Beyond the boundaries alternative augmentative communication strategies
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Beyond the Boundaries: Alternative & Augmentative Communication Strategies. Judith L. Page, Ph.D., CCC-SLP, ASHA-F, ATP Associate Professor & Director Division of Communication Disorders University of Kentucky. Assistive Technology Considerations for Communication :.

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Beyond the Boundaries: Alternative & Augmentative Communication Strategies

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Beyond the boundaries alternative augmentative communication strategies

Beyond the Boundaries: Alternative & Augmentative Communication Strategies

Judith L. Page, Ph.D., CCC-SLP, ASHA-F, ATP

Associate Professor & Director

Division of Communication Disorders

University of Kentucky


Assistive technology considerations for communication

Assistive Technology Considerations for Communication:

  • No tech objects or symbols

  • Light tech communication board or book

  • Single message voice output device

  • Simple voice output device

  • Voice output device with levels

  • Voice output device with dynamic display

  • Voice output device with icons

  • Voice output devices that rely on spelling


Laws for applying technology

Laws for Applying Technology

  • Law of Parsimony

  • Law of Minimal Learning

  • Law of Minimal Energy

  • Law of Minimal Interference

  • Law of Best Fit

  • Law of Practicality & Use


Beyond the boundaries alternative augmentative communication strategies

  • Make sure that, very early in the teaching process, the child is able to communicate effectively and efficiently at least a little bit with his or her newly-learned skills. This clearly demonstrates the value of communication and increases the motivation of the child. Early success is one of the best predictors of future effort and diligence.


Beyond the boundaries alternative augmentative communication strategies

  • Make sure that both the AAC system and choice of goals and objectives are developmentally appropriate.

    • Too hard = failure

    • Too easy = boredom

  • The resulting behaviors look very similar


Beyond the boundaries alternative augmentative communication strategies

  • Don’t replace existing idiosyncratic modes with conventional modes

    • Undermines value and benefit of communication

    • Being taught a new, more difficult replacement

  • There are situations where teaching more conventional is appropriate


R eplace old method when

Replace old method when:

  • It is harmful to child or others

  • It is socially unacceptable or age inappropriate

  • New method is easier

  • New method is more effective/more easily understood

  • New method is more efficient


Aac can be categorized by

AAC can be categorized by

  • Materials required

  • Level of technology used

  • Characteristics of display

  • Manner of selection

  • Type of output


Materials required

Materials Required

  • Unaided: requires only the users body

    • speech

    • sign

    • gestures

  • Aided: requires something in addition to users body

    • objects

    • symbols

    • communication boards

    • electronic devices


Level of technology

Level of Technology

  • No tech: Any communication system that does not require a power source.

  • Low tech systems: Any communication system that requires a source of power and is very easy to program.

  • Mid tech systems: Any communication system that requires a power source and requires some level of training to adequately program and maintain the device.

  • High tech systems: Any communication system that requires a power source and extensive training to competently program and maintain the device.


Characteristics of display

Characteristics of Display

  • Components

    • messages

    • symbols & codes

    • operational commands

  • Physical Characteristics

    • number of items

    • size

    • spacing and arrangements

    • orientation of display

  • Types of Displays

    • fixed

    • dynamic


Fixed static display

FIXED/STATIC DISPLAY


Dynamic display

DYNAMIC DISPLAY


Manner of selection

Manner of Selection

  • Direct Selection

    • selection options

      • physical pressure

      • physical contact

      • pointing (no contact) (includes eye gaze)

      • voice recognition

  • Scanning

    • scanning patterns

      • circular

      • linear

      • group-item

      • auditory


Type of output

Type of Output

  • Visual

    • Signs/gestures

    • Symbols/objects

    • Communication board

  • Auditory

    • Talking switches

    • Voice output communication aid (VOCA)


Beyond the boundaries alternative augmentative communication strategies

Provide materials that are appropriate for student

coralreef

Tangible

Symbols

PCS

Symbols

  • Tactile Symbols

http://www.ohsu.edu/oidd/d2l/ts/index.cfm

http://www.tsbvi.edu/Education/vmi/tactile_symbols.htm

www.mayer-johnson-symbols.com


Symbol hierarchy

SYMBOL HIERARCHY

  • Real Objects Concrete

  • Miniatures

  • Photographs

  • Colored Pictures

  • B & W Pictures

  • Line Drawings

  • Printed Words

  • Alphabet Abstract


Beyond the boundaries alternative augmentative communication strategies

Moving Through the Symbol Hierarchy

  • Increase number of symbols in vocabulary

  • Increase size of symbol array presented

  • Provide opportunities for generalization to other contexts

  • Encourage student to use symbols fordifferent communicative functions (e.g. labeling, requesting, commenting)

  • Teach multi-symbolic utterances

  • Make symbols smaller, more portable to transition to 2-dimensional symbols


Beyond the boundaries alternative augmentative communication strategies

  • Be consistent! Communicate with team so all are using same strategies (e.g. show cue card to student to prompt focus on the teacher when she is speaking)


Beyond the boundaries alternative augmentative communication strategies

  • Encourage independence! Plan communication opportunities in a variety of settings with a variety of partners.

  • With IEP team, prioritize curriculum content.

  • Collaborate to monitor progress

  • Roles and responsibilities

  • Sample chart


Adaptations modifications

Adaptations/Modifications

  • Visual consultation

  • Contrasting background w/o clutter

  • Proper positioning

  • Big Mac switches with messages paired with objects

  • Vertical presentation of switches & objects

  • Time delay procedures

  • Small motor preparation

  • Implementers Teacher, OT, PT, SLP


Overview of strategies

Overview of Strategies

  • Training Alternate Responses to Disruptive Behaviors

  • Aided Language Stimulation

  • Language Modeling

  • Instructional Strategies


What is aided language stimulation

What is Aided Language Stimulation?

  • A strategy in which the facilitator models symbol use while speaking to the child


Language modeling strategies

Language Modeling Strategies

  • Speak slightly slower than usual

  • Insert numerous pauses

  • Use single words followed by short phrases

  • Emphasize key words


Beyond the boundaries alternative augmentative communication strategies

  • Pair manual sign or symbol with its corresponding key word

  • Keep phrases and sentence short and grammatical

  • Provide frequent examples of language concepts


Modelling example aac

Modelling Example: AAC

  • Popcorn….Let’s make some popcorn…

  • First open (as assist child in opening bag of popcorn)….

  • Open the popcorn…. Now pour…..

  • Pour it in …. More …. We need more ….

  • Pour it in ……


Training alternate responses to challenging behavior

TRAINING ALTERNATE RESPONSES TO CHALLENGING BEHAVIOR


Some examples

Some Examples:

  • Bill is a 17-year old male with severe developmental delays and very poor vision. He does not eat green peas. Whenever he is given peas at meal time, he picks them up one at a time and throws them across the room.

    • What are two possible communicative messages Bill could be sending via this behavior?


Beyond the boundaries alternative augmentative communication strategies

  • Rodney is an 8 year old child with autism. Rodney has a history of escaping from classrooms and running outside. Fortunately, his current classroom has a door that can be locked. Rodney’s teacher reports that he has developed a troubling new behavior – he gets up from his seat, goes to the back of the room and bangs his head repeatedly against the wall. She is concerned that he will hurt himself.

    • Is there a possible communicative message in Rodney’s behavior?

    • What questions might you ask Rodney’s teacher to help sort out this problem?


Principles

Principles

  • Principle of Functional Equivalence: the replacement behavior must serve the same function as the challenging behavior.

  • Principle of Efficiency: alternative behavior must be at least as easy to produce as the challenging behavior


Beyond the boundaries alternative augmentative communication strategies

  • Principle of Response Effectiveness: alternative behavior must be as effective in obtaining desired outcome as the problem behavior

  • Principle of Appropriate Listening: sometimes the best solution is to identify the function of the problem behavior and alter the environment to fulfill that function


Teaching basic rejecting

Teaching Basic Rejecting

  • relationship to challenging behavior

    • rejection is the underlying communicative function of many so-called behavior problems

    • functional communication training incorporates AAC means to express “break”, “no”, “done”, “go”, “stop”

  • Look for subtle behaviors that precede challenging behavior


Beyond the boundaries alternative augmentative communication strategies

  • Remove negative stimulus as soon as subtle behavior is noted / model socially acceptable behavior

  • Continue modeling acceptable behavior / insert pause

  • Begin requiring correct response to remove negative stimulus


First then break

First, Then & Break


Training facilitators

Training Facilitators

  • be attentive to communicative attempts

  • provide comfort, support and affection

  • create positive environments for interactions

  • focus on the individual’s needs

  • use age-appropriate interaction strategies

  • be more consistent in response to communication attempts

  • respond to random signals as if they were intentional


Training symbolic communication

TRAINING SYMBOLIC COMMUNICATION


Basic choice making requesting

Basic Choice Making & Requesting

  • choice-making opportunities

    • ID when, where and by whom choices can be offered during day

    • initial goal is to expand opportunities for choice-making, rather than develop more sophisticated ways to make choices

  • choice-making items or symbols

    • initially use real, meaningful items

    • shift to symbols


Making choices

Making Choices

  • Choice-making formats

    • Active vs. passive

    • Number of choices

    • Actual or symbolic

    • Preferred/non-preferred

  • Choice-making arrays

    • # of items in display

    • Levels

    • Spacing of items

    • Horizontal vs. vertical spacing

    • Cross vs. four corners


Organization of display determined by

Organization of Display Determined by:

  • User’s motor ability

  • User’s cognitive ability

  • User’s language ability

  • User’s visual ability


Beyond the boundaries alternative augmentative communication strategies

  • Natural consequences

    • Don’t provide corrective feedback


Strategies

Strategies

  • Place items out of child’s reach

  • WAIT, WAIT, WAIT

  • Up the ante

  • Provide many opportunities for choices (forced choice)

  • Block access

  • “Play dumb”

  • “Mess up”, forget parts, something’s wrong here

  • Disrupt expectations

  • Provide natural consequences: respond, acknowledge, map-translate into words, get what you ask for

  • Provide prompts: time delay, gaze intersection, verbal

    (Stremel-Campbell, l985; MacDonald, 1982; Neetz, 1984; Kaiser, 1986; Halle, 1984; Schumacher, 1988; Smith & Kleinert, 1989)


Specific strategies

Specific Strategies


Calendar schedule systems

Calendar/Schedule Systems

  • Purposes

    • intro concept of symbolization

    • provide an overview of a sequence of activities

    • provide specific info on what will happen next

    • ease transitions

    • part of a behavioral support plan for students who need predictability

  • Used for

    • dual sensory impairments

    • visual,cognitive or multiple disabilities


Beyond the boundaries alternative augmentative communication strategies

  • Organizing the system

    • ID daily schedule

    • ID symbols to represent each activityconstruct a container

    • devise a system to mark “finished”

  • Using the system

    • go to system & remove symbol for next activity

    • discard at completion

    • discarded always available

    • try to comply if remove symbol from box to request


Talking switch techniques

Talking Switch Techniques

  • Purposes

    • intro symbolic communication

    • provide limited context communication with voice output

  • Examples

    • Commercial talking switches (e.g. BigMACK, Brix)

    • Some have a sequence of message and levels (e.g. Step-by-Step with Levels)


Picture exchange communication system pecs

Picture Exchange Communication System (PECS)

  • A training package that allows children and adults with autism and other social-communication deficits to initiate communication

  • Developed for preschool children with autism, pervasive developmental disorders (PDD), and other social-communication disorders who display no functional or socially acceptable speech - expanded to include individuals of all ages with a wide variety of communicative disorders


Beyond the boundaries alternative augmentative communication strategies

  • Allows a mode of communication within a social context as children are taught to approach and give a picture of a desired item to a communicative partner in exchange for that item. This allows the child to initiate a communicative act for a concrete outcome within a social context


Beyond the boundaries alternative augmentative communication strategies

  • Begins with teaching a student to exchange a picture of a desired item with a teacher, who immediately honors the request. No verbal prompts are used at this point, which builds immediate initiation and prevents prompt dependency


Beyond the boundaries alternative augmentative communication strategies

  • techniques include backward chaining, shaping, anticipatory prompting, delayed prompting, and fading of physical prompts. Incidental training is also used once the physical exchange is mastered


Intervention with eye gaze

Intervention with Eye Gaze


Strategies1

Strategies

  • Intervene early to provide control over environment

  • conduct intervention in position most conducive to accuracy

  • establish “eye referencing” early

  • move through representational hierarchy

  • use pairing to transition through representational hierarchy


Beyond the boundaries alternative augmentative communication strategies

  • Use the following display options

    • holding two choices

    • choice boards

    • plexiglass eye-gaze frame

    • mounting stimulus on adult’s body

    • eye gaze vest

    • mirror with stimulus choices displayed on outer edges


Beyond the boundaries alternative augmentative communication strategies

  • present early eye-gaze stimuli in cross rather than four-corner

  • use multiple displays to expand functional vocabulary

  • foster peer interaction with shared eye-gaze frame


Beyond the boundaries alternative augmentative communication strategies

Using Palmtop Impact Communication Device to Follow Daily Schedule

Peer: Where do you go next, Tyler?

1. Home Screen-Tyler independently pushed School button to access school activities.

2. School Screen-Tyler independently pushed Schedule button to access his bell schedule.


Consider bruce

Consider Bruce


Beyond the boundaries alternative augmentative communication strategies

  • What was blocking Bruce’s full participation in his age-appropriate academic curriculum

  • Communication, yes BUT

  • Gross motor deficits

  • Fine motor deficits

  • Creative teaming to develop access to an appropriate communication system

  • SO TO ALLOW HIM ACCESS TO THE GENERAL CURRICULUM!


Content board for stories

CONTENT BOARD FOR STORIES


Beyond the boundaries alternative augmentative communication strategies

Content Catalog of Academic Activities

AGE/GRADE ______2______ Teacher _____________


The enormous potato in clip art

The Enormous Potato in “clip art”


Beyond the boundaries alternative augmentative communication strategies

Let’s Meet Grace

Grace 1

Grace 3

Grace 2


Your aac tool box

Your AAC Tool Box


7 level communication builder

7-Level Communication Builder

The 7-Level Communication Builder is a self-contained communication device. It allows the user to record and play back 1, 2, 4, 8, or 16 different messages per level. There are seven levels for recordings, giving you a total of up to 112 messages (in the 16 window setting). Total record time is 300 seconds

http://enablingdevices.com/catalog/assistive_technology_devices_used_in_education/communication-builders/7-level-communication-builder


Cheap talk 4

Cheap Talk 4

Allows the use of single or dual switch scanning.

also allows direct activation by pressing the squares or 1 to 4 external switches.

Features scan modes, with a choice of eight different scanning options, including audible scan (see below).

scanning speed is adjustable to accommodate a wide range of abilities

http://enablingdevices.com/catalog/assistive_technology_devices_used_in_education/cheap-talks-accessories/cheap-talk-4-8-direct-scan-jacks


Beyond the boundaries alternative augmentative communication strategies

Book Talker

Any book can talk! Place our thin 16-position flat switch array inside the back of any book and record the story. • Place a marking sticker on any page over one of the segments on the switch • Pushing the marker plays your recording • You can pre-record from one to sixteen messages on 7 different levels• Total recording time is 300 seconds

http://enablingdevices.com/catalog/assistive_technology_devices_used_in_education/special-communicators-accessories/book-talker


Put em arounds

Put-Em-Arounds

Pressing on each of the four corners of the front plate plays one of your four pre-recorded messages (5 seconds per message). Wall mounting hardware is included


Go board

Go! Board

designed for children who would benefit from a picture schedule.

Pictures or symbols representing a desired activity or task can be framed in the icon holders.

When the activity is completed, the icon holder is removed and placed into the pocket at the base of the Go! Board.

a valuable asset for any classroom that uses scheduling techniques


Clear clock communicator

Clear Clock Communicator

student communicates by activating a switch which moves the clock hand to the desired picture, word, or object affixed to the clockface.

Customizable with the as few (or as many) objects as you’d like.

Single or double switch capability available: one switch moves the hand clockwise; the other moves it counterclockwise.

Encourages face-to-face communication


Eye talks

Eye-Talks

makes eye-gaze communication more accurate and understandable

made with clear, shatter-resistant plastic

comes with two self-contained height adjustable triangle stands


Upright take or place n talk

Upright Take or Place N’ Talk

Taking or replacing the 2" x 2" Velcro mounted icon holders will play one of four 5-second pre-recorded messages.

Can be secured to a table with clamps


Talking photo album

Talking Photo Album

Use the Talking Photo Album to create a talking slide show, a talking story book or for basic communication. Each of the 24 pages can record up to 10 seconds and can hold a 4" x 6" photo.


Voice pal 8

Voice Pal 8

Up to eight natural-voice messages (11 seconds per message) can be recorded and played back on the VoicePal 8

messages can be recorded in any order

has Delayed Activation, a Repeat Message Mode and an External Speaker Jack


Pal pads

Pal Pads

can be plugged into any communication aid or battery-operated assistive device

can be activated with the slightest touch, whether it comes from directly above or at a shallow angle

flat membrane switches approximately 1/10" thick.


Taction pads

Taction Pads

clear, adhesive-backed, touch-sensitive plastic patches; hen adhered to a surface or object, they act as switches

peel the backing off and stick it on almost any object or surface

activates by touch (moisture)


Tech speak

Tech Speak

Record and playback 32 messages per level on a light touch membrane panel

2, 4, 6 or 12 levels for up to 384 independent messages

Standard message length of 2.25 seconds per message

Square picture size of 1.25 in.

External speaker and record jacks for increased flexibility


Jelly bean switch

Jelly Bean Switch

2.5-inch activation surface with tactile and auditory feedback

switch tops can be removed and replaced with the color of your choice: Red, Blue, Yellow, or Green


Switch caps jelly bean size

Switch Caps – Jelly Bean Size

Clear, rigid plastic caps make placing, protecting, viewing and changing symbols a snap

Symbols stay in place without adhesive


Specs switch

Specs Switch

With a 1 3/8-inch activation surface, this switch is small enough to be worn, but is most often used as a mounted switch.

includes three bases: a standard flange base, a space saving flush base and a strap base for mounting around items


Choice switch latch and timer

Choice Switch Latch and Timer

Allows 2 to take turns operating a device or 1 person to operate 2 devices in sequence or make choices

Can be used for a single device

http://store.ablenetinc.com/videos/how_to/slats_howto.mov


Step by step with levels

Step-by-Step with Levels

Record digitized messages

ideal for pre-recording sequential messages to be used at specific times of the day, or for recording and storing sequential messages that are used on a regular basis

four minutes of recording time

http://www.ablenetinc.com/Store/tabid/205/Default.aspx?CategoryCode=108


Talking brix

Talking Brix

Connectable devices for customizable layouts

Easy single-message recording on each Brix

10 seconds of recording time

Power on/off switch

Rechargeable battery

1.8” Activation area

Free Snap Switch Cap

Built-in magnets


Bigmack

BIGmack

Records a message up to 2 min. long

Can also connect a toy or appliance

5 in activation surface

Good for visual impairment and physical disabilities

http://www.ablenetinc.com/Store/tabid/205/Default.aspx?CategoryCode=105


Beyond the boundaries alternative augmentative communication strategies

Case Study

What strategies and tools can be used to support learning and communication in the classroom for Carrie, the student in our Case Study?


Beyond the boundaries alternative augmentative communication strategies

Let’s play with AAC


Beyond the boundaries alternative augmentative communication strategies

  • http://aacintervention.com/potpourri.html

  • http://aacintervention.com/

  • http://www.autismnetwork.org/modules/comm/aac/lecture01.html

  • http://aac.unl.edu:16080/yaack/

  • http://aac.unl.edu/

  • http://www.asha.org/public/speech/disorders/AAC.htm

  • http://www.lburkhart.com/links.htm

  • http://www.augresources.com/vindex.html


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