speechies…. “get out your road map!” · display (podd) books podd books • vocabulary to...

Speechies…. “Get Out Your Road Map!” From the Village of First Words to the City of Fluency

Darcy Regan, M.A., CCC-SLP Wyoming Assistive Technology Resources (WATR) Wyoming Institute for Disabilities (WIND) Wyoming Speech-Language Hearing Association (WSHA) June 25, 2015

Disclosures

• No disclosures I have no relevant financial or nonfinancial relationship(s) within the products or services described, reviewed, evaluated or compared in this presentation.

Overview

Augmentative Alternative Communication 1. Assessment 2. Integration 3. Pragmatic Organization Dynamic Display

(PODD) 4. “Appy” Time

Learner Outcomes

• Describe key AAC Assessment Procedures • Identify and be able to access at least three

additional AAC assessment resources • Describe how to use Core Vocabulary • Identify at least three strategies to keep data • Describe at least two different AAC

curriculums/approaches

The Village of First Words

Aided

Unaided

Romich, B., & Hill, K., 2004

Spoken Word

Signs

Gestures/Touch Cues

Printed Word

Line Drawings

Photographs

Objects

(Romski & Sevick, 2005, Light, Drager, Curran, & Collegues, 2005)

(Romich, & Hill, K.,2004;(Brandstatter, Leonesio, & Visvader, 2011)

Village of First Words “There are no prerequisites for communication!”

(Brandstatter, Leonesio, Visvader, 2011)

Section 1: AAC Assessment

AAC Assessment

• Once you’ve considered the use of AT – and more specifically, AAC – it’s time to plan a full AAC assessment – The SETT process helps you conduct a very

pointed assessment

(http://www.joyzabala.com)

The approach

Take a broad approach to assessment

• AAC Assessment is not just about prescribing a device

• It is about determining communication needs

(Guiberson, 2012, Binger, 2011)

Evaluation Procedures

• Underestimating Abilities • Overestimating Abilities

Evaluation Procedures

• Peabody Picture Vocabulary Test (PPVT) • Test of Auditory Comprehension of Language (TACL-3) • Receptive One Word Picture Vocabulary Test (ROWVT) • TOLD:P, TOLD:I • AAC Evaluation Genie • Communication Matrix

(Guiberson, 2012; Binger, 2011)

Overestimating Abilities

Is the child symbolic? • “No”

Does the child orient

communication toward a partner?

• “No”

Does the child exhibit joint attention?

• “No”

Create a communication

matrix

http://www.communicationmatrix.org/ (Guiberson, 2012)

Expressive Language & Communication

• Augmentative Communication Interaction Checklist (Glennen &

DeCoste, p. 165) • Pragmatics Profile of Everyday Communication Skills http://complexneeds.org.uk/modules/Module-2.4-Assessment-monitoring-and-evaluation/All/downloads/m08p080c/the_pragmatics_profile.pdf • Language Development Survey (Rescorla, 1989) • Rosetti • MacArthur CDI

(Guiberson, 2012, Binger, 2011)

5/18/2015 SPPA 5210, Guiberson

How will you figure out each piece?

• TASP (Test of Augmented Symbol Performance • AAC Tech Connect Kits • Use devices, on-line demos and free demo CDs from

vendors • Exploratory pages on DynaVox

• Use PPT ( Chase Me , below)

http://www.childrenshospital.org/centers-and-services/augmentative-communication- program/downloads

17 5/18/2015 SPPA 5210, Guiberson

Feature Matching

Motor Access for AAC Direct selection

Digital mouse

Directed scan

Step Scan

Automatic Scan

Inverse Scan

Graded motor control

yes

Gross/Discrete Motor Control

yes yes yes, have to get on/off switch

yes

Move body segment in multiple directions

yes maybe

Coordinate Movements between more than one body segment

yes Yes with 3 switches

yes Only if doing 2 step switch scan

Momentary Action

yes yes yes

Sustained Action

yes

Timely Release

(Breaux, 2013)

Language Stealers Video

• http://www.youtube.com/watch?v=iOVm8q0mCYA

Section 2: AAC Integration

Core Vocabulary • Available on various word lists

– Vocab of other successful AAC users – Source for toddlers

• Banajee, DiCarlo, & Stricklin, 2003, in AAC journal • Normal Language Development, Generative Language and AAC,

Gail VanTatenhove

– http://aac.unl.edu/vocabulary.html – excellent resources for AAC core vocab

(Binger, 2011; Reed & Gierarch, 2009)

5/18/2015 SPPA 5210, Guiberson

http://www.prentrom.com/training_materials/class-slides-3.pdf

Icon Sequencing

Icon Sequences

http://www.minspeak.com/teachers/documents/Did_That_Hurt.pdf

Speedometer of AAC

http://www.speakingofspeech.com/uploads/Bristle_LegoBd.pdf

“Can I have a turn?”

Embedded Communication Supports

Springer, 2012

Adapted Play Squares

Linda Burkhart lburkhart.com (Springer, 2012)

Engineering the Environment

• Expect augmented speakers to communicate • Provide frequent opportunities to

communicate • Facilitate interactive communication • Respond to communicative attempts by

augmented speakers

(Elder & Goosens’, 1994)

Engineering the Environment Engineering the Environment for Preschoolers

Scripts

• Create Joint Action Routines – Action organized around mutual goal and/or

shared materials

– Prioritize based on: • Functional activity • Frequently occurring • Motivating • Age Appropriate

(Elder & Goosens’, 1994)

Achieving Communication Competence

• Communication settings, & communication opportunities

• Individual’s communication skills - rate independence in 11 communication skills

(Gillette, 2012)


• Intervene by increasing: – # of communication partners/settings – # of communication opportunities – Use of messages with unaided/aided AAC – Partner strategies to support individual’s

communication

(Gillette, 2012)


Scripts

• Creative Communicating http://www.creativecommunicating.com/ • Teaching AAC

• Everyone Communicates Challenge

Visual Scene Displays

DynaVox Maestro

DynaVox Compass App

DynaVox Compass App

Visual Scene Displays

Smart/128 AMDI

Scene Communication Builder Enabling Devices

Tobii C-Series or Tobii S32

Visual Scene Displays Research

• 21/2 year-old children located more vocabulary in a schematic scene (Drager & Light et al 2003)

• 3 year olds performed significantly better with AAC in a contextual format versus grid (Drager & Light et al 2004)

• 2 year olds can learn VSD’s with few instructional opportunities (Olin, Reichle, Johnson, & Monn, 2010)

Visual Scene Displays Research

• Shared Reading – 39 preschoolers, including complex

communication needs (CCN’s) – Children responded better when responding to

questions using VSD’s versus grid display – Greater number of activations in grid display

during introduction/free play – More activations when responding to open ended

questions in grid display (Jackson, Wahlquist, & Marquis, 2011.)

Visual Scene Displays & Aphasia

Dietz, A., McKelvey, M., & Beukleman, D. (April 2006). Visual Scene Displays (VSDs): New AAC Interfaces for Persons with Aphasia, Perspectives AAC for Aphasia: A Review of a Visual Scenes Display Project http://aac-rerc.psu.edu/index.php/webcasts/show/id/4

Welcome to the City of Fluency

Population: 1.3 million & GROWING!

AAC in the Classroom

• Language Acquisition Through Motor Planning (LAMP) http://www.aacandautism.com/lamp

• Minspeak – Semantic Compaction Systems Teaching Plans and Materials • DynaVox Implementation Toolkit http://www.dynavoxtech.com/implementation-toolkit/ AAC in the Classroom- Observing the Classroom Environment

AAC Curriculums

• Teach Me AAC – Web based course, Aided language stimulation, scripting, core words

and literacy • Scripts: Engineering Training Environments for Interactive Augmentative

Communication (Elder & Goosens’)

• Pixon Project Kit

– Core Word Techniques, Aided Language Stimulation, Manual boards – Available for loan through WATR – Teach the training of icons used in PRC devices

Service Delivery: Much more than direct

( Maro, & Tufte, 2005; Binger,2011)

So, what should we do? A CPI Model Improving Partner Applications of Augmentative Communication

(ImPAACT; (Kent-Walsh, Binger, & Doan Malani, 2010)

– 8-step model developed for teaching ANY skill to the communication partners of individuals who use AAC

SPPA 5210, Guiberson


RAAP

Binger, Kent-Walsh, 2012


Case Study P Prompt Hierarchy

Natural Cue

Expectant Delay

Direct Cue: Point toward Device

Direct Verbal Cue: Model on Device

(Binger & Kent-Walsh, 2012)

The goal of Project ECHO-UW is to increase the capacity of educators to

use best practices in assistive technology for the benefit of students.

http://www.uwyo.edu/wind/echo/

Section 3: Pragmatic Organization Dynamic Display (PODD) Books

Pragmatic Organization Dynamic Display (PODD) books PODD Books

• Vocabulary to interact for a variety of communication functions AT ANY TIME

• “Efficiency to meet varied communication requirements is the overriding factor determining the organization and placement of vocabulary (pragmatics)

• PODD books go everywhere with the person, it is their voice!

(Porter & Tanish, 2013)

(Costello, 2013)

What is the weather? Smart Partner Operating System

• Go to “page number” instructions

• Color coded tags

• Operational Commands


PODD

• Developed to enable aided language stimulation AT ANY TIME in order to support autonomous communication


PODD supports more efficient communication

• Easy access to “Quick Chat” • Predictably associated vocabulary • Page layout • Main navigational indexes depending on the

style of PODD • Predictive links (provided to be part of the

conversation) (Porter & Tanish, 2013)

First pages of PODD

• Words and phrases that are contingent on the ongoing activity

• Increases the frequency of use of aided symbols to actively

participate during activities and contribute to conversations


Differences Between PODD vs. PECS

PECS PODD

J. Caifero, 2012, K. Ahren, 2012, personal communication

Advantages of PODD books

• Wider Range of Communicative Functions than: – Choice-making Displays – Activity Displays

(Burkhart & Porter, 2006)

Early Development and AAC • Early gestural control • AAC is dependent on whole body movement • Intelligibility may deteriorate • With babies we assume everything is meaningful &

shape into a more adult model • AAC feedback is focused on correctness

(Porter & Burkhart, 2014)

Learning AAC

• Respond to all communication as meaningful so we can build competence

• Communication is about something we don’t already know


SSS Spoken Language

Spoken Language

Spoken Language

Input Output Spoken Language Development

Child Learning Aided Symbols (pictures, symbols, written text)

(Burkhart, 2011)

Aided Language

Rett’s Syndrome • Dyspraxia • Don’t keep re-stating the message • Sometimes they may move away before moving towards • Sometimes it takes a lot of movement to “wake the system up”


Coordination of Skills

Sensory

Cognitive Language

(Burkhart & Porter, 2006)

Hmm, She’s looking at me! What can I say?

Keep hand off switch!

Illustration:

Eleanor Porter

Gayle Porter

GOT it!

I’ll tell her it’s cool. I I I – MM a pronoun Keep hand off switch!

Illustration:

Eleanor Porter

Gayle Porter

LOOKING LOOKING Where is pronoun? Ha column 2

Illustration:

Eleanor Porter

Gayle Porter

Is she still waiting? (look) Yep

Illustration:

Eleanor Porter

Gayle Porter

OK, start it up stretch arm, touch switch

Illustration:

Eleanor Porter

Gayle Porter

Oh No, leaning back Head middle, sit up

Gayle Porter

Watch it, column 1 no Hand away

Illustration:

Eleanor Porter

Gayle Porter

Column 2, that’s it, quick - stretch arm, touch switch

Illustration:

Eleanor Porter

Gayle Porter

Watch it, looking for I, hand away, here it comes get ready –

Illustration:

Eleanor Porter

Gayle Porter

What is she saying now? OH =!*** Missed it!

Illustration:

Eleanor Porter

Gayle Porter

Start again. What was I saying? OH she’s gone!

Illustration:

Eleanor Porter

Gayle Porter

Video Partner Assisted Scanning

Goals and Objectives:

http://www.lburkhart.com/Writing%201EP%20Goals%201%20hr%205%2010.pdf • Pragmatic Profile-Children & Adults http://wwwedit.wmin.ac.uk/psychology/pp/children.htm

Pragmatics

• Think about appropriate use • Teacher Topics versus Child Directed • Many communication turns are non-

obligatory • Adolescents become very passive

– Classroom-only ask questions – Only pragmatic function is answering questions – Tell me____......=Compliance

Goals and Objectives

• Increase the number of functions a child will use & get that info from language sample

• Don’t write 4 out of 5 times • Use a timed language sample over baseline

(baseline has percentages)

Beginning Goals

(Name) will show increasing interest and attention to someone using a comprehensive aided communication system (such as a PODD) to talk to him/her in natural contexts throughout the day. This will be observed as in increase in: looking towards the communication symbols or the communication partner, calming during this process, looking away to the side but with a stillness as if listening, or responding the partner’s message. (define this specifically for this child) Minimum of (10) times during the school day in a variety of contexts.

(Burkhart & Porter, 2009, 2010)

Data Tracking


Writing IEP Goals and Objectives:

• The child will _____ more than _____ number of times within the natural context of school activities.

(Soto & Zangari, 2009)

Writing IEP Goals and Objectives:

• Child will increase the number of communicative functions:

- request objects, request/direct actions, request assistance, request recurrence, request cessation, ask questions, express opinions, protest, complain, etc.

(Burkhart, & Porter, 2009, 2010)

Writing IEP Goals and Objectives

• Goals that address specific communicative functions in appropriate contexts – Ask questions in a group discussion, – Tell a story – Instruct assistants in pretend play


Goals and Benchmarks

• (Name) will generate a 3-4 word sentence using his/her communication book – Complete multi-word sentence using PODD when

provided with models and visual supports – Produce 2-word sentences when provided with

verbal cue, “tell me more,” during genuine interactions

– 2-word spontaneously – 3-word, when provided “tell me more,” – 3-word spontaneously

(Burkhart, & Porter, 2009, 2010)

Sample Goal

• Within natural contexts throughout the day, (Name) will indicate a choice through a partner-assisted scan, when given a list of choices of toys to interact with or foods to eat. – List includes 3 toys, or foods, and final choice of

“something else,” or “None of these”


Data Tracking


Language Sample Form-Partner Assisted Scanning


Section 4: “Appy” Time

Apps Rating Sheet Speech Settings Representations Display Feedback Rate Enhancement Access

Motor Competencies

Cost

Predictable

Synthesized speech after word, phrase, or upon selection; Customizable Pitch

Text Photos ClipArt

Keyboard High Frequency Layout; Dynamic Display

Auditory, Zoom upon selection, Visual contrasts Highlights selection when scanning

Word and Phrase prediction; Saved phrases, Adjustable rate of speech; Phrase Categories, Dictionary

Direct Single Switch Scanning

Point Swipe Switch Adaptable

$159

TouchChat HD

Seven synthesized voices, Male and Female, and Child options, US and UK accents

Symbol Stix Import own images

Grid layout with navigation

Advanced word prediction, Pre-Programmed 7,000 Vocabulary items

Pre- Programmed buttons of words and phrases

Direct Point $149

Proloquo2go

Male Female Child Synthesized voice, US and UK accents

Symbol Stix Import own images

Grid Layout with navigation links; onscreen keyboard

Word prediction keyboard; Auditory feedback upon message access; Visual symbol

Advanced word prediction; pre-programmed 7,000 vocabulary items

Direct Switch?

Point Swipe

$189

Go Talk Now

Digitized and Synthesized; 20 languages Extra voices 99

Imagine Symbol set, photo library, import own images from camera, video, or Internet In-app purchase of SymbolStix or Widgit Symbols

Static, Dynamic, recorded or text-t0-speech messages play, Visual Scenes, Social Stories

Auditory feedback upon message access, music, video, Auditory cues for row/column scanning

Core Vocabulary location, pre-programmed text-to-speech, video, photo, Internet

Direct Step, Auto, or Group Scanning

Point Switch Scan

$79

Verbally

Synthesized speech after word, phrase, or upon selection; customizable pitch

Text Keyboard; Portrait or landscape view

Auditory; Visual; Highlights selected keys

Word prediction; Stored words and phrases; Adjustable speech rate; conversations stored for phrase recall

Direct Bluetooth

Point: Swipe Free to $100

Scene & Heard

Digitized and Synthesized

10,000 Widgit Symbols Grid Flip Book Visual Scenes, with built-in symbol vocabulary photos videos

Auditory, video

Visual Scenes Link one Scene to another

Direct One or Two Switch Bluetooth

Point Switch Scan

Free to $50

Choosing Apps for Communication

• Choosing Apps for Communication (reproduced with permission by Janelle Sampson, 11/28/2013)

Research on iPad Use

• Taking the Pulse out of Augmentative and Alternative Communication- white paper

• http://www.assistiveware.com/taking-pulse-augmentative-and-alternative-communication-ios

• Other helpful articles: • http://www.asha.org/Publications/leader/2011/111011/Apps--An-Emerging-Tool-

for-SLPs/ • http://div12perspectives.asha.org/content/21/2/60.abstract • http://blog.palsoftwaredesigns.com/index.php?/archives/12-A-Slew-of-iPad-AAC-

Articles.html

Predictable

Predictable TouchChat HD

• VocabPC • Spelling on QWERTY keyboard • Multichat 15 • Word Power • Facebook, Twitter, email (Social Chat)

TouchChat HD

• Customizable • iShare • High quality text to speech • Pronunciation editor

Scene and Heard

• Multimedia App • Visual Scenes Displays (VSDs)

Scene and Heard Proloquo2Go

• Core Word • Basic Communication • Easy to Program

Verbally

• Text-to-Speech • Free and Paid Version

AACorn

Go Talk NOW

• Standard Pages • Express Pages • Combines Multimedia: Video, Music, Photos

Go Talk NOW

• Communication and Aphasia: – More storytelling – Co-constructed communication – Cautious users: don’t like to experiment

• Communication needs of Aphasia patients: – Home: socializing, eating, dressing – Medical: communicating ailments, managing

medications, talking to the doctor – Phone: calling, answering – Community: shopping, participation in social

groups & support groups, news

The Small Talk Family of Apps

• Icons in List View – Scroll with your finger – Single words and phrases – Photos & custom recordings

Small Talk Family of Apps

• Big Picture View – Turn horizontally – Larger icons and text – Scroll with finger

Small Talk Aphasia Aphasia

• The Multimodal Communication Screening Task for Persons with Aphasia (MCST-A) – 8 tasks – Determine if partner dependent or independent

communicator – List succesful communication cues – https://www.youtube.com/watch?v=38bv0-Zm0Qo

Small Talk Dysphagia

• 50 phrases, 4 videos • Vocabulary for equipment, meal assistance, diet, liquids, medications • Compensatory treatment techniques • Male/Female voices

Small Talk Dysphagia Small Talk Oral Motor Exercises

• 52 videos • Cheek, tongue, soft palate, lip & jaw

Small Talk Conversational Phrases s

Small Talk Daily Activities

Small Talk ICU

Small Talk Video Apps

Phonemes

Consonant Blends

Common Phrases

Days, months, Dates Letters,

numbers, colors

Voice Banking

• Model Talker http://www.modeltalker.com/

• Audacity http://audacity.sourceforge.net/ ChatAble Predictable

Voice Banking

• Would you like to voice bank your speech? http://www.alsforums.com/guides/documents/Voice-Banking-Guidelines.pdf

Hospital Based Communication

• On The Spot Communication Toolkit for Medical Staff – https://www.wy.at4all.com/Items/ItemDetails.asp

x?ItemID=48060

AAC & Dementia

• Teach partners to support satisfying communication opportunities • Decrease Social Isolation • Maintain quality of life

(Beukleman, Garrett, & Yorkston, 2007)

AAC & Dementia

• Assessment & Goal Setting – Beukelman, Garrett, & Yorkston, 2007, pg. 249-

251 – Pg. 258 list of standardized tests – Accompanying CD-ROM provides protocols – Terminology for Goal Writing for Reimbursement

pg. 279

AAC & Dementia

• Spaced retrieval – E.g. using a cue card to recall proper transfer

procedures, “Before you go from your bed to your wheelchair, you read this card. What do you do before you go from your bed to your wheelchair?”(pg. 263)

(Beukelman, Garrett, & Yorkston, 2007)

Apps for Dementia

• Keynote -add pictures, life stories, & histories

iDevices and Dementia

• Time Organization, reminders • Help with recall of names/contact info • Drawing/writing • Navigation- helping find their way • Skype/Face Time- video phone calls

Resources for Adult Populations

• http://aac.unl.edu • http://aac-rerc.psu.edu - webcasts, presentations, resources, research updates, Medicare funding guides and sample reports

Books for Adult Populations

• Beukelman, D.R., Garrett, K.L., & Yorkston, K.M. (2007). Augmentative communication strategies for adult with acute or chronic medical conditions. Has CD forms

• Beukelman, D.R., Yorkston, K.M., & Reichle, J. (2000). Augmentative and alternative communication for adults with acquired neurologic disorders.

• Yorkston, K.M., & Baarslag-Benson, R. (1992). Augmentative communication in the medical setting.

Helpful Hints

• Give the individual time to explore the app • It’s not about the app, it’s about

communication! – www.communicationmatrix.org

Additional Resources on Communication Apps

• Archived audio recordings on three

communication apps webinars • App Rating Sheet • Implementation Rubric for AAC Apps • http://www.uwyo.edu/wind/watr/webinar/re

corded.html

iPad Loans

• Wyoming Assistive Technology Resources • https://www.wy.at4all.com/

speechies…. “get out your road map!” · display (podd) books podd books • vocabulary to...

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