The Changing World of Augmentative and Alternative Communication (AAC)

September 6, 2012

 

 

 

 

Each time I prepare to teach a graduate student class, train a group of therapists or provide therapy for a client, I spend time making sure my information is up to date. I recently taught a symposium at George Washington University titled,“AAC Devices and Implementation Strategies to Promote Success: An Update on Cutting-Edge Technologies for Augmentative and Alternative Communication”. Although I have been immersed in this world of AAC for quite a while and use many iPad apps as well as more traditional devices, as I gathered information and prepared for the presentation, I became even more aware of how much the entire world of AAC including its purpose, products and delivery model have changed.

Back in the mid-1980s when I attended Northwestern University, I took an elective AAC class. I remember it well. I learned about devices produced by well-known companies such as Prentke Romich and Dynavox. We learned a formal very lengthy AAC protocol to help us decide which device would be best for individuals with significant communication needs from congenital challenges such as Cerebral Palsy or degenerative diseases such as MS or ALS. We wrote comprehensive reports which included measurable goals to use in therapy. There was a long process to go through to obtain funding of the machines that were many thousands of dollars. I recall spending hours reading manuals so that I could try to customize the vocabulary content to meet the user’s needs.

Fast forward to now. AAC has existed for about 40 years. The types of technologies that provide augmentative and alternative communication functions have grown exponentially. The way our society communicates is changing. Texting, email, video calls, text to speech and speech to text technologies are becoming mainstream. There are now many technology tools available that can help people express themselves. Cell phones, tablets, SmartPhones, Skype, Facebook, and technology devices with vocal output, have worked their way into mainstream society and are readily available to all. Speech-language pathologists are no longer the gatekeepers to the AAC world. It is now more affordable and easy to access AAC solutions.

There are pros and cons to this situation. On the positive side, more individuals who have difficulty expressing themselves now have easier access to potential solutions to improve the quality of their lives. Affordable technologies are finding their way into the lives of individuals who in the past might have spent their lives unable to effectively communicate. There are now more than 200 AAC apps in iTunes alone and more and more are becoming available in the Android marketplace.

The problem is that very often individuals who have complex communication needs (CCN) are frequently not provided with the most appropriate tools and training to develop and maximize their communication skills. It is critical to consider the strengths, communication needs, goals, interests, and characteristics of each person as well as typical language development. There should also be an effort made to appropriately reinforce communication attempts, model the use of the device, and expand newly learned skills into the home and daily routines. I strongly encourage individuals to seek professional guidance from a qualified speech-language pathologist when choosing and using AAC apps. In my practice, families are coming to me with a number of AAC apps that they found already on their iPads- but they don’t know how to go about configuring them or using them to help their loved ones. This often leads to frustration and abandonment.

When I work with individuals who have limited communication abilities, I have found that I often have to work with other apps and toward goals such as first establishing joint attention, promoting the concept of cause/effect and working on ways to motivate individuals to initiate communication and interact with the iPad or other device. I have found the built-in features of the iPad and many free and low cost apps make therapy more engaging and efficient in reaching these initial goals as well as helping people advance to more involved communication tasks.

Tablets with AAC apps are not necessarily the best solutions for individuals with difficulty using their hands to touch pictures and words to be said aloud by a device. Not all consumer products- even those with many accessibility options such as the iPad – meet the needs of every person. When working with adults who have aphasia or individuals with severe autism spectrum disorder the task of learning to use AAC apps to communicate is complex. It is a bit less complex when the lack of communication is due to speech or voice disorder as opposed to a language or cognitive disorder. There are also individuals with significant physical disabilities who may need to use eye gaze or scanning to access the technology. A multidisciplinary team including a physical therapist, occupational therapist, speech-language pathologist and an assistive technology expert is ideal in this situation. It is important that if an iPad is to be used with a person with significant physical limitations, the person selecting the apps and training the individual be familiar with issues relating to seating, positioning, and the apps that are switch accessible as well as recent products using alternate ways to access the iPad..
Many of the products that have been around for a long time have had years of research to support the many features they offer in terms of teaching language and facilitating verbal expression. An increasing number of products are becoming available for tablets- but the products are new. The research on their efficacy has just begun. In addition, if a tablet computer is indeed the product of choice, there is a great deal of planning that needs to go into configuring the device and teaching the individual how to most effectively use it. Careful consideration needs to be given to :
• Language representation- What is the best way to present words and concepts? Photos of people and items in a person’s environment, abstract images, and printed words can be used.
• Visual display- How many images or words should be presented at one time? Should a person have a finite group from which to select or should the person be able to scroll for more choices and produce novel messages?
• Word selection- What needs to be communicated? There is much more to life than just naming objects. Comments, requests and questions are an integral part of communication.
• Communicative Intent- Does the individual need to be externally motivated to communicate? How are the person currently communicating and what further skills need to be developed?
• Communication Abilities- What are the language, speech, cognitive and social skills of the person?
• Implementation Plan- How will the device be configured and what are the strategies for successful implementation of the device into daily routines? How much support is available? Who will continue to update the device as the needs of the individual change?
Even if families do turn to communication professionals for comprehensive assessments- the speech-language pathologists are confronted with a number of dilemmas. How should the availability of these new products change the traditional AAC assessment and intervention process? Should professionals wait for research to take place as new products become available prior to using them in their professional practices?
The following online resources may be helpful for individuals trying to learn more about this exciting but complicated field of AAC during this transformation:
The SETT framework – Joy Zabala’s model to be used in the collaborative decision-making process in all phases of assistive technology and AAC selection and implementation.
AAC TechConnect – A site filled with great suggestions and resources re AAC
Children’s Hospital Boston– An AAC feature matching resource
Spectronics AAC Apps – A wonderful blog by Jane Farrall- a SLP and special educator in Australia who is passionate about literacy, assistive technology and AAC
AAC Institute– A compilation of helpful AAC resources
AAC Language Lab– Great information on language stages and helpful teaching resources provided by Prentke Romich Company
Learning Paths – Many wonderful resources provided by Dynavox

Innovative Speech Therapy– Newsletters, Workshops, Lectures, Webinars,Special Reports, Consultations and Therapy


Webinar with Joan Green: Learn the basics of using your iPad to help individuals with special needs

September 6, 2012

Friday October 5, 2012 1:00-1:30 EST

During this 30 minute webinar, Joan L. Green M.A. CCC-SLP ( The founder of Innovative Speech Therapy) will introduce you to the many features of the iPad which are helpful for individuals with special needs. She will share some of her top app picks and strategies to help you learn to use the iPad to help children and adults who have a wide variety of communication, cognitive, literacy and learning challenges.

Registering now will save you a seat in the live webinar and entitle you to one copy of the “special report” which will be available on the day of the event . “Seating” is limited.

If all goes according to plan, Joan will record the webinar and then offer a “pay per view” option so that the webinar can be viewed online with the accompanying “special report” to be used for future reference of discussed products and ideas.
$25.00 registration fee

Click Here to Reserve Your Space Now


Talking Temptations- Strategies and a few apps that promote the urge to speak

June 7, 2012

During speech therapy sessions with children and adults with severely impaired communication skills, one of my primary challenges is setting up situations that promote the urge to talk. As parents, therapists and educators, when helping individuals who have significant communication challenges, we need to set up an environment that gives the individual a reason to talk and make sure to give individuals enough wait time so that they can initiate speech.  Most of us often know what a person is trying to say and help meet their needs to avoid conflict or make life easier, but there are times that it is more appropriate and therapeutic to actively intervene so that there is more of a reason for the person to initiate a communicate attempt.

There are quite a few methods for doing this. We can sabotage the situation- place something in full view but out of reach that we know the person wants, give them something broken that they need to have fixed or engage them in a pleasurable activity such as swinging on a swing, listening to music or playing a fun game- then suddenly stop the activity. Lots of praise for communicative attempts is critical to promote communication- as is providing frequent opportunities for communication during enjoyable activities. If communication does break down- we try to give just enough help for success. It’s important once the communication is repaired- to then review what happened and practice what the individual could have done or said to communicate the desired message.

I use these techniques with a wide range of individuals- young and not so young individuals with autism spectrum disorder ( ASD), adults with aphasia and individuals with dementia or other cognitive challenges. The initiation of communication is critical for quality of life- and often quite a challenge to establish.

I encourage families, teachers and therapists to create situations throughout the day during everyday activities such as morning rituals, mealtimes, work/school and leisure activities.

When using the iPad- I have recently been using quite a wide variety of apps to create these temptations. Of course- the selection depends on the interests and motivations of the client. For individuals with more advanced communication abilities- these same apps can be used to give each other directions or describe what has happened in the app or what they are about to do.

Here are a few of the apps I have recently been using to generate or improve communicative interactions:

YouTube-    on my iPad I have saved many great videos in the “favorites” section for easy viewing. At times I might pause them engage in comments about what we see. I may offer written word choices using paper/pencil, include targeted vocabulary in an AAC app or provide hands on prompting to facilitate accurate verbal productions. Older clients often like “Dancing with the Stars” , while younger ones often respond to amusing Disney clips or favorite singers. Whenever possible I try to find funny clips to promote enjoyment.

    

Cut the Rope or Where’s My Water– These two apps are very popular with just about all clients. I hold the iPad and encourage clients to say words such as “dig” , “cut” etc prior to interacting with the app. Hand over hand guidance may be needed for individuals with limb apraxia- but many people young and old love these apps.

  My PlayHome and Cookie Doodle- These apps are not “drill and practice” , but offer motivating ways to engage clients with motivating fun activies. I try hard not to have individuals repeat what I say- but facilitate their production of utterances to make things happen. An example might be “Dad on swing” , “Baby bounce” or “eat cookie.”

Below I have listed a a few websites, blogs and videos that do a great job of presenting ideas about how to create communication temptations and facilitate communicative interactions. I am sure there are many more.

Top 5 Ways to Encourage Spontaneous Language

Communication Temptations: How Use Your Environment to Get Your Child Talking

8 Ways to get your Child to Speak

Communication Temptations

How to make communication temptations really work

Activities to Encourage Speech and Language Development

If you know of other sites or videos that illustrate the use of communication temptations to encourage verbal initiative- please email me at Joan@innovativespeech.com.


Introductory Interactive iPad Workshop with Joan L. Green, M.A.CCC-SLP

June 6, 2012


 iPad Insights and Implementation Strategies to Improve Communication, Cognition, Literacy and Learning

Thursday October 25, 2012

Rockville, MD 10:30 AM- 2:30 PM ( 45 min.  break for lunch)

$125.00

Click Here to Reserve a Seat

The morning will begin with an introduction to the many helpful features of the iPad and an overview of how the iPad and iPhone can be used to help children and adults with communication and learning challenges.  During the workshop, Joan  will demonstrate  many helpful features of iDevices and her top app picks for helping others to have fun while maximizing learning and quality of life.  A wide variety of Innovative Technology Treatment Solutions will be presented.

Participants are encouraged to bring their iPads and iPhones and to use them  as Joan presents an overview of her most recent cutting-edge motivating approach for using the iPad to help individuals of all ages with and without special needs including:

  • autism spectrum disorders
  • learning disabilities
  • speech and language delays and disorders
  • twice exceptional learning challenges
  • executive functioning weaknesses
  • aphasia
  • apraxia
  • dyslexia
  • dysgraphia
  • dementia
  • traumatic brain injury

The day will include strategies and suggestions for approaches to improve speaking, understanding, reading, writing, thinking, remembering, socializing, organizing and learning. Participants will be encouraged to actively collaborate throughout the day.

A limited number of professional, graduate student and family scholarships are available. Contact Joan@innovativespeech.com for  for scholarship application information.

MD SLP CEUs approved for 3.25 hours


Reviews sites to learn more about iDevice Apps

January 15, 2012

I have been speaking quite a bit to private therapy practices, SLP associations, schools, hospitals and families about the iPad. I have added it to my frequently used collection of “technology tools” and bring it out with just about all of my clients in addition to a laptop computer and online interactive sites.

Once you take the plunge and shell out a considerable amount of money to purchase an iPad- the challenge becomes how to use it. What is all the hype about? Was it worth the investment? There are currently hundreds of thousands of apps. Which are best for you and your situation? How should you configure you iPad and what is the best way to do it? I help individuals and organizations, in person as well as online, learn about strategies and apps that are most appropriate for their situation- but I also strive to teach people how to continue this learning process since new apps and features are coming out every day. There are also many ways to use the iPad to help individuals who have communication, cognitive and learning challenges. The calendar, cameras, online access and features such as the contact list can be very helpful.

In my newsletters (which are free and you can sign up to receive them at www.innovativespeech.com), I write about some of my top picks for apps which are the best value for a wide range of people as well as my top picks for  individuals with specific challenges . I have only skimmed the surface with regard to helpful ways the iDevices can help people. Many people ask me what I do to learn about the apps. How do I keep up with it all? I subscribe to many listserves, blogs, and newsletters. I also connect online with Facebook and LinkedIn Groups. I probably spend at least 5-10 hours a week trying out new technologies/apps. As I prepare for new clients or to give a presentation- I make sure I am up to date on the latest technologies.To me it is fun- I really enjoy it. Finding tools to help others improve their lives is one of the activities I most enjoy about being a speech- language pathologist. I want to empower people to help themselves.

Here are a few of my favorite online resources which review apps that are helpful for individuals with communication, cognitive and literacy challenges. Check them out and let me know what you think…. these sites tend to be well organized and updated. They each have a different focus and are written by individuals or organizations with different sets of experiences, strengths and professions. Some are produced by parents, some by SLPs or teachers and some by organizations.

I’d love to hear from you at Joan@innovativespeech.com which sites you find most helpful. I will try my best to add to this list as appropriate.

Although the lists and blogs mentioned below are extremely helpful, it can  be overwhelming. If you would like a personalized in-person session in the Washington, DC area, an online coaching sessions anywhere on the globe or to find out about upcoming workshops and webinars- please send an email to jgreenslp@gmail.com, make a reservation at ist.ticketleap.com or go to www.innovativespeech.com for more information.

Once you select one of the above sites and find a few you think might be helpful- keep the following tips in mind…

Reviews- On the iTunes store there are often helpful reviews and ratings shared by users of the app that can shed unique insights on how they use the app. I also often do a Google search for reviews of the app.

Company Website-Most app pages include a link to the developer’s website. Check it out. Some have reviews on their site and provide instructions and videos on their site or linke to You Tube demo or instructional videos.

Free and Lite Version– Many of the more expensive apps offer limited versions of their product which are a great way to find out if the app is a good match for your situation. Sometimes the difference is that here are no advertisements or requests for in app purchases.

Intended Use- Some apps are produced solely for entertainment and reinforcement, some to improve specific behaviors and some to compensate for areas of weakness. There are apps that are more appropriate for children and others for adults. Some apps are best used by professionals and others are fine for the individuals with the impairments to use on their own. I have found that how I use the app with a client is often at least as important as the quality of the app itself.


The World of Apps- They keep on coming!

November 18, 2011

My thoughts on some of the challenges of using apps to help individuals with communication and learning impairments

It’s astounding how much this new world of apps is changing the way I do therapy and run my practice. iPad apps. Droid apps. Google apps. Android apps. Mac apps. They just keep on coming!

I recently gave up my Blackberry for my first iPhone- the iphone 4s just began to explore my KindleFire which arrived a few days ago, ordered a Velocity Micro Cruz Android 7 inch Tablet on Woot two days ago for a deep discount of $70.00, and am about to get a hand-me-down Mac from one of my kids that I will upgrade to run the Lion operating system so I can start to learn about Mac apps rather than just read about them. I strive to use all apps prior to suggesting them to clients or speaking about them in my presentations. In my spare time while I take my son to swimming practice or my daughter to piano lessons, I find myself bringing along my iPad 1 or iPad 2 with headphones to review apps.

My private practice has constantly evolved over the past 19 years, but lately there has been so much to learn I find myself spending more and more time keeping up with the cutting-edge technologies. I feel like I have become an “app consultant.” Calls keep coming in. Everyone wants to know which apps are right for their situations. It’s overwhelming to start from scratch in the iTunes store, Mac Apps store, Amazon store for Kindle Fire apps or Android Marketplace. An increasing number of bloggers feature their favorite apps and offer reviews, but there again, the lists now are quite long. Apps are usually not very expensive except for some of the AAC apps or very robust professionally developed apps, but the cost adds up quickly and it takes time to download and give them a try.

Yesterday I talked to families about apps to help: a woman who had a brain tumor removed, another woman who has memory loss, a man with aphasia and apraxia after a stroke, a 5 year old boy with severe autism, a 3 year old boy with Down syndrome, a 12 year old boy with executive functioning challenges and an 8 year old girl with severe apraxia of speech. I can’t offer concrete guidance on the phone. I have to see each person, learn about their individual strengths and weaknesses as well as goals and interests, explore their environments, speak to others who help them in daily activities and try out what I think may work with the person before sending them on their way with apps that are customized as needed to practice. With each new client I find myself doing research to make sure they have the latest information. I am also preparing for a few presentations and it is incredible how much has changed since the last full day presentation I gave just this past summer. No two presentations are ever alike. Too much changes.

Although I truly believe that the new tablets have quite a bit to offer and may be the most appropriate tool to use in a variety of activities- they aren’t always the most appropriate solution and there are still plenty of challenges to be faced. Some recent publicity has made them appear to be the perfect solution when, in reality, many hurdles still have to be jumped. We can’t forget about the often more robust computer programs which may be more effective for cognitive retraining, reading and studying, communicating or writing essays.

Here are a few of my concerns and thoughts regarding app use and the reasons why I don’t have generic lists of apps to recommend for different diagnoses:

  • It is challenging to select the most appropriate apps as well as online programs and other technology tools to make sure that they are a good fit for the client and their needs and interests.
  • There are some apps that the user is meant to practice with alone, apps that are more appropriate to be used by an education or rehabilitation professional, apps which need to be customized to be effective, and apps which don’t work directly on the skills to be developed but which are great to use for joint attention or to encourage interaction while working on skills in person.
  • Many individuals need to be behaviorally managed while using the apps. These individuals may try to exit the apps, mistakenly touch the wrong locations and need skilled human intervention (with good training from a clinician such as a speech-language pathologist) to maximize the benefit from them.
  • Not everyone has the motor control to interact with apps and may need special accommodations such as switches for input or a different type of device.
  • Insurance companies and schools are now starting to suggest iPads be used as primary dedicated communication devices when children or adults can’t speak, when a more robust dedicated communication device (which is typically much more expensive and takes longer to acquire) with integrated environmental controls, and features to accommodate for poor motor control or learning abilities may be more appropriate. Finding the most effective communication tool is a process and setting it up, teaching the client how to use it and integrating it into daily routines to promote communication skills takes time and expertise. In most cases purchasing an iPad and an app to use is just the beginning and may not always be most appropriate but is often the least expensive and easiest way to provide fast access to a communication tool. In some cases using it as an intermediate step or backup system is more appropriate.
  • Individuals who are “let loose” with a tablet computer to entertain themselves are often difficult to pull back and structure in therapy tasks using apps on the device.
  • If the iPad is going to be an individual’s primary means of communication, these individuals need another device with a different color cover to use as a learning tool or for entertainment. There are now less expensive devices such as the Kindle Fire which makes having two a more affordable option.
  • It is important to keep in mind that if an individual does have a tablet such as an iPad, we should take advantage of the many wonderful integrated tools it has to enhance learning, executive functioning and communication. There is a calendar, address book, still camera, video camera, email, Internet access and many accessibility options such as enlarging print and reading aloud. When used creatively these are also really wonderful supports for individuals with communication, cognitive, learning and literacy challenges.

I’d really like to hear from those of you who are reading this to let me know which apps or computer software/ websites you use and find helpful and whether or not you agree with my concerns. It’s one of my favorite parts about speaking to large groups of people and interacting with you all online. I am always learning from everyone else.

I can be reached at Joan@innovativespeech.com if you would like to discuss the possibility of setting up an individual consultation or  webinar/presentation for your group or organization.


Two New App Goldmines by Tactus Therapy

September 15, 2011

I spend a great deal of time trying out new Apple apps- and currently have over 900.  It’s hard to believe that iTunes currently features over 425,000 apps. There are very few apps which are created specifically to help adults who have aphasia. Tactus Therapy Solutions has recently released two which are wonderful! I find myself using them daily in therapy with adults as well as children who have a wide variety of language and learning challenges. They are a great extension to traditional speech therapy techniques and make it much easier for families to practice at home with guidance about the most appropriate way to configure the apps. They each cost $24.99 and are well worth it!

   

 Naming TherAppy     

This app is very helpful for children and adults who have word retrieval challenges.

  • The home screen presents four modes: Naming Practice, Describe, Naming Test, and Flashcards.
  • In the upper right corner is the Settings button which will allow you to choose your desired number of trials, the email address to which you want results to be sent, and the Child-Friendly toggle button which takes out pictures that contain alcohol, violence, and adult themes.
  • The upper left corner holds the Info button and contains the basic instructions the user needs in order to use the app. So far I find myself using the “naming practice” mode the most.
  • This app includes over 400 high quality pictured nouns with a flexible cueing hierarchy and optional scoring.
  • The nouns are divided into 10 categories and one or more can be selected for targeted practice.
  • The voice output is a high quality male voice with a neutral accent in slow natural speech to facilitate comprehension.
  • Scoring allows a therapist or partner to indicate when the word is correct or incorrect. The app records which cue was used to get the correct answers and produces a score report for email.

Naming Practice Cueing Hierarchy:

Description: plays a short definition and works as a semantic cue
First Letter: shows the first letter of the target word
Whole Word/Written Word cue: shows the complete written word above the picture
Phrase completion: plays a phrase that the client can complete by supplying the target word
First Sound/Phonemic cue: plays the first sound of the target word
Repetition: plays the entire spoke word for the client to repeat

Describe Cueing Hierarchy
This activity includes over 460 pictures with 4-6 question prompts, with each prompt programmed to be appropriate to the picture currently being shown. The Describe Mode offers questions based on semantic properties such as location, function, smell, color, texture, appearance, shape, size, person, time, sound, taste, sound, category, and association.

Comprehension

TherAppy

I find that I am using Comprehension TherAppy daily with adults and children who have aphasia, auditory processing issues and a variety of attention and cognitive challenges. The pictures and voice are very high quality and there are many ways that this app can be configured to work toward goals. Many nouns are initially includes and expansion packs can be purchased with verbs and adjectives.
There are 3 modes:

  • Listen“: match an auditory stimulus (spoken word) to a picture
  • Read“: match a written stimulus (printed word) to a picture
  • Listen & Read“: match an auditory stimulus (spoken word) to a written word
  • 10 categories of nouns are available  including animals, foods, objects, concepts, places, people, body parts and more. Specific categories can be selected.
  • Users are able to determine the number of photos on the screen (2-6) or the “Auto” feature can be selected to automatically adjust the field size based on performance
  • There are 3 levels of difficulty which adjust the relatedness of foils (semantic and phonemic) to move from Easy to Hard
  • Automatic scoring tracks success and progress on-screen

I look forward to new releases in the near future for Tactus Therapy Solutions. Writing TherAppy will soon be available.

To learn about other ways technology can be used to help adults or children who have a wide range of communication, cognitive, literacy and learning challenges – check out my website at  www.innovativespeech.com, contact me at Joan@innovativespeech.com or buy my newest book titled The Ultimate Guide to Assistive Technology in Special Education which is full of info about computer software, iPad apps and other tools and strategies which are helpful for improving speaking, understanding, reading, writing and thinking  for adults as well as children.