Treatment Overview I Flashcards
1
Q
orienting framework
A
- AAC is not a diagnostic category (such as adult language disorders, fluency, voice, etc.) but a set of methodologies used to treat individuals with various diagnoses/disorders of communication
- as such there is a wide variety of problems to address and intervention is highly dependent on the characteristics of the patient
- it can be useful to classify patients according to some broad guidelines in an effort to help the clinician organize their thinking and approach to intervention
2
Q
one of these is an older framework, with both pluses and minuses, InterAACt. it can be somewhat complex in its implementation but, fundamentally, is based on…
A
- patient age
- current level of communication
- situational/functional setting
- some prior Dynavox devices figured it prominently in their menu of pre-programmed page layouts
3
Q
a simplified version of this approach is to consider 3 basic categories of patients (based on the results of the initial evaluation)
A
- noncommunicator
- developing communicator
- linguistically accomplished communicator
4
Q
- noncommunicator
A
- similar to the emergent category in InterAACt
- patient has not fully developed the concept of communication
- not the same as a patient who knows they want to communicate but can’t
- all children, including typically-developing individuals, are born without these concepts and must develop them
- before even working on language development, these patients need to develop aspects of these very basic concepts
- typically this could be a young child, but in individuals with severe linguistic/cognitive deficits, they can be any age (including adult)
- the focus of therapy is to get the patient to both respond to communication from others and to initiate communication (often the hardest part)
5
Q
- noncommunicator: not the same as a patient who knows they want to communicate but can’t
A
rather, these individuals have not yet understood that communication even exists or what it can be used for
6
Q
- noncommunicator: before even working on language development, these patients need to develop aspects of these very basic concepts
A
- cause-and-effect: what the Ablenet pig could be useful for
- the idea that if you want something, someone might be able to get it for you if you can’t yourself
7
Q
- developing communicator
A
- similar to the situational category in InterAACt
- the concept of communication has been established in the individual’s cognitive model of the world, but the individual does not have a full set of linguistic skills
- here the task is to expand linguistic competence and complexity (both receptive and expressive)
- includes literacy development at the appropriate age/skill level
- all children, including typically-developing individuals, need to develop these skills, but they will do it without direct intervention, as opposed to AAC users who will need assistance
- the age range for typically-developing children would be anywhere from early preschool through middle school
8
Q
- developing communicator: the age range for typically-developing children would be anywhere from early
A
any age up to about 14-16, where adult-level language (although not necessarily adult-level knowledge/cognitive/reasoning abilities) is thought to be established
9
Q
- developmental communicator: treatment here has to focus on both
A
- functional communication for all daily needs
- acquiring further linguistic skills to be used functionally
10
Q
- linguistically accomplished communicator
A
- similar to the independent category in InterAACt
- the individual has good (or fully functional for all their needs) linguistic skills internally, but cannot implement them because of various deficits
- age range here would be anywhere from 14-16 years on up
- treatment here is not directed toward developing language and communication concepts, but making whatever system is used as functional, efficient, and non-limiting so that the patient can say anything they want without being limited by the system
11
Q
- linguistically accomplished communicator: the individual has good (or fully functional for all their needs) linguistic skills internally, but cannot implement them because of various deficits
A
- think of an ALS patient with dysarthria and motor control issues, but intact adult-level comprehension and formulation of sentences/ideas
- they don’t need language intervention, just efficient device access to replace speech/writing
12
Q
Picture Exchange Communication System (PECS)
A
- a token-based economy system whereby patients give pictures to communication partners as their “utterances” and receive various items or reinforcers in return
- the system is highly behavioral and depends on various reinforcement schedules
- the system includes a highly structured, progressive plan of treatment which takes a patient from entirely uncommunicative through the various pragmatic functions of language (requesting, commenting, etc.) although progress is obviously dependent on patient potential
13
Q
the most important aspect of PECS to this discussion is the…
A
emphasis on getting the patient to initiate communication; far too often, patients with very limited communication enter a pattern where they respond to others communication, but never initiate spontaneous communication attempts
14
Q
the first steps of PECS focus on the communication partner never asking the patient anything, but waiting until the patient initiates and indicates what they want
A
- this is critical
- if the listener starts to cue or ask, then the motivation to initiate communication is lost and the approach breaks down
15
Q
PECS: obviously just waiting for a patient to do something could take forever
A
- so in a typical early treatment session for PECS, there are 2 clinicians, the “listener” or communication partner and the “facilitator” who acts as a prompter, modeling and cueing the patient as to what to do
- generally the facilitator needs to be the skilled clinician (SLP)
- the listener/communication partner can be an aide or even a family member or other interested stakeholder
16
Q
while PECS is a specific AAC method with various advantages/disadvantages,…
A
the emphasis on having patients initiate communication can be applied to any system of AAC communication
17
Q
communication in multiple settings
A
- patients need to communicate throughout the day (and sometimes at night in bed)
- sometimes a methodology (tablet-based touch-screen device) is not appropriate (in the shower)
- clinicians need to consider where/when/how a patient will need to communicate and plan for all settings
18
Q
visual scene displays
A
- for a beginning communicator, especially one with limited cognitive skills, the typical layout of a tablet-based AAC device may not be optimal
- remember that recognizing pictures/icons as symbols of the real thing is a skill that must be developed
- similarly, a screen full of disconnected icons (even if categorically related–i.e. a page of icons of food) can be cognitive confusing
- one workaround for this is the concept of a VSD in which a drawing or picture of a scene (kitchen, bathroom, bedroom, classroom, etc.) is presented to the patient
- designed into the picture are “hot spots” which, when accessed (touched, mouse clicked, etc.) generate the desired word
- so instead of separate icons for “blanket”, “light”, “pillow”, accessing the blanket, or the light, or the pillow in the picture generates the word
- note that a drawing could be used, but also a photograph of the patient’s own bedroom or other familiar location can be used
- the “hot-spots” need to be programmed by the clinician, and there is wide flexibility in size, location, etc.
- one downside of this is that generally there is no indication of what is a hot-spot or not
- often they are not colored, outlined, or highlighted and one is not always sure of what is active
19
Q
InterAACt framework, based on 3 parameters
A
- age
- communication competence level (ability)
- context (setting and functional purpose of communication)
20
Q
InterAACt: age
A
one implementation (Dynavox) used 5 subgroups on the assumption that communicative needs are somewhat similar within each group (maybe true, but there is some arbitrariness here)
- young child = 2-6 years old
- child = 7-13 years old
- teen = 14-21 years old
- young adult = 22-49 years old
- adult = 50+ years old
21
Q
InterAACt: communication competence level (ability)
A
- functional (emergent)
- situational (context dependent)
- creative (independent)
22
Q
communication competence level: functional (emergent)
A
- the individual is beginning to communicate using a variety of methods including gestures, body language, facial expression, and simple symbols
- the focus is on communicating basic needs and beginning social interaction
- the individual communicates best with familiar communication partners and in familiar settings
- it is often difficult to know if the individual actually understands his or her communication partners
- the individual communicates a limited number of messages in small set of specific contexts and routines
23
Q
communication competence level: situational (context dependent)
A
- the individual shows understanding of simple and clear symbols
- the individual may communicate effectively in a limited number of situations or may communicate in a limited way across a variety of situation
- the individual’s ability to communicate effectively depends on the environment, topic, or communication partner
- the individual understands most communication about things that are present but may misunderstand references to people, situations, and items that are not present
- the individual is beginning to understand more abstract symbols to create new messages
- generally, the individual is not literate
24
Q
communication competence level: creative (independent)
A
- the individual understands communication and follows the linguistic rules appropriate for their age
- the individual is socially engaged at his or her age level
- the individual writes and spells at or near his or her age level
- the individual is able to combined single words, spelling, and phrases together to create novel messages about a variety of subjects
