Chapter 7 - Assessment Flashcards
Principle 1: A primary purpose of AAC capability assessment is to: (2)
- identify strengths and abilities, not (just) weaknesses and impairments.
- Adaptations may be needed for testing – headpointing, nodding yes/no, etc.
Assessing Specific Capabilities/Functions
Principle 2: Address seating and positioning concerns before…
… finalizing motor access assessment.
A person must be seated with a stable base in order to effectively access their devices.
Assessing Specific Capabilities/Functions
Factors found in neuromotor impairments that affect positioning and seating:
4
(1) Muscle tone
(2) Presence of primitive reflexes (reflexes that are normal in infancy and should disappear in normal developing children)
(3) Skeletal deformities
(4) Movement disorders - they may not have enough control of arms to write or point and may need switches
Assessing Specific Capabilities/Functions
Factors found in neuromotor impairments that affect positioning and seating:
–> Muscle Tone
- too much tone causes difficulty making voluntary movements; too little tone and the person has trouble with posture, balance and strength
Assessing Specific Capabilities/Functions
Factors found in neuromotor impairments that affect positioning and seating:
–> Primitive reflexes (reflexes that are normal in infancy and should disappear in normal developing children):
(3)
a. rooting reflex
b. asymmetrical tonic neck reflex (ATNR)
c. symmetrical tonic neck reflex (STNR)
Primitive reflexes:
Rooting relex:
- the person turns when cheek is stroked to that side, should disappear around first few months
Primitive reflexes:
Asymmetrical tonic neck reflex (ATNR):
- affects how they use a switch, etc
- should disappear around 6 months
- when head is turned to the side- child extends arm and leg on same side and flexes arm and leg on opposite side
- can become stuck in this position
- don’t use systems where they have to rotate the head to scan because once head is turned, can’t use the arm on that side to direct select.
Primitive reflexes:
Symmetrical tonic neck reflex (STNR):
- when neck is flexed it causes flexion of arms at elbows and extension of hips.
- When neck extends backwards, the opposite occurs.
- To avoid triggering this, don’t use displays that are horizontally placed so the person has to look down, use vertical ones
Assessing Specific Capabilities/Functions
Factors found in neuromotor impairments that affect positioning and seating:
–> Skeletal deformities
- curvature of the spine
e. g. affects upright posture
Assessing Specific Capabilities/Functions
Factors found in neuromotor impairments that affect positioning and seating:
–> Movement disorders
- they may not have enough control of arms to write or point and may need switches
Most people use AAC devices in wheelchairs or while seated.
If not properly seated it may affect:
a person’s level of:
- fatigue
- comfort
- emotional state
- and ability to attend to a task
***If the person to be assessed doesn’t have optimal positioning at the time of assessment, temporarily place them in the best position using pillows, etc.
Assessment of Motor Abilities
Principle 3: The goal of motor assessment in AAC is to…
…discover motor capabilities, not to describe motor problems.
The first step is to assess what motor skills are available to use in the assessment itself.
Try direct selection first because scanning is harder to learn.
Assessment of Motor Abilities:
Determining a reliable yes/no –>
Determine if there is a reliable yes/no system. Ask age appropriate and clear cut questions, etc. “Are you a boy? Is this a book?”
See how they respond - head nod, eye blink, vocalization, etc. If you decide that you are going to use a yes/no format for the rest of the assessment, be sure that it is unambiguous.
If you don’t get reliable yes/no, (and also if you do) try pointing with finger/hand. Put out food or toys and say “point to —”.
Assessment of Motor Abilities:
After Determining a reliable yes/no
….Next step - decide on what you’ll use for long-term use:
Again - if direct selection works, use it, if not scanning.
May use direct selection on some days and scanning when fatigued.
Assessment of Motor Abilities:
For direct selection, must find a good site–>
Start with hand and arm – check control.
If not good control try head and orofacial
If not good control - go to foot and leg. It’s hard to find people with good control of leg and feet.
Hand is usually best - better control and most normal looking.
Assessment of Motor Abilities:
Look at how you can optimize this motor control.
Determine what size target is the person the most accurate, what support they need - trunk or head support
– to make them reach their target quickly. If the person can’t do it well, remember that they will get better with practice.
Assessment of Motor Abilities:
Assess negative impact
- does this cause the abnormal reflexes or make them too tired.
Look at the overall impact on the person.
Manual Signing
- If you plan to use signing, must assess the fine motor abilities to do so
Scanning
- if direct selection doesn’t work - assess what site to use for scanning.
Hands/arm first, if that’s OK, you don’t need to go further.
If it doesn’t work, go to head control, then feet/legs/knees. Training will improve performance.
If an option appears only marginally usable - reassess it after a few weeks or practice
Switch Assessment for Scanning
- use a simple task, such as turning on a radio, musical toy or moving toy with switch attached
Six components of switch control success:
- Must be able to wait for the right moment
- Must be able to activate the switch - look for accuracy, ease, time it takes for a variety of switches
- Must hold the switch in activated position for required time
- Must release the switch accurately and efficiently
- Wait again
- Re-Activate at appropriate times
Assess Cognitive/Linguistic Capabilities
Principle 4. Assessment of cognitive and linguistic capabilities should…
… enhance the process of matching an AAC user to an appropriate AAC technique or device.
Thus the goals of such assessment are inclusionary, not exclusionary
Assess Cognitive/Linguistic Capabilities
Cognitive assessment
- using AAC devices requires a certain amount of cognition, the degree depends on the type of device. You have to understand cause and effect.
Assess Cognitive/Linguistic Capabilities
Cognitive assessment
Need to consider these skills:
(7)
- alertness
- attention span
- vigilance (ability to visually or auditorily process information over time) d. understanding of cause and effect
- ability to express preferences
- ability to make choices
- understanding of object or pictorial permanence
- symbolic representation skills
Assess Cognitive/Linguistic Capabilities
Symbol Assessment
– A person must be able to relate to a symbol system of some kind. Most AAC systems rely on a symbol system. There are some people who can’t do this.
Assess Cognitive/Linguistic Capabilities
Symbol Assessment
There are several steps to symbol assessment (5):
1) Select what kind of symbols will work best.–> First determine several objects the person knows
2) Assess if he understands the function of the object
3) Assess receptive labeling
4) If the above doesn’t work well, see if they can match
5) If the person can’t do these things: show functional use, recognize verbal labels-and receptively match a symbol to the referent
Symbol Assessment
There are several steps to symbol assessment:
1) Select what kind of symbols will work best.–> First determine several objects the person knows
- Examples-things he uses in daily life - brush, cup, spoon, etc.
- If he/she doesn’t recognize or isn’t familiar with the objects, they won’t be familiar with symbols representing the object and you’ll judge them wrongly
- Get several symbols that represent the objects, PCS, etc.
Symbol Assessment
There are several steps to symbol assessment
2) Assess if he understands the function of the object
- say “show me what you do with this”.
- If the person is too motorically impaired, then you can mime it and say - is this what you do with this?
- Look for yes/no answer
- Does the person recognizes that the object has an actual use
Symbol Assessment
There are several steps to symbol assessment
3) Assess receptive labeling
- put two or more symbols up of an object
- Ask him to point to the “cup”
- it has to be one of the items that you know he knows
- If they can’t point but can do reliable yes/no- you can say – “Is this a cup?” and point to a picture.
- Do it randomly (don’t always have the right picture on the right side)
Symbol Assessment
There are several steps to symbol assessment
4) If the above doesn’t work well, see if they can match:
- Put out the object and show 2 pictures – (one of them being pictures of the object) and ask which one is the same as the object
Symbol Assessment
There are several steps to symbol assessment
5) If the person can’t do these things: show functional use, recognize verbal labels-and receptively match a symbol to the referent
- show functional use, recognize verbal labels-and receptively match a symbol to the referent
- then you’ll need to start with “beginning communicator” strategies,
- Bigmac and symbol schedule systems to teach associations between symbol and referent
Symbol Assessment
There are several steps to symbol assessment
If the person can do these things:
1) show functional use
2) recognize verbal labels
3) receptively match a symbol to the referent
Then…
Then go on to asses as to how they use the symbols to answer verbal questions.
Use either a question and answer format or requesting format.
Example of Q & A format:
What did you eat for dinner? Where did you go yesterday? Who came to see you yesterday?
These are not just receptive labeling which would be, “Show me the car”
Example of requesting format
What do you want to eat?
Symbol Assessment
There are several steps to symbol assessment
If they have difficulty with (below) they will….
1) show functional use
2) recognize verbal labels
3) receptively match a symbol to the referent
… need to be taught how to use symbols functionally.
Persons who can respond to the Q&A and requesting should then be…
… assessed for advanced symbol use.
Advanced symbol use
- If a client performs well with using single symbols to represent concepts, you need to determine if a client can use more than one symbol
i. e. combining 2 or more symbols to make messages. - Playing a GO Fish game is an example of how to assess this. Make available the opportunity to combine messages in this game and see if it happens
Assess symbol categorization and association assessments
- to determine person’s ability to use categories for encoding and rate enhancement
Can they sort symbols into categories - food, transportation, clothing, etc.
Some systems (Minspeak) requires the ability to make____
associations. Must be able remember what about an icon/symbol reminds them of the association
An apple is red and therefore represents the color red.
To assess ability to make associations:
use a few symbols the person already can name - car, apple, etc.
Then ask certain question to determine if they can associate, such as: what do you use to tell time (clock)
Language Assessment:
What to assess? (2)
a. Asses single word vocabulary
b. Language abilities
***Usually the person doesn’t have a formal communication system, so language sampling is not possible.
Language Assessment:
Tests that Asses single word vocabulary (3)
- PPVT
- ROWPVT
- Boehm Test of Basic Concepts
Language Assessment:
Test that Assess Language abilities:
– assess understanding of syntax – TACL or others.
Assess Sensory/Perceptual Capabilities:
Use the material or devices that are being considered for the person’s AAC system to assess vision, hearing and tactile abilities.
Visual assessment:
– determine how much space needed between symbols, what size symbols do they require, etc.
Visual assessment:
When a person’s visual status is evaluated, there are several components that are looked at:
1) visual acuity
2) visual field magnitude
3) occulomotor functioning
4) light and color sensitivity
5) and visual stability
Visual assessment:
Visual Acuity –> (6)
- Normal vision is 20/20.
- Numerator represents the distance away from the target
- Denominator represents size of the target you are trying to read.
- 20/200 is considered legally blind, 20/70-20/200 are partially sighted.
- When only the presence or absence of light can be detected, vision is termed light perception.
- When designing AAC material, keep in mind visual acuity. It affects the size of the type or symbols and how far away device should be from the user
A person’s visual field is
The field of sight - that area that is in your line of vision.
The area is an arced area that goes left to right and vertically.
Vision in the peripheral visual field =
The sides, is not as clear as in the central field
The peripheral field is mainly concerned with detecting movement and what you see in reduced light
The kind of visual impairments you might see with visual field problems are:
(4)
(1) decreased vision in the central or peripheral field,
(2) depressed visual sensitivity in specific areas
(3) blind spots,
(4) field losses as a result of TBI, stroke, etc, where whole segments of the visual field are missing
If you have a central field loss you have problems…
… seeing things right in front of you
People with peripheral field losses have trouble with…
…vision when they are moving
Vision:
Problems with decreased sensitivity causes a reduction in…
… visual acuity
When a person has blind spots, you have to work on:
adjusting head position, and placement of AAC materials
Ocular functioning/motility:
- how the eye muscles function so eyes move together smoothly
- It is what allows the eyes to fix on a target, to locate and scan for items, and following moving objects.
If a person has problems with ocular functioning/motility:
they might not be able to direct their gaze on an item
Strabismus:
- the eyes cross
Nystagmus:
- involuntary movements in the eye. Persons with this will have to experiment on where to locate an AAC device to aid in the fixation of gaze
Some people are overly sensitive to light.
What will they need?
Will need the amount of light reduced so they can see their AAC device
Some people may need more light available to see their AAC device.
Example of a disorder where this would be a problem?
People with degenerative myopia need more light to see.
Some people have problems with the perception of color
= color blindness.
The main color blindness is with confusion of red and green
This is important in determining what colors you use in coding the symbols
Determine if a person’s visual status is stable or if it changes over time:
- Some conditions fluctuate daily and this would be important information to know
- There are degenerative diseases and these need to be taken into consideration when selecting long-term devices
Hearing assessment:
3
1) Can they hear the auditory display for scanning
2) Can they understand the synthesized speech
3) Do they understand the feedback
Tactile assessment:
- some systems rely on tactile feedback
- is that effective for that individual?
