Facilitating Literacy Skills in an Adult Who Uses AAC

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Facilitating Literacy Skills in an Adult Who Uses
AAC

• Melissa Ollie and Marie Swanson
• Minnesota State University, Moorhead
• Poster session at ASHA, Miami, 2006

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Introduction

• Literacy should be viewed as a right rather than
  a privilege for individuals who are unable to
  communicate vocally and require the assistance of
  various means of augmentative or alternative
  communication (AAC).
• (Erickson, Koppenhaver, Yoder, 2002)
• Individuals who use AAC are entitled to the right
  to
• service providers who are knowledgeable about the
  methods of literacy instruction
• live and learn in environments in which all
  individuals are viewed as literacy learners
• make life choices that are made available through
  reading and writing
• (Yoder, Erickson, and Koppenhaver, 1997, as cited
  by Erickson, Koppenhaver, Yoder, 2002)

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Purpose

• The purpose of this single subject case study was
  to determine the effectiveness of using literacy
  instructional strategies designed for child AAC
  users to develop literacy skills in an adult with
  cerebral palsy who uses AAC.

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Rationale

• Most children who use AAC are not literate even
  at the most basic levels, and more than 50 to as
  many as 90 either cannot read at all or read
  below what is expected for their age-level.
• (Koppenhaver and Yoder (1992a)
• Literacy is frequently not incorporated into AAC
  assessments or interventions.
• Professionals feel there is not time to include
  literacy instruction in AAC.
• Clinical programs do not routinely incorporate
  literacy in AAC evaluations or treatment
  packages.
• (Koppenhaver, 2000)

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Rationale continued

• Literacy skills are important for AAC users
• provides access to language
• enhances communication and self-expression
• builds critical thinking skills
• opens doors to educational and vocational
  opportunities
• increases self-worth
• encourages independence
• provides access to the world beyond the
  individuals immediate surroundings
• (Light McNaughton, 1993)

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Rationale continued

• The ability to read is a valuable tool for AAC
  users as they participate in home, work, school,
  and social settings.
• (Koppenhaver, Coleman, Kalman, Yoder, 1991)
• Literacy skills increase the flexibility of an
  AAC system as the individual is capable of using
  a combination of symbols and orthography.
• (Beukelman Mirenda, 2005)
• Literacy should be as much a part of AAC as
  communication strategies, skills, tools,
  processes, and products.
• (Koppenhaver, 2000)

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Challenges in Literacy Instruction

• Literacy learning difficulties are clearly
  documented for children with severe speech and
  physical impairments (SSPIs), especially those
  with cerebral palsy.
• Individuals with cerebral palsy may face the
  following challenges when learning literacy
  skills
• physical, visual, and auditory perceptual
  limitations
• (Beukelman Mirenda, 2005 Smith, 1992)
• reading opportunities are restricted in terms of
  length, number, range, and quality
• (Koppenhaver Yoder, 1993)
• misconception that they are not capable of
  learning to read
• (Light McNaughton, 1993)

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Challenges in Literacy Instruction

• A limited amount of research is currently
  available on literacy instructional strategies
  for adult AAC users.
• Literacy instructional strategies for the adult
  AAC population can be derived from the larger
  body of literature available on literacy
  development in child AAC users as adults require
  many of the same features of literacy instruction
  as do children.
• (Smith, 2005)
• Assessment and instruction requires adapted
  curriculum and methods.
• (DeCoste, 1997)

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Subject Information

• Female, age 54, with a medical diagnosis of
  spastic cerebral palsy.
• No records available on formal education.
• No formal cognitive assessment however,
  demonstrates cognitive delay.
• Hearing within normal limits visual-perceptual
  involvement.
• No previous communication assessment or
  intervention.

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Subject Information

• Initial evaluation, September, 2004, for AAC
  through the Regional Assistive Technology Center
  in the Speech and Language Clinic at Minnesota
  State University Moorhead (MSUM).
• Speech was her primary means of communication,
  however, her speech was rated 98 unintelligible.
• Severe physical involvement no controlled
  movements of upper body, controlled movements of
  legs and feet.
• Accesses communication technology and
  instructional materials with the big toe on her
  right foot.

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Subject Information

• Enrolled in therapy at the MSUM clinic. Therapy
  goals have focused on
• enhancing her communicative abilities through
  increasing spontaneous initiations and responses
• increasing the complexity of the syntactic
  structure of her utterances
• increasing the variety of communicative functions
• In June, 2006, the subject received a DV4
  (Dynavox).
• Simultaneously received language intervention and
  literacy instruction.

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Methods

• The subject was seen a total of 34 times over the
  course of approximately three months (July 18th,
  2006 through October 27th, 2006). Each session
  took place in her group home.
• The subjects caregivers were asked to read to
  her for at least fifteen minutes a day from
  whatever text she selected (e.g., newspaper).
• Assessment
• Data was collected prior to beginning each step
  of literacy instruction (initial phoneme
  segmentation, sound blending, letter names,
  letter-sound correspondences, and single word
  decoding).

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Methods

• Assessment continued
• The following guidelines were followed during
  informal assessment
• 20 seconds were allowed for a response once the
  subject was visibly attending to the task.
• Items were only repeated twice.
• Verbal reinforcement was provided based on
  completion of items rather than correctness of
  response.
• Performance measure was based on percentage of
  accuracy (e.g., the number of correct responses
  divided by the total number of items presented).

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Methods

• Instruction
• Interventions used for this study followed an
  outline of procedures presented by Light,
  McNaughton, Jansen, Kristiansen, May, Miller,
  Weaver, York in a seminar, Maximizing the
  Literacy Skills of Individuals Who Require AAC,
  at the American Speech-Language Hearing
  Association (ASHA) Convention, 2005.
• The interventions included instruction in
  phonological awareness skills (e.g., initial
  phoneme segmentation and sound blending),
  letter-sound correspondences, decoding skills,
  shared reading, and independent reading. In
  addition to the procedures used by Light et al.,
  the clinician included instruction in letter
  names.

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Methods

• The following modifications, adaptations, and
  expectations were in place during each phase of
  instruction
• Instructional materials were modified to include
  graphic symbols familiar to the subject.
• Instructional materials were placed on a podium
  on the floor to accommodate her visual and
  physical limitations.
• Instructional materials were adapted to allow
  nonverbal response.
• Subject accessed the materials pointing with the
  big toe on her right foot.
• Unlimited amount of time was given to respond.
• Unlimited number of item repetitions were
  provided.
• Feedback provided on completion of items and on
  correctness of response
• Percentage of accuracy calculated on the number
  of correct responses divided by the total number
  of items presented in the task.
• Criterion was 90 accuracy across three
  consecutive sessions
• Progress was determined by comparing percentage
  of accuracy during instructional sessions to data
  collected prior to beginning instruction.

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Results

• Pre- and post-instruction data on initial phoneme
  segmentation, sound blending, and letter-sound
  correspondences were collected through informal
  procedures within a single session.
  Post-instruction data was collected two weeks
  after instruction was completed.

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Results

• Progress was determined by comparing percentage
  of accuracy during instructional sessions to
  pre-instructional data and data collected at the
  beginning of each phase. The subjects progress
  for each phase is presented in the following
  graph

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Discussion/Implications

• The results of the study up to this point support
  the appropriateness and effectiveness of literacy
  instruction with this adult subject.
• Preliminary analysis of the results to this
  point suggests the following implications
• Psycho-social
• The contrast between the initial data point
  (pretest) and the first and subsequent
  interventions suggests the subject may have had
  some apprehension about the new task. The
  initial session was a testing format, and the
  task involved no cueing following the initial
  instructions and no reinforcement of correct
  response.
• This subject is typically reticent to respond in
  new situations and to respond to new task
  demands. She is anxious about making mistakes
  and hesitates to respond. Therefore, the
  contrast in accuracy between the pretest and
  initial interventions may be explained in part by
  the considerable support provided during the
  intervention sessions.

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Discussion/Implications

• Literacy
• Although the subject had no previous formal
  education or specific literacy instruction, the
  rate at which she acquired these specific skills
  suggests these skills may have been present to
  some degree.
• During the communication intervention prior to
  this study, the subject had demonstrated a few
  sight words that were assumed to be memorized.
  She did not demonstrate the skills targeted in
  the literacy instruction.
• These preliminary findings support the idea that
  literacy assessment and instruction be provided
  to AAC users of all ages and abilities.
• Further, these preliminary findings underscore
  the need for ongoing research in adult literacy
  instruction with AAC users.

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References

• Beukelman, D.R. Mirenda, P. (2005).
  Augmentative alternative communication
  Supporting children adults with complex
  communication needs. Baltimore, MD Paul H.
  Brooks Publishing Co., Inc.
• DeCoste, D.C. (1997). The role of literacy in
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  of augmentative and alternative communication
  (pp. 283-333). San Diego Singular Publishing
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• Erickson, K.A., Koppenhaver, D.A., Yoder, D.E.
  (2002). Waves of words Augmented communicators
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• Koppenhaver, D.A. (2000). Literacy in AAC What
  should be written on the envelope we push?
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• Koppenhaver, D.A., Coleman, P.P., Kalman, S.L,
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