9 aac intervention 1

7/24/2019 9 AAC Intervention 1

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AAC INTERVENTION 1Liora Ballin, PhD

Johanna Korkalainen, Cerebral Palsy Alliance


2/57

O!line

" Re#ie$ assess%en!, &oal se!!in& an' in!er#en!ion

" Decision %akin& in !hera(y

" )oal se!!in&

"Aban'on%en! o* AAC" Challen&es in learnin& !o se AAC

" O#erco%in& barriers


3/57

CLINICAL REA+ONIN) PROCE++IT- AAC. A++E++/ENT 0 )OAL

+ETTIN) I/PLE/ENTATION


4/57

Process

PLANNING

INTERVENTIONEVALUATE

ASSESSM

ENT

GOAL

SETTING


5/57

PLANNIN)


6/57

Plannin&

" In#ol#e%en! o* collabora!i#e !ea% an' !ea% roles

"A''ress barriers an' challen&es 2

" Consi'er &oal li%i!in& *ac!ors.

ID 3a%ily circ%s!ances an' a#ailabili!y in or'er !o

" 4se o* AAC in na!ral en#iron%en!s

" Pro#i'in& %o!i#a!in& o((or!ni!ies

" 4se o* %o'ellin& !echni5es


7/57

" The sccess o* AAC 'e(en's on !he s((or! !ea%6" Lack o* &oo' s((or! lea's !o AAC aban'on%en!6

" 4n'ers!an' !he (r(ose o* !he sys!e%

" 4n'ers!an' ho$ !he in'i#i'al ses !he sys!e%

" Encora&e an' %o'el !he se o* !he sys!e%

" Re#ie$ an' ('a!e !he sys!e%

Role o* !he +((or! Tea%


8/57

Pr(ose o* !he sys!e%

Clari*y !he crren! (r(ose o* !he sys!e%" E6&6 To re5es!7 &ree!7 co%%en! 0 co%bina!ion

" To a&%en! nclear s(eech

Realis!ic n'ers!an'in& o* *!re &oals7 (o!en!ial" I! %ay !ake years o* (rac!ise *or !he 'e#ice !o

beco%e !he (erson8s 9#oice:

" 4n'ers!an'in& o* ho$ !he crren! &oals bil'

!o$ar's &rea!er (o!en!ial


9/57

E;(ec!a!ions

Es!ablish realis!ic e;(ec!a!ion o*" !he !i%e i! !akes !o learn !he &oals an' learn !he se o* !he

sys!e%

" ho$ !he chil' is crren!ly able !o se !he 'e#ice

" !he a%on! o* s((or! an' co%%i!%en! !ha! is re5ire' *ro%e#eryone

" ho$ !he se o* an AAC sys!e% can slo$er an' see%in&ly i%(e'e

con#ersa!ion


10/57

E;(ec!a!ions o* AAC

"AAC s!akehol'ers, incl'in& *a%ily %e%bers an' en'

sers o* !he !echnolo&y, #ie$ !he (ro#ision o* AAC as a

sol!ion !o !he co%%nica!ion 'i**icl!ies o* (eo(le $i!h

CCN ??>@

" Bailey e! al6 ??@ s!'ie' *a%ily %e%bers8 (erce(!ions

o* +)D se" Paren!s $ere 'isa((oin!e' $i!h ho$ li!!le co%%nica!ion chan&e'

*ollo$in& (ro#ision o* an +)D an' !he li%i!e' resorces an's((or!s !hey $ere able !o access !o bil' AAC skills


11/57

On&oin& s((or!" In!ro'ce !he s((lier" De%ons!ra!e ho$ !o se

!he $ebsi!es7 3As

" Dis!rib!e in!er#en!ion hors

!o incl'e s((or!

" Ne$ re*erral *or *r!her s((or!


12/57

+4PPORTIN) PER+ON

CENTERED PLANNIN)


13/57

" Ensre !ha! !he (erson $i!h CCN is incl'e' a! all s!a&es

o* !he AAC assess%en!, %ana&e%en! 'ecisions, an'

in!er#en!ion

" 3or (eo(le $i!h CCN, !here is a nee' !o !hink care*lly

abo! ho$ (ar!ici(a!ion in (erson cen!re' (lannin& is

or&anise'


14/57

-o$ !o s((or! (ar!ici(a!ion in (lannin&

" Pro#i'e in!eri% co%%nica!ion s((or!s

" Pro#i'in& in*or%a!ion in *or%a!s !ha! are accessible

" Co%%nica!ion s((or!s %ay incl'e." AAC*rien'ly8 in*or%a!ion shee!s an' consen! *or%s

" In*or%a!ion 'is(lays

" +che'les

" 4se o* a((ro(ria!e (ho!o&ra(hs, (ic!o&ra(hs or o!her sy%bolic or

nonsy%bolic *or%s o* co%%nica!ion" Talkin& /a!s


15/57

Incl'in& (eo(le $i!h ID in 'ecision %akin&

" The +((or!e' Decision /akin& 3ra%e$ork ?1?@ hel(s !o (ro#i'e an obec!i#e $ay !o s((or! !he

(erson $i!h in!ellec!al 'isabili!y

" ha!e#er is kno$n abo! !he (erson8s (re*erences an'

co%%nica!ion is !aken in!o accon! an' re#ie$e' !o

allo$ *or chan&es in 'ecisions, as circ%s!ances can an'

$ill chan&e o#er !i%e


16/57

AAC BARRIER+


17/57

Barriers !ha! rela!e !o !he in'i#i'al sin& !heAAC sys!e%6

" The in'i#i'al8s skillsF co&ni!i#e skills, co%%nica!ion skills,(hysical abili!y, li!eracy abili!y #ision, hearin&

" A!!i!'esF !he in'i#i'al8s a!!i!'e !o$ar's !he AAC sys!e%

e6&6 ne&a!i#e a!!i!'e7 *ear7 e%barrass%en!

" Resorce li%i!a!ionsF li%i!a!ions o* !he ac!al AAC sys!e%

e6&6 A%on!7 !y(e o* #ocablary

Barriers !o AAC 0 Access


18/57

Barriers !ha! rela!e !o !he en#iron%en! or !hes((or! !ea%" Policies !ha! i%(ac! on AAC se, e6&6 no se o* elec!ronic 'e#ices in

hos(i!als

" Prac!ices, (roce're or con#ic!ions, e6&6 no AAC se 'rin& %eal !i%es" +kill !o o(era!e !he AAC, e6&6 ('a!in&7 (ro&ra%%in&

" +kill !o i%(le%en! !he sys!e%, e6&6 $here an' ho$ !o se !he sys!e%

" A!!i!'es an' belie*s o* o!hers !o$ar's AAC

" Kno$le'&e7 n'ers!an'in& o* !he se o*

AAC, e6&6 i!s (r(ose

Barriers !oAAC 0 O((or!ni!y

-o'&e ??G@, /r(hy e! al


19/57

Lack o* kno$le'&e7 n'ers!an'in&.

"AAC is a 9las! resor!: in s(eechlan&a&e in!er#en!ion

"AAC hin'ers s(eech 'e#elo(%en!" Peo(le %s! ha#e a cer!ain se! o* skills !o be able !o

bene*i! *ro% AAC

" +)Ds are only *or chil'ren $i!h in!ac! co&ni!ion

" Chil'ren shol' be o* cer!ain a&e !o be able !o bene*i!

*ro% AAC" Ro%ski an' +e#cik ??@


20/57

9Or %ain co%%nica!ion &oal is *or !he (erson !o

!alk:

"AAC in!er#en!ions $ill no! inhibi! s(eech an'

co%%nica!ion 'e#elo(%en! ??F +chlosser = en'!, >??@" a sys!e%a!ic re#ie$ $i!h %e!aanalysis

"AAC (ro%o!es lan&a&e learnin& ??@


21/57

9Nobo'y else $ill se !he AAC sys!e%, so $e 'on8!

$an! i!:

" I* co%%nica!ion (ar!ners an' en#iron%en!s 'o no!

s((or! !he se o* AAC, !here $ill be a 'ecrease'

likelihoo' o* sccess


22/57

AAC ABANDON/ENT


23/57

AAC aban'on%en!

" The !er% abandonmentis se' in 'i**eren! $ays in !he AAC li!era!re

??@

" Dis!in&ish be!$een !hose $ho a((ro(ria!ely 'iscon!ine sin& AAC

once !hey no lon&er nee' i! $i!h !hose $ho con!ine !o nee' AAC, b!

'o no! se i! ??@

" They se !he !er% abandonment!o re*er !o 9ina((ro(ria!e

'iscon!inance o* $ha! (ro*essionals *eel is an a((ro(ria!e AAC

sys!e%: ??, (6 H@

" There are hi&h ra!es o* aban'on%en! e#en a%on& !hose $i!h access

!o sys!e%s" Varie!y o* reasons *or aban'on%en! e6&6 lack o* s((or!, lack o*

!rainin&, lack o* kno$le'&e, 'i**icl!y !robleshoo!in& !echnical isses,

o((or!ni!y an' access barriers


24/57

De#ice aban'on%en!

" Varie!y o* reasons *or aban'on%en! e6&6 lack o* s((or!,

lack o* !rainin&, lack o* kno$le'&e, 'i**icl!y

!robleshoo!in& !echnical isses, o((or!ni!y an' access

barriers


25/57

AAC 4se $i!h (eo(le $i!h CP

AAC is o*!en no!se' by (eo(le

$i!h si&ni*ican!

co%%nica!ion

'i**icl!ies

+(eech is %os!co%%only se'

by (eo(le $i!h

si&ni*ican!

co%%nica!ioni%(air%en!sLo$ !ech AAC

sys!e%s are %os!

co%%on 1 An'ersen e! al >?1?, > -i%%el%ann e! al, >?1>, Cockerill e! al, >?1, No#ak e! al, >?1


26/57

De#elo(%en!s in AAC

" Ra(i' 'e#elo(%en!s ha#e been !akin& (lace in AAC

!echnolo&y o#er recen! years


27/57

/ains!rea% !echnolo&y

" 4se o* iPa's has increase' %ore !han se o* o!her AT

" 9/ains!rea%: no! 'i**eren! or in'ica!i#e o* a 'isabili!y


28/57

)OAL +ETTIN)


29/57

Example handout from package


30/57

Example handout from package


31/57

Co%(e!ence )oals

Lin&is!ic co%(e!ence" Lan&a&e (rinci(les

O(era!ional co%(e!ence" Technical skills !o o(era!e !he sys!e%

+ocial co%(e!ence" Con#ersa!ion roles

+!ra!e&ic co%(e!ence" +!ra!e&ies *or co%%nica!ion break'o$ns

Janice Li&h!, 1HH


32/57

PLANNING

INTERVENTIONEVALUATE

ASSESSM

ENT

GOAL

SETTING


33/57

" Re*lec!s clien!s = !hera(is!8s (riori!ies

" I%(ro#es clari!yo* &oals

" 3acili!a!es clien! (roble% sol#in&

" Es!ablishes realis!ic e;(ec!a!ions o*

in!er#en!ion

Ottenbacher & Cusick, 1993Forbes, 1998

"Es!ablishes realis!ic &oals

")oals are in'i#i'alise'

"Res(onsi#e !o chan&e

"No! bon' by any !rea!%en!

a((roache'

Person Cen!ere' )oal +e!!in&


34/57

T6J Kiresk = R6E6 +her%an


35/57

essels e! al, 1HHH

" E**ec!i#eness in %easrin& chan&e $i!h assis!i#e

!echnolo&y

" +bec!i#e %easre o* !he i%(ac! !ha! (roble%s ha#e on

'aily li*e6

" Pro#i'es %easres be*ore an' a*!er !he se o* assis!i#e

!echnolo&y6

In'i#i'ally Priori!ise' Proble% Assess%en!


36/57

")oal *or !he se o* !he co%%nica!ion sys!e%6 ha! is !he clien! sin& !he sys!e% *or here is !he clien! sin& !he sys!e%

-o$ is !he clien! accessin&7 sin& !he sys!e%

-o$ o*!en is !he clien! sin& !he sys!e%

ho $ill s((or! !he se o* !he sys!e%

"I'en!i*y !he %e%bers an' !he roles o* !he s((or!!ea%6

"Deci'e on !he re#ie$ (rocess

Ti%e *ra%e -o$ 'o yo kno$ i* !he sys!e% has been sccess*l

)oals 0 lon& !er% an' shor! !er%


37/57

IPPA Assessment Form

! " # $

No!i%(or!an! a!

all

No! soi%(or!an!

+o%e$ha!i%(or!an!

i!ei%(or!an!

/os!i%(or!an!

! " # $

No! 'i**icl!ya! all

Li!!le'i**icl!y

i!e so%e'i**icl!y

A lo! o*'i**icl!y

Too %ch'i**icl!y !o(er*or% !heac!i#i!y a! all

Please descr%&e the pro&lem'

(o) do *ou rate the %mportance of th%s pro&lem+

(o) do *ou rate the le,el of d%ff%cult* *ou ha,e )%th th%s pro&lem %n

e,er*da* l%fe+


38/57

Implementat%on phase

" De#ice access

" Plan in!o ac!ion

" Plan re#ie$

"

/akin& chan&es


39/57

E,aluat%on phase

" On&oin&

" Re#ie$ &oals

" E#ala!e ac!i#i!ies

"

E#ala!e roles" E#ala!e s!ra!e&ies


40/57

C-ALLEN)E+ INLEARNIN) TO 4+E AAC


41/57

Challen&es

" Peo(le *ace challen&es in learnin& !o se AAC

!echnolo&ies" ??GF /cNa&h!on, e! al6, >??F Perry, e! al6,

>??>F Rackens(er&er, e! al6, >??F +%i!h = Connolly, >??@

" Rackens(er&er e! al6 ??@ re(or!e' challen&es !o AAClearnin& *ro% !he (ers(ec!i#e o* (eo(le $ho se an +)D

!o co%%nica!e

" They i'en!i*ie' challen&es, sch as

" 'i**icl!ies accessin& ins!rc!ion an' s((or!" ser#ices *ro% +LPs an' o!her AAC (ro*essionals $ho 'o no! ha#e

!he !rainin& or e;(erience !o !each +)D se

" ins**icien! o((or!ni!ies !o (rac!ise


42/57

Di**icl!y accessin& !rainin&

" Peo(le ne$ !o an +)D can e;(erience 'i**icl!y ob!ainin& !he

!hera(y ser#ices re5ire' $i!h !he s**icien! *re5ency !o

s((or! learnin&


43/57

Pro*essionals $i!ho! AAC !rainin&

" +LPs %ay no! ha#e !he kno$le'&e, !rainin&, an' e;(erience !o

!each ne$ learners ho$ !o se !he #arie!y o* +)Ds a#ailable

??@

" Clinicians ha#e re(or!e' lo$ le#els o* e;(er!ise in AAC an'

li%i!e' !rainin& ??@" Johnson e! al6 ??@ sr#eye' >G +LPs in !he 46+6 abo! AAC sys!e%

se an' aban'on%en!

" The a!hors concl'e' !ha! lack o* !rainin& an' s((or! in AAC sys!e%s

$ere key *ac!ors in 'e#ice aban'on%en!

" In'i#i'als $ho re5ire AAC an' !heir co%%nica!ion (ar!ners

also re(or! a lack o* !raine' (ro*essionals in !he AAC *iel'

??F Rackens(er&er, e! al6, >??@" Paren!s hi&hli&h!e' li%i!e' e;(erience o* +LPs ??@


44/57

Prac!ice o((or!ni!ies

" Co%(e!ence in AAC !akes !i%e an' (rac!ice

" Peo(le learnin& !o se AAC 'o no! al$ays ha#e !heir AAC

a#ailable

" Lack o((or!ni!ies !o a((ly an' (rac!ise skills in %any

e#ery'ay en#iron%en!s ??@

" Research $i!h schoola&e sers o* +)Ds s&&es!e' !ha!

'e#ices are o*!en inaccessible in !he classroo%


45/57

Co%%nica!ion (ar!ner skill

" Ty(ically, co%%nica!ion (ar!ners con!rol in!erac!ions

sin& #erbal an' (hysical 'irec!i#es an' 'o no! (ro#i'e

(eo(le learnin& AAC $i!h co%%nica!ion o((or!ni!ies?11F Pennin&!on, e! al6,

>??@" Co%%nica!ion (ar!ners.

" ask close'en'e' 5es!ions

" !ake !he %aori!y o* con#ersa!ional !rns

" en&a&e in %essa&e cocons!rc!ion

" These s!ra!e&ies 'ecrease !he %essa&e len&!h o* (eo(le

sin& AAC an' can (ro%o!e 'e(en'ency


46/57

In(!o!(! assy%e!ry

" /o'ellin& o* AAC sys!e% se is no! co%%only (er*or%e'

by s(eakin& (ar!ners ??@" The resl! is !ha! (eo(le learnin& AAC 'o no! o*!en recei#e in(! in

!he co%%nica!ion %o'e !ha! !hey are e;(ec!e' !o se ?11@

" I* (ar!ners 'o %o'el AAC se, !y(ically con!en! $or's are

(ro#i'e' in !he ai'e' %o'ali!y ??@


47/57

Access !o (osi!i#e (eer %o'els

" Peo(le learnin& AAC rarely see !he sys!e% !hey se bein&

se' by so%eone %ore co%(e!en! !han !he%sel#es

" Lo$ le#els o* con!ac! a%on& (eo(le $ho se AAC %ean

!ha! !hose ne$ !o AAC %i&h! recei#e ina'e5a!e

%o'ellin& o* co%(e!en! +)D se ??@

" Peo(le $ho se AAC col' bene*i! *ro% !he s((or! an'

encora&e%en! o* a'l!s $ho also se AAC e**ec!i#ely

an' $ho ha#e o#erco%e challen&es an' achie#e'sccess ??G@


48/57

" Kno$le'&e o* barriers is i%(or!an! in or'er !o (ro#i'e

*ocs !o in!er#en!ions

" ha! 'oes !his %ean *or clinical (rac!ice


49/57

AAC I/PLE/ENTATION


50/57

I%(le%en!a!ion consi'era!ions

" In!er#en!ion s!ra!e&ies !eachin& s!ra!e&ies incl'in&

lan&a&e s!i%la!ion, (eer learnin&, e;(lora!ion

" Pro%(!in& *ee'back !y(es an' *re5ency

" /o'e o* s((or! one on one #s #ia corres(on'ence6

ha! is !he *re5ency

" Doc%en! !he (lan an' share $i!h !he !ea%

" Pyra%i'al !rainin&

" Lan&a&e s!i%la!ion !echni5es


51/57

Crea!e an AAC en#iron%en!" /o'el !he se o* AAC

" Crea!e n%eros o((or!ni!ies !o se %l!i%o'al AAC

" Consis!en! lan&a&e

Assis! !he (erson !o se !heir AAC sys!e%" Physical an' #erbal (ro%(!in&

" )i#e !he (erson *ll a!!en!ion

" )i#e clear ins!rc!ions abo! 9here an' no$:

Co%%nica!ion En#iron%en!


52/57

" 9+abo!a&e: si!a!ions

" +(ecial cha!s $i!h (eers an' s!a**

" +(ecial !asks $here !he se o* AAC is re5ire'

" Role (lay !o (rac!ise ro!ines

I'en!i*y o((or!ni!ies a! yor $ork(lace $here

AAC col' be encora&e'6

Prac!ise I'eas


53/57

Prac!ise Ins!rc!ions e;a%(le

Clear n'ers!an'in& o* ho$ !o se !he sys!e% in 'i**eren!

con!e;! $i!h 'i**eren! !ea% %e%ber

Act%,%t* Place Team mem&er

Tell ne$s a! ne$s!i%e Pro&ra% ne$san' (ho!os *ro%!he $eeken'

+chool /% an' sel*

Play !rains Na%e !he coloran' sie o* !hecarria&es

)ran'%a8s hose )ran'(aren!s


54/57

/y o$n 'e#ice

Personalise !he 'e#ice" Personal an' ni5e only !o !he ser

" Na%es, (ho!os, #i'eos

3n" Ty(ically 'e#elo(in& chil'ren ha#e *n

Chil'ren $i!h AAC 9(rac!ise co%%nica!ion:6

" A&e a((ro(ria!e okes an' s!ories


55/57

" Kno$s co%%nica!ion sys!e%

" 4ses !he co%%nica!ion sys!e%

" Lis!ens

" )i#es !i%e an' a!!en!ion

" 4ses lo!s o* 'i**eren! s!ra!e&ies

" Is a$are o* *a!i&e

Co%%nica!ion Par!ner


56/57

Re*erences" Co(e OQKane, J6, = )ol'bar!, J6


57/57

" Reichle, J6, Bekel%an, D6 R6, = Li&h!, J6 C6 ??>@6 -emplary practices for beginning

communicators: /mplications for C. 0altimore, 1D: %aul !. 0rookes %ublishing Co." Pennin&!on L, )ol'bar! J, /arshall J ??@ +(eech an' lan&a&e !hera(y !o i%(ro#e !he

co%%nica!ion skills o* chil'ren $i!h cerebral (alsy6 Cochrane Database+ys!e%a!ic Re#ie$ @FCD??

" Pennin&!on6 L, )ol'bar!6 J = /arshall6 J ??@ In!erac!ion !rainin& *or con#ersa!ional (ar!ners o*chil'ren $i!h cerebral (alsy. a sys!e%a!ic re#ie$6 /nternational $ournal of "anguage &

Communication Disorders (2'): 3#3+3*4." +ie&el, E6 = Cress, C6 J6 ??>@6 O#er#ie$ o* !he e%er&ence o* early AAC beha#iors. (ro&ression

*ro% co%%nica!i#e !o sy%bolic skills6 In J6 Reichle, D6 R6 Bekel%an = J6 C6 Li&h!

9 aac intervention 1

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