AAC:

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• AAC
• An Introduction
• Tuesday
• 30th January 2007
• Helen Whittle SLT ACT
• Carole-Anne Burnett SLT ACT

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Contacting ACT

• Helpline 0121 472 0754
• Website www.wmrc.nhs.uk/act/
• Email format Firstname.Secondname_at_sbpct.nhs.uk
• Main phone number 0121 627 8235
• Address ACT, WMRC, 91 Oak Tree Lane, Selly Oak,
  Birmingham. B29 6JA

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New ACT Website
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Timetable

• 9.00 Registration and Coffee
• 9.30 Introduction
• 9.45 AAC definitions and who can use it
• How to be an effective communication partner
• 10.45 Tea/Coffee
• 11.00 Low tech AAC
• 12.15 Lunch
• 12.45 High tech AAC
• 1.45 Tea/Coffee
• 2.00 Assessment and support issues
• 3.00 Summary and questions
• 3.30 Close

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Introducing ACT

• Regional NHS Tertiary Assistive Technology
  Service all ages and conditions
• Mission statement
• To empower people with disabilities, using
  techniques and technologies which optimize
  potential for communication and control.
• Staff OT, SLT, Clinical Scientists, Workshop
  team, Administrators about 30 people.
• Other teams in UK are similar but each is unique

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The West Midlands AAC Care Pathway

• Brief history
• About the training packages
• The documentation and how it can be used.
• Sourcing the documentation

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The West Midlands AAC Care Pathway
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The West Midlands AAC Care Pathway
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Learning outcomes

• Delegates will come away from this course with
• A greater understanding of Augmentative and
  Alternative Communication
• Strategies to help them become an effective
  communicator with a person who uses AAC
• Knowledge of a range of resources available to
  help them explore AAC further

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Introductions

• Why you are on the course?
• Questions for us to answer during the day

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Activity

• What do we understand by AAC -now

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AAC

• Augmentative and Alternative
• Communication Sounds complicated!!
• Augmentative supplements/ in addition to
• Alternative instead of

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In detail

• AAC includes many different methods. Signing and
  gesture do not need any extra bits and pieces and
  are called unaided systems. Others use picture
  charts, books and special computers. These are
  called aided systems. AAC can help people
  understand what is said to them as well as being
  able to say and write what they want. - ISAAC
  website

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AAC

• An area of clinical practice that attempts to
  compensate either temporarily or permanently for
  the impairment and disability patterns of
  individuals with severe and expressive
  communication disorders. - ISAAC website
• http//www.isaac-online.org/en/aac/what_is.html

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More definitions

• Low tech anything that does not involve
  electricity or electronics
• Communication book, symbol chart, e- tran frame,
  Letter board, tangible symbol, photos

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• High tech anything using electronics or
  electricity
• Pointer boards, switches connected to mains
  adapter, single message devices, complex
  communication devices, toys that speak

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• Can also include writing aids for people who use
  writing as a form of AAC. This is the broad
  definition of AAC

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Who may use AAC?

• Any ideas?
• People you know?

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Who may use AAC?

• Probably less than 1 of the population but
  still 100,000s people in the UK
• Congenital physical or language disability
• Accident or illness
• People with cerebral palsy, stroke, head injury,
  motor neurone disease, complex cognitive
  difficulties and lots more

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Describing successful AAC

• Janice Lights (1988) 4 agendas of communicative
  interactions the successful AAC user needs to be
  able to access and use these purposes
• Expression of wants and needs
• Information transfer
• Social closeness
• Social etiquette

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These successes depend on 4 Communicative
competencies

• Communicative Competenceis the ability to
  communicate functionally in the natural
  environment and to adequately meet daily
  communication needs (Dr. Janice Light, 1989)
• Light 1989 4 competencies
• Linguistic
• Operational
• Social
• Strategic

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How to be a good Communication partner

• The Communication Bill of Rights
• You have the right to
• Be offered choices
• Express feelings
• Understand communications
• Reject
• Request information

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Continued..

• have access to information
• be communicated with in a dignified manner
• aids, services and resources
• be listened to
• be included in social interaction
• learn about yourself
• Learn about life
• Joint initiative between Compic and the Spastics
  Society of Victoria, Australia

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What should we do when talking with someone who
uses AAC?

• Do look at me,not my Talker
• Do give me a VERY LONG time to respond
• Do ask me how I indicate Yes and No if I
  dont have my Talker
• Do read my facial expression and body language
• Do ask me to expand/explain, rather than always
  asking questions to which I can only answer yes
  or no

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Continued..

• Do check that I mean to say what I said (check
  that it was not a miss-hit) and also that you
  have not misunderstood. Just ask Did you mean
• Do make sure that I can access my Talker. (On?
  Switch In? Light reflecting?)
• Do talk to me at eye-level
• Do tell me things, its boring just to be asked
  questions
• Do tell me when you want to move my chair- Im
  not a sack of potatoes

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Donts

• Dont ask a question and then answer it yourself,
  or immediately turn to someone else for the
  answer
• Dont talk about me in front of me without
  acknowledging that you are being rather rude
  and apologizing
• Dont lean on my device or wheelchair without
  permission
• Dont anticipate what Im going to say without
  askingCan guess what you mean?
• Dont switch off my device because I am being a
  pain or you disagree with me

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More Dont s

• Dont laugh at my mistakes, it gets
  dis-heartening. When you did your best to speak
  French, would you like it if someone laughed at
  you?
• Dont just ask me questions tell me about
  yourself or talk about music, TV, football etc
• Dont put me on the spot by asking me to
  demonstrate my Talker unless I have agreed in
  private
• Dont stand behind me when Im taking to you

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Functions of Communication

• Social Conventions
• Request for object or actions
• Request for Information
• Request for clarification
• Request for attention
• Confirmations and denials
• Provision of information
• Provision of clarification and repair of
  misunderstandings
• Expression of self
• Rejection

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• Tea/Coffee

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Activity

• Create a communication chart for one of your
  clients or yourself.
• You will be using the communication chart when
  you meet a friend down the pub for a drink. You
  have not seen this person for a while and want to
  catch up with them.

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Low tech AAC

• This is used to refer to paper based materials
  and also to simple pieces of technology such as
  single message devices.

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Low tech AAC

• What have you seen or used?

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Ways of representing things to talk about

• Symbol hierarchy Mirenda and Locke 1989
• Objects
• Objects of reference
• Colour photographs
• Black and white photographs
• Miniature objects
• Black and white line drawings
• Blissymbols
• Traditional orthography

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AAC Options

• Low Tech
• Usually using picture symbols on paper of some
  type
• A spectrum of symbols
• Objects of reference,
• Photos
• Colour picture drawings,
• Line drawing symbols
• The written word
• A spectrum of complexity
• single symbols/displays/communication
  books/bags

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Symbol systems

• Makaton
• http//www.makaton.org
• Rebus
• http//www.widgit.com/index.htm
• Picture Communication Symbols
• http//www.mayer-johnson.com
• Blissymbolics
• http//www.blissymbols.co.uk/
• Lots others too

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Egs of low tech

• Communication chart
• What symbol system? How will it be laid out? How
  many items can the user choose from?
• Communication book
• Will you use colour coding? Will you use turning
  tabs?, flip out vocabulary?
• E- tran frame

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Personal Communication Passports

• These books are practical, person centred. Good
  at times of transition
• Eg. I am good at
• My sight
• Things I am working on
• Cool stuff

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Symbol Software

• Boardmaker
• Clicker
• Writing with Symbols 2000
• Now Communicate in Print

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lunch
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High tech AAC
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Purpose of this session

• To give you some understanding about
• what VOCAs are
• their purpose
• the main differences between VOCAs available and
  how this can determine which is most suitable for
  an individual
• the complexities of acquiring skill using a VOCA
  and the importance of a well thought out program
  of implementation and support

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The main differences

• Synthetic vs. Digitised speech
• Range of messages available
• Rationale i.e. one hit one message, icon
  sequencing, categorised vocabulary via dynamic
  display, spelling
• Access method
• Cost

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Why a VOCA?

• When difficulty experienced conveying a message
  in a face to face communication situation such
  that they are failing or experiencing a high
  degree of frustration and when other ways of
  improving this have been tried
• May be main way of communicating, part of total
  communication strategy or used only in certain
  situations

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Deciding which is best for an individual

• Will depend upon a number of factors including
• Cognitive abilities / communication potential
• Accessing abilities
• Preference for synthesised / digitised speech
• Mobility
• Low tech AAC needs
• Other assistive technology needs
• Funds available

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Cognitive abilities / communication potential

• Huge range in sophistication of VOCAs
• One hit for one message - choice of one message,
  nothing unique
• One hit for one message - choice of 1 messages
  (typically 4 - 40ish), nothing unique
• Sequence 2 / 3 hits for one message - potentially
  choice of hundreds of unique messages

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Choosing vocabulary

• How do you sort out an appropriate vocabulary?
• Core vocabulary
• Subject / topic specific vocabulary
• Fringe vocabulary
• Use familiar people to brainstorm with the aim of
  producing an inventory of vocabulary items
• Some packages ready made but will need altering

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Access Devices

• VOCAs vary in access methods possible
• Direct access by pressing cell
• Headpointer
• Switch
• Mouse or mouse alternative,
• e.g. roller/joystick

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Preference for synthesised or digitised speech

• VOCAs vary
• Some have synthesised speech only
• Some have digitised speech only
• Some allow a mix

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Mobility

• Degree of mobility can determine which VOCA is
  most appropriate
• Some are highly portable and suitable for an
  ambulant user
• Some are not easily portable and are best suited
  to use by a wheelchair user

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Low tech AAC needs

• Some systems lend themselves to duplication in a
  low-tech form, e.g. dynamic screen communication
  aids
• Some high tech systems cannot be directly
  represented in a low tech form

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Other assistive technology needs

• User may need assistive technology for recording
  or to participate in a curriculum
• Thus, a PC based communication system may be more
  appropriate and more flexible

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Factors critical for success

• Proper period of assessment and evaluation
• Team involvement
• Emphasis on functional communication
• Access to appropriate messages and vocabulary
• Explicit teaching of system in natural, familiar
  settings
• Creation of communicative opportunities
• Support for communication partners

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Important features of AAC systems

• Factors rated as most important features of AAC
  systems by sample of users
• Ease of learning
• Situational flexibility
• Reliability
• Easily understood
• OKeefe, Brown and Schuller 1998

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Developing the use of AAC

• Failure with AAC, if a full assessment of an
  individuals needs has been properly carried out,
  is nearly always to do with a failure of
  implementation

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Tea/coffee
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Implementation

• Communicative competence
• Language Functions
• Means, Reasons and Opportunities Money and
  Thurman

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Approaches that can be of use

• Hanen
• Portage
• Supported Conversation for people with Aphasia
• Total Communication

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Practical approaches

• Having a bank of ready made resources
• Ready made resources
• Online symbol resources
• Fit in with curriculum or person centred planning

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AAC Programmes to follow

• SCOPE pack
• Communication passports