AAC

=AAC: Alternative and Augmentative Communication= Standards: III-C, III-D, IV-B

Let's start with defining the terms in AAC. Yay for VOCAB AAC is used to compensate for //temporary or permanent// impairments, activity limitations, and participation restrictions for persons with //severe// impairments in speech-language //production and/or comprehension//. __Augmentative:__ communication modes that are supplemental to speech such as writing, gestures, facial expressions __Alternative__: as an alternative to speech

__symbol:__ something which stands for something else (its referent). symbols can be graphic, auditory, gestural, and tactile and can be aided or unaided __aid__: a physical object or device that helps an individual communicate (communication board, VOCA) __technique:__ ways that messages can be transmitted (direct selection, scanning) __strategy:__ ways that messages can be conveyed most effectively and efficiently (for message timing, assist in grammatical formation, and enhance communication rate such as topic setting and word prediction)

__Iconicity:__ symbols that have a strong resemblance to their referent (symbols with high iconicity should be easier to learn) here the picture symbol and ASL sign for "eat" has more iconicity than the symbols for "help"

When developing and AAC device, there are many factors to consider...
To start, remember **//__all__//** of the reasons for communication 1) express wants and needs 2) transfer information 3) social closeness 4) social ettiquette 5) internal dialogue with oneself
 * most communication boards consist of only this type of vocabulary
 * telling a story, answering a question... requires a large variety of words
 * telling a joke, cheering at a basketball game, expressing feelings
 * please, thank you
 * making lists, schedules, journaling

Messages for a variety of communication functions during conversation
 * greetings, wrap up remarks, farewells
 * small talk
 * storytelling
 * procedural descriptions
 * content-specific conversations

Vocabulary Selection __Coverage vocabulary__: vocab needed to communicate essential messages __Core vocabulary__: words and messages commonly and frequently used by a variety of individuals __Fringe vocabulary__: words or messages specific to the individual, personalization (interests, family member's names, etc)

Types of displays:
 * fixed: typical low tech comm board
 * dynamic: many high tech devices that allow you to push a button to bring up another page
 * hybrid: a fixed display with dynamic components, such as lights to indicate which items are active
 * visual scene: a picture/virtual environment, in which parts can be activated (a picture of a kitchen, where you can click on the refrigerator and it will say that word and/or pop up another board with items that might be in a refrigerator)

Types of selection: 1) Direct selection: person indicates item directly 2) Scanning: usually due to motor difficulties, person cannot directly select, so options must be presented and the person will indicate which option he chose
 * finger pointing
 * headpointing
 * eyegaze
 * circular scanning (similar to a clock)
 * linear scanning (all items are presented one at a time in a specific order)
 * row and column scanning (each row is presented, person indicates row, then the items in the row are presented and the person indicates which item)

Assessment: Determine what person's communication needs are, how they are currently communicating, and what sort of AAC would improve their communication, taking into account their cognitive, motor, sensory, and social abilities/impairments.

Identify barriers to AAC use 1) Opportunity barriers--based on attitudes of people around the AAC user 2) Access barriers--based on the AAC users abilities and attitudes
 * Policy barriers--based on laws or rules--example: child who uses AAC must go to special school, not in gen ed. example: hospital does not allow AAC device to be used near medical equipment
 * Practice barriers--based on the idea that "this is the way we've always done it, so it must be done this way"
 * Knowledge barriers--others' lack of information about AAC, limits its use
 * Skill barriers--even given knowledge, supporters have difficulty implementing example: even though they have been taught how to program the device, actually doing it is difficult or takes too long and so it doesn't get done
 * Attitude barriers--based on the often unconcious attitudes of others towards AAC users

Assessment--by the SLP and other team members 1) seating and positioning 2) motor capabilities 3) sensory/perceptual skills 4) cognitive/linguistic capabilities symbol assessment--- language assessment literacy skills
 * understand functional use of object
 * receptive labeling (point to the, is this a _?)
 * alternative visual matching (real object, color photo, line drawing)
 * answering questions (What did you eat for breakfast?)
 * make requests
 * multi symbol combination
 * symbol categorization and association
 * single word vocabulary
 * morphosyntactic and grammatical knowledge (show me: the baby's pig is dirty)
 * language sample
 * print and phoneme recognition
 * phonological awareness
 * word recognition and reading comprehension
 * spelling (spontaneous, first letter--for word prediction, recognition)

Intervention websites with resources:  www.mayerjohnson.org http://aac.unl.edu
 * choose AAC for today and tomorrow (If the child is 3, with good cognitive skills, include preparation for a literacy based system; if the adult has a progressive disorder like ALS, choose a system that he will still be able to use as his symptoms worsen)
 * provide instruction to the AAC user and their caregivers/conversation partners
 * measure and evaluate outcomes
 * functional use
 * consumer satisfaction
 * quality of life
 * Follow up and start the cycle over if changes are to be made

References: American Speech-Language-Hearing Association. (2002). Augmentative and Alternative Communication: Knowledge and Skills for Service Delivery [Knowledge and Skills]. Available from www.asha.org/policy.  Beukelman, D. & Mirenda, P. (2005). __Augmentative and Alternative Communication: Supporting Children and Adults with Complex Communication Needs (3rd Ed.__). Baltimore, MD: Paul Brooks Publishing Co. Stevens, L. (2008). Lecture notes from SPSI 622: AAC, Eastern Michigan University.