Spa Final Flashcards
Does unaided AAC include?
- Sign Language
- Facial Expressions
- Gestures
Yes
What is AAC?
An approach to facilitate communication/communication
intervention for individuals with little to no functional speech output
or those with complex communication needs.
AAC is any communication modality that is not speech output.
Regular AAC includes what?
Sign language
Use of pictures, symbols, and/or gestures
Speech-generating devices
Does the need for AAC increase with age?
Yes
Which of these options are developmental disorders?
- Cerebral Palsy “CP”
- Autism Spectrum Disorder “ASD”
- Apraxia of Speech
- Genetic Disorders
- Intellectual Disabilities
- Amyotrophic Lateral Sclerosis “ALS”
Answer: 1, 2, 3, 4, 5
What are the Acquired Disorders?
Amyotrophic Lateral Sclerosis
(ALS)
* Multiple Sclerosis (MS)
* Traumatic Brain Injury (TBI)
* Stroke (CVA)
* Acute illness
* Requiring intubation or
tracheostomy and/or
ventilator support
* Laryngectomy
* Glossectomy
Augmentative Communication
Use of a mode of communication, in addition to the current mode,
to improve the ability to convey a message.
Assistive Technology
Use of technology to complete tasks that would not be possible
due to disability.
* Wheelchairs
* Computer hardware and software
The choice of which AAC is utilized is based on an individual’s
needs, function/abilities, and the environment where
communication is taking place.
* Many people utilize both unaided and aided AAC
communication – this is considered to be multimodal
communication. True/False
True
Intelligibility
The degree by which speech (natural or that generated by a device) can be
understood by the communication partner(s).
Comprehensive communication
How well an AAC user’s communication is understood when it is combined with
the context.
* Linguistic context/topic of the conversation
* Physical environment
* Gestures
Efficiency with use of the AAC system
The time and rate that an individual can communicate with an AAC system and
the time required to interpret the message
Unaided AAC
Does not utilize a device
* “No-tech” – no technical support is required
* May include:
* Sign language
* Gestures
* Eye gaze
* Facial expressions
* Tone of voice
* Can enhance existing communication ability.
* Requires the physical/motor function to produce the required nonverbal
movements.
Aided AAC
Utilizes an external device for communication.
* These devices have two categories:
* Low-technology AAC
* High-technology AAC
* For both categories, the uses access the device directly or
indirectly.
Low-Tech AAC
Does not require a power source.
* Could be a primary means of communication or a supplemental/back-
up system.
* Communication boards or books
* With letters, words, pictures or symbol systems.
* Limitation: Utilized for requesting; does not easily allow for a variety
of communication functions.
High-Tech AAC
There is a wide selection of high-tech AAC devices from a variety of
companies.
* For high-tech AAC, the user accesses the computer/device to
generate speech output,
* A speech generating device (SGD)
* Speech output can be:
* Digitized – a human voice stored on a computer
* Voice banking
* Synthesized – computer generated
* Provide more interactive communication (not just requesting)
* Expensive
Design of the system can be:
* Dedicated
* Created exclusively for speech output
* Open
* A multifunctional device
* Provides speech output AND has the functions of a regular
computer
AAC Assessment
- What is the cause of the individual’s communication disorder?
* 2. How does the person communicate currently?
* 3. Is the person able to communicate effectively using natural
speech?
* If not, what is the best way for this individual to communicate?
* 4. What are the individual’s communication needs?
* 5. What kind of AAC would be the most appropriate to match the
individual’s cognitive, physical and linguistic strengths?
* 6. Can the AAC system be modified in the future to meet the
individual’s changing needs?
ASHA, 2018 – The outcome of an assessment is to recommend an
AAC system and design treatment that will assist the individual in
achieving the most effective interactive communication possible.
* Evaluation often occurs over the course of several sessions.
* Various unaided and aided approaches can be trialed.
True/False
True
How is an AAC Assessment Different?
Evaluation batteries may need to be adapted and extra support may be
required for completion.
* AAC assessments typically take a great deal of time to complete.
* AAC assessments are ongoing.
* A team of professionals may be involved.
* OT
* PT
* Optometry/Ophthalmology
* Tends to focus on communication competence, rather than specific
language areas/skills.
* Includes assessment of physical and sensory abilities
A successful assessment for AAC results in:
Matching the AAC approach to an individual’s:
* Wants
* Needs
* Capabilities
Treatment of AAC
Promoting success with the chosen AAC device/approach.
* Device/system training with:
* The client
* Family members
* Caregivers
* Treatment should take place in the natural environment to promote
generalization.
* Move to promote generalization AND to use the AAC system to target broader
communication goals (development of language, literacy and social
interaction).
Treatment Models AAC
- Participation Model
* 2. Communicative Competency Model
AAC Treatment: Participation Model
A functional intervention that is based on the person’s
participation requirements, particularly in relation to
her/his peers of the same age that do not require AAC.
AAC Treatment: Participation Model
The goal of treatment is for the user of AAC to
communicate as their peers do. Treatment stresses
communication opportunity and communication access,
both of which must be addressed for individuals to
participate fully in their lives.
An important feature of the Participation Model is the
creation of a participation inventory that identifies the
person’s communication patterns and needs.
AAC Treatment: Communicative
Competency Model
Defined as the state of being functionally adequate in
daily communication and of having sufficient
knowledge, judgment, and skills to communicate
effectively in daily life.
To achieve communicative competency in the use of
AAC, the individual needs to develop knowledge,
judgment and skills in four domains:
Operational
Strategic
Linguistic
Social
True/False
True
History of AAC – Where did it start and where is it going?
Use of AAC began in the 1950’s.
* Multidisciplinary assessment/intervention
* Communication boards
* In 1960, an early electronic AAC device was developed
* Activation of a typewriter with a sip-and-puff switch was utilized.
* Sip-and-puff switch development – based on use of a whistle in hospitals.
* In the 1970’s there was hesitation by professionals to utilize AAC with
individuals thought to have potential to develop verbalizations/speech.
* In the early 1970’s Shirley McNaughton began use of Blisssymbolics (the Bliss
symbol system)
* Goal was to develop a universal picture language system with a specific grammar to
order and combine symbols.
where is it going?
AAC advanced during the 1970’s & 1980’s.
* Gregg Vanderheiden (a student of another AAC leader, David Yoder),
credited with coining the term augmentative communication, further
developed the technology.
* Advances in the past 20 years have been amazing and are ongoing.
* Check out the website links provided in our Module
Cultural Considerations and AAC
The selection of unaided and aided forms of AAC, as well as the choice of
symbols, and manner of interaction needs to be considered from the
cultural perspective of the client.
Having a clear understanding of family members’ values, beliefs, child-
rearing practices, parent-child interaction styles, interpersonal styles,
attitudes and behaviors can help professionals remove barriers to culturally
sensitive practice.
Considerations for bilingual clients (assessment in both language) with
device set-up appropriate for language use.
Current Research in AAC
AAC use in the area of Autism Spectrum Disorder (ASD)
* Approximately 1/3rd of children with ASD who do not develop functional
speech and language could benefit from AAC.
* Some of these individuals were not considered for AAC use due to expressive
language.
* Evidence continues to grow that demonstrates that use of an AAC is beneficial
to augment communication skills.
Visual Display and Tracking
Use of AAC devices require visual skills.
* Our understanding and the technology for use with users with visual
issues continues to improve.
* Screen colors
* Eye gaze technology
The communication board makes it easy for patients and clients to make more than just requests. True/False
False
Use of an AAC device should only be used on patients with autism spectrum disorder as a last resort because it can negatively impact expressive language development. True/False
false
To use an AAC device the client must have some visual skill or function. True/False
True
AAC should be used in a clinical environment rather than the patients to avoid distraction. True/False
False
AAC means to intervene with a speech-generating device. True/False
False
AAC Assessment involves which of these options?
- frequently occurs over several sessions
- Can include trial varieties of aided and unaided communication approaches
- focuses on communication competence
- Often includes a multidisciplinary team
Answer: All options
What model is used to help AAC users communicate as their peers?
The participation model
What high-tech AAC allows for the functions of speech output, and the functions of a regular computer?
Open
An individual who uses an AAC device can select symbols directly and indirectly. True/False
True
Training for an AAC device should include everyone. True/False
True
A communication board is a what?
A low tech AAC
Hearing Anatomy
The anatomical components of hearing (audition) have two
components:
* 1. Peripheral Auditory System
* 2. Central Auditory System
The Peripheral Auditory System
Begins with the outer ear and ends at the auditory nerve
1 2
The Central Auditory System
From the auditory nerve all the way to where
the final processing of information occurs,
within the auditory cortex (Heschl’s gyrus in
the temporal lobe of the brain).
Outer Ear
The auricle (AKA: the pinna)
* Our visible “ear”
* Comprised of elastic cartilage
* Components:
* Helix – the outer rim
* Tragus – in front of the external canal
* Lobule – the ear lobe
* Functions:
* 1. Protects the middle ear
* 2. Assists in localizing sounds
* Minimizes front-back confusion
* Ear movements in animals
* Cupping of a hand behind the ear
The external auditory canal (meatus)
* 2.5 cm in length
* Extends from the auricle to the eardrum
* Outer 1/3s - made of elastic cartilage
* Inner 2/3s – carved into the temporal bone
* This canal is lined with skin and hair
* Also contains ceruminous glands
* Secrete cerumen – ear wax
* Prevents drying of the canal
* Deters intruders
* Function: Directs sound toward the eardrum
* The shape also increases the loudness of high-pitched/frequency sounds
Middle Ear
A small air-filled space
* Located within the temporal bone
* Structures:
* Tympanic membrane (ear drum)
* Three bones (tiny)
* Malleus (hammer)
* Incus (anvil)
* Stapes (stirrup)
* Two muscles
* Eustachian tube
Tympanic Membrane
* Amplifies
Ossicular Chain
* Amplifies
Eustachian Tube
* Equalises
The Tympanic Membrane “Middle Ear”
A tightly stretched membrane that spans across the ear
canal.
* The sound waves that reach the tympanic membrane set it
into vibration.
The Ossicles “Middle Ear”
Referred to as the ossicle chain
* The malleus is in contact with the tympanic membrane.
* Vibration of the tympanic membrane moves the malleus.
* Next, the incus moves.
* Lastly, the stapes moves.
* The stapes is in contact with the oval window of the cochlea (the
inner ear) – coming up next!
Muscles of the Middle Ear
In contact with the ossicle chain.
* 1. Tensor tympani
* Extends from the front wall of the middle ear and attaches to the malleus.
* 2. Stapedius
* Extends from the back wall of the middle ear and attaches to the stapes.
* Both muscles provide protection for the inner ear.
* These muscles stiffen the ossicular chain when a very loud noise occurs to
restrict movement; this dampens the transmission of sound.
* The contraction of these muscles in response to loud sounds is
involuntary.
* Called the “acoustic reflex”
The Eustachian Tube “Middle Ear”
Courses from the middle ear downward, toward the upper pharynx.
* Has an opening in the upper pharynx.
* Functions to drain the middle ear and to equalize middle ear pressure with
atmospheric pressure.
* At rest, the eustachian tube is closed; it opens with changes in pressure.
* “Ears popping”
* In younger children, the eustachian tube is short and is situated more
horizontally.
* This results in poor drainage of any middle ear fluid which results in a greater risk of
middle ear infections in young children.
* Middle ear infections – otitis media
Inner Ear
Housed within the temporal bone of the
skull.
* Fluid-filled space
* Made-up of two organs
* 1. Cochlea
* Hearing
* 2. Vestibular apparatus/system
* Made up of the semicircular
canals
* Balance
Cochlea “Inner Ear”
Has the appearance of a snail shell
* Cochlea is Greek for “snail shell”
* In humans, the cochlea has about 2.75 turns.
* The largest turn, near the stapes, the basal end.
* The smallest turn, the apical end
Comprised of three
compartments
* The organ of Corti – located
within the cochlea
* Has 4 rows of hair cells
* The hair cells span the entire length
of the cochlea (from the basal end to
the apical end)
* There are approximately 20,000 total
hair cells
* At the top of each hair cell, there is a
very tiny fiber from the auditory
nerve that is attached.
* Hair cells sense the sounds from
transferred from the middle ear and
they transmit the signal to the brain.
The organ of Corti
Organized by pitch/frequency
* Tonotopic organization
* Different areas of the cochlea
respond to different frequencies.
* The basal end of the cochlea
vibrates most with high
frequency tones.
* The apical end of the cochlea
vibrates most with low
frequency tones.
Central Auditory System
The electrical (neural) energy generated in the
cochlea is carried by the auditory nerve.
* The auditory nerve travels to the brainstem
(specifically the medulla of the brainstem)
* At the level of the brainstem, most of the nerve
fibers cross over to the other side of the
brainstem.
The nerve fibers course upward, through the
brainstem.
* Nerve fibers exit the brainstem and course to the
temporal lobe of the brain.
* The auditory cortex (Heschl’s gyrus)
Sound is processed within the auditory cortex (Heschl’s gyrus) within
the temporal lobe.
* Since the nerves cross over to the other side, within the brainstem,
sound entering the right ear will be processed on the left side of the
brain (the left hemisphere) and sound entering the left ear will be
processed on the right side of the brain (the right hemisphere).
Hearing – Energy Transformation
The human hearing mechanism transforms sound energy
* The vibration of molecules in the air (or another medium) is
called acoustic energy
* This energy is transformed several (three) more times within
the auditory system.
Summary of energy transfer within the ear
Vibration of air molecules / Acoustic energy is directed into the ear via
the pinna (auricle).
2. The acoustic vibration travels through the ear canal (auditory canal or
auditory meatus) and reaches the tympanic membrane which then
vibrates. This changes the acoustic energy into mechanical energy.
3. The mechanical energy reaches the oval window at the beginning of the
inner ear (the cochlea). This moves the fluid within the cochlea and
converts the mechanical energy into hydraulic energy.
4. The hydraulic energy moves the hair cells/nerve endings which converts
the energy to electrochemical (neural) energy. These neural impulses
are sent to the brain (via nerves).
Human Hearing
We hear sounds that range from 20 Hertz (Hz) to
20,000 Hz.
* The frequency range that we hear.
* Think about sounds that we cannot hear – a dog whistle
* It is above 20,000 Hz
Sound
Results from a disturbance of molecules (air particles) – typically caused
by vibration (think of a speaker or the string on a guitar).
