Augmentative Communication Devices as

Augmentative and Alternative
Communication Devices as Employment
Supports
January 26, 2015
 Megan Case, MA, CCC-SLP
 Speech-Language Pathologist for the Assistive
Technology Center
Month
Trainings available at Ohioemploymentfirst.org
website
June 30, 2014
Task analysis for job coaches
July 21, 2014
Worksite Analysis for job coaches
August 28, 2014
Tablet Computers and Smartphones as workplace supports
September 23, 2014
January 26, 2015
The Role of the Occupational Therapist in supporting
employment
The Role of Rehab Engineering and the Assistive Technology
Center in supporting employment
Video Resumes and Professional Portfolios: Presenting Job
Seekers in the best light
Augmentative Communication Devices as employment supports.
February 26, 2015
Employment supports for those with IDD and Autism.
March 16, 2015
Employment supports for those with Physical or Sensory
involvement.
The Job Matching Process
October 27, 2014
November 20, 2014
April 28, 2015
2
Previous Presentations: Ohioemploymentfirst.org
Objectives
 Explore the different options of AAC devices that are
available to help individuals with communication
difficulties communicate with a wider variety of
individuals
 Emphasize the importance of communication as an
essential skill to obtain and maintain employment
 Review how using an AAC device can aid individuals
with obtaining employment
 Explain how AAC devices allow individuals with
communication difficulties to increase their functional
independence and more effectively and efficiently
interact with co-workers, supervisors, and customers
and decrease the need for additional support
personnel in the workplace.
Assistive Technology
 Services, devices, strategies and practices that are
conceived and applied to increase, maintain or
improve functional capabilities of individuals with
disabilities.
Service
Device
AT
Strategy
Cook and Polgar (2008)
Practice
HAAT Model
What is AAC?
 Augmentative
 Alternative
 All forms of communication other than verbal
communication that are used to express thoughts,
needs, wants, and ideas.
 Other names: Speech Generating Device (SGD),
Augmentative Communication Device (ACD)
AAC
 System
 Method
 Device
Why and When to Use AAC
• Enhance Speech Intelligibility
• Supplement Verbal Speech Production
• Supplement Written Communication
• Replace Nonfunctioning Speech System
• Provide Audible Voice Output
Why and When to Use AAC
 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….
Interaction of AAC and ECD
Comprehensive Evaluation
• Pertinent Medical Background
• Communication/Speech and Language Status and Limitations
• Communication Needs Assessment
• Communication System Suitability
• Cognitive Status
• Postural and Mobility Status
• Sensory Status
• Access Capability
• Device Trial
• Mounts
• Use and Learning of SGD Selected
• Treatment Plan and Follow Up
Who is Involved?
 Patient
 Family/Caregivers
 Educators
 Vocational Rehab/OOD
 Case Managers
 Speech-Language Pathologist
 Occupational Therapist
 Physical Therapist
 Rehab Engineer
 Physician
 Vendor/Manufacturer
What is Out There?
Features to consider when selecting a device:
 Low Tech to High Tech
 Dedicated vs. Integrated
 Speech Output
 Display
 Rate Enhancement
 Access Method
 Portability
Low Tech vs. High Tech
 Low Tech = Non Electronic
 Writing, gestures, facial expression, sign
language, letter board, picture board
Low Tech to High Tech
 Mid Tech
 Requires source of power
 Recordable device (digitized speech)
 Paper “overlays” with static display
 1-128+ buttons/messages
 Can hold multiple pages (levels) of recordings &
pictures
Low Tech to High Tech
 High Tech = Electronic
 Rechargeable power source
 Speech Generating Device
 Can produce synthesized speech
 Some also allow for recorded speech
 Dynamic Display
 Computer features
 environmental controls
 computer access
 Most require programming
 Require training, support, and maintenance
Dedicated vs. Integrated
 Dedicated means the device is used only for
communication
 Integrated means the device is built on PC format
with other computer applications
Speech Output
 Digitized Speech
 http://depts.washington.edu/augcomm/original_modules/module_equipt/equipt_features_output.htm
 Synthesized Speech
 http://www.nextup.com/
Rate Enhancement
 Purpose: To Accelerate Message Production
 Message Encoding/Abbreviation Expansion
 Salient Letter, Category, Numeric
 Prediction
 Letter, word, phrase, and grammar
 http://www.youtube.com/watch?v=5_KEjkONjR8
 Message Storage
 Store an entire message under one button (e.g. TT)
Access Method
 Direct Selection
 Use of fingers
 May involve use of keygaurd
 Assisted Direct
 Use of an external device that is controlled by a part of the body
 Wooden pointer/stick, laser pointer, mouth stick, head pointer
 Indirect Selection
 Use of a separate device that is not part of the body
 Switch
Scanning
 Switch for Scanning
 The device highlights messages according to a set
pattern and the user activates a switch to select the
message
 Varies by pattern, selection technique, and speed
 Patterns include linear, row-column, and group-rowcolumn
 Selection techniques include automatic, directed, and
step
 Visual vs auditory
Switches
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Switch Types
 Considerations:
 Location- The most effective site may not allow for
mobility
 Should be easily activated
 Need appropriate timing
 Variables:
 Type of feedback
 Size
 Weight
 Pressure needed to activate
 Moisture resistance
Alternative Access
 Headmouse
 Eye Gaze
Portibility
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Size
Weight
Carrying Cases
Mounts
Mounting
Smartphone and Tablets
 Portable, generic, easily-available devices
 Music/game players
 Smart phones
 Tablet computers
 Run Communication Apps (software)
Tablet Phenomenon
 Benefits:
 Universal design
 Portability
 Ease of availability and purchase
 Cost considerations
 What’s not being said:
 Trials versus required purchase
 Skipping comprehensive assessment
 Portability
What is the Best System to Use?
 There is no “best” type of AAC system.
 Each has its own pros and cons
 Goal is FEATURE MATCHING- to identify the most
suitable system for an individual depending on their
personal preference as well as on their abilities and
needs.
AAC and Employment
 Discuss 3 key components for obtaining and
maintaining employment:
 developing employee knowledge and skills that are
valued in the workplace
 identifying jobs that are a good match for the skills
and interests of individuals who use AAC
 ensuring that needed supports are available to
maintain employment success
 Employment support teams
 Job carving
McNaughton, D., and Arnold, A.
AAC and Employment
 Bryen et al.
 Communicate effectively in the workplace - KEY skill
 Involves more than discussing work-related activities.
 Storey and Provost
 Benefits of providing communication skills instruction
and communication books featuring social vocabulary
 Breaks/social meals included core vocabulary as well
as work site specific fringe
 AAC device had substantially helped in many major
life activities, including maintaining a source of
income.
AAC and Employment
 Effective use of assistive technology in work setting
requires more than just access to a device!
 Organized instruction and opportunities for
meaningful practice are also needed
 Committed Employer - Need for increased effort at
the beginning of the employment process as well as
ongoing needs for assistance with work activities and
ADLs in the workplace
“Extensive, intensive teaching during implementation is
the key to success” (Horton, Horton, & Meyers, 2001)
Who funds these services?
 Medical Model
 MD referral
 Bill for services based on LCD codes
 Submit to insurance for approval
 OOD referral, DD services, waiver services
 Must have prior authorization
 Private Payment model
 When above not available, services provided on
discounted rate
 Consumer agrees upon services and signs an
agreement
Additional Resources
 Low Tech AAC
 www.speakingofspeech.com/AugCom_Materials.html
 Alphabet Boards
 http://www.spectronics.com.au/blog/tools-andresources/free-downloadable-alphabet-boards-forpeople-using-aac/
 Make your own communication board
 http://connectability.ca/visuals-engine/
Additional Resources
 ATIA (Assistive Technology Industry Association)
 www.atia.org
 Sample AAC Vendors
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Forbes Rehab Services (www.frs-solutions.com)
Prentke Romich (www.prentrom.com)
Saltillo (www.saltillo.com)
Tobii DynaVox (www.tobiidynavox.com)
Questions?????
Thank you!!!!!
Tablet Phenomenon
 What is Not Available?
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Training on App
Technical support
Limited alternative access
Limited speaker volume control
App for monitoring use
Performance measurement
Outcomes measurement
State Centers
 Assistive Technology of Ohio
www.atohio.org
 Assistive Technology of Ohio Device Lending Library
www.atohio.org/devices.html
 Assistive Technology Trading Post
www.atohiotradingpost.org/home.php
 Autism Society of Ohio
www.autismohio.org