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AAC EBP Group

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AAC EBP Group

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    1. AAC EBP Group, December 2006 AAC EBP Group THE EBP EXTRAVAGANZA DAY December 2006

    2. AAC EBP Group, December 2006

    3. AAC EBP Group, December 2006 Topics AAC Design AAC and Dyspraxia AAC Technology and Literacy

    4. AAC EBP Group, December 2006 AAC System Design Special thanks for the contributions of Spastic Centre staff: Alison Wu, Harriet Korner, Angela Kinsella-Ritter, Katherine Swinburn, Jenny Kidd and Hayley Smithers-Sheedy

    5. AAC EBP Group, December 2006

    6. AAC EBP Group, December 2006 Answerable question What is the best practice for the layout / design in Augmentative and Alternative Communication systems for people who have a communication disability?

    7. AAC EBP Group, December 2006 Results: 21 Articles

    8. AAC EBP Group, December 2006 CAP: Light, J. & Drager, K. (2002) Objective: To summarise what we know about young children & AAC Technology To stimulate discussion for future research regarding design of AAC technologies Results: AAC technology – high smile value (should be fun) Integrated systems are favoured For concrete concepts use of a scene layout is advantageous Personally relevant schematic layout preferred Insufficient evidence available to determine whether dynamic or fixed displays more appropriate for young children This study was an unstructured literature review and commentary: To summarise what we know about young children and AAC Technology To stimulate discussion for future research regarding design of AAC Technologies RESULTS There is some evidence to support: the idea of AAC Technology and AAC Design needing to have a high smile value (should be fun) if it is to engage young children children show some preference for integrated systems e.g. something you can play with, use as a telephone and also use as a communication system for concrete concepts use of graphic metaphor or scene layout has some advantages for young children. However more abstract concepts are difficult to display in this way. of the five ways to group vocabulary: taxonomic (categories) , schematic (event schema), semantic / syntactic, alphabetic, idiosyncratic, young children generally have a preference for personally relevant schematic layout. Currently insufficient evidence to know: whether dynamic or fixed displays are more appropriate for young childrenThis study was an unstructured literature review and commentary: To summarise what we know about young children and AAC Technology To stimulate discussion for future research regarding design of AAC Technologies RESULTS There is some evidence to support: the idea of AAC Technology and AAC Design needing to have a high smile value (should be fun) if it is to engage young children children show some preference for integrated systems e.g. something you can play with, use as a telephone and also use as a communication system for concrete concepts use of graphic metaphor or scene layout has some advantages for young children. However more abstract concepts are difficult to display in this way. of the five ways to group vocabulary: taxonomic (categories) , schematic (event schema), semantic / syntactic, alphabetic, idiosyncratic, young children generally have a preference for personally relevant schematic layout. Currently insufficient evidence to know: whether dynamic or fixed displays are more appropriate for young children

    9. AAC EBP Group, December 2006 CAP: Wilkinson, K. & Jagaroo, V. (2004) Objective: To provide an overview of some of the considerations in visual cognition that apply to AAC display design. To consider how design properties can enhance / inhibit access and use of visual symbols. Results: Currently insufficient evidence to show that use of colour in AAC design is advantageous. Some evidence to support use of colour in natural scenes or schema as a memory cue. In this case colour can be used to provide segmentation of a visual scene highlighting contrasts between objects highlighting detail This paper takes the form of a non-structured literature review and commentary focussing on: To provide an overview of some of the considerations in visual cognition that applies to AAC display design. To consider how design properties can enhance / inhibit access and use of visual symbols. Four key areas: - grid vs schematic displays - symbol location - colour and contrast symmetry and axial orientation This paper takes the form of a non-structured literature review and commentary focussing on: To provide an overview of some of the considerations in visual cognition that applies to AAC display design. To consider how design properties can enhance / inhibit access and use of visual symbols. Four key areas: - grid vs schematic displays - symbol location - colour and contrast symmetry and axial orientation

    10. AAC EBP Group, December 2006 CAP: Drager, K., Light J., et al (2004) Objective: To evaluate the performance of typically developing 3 year olds locating vocabulary in AAC technologies within grid layout with a menu of screen shots to represent alternate pages contextual scene with a menu of screen shots to represent alternate pages Results: Initial transparency for all the technologies was poor. On the second learning session children in the contextual scene group performed slightly better than children using the grid display. Embedding language concepts within contextual scenes may be an effective approach for young children learning dynamic display technology. Generalization of learning was minimal. To evaluate the performance of typically developing 3 year olds locating vocabulary in AAC technologies within - grid layout with options on a menu page containing an array of screen shots to represent alternate pages - a contextual scene with options on a menu page containing an array of screen shots to represent alternate pages To consider learning with these different layouts and generalization. Method: The authors measured accuracy of ability to target items during learning, sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. To evaluate the performance of typically developing 3 year olds locating vocabulary in AAC technologies within - grid layout with options on a menu page containing an array of screen shots to represent alternate pages - a contextual scene with options on a menu page containing an array of screen shots to represent alternate pages To consider learning with these different layouts and generalization. Method: The authors measured accuracy of ability to target items during learning, sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    11. AAC EBP Group, December 2006 CAP: Drager, K. et al (2003) Objective: To evaluate performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within grid format, vocabulary organised taxonomically grid format, vocabulary organised schematically vocabulary organised into a scene schematically Results: All organisations were difficult for children re dynamic display systems. Whilst still finding it difficult children in the schematic scene group did significantly better that the children in the two groups with grid layout. Of the grid layouts – there was no advantage in schematic organisation over taxonomic. On average children did not show evidence of generalisation to novel vocabulary on any layout, and they demonstrated little use of AAC device during free play sessions Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Taxonomically: grouping similar things together eg transport Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ½ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed. Aim of the Study To evaluate the performance of typically developing 2 1/2 year olds locating vocabulary in AAC technologies within - grid format, vocabulary organised taxonomically - grid format, vocabulary organised schematically - vocabulary organised into a scene schematically To consider learning with these different layouts and generalization. Taxonomically: grouping similar things together eg transport Method 10 children randomly assigned to the three conditions. During each learning session (four in total) 12 vocabulary items were probed. The authors measured accuracy of 2 ½ year old children’s ability to locate target vocabulary items during learning sessions and generalization (free play) sessions. The assessors’ reliability was also assessed.

    12. AAC EBP Group, December 2006 CAP: Oxley, J. & Norris, J. (2000) Objective: To identify some of the memory and memory strategy issues implicated in VOCA use, particularly for school aged children. Results: For young children some memory strategies may be appropriate to use and may influence the layout and design of vocabulary on a VOCA: clustering, sorting and categorising vocabulary using age appropriate strategies e.g. thematic pages non-specific markers and pictures e.g. a star or a colour marking to remind a child where a message is stored picture markers together with elaboration e.g. a dog symbol next to a house symbol might have a message ‘this is my dog spot’ whereas a dog symbol next to a symbol for vet could have a message ‘last month my dog was sick’. This paper takes the form of a non-structured literature review and commentary focussing on: - Memory strategies and their cognitive demands Strategy development and associated error patterns Memorization strategies applicable to VOCA use Memory demands from VOCA use are high particularly for young children. A range of memory strategies are available that can assist with this – these need to be taught. Some memory strategies for layout and design were also highlighted that may be applicable to AAC design. For young children some memory strategies may be appropriate to VOCA use and influence the layout and design of vocabulary: clustering, sorting, categorizing vocabulary using age appropriate strategies e.g. thematic pages non-specific markers and pictures e.g. a star or a colour marking to remind a child where a message is stored picture markers together with elaboration e.g. a dog symbol next to a house symbol might have a message ‘this is my dog spot’ whereas a dog symbol next to a symbol for vet could have a message ‘last month my dog was sick’.This paper takes the form of a non-structured literature review and commentary focussing on: - Memory strategies and their cognitive demands Strategy development and associated error patterns Memorization strategies applicable to VOCA use Memory demands from VOCA use are high particularly for young children. A range of memory strategies are available that can assist with this – these need to be taught. Some memory strategies for layout and design were also highlighted that may be applicable to AAC design. For young children some memory strategies may be appropriate to VOCA use and influence the layout and design of vocabulary: clustering, sorting, categorizing vocabulary using age appropriate strategies e.g. thematic pages non-specific markers and pictures e.g. a star or a colour marking to remind a child where a message is stored picture markers together with elaboration e.g. a dog symbol next to a house symbol might have a message ‘this is my dog spot’ whereas a dog symbol next to a symbol for vet could have a message ‘last month my dog was sick’.

    13. AAC EBP Group, December 2006 CAP: Hochstein, D. et al (2003) Objective Assessment of performance in relation to single versus dual-level display and consideration of performance in relation to type of vocab. Results More errors were made for abstract words than concrete, more errors made with dual-level system that single level. If the clinical goal is for quick and proficient AAC it is suggested that a small vocabulary on a single level chart may be effective If dual- level system is used extra training in category structure may help to reduce errors. Aim of the Study To provide an initial examination of the usefulness of nomothetic research design within the field of communication device usage. Intervention Investigated Sample of 16 children, 8 who had CP and were familiar with single level AAC systems, 8 typically developing children with no experience with AAC. Outcome Measures (Primary and Secondary) Assessment of performance in relation to single versus dual-level display and consideration of performance in relation to vocabulary concreteness. Results and Original Authors’ Conclusions There was no difference in performance pattern between children with CP and other children. More errors were made for abstract words than concrete, more errors made with dual-level system that single level. Aim of the Study To provide an initial examination of the usefulness of nomothetic research design within the field of communication device usage. Intervention Investigated Sample of 16 children, 8 who had CP and were familiar with single level AAC systems, 8 typically developing children with no experience with AAC. Outcome Measures (Primary and Secondary) Assessment of performance in relation to single versus dual-level display and consideration of performance in relation to vocabulary concreteness. Results and Original Authors’ Conclusions There was no difference in performance pattern between children with CP and other children. More errors were made for abstract words than concrete, more errors made with dual-level system that single level.

    14. AAC EBP Group, December 2006 AAC Design: clinical bottom line The search results yielded insufficient evidence to guide clinicians in regards to this question. The level III and IV evidence found during the search suggested the following: There is a need for the AAC system to be engaging and to be used for multiple purposes e.g. play, games and communication. The use of schematic layout / contextual scenes (schema) design with personally relevant content for both dynamic and static displays may be useful. Colour may be useful in designing AAC systems. In a natural scene or schematic layout – it may assist in segmentation, to highlight contrasts between objects or to highlight detail and as a means of cueing memory. There is little evidence available to guide clinicians in the design and layout of AAC systems. The Grade B & C level evidence that is available provides some broad guidelines for consideration when designing AAC displays and systems for young children. There is little evidence available to guide clinicians in the design and layout of AAC systems. The Grade B & C level evidence that is available provides some broad guidelines for consideration when designing AAC displays and systems for young children.

    15. AAC EBP Group, December 2006 AAC Design: clinical bottom line Location markers or use of specific and consistent placement of symbols in an AAC system may assist in providing a reminder or prompt In the case of simple quick communication – it may be useful to use a small vocabulary on a single level chart. The points highlighted above must be interpreted with caution as the level of evidence is not high. As highlighted in many of the articles there is a need for future research into the design and layout of AAC systems for young children.

    16. AAC EBP Group, December 2006 Impact on clinical practice: Future CATS have commenced on: The usefulness of AAC systems with schematic layout for adults or children who have communication disabilities The use of core vs fringe vocabulary in relation to AAC design Investigation as to whether use of colour / taxonomic layout makes it easier for the communication partner to find vocab therefore provide better modelling for the AAC user therefore provide more help to learn the system

    17. AAC EBP Group, December 2006 Therapists in their everyday practice will trial the use of schematic layouts, as opposed to using more traditional grid layouts organised taxonomically. Therapists in their everyday practice will trial the use of schematic layouts, as opposed to using more traditional grid layouts organised taxonomically.

    18. AAC EBP Group, December 2006

    19. AAC EBP Group, December 2006 Need for research: As the standard of research is not high in this area clinicians are encouraged to write up any case studies or simple research studies as these would contribute significantly to the evidence base. Impact on clinical practice:

    20. AAC EBP Group, December 2006 AAC & Dyspraxia (DAS) Special thanks for the contributions of all the members of AAC EBP Group

    21. AAC EBP Group, December 2006

    22. AAC EBP Group, December 2006 Answerable question Is the use of AAC effective in facilitating communication in people who have dyspraxia / apraxia?

    23. AAC EBP Group, December 2006 Results: 5 Articles

    24. AAC EBP Group, December 2006 CAP: Lane, V & Samples, J.(1981) Objective: This study investigated a group of four individuals and their ability to use Bliss symbols as a technique for facilitating communication and to learn Bliss in a group setting Results: This paper found the effectiveness of using Bliss symbols to facilitate communication was highly individualised and time consuming.

    25. AAC EBP Group, December 2006 CAP: Patte, C., Von Berg, S. & Ghezzi, P. (2006) Objective: Single case study of a 57 year old female who has primary progressive aphasia and apraxia of speech Trialled both American Sign Language and use of a Text to Speech AAC system. This study investigated the effect of the above on her communicative output Results: The results showed better performance in relation to ASL and this was reflected in the participants preference for this form of AAC. This was a poorly designed study.

    26. AAC EBP Group, December 2006 AAC &DAS: clinical bottom line The search results yielded insufficient evidence to guide clinicians in regards to this question.

    27. AAC EBP Group, December 2006 Impact on clinical practice: Continue to use fundamental AAC practices with this population until more is known Highlight this population as a key area for research Write up case studies

    28. AAC EBP Group, December 2006 NEXT TOPIC……………. Answerable question Does use of AAC technology support the development of literacy skills?

    29. AAC EBP Group, December 2006

    30. AAC EBP Group, December 2006 THANK YOU

    31. AAC EBP Group, December 2006 AAC design references Bredosian, J., Hoag, L. & McCoy, K. (2003). Relevance and speed of message delivery trade-offs in augmentative and alternative communication, Journal of Speech, Language, and Hearing Research, 46 (4) 800 Downey, D., Daugherty, P., & Helt, S. (2004). Integrating AAC Into the Classroom: Low-tech strategies. The ASHA Leader (36) pp 6-7 Drager, K. (2003). The Performance of typically developing 2 ½ year olds on dynamic display AAC technologies with different system layouts and language organizatioins, Journal of Speech, Language, and Hearing research, 46 (2) 298 Drager, K. (2004). Learning of Dynamic Display AAC Technologies by Typically Developing 3-Year-Olds: Effect of Different Layouts and Menu Approaches, Journal Of Speech, Language, and Hearing Research, 47 (5) 1133 Fallon, K., Light, J. & Achenbach, A. (2003). The Semantic Organization Patterns of Young Children: Implications for Augmentative and Alternative Communication, Augmentative and Alternative Communication, 19 (2) 74-85

    32. AAC EBP Group, December 2006 AAC design references Hochstein, D., McDaniel, M., Nettleton, S. & Neufeld, K. (2003). The fruitfulness of a nomothetic approach to investigating AAC: Comparing two speech encoding schemes across cerebral palsied and non-disabled children, American Journal of Speech-Language Pathology, 12 (1), 110 Hochstein, D.,McDaniel, M & Nettleton, S. (2004). Recognition of Vocabulary in Children and Adolescents with Cerebral Palsy: A Comparison of Two Speech Coding Schemes, Augmentative and Alternative Communication, 20 (2) 45-62 Hudson, P. (1979), Recommitment to the Fitzgerald Key, American Annals of the Deaf, 124 (3) 397-9 Light, J. & Drager, K, D. (2002), Improving the Design of Augmentative and Alternative Technologies for Young Children, Assitive Technology, 14, 17-32 Light, J. & Drager, K. (2005), R3: Improving AAC Technologies for Young Children with Significant Communication Disorders, http://www.aac-rerc.com/archive_aac-rerc/pages/ProjectSite/R3.htm Last accessed September 2005

    33. AAC EBP Group, December 2006 AAC design references Light, J., Drager, K., McCarthy, J., Mellot, S., Millar, D., Parrish, C., Parsons, A., Rhoads, S., Ward, M. & Welliver, M. (2004). Performance of Typically Developing Four-and Five-Year-Old Children with AAC Systems using Different Language Organization Techniques, Augmentative and Alternative Communication, 20 (2) 63-68 Light, J., Drager, K. & Nemser, J. (2004). Enhancing the Appeal of AAC Technologies for Young Children: Lessons from the Toy Manufacturers, Augmentative and Alternative Communication, 20 (3) 137-149 Light, J. & Lindsay, P. (1991), Cognitive Science and Augmentative and Alternative Communication, (7), 186 – 202 Mizuko, M. (1987), Transparency and Ease of Learning of Symbols Represented by Blissymbols, PCS, and Picsyms, Augmentative and Alternative Communiction, 129-135 Mizuko, M., Reichle, J., Ratcliff, A. & Esser, J. (1994). Effects of Seclection Techniques and Array Sizes on Short-Term Visual Memory. Augmentative and Alternative Communication, 10, 237-244.

    34. AAC EBP Group, December 2006 AAC design references Oxley, J. & Norris, J. (2000). Children’s Use of Memory Strategies: Relevance to Voice Output Communication Aid Use, Augmentative and Alternative Communication, 16 –94 Reichle, J., Dettling, E., Drager, K., Leiter, A. (2000), Comparison of Correct Responses and Response Latency for Fixed and Dynamic Displays: Performance of a Learner with Severe Developmental Disabilities, Augmentative and Alternative Communiction, 154-163 Schlegel, R., Spencer, R. & Whitbeck, C. (1988). Keyboard interface of a speech synthesizer for the physically handicapped, Applied Ergonomics, 19.1, 67-70 Sevcik, R.A., Romski, M.A. & Wilkinson, K.M. (1991). Roles of Graphic Symbols in the Language Acquisition Process for Persons with Severe Cognitive Disabilities. Augmentative and Alternative Communication, 7, 161-170. Stuart, S. (2000). Understanding the Storytelling of Older Adults for AAC System Design, Augmentative and Alternative Communication, 16, 1-12

    35. AAC EBP Group, December 2006 AAC design references Wilkinson, K. & Jagaroo, V. (2004), Contributions of Principles of Visual Cognitive Science to AAC System Display Design, Augmentative and Alternative Communication, 20, (3) 123-136

    36. AAC EBP Group, December 2006 AAC & DAS References Ballard, K., Granier, J. & Robin, D. (2000) Understanding the nature of apraxia of speech: Theory, analysis and treatment, Aphasiology, 14 (10), 969-995 Bornman, J., Alant, E. & Meiring, E. (2001) The use of a digital voice output device to facilitate language development in a child with developmental apraxia of speech: a case study, Disability and Rehabilitation, 23 (14), 623 - 634 Hall, P, K. (2000) A letter to the parent(s) of a child with Developmental Apraxia of Speech, Language, Speech and Hearing Services in Schools, 179 Lane, V & Samples, J.(1981) Facilitation Communication in adult apraxics: Application of Blissymbols in a group setting, Journal of Communication Disorders,14. 157 – 167

    37. AAC EBP Group, December 2006 AAC & DAS References Ogar, J., Slama, H., Dronkers, N., Amici, S. & Gorno-Tempini, M.L., 1985, Apraxia of Speech: An overview, Neurocase,11, 427-432 Pannbacker, M. 1988, Management Strategies for Developmental Apraxia of Speech: A review of literature, Journal of Communication Disorders, 21, 363-371 Patte, C., Von Berg, S. & Ghezzi, P. (2006), Effects of alternative communication on the communicative effectiveness of an individual with a progressive language disorder, International Journal of Rehabilitation Research, 29:151–153 Sevcik, R.A., Romski, M.A. , & Adamson, L.B. (2004) Case Study: Research directions in augmentative and alternative communication for preschool children. Disability and Rehabilitation, 26 (21/22), 1232-1329

    38. AAC EBP Group, December 2006 Wambaugh, J.L., (2002), A Summary of Treatments for Apraxia of Speech and Review of Replicated Approaches, Seminars in Speech and Language, Vol 23 (4) 293-308 AAC & DAS References

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