Aug Comm Evals Simplified ACES Tools Resources Using

Aug Comm Evals Simplified (ACES) Tools & Resources Using your toolkit 1

Goal Learn the ACES module to assist in your evaluation process n To define and finish your toolkit list n To learn more web-based resources n Your local reps and the ways they assist n To leave with “next steps” for the cases you came with n 2

Agenda n n Evaluation Examples: 3 types of communicators Work through your individuals with complex communication needs (CCN) – Use the ACES module and Evaluation Toolkit – Feature matching n AAC equipment – – – Communication evaluation tools Website resources Meet your vendors 3

Your turn Do case histories – n Yours & in group n – ACES module n Tools used n Communicator skills n Device features n Next steps. . . Lunchtime – trial toolkits 4

n What was one idea yesterday that you will implement? 5

Evaluation software Tobii Communicator n Homepage n Choose 1 from each category n Try spelling 6

Evaluation Examples n 3 types of communicators –who is yours? – Emerging – Context – dependent / situation dependent – Independent 7

What you will need: 8

Emerging No RELIABLE means of EXPRESSIVE communication through SYMBOLIC language n Have some functional non-verbal communication (gestures, vocalizations, other nonsymbolic communication) n Able to attend, even briefly, to individuals, conversations, pictures, or symbols n Yes/no (acceptance/rejection) depicted with body language; i. e. no reliable yes/no for more complex communication 9

Case history for LM; Pertinent background Age: 4 years old n Diagnosis: Seizure disorder Communication Diagnosis: Dysarthria n School setting: Attends university preschool n Previous evaluation by AT team / school n – Did not address communication components; recommendations for AT good – other info wanted to expand on: What doing? How doing it? 10

LM continued Mother very involved – attend workshop w/ team n Previous program set up for school; several things tried at home n Reason for evaluation: mother wants support for home program – and wants to coordinate with school. n 11

Observations: Limited interests n Short attention span for most activities n Very active – did not sit for long n Needed constant attention for safety due to balance n Mother felt she was a distraction - not wanting to be there n 12

Toys mother brought (books with sound, IPOD) Objects – monkey; ball, bubbles, etc. Switch - Switch interface – toy Single Message communicator Computer (with touchscreen) w/ RJ Cooper Software 13

Level: Emerging Vision: not sure Hearing: normal Current communication: facial, body language, vocalizations, some eye contact, sign more / all done (approximations) Fine motor: gross imitations of signs Gross motor: poor balance, constantly moving Switch access: best with no wires 14

Observations n n n Use of objects recommended: Starting to use; tried “monkey” for song Cause – effect with toys: (magic frog / bubble machine) – Played with switch cables – needed to cover up (wireless would be better and attach switch to table) – Reached for toy – needed to keep toy out of reach – Not much attention n n Voice output – single message communicator – no interest Computer program / using CE software with touchwindow – Limited attention 15

Chart – not appropriate Instead use Communication Matrix – Likes / Dislikes checklist 16

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Communication Matrix 18

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University of Washington n likes_and_dislikes_checklist. doc A checklist can be helpful when searching for initial likes and dislikes for an individual with "emerging" communication skills. n Searches auditory, visual, kinesthetic, tactile, tastes, textures, smells, etc. n n Copyright (2002) Patricia Dowden, Ph. D. , CCC-Sp; UW Speech & Hearing Sciences 20

Goals: Communication Functions n n n Make request – use objects Make choices – touch; choice of 2 Continue – more; touch object Stop – all done Protest/reject – push away; head shake Help – approach person; hand something to person 21

Questions? ? ? 22

Case Study #2 - DZ n Age 7 n Diagnosis: Down’s Syndrome: Autistic Communication Diagnosis: Dyspraxia n Reason for referral: Mother and SLP felt like he could benefit from use of voice output; felt he was “ready” due to new interest in computer 23

Context- or Partner. Dependent Has SYMBOLIC communication that is RELIABLE but limited to particular CONTEXTS or PARTNERS n n n Rely on partners to provide limited response set Need frequent instruction and cueing Difficulty with initiation May only be functional in particular settings Wide range with regard to # of partners and # of settings 24

Pertinent Background Info: Home schooled n Receiving private speech therapy n Previously tried verbal, gestures, signs, PECS – not successful n Interest in computer; was using computer and had started accessing it with a mouse. n 25

Observations: Limited interests n Short attention span for most activities n Had cloth he carried much of the time n Brought items to session (his CD) n Limited communication functions n (currently completing Communication Matrix & Likes / Dislikes form) 26

Tools used Single Switch – Switch Latch Timer – Battery operated toy (bubbles) Single message communicator Go Talk 4+ - 9+ - 20+ Computer with his software, RJ Cooper software, and communication software (navigating pages) 27

Observations n n n Demonstrated ability to operate switch (bubble machine). Used with switch latch timer Tried voice output devices (Go Talks) Computer program / access: Moved mouse to drag object from bottom of screen to picture above it (example bone up to dog) Enjoyed voice output – when paired with high interest activity Was very purposeful and accurate almost immediately 28

Video - DZ 29

Level: Contextdependent Vision: glasses Hearing: normal Current communication: facial, body language, vocalizations, reach , some eye contact Fine motor: use single finger; tap Gross motor: very ambulatory 30

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Symbols Used 2 symbols: ball and computer on 4 pictures device (Go Talk) n 2” size (color with background colored) n Progressed to 1” pictures on 20+ Go Talk n 1” size (color with white background) n Concrete (ball) and abstract (more) n 32

Language representation n Single meaning pictures 33

Navigation page changes n One page per situation n Facilitator change 34

Keyboard – not at this time Voice / speech – digitized; high interest – easier to understand Type of device – digitized static display; (Ruled out dynamic display: lack of vocabulary needs; durability) Device functions - NA 35

Rate enhancement - NA Message formulation – single message – or combine words into routine phrase Message display - NA 36

Device types tried n Static display (Go Talks) – 9+ (2 inch); 20+ (1 inch) n Dynamic display – Not as easy to see; short visual attention – Knocked on the floor – Too sensitive; touched multiple places at one time – Could be used as 37

Symbols: Pictures; digital photos – people Language representation: single meaning pics; Navigation: facilitator change; few pages needed for vocabulary interest – up to 10 pgs Keyboard: NA Voice/speech: digitized Type of device: digitized Device functions: NA Rate enhancement: NA Message formulation: single key messages 38 Message display: NA

Other Factors 39

Functions – WHY are they communicating? n n n n X Attend to environment/others X Express wants/needs X Make requests / choices X Continue/stop X Request attention / help X Protest X Greet Answer / ask questions Direct actions of others Initiate – maintain – end conversation Make comments Relate personal experiences/events Repair communication breakdowns Express novel thoughts / ideas 40

Places – where are they communicating? n Home 41

Communication partners – who are they Mom n Dad (occasionally) n Speech therapist n Siblings n 42

Researching devices aac. Tech. Connect. com n Free resources n – Simpler digitized – Digitized 43

aac. Tech. Connect. com – possibilities simpler digitized devices 44

Digitized devices to consider 45

Device Assistant Searchpick the symbols to use 46

Helps you decide on type of device 47

Answer the questions about features 48

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www. aac. Tech. Connect. com * Review simpler digitized devices 52

Decision-making Funding Devices to consider Trialing devices Recommendations 53

Accessories sheet (on CD) 54

Report template (on CD) the Communicator 55

The Communicator – Other Factors 56

Decision-making 57

Device decision-making 58

SDT video SDT 59

Other examples YG n Used to promote verbal speech – Severely apraxic 9 year old, bilinguqal girl – Very little verbal speech – choose not to speak – Teach to imitate words as she selects themincluding sentences (highlighting) – Helps to facilitate syntax – Used to clarify speech – Increases confidence and use of verbal speech 60

YG video 61

Independent (Generative) Can communicate ANYTHING on ANY TOPIC to ANYONE in ANY CONTEXT n n n Locate, select, and convey messages on their own Can interact with familiar / unfamiliar partners equally well Can sequence symbols or letters to generate novel messages 62

Case Study #3 - MS Independent communicator n ALS n Computer literate n Current condition n Verbal speech minimally adequate in a few situations; changing quickly n Physical access – severely limited- in wheelchair – and unable to use hands on keyboard / mouse n Very computer literate – used to communicate by email 63

Toolkit n Access – Headpointing - fatigues – Eye gaze – good – Scanning – single / double switch – could do- much slower n Language Representation method – – Spelling Word-based Pre-stored messages Conversation facilitation 64

n Free software (no voice) – Point-N-Click – Click-N-Type – Etriloquist n Word + – EZ keys – rental (with voice) 65

Outcome n n n n Trialed various systems – decided on Tobii ATI (recommended by otherapist) Not used for while Not working – problems and no local support Insurance provided first system Added Medicaid – should pick it up Continued use of computer for written communication (offered) MDA funding 66

2 nd evaluation requested n Called vendors – – – 3 in area Patient request for 1 Short timeline too provide trials for all Eye. Max worked immediately Company agreed to provide loaner during funding process – Waiting – using device independently with grammar based text-boards 67

TM n n n 27 year old autistic boy Very good on internet browsing (Google King) Need device for community Previous evaluation-recommendations Use of several communication systems (low & high tech) – Word. Power – home use – slow down words – pace himself – Calendar – for all – Device – for additional spelling/conversation/community interactions – Spelling system – character prediction – use of word 68 prediction

TM - continued n Program own device- Say It Sam Communicator by Words + – I will repeat the steps AFTER he does them (100% proficient) – Select his own vocabulary – Where he wants to program it – Chooses pictures – Do not give him access all of the time 69

TM video 70

SR First met – device down – with keyguard n Increase access by putting device up improve access by 50% n Found software to replace keyguard n Highlights as she moves over it – used to use screen to stabilize – now access has improved n 71

SR video 72

Questions? ? ? 73

Your turn n Decide on groups - Emerging communicators – Context – depending communicator – Independent communicator Decide on 1 person the group will focus on n Get out your worksheets: Communicator / Device / Toolkit n 74

Pertinent Background Info Age: n Diagnosis n Medical concerns n Educational /residential setting: n Behavioral (attention, continue/end situation/activity; help, express desires/ needs, etc. ) n Other Reason for evaluation: n 75

Communicator 76

Device 77

Other factors 78

Functions – WHY are they communicating? n n n n Attend to environment/others Express wants/needs Make requests / choices Continue/stop Request attention / help Protest Greet Answer / ask questions Direct actions of others Initiate – maintain – end conversation Make comments Relate personal experiences/events Repair communication breakdowns 79

Other factors n Where n With whom? 80

Device Selection Options n Catalogues – AAC Tech. Connect – contact manufacturers n Manufacturer websites – Go to individual ones – AAC Tech. Connect has list n AAC Tech. Connect – free resources – Pictures (thumbnails of 85+ devices) – Free flyers 81

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Lite Tech Low Cost Chart 83

Trialing equipment Vendors – local resources n Manufacturers n Loan equipment n Rental options n 84

Manufacturers Reps n Companies: – Dyna. Vox Mayer-Johnson – PRC – Tobii ATI – Saltillo – Tellus – Words + – Zygo 85

Funding n n n www. aacfundinghelp. com 3 rd party medical funding (Medicaid, Medicare, Private Insurance) Medicaid Available Educational or Vocational or Independent living Private pay or donations (Used equipment) Work with your local device representatives 86

www. aacfundinghelp. com 87

Explore programming of the device Try the actual programming – see how it feels n Communication partners need to feel comfortable with the programming n Sales representatives can assist n Ask what support options include n 88

Accessories (list on CD) n n n n n Carry bags Keyguards Access hardware (switches/head controlled device, joystick, etc. ) Mounting systems/componants Extra power (if required) Internet/computer access (hardware/software) Environmental controls Software to make overlays (for digitized devices) Others? 89

Completing the paperwork (on CD) Gather – Case History n Summarize – Assessment Summary n Write report - Report n Get quote / info from manufacturer n Complete funding paperwork (packets from each company) n 90

Free templates n n n CD www. aac-rerc. org Report Coach: aacfundinghelp. com Dynavox – Funding Manager Prentke-Romich: Funding Submission Assistant Templates on www. aactechconnect. com 91

Questions? ? ? Features Access methods Hands-on Programming Funding Support 92

Do you. . . Have some new strategies to try? Have some things in your closet you will dig out for use? 93

Our goals were. . . n Explain the process of obtaining an AAC tool/device n Describe tools/techniques used to determine the AAC candidate’s skills n Complete many of the components with templates provided for gathering, compiling and reporting the results. n Identify components on AAC devices such as common features and categories of devices (i. e. dynamic display, digitized, integrated, etc. ) n Identify local resources and consultants for trials, support, and funding assistance for AAC devices. 94

Review your goals How did we do? Place a check mark by the ones you accomplished. What else to include next time? ? ? n Please complete survey – we make changes based on your input n Testimonials – greatly appreciated and will be posted on website 95

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THANK YOU for helping others get their voice 98

www. aac. Tech. Connect. com 866. 4 U. AAC. RX info@aac. Tech. Connect. com www. aac. Tech. Connect. com 866. 4 U. AAC. RX ( 866. 482. 2279) 99