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Dawn Russell, M.A., CCC-SLP & Bridgit Bruce
AAC Technology Specialist Assistive Technology Specialist
Synergy412 High Plain Street, Walpole, MA 02081
With advances in computer technology and greater awareness of assistive technology, more and more individuals are looking at computer-based augmentative communication systems to provide multiple functions. This paper presents case studies of individuals successfully using the Synergy mAAC computer-based AAC system to integrate augmentative communication, cognitive, educational and literacy development, educational and vocational productivity, and increased overall independence. Guidelines and strategies for effective implementation of a computer-based AAC system are provided.
Developed in 1990, the Synergy PC was the first computer system to provide integrated augmentative communication and full computer functions in a portable, rugged design. The Synergy mAAC, a Macintosh based system, was introduced in 1993 and gradually replaced the original Synergy PC. The current version, the Synergy mAAC 2, is about the size of a full-sized book (9x12x3), provides a large active matrix color screen (11.3 diagonal) and weighs 6.5 pounds. It can be powered by internal batteries, external LongLife batteries or connection to a power wheelchairs battery.
Two new Synergy PC systems also will be available in August and October, 1998. The Synergy PC Carry will provide a more compact lightweight design (4 pounds) and extended internal battery life (6 hours). The Synergy PC 2 will provide an even larger screen (12.5 diagonal) and high-end computer features.
The Synergy mAAC 2 provides the fastest processor available in a computer-based AAC system (166 MHz with 128K Level 2 Cache); a 2 gigabyte hard drive; 24 to 64 megabytes of RAM; interchangeable built-in floppy drive and CD-ROM; built-in microphone; and all standard Macintosh connectors (ADB, SCSI, LocalTalk/serial). The speed and capability of the Synergy mAAC 2s computer functions help to prevent obsolescence and will allow the use of upgraded software and hardware options as they become available.
Individuals can access the Synergy mAAC using any Macintosh compatible access method. A number of access methods can even be built into the Synergy mAAC, providing a more streamlined system: touch screen, single switch adapter, HeadMouse (Origin Instruments), Discover:Kenx and Discover:Switch (Don Johnston). Additionally, adaptive keyboards, such as IntelliKeys (IntelliTools) or Discover:Board (Don Johnston) can be connected to the Synergy mAAC.
Discover:Screen or Discover:Switch software (Don Johnston) provides on-screen keyboards and mouse functions which can be accessed using a variety of adaptive inputs, such as single switch. This allows full access to computer functions and augmentative communication. For persons who have well developed literacy skills, software such as Speaking Dynamically Talk Boards (Mayer-Johnson), Talk:About and Co:Writer (Don Johnston) provide powerful text-based augmentative communication and work in conjunction with Discover:Screen or Discover:Switch for adaptive access.
For those who require the support of picture symbols or whole words, Speaking Dynamically Pro software provides powerful, flexible augmentative communication. Discover:Screen and Discover:Switch software allows the use of picture based on-screen boards that work with standard educational software programs, providing adaptive access.
Research has shown that 25-30% percent of assistive technology devices are no longer in use after one year (DeRuyter, F. 1997; Scherer, M. 1991; Phillips, B. 1991) . However, over the three and a half years that it has been on the market, 96% of Synergy mAAC systems are still in use. This high success rate has been attributed to a number of factors:
Customers can use a Synergy mAAC system for two weeks to determine how well it works for them; the only charge is for shipping expenses. Once a customer decides that they would like to purchase a Synergy mAAC system, Synergy's Funding Counselor is available to help locate sources of funding and provide guidance in preparing supporting documentation. To date, Synergy has been highly successful in obtaining funding from third party sources.
Synergys clinical team has developed Training Guidelines for implementing a computer-based augmentative communication system. Some of these guidelines include:
Synergy offers Customization Packages that can be included with the purchase of a Synergy mAAC system. When a Customization Package is provided, the speech-language pathologists and assistive technology specialists at Synergy work directly with the Implementation Team. Synergys clinicians can integrate and customize the hardware and software in order to optimally address the applications and access criteria identified by the Team.
Over the years, Jessica, who has cerebral palsy and uses a powered wheelchair, has tried a number of different dedicated communication devices and manual communication books for augmentative communication. Her first voice output communication system provided a static display with picture symbols. She combined symbols to convey words and produce complete sentences. Jessica was able to quickly learn symbol combinations for her most popular messages, like "Hi, how are you doing," or "I'd like to get something from McDonald's." Over time, she was able to learn approximately 150 different symbol combinations that she could use in everyday conversation. But, when Jessica tried to learn more symbol combinations for extended communication, the memory load was more than she could handle effectively.
Jessica was able to access more vocabulary using her communication book which contained as many as a thousand different pictures and words. As new vocabulary needs became apparent, new pictures and words were constantly being added. As events occurred, her family and support staff took Polaroid pictures and put them into her book with explanatory paragraphs.
Jessica used her communication book effectively, flipping the pages to find the word she needed. But turning the pages was laborious and time consuming, making her communication very slow. Her communication partners needed to vigilantly attend to the pictures that Jessica selected. Using her book, Jessica was able to select single pictures to convey ideas, but was rarely able to combine pictures to create sentences.
In 1994, Jessica was provided with a Synergy mAAC system with Speaking Dynamically software for augmentative communication. She accessed her Synergy mAAC using a built in touch screen. Jessicas speech-language pathologist was able to use Speaking Dynamically software to customize numerous on-screen communication boards that addressed Jessica's unique abilities and needs and optimized her communication. Since Jessica had excellent visual and fine-motor abilities and the capability to use a large vocabulary, her boards were designed with 1/2" squares, allowing up to 80 symbols to be displayed on each page. To help Jessica quickly locate symbols, they were grouped using different colored backgrounds.
Over time, Jessica and her speech-language pathologist developed hundreds of on-screen boards, allowing her to communicate more than 7,000 different words and complete messages. In September, 1997, Jessica upgraded her software to Speaking Dynamically Pro, which adds many new capabilities, especially the ability to use pop-up boards and grammatical markers.
Jessica's boards are organized according to topics and sub-topics. For instance, she might select "Places" from her "Main Menu" board to tell about places she likes to go. She also can convey detailed information relevant to a specific place by selecting that place from her topic list.
Jessicas boards also are designed to enhance conversation by containing:
Her boards are also designed to enhance her ability to generate novel sentences by combining symbols conceptually. For example, to generate the sentence "I am going to go to McDonald's with Mary." Jessica would select the following symbols:
She can then speak the entire sentence by simply touching the "message display" where the sentence is printed. The design of Jessicas communication boards provides her with continual prompts to help her generate novel sentences. She does not need to know different grammatical forms, such as "went" vs. "am going to go." She simply selects the concepts she is trying to convey.
The software's ability to provide multiple boards relevant to different topics, as well as to present pop-up boards to expand on selections allows Jessica to generate a wide range of vocabulary and sentences using her conceptual knowledge and recognition memory rather than her recall memory.
Because the Synergy mAAC 2 provides an fast computer processor, there is no time delay as different on-screen boards are presented. Jessica also enjoys telling people about special events in her life. She has a number of boards for "stories," where she selects a single symbol to tell a lengthy "story" which is both spoken and written in a message display. Since Jessica is an avid music fan, she also includes recordings of her favorite songs in some of her stories; using the capability of the Synergy mAAC and Speaking Dynamically to include recorded speech and sounds. She also includes photographs of places that she's been on her stories pages, another function of the Synergy mAAC and Speaking Dynamically software.
In addition to using her Synergy mAAC for powerful augmentative communication, Jessica uses her Synergy mAAC as a full-functioning Macintosh computer. She runs many different software programs to develop her reading skills, draw, create greeting cards, write letters to friends, and more. Jessica doesn't need to know anything about how a Macintosh works in order to independently use educational software anytime she wants.
Speaking Dynamically has the capability to also act as a "launcher". One of Jessica's Speaking Dynamically boards has symbols for each of the software programs that she uses. When Jessica selects the symbol for a program, it automatically starts up. When she quits the program, she automatically returns to Speaking Dynamically for communication.
Jessica is just one of many individuals across the United States and Canada who has used the Synergy mAAC computer-based augmentative communication system over the past four years. Since Speaking Dynamically software can display large pictures and photographs, many preschool children - even younger than three years of age - also use the Synergy mAAC.
For young children, the Synergy mAACs generous hard drive and RAM memory allows use of memory-hungry files such as pictures, photographs, songs, recorded speech and QuickTime movies without running out of space. Its efficient processor speed and cache allows software programs to start up and run without significant delays where a child may lose attention.
Katie is a 3-year-old girl with cerebral palsy who uses the Synergy mAAC for augmentative communication and early learning. Due to visual needs, Katie requires picture symbols that are at least two inches. Since the Synergy mAAC, provides the largest screen available in augmentative communication (9.25" x 7"), it allows Katie to have twelve two-inch pictures displayed on the screen at once. Katie accesses her Synergy mAAC using a switch.
Speaking Dynamically software is able to provide prompts that help Katie access multiple boards. For instance, a main board might have choices for things to do, such as "eat," "play," etc. When she selects "play" the software automatically says "I want to play" and presents another board containing different toys. When she selects a toy, such as "doll," the software automatically says "I want to play with the doll" and presents another board containing vocabulary related to playing with the doll.
Each time, she simply selects what she wanted from a range of choices; a well developed sense of categorization isnt required to access multiple boards.
In addition to augmentative communication boards, Katie uses Speaking Dynamically boards to sing songs by selecting targets that play recorded singing and music. She also has a number of picture books that have been scanned into the Synergy mAAC. She can listen to stories by just pressing her switch. By selecting the symbol for read the text from the story appears and the story is read to her via a recorded speech; by selecting the symbol for go on she turns to the next page; by selecting the symbol go back she turns to a previous page.
Since the Synergy mAAC provides computer functions, including a built-in CD-ROM, Katie also can independently access early learning software with exciting music and graphics. She can independently load up early learning computer programs using Speaking Dynamicallys ability to launch software.
Discover:Switch allows her to access standard educational software by providing scanning on-screen picture keyboards that allow her operate specific early learning software programs, as well as talk about what shes doing using on-screen communication boards. This seamless access to early learning helps Katie to learn independent control and cognitive exploration at an early age. Also, having easy access to a wide variety of activities has helped to maintain Katies interest in activities which enhance her linguistic and cognitive development.
Brian is a college student who uses the Synergy mAAC for augmentative communication, completion of class assignments and access to the internet.
Since his most consistent motor control is head movement, he accesses the Synergy mAAC using the HeadMouse (Origin Instruments) and Discover:Screen on-screen keyboard (Don Johnston). He uses the same access methods for speaking , writing and computer access. He can easily toggle between each of these functions as needed. To decrease the number of selections required to say or write words, Brian uses Co:Writer (Don Johnston) for word prediction. To further increase the speed of his speaking and writing, Brian uses a combination of the abbreviation-expansion functions of Co:Writer along with the ability to customize on-screen keyboards with Discover:Screen.
Brians primary on-screen keyboard contains the alphabet, basic punctuation and function keys and numbers; plus, it contains additional sections for quick access to spoken or written messages. The additional sections on Brians primary on-screen board include:
Since Co:Writer and Discover:Screen can work simultaneously with any application program, Brian is able to use the same access method and strategies for communication, writing and access to computer applications.
Since the Synergy mAAC provides standard Macintosh connectors, he is able to access the internet by connecting to a modem and using the HeadMouse along with customized set ups for Discover:Screen and Co:Writer.
The Synergy mAAC provides a highly durable, powerful and versatile system for augmentative communication. A variety of software and hardware options can be combined to create an individualized system for each user. Along with providing strong augmentative communication capabilities, the Synergy mAAC is a fully functioning Macintosh computer providing the same capabilities that are available from a desktop Macintosh. A computer-based augmentative communication system, such as the Synergy mAAC, can be a powerful tool to integrate linguistic and cognitive development and provide independent access to educational and vocational tasks. Successful use requires careful planning and implementation strategies by an interdisciplinary team.
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