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AAC Best Practice using Language Activity Monitoring

Katya Hill, M.A., CCC-SLP
Barry Romich, P.E.

The field of augmentative and alternative communication (AAC) has been developing for three decades. Components of the field of AAC today include clinical intervention, outcomes measurement, and research. In all of these areas, little quantitative data based on real use of AAC systems in the natural environment is available to guide practice. Questions about therapeutic effectiveness and accountability are legitimate concerns being raised by various stakeholders today (Edyburn 1999; Zabala 1999). The lack of performance data on augmented communicators limits clinical decision-making and precludes objective outcomes measurement.

The monitoring of language activity can provide the information needed to improve this situation. However, clinicians agree that historical methods of language sampling have been cumbersome, conspicuous, and expensive. Consequently, traditional language sampling procedures are limited in their functionality and yield untimely results. Only a few AAC systems have features that provide for language use information. Because of these limitations, most AAC clinicians never gather data on AAC system performance in the natural environment and never measure progress quantitatively.

Historically, language activity monitoring has been limited primarily to the area of research. Even in this area, most research has been done using subjects who are not people who rely on AAC. Consequently, they never achieve the level of expertise common among system users, which can reduce the integrity of research data. Further, data is gathered in controlled sessions rather than in the natural environment.

The recent innovation of automated AAC Language Activity Monitoring (LAM) addresses these issues directly, providing tools for the gathering, editing, and analysis of language data generated in the natural environment (Romich & Hill 1999).

LAM Tools

LAM tools fall into three areas. The LAM function records the language data. The LAM Edit computer program provides for the semi-automation of the process of preparing the data for analysis. Analysis tools look at the data and report specific information.

The LAM function creates a record of the time of day and content of each language event, the generation of one or more letters or words. Non-language events, such as device operation functions, also can be recorded. Standardization of the reporting protocol has been proposed to assure compatibility among various recording, editing, and analysis features and tools (Hill & Romich 1999a).

The format for LAM recording of a language event is: HH:MM:SS "Language event". HH:MM:SS is the time of day in a 24 hour clock with a resolution of one second. The time block is followed by a single space and then, within quotes, the language event. The language event is any string of characters having not more than 0.2 seconds between characters. Each new language event starts a new line. The non-language event is identified within the AAC device by the star(*) bracket ([) sequence. Here is an example of an utterance recorded by LAM:

The LAM function is available in two basic configurations. Modern high performance AAC systems have the LAM function as a built in feature. This is true of Axs1600, Vanguard, and Pathfinder, all Minspeak systems available from Prentke Romich Company (PRC). The LAM function must be activated, typically by going to the maintenance menu. In order to comply with AAC best practice, it is expected that all higher performance AAC systems in the future will include LAM.

For older AAC systems based on synthetic speech, the LAM Device can be connected to the serial port. The LAM Device is a small box that can be mounted to the AAC system. The attaching cable can include a connector to allow the connection of other items that also might use the serial port. The LAM Device can be configured to accept data at 300, 1200, and 9600 baud. It has buttons for RECORDING ON and RECORDING OFF that also can be used to set the baud rate, start the upload process, and clear the memory.

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The LAM data can be uploaded to a computer by attaching the LAM Device (or the AAC system with the LAM function) to a computer. Using the HyperTerminal program, which is part of Windows, the data can be put into a file in the computer.

LAM Edit, the second of the LAM tools, is a program that runs in the AAC clinician's computer. LAM Edit partially automates the process of preparing the LAM data for analysis. This function includes the stripping away of the time stamps and the non-language data. Utterances can then be defined. Typically, this process requires some manual intervention since most people who rely on AAC do not use sentence terminators (".", "?", and "!") in their routine spoken communication. The editor features two side by side windows on the computer screen. This facilitates reference to the raw time stamped

data during this task. The time stamps can offer useful clues as to which words are part of the same utterance. LAM Edit also includes the formatting of the utterances to meet the requirements of particular analysis programs. This can include the identification and correction of spelling errors.

The analysis program used primarily at this point is Systematic Analysis of Language Transcripts (SALT) (Miller & Chapman, 1983), from The University of Wisconsin. When edited LAM data is entered into SALT, many reports can be generated. These include lists of words used (ordered alphabetically, by category, or by frequency of occurrence), total number of words, mean length of utterance, and other quantitative indicators of the quality and quantity of the communication. Other analysis programs may be available that would yield other information that could be of value.

Clinical Intervention

The most significant implication of language activity monitoring is in the area of clinical intervention. Building communicative competence of individuals using AAC requires procedures for specifying target skills and completing baseline observations to document performance (Light & Binger 1998). The LAM allows for the collection of baseline and performance data. In addition, through the use of the LAM the clinical intervention process can yield better results in less time at a lower cost. Here are some examples of how LAM is being used clinically.

A common approach to intervention is a weekly therapy session. Sessions frequently include the review and practice of old vocabulary, the introduction of new vocabulary, instruction on system use, and modeling of normal communication interaction. The AAC clinician frequently has little or no quantitative information on what happens in the natural environment between sessions. Using LAM, the first step in the therapy session is the uploading of LAM data. For a quick search, this file then can be pasted into a word processor and the FIND function can be used to look for uses of words covered in the previous session. They can be counted and the context within which they were used can be assessed.

Identification of language representation method(s) being employed can be useful in guiding therapy. Pilot studies are being conducted that identify the language representation method(s) and vocabulary diversity of school-age children (Hill & Romich 1999b) and persons with ALS (Hill & Romich 1999c) using AAC systems. The most effective users of AAC systems have been documented to use semantic compaction for between 90% and 100% of communication. Observation of much lower use of semantic compaction offers a clear opportunity for improvement.

Selection technique performance comparison is another area of LAM value. Generally, there is a single physical selection technique that provides the best performance for an individual. While every performance advantage is important, the differences may not be easy to assess without objective measurement. The AAC clinician can ask the individual to use LAM for some characteristic, routine communication using a particular selection technique. Then the same communication can be repeated using a different technique. The time stamps make the performance comparison a simple task.

Outcomes Measurement

Everyone wants to know the degree to which progress is being made in the use of an AAC system. With a shift toward accountability, improving databases and integrating them across service delivery sectors would have a tremendous impact on outcomes measurement (DeRuyter 1995). All stakeholders have this interest: funding agencies, administrators, AAC professionals, and people who rely on AAC, whether or not they are receiving intervention services.

Funding agencies support the use of LAM when they learn that it improves the effectiveness of the clinical intervention investment. Either the same results can be achieved at a lower cost, or the investment can remain the same with greater results.

School administrators have the responsibility of meeting many regulatory requirements. Among these is the requirement that every student on an IEP is subject to outcomes measurement. LAM data is without equal as a means of satisfying this requirement of IDEA 97.

Clearly, AAC clinicians can produce better results when they know the effects of their efforts. The use of LAM is consistent with the ASHA Code of Ethics in that it honors the interests of persons served professionally.

Many people who rely on AAC know very well the impact of communication speed on their lives. With LAM data they can see how to improve speed. For example, they can identify words used frequently, but spelled. These words then can be added to the core vocabulary accessed much faster using semantic compaction.

Parents use LAM data in IEP negotiations. With this capability of measuring progress, the IEP can include a beginning base level of performance, allowing quantitative goals to be set. Performance can again be measured periodically through the school year to indicate if goals are being met.

Research

Researchers contribute to the knowledge base that guides the practice of AAC. For people who rely on AAC, it is generally the language issues that can have the most profound impact on their communication and hence on their lives. Yet research in this area has been among the most difficult. LAM tools provide the means of pursuing research that can be truly meaningful. LAM can record language data in the natural environment over many days as readily as in controlled sessions.

Language Sample Library

A library of language samples collected using LAM is being developed. These samples, available on the Edinboro University of Pennsylvania web site, are valuable for different purposes. For AAC clinicians providing services to an individual, samples from individuals of like diagnosis, age, physical ability (selection technique), cognitive ability, cultural background, and gender can be viewed to obtain a vision of what can be expected. For researchers, language samples offer a valuable resource for data on which to conduct work that will advance the knowledge base of the field of AAC. University SLP students can use the library as a resource for learning about language activity monitoring and how to use it.

Privacy Issues

While the recording of language data has been done for many years, the application of LAM requires normal consideration for privacy protection. Individuals whose communication is being monitored should understand this and be made aware of the benefits and cautions. LAM actually offers an advantage over historical methods of audio and video recording. Using these methods, the person who relies on AAC would consent to monitoring, but others in the environment generally were being recorded without permission. LAM records only the language activity of the individual.

LAM tools address privacy issues in various ways. The LAM function can be turned on and off. When possible, individuals should be provided with the means to do this themselves. When using the LAM Device with older AAC systems, recording can be disabled in four ways: panel pushbutton, command from the device being monitored, turning off the serial port, disconnecting the cable.

When LAM data is uploaded to a computer, the file begins with a warning:

*** CAUTION ***

The following data represents personal communication.

Respect privacy accordingly.

If sensitive information is still inadvertently recorded, two methods of erasing it are available. The user can evoke a function to erase data recorded over a block of time on the same day that it was recorded. Finally, since the uploaded data includes time stamps, the first step in the editing process could be to erase data collected during a particular time block.

Privacy issues have been discussed with many people who have consented to language activity monitoring. At this time, no one has failed to offer consent. To the contrary, people who rely on AAC have been quick to identify the value of LAM to themselves and have expressed enthusiasm for the concept. They see LAM as a way to identify vocabulary used frequently that could be accessed faster using other methods, as in semantic compaction versus spelling or word prediction. Parents see LAM as a tool for facilitating the IEP negotiation.

Summary

Automated Language Activity Monitoring is becoming a component of best practice in AAC clinical service delivery, outcomes measurement, and research. Data gathered using LAM methods and tools can be edited, analyzed, and used to improve practice. Through the use of language activity monitoring, the field of AAC has begun a conversion from the art of yesterday to the science of tomorrow. The result is improvement in the quality of communication and potential for personal achievement for people who rely on AAC.

Acknowledgements

Much of the work in this area has been supported by a grant to Prentke Romich Company from the National Institute for Deafness and Other Communication Disorders of NIH. LAM is offered under license from The University of Pittsburgh.

References

Contacts
Katya Hill, MA, CCC-SLP
Assistant Professor
Leader Clinic
Edinboro University of Pennsylvania
Edinboro, PA 16444
Phone: 814-732-2431
Fax: 814-732-2184
khill@edinboro.edu

Barry Romich
Prentke Romich Company
1022 Heyl Road
Wooster, OH 44691-9786
Phone: 330-262-1984 ext. 211
Fax: 330-263-4829
Email: bromich@aol.com


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