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“ Personal achievement in life is a function of the ability to communicate.”

“ Personal achievement in life is a function of the ability to communicate.”. A Guide to Goal Selection & Intervention for AAC Users Trina Becker, M.S., CCC/SLP tmbecker@eiu.edu. What is AAC?. Refers to ways other than speech that are used to send a message from one person to another

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“ Personal achievement in life is a function of the ability to communicate.”

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  1. “Personal achievement in life is a function of the ability to communicate.” A Guide to Goal Selection & Intervention for AAC Users Trina Becker, M.S., CCC/SLP tmbecker@eiu.edu Becker, T. 3/1/13

  2. What is AAC? • Refers to ways other than speech that are used to send a message from one person to another • Includes: • Gestures • sign language • facial expressions • picture symbol or alphabet boards • sophisticated computer systems Becker, T. 3/1/13

  3. Benefits of AAC • Provides means to communicate • Increases participation & improves self-concept • Facilitates learning • Improves/restores receptive and expressive language • Reduces frustration and behaviors • Facilitates speech Becker, T. 3/1/13

  4. Who uses AAC? • Anyone who has significant difficulty using speech to communicate • Used by people of all ages and disabilities • Etiology either acquired or congenital Becker, T. 3/1/13

  5. Individuals who use AAC • Developmental Disabilities • Cerebral Palsy • PDD • Mental Impairment • Developmental Apraxia of Speech • Neurodegenerative Diseases (ALS, MS) • Acquired Disorders (TBI, Aphasia) Becker, T. 3/1/13

  6. Classification of AAC Users Becker, T. 3/1/13

  7. Classification of AAC Users • Emerging Communicator • Wants/Needs Communicator • Context-Cue Dependent Communicator • Transitional Communicator • Independent Communicator Adapted from Garrett (1992) and Beukelman (1998) Becker, T. 3/1/13

  8. Communication Ability Levels • Respects the fact that individuals with complex communication needs fall on a broad spectrum. • Uses characteristics of individuals with complex communication needs to determine placement on the continuum. • The InterAACT Framework (P. Dowden): DynaVox http://depts.washington.edu/augcomm/03_cimodel/commind1_intro.htm • Emergent • Context-Dependent • Independent Becker, T. 3/1/13

  9. Emerging Communicator • Does not reliably use symbolic communication • Relies primarily on nonsymboliccommunication (gestures, vocalizations, etc.) • Emerging does not always = beginner • May also display • Minimal turn-taking (object) • Limited or no joint attention Becker, T. 3/1/13

  10. Wants/Needs Communicator • Identifies basic symbols • Do not have a wide range of vocabulary • Uses symbols to make choices and meaningful requests objects • Primarily uses 1 symbol at a time • Does not use symbols to interact socially only for wants/needs Becker, T. 3/1/13

  11. Context Cue Communicator • Vocabulary includes nouns, pronouns, verbs, some descriptors • Combines symbols to produce phrases • Produces socially appropriate comments • Participates in structured conversations with familiar partners • Appropriately answers routine questions with prompts Becker, T. 3/1/13

  12. Transitional Communicator • Initiates conversations and social interactions with familiar partners • Answers questions of unfamiliar partners without prompts • Not comfortable initiating interactions with unfamiliar partners and using AAC in unfamiliar settings • Creates novel utterances • Recognizes conversational breakdowns and uses repair strategies with mod cues Becker, T. 3/1/13

  13. Independent Communicator • Understands communication the same as same-aged peers • Appropriately uses AAC system to communicate across all environments independently the same as peers • Generates novel utterances • Effectively uses repair strategies to fix communication breakdowns • Independent in operational competence (as much as physical ability will allow) Becker, T. 3/1/13

  14. Levels of CommunicationChildren with Dev. Disabilities • Follows typical hierarchy • Emerging Communicator • Wants/Needs Communicator • Context-Cue Dependent Communicator • Transitional Communicator • Independent Communicator Adapted from Garrett (1992) and Beukelman (1998) Becker, T. 3/1/13

  15. Becker, T. 3/1/13

  16. Technology Becker, T. 3/1/13

  17. No Tech Systems Becker, T. 3/1/13

  18. Low Tech Systems

  19. Mid Tech Systems Becker, T. 3/1/13

  20. High Tech Devices Becker, T. 3/1/13

  21. Becker, T. 3/1/13

  22. Language through Symbols • Symbol – “something that stands for something else” ( Anderheiden & Yoder, 1986, pg. 15) • Single meaning • Icon – based • orthographic Becker, T. 3/1/13

  23. Single meaning DynaSyms – DynaVox PCS – Boardmaker Proloquo2Go – iPad Symbolstix – Tobii - ATI

  24. Icon • Unity Language – PrentkeRomich

  25. Orthographic Becker, T. 3/1/13

  26. Levels of Communicators & Levels of AAC NOTE: High tech devices can be adjusted to meet any communication ability level Base decision on individual Trials, Trials, Trials! Becker, T. 3/1/13

  27. Continuum of Intervention Becker, T. 3/1/13

  28. Intervention goals • Goals should be chosen to build communication skills to the next level of the AAC continuum Becker, T. 3/1/13

  29. Becker, T. 3/1/13

  30. Ultimate Goal Whatever Whomever Wherever Becker, T. 3/1/13

  31. What’s your ultimate goal? • How are you going to get your client to be able to tell you what they are thinking? • How are you going to get them competent communicating in a variety of situations with a variety of communication partners? • Consider functional vs developmental • Consider communication skills vs discrete language skills Becker, T. 3/1/13

  32. LEVEL ONE COMMUNICATOR Emerging Communicator • Develop symbolic Communication • Understand Cause and Effect • Make meaningful choices • Make meaningful requests • Develop turn-taking (object) • Increase initiation • Use greetings hi/bye • Build receptive knowledge of picture symbols Becker, T. 3/1/13

  33. LEVEL TWO COMMUNICATOR Wants/needs Communicator • Begin to combine symbols to make 2 word utterances • Expand types of requests • Make socially approp. comments with prompts • Answer routine questions with prompts • Expand vocabulary/symbols – verbs/nouns/adjectives • Increase spontaneous use of greetings (hi/bye) • Effectively and efficiently locate symbols on AAC system • Demonstrate ownership of device • Gain attention of communication partner Becker, T. 3/1/13

  34. LEVEL THREE COMMUNICATOR Beginning of Context-Cue Communicator • Combine symbols to make phrases with minimal cues • Use comments with minimal cues in routine activities • Engage in short social interactions/conversations with familiar partners with mod - max cues • Expand vocabulary (questions, adjectives, verbs) • Use function symbols on AAC system (clear, delete, etc) • Navigate through communication system (dynamic) with prompts • Learn to adjust volume based on environment • Recognize communication breakdowns with prompts Becker, T. 3/1/13

  35. LEVEL FOUR COMMUNICATOR Middle to end of Context Cue Communicator • Initiate conv/social interactions with familiar partners • Produce novel utterances • Expand utterance length • Develop morphology • Continue to expand vocabulary • Answer questions and participate in conversations without prompts • Recognize conversational breakdowns • Use strategies to repair breakdowns with prompts • Navigate through communication system with prompts • Introduce programming (if appropriate) Becker, T. 3/1/13

  36. LEVEL FIVE COMMUNICATOR Transitional Communicator • Encourage use of AAC across all environments • Increase comfort level in unfamiliar situations • If appropriate, continue to develop morphology • Increase independence in using repair strategies • Encourage programming to increase independence • Encourage independence in operational functions (volume control, maintenance of system) Becker, T. 3/1/13

  37. Resources for Goal Selection • Dynamic AAC Goals Planning Guide • DynaVox: Implementation Toolkit • PrentkeRomich • AAC Language Lab • http://www.aaclanguagelab.com/ • AAC Communication Profile (Tracy M. Kovach) • http://www.linguisystems.com/products/product/display?itemid=10547

  38. Dynamic AAC Goals Grid

  39. Choosing and Writing Appropriate Goals Becker, T. 3/1/13

  40. Increasing Complexity of Goals • Do you have clients who seem to work on the same goal forever? • How we can we increase complexity? • Level of prompting • Different activities • Different environment • Different communication partners Becker, T. 3/1/13

  41. Prompting Hierarchy • Physical assistance (PA) • Direct Pointer Cue (DPC) • Direct Verbal Cue (DVC) • Indirect Cue (IC) Becker, T. 3/1/13

  42. Chain of cues

  43. Hierarchy of Activities Becker, T. 3/1/13

  44. Hierarchy of Activities • Routine structured activity (activity used to teach the skill) • Requesting – snack activity • Various structured activities • Want client to be able to use skill in a variety of structured activities • Requesting – Mr. Potato head, puzzle pieces, blocks Becker, T. 3/1/13

  45. Levels of Communication Partners

  46. Hierarchy of Communication Partners • Teacher/therapist (individual teaching skill) • Familiar adult or peer • Start with partner client is most comfortable with • Unfamiliar Becker, T. 3/1/13

  47. Hierarchy of Environments Becker, T. 3/1/13

  48. Hierarchy of Environments • Environment in which skill is taught • Therapy room • Classroom • Environment client is highly familiar with • Classroom • Home • May even move around different areas in familiar environment Becker, T. 3/1/13

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