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Multidisciplinary Team Approach to AAC Assessment

Center for Applied Rehabilitation Technology (CART)
Multidisciplinary Team Approach to AAC Assessment

Carlene MacBride, MS CCC
Molly Doyle MS CCC
Barbara Phillips, MS, OTR, ATP

• Interdisciplinary team dedicated to assistive technology

• Technology areas: AAC, Seating & Mobility, Computer Access, Environmental Control, Technology Integration

• Serve individuals with wide range of disabilities

• Service Delivery Model - center based collaborative

• Evaluation at center or on site
• Make recommendation
• Provide device set up and initial instruction
• Help primary support system carryout Rx
• Provide followup
• Limitations with model
• Evaluation not conducted in environment where AAC indicated
• Difficult to ascertain level of support
• Depend on others to follow through with Rx
• Support system changes
• Depend on user or support system to contact us w/ problems

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OVERVIEW OF DISABILITIES

ASSESSMENT

Definition of AAC - "integrated group of components, including symbols, aids, strategies and techniques used by individuals to enhance communication" (ASHA 1991)

• Includes multiple methods of communication

• Use of particular method depends on content, partner, situation & ease of use

• Partners will encourage AAC use only if the system makes communication quicker, and easier

• Purpose of assessment
• Identify techniques individual currently uses
• Determine effectiveness
• Refine current methods & identify new methods
• Determine optimal way to configure system
• Goal of AAC assessment & intervention
• Independent, functional interaction
• Achieved through assessment, system trials, instruction

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Feature Approach to AAC Assessment

• Identify features in optimal AAC system based on individuals needs, abilities, preferences
• Identify systems that have these features
• Provide trials and Rx system
• Device to meet the needs of the person, not the person meet the design of the device
• Benefits of the Feature Approach

• Helps to design an appropriate system

• Understand how to change or expand system

• Puts individual first (configuring system that "fits" user)

• Helps user & family recognize the need to compromise; no perfect solution

• Examples of Feature Categories

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ASSESSMENT COMPONENTS - obtain information via interview, assessment and observation

Communication Needs

Seating, Positioning and Mobility Needs

• Basic Principles
• Factors that influence access to and functional use of ACC

Visual Status - Baseline of functional status, determines if further evaluation necessary.

Motor Control

• Movements should be consistent, reliable, effortless and transparent.
• Direct Selection – User can select any cell equally and directly
• Scanning - Different types of scanning, cognitive and motor skills dictate scanning method
• Customize the scanning array

Switch Assessment

• Determine type and placement of switch (motor control must be consistent, reliable, transparent)
• Features of switches (e.g. size, feedback, travel, durability)
• Functional performance with switch may differ from evaluation performance

Cognition and Language Assessment

• Criteria based assessment
• Receptive language (receive school records or SLP report)
• Behaviors & social interaction:
• Symbol use: what type of symbol individual understands & what symbol they use to convey

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SYSTEM SELECTION, TRIALS AND RECOMMENDATION

• Will system augment speech or serve as primary means of communication
• List, prioritize features; provide trials
• Dedicated vs. Integrated System
• Factors to consider before making recommendation
• Needs
• Context, environmental conditions, constraints
• Level of support
• Client motivation to learn strategy
• Strategies to ensure device use
• On site instruction and observation
• Trial training at CART
• Extended trial or rental
• Prefer use of manual system first

Pros and Cons of an Integrated System

• To Integrate or Not to Integrate
• When should you consider Integration?
• When is Integration not recommended?
• Potential compromise in performance accessing different technologies
• Device Trials
• Simulation Techniques

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CASE STUDIES

AAC DEVICE FUNDING - Payor Sources and Criteria

SYSTEM INSTRUCTION - Critical as merely providing individual with device does not guarantee functional use

• Direct instruction to user
• Instruction to support system
• Basic mechanics
• Provide opportunities to communicate
• Reinforce use of augmentative methods

CONCLUSION

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REFERENCES

• Beukelman, D.R. Magic and cost of communicative competence. Augmentative and alternative communication, 7 (1), 2-10.
• Beukelman, D.R. & Mirenda, P. (1997). Augmentative and alternative
• Communication: Management of severe communication disorders in children and adults.
• Baltimore: Paul H. Brookes.
• Blackstone S. Augmentative Communication News. Monterey, CA (All issues are good resources)
• Buzolich, M.J. & Lunger, J. (1995). Empowering system users in peer training. Augmentative and alternative communication, 11 (1), 37-48.
• Calculator, S.N. & Jorgensen, C.M. (1991). Integrating AAC instruction into regular education settings: Expounding on best practices. Augmentative and Alternative Communication, 7,204-214.
• Cook A. Hussey S. (1995). Assistive Technologies: Principles & Practice. Mosby Publication
• Cottier C., Doyle M., Gilworth K. (1997). Functional AAC Intervention A Team Approach Imaginart.
• Cress, Cynthia J. (1997). AAC Service Delivery with Children: Twenty Frequently Asked Questions. ASHA
• Downing, J. (1988). Active versus passive programming: A critique of IEP objectives for students with the most severe disabilities. JASH, 13 (3), 197-201.
• Durand, V.M. (1993). Functional communication training using assistive devices: Effects on challenging behavior and affect. Augmentative and Alternative Communication, 9 (3) 168-176.
• Goossens, C., Crain, S. & Elder, P. (1994). Engineering training environments for interactive symbolic communication. Birmingham AL: Southeast Augmentative Communication Conference.
• Goossens, C. (1989). Aided communication intervention before assessment: A case study of a child with cerebral palsy. Augmentative & alternative communication, 5, 14-26.
• Gorenflo, C. & Gorenflo, D. (1991). The effects of information and augmentative communication technique on attitudes towards nonspeaking individuals. Journal of Speech & Hearing Research, 34, 19-26.
• Huer, M.B. & Lloyd, L.L. (1990). AAC users perspectives on augmentative and alternative communication. Augmentative and alternative communication, 6 (4), 242-249.
• Kangas, K.A. & Lloyd, L. (1988). Early cognitive skills as prerequisites to augmentative and alternative communication use: What are we waiting for? Augmentative and Alternative Communication, 4 (4), 211-22 1.
• Light, J. (1988). Interaction involving individuals using augmentative and alternative communication systems: State of the art and future directions. Augmentative and alternative communication, 4 (2), 66-82.
• Mirenda, P. (1985). Designing pictorial communication systems for physically able-bodied students with severe handicaps. Augmentative and alternative communication, 1 (2), 58-64.
• Reichle, J., Mirenda P., Locke, P., Piche, L. & Johnson, S. (1992). Beginning augmentative communication systems. In S.F. Warren & J. Reichle (eds). Causes and Effects in Communication and Language Intervention. Baltimore: Paul H. Brookes.
• Yorkston K. (ed) (1992). Augmentative Communication in the medical setting. Communication Skill Builders.

For Referral Information Contact:

CART
Rancho Los Amigos National Rehabilitation Center
7601 E. Imperial Highway
Downey, CA 90242
Phone: 562/401-6800
FAX: 562/803-8892
TTY: 562/401-2845
Website:http://www.rancho.org/cart/index.html

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