Augmentative-Alternative Communication (AAC)

What is Augmentative-Alternative Communication (AAC)? • Augmentative - alternative communication (AAC) consists of all forms of communication, except verbal communication, that express a person’s thoughts, needs, wants, and ideas. Facial expressions or gestures, use of symbols or pictures, and writing or texting are all forms of AAC. • People with severe speech or language problems use AAC to enhance existing speech or replace nonfunctional speech. AAC systems such as picture and symbol communication boards and electronic devices can help people express themselves as well as increase social interaction, school performance, work performance, and self esteem.

Who uses AAC? • People who have a severe communication disorder that impairs their ability to talk as a result of a congenital problem, acquired problem, or degenerative problem. • Congenital Causes: Cerebral Palsy, Autism, Severe Intellectual disability, Physical disabilities • Acquired Causes: Stroke/Aphasia, Head injury, Spinal Cord injury, Cancer • Degenerative Causes: Amyotrophic Lateral Sclerosis (ALS), Multiple Sclerosis (MS), Muscular Dystrophy, Huntington disease, Parkinson disease

Types of AAC Systems • Unaided communication systems: The person uses his/her body to convey messages such as gestures, body language, and/or manual signs or American Sign Language (ASL). • Aided communication systems: The person uses tools or equipment (low tech and high tech) along with his/her body. Examples of aided communication systems include paper and pencil, communication books or boards, electronic devices that produce voice output (e.g., speech generating devices, I-pads and laptops with communication apps) and/or written output (e.g., texting on cell phones, typing on I-pads or lap top computers). The electronic communication devices allow the person to use picture symbols , letters, and/or words and phrases to create messages.

How do people use AAC systems? • People can access or make selections on a communication board or speech generating device in two primary ways (direct selection and scanning). • Direct selection: – Pointing with a body part such as a finger, hand, or toe – Using a pointing instrument such as beam of light, head stick, or mouth stick. Those with severe physical impairments may need to make selections using a switch, which can be turned on with a body part, puff of air, eyegaze or eyebrow movement. – Usually faster than other methods

AAC systems access methods (cont.) •

Scanning: – Can be used with and without an electronic device. – Symbol choices are presented to the user one at a time using a light on the system that passes over each choice and the user activates a switch or uses eye gaze/movements to stop the light and select a choice. – Auditory scanning consists of a communication partner or a speech generating device saying vocabulary items, one at a time, until the AAC user hears what he or she wants to say and chooses the item. This method is usually slow and useful only with a few choices available. – Scan patterns such as rows, columns, and quadrants can be used when more choices are needed. For example, the user locates the desired symbol and allows the light to move from column to column until it reaches the right one then from row to row until the desired symbol is lit or selected.

Example of Scanning

Examples of Access Methods

How is language represented in AAC systems? •

There are three basic ways to represent language in an AAC system: – Single meaning pictures – Each word in the vocabulary is represented by a different picture, but the symbol set needs to be large for a significant vocabulary; some meaning to pictures must be taught since it is difficult to represent some words with pictures; does not require reading. Least used system compared to others. – Alphabet based systems – This method includes spelling, word prediction, letter codes, and whole words; reading is required. – Semantic compaction – This method uses sequences of multimeaning symbols or icons to represent vocabulary items; does not require reading. Many people who use AAC systems prefer using multiple methods for effective communication. Semantic compaction used with some spelling and word prediction when needed.

Communication Board Example

Speech Generating Devices • Speech generating devices (SGDs) enable communication in various forms, i.e., voice output, environmental control, computer access and long distance communication. Various sizes of devices are available to meet the person’s needs with multiple access methods such as eye gaze or tracking, head tracking, touch screens, etc.. • Types of Devices: – Lingraphica: AllTalk, TouchTalk • Features TalkPath software – Prentke Romich: Accent 800, 800-D, 1000, 1200 • Features language program software such as Unity, LAMP Words for Life (access vocab through motor patterns), Essence, Word Power, etc... – Tobii Dynavox: T-Series: T7, T10, T15; I-Series: I-12+ and I-15+ • Features language program software such as Tobii Dynavox Compass and Tobii Dynavox Communicator

Speech Generating Devices (cont.) •

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SGDs come with pre-programmed messages, vocabulary, and pictures/symbols but have the capability to add personal messages, vocabulary, and pictures. Some can be programmed to produce different voices including the patient’s voice (e.g. voice banking) or a family member/caregiver ‘s voice and produce voices in different languages. Voice banking = uses a software such as ModelTalker System to use a personal synthesized voice that represents the patient’s voice to communicate when using the Speech Generating Device (SGD). This system was designed to benefit people who are losing or who have already lost their ability to speak. It uses recorded speech either from a prospective SGD user or from a voice donor chosen by or for the SGD user to create a unique synthetic voice. The ModelTalker Text-to-Speech system is an option to be used with some SGDs and text to apps for mobile devices. More information available at www.modeltalker.org. Communication apps are available from various websites to be downloaded on the iPad and some on the iPhone. Some apps have a fee and some may be free. Technical support may not available. • Examples of communication apps: LAMP Words for Life by Prentke Romich, Compass by Tobii Dynavox, Lingraphica Small Talk, Proloquo 2go, Proloquo4text, Go Talk Now, SpeakIt!, SpeakText

Examples of Speech Generating Devices

Examples of Speech Generating Devices

Using a speech generating device

Interdisciplinary team approach

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An evaluation to develop the best communication system should involve a team of professionals. In addition to the AAC user and his/her family and caregivers, the team often includes some of the following: – Speech-language pathologist – Physician – Occupational therapist – Physical therapist – Social worker – Learning specialist – Rehabilitation engineer – Psychologist – Vision specialist – Vocational counselor

Interdisciplinary team (cont.) • The team members evaluate the person’s needs (cognitive, physical, and visual), current means of communication, and the potential for using different kinds of AAC. The team members may change as the person’s needs change over time. • When the AAC system is selected, the user will follow up with the professionals. It may be a one time training session or may require several speech-language therapy sessions that focus on the development of communication using the system. • The user and the communication partners will have to learn a variety of skills and strategies, for example learning the meaning of hand signs and/or operating the electronic equipment. • A Physician’s prescription is required and is submitted along with the AAC evaluation report to the insurance company or payer source for approval.

Funding • Funding for speech generating devices or communication devices and most likely the accessories (e.g., mounts, switches, etc..) has become more available of the last few years. • Most insurance companies will cover 80% if the device is in network with the company or if the plan allows for a SGD. Deductibles and copayments will apply. • Medicare covers 80% and Medicaid will cover 100%. If the patient has Medicare AND Medicaid, then the device should be covered at 100%.

• Community resources – Associations for ALS, MS, Brain Injury, Cerebral Palsy – Service Organizations such as Louisiana Assistive Technology Association Network (LATAN), Mississippi Project START (Success through Assistive Rehabilitation Technology, Alabama’s Assistive Technology Resources – Private donors and Foundations

Information presented was obtained from the American Speech Language and Hearing Association (ASHA) (www.asha.org), Prentke Romich (www.prentrom.com), Tobii Dynavox (www.tobiidynavox.com), and Lingraphica (www.lingraphica.com) websites.

Alicia S. Cantrell, M.C.D., SLP Ochsner Neurological Rehabilitation Therapy and Wellness acantrell@ochsner. org