Alternative and Augmentative Communication

Chapter 1
The four critical elements of AAC that are part of all AAC interventions (from ASHA) Symbolscan be graphic, auditory, gestural, or tactile. Can be aided or unaided. o Unaidedsigns, gestures, facial expressions o Aidedreal objects, pictures, line drawings, orthography Aidsany device used Techniquesthe way the message is transmitted Strategiesthe way messages can be conveyed most effectively o Enhance timing, assist grammatical formulation, enhance communication rates The goal of AAC intervention is to enable individuals to efficiently and effectively engage in a variety of interactions and participate in activities they enjoy. There are five different purposes for communication: 1. Communicate wants and needs a. Predictable vocabulary and form, so these are generally easy to create AAC for. b. The goal of this type of communication is to regulate the behavior of others. 2. Information transfer a. These messages are more difficult to convey because the vocabulary and sentences are novel. b. Rate and accuracy are important 3. Social closeness a. Establish, maintain, or develop relationships b. Interaction itself is more important than the message 4. Social etiquette a. Often brief and with predictable vocabulary 5. Communicate with self/internal dialogue a. Lists, calendars, reflections In an AAC evaluation, the therapist should consider the individual goals, wants, and needs of the client and match the AAC accordingly. There are four parts of language competence for people using AAC. 1. Linguistic competencethe receptive and expressive language skills of ones native language--including knowledge of the linguistic code. 2. Operational competencethe technical skills needed to operate the device 3. Social Competence 4. Strategic Competenceincludes adaptive/coping strategies for communication breakdowns, compensating for slow rate

Chapter 2Message Management

What affects AAC message selection? Differences in age, gender, and social role Living situation (home vs. school vs. hospital) Interests of AAC user Messages needed for conversation: Greetingsshould include a range of culturally sensitive messages for a variety of situations (formal, informal, etc) Small talkgeneric vs. specific small talk. Generic is easier to program. Ask the AAC user to select his/her own messages from a detailed list. Storytelling Procedural Descriptionsinstructions are usually unique to the specific AAC user. Content-Specific Conversationsusually done word-by-word or letter-by-letter Different vocabulary needs for individuals with different communication abilities: Preliterate individuals need vocabulary to develop language skills and coverage vocabulary (messages necessary to cover an individuals basic needs. o Include words from various semantic categories Nonliterate individuals (those never expected to progress) primarily need messages to meet their daily communication needs in varying environments. o Usually functional and not developmental (but it is appropriate to add some developmental vocabulary). o Should be age and gender appropriate Literate individuals have access to a wider range of options. o Timing enhancementprogramming time-sensitive messages in whole on the device (e.g., will you help me before you go?) o Also program in commonly used words to accelerate messages and to reduce fatigue Resources for vocabulary selection Core vocabularywords used frequently by a variety of people o Lists based on the patterns of existing AAC users o Words selected from the past use of the individual AAC user o Words from the patterns of typically developing individuals Fringe vocabularywords unique to the individual user. o Informantsspouse, parent, siblings, peers o Environmental inventoriesAAC team listens to peers during common activities and creates a list to choose from. o Communication diaries and checklists

Chapter 12Language Learning and Development

Language Characteristics in Persons Who Rely on AAC Pragmaticspeople who use AAC tend to not initiate, respond mostly when required, provide terse messages, ask fewer questions. Phonologytests show significantly poor scores, indicating risk for reading problems SemanticsAAC users are often delayed for several reasons: o They may be spoken to less frequently o Children receive and process language one way (speech) and communicate through another (symbols, etc) o They cannot select their own lexicon, so their external lexicon (what is available to them on the device) may not reflect their internal lexicon. o Et. Al. Morphologystudies show significant difficulties Syntaxstudies show significant difficulties. o Predominance of one and two word messages o Prevalence of simple clauses o Often have word order problems o Omit words like verbs and articles

Many individuals who use AAC show signs of language impairment, and these difficulties with language are influenced by the fact that their language-learning experience is different from that of individuals who can speak. Interventions to Support Language Learning and Development Organizational Strategieswhen using symbols, they must be organized to be efficient and effective in communication. Grid displays: o Semantic-Syntactic Grid Displaysorganizes vocabulary according to parts of speech and their relationships. o Taxonomic Grid Displaysgrouping symbols according to categories (people, places, feelings, etc.). Research indicates this strategy may not be useful until the AAC user is developmentally past 6 years of age. o Activity Grid Displayspopular strategy. Organizes vocabulary into event schemes, routines, or activities. Each display shows symbols related to a specific activity, and those symbols are typically arranged by semantic category. Can be used in both high and low-tech aids. Participation is better when multiple displays are available Low-tech displays can be mounted in specific locations Can be used for all ages and in a variety of settings (school, vocational, community) Enhances probability that specialized vocabulary will be available when needed (as displays can be quickly made for special events and stored for access later) Can promote multi-word utterances and receptive language Visual Scene Displayscontain vocabulary associated with certain events, and the words are arranged schematically and not semantically.

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Research shows these displays are easier for young, typically developing children to use. Most appropriate for speech generating devices with dynamic screen displays, but can be used with lower tech devices (just not as efficiently).

Message Unit Lengthwe really dont know how the message length (paragraph, word, sentence, morpheme) affects language development. Longer units (paragraphs and sentences): o Speed up the communication process o May be better for individuals who fatigue easily, are not motivated to communicate, or are learning to use AAC. o Allows person to produce messages that are beyond their linguistic capability o May impede accuracy (having only one sentence for the picture dog may hinder the ability to communicate a different message than what is programmed) Word and morpheme length units o Likely to enhance language development because the user can independently break down and analyze the parts of a message o Correct language structures can be reinforced and incorrect structures can be corrected via modeling. Instructional Approaches Structured Approachesuses discrete trial teaching. StimulusPromptResponse, then fade prompt. Often used to teach labeling o Allows mass trials and practice (more exposure to the word) o May be useful for someone who makes frequent errors o Can be used for receptive labeling, expressive labeling, morpheme and syntax Interactive Modelteach parents to provide rich language input and respond to communicative attempts of child. Aided Language Stimulationa facilitator highlights the symbols on the AAC users communication device while speaking. Should be used in natural routines and activities. o Nonverbal juncture cuesnonverbal cues (gesture, facial expression, etc) the facilitator uses before highlighting a symbol. Teaches the AAC user another way to indicate the word and also gives a delay where the AAC user may hit the symbol before the facilitator. o Verbal cues and Light cueslight cues are highlighting the term with a light. The System for Augmenting Language (SAL)similar to aided language stimulation, except a speech generating device (SGD) is necessary and SAL techniques are simpler. This method is loosely structured and naturalistic.