Course: Level 3

• Level 3 - Plan for Progression

  • 
  • Mark as done

    This final Level 3 provides guidance about report writing and planning for the next stages in any AAC journey. 
    

    The following topics will help you:

    • Explore the design aspects of symbols and communication charts. 
    • Discover the importance of positioning and integration of other AT
    • Develop report writing skills
    • Evaluate outcomes for success
    • Design successful progression and action planning strategies
      

    
    

  • 

    URL

    AAC Glossary URL

    Mark as done

    Glossary items will continue to be added over time.  The list will include vocabulary linked to Assistive Technology, Speech, Language, Literacy and Augmentative and Alternative Communication (AAC)
    

  • Mark as done

    Please work through the topics below in the order they are provided, unless you feel confident that you know the subject.  

    Select individual arrows beside the topic heading or 'Open all'.  This action will show one long page of content. The arrows and titles work like a toggle to open and close sections. When you have finished a topic you may find it easier if you close that section before you move onto the next one. 
• 

  Open all

  Close all

  
• 

  Instructions: Clicking on the section name will show / hide the section.

  

• AAC Vocabulary Building

  • 
    

    Planning for progression when thinking about vocabulary building to enhance communication allows us to:

    • Consider the move from an initial lexicon of core words to a more varied one that includes a wider vocabulary
    • Discuss what words might be used in a enlarged vocabulary
    • Assess understanding of linguistic concepts
    • Explore some case studies to support the types of vocabulary needed. 

    
    

  • Mark as done

    Building Language

    Vocabulary building is complex and it is important to have a clear idea of the child's language/linguistic abilities.  Let's refresh our memories... 

    There are several aspects to learning language when using AAC, such as 

    • "reasons to communicate (pragmatics), 
    • the communication dance (discourse), 
    • word meanings (semantics), 
    • word building (morphology) and 
    • sentence building (syntax)." (Van Tatenhove, 2005).   

    Let's compare typical vocabulary developement to that of Atypical Language Experiences (AAC)
    

    
    

    Typical and Atypical Language Development (Murray & Goldbart, 2009)
    

    Typical	Atypical (AAC)
    12-18 months First 50 Words - objects and relational words that indicate the context or activity 1-2 years Referential style - lots of single word naming mainly people, animals food - concrete rather than abstract concepts.  has fun with words - made up ones.    Expressive style with whole phrases with prepositions and other core words appearing.	2-5 years nouns introduced verbally and used via AAC.  Later two or more words used, but not necessarily  with correct grammar or syntax (word adjacency versus word order).
    2-3 years: Approximately 500 words - use sentences with three or more words with improved grammar and word order (syntax).  Plays with language, songs, rhymes etc.	2-3 years Icons or symbols organised into semantic groups (by meaning) rather than by groups which have similarities.  Referential style (single words used). Limited expressive communication strategies using core words /symbols with personlised fringe vocbulary.
    3-4 years Approximately 1000 words  Answers simple questions. Uses sentences of five to six words often with the correct syntax, even if the grammar or pronunciation may not be totally correct.	3 years  - onwards  Dynamic (several layers of vocabulary on offer) versus Static (single layer) AAC devices considered with corresponding impact on vocabulary development.  Word recognition and lingusitic skills. Knowledge and evaluation of graphical symbol systems has an impact on language acquisiition
    5 years Approximately 3000 words with longer sentences although some pronouns and relationals such as more or less big or little may still be muddled and not all family relationships are understood such as Aunt and Uncle.  May start to depend on the context of a word for understanding - cool person as opposed to being cool weather.	The gap between understanding language and vocabulary use may widen. Communication skills may be hampered by the AAC system.  Professional's knowledge and evaluation of graphical symbol systems affects potential language acquisition.

  • Mark as done

    Activity - Building an Initial and Core Board

    No one word list is adequate for selecting valid vocabulary for an AAC user and as you have learnt it also depends on many factors including ability, environment, culture, language, task and tools.  The process has to be collaborative and highly individualised, as well as being regularly reviewed. 

    

    Here is a 'Universal Core Vocabulary' in English from Project Core.  Make a communication board using any symbol set and chart building system.  Think about semantics and syntax. You may have already tried Boardbuilder, Cboard and Coughdrop and had a conversation with a young child using a chart but these words can be used with any classroom activity.  Make a note in your reflective journal about the number of phrases you were able to generate and how the conversations went. 

    all	finished	he	in	make	open	some	up	where
    can	get	help	it	more	put	stop	want	who
    different	go	here	like	not	same	that	what	why
    do	good	I	look	on	she	turn	when	you

  • Mark as done

    Planning for more words

    Progression to increasing numbers of core words, including important fringe words is dependent on many aspects of a child's ability and the AAC system being used, but plan for:
    

    • immediate needs to include "descriptive talking" words such as 'it', 'this' and 'that' etc.
    • recurring activities
    • all parts of speech (mainly found in core words) and part of normal language development
    • words that span many environments. 

    
    

    All these types of words can be found in the Dynamic Learning Maps Comparison of 405 AAC ranked words compared to frequently written words in US English.  There are interesting differences.  

  • Mark as done

    Activity - Getting started with Literacy - The importance of grammar

    When exploring language and literacy knowledge (Murray and Smith, 2014) don't forget to evaluate receptive as well expressive skills. Think about the ability to match symbol meaning and language form (grammar) and content (semantics) to show you understand what is happening in for example a composite picture. 
    
  • Mark as done

    Case Studies

    We have discussed the use of Janice Light's (1989) communicative competencies and how they can be applied in an assessment setting.  Tobii dynavox have applied them in a way that supports the planning of interventions.  At this stage their Dynamic AAC Goals Grid-2 (download DAGG 2 PDF) can be very helpful with 'Laura' as a Case study.  
    

    "Laura is 4 years old and just received her new communication system. She understands and follows general conversations. She is starting to use clear and simple symbols in motivating situations or favorite activities. In addition, she is beginning to show more interest in social interactions which is one of the main reasons the school SLP suggested an evaluation for a high-tech communication device. 

    Below is her overall picture from working through the Ability Level Continuum. 

    
    

    When you have read her case study you might think about an activity such as picture sequencing to encourage understanding or little exercises where phrases are completed with one word answers such as a cup of .... or drink of...  and watch for her reactions  the aim of increasing phrase length.  Literacy skill goals need to be included in the planning for progression with activities that encourage letter sound correspondence. 
    

    Now read Edie's case study and see if you can apply DAGG 2 to work out her needs and make notes in your reflective journal. 

    Mary Baumann-Spooner also has three case studies that offer ideas from Evaluation to Implementation. 

  • Mark as done

    Summary 

    • Think about the balance between speedy access to the core vocabulary and those fringe words that may require more effort to access.
    • The lexicon chosen needs to allow for progression and enable use in a wide number of settings
    • AAC systems can cause constraints on vocabulary selection and this can be frustrating
    • Pictographic symbols may not have one to one semantic relation as with gestures and words. 
    • Time is critical for AAC users, so communication may be made up of the least number of symbols possible that provides meaning. 

    
    

  • Mark as done

    Further Reading 

    • Van Tatenhove, G.M., 2005. Normal language development, generative language & AAC. Retrieved Sept, 25th 2023.
    • Murray, J. and Goldbart, J., 2009. Cognitive and language acquisition in typical and aided language learning: A review of recent evidence from an aided communication perspective. Child Language Teaching and Therapy, 25(1), pp.31-58. (university access)
      
    • Light, J., 1989. Toward a definition of communicative competence for individuals using augmentative and alternative communication systems. Augmentative and alternative communication, 5(2), pp.137-144.
      

    
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    AAC Vocabulary Building URL

    Mark as done
  Topic
  1
• Principles of Symbol Design

  • 
    

    In this topic we will consider:  

    • The importance of language and culture in symbol design
    • Recognising the importance of both translation and localisation
    • How symbol design is influenced by how the symbols will be used 
    • Why open licences are important 

    
    

  • Mark as done

    Pictographic Symbol Sets

    In the following YouTube video Edie's mother goes through some symbols watching for her reaction - look at the symbols carefully and think about the mix on offer.

    There are many pictographic symbol sets available for AAC users and several are suitable for children with complex communication needs, such as those offered to Edie. They tend to be made up of core and fringe words and have consistent design principles and schema as illustrated by Widgit.

    Some symbol sets are available across the world, but often they have been developed specifically for a language with a particular group in mind. You will have already explored the range available on Global Symbols and Open Symbols when using Boardbuilder. 

    
    

    Open licenced symbols offer us the chance to explore which symbols need adaptations to suit localisation and personalisation as we discussed early on in the course.

    
    

  • Mark as done

    Activity - Considering symbol design

    Symbol design is not just about the graphics, there may also be challenges with the orthography.  Think about the way a language is written - the spelling of words.  Have you thought how this affects symbol design and the choices you may make for the symbol labels when working on communication boards?

    

    • Write two sentences that involve the past and future tense, two plurals and a male and female character with descriptive adjectives. 
    • What happens to the symbol label when the way the text is written depends on grammar, number and gender and even the next word in a sentence?  Does every language use the root word?
    • Words have mulitple meanings (polysemy) for example the word 'will' in English or there are different words which have the same sound (homophones) as in 'bough' and 'bow' said in the same way as 'cow'.  You can also say 'bow' as in 'know' which can also be a problem when searching for symbols or using text to speech, unless there is more information provided.  
    • Explore how a search for these words on a symbol repository such as Global Symbols (which offers different languages) might affect the symbols found. 
    • Did you discover any verbs with past tense?  If not, how will you deal with this concept? 
    • Widgit offer clear guidelines to their schema.

    Make a note in your reflective journal about any issues that you feel are relevant to symbol design that you wish to explore further - it is a subject that is often left to the symbol set developers! 

    In some ways it is much easier to think about the look and feel of images that might reflect cultural differences such as housing, social settings and dress compared to abstract concepts.  Small adaptations to symbols can improve iconicity as we have already discussed.  

    
    

  • Breaking down Barriers

    Consider participatory ways of encouraging collaboration when designing and developing symbols, as this can have an impact on AAC users and their families  When a whole team is involved there is often an increased willingness to use the localised symbols.  

    Using social media and open communication systems can make for easier changes; being responsive to comments and requests based on the opinion of the majority.

    Think about developing a voting system if you are involved in symbol designs.  In the picture Adam is voting on new symbols in Qatar.  You are welcome to make use of the free voting training materials available.  

    The image below is an illustration of a symbol set where symbols have received votes and a survey has been completed.

    
    

    
    

  • Mark as done

    Symbol Design requirements

    Main Points

    • Iconicity
    • Size
    • Outline
    • Consistency
    • Colour

    Iconicity is when a symbol’s relationship to its referent (what it relates to) can be guessed,  consider the ease of learning as this is important. A child may move from objects to photographs that have a particular meaning, but understanding the concept may be harder.

    
    

    Average symbol size tends to be 500 x 500 pixels (use points for measuring unit options) but this can vary especially when used in different settings or for those with specific pointing difficulties. It is therefore important to remember that symbols will always need to be resized to suit individual requirements.

    
    

    There should be clear outlines to all parts of a symbol. Usually these are black outlines around and within objects, faces and bodies from 2 to 7 points (although it depends on the size of the character within the image).

    
    

    The style of the symbols needs to be consistent where possible, with a understandable schema such as the one Widgit offer.

    File names and symbol IDs need to be unique. Use vector files to allow for adaptations for example .svg with transparent backgrounds, but offer an alternative such as a .png. There may be a need to convert the images to jpgs and pdfs for print outs of any size  

    Colour may be used as a border around a symbol cell or as a background to the symbol.  Colour contrast levels are important especially for those with visual difficulties.

    
    

    Remember Symbols are used everywhere and ...

    • may need to be printed on card, on a chart, on a wall – size matters
    • can provide text enhancement for literacy skill development, so need flexibility for label changes or even appearance.
      
    • have to transfer from paper to device.
      
    • need to be device agnostic – used with various applications on different types of AAC aids
      
    • Integrate with text to speech – labels with accents (diacritics)

    Download a Word document about AAC Symbol Design  
    

  • Mark as done

    Activity - thinking about developing a schema for design

    There are times when iconicity or guessability and developing a schema for particular types of words can be challenging.  There may also be the problem of the gloss or text label failing to translate well into another language. Drag the labels to the appropriate symbol. (Thanks to ARASAAC)

    
    

  • Mark as done

    Open Licences

    You may feel that a discussion about licences related to the content on an AAC communication chart is not relevant to your support for a young child's communication skills.  However, anyone building or making use of symbols on assistive technology devices needs to be aware of the copyright of images  and how they can be shared or adapted to suit user needs.  Open licences and Creative Commons licences (like commercial licences) can be quite complex, but the main point is to share symbols in the same way that the developers or owners have chosen to share their symbol set or images.  It is also important to use the same type of licence if you want to create symbols that you are adding to a particular set. 
    

    The advantage of an open licence is in the way localisation and personalisation can happen in the particular region or setting in which the potential AAC users are living. 
    

  • Summary 

    • Whilst some symbols can be considered “universal” we recognise that symbols are nuanced and carry meaning beyond concrete representation.
    • "Symbolic value rests only in the mind of the user, the picture or manual sign has no symbolic meaning unless the user knows or recognises the meaning" (Loncke, 2014)
    • Because symbols are open to interpretation engaging in the design of symbols for a specific community will help ensure that there is a shared understanding and interpretation of all of the symbols in a set.
    • Always check the copyright of images and symbols you may be sharing publicly. 

    
    

  • Mark as done

    Further Reading 

    • Light, J., Wilkinson, K.M., Thiessen, A., Beukelman, D.R. and Fager, S.K., 2019. Designing effective AAC displays for individuals with developmental or acquired disabilities: state of the science and future research directions. Augmentative and Alternative Communication, 35(1), pp.42-55.
    • “Getting Started with AAC: Using low tech symbol based systems with children” – introduces low tech symbol based AAC to support individuals who can’t rely on speech to communicate to the best of their ability.
      
    • AAC Applications for Beginning Communicators: Design and Application (2016) K. Drager & N. Muttiah
      
    • Loncke, F., 2019. Augmentative and alternative communication: Models and applications for educators, speech-language pathologists, psychologists, caregivers, and users. Plural Publishing. (Amazon book purchase updated) 
      

    
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Principle of Symbol Design URL

    Mark as done
  Topic
  2
• Communication Boards for Different Technology

  • 
    
    

    In this topic we look at building and designing communication boards for the classroom with added complexity. You will find that:
    

    • Low-tech boards, mid-tech systems, and high-tech communication aids all have their advantages and disadvantages
    • Considering the vocabulary available to AAC users is paramount
    • Users may need access to core words even more than fringe vocabulary on many occasions.

    
    

  • Mark as done

    Variations in Board Design for different Tech

    • No or LowTech
    • Mid-Tech
    • High-Tech

    Low Tech AAC includes the use of symbols on a keyring to large paper charts with up to 140 symbols that are either viewed on a laminated sheet or in a communication book.  Large communication charts are also ideal beside playgrounds and on school classroom walls at one level. Communication books offer categorisation of symbols by topic over several levels. 

    
    

    PODD (Pragmatic Organisation Dynamic Display) is an example of a specific way of presenting symbols in a communication book, but there are many other types of communication books and there are three very good freely available online books on the subject that cover this subject in greater detail than can be achieved in one topic. 

    Ace Centre: Getting Started with AAC: Using Low Tech Symbol Based Systems with Children

    Ace Centre: Designing and using alphabet charts including the use of an E-Tran frame and the implications for layout and encoding. 
    

    Ace Centre: Access to low tech symbol based resources when pointing is difficult 

    Key Points

    • It’s better to use matt laminate, not gloss, prevents reflections
    • Text / Font size is important - check vision and the distance from the chart and spacing of the cells with the symbol and label to aid accurate pointing.  
    • Contrast levels and use of colour for clarity.
    • Labels positions vary; can be above the symbol if finger pointing makes it hard for communication partners to read the word or below if literacy skills are being taught.  
    • There is no speech output so the communication partner needs to understand symbols or to be able to read the text accompanying each symbol. 
    • The vocabulary that the person is able to use is limited by the symbols on the sheet. 

    Typically Mid-tech aids use paper or laminated sheets where printed symbols are placed in a fixed grid of cells. Some devices have speech output and some offer extra accessibility options, but all require that someone changes the sheet when new vocabulary is required.  These options offer instant access at one or two levels, reduce memory load and encourage direct responses, as vocabulary is built with human recorded messages rather than speech synthesis. 

    AbleNet offer many switches that can be used for recording messages and others such as the Quicktalker 7, 12 and 23 that have robust grids with templates for printing out (example core board).  Battery operated, you press the cell and the message or symbol label is said aloud.  AbleNet provide their Remarkable Ideas and an Action Dictionary as a free epub book of activities along with online learning activities. 

    Attainment Company make the GoTalk 4+, 9+,20+ and 32+ which also allow messages to be recorded for each cell and there is software to make the templates but try LessonPix and make your own 20 cell GoTalk sample communication chart. 

    LessonPix also offer overlays for AMDI devices such as the Tech/Talk

    Key Points

    • Single message devices can be useful for 'cause and effect' activities and offer a stepping stone to the possibility of 2 -3 recording levels and some have buttons with transparent covers for symbols. 
    • Multiple cell devices tend to come with templates that can be copied or developed online using any licence free symbols - free examples can be found on LessonPix.  
    • Often high contrast and clear block colouring is used for images rather than detailed symbols. 
    • Symbol sizes may vary and label text needs to be larger than on an iPad or other high tech aid - there is no Zoom feature. 
    • The devices vary in complexity and how many levels of audio recording are possible. 
    • Just as with paper-based, no tech or very low tech these devices need to come with clear instructions, training, modelling and support with regular reviews. 

    Many AAC devices are now based on a mainstream tablet with specialist software or apps. However,  those tailored to a user as a dedicated communication aid are still very popular. Dedicated AAC devices tend to have louder speech output, meaning that the person can communicate more easily in groups.  There are also many more access options for those with physical disabilities and may come with added sturdiness and reliability due to their special cases and company support.  

    There are several companies with dedicated systems such as the Tobii dynavox devices, AbleNet QuickTalker, Inclusive Technology and Liberator AAC aids in the UK.  There are many options for commercial board building software that also works as a communication application with speech output, such as MindExpress or Grid 3 and can be linked to environmental aids as well as social networking. 

    Key Points

    • Make sure the AAC device chosen has access to a board building application as well as a communication app.  These may be integrated in more sophisticated systems. 
    • Personalise the communication board as soon as possible as well as the aid so that there is a sense of ownership.  
    • Don't forget 'masking' when there may be an overload of symbols on a grid, rather than removing them and the ability to use visual scene displays when discussing topics, as these can offer a 'just-in-time' programming - adding symbols on the fly. 
    • AAC use may still come with feelings of stigma and high levels of abandonment,  so encouragement by offering easy access to most used words and engaging symbols is important 
    •  Awareness that high tech may not work in all settings, so other options should always be available for example a communication book or keyring. 

  • Video: DIY Core board with masking

    This is one way of making a paper based symbol core board that allows for masking. The printed version is available as a downloadable PDF using SymbolStix, but these can be changed to the users' preferred symbols.

    
    

    
    

  • Mark as done

    Activity - A Bathroom Visual scene display

    This no cost activity has been created using an example from H5P with a background image from Pixabay and downloads of .png ARASAAC and Openmoji symbols.  You could add audio and there are apps specifically for this task such as Scene Speak for the iPAD and EasyVSD for Android tablets.
  • Video: Visual Schedules

    Communicating a sequence of events is an important aspect of progression, helping the child to discuss the 'now' and 'then later'. This is good preparation for sequences in stories and reading activities.

    
    

    Visual schedules based around symbols are a good way of helping the child to plan, predict and anticipate a day, week or month.
     

    
    

    
    

  • Mark as done

    Summary 

    • Children need an AAC system that will work for them in any situation
    • Children need access to lots of language whether it is paper based or using assistive technology. 
    • Considering the language you give AAC users is paramount, especially as they find the power of interacting with their chosen sounds, gestures and symbols. 
    • Personalise aids and vocabulary to encourage ownership.

    
    

  • Mark as done

    Further Reading 

    • TalkLink: Visual scene displays: Creative ways to promote communication (Download PDF)
    • PrAACtical AAC:  Five Resources for Making and Using Visual Scene Displays
      
    • Stories of Ourselves: I DARE to Build/Expand Communication and Literacy Skills
      
    • Ace Centre in the UK provide free symbol charts that you can download and use right away.

    Here is a list of popular vocabularies on communication boards that you can print or install on some devices. Note that most of them focus on core language and some use commercial symbols such as PCS or Widgit:
    

    • Crescendo 
    • LAMP 
    • Core First 
    • Super Core 
    • SCORE
    • Quick Core (CoughDrop 60 cells)
    • easyChat
    • Vocabulary for Life 
    • Unity 
    • CommuniKate 
    • Symbol Talker A - D

    
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal
  • Presentation slides

  • 

    URL

    Building and designing boards for communication URL
  Topic
  3
• Positioning

  • 
    

    In this topic we will take a look at the importance of the careful positioning of communication aids and their accessories. We will cover:
    

    • Why we need to mount and position access communication devices and their accessories
    • Some examples of equipment used to mount and position devices
    • Positioning

  • Mark as done

    Positioning Switches

    Children with physical disabilities are usually limited in their range of movement for their hands and arms. They may also have uncoordinated movements which can be controlled, to some extent, by gripping onto something, such as the corner of the device. 

    It is very important that when using direct access, or any of the other access methods, that the device is positioned in such as way that it is easy, comfortable and not tiring, for them to access for extended periods of time. If the communication aid requires too much effort or causes discomfort or pain then the child is unlikely to use it.
    

  • Mark as done

    Thinking about the questions that need to be asked

  • Mark as done

    

    Positioning Switches

    The positioning of a switch as an input device, so that the user does not find it awkward or tiring, is a very important part of the AAC assessment.

    

    Understand the User

    How will the switch be controlled? Head, mouth, hand, knees or foot? What pattern of movement is possible and how consistent? Fine motor pattern or gross - more random? How much pressure or force is possible (as this determine the required stability of the switch in a clamp or on a mat)?

    

    Switch Choices

    Each switch may require a specific connection, each type of mount may require a specific clamp, fixing or nonslip mat. Not all switches and mounts are compatible and most switches can have several options in terms of positioning depending on the user and the setting.

    
    Positioning

    Positioning

    This will depend as much on the way the user activates the switch as it does not the setting. Will the switch be activated when the user is in a wheelchair, bed, at a desk or on the floor? Does the switch need to have additonal clamps around the wheelchair tubing, perhaps when using foot or knee access or a head fixing. If the switch is on a desk does it need velcro or a sticky mat or wedge to stop it slipping or provide the right angle?

    

    Review and review again

    Evaluating the success of any positioning is ongoing. Repetitive strain injuries can occur, just as they can when we sit at the computer and use a mouse incorrectly for any length of time. Abandonment of the AAC device may not be because communication is difficult, but because the assistive technology is uncomfortable to use. Keep checking and updating!

    ‹ ›
  • Mark as done

    Activity - Matching movements to switches and position

    Consider these movements:

    1. extend and flex elbow to move forearm (like banging a drum)
    2. move forearm side to side from elbow (like using a pencil eraser)
    3. rotate hand (palm down to palm up and reverse)
    4. make a hand wave (side to side at the wrist)
    5. make a door knocking movement
    6. make a pointy finger or stick thumb out

    Now consider for each of these movements which switch you might use and where you would place it. AbleNet have a series of webinars about switch access, positioning and use on YouTube. 

    Write down your findings in your reflective journal
    

    
    

  • Mark as done

    The importance of placement

    Any type of switch is dependent on the child’s reliable movements. It follows that positioning the switch accurately will be very important in order to use these movements. 

    Take for example a Microlight switch which is very good at activating anything electronic, using very small movements with very little force. The switch requires just 0.7mm of movement in order to cause something to happen and is often used with very small finger or hand movements. In order to be reliable the switch would typically be placed very close to the area of the body part used to activate the switch.

    Often the easiest way to position switches is to use Velcro boards such as the Maxess trays or by fixing Velcro directly to the wheelchair trays.

    Getting head switches into the right position is also very important. It’s essential that the switch can be easily activated through a purposeful head movement, such as a tip to the left or right, but that the switch does not get activated during typical head movements, such as turning to see someone. 

    There are a number of specialist mounts and poles such as those designed by Daessy that can be used to get switches in the right location, usually attached to the child’s wheelchair. 

    
    

  • Mark as done

     Eye Gaze Video - Reviewing use

    Watch the video and think about all of the issues that had to be considered in setting up this system for her use 

    Ava using a Tobii Dynavox I-12+, PCEye Mini, and PCEye Go. Transcript available

    
    
  • Mark as done

    Positioning Eyegaze

    Even eyegaze requires careful positioning. It must be mounted using a floor mount, desk mount, or attached to the wheelchair, so that the device is held around 60cm away from the child’s face. If it is not in the best position then accuracy will be poor and the child will give up quickly!

    Track Boxes

    Each eyegaze system has a Track Box size rating. This indicates the amount of movement that a child can make and still have accurate eyegaze. It also indicates the amount of tolerance for the positioning. As an example, the Tobii Dynavox IS4 camera found in the EyeMobilePlus and i-Series devices has a track box of 35cm by 30cm. This represents an invisible box around 60cm directly in front of the camera. The eyegaze will work as long as the child’s eyes are within the box.  The LC Edge camera, by comparison, has a tracking box that measures 7.6 x 6.4cm so requires the user to keep their head still. 

    This image is taken from the Tobii Dynavox website which also contains a video guide to eye gaze.

  • Mark as done

    Summary 

    • Devices should be comfortable and easy to use, so getting them into the right position is vital for success
    • Positioning switches accurately is very important if someone with a motor impairment is going to consistently hit the switch with minimal effort.
    • Like switches, eyegaze systems also need to be mounted carefully so that they are the correct distance and angle from the child’s eyes. 

  • Mark as done

    Further Reading 

    • Boston Children’s Hospital slides: Get in Position to Communicate seating, mounting, and physical access (Download PDF) In depth information although it mainly shows adults similar mounts and positioning can be set up for children.
    • Ablenet Switch Selection Guide (download PDF)
    • The Eyegaze Edge® : How does it work? What do you need to know? (download PDF)

    
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Positioning and Mounting URL

    Mark as done
  Topic
  4
• Integration of other technical solutions

  
  

  • 
    

    This topic takes a brief look at environmental and games control and the integration of wheelchairs to access communication aids. We cover:

    • How to use wheelchair control joysticks as an access method for communication aids
    • environmental  and games control resources to help children to control videos television and other devices
    • The role of smart speakers such as the Amazon Echo for communication aid users

  • Mark as done

    Wheelchair Controls

    
    If a child has learnt to control their wheelchair using a joystick then often they will be able to access an electronic communication aid also using a similar joystick. 

    Modern wheelchairs can have Bluetooth integrated into their systems which means it’s really easy to connect them to Windows, Apple and Android devices with apps or mouse devices. 
    

    For older wheelchairs without Bluetooth, it is possible to position and fix an additional joystick onto the wheelchair, usually in close proximity to the wheelchair joystick. 
    

    This also works for children who use switches to control their wheelchairs, although the set-up process is a little more complicated.
    

    Watch the first 2.44 minutes of this video to see how a joystick and switch, integrated with wheelchair access can be used with an AAC system.

  • Mark as done

    Environmental Control and Access to Games

    Many AAC users also have physical disabilities which affects their ability to interact with their physical environment. 

    
    

    
    

    Some children find it difficult to accomplish every day tasks such as changing TV channels, putting on music, opening and closing curtains, and so on. Most dedicated communication aids, other than iPad and Android tablets, support some form of environmental control. This involves the addition of special symbols to their device that send wireless signals to the lights, television and so on to perform these essential everyday functions.   The lights etc also need the bluetooth or wifi enabled connections via a plug and it is essential to check any possible security issues when networ connection are used.

    Children might also want access to games and videos that allow them to play with others both off and online.  This may require some careful research on app stores if you are looking for tablet games in English.  There is a dedicated UK switch access website for Windows PC accessible games called One Switch.  

    Discussions about specific access ideas using assistive technologies often happen online between experts freely offering advice - one of the largest groups, with 4.7K members, is AT Makers on Facebook.  Enabling Devices have a large number of adapted or specially designed toys that provide ideal interactive communication moments. 

  • Mark as done

    Activity - Online Games

    There are many online games that can be used in a browser such as Chrome, Firefox and Windows Edge and this means they can also be used on tablets whether they are iOS or Android with direct pointing - touch or when the switch is set up to work in the same way as a mouse. Keyboard access is possible using Mouse Keys on Windows and Mac OS.  Click into the Sensory web app below and select a game.  It can be saved onto your device and run later without internet access if required. 
    

    
    

  • Mark as done

    The Role of Smart Speakers

    Recently smart speakers such as the Google Assistant and Amazon Echo have become very popular. On their own these can report the weather, give out reminders, tell jokes, play music and send messages; but with additional hardware they can also change TV channel, dim the lights, open the door, and adjust the heating. The great thing about these devices is that they can be purchased in many shops and installed very easily. They also work with all electronic communication aids as they rely on voice to work.

    The video below is not specific to children, but shows how an AAC device can be used to access Alexa. It is important to remember that the pauses between commands when using AAC may cause an issue for the smart speaker which is why there may need to be some set phrases linked to reequests such as 'turn the lights on', or 'today's weather' and Spotify 'Name of music' etc. 

    
    

    

    Try to imagine how you would access all your devices if you had poor dexterity and no verbal means of communication?  What would you do?  Use your reflective journal to make a quick note
    

    
    
  • Summary 

    • Using the wheelchair’s joystick or switches to access the communication aid is easy – so long as the wheelchair is compatible
    • Most electronic communication aids, other than the iPad, can have additional symbols to change the TV channel, operate the air conditioning and so forth 
    • Smart speakers are getting better all the time, can control the environment and are accessible 
  • Mark as done

    Further Reading 

    • Ian Bean SENswitcher - free resources for young people who are learning to use a switch, touch screen, mouse or eye gaze with a series of free 'switch skill progression' webinars in English.

    Examples of various commercial control systems for AAC and the environment:
    

    • Curtis Write CJSM2 Wheelchair Joystick with Bluetooth 
    • Possum Environmental Control 
    • Steeper Group Environmental Control 
    • Abilia Environmental Control 
    • Amazon Echo for Grid 3 
  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Integrating Access Technologies URL

    Mark as done
  Topic
  5
• Emerging Technologies

  • 
    

    This is more of a chance to review and exploration topics such as:

    • Further access and emerging technologies
      
    • Identifying unmet needs
    • Eye Pointing
    • Brain Computer Interfaces (BCI)
    • Emerging technology and innovation for access

    So before you read on...

    We have discussed a wide range of ways it is possible to access AAC systems, environmental aids and games by direct or indirect methods. Think about the ones you remember? You can make a note of these in your reflective journal.  Looking at the list you have created think about the following questions    

    
    

    
    

    • What skills and ability does a child need to use each of your input methods ?
    • Can you think of a child you have worked with where none of these options would be easy to use?
    • Why would they be difficult?

    
    

  • Mark as done

    Possible Choices

    How many of these options do you recognize? Which ones have you used and why? Move the slider at the bottom of the picture to the right. 

    
    
  • Mark as done

    Challenges to AAC access

    It is reasonable to ask, why we need further innovation in access to AAC when so many options already exist. As we have discussed earlier in the course each form of AAC access requires or demands that the user has certain skills. These might include:-  

    • Gross motor, large physical movements such as with an arm
    • Fine Motor, including use of hands or fingers
    • Production of sounds, often before the formation of words.
    • Intellectual or cognitive skills which might include cause and effect, choice making or sequencing.

    Access to AAC systems is based on identifying the ability of the child to make reliable, consistent movements or actions. These might involve any part of the body, in the past we have found switches that have used hands, feet, eyebrows or tongue to provide access. But despite this there are some cases where such consistency of movement may not be possible, and innovation is finding ways to address this.

    Advances in Technology

    Gradually, new technologies are emerging that help overcome some of the barriers experienced by children where other options have not been successful. We would stress that these are not always available or affordable, but think it is important that as professionals we are aware of future options in providing a solution where all other options have been exhausted.

    These new technologies may yet become readily available in the future as we found with multi-touch devices such as tablets. Here are some new technologies to think about.

    Option 1 – Using a joystick or trackball on a tablet

    Did you know that it is possible to control a tablet such as an iPad or Android device using a Bluetooth pointing device such as a mouse, joystick or trackball? Some of these connect to the device using a Bluetooth whilst others require a special interface box that allow different USB devices to work.   Don't forget there may be others accessing devices using Wifi and Bluetooth - always check your AAC user can use their access method - USB and cable may be the most robust method!

    
    

    Watch the following video and then think of situations or children that you have worked with where this might have been helpful?

    
    

     

    Option 2 – Eye Pointing

    There have always been some children who find it is extremely difficult to achieve a reliable and consistent movement that can be used to activate a switch in order to access and control a device or application.  Eye pointing at symbols has been one approach to address this challenge. Solutions such as an e-Tran frame have been used as a low-tech solution based on eye movement and gaze.  

    

    We have learnt that these same eye movements can also be used to control an AAC device electronically. But there are challenges to think about : 

    • Glasses: Sometimes the eye gaze camera has difficulty locating the user’s eye. 
    • Other visual issues: Some children have strabismus, nystagmus etc. Calibration can take too long or be hard for the child when the set up does not work immediately calibrate. 
    • Cognitive impairments: There can be a significant learning curve without optimal support and positioning etc. 
    • Language impairments: Layout and ease of access to symbols etc remains vital to speed access 
    • Environmental supports: Resources, time and expert knowledgeable human support are crucial for success as with all AAC systems

    Option 3 – Brain Computer Interfaces (BCI)

    One of the most fascinating areas of research in recent years involves making a connection between brain impulses and controlling technology. These interfaces are not likely to be suitable for young children currently but may become an option in the future

    BCI technology is based upon a series of sensors being attached to the skull of the person with a disability. In most cases these are “non-invasive” resting on the scalp of the user with a signal being strengthened through a conducting gel similar to that used for ultrasound scans during a pregnancy. The sensors detect and identify patterns of brain impulses that are consistent when the person thinks about something specific, something with strong emotional connotations is often used.

    These patterns become the basis of making selections on an AAC grid as each pattern in effect becomes the equivalent of a switch press. For instance one pattern might be used to scan through rows and columns, whilst a second pattern is used to make a choice as discussed in Brain–Computer Interfaces for Augmentative and Alternative Communication: A Tutorial.  To learn more about potential uses of BCI, the TechPlanet video provides some explanations, as well as some points for discussion regarding the dangers of losing control of signals that might be sent or even received.

    
    

  • Mark as done

    Improved AAC through Artificial Intelligence

    Artificial Intelligence has beeen described as the "development of computer systems that are able to perform tasks normally requiring human intelligence, such as visual perception, speech recognition, decision-making, and translation between languages".

    As an introduction to the subject it may be helpful discover how research with 12 AAC users helped to uncover some pros and cons of AI language models.  The following YouTube video is 8.46mins long and titled “The less I type, the better”: How AI Language Models can Enhance or Impede Communication for AAC...
    

    
    

    Now AAC apps are making use of AI to enhance the speed symbol based AAC output.  One of the first was Livox.  Machine learning using data gathered to adapt to the child’s situation and skills. Through artificial intelligence Livox learns a user’s routine and creates grid options that are consistent with use based on time and location. The algorithms adapt content to the tasks and environment of child. This reduces the number of choices of boards that a child has to navigate and then helps speed up AAC communication.

  • Mark as done

    AAC and Wearable Technology

    Wearable technology has been one of the most rapidly growing areas of technology in recent years with fitness trackers become very widely used. At the same time smart watches have also become widespread and offer new opportunities to provide access to communication through innovation. Watch the next video showing an AAC solution on a smartwatch, what do you think are the strengths and weaknesses of this as a solution. At the very least it might be that wearable technology is one way in which we can make sure that a child never forgets their device!

    
    

  • Mark as done

    Using Alexa with Sign Language

    Further developments and research are now exploring how someone whose first language is signing could interact with an Echo device using Alexa. Watch the next video and think about the opportunities for communication and control offered for people who are deaf

    
    

  • Mark as done

    Summary 

    By providing an AAC and communication solution you may be enabling far more than just functional communication, the tools can allow children to have 

    • control over the environment, 
    • access to entertainment and 
    • search the internet as well as 
    • engage with their peers

    These activities may be highly motivating to the child learning AAC. Innovations and new ways of engaging with technology, mean that increasingly communication need not be denied to anyone. This research and development is very exciting and many of the ideas discussed could become real options for you to recommend in the near future. 
  • Mark as done

    Further Reading 

    • PrAACticalAAC blog - This AAC newsletter is run by Carole Zangari and colleagues.  It is free to subscribe and covers many of the latest subjects being discussed by AAC experts in USA and abroad.  
    • Plug and Pray - A disability perspective on artificial intelligence, automated decision-making and emerging technologies. (Download PDF)
    • Tecla news and links to the way users gain innovative hands free access to devices

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Further Access and Emerging Technologies URL

    Mark as done
  Topic
  6
• Progression Planning

  
  

  • 
    

    The idea of progression for children who use AAC is not an easy one as children develop at such different rates. 

    Here we explore ideas related to:

    • Ensuring the AAC solution is ready for the child to develop their language beyond the here and now
    • Monitoring progress as a child improves through language activities
    • Using  logs to keep a record of improvements, or otherwise to help support the child to become a competent AAC user

  • Mark as done

    Preventing Missed or Mixed Messages

    Some children can get ‘stuck’ with a communication aid which limits their ability to explore and use new words or they are limited only to making requests through nouns. 

    Other children are left with an inability to develop their language further by not being given the vocabulary that allows them to progress.   Messages fail to happen in a way that they expect and the communication cycle breaks down.  Adler and Towne (1978) (whose adapted communication cycle we have used) said;  "If everyone were to have the same experiences, all messages would be encoded, transmitted, and decoded alike. Symbols would have the same meanings for everyone, and all communication would be received as the senders intended."

    
    

    
    

    
    

    This idea is especially important when remembering that the average communication aid user communicates at 12-50 words per minute compared to 140-206 words per minute for the typical adult speaker (Walker, 1988).

    We need to plan to encourage the best communication skills possible, using multiple means with a large vocabulary, increasingly more core words, modelling and considering Janice Light’s four competencies as well as creating an AAC-friendly home environment and classroom.  But...

    

    • Who do you think is responsible for creating this positive AAC environment? 
    • How would you go about making sure this is a collaborative process?  
    • Which is the most influential document that plots the progression of a child over time?  
    • What strategies can you develop to ensure what is written down is implemented?

    Once at school age in many countries it is the Individual Education Plan (IEP) or something similar that details the goals and objectives.  Add some ideas of how these questions could be answered in your situation using your reflective journal. 
    

  • Mark as done

    Individual Education Plan (IEP)

    "An Individual Education Plan (IEP) – sometimes known as an Individual Learning Plan (ILP) - is a tool to help plan, teach, monitor and evaluate a particular student's progress."

    One way to ensure that everybody is on the same page is to document important considerations for AAC progression as a series of statements.  These need to be developed collaboratively with the involvement of the family and professionals from the school and regularly reviewed. That way if there is any doubt about how the communication solution should be supported, this document can be referred to. 

    The IEP should contain AAC training opportunities for the staff as well as for the child. 

    It is also important to remember that you do not need to mention specific communication devices, applications or other products, but write about the strategies used by the child e.g. using a coreboard, choice board, and fringe vocabulary rather than the use of Boardmaker, Lessonpix, etc. as products tend to change over the years. 

    You can also use the SETT Scaffold for Implementation (discussed in Level 2) as a way of supporting a plan. 
    

  • Goals, Objectives and Targets

    Goals tend to be long term aims; objectives are relatively short term milestones to be accomplished, while targets generally refer to achievements that can be counted or classified e.g. number of gestures or words, requests or other successful interactions.

    IEPs provide a good opportunity to set small targets to work towards as well and longer term goals. 

    Goals

    Specify your goals and how you are going to measure them

    Small Objectives

    Schools are busy so start with small objectives, saying ‘hello’ in the morning is part of a wider social goal

    Progression

    Go beyond ‘requesting’ when stating goals – include commenting, asking questions, sharing stories etc.

    Non-Linguistic Goals

    Consider non-linguistic goals – remember Janice Light’s four areas of competency

    Finding goals and planning progress is difficult for those unfamiliar with AAC. Fortunately there are a range of free resources to help teachers, families and speech & language therapists to make sure they are supporting their children in the best way possible.  They have all been mentioned in Level 1 and 2 in various topics.  As a reminder:
    

    • Communication Matrix
    • Pathways
    • Project Core
    • AssistiveWare
    • AAC Language Lab

    The Communication Matrix is a free website that can be used both as an assessment tool and to monitor improvements in communication skills.  There are now certain restrictions related to the cost of assessments but trial sessions are still available. 

    Tobii Dynavox’s Pathways provides a free set of lesson plans, activities, banks of pre-written goals which can be ticked off, and videos. Pathways Divides competency achievement into Janice Light’s four areas which makes it really easy to ensure you are not missing anything out. Although it was designed to accompany Snap & Core First, these resources can be applied for all symbol communication aids and provide a clear and easy way to measure and orientate progression.

    Project Core is a free resource to skill up teachers and other people who support emergent communicators such as young children. It is seen primarily as a professional development package for therapists, teachers and other professionals but the resources can be used to support implementation of AAC in the classroom with a wide range of individuals.

    The makers of Proloquo2go and Proloquo4text also provide a well-researched and easy-to-read articles on their website. They cover everything from the basics of ‘presuming competence’ and ‘modeling,’ they also provide a lot of useful to help you with:

    • Engaging when interacting
    • Developing language
    • Teaching grammar
    • Preparing for literacy

    AssistiveWare also offer a range of free worksheets and other resources to help support the learning of core words in the classroom.  The three founding principles of the Core Word Classroom are: 

    • Use core words
    • Use Modeling / Aided Language Stimulation
    • Communicate everywhere!

     AAC Language Lab provides lesson plans, activities and resources to help keep children’s AAC language development on track. There are some free resources but if you want to make the most of the content you will need to pay a subscription.

    
    

  • Mark as done

    Logging Progress

    Making a daily note on how the child is developing their communication aid skills is very important to ensure that the right communication aid is in place, and it is being used in a way that will help them progress. It’s very useful for reviews and also to send information home to parents. 

    Many people will keep a written log of what happened in the classroom. For most users it is best for a teaching assistant or teacher to record the progress made. It is difficult for the Speech and Language Therapist to do this as they are rarely in the classroom with the child. Some AAC devices, such as CoughDrop can log actions automatically. This is a  time-saver and the data can be easily visualised. A written log will also need to be kept of the activities used and the response of the child. (See below CoughDrop log example)

    
    

    There are some ethical dilemnas when logging as the child has a right to privacy. 

    You need to consider what is being recorded and how this information is stored and used. It is important to get the consent from the child if possible, or at least from their parents. This will need to be compliant with local policies and laws, such as the European General Data Protection Regulation (GDPR). 
    

    
    

  • Mark as done

    Summary 

    • Make sure you document requirements for AAC in the IEP or equivalent so that the school or other organisation has a commitment to make improvements
    • There are many free resources that will help you ensure that the AAC user you are working with will make improvements and reach communicative competence!
    • Logging progress can help understand what is happening now and plan for the future, very useful for discussions with parents and during review meetings

    
    

  • Mark as done

    Further Reading 

    • “Natural Language and AAC” Gail Van Tatenhove (2016) discusses "How should a normal language acquisition (NLA) model be used when working with children who use AAC systems? " (Download Word .doc)
    • Role of the IEP Team when integrating AAC into the classroom. from American Speech-Language-Hearing Association (ASHA)
    • Collaborative Teaming for students who require AT/AAC : Working effectively to meet the needs of students who require AAC/AT in the educational setting Marilyn J. Buzolich, Ph.D.,CCC-SLP
    • Hunt, P., Soto, G., Maier, J., Müller, E. and Goetz, L., 2002. Collaborative teaming to support students with augmentative and alternative communication needs in general education classrooms. Augmentative and alternative communication, 18(1), pp.20-35.
      
    • Team Communication: AAC Communication Log (Example Download PDF)

  • Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Presentation slides

  • 

    URL

    Planning for Progression URL
  Topic
  7
• Producing a Report

   
  

  • 
    

    This topic continues to look at documenting the assessment process and preparing to get the AAC strategies into the classroom. 

    • How SETT helps you with your documentation
    • Things to consider when writing your AAC assessment report
    • Implementation issues to consider – how will this work in practice?

  • Mark as done

    Report Writing

    Lots of professionals begrudge the report writing stage, but it provides a great opportunity for individuals and the team to reflect on what happened with any aspect of an AAC journey and to illustrate clearly the reasons why they selected the AAC solutions recommended. 

    Fortunately all the notes taken using the SETT scaffold documents come into use when writing the report as information can be easily copied and pasted and there’s no need to rely on your memory.  These were all mentioned in Level 2 under the topics of Different Types of Assessment, The Sett Framework and the Environement and Sett Tasks and Tools.
    

  • Mark as done

    Activity _ Finishing SETT

    Final Activity using SETT

    • Print out the SETT Scaffold for Implementation from the tasks and activities area.
    • Thinking of Stefan, work your way through and answer the questions as best you can.

    • Acceptance – How is the solution going to be embraced and integrated into family and school life? 
    • Modelling – Who will support this strategy for language development and ‘normalizing’ the device?
    • Technical Support – What support is there for charging, logistics, repairs and maintenance?
    • Differentiation in the classroom –  Who can ensure extra time is allowed for reponses to questions?
    • Motivation – how is the solution going to be motivating for the child so they want to go to the additional effort of using it?

    • Use the previous two SETT forms from Level 2 to help you with the answers, and go back to the document that describes Stefan.
    • After you have tried to fill in the forms, check the example provided in the tasks and activities section. 

    
    

  • Mark as done

    Language Used

    It is important to consider your language when writing a report. Often reports will be read by families, teachers and other people who may not know the complicated language associated with AAC and the medical world. It is important to use words that everybody understands.  There is an 'Easy-to-Read' guide available in many languages. 
    

    There are lots of ways of laying out a report, but one popular approach is to use SOAP. This stands for:     
    

    • Subjective
    • Objective
    • Analysis
    • Plan

    • What was said by the child and those around them?
    • What do they think of the solutions tried?
    • Do they have any concerns?

    • What did you observe when you saw the child?
    • Were they able to easily access the solutions tried?

    • What is your understanding of the issues involved?

    • What are you going to do next?
    • Who is going to fund the solution?
    • What training is required and who will provide it?

    By writing in order from the top-down, you will create a trail of thought that helps you to gather your thoughts for the Assessment and Plan sections. It is not unusual to come up with new ideas and solutions while writing these notes.  SOAP reports are also easily read and can be combined if multiple people were involved in the assessment. 
    

    

    Try writing a brief SOAP report for Stefan using the above headings. You’ll have to really use your imagination as to what happened in the session, and what was said. Keep a copy in your reflective journal. 

    
    

  • Mark as done

    Summary 

    • By using the SETT framework throughout, it is easier to write the documentation.
    • The report should consider the needs and level of understanding of the audience.
    • The report should justify the recommendations and provide tips to make sure that the solution is used to best benefit the child.
    • The report should also include a plan was to what is going to be done immediately, and how the solution should be implemented.

    
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  •  Tasks and activities

  • 

    File

    SETT Scaffold Implementation Template File
  • 

    Page

    Example - SETT Implementation Scaffold for Stefan Page
  • Mark as done

    Presentation slides

  • 

    URL

    Producing a report for individual support and Key issues for implementation URL
  Topic
  8
• Evaluating success

  • 
    

    In this topic we will learn about:-        
    

    • Evaluating the impact of our AAC intervention
    • Options for measuring success
    • Using PIADS to measure impact
    • How to use PIADS forms and scoring sheets

    
    

  • Mark as done

    What are we evaluating when we think about AAC?

    

    You have already learnt about some of the criteria and prerequisites for success in seeking to implement different forms of AAC. For instance, we discussed the various ways in which people communicate the different functions of communication.

    These might include
    

    • Gestures?
    • Eye-contact?
    • Requesting?

    

    Can you recall others?

    Many factors impact upon successful implementation. It is crucial to understand how successful implementation has been.

     

    Moving beyond basic communication

    We need to measure the impact of providing access to AAC from a range of perspectives. Not merely by just measuring the length of utterances or symbol use, but by exploring the way an intervention affects confidence, capability and ability to progress.

    One of the most useful tools for this is “PIADS.”

    PIADS stands for the Psychosocial Impact of Assistive Devices Scales and was developed by Jeffrey Jutai from Canada. Full details of PIADS can be found at www.piads.at

  • Mark as done

    What is PIADS?

    PIADS is a 26-item, self-report questionnaire designed to assess the effects of an assistive device on functional independence, well-being, and quality of life. It was researched and developed to fill the need for a reliable, valid, and economical measure that is applicable across all major categories of assistive technology, including communication and AAC. 

    Although designed to allow people with a disability to self-report on their experience and any impact, it has been successfully used with young children where parents, teachers and therapists complete the questionnaire on behalf of any child who is using an AAC system or device.

    Research has established that PIADS has good internal consistency, reliability, and construct validity and is a responsive measure that is sensitive to variables such as the user’s condition, device stigma, and the functional features of the device or system. Such research has proven that PIADS accurately reflects the experiences of people who use assistive devices and has good validity for predicting device use and abandonment and can be used reliably by carers. Importantly PIADS has been shown to produce valid results when translated into languages other than English.

    The Questionnaire

    The questionnaire has 26 dimensions. The child, parent or other person scores each dimension on a scale of -3 to +3. So on the happiness dimension, the respondent would answer according to whether having an AAC device has made the child happier or less happy
    

    The 26 Dimensions

    Competence	Skillfulness
    Happiness	Well-being
    Independence	Capability
    Adequacy	Quality of life
    Confusion	Performance
    Efficiency	Sense of power
    Self-esteem	Sense of control
    Productivity	Embarrassment
    Security	Willingness to take chances
    Frustration	Ability to participate
    Usefulness	Eagerness to try new things
    Self-confidence	Ability to adapt to the activities of daily living
    Expertise	Ability to take advantage of opportunities

     

    Many of these could provide the basis of aims and objectives of AAC intervention. To reduce frustration, to increase self-esteem, to participate more fully etc.

    The Scoring Sheet

    After the questionnaire is completed the reviewer enters the scores into each row of the scoring sheet. As this is done the subscale scores for competence, adaptability and self-esteem are calculated. The subscales are good indicators of success and the foundations of future learning 

    The higher the scores, the greater the impact of the intervention 

    
    

    Interpreting the results

    Completing the VOCA or speech generating device background form may be useful in gathering information on the context which we can use to interpret results. 

    However, the VOCA form may need to be updated before use as it does not yet reflect the increased use of tablets and mainstream technologies. Individual forms provide essential information about how successful intervention has been for a child. 

    Equally, collating data from a cohort of children will allow us to ask questions about successful approaches, technologies, and the importance of context.  
  • Mark as done

    Activity - Create your own example 

    

    Worked Example

    Think about a child you have worked with for more than six months

    Download the forms from www.piads.at

    Fill out the questionnaire for the child

    Now transfer the information to the scoring sheet

    Find a colleague who has completed the same exercise and discuss the results

    • What differences do you find? 
    • Why do you think there might be differences?
    • What might you do next time as a result?   Make notes in your reflective journal

    Other measures

    We have focussed on PIADS as a starting point for measuring the impact of an intervention because it has been validated in many languages and has a scoring system that can be used by professionals in AAC and those who are not experts. 

    There are other tools and scales that can be useful. You can find out more about these in the further reading section.  

    
    

  • Mark as done

    Summary 

    • PIADS is an ideal way of understanding the impact of an AAC intervention on the quality of life of a child.
    • By comparing results offered by different children we can have an open discussion on when AAC is working well and when it is not.
    • When comparing the results of different children, we can try to understand differences in approach or other factors that impact upon success.
    • When comparing results across devices, we can think about which solutions have the most significant impact and value.

    
    

  • Further Reading 

  • 

    URL

    Therapy Outcome measures for AAC URL

    Mark as done

    Therapy Outcome Measures (TOMS AAC) is an outcome measure used by professionals to measure the impact of their interventions. Based on the World Health Organisation’s International Classifi cation of Functioning, Disability and Health (WHO ICF, 2001), a professional administers TOM before and after an individual’s intervention.
    

  • 

    URL

    RCSLT Guidance on Outcome Measures URL

    Mark as done

    If you are a Speech & Language Therapist, please sign up or log in to access the full version of this content.

    The delivery and measurement of the outcomes associated with speech and language therapy is an essential component of delivering effective and high-quality services.

    Here you will find resources about outcome measurement, including information about the role of outcome measurement in speech and language therapy and the RCSLT Outcomes Programme.

  • 

    URL

    Goal Attainment Scaling URL

    Mark as done

    GAS offers a number of potential advantages as an outcome measure for rehabilitation. As goal-setting is already a part of routine clinical practice in many centres
    

  • 

    URL

    Goal Attainment Scales URL

    Mark as done

    Goal Attainment Scaling (GAS) is an option that can be used as a means of measuring outcome data from different contexts set out on a 5 point scale of -2 to +2. It enables the data to be placed on a quantitative measurement scale thus tackling the problem of how to adequately identify and measure qualitative goal impact and attainment. This is very useful as it enables a linking of measures from the frontline to upper levels of an organization’s management.
    

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Evaluating Success URL

    Mark as done
  Topic
  9
• Action Planning

  •  

    This final topic covers

    • How to prepare an action plan to use AAC more effectively in your daily work and in your work with colleagues
    • Support to prepare a SWOT analysis of your current status
    • An action plan format for your own development or that of your team

  • Mark as done

    Why Action Planning?

    
    Action plans are a good way to turn your training experience into measurable results. Action plans have been defined as written documents completed by learners that describe how they expect to implement any learned skills or knowledge.

    Start by writing down anything that to feel you could do to implement what you have learned from the course. 

    Keep this list as a reference. You can refer to it later to see if your action plan has addressed the issues that you thought of at this early stage. 

    Starting Simply

    Now you have finished the course, look back over the content of the topics and your reflective journals, you can use your list as an additional reference. 

    Refine your list in the light of further reflection and update your list as a reminder. As we develop the action plan always return to one simple question: “What do I want to do as a result of this new information and insights?”  Make some notes in your last reflective journal

  • Mark as done

    Activity

    This is a good stage to undertake a SWOT analysis of your work in AAC. You can do this by thinking about yourself, or thinking about the service you work within.
    

    Think about what you have learned on the course and whether that changes your thoughts of the strengths and weaknesses
    

    Make a simple grid and fill it in being very honest about your thoughts before moving on to an Action Plan.

  • Mark as done

    Action Plans

    Action Plans can range from a simple list – ‘3 things I will do differently’ – to more complex plans with detailed steps, timescales and resources needed. When using action plans, there are a few issues to consider:

    • Your action plan should have specific, measurable, achievable goals with timescales (SMART) – success cannot be measured from using vague or open-ended plans
    • Share your plan with the group – public commitment encourages us to follow through on our plans
    • Find a planning partner to work with, someone who can help you make decisions
    • As you try to implement your action plan, you can check together what progress has been made, or discuss it on the course forum, email each other and share ideas and challenges.

    We are going to start with a simple list which can then be elaborated into a more formal plan for yourself.

    Action Plan Format

    Using your SWOT analysis, and your refined list we will now ask you to start to create objectives and actions for yourself.

    Step 1

    Define what you plan to do in the next week, next four weeks and over the next three months. Be realistic about what you can achieve in the light of opportunities and threats. Try to identify areas of strength to build upon and weaknesses to address.

    Step 2

    Describe how you will know you have achieved what you set out to do, what evidence will there be that you have been successful in implementing the changes you wanted.

    Step 3

    Set a date when you will review your progress, put it into your diary for about 3 months from today. Think about who you might share your progress with to get another opinion.

    Step 4

    Complete the progress review and think about what has worked well and what has not, ask yourself why this was. Again, there will be some external factors that may be beyond your control, but there will also be personal factors that you might want to consider carefully  

    Step 5

    Prepare a new action plan, building upon what you have achieved so far and addressing anything that has been challenging. Action planning is cyclical and is the basis of continuous improvement.  

    Download the action plan template
    

    
    

  • Mark as done

    Summary 

    "Have a bias towards action – let’s see something happen now. You can break that big plan into small steps and take the first step right away.” – Indira Gandhi
    

  • Mark as done

    Further Reading 

  • 

    URL

    IPAACKS URL

    Mark as done

    Informing and Profiling Augmentative and Alternative Communication (AAC) Knowledge and Skills Supporting the learning and development of people working with individuals who use AAC
    

  • 

    URL

    Simple Planning URL

    Mark as done

    Completed simple plan for AAC training implementation 

  • 

    URL

    Putting Knowledge Into Practice URL

    Mark as done

    Some crucial tips on how to ensure that your training impacts on your practice

  • Mark as done

    Reflective Journal 

  • 

    Journal

    Reflective Journal

    Mark as done
  • 

    Journal

    Journal Review

    Mark as done
  • Mark as done

    Presentation slides

  • 

    URL

    Action Planning URL

    Mark as done
  Topic
  10
• Review your learning

  This is a final few questions to refresh your memory about all you have learnt in Level 3. 

  • Mark as done
  Topic
  11