Augmentative and Alternative Communication AAC:

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• Augmentative and Alternative Communication (AAC)
  
• An Introduction
• 7th March 2008
• Chris Sherlock SLT ACT
• Julia Hampson SLT Coventry PCT

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Contacting ACT

• Helpline 0121 472 0754
• Website www.wmrc.nhs.uk/act/
• Email format Firstname.Secondname_at_sbpct.nhs.uk
• Main phone number 0121 627 8235
• Address ACT, WMRC, 91 Oak Tree Lane, Selly Oak,
  Birmingham. B29 6JA

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Timetable

• Registration and Coffee
• 9.30 Introduction
• AAC definitions and using AAC
• Break
• ACT and the WM AAC care pathway
• Low tech AAC
• 12.30 Lunch (in the new palm room)
• Meeting a user of AAC
• High tech AAC
• Break
• Factors critical for success with AAC
• 3.30 Questions, feedback and Close

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Learning Outcomes

• Following today participants will be able to
• Define and describe AAC
• Use a range of AAC systems to communicate basic
  messages
• Describe people for whom AAC might be useful and
  the categories of AAC
• Demonstrate awareness of the WM AAC care pathway
  and how it might be used, and links to ACT
• Use some communication strategies that will
  enhance their communication with a person who
  uses AAC
• Know where to find resources that will assist
  them to explore AAC further

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Introductions

• Name and role
• Please tell us a little about your current
  knowledge of AAC.
• Please tell us more about why you would like to
  know more about AAC today.
• Are there any special questions for us to answer
  during the day?

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What is Augmentative Alternative Communication
(AAC)?

• Any system that is used TO and BY someone who
  is not able to use speech as their main form of
  communication
• Augmentative add to
• Alternative instead of speech plus the
  persons own non-verbal communication

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AAC, CQ3, 7.2.1, Page 229

• AAC refers to methods of communicating which
  supplement or replace speech and handwriting.
  The term refers to a function not to any specific
  communication systems or methods. In practice
  augmentations and alternatives to speech often
  overlap and go together, but it should be
  recognised that they are not interchangeable
  terms.
• AAC is a means by which an individual can
  supplement or replace spoken communication.
  Communication may range from any movement or
  behaviour which is observed and interpreted by
  another person as meaningful to the use of a code
  agreed upon between people where items have
  specific meaning i.e. a language.
• AAC encompasses various types of communication
  both aided and unaided systems. Unaided
  communication refers to the use of systems
  involving the users body such as body movements,
  facial expressions, gestures, signing, eye
  pointing and vocalisations. Aided systems refers
  to the use of additional resources and, or
  equipment such as objects, photographs, symbols
  and VOCAs (voice output communication aids).

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AAC, CQ3, 7.2.1, Page 229

• AAC refers to methods of communicating which
  supplement or replace speech and handwriting.
• The term refers to a function not to any specific
  communication systems or methods.
• In practice augmentations and alternatives to
  speech often overlap and go together, but it
  should be recognised that they are not
  interchangeable terms.

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AAC, CQ3, 7.2.1, Page 229

• AAC is a means by which an individual can
  supplement or replace spoken communication.
• Communication may range from any movement or
  behaviour which is observed and interpreted by
  another person as meaningful to the use of a code
  agreed upon between people where items have
  specific meaning i.e. a language.

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AAC, CQ3, 7.2.1, Page 229

• AAC encompasses various types of communication
  both aided and unaided systems.
• Unaided communication (no tech) refers to the use
  of systems involving the users body such as body
  movements, facial expressions, gestures, signing,
  eye pointing and vocalisations.
• Aided systems refers to the use of additional
  resources and, or equipment such as objects,
  photographs, symbols and VOCAs (voice output
  communication aids).

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Who may use AAC?

• Your ideas?
• Do you know any people who use AAC?

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Who might use AAC?

• Probably less than 1 of the population but
  still 100,000s people in the UK
• People who
• Have a physical and/or speech and language
  disability from birth
• e.g. Cerebral Palsy, Learning Disability, Autism,
  Dyspraxia
• Have had an injury or illness during their life
• e.g. stroke/CVA, head injury, Motor Neurone
  Disease, Multiple sclerosis, Parkinsons disease

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Some people who use AAC

• Video of a person using AAC
• Some one with an acquired communication need
  Toby Churchill
• (high tech)
• Some one with a developmental communication need
  Daniel
• (low tech)

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Trying out some AAC!

• SSPIDER activity cartoon and ALD
• Try using the aided language display (ALD) to
  describe the cartoon.
• Try using the Lightwriter (or similar) to
  describe the second scene.
• Think about how the experience feels for both
  people
• Think things that help or hinder the conversation

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What was important?

• As the AAC user how did you find the experience?
• As the communication partner how did you find the
  experience?
• What helped your communication?
• What hindered your communication?

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What helped the communication?

• Giving enough time
• Having the right words
• Being listened to
• Checking that you have been understood
• Noticing body language, facial expression etc
• Patience and respect
• Position relative to each other and the AAC
• Taking even turns

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What hindered the communication?

• Limited eye contact
• Communication going very slowly
• Problems with noticing non verbal communication
  while concentrating on AAC
• Missing out on tone of voice
• Not having the right words

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How did it feel to be the user of AAC?

• Frustrating?
• Good really having the experience and getting
  message across?
• Wanting to be able to say more
• Embarrassing?
• Lots of ideas of how to make it better

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How did it feel to be the communication partner?

• Frustrating?
• Embarrassing?
• Tried your patience?
• Good to have a real conversation finding out real
  information from the user of AAC?
• Realising how slow it can be.

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Bill of Rights and Dos and Donts

• These are in your pack
• From SCOPE package
• Supporting Communication through AAC
• SCOPE website reference on resources sheet.
• We will come back to these issues when we meet
  user of AAC later.

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Personal Communication Passports

• This is a moment to mention communication
  passports or dictionaries
• Example
• Website http//www.communicationpassports.org.uk/
  
• Can be used to guide people new to a client to
  the best ways of facilitating that persons
  communication.
• Have far wider uses too

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Video examples to go with points

• Video from Attitudes and Strategies video
• Book and video can be borrowed from ACT and
  bought from AAC Scotland
• View some clips about etiquette and success

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Break
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Introducing ACT

• Regional NHS Tertiary Assistive Technology
  Service all ages and conditions
• Mission statement
• To work with patients / clients and their local
  teams to assess for and provide techniques and
  technologies which optimise the potential for
  communication, mobility and control.
• Staff OT, SLT, Clinical Scientists, Workshop
  team, Administrators about 30 people.
• Other teams in UK are similar but each is unique

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ACT Website www.actwmids.nhs.uk
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The West Midlands AAC Care Pathway

• Mission statement
• The AAC Care Pathway aims to achieve the delivery
  of high quality services for people with AAC
  needs in the West Midlands region
• Now version 3
• RCSLT Bulletin article Feb 2008

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The West Midlands AAC Care Pathway

• Integrated Care Pathways - what are they?
• ICPs are both a tool and a concept that embed
  guidelines, protocols and locally agreed,
  evidence-based, patient-centred, best practice,
• into everyday use for the individual patient.
• In addition, and uniquely to ICPs, they record
  deviations from planned care in the form of
  variances.
• An ICP aims to have...
• the right people
• doing the right things
• in the right order
• at the right time
• in the right place
• with the right outcome
• all with attention to the patient experience
• and to compare planned care with care actually
  given.
• It is this last point that sets ICPs apart from
  the myriad of other tools supporting best
  practice
• http//www.library.nhs.uk/pathways/

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The West Midlands AAC Care Pathway

• Brief history
• From 2002 onwards a process to
• Reduce waiting times for ACT intervention for
  those complex clients who are referred.
• Develop the skills of colleagues in the region so
  that there is more consistency for clients
• Alter ACTs services to better meet the needs and
  wishes of service users clients, their carers
  and clinicians
• Facilitate clearer and more consistent
  information gathering about AAC needs

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The West Midlands AAC Care Pathway

• The training packages on the website.
• 9 training packages delivered mainly by ACT team
  as pilots in 2006.
• Repeated in 2007 with more local clinicians
  participating in the delivery.
• Plans for packages to be used and adapted more
  widely in WM by other AAC teams
• PLUS the WM AAC care pathway Special Interest
  Group (SIG)

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The West Midlands AAC Care Pathway
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The West Midlands AAC Care Pathway

• The documentation and how it can be used.
• Down load from the website and print or use as an
  e copy.
• Here are some of the uses
• Guide and record a teams work with a client
  around AAC
• Help a team decide whether to refer to ACT or
  other service.
• Guide your own development of skills and
  knowledge

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The West Midlands AAC Care Pathway
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The West Midlands AAC Care Pathway
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Low tech AAC
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Low tech AAC

• Low tech is used to refer to paper based AAC
  systems.
• Medium tech AAC refers to simple technology such
  as single message devices e.g. Big Mack
• Some examples

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Low tech AAC
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Medium tech AAC
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Practical exercise around Low tech AAC
andvocabulary

• Two AAC symbol displays AB
• Please use them to role play a conversation when
  out for a simple meal.
• The person with the display can not talk but can
  use their hands, and can signal a clear yes and
  no
• Swap roles for the second (B) experience
• What happened with the conversation with A?
• What happened with the conversation with B?
• Consider Strengths / Weaknesses / Opportunities
  / Challenges
• Which of these ALDs would you take if you had to
  choose, and why? 

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AAC exercise (PCS/Mayer-Johnson symbols)
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AAC exercise (PCS/Mayer-Johnson symbols)
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Low tech AAC example
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Symbol hierarchy Mirenda and Locke 1989Ways of
representing things we talk about

• A spectrum of symbols
• Objects of reference
• Photos
• Colour picture drawings
• Line drawing symbols
• Bliss symbols
• The written word
• A spectrum of complexity
• single symbols/displays/communication
  books/bags

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Examples of symbols

• Objects of reference

Photos
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Examples of symbols
Line drawing symbols E.g. Widgit Literacy
Symbols Previously Rebus

• Colour picture drawings
• E.g. Picture communication symbols from Mayer
  Johnson
• Or Dynasyms

Or Makaton symbols
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Examples of symbols

• Bliss symbols

Written word Swimming
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Relating this to the WM AAC care pathway

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Low tech books and charts

• Let us look at some examples

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Lunch
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High tech AAC

• define

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Axel

• Chris

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Why a VOCA?

• When having a voice is important
• When the person needs to initiate independently
• To teach and practise interaction
• May be main method of communicating,
• May be used with a low tech system or used only
  in certain situations

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The main differences

• Synthetic vs. Digitised speech
• Range of words/messages available
• Various types of displays
  e.g. Spelling, symbolised words,
• icon sequences, whole messages
• Access method
• Cost

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The right communication Aid

• Will depend upon a number of factors including
• Cognitive abilities / communication potential
• How to access the device
• Preference for synthesised / digitised speech
• Will it be carried or mounted on a wheelchair
• Low tech AAC needs
• Other assistive technology needs
• Funds available

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How to make messages.

• A whole phrase or message pre-programmed.
• Lots of single words /phrases.
• Starter phrases words/phrases to add to it.
• Lots of single word vocabulary to build into
  sentences.
• Letters to write words word prediction.
• Icons to combine to make words/phrases

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Vocabulary available

• Vocabulary needs to be appropriate to the users
  ability and needs.
• Need to learn and remember the words/symbols and
  where they are stored.
• Core vocabulary little words used a lot
• Subject / topic specific vocabulary
• Fringe or extra vocabulary

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Choosing vocabulary

• Build your own vocabulary package
• Choose vocabulary that will be used
• Use familiar people to produce a list of
  possible vocabulary
• Ready made vocabulary packages with a big
  vocabulary but need altering.
• Vocabulary organised in categories.

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Access Devices

• VOCAs vary in access methods possible
• Direct access by pressing touch screen
• Head Mouse
• Switch or switches using scanning
• Mouse or mouse alternative,
• e.g. roller/joystick

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Try some

• Look at the layout of the vocabulary
• Look at how many things you can say
• Look at the different ways to access

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Break
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Feedback

• What made it easy to use?
• What made it difficult to use?

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Factors critical for success

• Proper period of assessment and evaluation
• Team involvement
• Emphasis on functional communication
• Access to appropriate messages and vocabulary
• Explicit teaching of system in natural, familiar
  settings
• Creation of communicative opportunities
• Support for communication partners

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Implementation of low/high tech systems

• Communicative competence internal communication
  skills
• Language Functions- types of communication
• Means, Reasons and Opportunities Money and
  Thurman

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Approaches that can be of use

• Hanen
• Portage
• Supported Conversation for people with Aphasia
• Total Communication
• Person centred planning and circles of friends
  networks

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AAC Programmes to follow

• SCOPE pack
• Teach and Talk (Minspeak)
• Makaton vocabulary
• LLL teaching materials from Liberator
• Claire Latham book
• Functional AAC book

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Going away message

• Video of a chat

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How to help.

• Create communication opportunities
• Responding to communication attempts
• Give time -lots and lots
• Phrase your questions appropriately
• Be aware of topics they can talk about.
• Finish messages or not?

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Finally

• Remember to be a responsive and supportive
  communication partner.

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Wrapping up

• Points you raised
• Thank you
• Questions
• Feedback sheets

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