Carol Schaeffler
Augmentative Communication Specialist

FREQUENTLY ASKED QUESTIONS about AUGMENTATIVE and ALTERNATIVE COMMUNICATION (AAC)

What is an augmentative communication aid?  

A communication aid is a physical object or device.  Graphic symbols, communication boards, charts, books and devices are considered communication aids.  Graphic displays are generally used to provide a method of expression for individuals with severe speech impairments.  Graphic symbols may also be used as a method to help individuals with severe disabilities better understand language.  These systems may be very simple or complex.  They are selected based on an evaluation of the individual’s needs and abilities.


Who benefits from using augmentative communication aids?

Individuals with severe communication disorders, that cause speech to be temporarily or permanently inadequate to meet all of their interaction needs, may benefit from the use of AAC techniques and strategies.  The degree and nature of the disability may vary widely.  Persons who make use of augmentative communication techniques may be of any age or cognitive level, and may exhibit a variety of disabilities such as visual, motor and cognitive impairments.  Individuals with a number of acquired and congenital disabilities may make use of AAC techniques.  Congenital disorders commonly resulting in the need for implementing augmentative communication techniques include cerebral palsy, autism and other developmental disabilities such as Down Syndrome and Rett Syndrome.  It has been found that visual displays and devices may not only help individuals with Autism Spectrum Disorders (ASD) express themselves but it may also provide a means of helping them to better understand language and reduce challenging behaviors.  Acquired disabilities commonly associated with AAC use include amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), multiple sclerosis and stroke.  Others with disabilities such as Parkinson’s Disease, Guillain Barre Syndrome and Muscular Dystrophy may benefit.

 
What is the evaluation process for an augmentative communication system?
 
An AAC evaluation may be completed relatively quickly or may be done over time as part of an assessment and training process.  Evaluation is a three-step procedure, including, determining the individual’s needs and abilities, trying different components and trial use with a device(s).  The process begins with gathering background information.  The individual’s language, cognitive, motor, sensory and visual abilities, as well the person’s social, academic, vocational and daily living needs will largely determine the optimal system.  Initially, this information may be gained through interviews and questionnaires.  The amount of direct testing done by the augmentative communication specialist in these areas is often dependent on the availability of evaluations that have been done prior to the AAC assessment.  Based on the individual’s needs and abilities, the AAC evaluator will introduce a variety of system components.  For example, the individual may try different access and retrieval methods and different communication programs with varying displays and vocabulary capability. During this phase of the evaluation, the individual may require training and practice with the various components that are being introduced. After the optimal components are determined, the individual will try devices that have the needed features and decide upon the most appropriate communication system.  Lastly, the required paperwork and a funding report are submitted to the appropriate funding agency for approval.

Often, early in the process, the individual is given a non-electronic communication board or book to provide an immediate basic method of interaction.  Later, these displays are used as a back-up for when an electronic system is not practical or available (i.e.: when driving in the car or when the device is out for a repair).  Additionally, the person may learn to use some vocalizations and / or gestures to express specific intentions  (i.e.: yes / no, stop, want).  These are used to provide the ability to quickly communicate important needs and desires.

Many individuals who make use of AAC techniques, will require system alterations over time. Components or entire systems may need to change if the individual’s condition deteriorates or if the person gains skills.  Some individuals with degenerative disorders, such as ALS, will need to change their access method as motor skills deteriorate.  Others, particularly children, may change their entire communication system as they mature and develop increased language and motor abilities. Sometimes, after a person has been provided with a method of interaction, we see growth in the desire and ability to communicate about more topics and to participate in a greater number of activities.  New vocabulary often needs to be added to accommodate increased interaction needs.

A team approach to evaluation is recommended.  The augmentative communication specialist is responsible for coordinating and overseeing the team effort.  She is often doing much of the assessment, writing the funding report and submitting the funding packet.  The individual and his / her family are integral members of the team.  Their opinions and impressions about needs, components and devices are of primary importance.  Other clinicians and educators may supply information and assist in providing needed training.  Sometimes an occupational or physical therapist must look at positioning and seating needs before an optimal access method can be determined.  Input from all involved team members is very important for determining the most appropriate system and implementing its use.

 
How does an individual become a successful user of an AAC Device?

Although AAC devices can provide an individual with voiced communication, the use of these systems is not intuitive.  The person must be able to effectively identify and retrieve desired vocabulary items and engage in conversation with desired partners. The amount of training each person requires to become an effective communicator will vary.  Training needs depend upon the user’s abilities, motivation, the complexity of the system, the available support network, the person’s goals and the opportunity to practice using the device.  Some individuals, such as a person with an acquired disability who has maintained cognitive functioning, may only need the device to be programmed with personal vocabulary and to learn their communication program and access method.  Others, such as children with developmental disabilities, often need intensive instruction and practice to develop communication and academic skills.  In addition to learning their communication program and access method, they may need to learn new symbols and develop their linguistic, literacy and conversational abilities. Practice and support in natural environments is crucial for success.  Use of the device often needs to be modeled and encouraged in natural settings before the individual becomes a successful user.  To meet the person’s goals, training may need to take place in individual treatment as well as in the classroom and home environments.

Personalization of vocabulary is essential to facilitate motivation to use a system.  Although there are many words that are commonly used by everyone, much of what we say is unique.  For example, the people in our lives, the places we go, the foods we eat and the activities we engage in are different for each person.  Therefore, devices must be programmed to accommodate personal needs.  Children often need their systems to be programmed on an on-going basis to reflect curriculum needs and growth in general language abilities.

 
What is an augmentative communication specialist?

The AAC Specialist is expected to coordinate the team effort in the area of augmentative communication, provide training for staff and family members, develop an on-going treatment plan, provide direct ongoing evaluation and treatment, do appropriate vocabulary selection, programming and display development and trouble shoot treatment or equipment related problems.  In addition to traditional knowledge and experience in her own discipline, the AAC Specialist requires extensive expertise and experience related to the area of augmentative communication.  She must have a broad understanding of related disciplines (language, cognitive, motor and sensory development), evaluation procedures, rehabilitation and implementation strategies.  She must have extensive knowledge of AAC devices, components and related adaptations and training materials.

 
How does augmentative communication effect speech development?

Research has shown that the use augmentative communication does not inhibit the development of speech.  In fact, emerging evidence shows that it may actually facilitate speech development (Miller,et al., 2006).
Reference

Miller, D.C., Light, J.C., Schlosser, R.W. (2006).  The impact of alternative and augmentative communication intervention on the speech production of individuals with developmental disabilities: A research review.  Journal of Speech, Language and Hearing Research, 49, 248 – 264.

 
How do I pay for an AAC device?

AAC systems can be funded through a number of sources, including Medicaid, the Board of Education, Early Intervention, Insurance Companies and VESID.  A comprehensive report and related paperwork, that follows the guidelines of the particular funding agency, generally must be written and submitted by a certified speech – language pathologist.

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