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Alternative and Augmentative Communication

Chapter 1

The four critical elements of AAC that are part of all AAC interventions (from ASHA)

Symbolscan be graphic, auditory, gestural, or tactile. Can be aided or unaided.o Unaidedsigns, gestures, facial expressionso Aidedreal objects, pictures, line drawings, orthography

Aidsany device used Techniquesthe way the message is transmitted Strategiesthe way messages can be conveyed most effectively

o Enhance timing, assist grammatical formulation, enhance communication ratesThe goal of AAC intervention is to enable individuals to efficiently and effectively engage in a variety of

interactions and participate in activities they enjoy. There are five differentpurposes for

communication:

1. Communicate wants and needsa. Predictable vocabulary and form, so these are generally easy to create AAC for.b. The goal of this type of communication is to regulate the behavior of others.

2. Information transfera. These messages are more difficult to convey because the vocabulary and sentences are

novel.

b. Rate and accuracy are important3. Social closeness

a. Establish, maintain, or develop relationshipsb. Interaction itself is more important than the message

4. Social etiquettea. Often brief and with predictable vocabulary

5. Communicate with self/internal dialoguea. Lists, calendars, reflections

In an AAC evaluation, the therapist should consider the individual goals, wants, and needs of the client

and match the AAC accordingly.

There are four parts oflanguage competence for people using AAC.

1. Linguistic competencethe receptive and expressive language skills of ones native language---including knowledge of the linguistic code.

2.

Operational competencethe technical skills needed to operate the device3. Social Competence4. Strategic Competenceincludes adaptive/coping strategies for communication breakdowns,

compensating for slow rate

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Chapter 2Message Management

What affects AAC message selection?

Differences in age, gender, and social role Living situation (home vs. school vs. hospital) Interests of AAC user

Messages needed for conversation:

Greetingsshould include a range of culturally sensitive messages for a variety of situations(formal, informal, etc)

Small talkgeneric vs. specific small talk. Generic is easier to program. Ask the AAC user toselect his/her own messages from a detailed list.

Storytelling Procedural Descriptionsinstructions are usually unique to the specific AAC user. Content-Specific Conversationsusually done word-by-word or letter-by-letter

Different vocabulary needs for individuals with different communication abilities:

Preliterate individuals need vocabulary to develop language skills and coverage vocabulary(messages necessary to cover an individuals basic needs.

o Include words from various semantic categories Nonliterate individuals (those never expected to progress) primarily need messages to meet

their daily communication needs in varying environments.

o Usually functional and not developmental (but it is appropriate to add somedevelopmental vocabulary).

o Should be age and gender appropriate Literate individuals have access to a wider range of options.

o Timing enhancementprogramming time-sensitive messages in whole on the device (e.g.,will you help me before you go?)

o Also program in commonly used words to accelerate messages and to reduce fatigueResources for vocabulary selection

Core vocabularywords used frequently by a variety of peopleo Lists based on the patterns of existing AAC userso Words selected from the past use of the individual AAC usero Words from the patterns of typically developing individuals

Fringe vocabularywords unique to the individual user.o Informantsspouse, parent, siblings, peerso Environmental inventoriesAAC team listens to peers during common activities and

creates a list to choose from.

o Communication diaries and checklists

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Chapter 12Language Learning and Development

Language Characteristics in Persons Who Rely on AAC

Pragmaticspeople who use AAC tend to not initiate, respond mostly when required, provideterse messages, ask fewer questions.

Phonologytests show significantly poor scores, indicating risk for reading problems SemanticsAAC users are often delayed for several reasons:

o They may be spoken to less frequentlyo Children receive and process language one way (speech) and communicate through

another (symbols, etc)

o They cannot select their own lexicon, so their external lexicon (what is available to themon the device) may not reflect their internal lexicon.

o Et. Al. Morphologystudies show significant difficulties Syntaxstudies show significant difficulties.

o Predominance of one and two word messageso Prevalence of simple clauseso Often have word order problemso Omit words like verbs and articles

Many individuals who use AAC show signs of language impairment, and these difficulties with language

are influenced by the fact that their language-learning experience is different from that of individuals who

can speak.

Interventions to Support Language Learning and Development

Organizational Strategieswhen using symbols, they must be organized to be efficient and effective in

communication. Grid displays:

o Semantic-Syntactic Grid Displaysorganizes vocabulary according to parts of speech and theirrelationships.

o Taxonomic Grid Displaysgrouping symbols according to categories (people, places, feelings,etc.). Research indicates this strategy may not be useful until the AAC user is developmentally

past 6 years of age.

o Activity Grid Displayspopular strategy. Organizes vocabulary into event schemes, routines, oractivities. Each display shows symbols related to a specific activity, and those symbols are

typically arranged by semantic category.

Can be used in both high and low-tech aids. Participation is better when multiple displays are available Low-tech displays can be mounted in specific locations Can be used for all ages and in a variety of settings (school, vocational, community) Enhances probability that specialized vocabulary will be available when needed (as

displays can be quickly made for special events and stored for access later)

Can promote multi-word utterances and receptive language Visual Scene Displayscontain vocabulary associated with certain events, and the words are

arranged schematically and not semantically.

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o Research shows these displays are easier for young, typically developing children to use.o Most appropriate for speech generating devices with dynamic screen displays, but can be used

with lower tech devices (just not as efficiently).

Message Unit Lengthwe really dont know how the message length (paragraph, word, sentence,

morpheme) affects language development.

Longer units (paragraphs and sentences):o Speed up the communication processo May be better for individuals who fatigue easily, are not motivated to communicate, or are

learning to use AAC.

o Allows person to produce messages that are beyond their linguistic capabilityo May impede accuracy (having only one sentence for the picture dog may hinder the

ability to communicate a different message than what is programmed)

Word and morpheme length unitso Likely to enhance language development because the user can independently break down

and analyze the parts of a message

o Correct language structures can be reinforced and incorrect structures can be correctedvia modeling.Instructional Approaches

Structured Approachesuses discrete trial teaching. StimulusPromptResponse, then fadeprompt. Often used to teach labeling

o Allows mass trials and practice (more exposure to the word)o May be useful for someone who makes frequent errorso Can be used for receptive labeling, expressive labeling, morpheme and syntax

Interactive Modelteach parents to provide rich language input and respond to communicativeattempts of child.

Aided Language Stimulationa facilitator highlights the symbols on the AAC userscommunication device while speaking. Should be used in natural routines and activities.

o Nonverbal juncture cuesnonverbal cues (gesture, facial expression, etc) the facilitatoruses before highlighting a symbol. Teaches the AAC user another way to indicate the word

and also gives a delay where the AAC user may hit the symbol before the facilitator.

o Verbal cues and Light cueslight cues are highlighting the term with a light. The System for Augmenting Language (SAL)similar to aided language stimulation, except a

speech generating device (SGD) is necessary and SAL techniques are simpler. This method is

loosely structured and naturalistic.