Section 10

Question 1

What are the different types of AAC?

Answer 1

Unaided: no external material required, typically involve sound, movement, or change in position to convey meaning, depends on recall memory and visuospatial processing Ex. ASL, gestures, facial expression
Aided: require external aids or equipment, low tech or high tech, require recognition memory to operate

Question 2

What are the different categories of AAC components?

Answer 2

Communicative concepts: inclusion and representation of concepts needed to construct messages
Organization strategies: arrangement and presentation of communicative concepts for message construction
Selection technique: method of physical construction of message
Output methods: information of the process and outcome of message contruction

Question 3

What aspects of communicative concepts can be customized?

Answer 3

Vocabulary: must support expression of wants and needs, exchange of information, development of social closeness, and fulfillment of social etiquette routines. Make sure to consider current and future development for children.
Representation of vocabulary: symbols (spoken, graphic, or manual) can be 2D or 3D. Impacted by configuration, iconicity, and individual’s ICF
Acceleration strategies: message prediction (fixed or dynamic), encoding strategies (alpha, alphanumeric, numeric, arbitrary code, or iconic)

Question 4

What are the different types of AAC display?

Answer 4

Fixed: symbols and layout don’t change but there can be multiple levels
Dynamic: layout is dynamic and can have an infinite number of concepts

Question 5

How can concepts be grouped?

Answer 5

Taxonomic: categories or words
Schematic: events and experiences
Semantic/grammatical: by semantic/syntactic role
Alphabetical
Importance/frequency of use

Question 6

What are the different symbol presentations?

Answer 6

Traditional grid

Visual scene: no distinct boundaries

Question 7

What are different methods of selection for AAC?

Answer 7

Direct: directly pointing with a body part (effector) including eyes or some adaptive tool. The activation strategy is either timed, release, or averaged.
Indirect: indicate target from selection set as an indicator scans each choice.

Question 8

What needs to be selected in the case of an indirect selection method?

Answer 8

Response signal by effector: vocalizations, consistent body movements, activation from an input device
Select input device (switch, joystick): mind cognitive and physical demands
Select scanning mode: automatic (stops when interrupted), inverse (starts with signal, ends with stopping), step (1 moves scan one step and second selects)
Select scanning pattern: single symbol (linear, circular, directed) or grouped (row-column, group-item)

Question 9

What are difference types of feedback?

Answer 9

Activation: indicates target was selected ex. partner reads out, points, tone from device, see selection on the message bar
Message: information about the message ex. partner repeats message, points to message, system reads out, see message on display

Question 10

Name some ways to optimize communication via communicative concepts in AAC.

Answer 10

Provide both core and fringe vocab
Promote language and literacy development
Use the hierarchy to symbols and a developmental pattern of learning
Iconicity
Choose symbols that reflect their conceptualization

Question 11

Name some ways to optimize communication via organization in AAC.

Answer 11

Visual scenes for kids with developmental delays, several language difficulties, or between 2-3 years

Question 12

Name some ways to optimize communication via selection in AAC.

Answer 12

Positioning impacts selection accuracy and speech
Scanning is harder for younger children
Linear scanning is between for preschool age with smaller arrays
Typically developing 2 year olds did better with modified scanning

Question 13

Name some ways to optimize communication via output in AAC.

Answer 13

Digitized is more intelligible for kids
Those with intellectual disabilities have a hard time with synthesized speech
Noise affects intelligibility
Practice and exposure improve intelligibility
Context impacts intelligibility: words < sentences < discourse

Question 14

Describe the characteristics of a motor speech disorder and the applicability of AAC.

Answer 14

Difficulty with coordination of oral structures leading to difficulty with articulation
AAC can be used to help children express their needs and communicate with others
Can use either low-tech or high-tech devices based on skills of the child and their needs

Question 15

Describe the applicability of AAC to neurodevelopment disorders.

Answer 15

Can use either low-tech or high-tech devices based on cognitive skills of the child and their level of mobility/motor
control
AAC can be used to help children express their needs and communicate with others
Difficulty with a variety of skills that would require AAC intervention i.e. language development, motor control, speech intelligibility, etc.

Question 16

Describe the applicability of AAC to DLD.

Answer 16

Children have failure to acquire language on their own for no obvious reason
AAC can be useful for developing language skills of children with DLDs as well as supporting their emotion
regulation
One method is to use voice output communication aids
(VOCAs) to help develop language and emotion regulation of children diagnosed with DLD

Question 17

Describe the applicability of AAC to CAS/DAS.

Answer 17

For most children, AAC is a bridge to speech, a temporary means to increase communication abilities and decrease frustration while working to improve speech
Can use either low-tech or high-tech devices based on skills of the child and their needs
Some children with severe CAS may use AAC as their primary mode of communication for long-term

Question 18

Describe the applicability of AAC to TBI.

Answer 18

Motor speech and/or language disorders that require AAC support
Some individuals may require AAC for short-term (have natural recovery of oral speech), others require AAC for long-term

Question 19

Describe the applicability of AAC to neurodegenerative conditions.

Answer 19

Require rapid changes to access methods (gross and fine motor capabilities are declining)
People with ALS are predicted to need AAC within 6 months
Motor initiation may be a problem
Vision and visual acuity may change
Beginning of day vs. End of day skills will be different

Question 20

Describe the applicability of AAC to brainstem stroke.

Answer 20

Cognitively may be intact but unable to demonstrate
capability
Eye movement issues
Quadriplegia

Question 21

Describe the applicability of AAC to spinal cord injury.

Answer 21

Language and speech often left intact
AAC use is mostly requested for help accessing social media, email, netflix, etc.
Can use voice commands (with AAC to access apps on
their phone) for written communication

Question 22

How does the developmental of grammar and vocabulary impact AAC use?

Answer 22

Ability to interpret and generate messages

Question 23

What is the social impact of AAC?

Answer 23

Feelings of isolation because the AAC makes them stand out
Having difficulty making and maintaining friendships → because of difference in
mode of communication
Uncomfortable/awkward in social situations and gatherings
Take on the respondent role in social situations rather than initiator
Dependence on parents, caregivers, and siblings for successful communication
may restrict participation in a variety of activities
Limited participation in certain environments
Limited opportunities to engage with peers socially
Can help increase functional communication to develop social closeness and fulfill social etiquette expectations
Increased independence

Question 24

How does AAC impact pragmatics?

Answer 24

Difficulty producing vocal intonation or depicting emotion in AAC output
Difficulty understanding/ delivering humor
Increased communication time because people have to wait for you to finish creating your thought
Reduced initiation of interactions
Reliant on competent communication partners
Can have a positive impact on social uses of communication such as turn taking

Question 25

How does AAC impact education?

Answer 25

Can act as a barrier and limit classroom participation Schoolwork may take longer to complete Requires constant advocacy for access to AAC in all aspects of education Increased access to educational opportunities Increased opportunity to communicate for a variety of purposes such as requesting attention/help/ tangibles, using devices during social routines, greeting others, commenting on an object or action, etc. Development of literacy skills Increased independence in classroom and when completing work at school Help with note taking, and also participate in classroom/group discussion

Question 26

How might AAC impact vocation?

Answer 26

Limited participation in meetings/group discussion as you cannot have preprogrammed responses and cannot get response out as fast as verbally Perceptions of co-workers → assuming reduced intelligence/capability because of dependence on AAC Requiring increased time frame to complete tasks Access barriers May be limited to work for equal opportunity employers only Increased independence both while doing work and while communicating Increase in functional communication Being able to work may help increase motivation for therapy and have a positive impact on quality of life

Question 27

How can cognition impact AAC use?

Answer 27

Difficulty attending to AAC device Difficulty with memory (short/long term, recall/ recognition) Impaired executive functioning (adaptable thinking, planning, self-monitoring, self-control, time management, organization)

Question 28

How can linguistics impact AAC use?

Answer 28

Decreased language and literacy skills (includes capacity for development) Limited vocabulary, impaired syntax or pragmatic skills Impaired ability to write/type own messages or read messages from communication partner

Question 29

How can sensory difficulties impact AAC use?

Answer 29

Difficulty interpreting tactile sensation (touch, pressure)

Question 30

How can motor difficulties impact AAC use?

Answer 30

Decreased range of motion (joint movement) Difficulty with gross motor control (core strength, head stability) Difficulty with fine motor control (hand movements to manipulate AAC) Impaired motor coordination (precision, efficiency, coupling of movement) Decreased motor strength Decreased endurance (tolerance for duration/ intensity of movement)

Question 31

How can vision and hearing impact AAC device

Answer 31

Difficulty seeing or hearing output | Difficulty focusing eye gaze on AAC device

Question 32

What are some components of an AAC assessment?

Answer 32

Background information Knowledge of typical language development Current and prior communication methods and needs Langauge and cognition levels Vision Motor skills

Question 33

What are some important client-specific factors to consider prior to starting AAC?

Answer 33

``` Client's behaviour Client's motivation Client's endurance Communication partners Environment Seating/positioning Mobility ```

Question 34

What are some advantages and disadvantages of unaided AAC systems?

Answer 34

Pros: always available, cost effective, consistent with non-AAC users, no breakdown, no set up, can be fast, Cons: may not be universally understood, limited or misinterpreted, transient, may only work face-to-face, needs to be familiar partners, may require a certain level of motor ability, require recall memory

Question 35

What are some advantages and disadvantages of low-tech aided AAC systems?

Answer 35

Pros: lower cost, may be less training, portability, can be used in places high tech cannot, easily replaceable, used recognition memory, may be used with limited motor skills Cons: wear and tear, hard to expand vocab, need to remember to carry around, limited messages, only works face-to-face, some concepts are hard to represent, can be slow, requires attention.

Question 36

What are some advantages and disadvantages of high-tech aided AAC systems?

Answer 36

Pros: more vocabulary, easier to adapt and modify, used for social media/email, easier to get listeners attention, communicate in groups, may be used with limited motor skills, voice output Cons: more training, tech issues, costly, not always portable, software/hardware compatibility, more difficult to recover from communication breakdowns.

Question 37

What service delivery models are used for AAC?

Answer 37

Ideally, the service delivery model would be a combination of models. This should including some one-to-one training for direct, explicit instruction with the device and consultation with communication partners in varying contexts (e.g., teachers at school, group home staff; family members and frequent communication partners) Since a combinations is not always possible, given varying models in different settings, below are some recommendations: ○ More direct one-to-one training will usually be needed when an AAC system or device is first introduced and being implemented ○ Over time, the amount of direct one-to-one training may not be as necessary and clinicians will often move to a more consultative role

Question 38

What is communication partner training?

Answer 38

Communication partner training is a vital part of AAC implementation and generalization of device use. The training needs to include: ● Aided language stimulation and modelling ● Basic device programming and maintenance ● Hands on practice!

Question 39

What are some strategies for communication partner training?

Answer 39

Kent-Walsh & McNaugton 8-stage model: - pretest and commitment to program - strategy description - demonstration - teach back (verbal practice of steps) - controlled practice and feedback - advanced practice and feedback - post-test and commitment to long-term strategy use - Generalization of targeted strategy use ``` Senner & Baud S'MoRRES pneumonic for stages 2-4 above: S: slow rate Mo: model R: respect and reflect R: repeat E: expand S: stop ```

Question 40

What is the AAC prompt hierarchy?

Answer 40

1. Expectant pause 2. Indirect nonverbal prompt 3. Indirect verbal prompt 4. Request a response 5. Gestural cue 6. Partial verbal prompt 7. Direct model 8. Physical assistant

Question 41

What is descriptive teaching?

Answer 41

Allows AAC users to practice using core vocabulary words while engaging with classroom content and curriculum Ask open ended questions