Augmentative communication therapy
Augmentative and alternative communication (AAC) refers to ways (other than speech) that are used to send a message from one person to another. We all use augmentative communication techniques, such as facial expressions, gestures, and writing, as part of our daily lives. In difficult listening situations (noisy rooms, for example), we tend to augment our words with even more gestures and exaggerated facial expressions.
People with severe speech or language problems must rely quite heavily on these standard techniques as well as on special augmentative techniques that have been specifically developed for them. Some of these techniques involve the use of specialized gestures, sign language, or Morse code. Other techniques use communication aids, such as charts, bracelets and language boards. On aids such as these, objects may be represented by pictures, drawings, letters, words, sentences, special symbols, or any combination thereof.
Electronic devices are available that can speak in response to entries on a keyboard or other methods of input. Input can come from any number of different switches that are controlled with motions as simple as a push of a button, a puff of air, or the wrinkle of an eyebrow. The possibilities increase virtually every day! Augmentative communication users don't stop using speech! When speech is used with standard and special augmentative communication, not only does communication increase, but so do social interactions, school performance, feelings of self-worth, and job opportunities.
A Word of Caution
Selecting the communication methods that are best for an individual is not as simple as getting a prescription for eyeglasses. But, language is also complex, and we learn to use it everyday. Indeed, developing the best communication system for a person with a severe speech and language problem requires evaluation by many specialists, all of whom may not have offices in the same building or even in the same city. Communication boards may need to be made. Vocabulary to meet the needs of a wide range of communication situations must be selected. Equipment may need to be ordered and paid for. Health plans or other third party payors may need to be contacted.
And once all the parts of the communication plan are in place, the user must learn to operate each part of the system effectively and efficiently. Effective communication with its speech, standard augmentative, and special augmentative part is not learned out of a book. Professionals need to help the user and his or her communication partners learn a variety of skills and strategies, which might include the meaning of certain hand shapes and how to make them; starting and stopping a piece of electronic equipment at a desired word or picture; ways to get a person's attention; ways to help a communication partner understand a message; and, increasing the rate of communication. Communication planning is a life-long process . And, problems will come up that will threaten the plan. Without effort by the user; professional help; ongoing practice; and support from friends, family and colleague, the promises of augmentative communication may not be realized. And even with all the parts in place, chances are that problems will arise. Continue to find out what can be done to solve these problems. Users of AAC will tell you the effort is worth it and that selection of their AAC system was the most important single event in their lives.
Team Evaluation
For anyone who is considering the use of augmentative communication, the first step is to get a complete evaluation of:
•Communication needs (both current and future)
•The communication technique currently used
•The potential for using different kinds of standard and special augmentative communication.
All of this information must take into account physical, mental, social, educational, and vocational abilities.
The evaluation will uncover a lot of information, and one specialist cannot do it all. Rather, the evaluation must be conducted by a team of experts working with you. With this team approach , a group of professionals, each with a special knowledge about certain areas of augmentative communication, will conduct the evaluation, after which it will share the information and, as a group, make recommendations about what to do.
Members of the Team
The list of possible experts who may serve as team members or consultants to the team can be a long one, depending upon the kind of information that is needed. Team members and the areas they might evaluate include:
The AAC User and Family
•desired outcomes
•user motivation for achieving outcomes
•abilities of other team members
Speech-Language Pathologist
•understanding of language (oral and written)
•use of language and interaction patterns with different
•communication partners
•muscle control for speech
•pronunciation of speech sounds
•use of nonverbal communication
•appropriate vocabulary for use with the augmentative communication system
•types of specialized communication aids and techniques.
Occupational Therapist
•muscle control or different body parts with and without special equipment for different body positions.
•ability to tell differences in size, color and shape
•mobility and seating.
Physical Therapist
•muscle strength, range of movement, flexibility, balance, and coordination
•muscle control in different body positions, with and without special equipment
Physicians of various specialties, such as pediatricians, neurologists, otolaryngologists, orthopedists, physiatrists
•general health
•appropriateness of medical and surgical treatments
Rehabilitation Engineer
•mounting of devices and switches
•design and development of customized parts
Educator (for children)
•classroom performance and academic performance
•communication skills needed to complete academic and
•vocational courses and to interact with classmates.
Social Worker
•individual's total living situation (family structure, finances, etc.)
•need for additional community resources
Psychologist
•individual's learning potential
•need for individual and family counseling
Computer Programmer
•usefulness of existing computer programs (software)
•possibility of modifying existing programs or developing new ones
Vocational Counselor (for adults and older children)
•individual potential to hold a job
•identification of career goals
Audiologist
•evaluation and treatment of hearing loss
Orthotist
•determination if there is a need for special splints, braces, or similar aids.
Manufacturer/Distributor of Communication Devices
•possible applications and modifications of a device
•repair information
•possible sources of funding
For children, the speech-language pathologist, the occupational therapist or physical therapist, and the child's teacher often form the core of the team. For adults, the teacher usually is replaced by one or more physicians. Other specialists are consulted as needed.
Keep in mind that team members may change. As an individual's abilities increase or as life situations change, the make-up of the team changes. As a person gets older or progresses physically, needs and capabilities change. While a preschool child may need a computer program that teaches early skill development, an older child may need word processing software to complete school assignments. As new needs arise, different professionals with special knowledge will lend their expertise to the team.
References
•Beukelman, D.R., & Mirenda, P. (1998). Augmentative and alternative communication (2nd ed.). Baltimore: Paul H. Brookes Publishing Co.
•Beukelman, D.R., & Ansel, B. (1995). Research priorities in augmentative and alternative communication. Augmentative and Alternative Communication, 11, 131-134.
•Light, J.C., Beukelman, D.R., & Reichle, J. (2003). Communicative competence for individuals who use AAC: From research to effective practice. Baltimore: Paul H. Brookes Publishing Co.
•Downey, D., & Hurtig, R. (2003, July). Augmentative and alternative communication. Pediatric Annals, 32(7): 467-474.
Source: American Speech-Language-Hearing Association