare insurance, school district funding or, in many cases, privately funded by families. Below are some general resources for SGD funding.

Resources

Roles and Responsibilities of Speech-Language Pathologists With Respect to Augmentative and Alternative Communication: Technical Report.

ASHA Special Interest Division 12: Augmentative and Alternative Communication (AAC) http://www.asha.org/policy/TR2004-00262/#sec1.7

Guidelines for Meeting the Communication Needs of Persons with Severe Disabilities

National Joint Committee for the Communication Needs of Persons with Severe Disabilities http://www.asha.org/policy/GL1992-00201/

National Joint Committee for the Communication Needs of Persons with Severe Disabilities (NJC) http://www.asha.org/NJC/

Beukelman, D. & Mirenda, P. (2013). Augmentative and Alternative Communication: Supporting children and adults with complex communication needs. Fourth Ed. Baltimore: Paul H. Brookes Publishing Co.

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