AAC EBP Group

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AAC EBP Group

• THE
• EBP
• EXTRAVAGANZA DAY
• December 2006

Compiled by Katherine Swinburn and Hayley
Smithers-Sheedy on behalf of the AAC EBP Group
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The AAC Group

• Core attendees of 8 12 people
• DADHC, Health, Uni of Sydney, Newcastle Uni,The
  Spastic Centre, Aspect and more!
• Mailing list of approx 33 people
• Met for the first time in May 2006
• 2nd meeting in September

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Topics

• AAC Design
• AAC and Dyspraxia
• AAC Technology and Literacy

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AAC System Design

• Special thanks for the contributions of Spastic
  Centre staff
• Alison Wu, Harriet Korner, Angela
  Kinsella-Ritter, Katherine Swinburn, Jenny Kidd
  and Hayley Smithers-Sheedy

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(No Transcript)
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Answerable question

• What is the best practice for the layout / design
  in Augmentative and Alternative Communication
  systems for people who have a communication
  disability?

CINAHL / Ovid, PubMed, Cochrane, Proquest, Hand
Searching
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Results 21 Articles
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CAP Light, J. Drager, K. (2002)

• Objective
• To summarise what we know about young children
  AAC Technology
• To stimulate discussion for future research
  regarding design of AAC
• technologies
• Results
• AAC technology high smile value (should be fun)
  
• Integrated systems are favoured
• For concrete concepts use of a scene layout is
  advantageous
• Personally relevant schematic layout preferred
• Insufficient evidence available to determine
  whether dynamic or
• fixed displays more appropriate for young
  children

Level IV
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CAP Wilkinson, K. Jagaroo, V. (2004)

• Objective
• To provide an overview of some of the
  considerations in visual
• cognition that apply to AAC display design. To
  consider how design
• properties can enhance / inhibit access and use
  of visual symbols.
• Results
• Currently insufficient evidence to show that use
  of colour in AAC
• design is advantageous.
• Some evidence to support use of colour in natural
  scenes or schema as a memory cue.
• In this case colour can be used to
• provide segmentation of a visual scene
• highlighting contrasts between objects
• highlighting detail

Level IV
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CAP Drager, K., Light J., et al (2004)

• Objective
• To evaluate the performance of typically
  developing 3 year olds
• locating vocabulary in AAC technologies within
• grid layout with a menu of screen shots to
  represent alternate pages
• contextual scene with a menu of screen shots to
  represent alternate pages
• Results
• Initial transparency for all the technologies was
  poor.
• On the second learning session children in the
  contextual scene group performed slightly better
  than children using the grid display.
• Embedding language concepts within contextual
  scenes may be an effective approach for young
  children learning dynamic display technology.
• Generalization of learning was minimal.

Level III
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CAP Drager, K. et al (2003)

• Objective
• To evaluate performance of typically developing 2
  1/2 year olds locating vocabulary
• in AAC technologies within
• grid format, vocabulary organised taxonomically
  
• grid format, vocabulary organised schematically
• vocabulary organised into a scene schematically
• Results
• All organisations were difficult for children re
  dynamic display systems.
• Whilst still finding it difficult children in the
  schematic scene group did significantly better
  that the children in the two groups with grid
  layout.
• Of the grid layouts there was no advantage in
  schematic organisation over taxonomic.
• On average children did not show evidence of
  generalisation to novel vocabulary on any layout,
  and they demonstrated little use of AAC device
  during free play sessions

Level III
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CAP Oxley, J. Norris, J. (2000)

• Objective
• To identify some of the memory and memory
  strategy
• issues implicated in VOCA use, particularly for
  school aged
• children.
• Results
• For young children some memory strategies may be
  appropriate to
• use and may influence the layout and design of
  vocabulary on a
• VOCA
• clustering, sorting and categorising vocabulary
  using age appropriate strategies e.g. thematic
  pages
• non-specific markers and pictures e.g. a star or
  a colour marking to remind a child where a
  message is stored
• picture markers together with elaboration e.g. a
  dog symbol next to a house symbol might have a
  message this is my dog spot whereas a dog
  symbol next to a symbol for vet could have a
  message last month my dog was sick.

Level IV
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CAP Hochstein, D. et al (2003)

• Objective
• Assessment of performance in relation to single
  versus dual-level
• display and consideration of performance in
  relation to type of vocab.
• Results
• More errors were made for abstract words than
  concrete, more errors made with dual-level system
  that single level.
• If the clinical goal is for quick and proficient
  AAC it is suggested that a small vocabulary on a
  single level chart may be effective
• If dual- level system is used extra training in
  category structure may help to reduce errors.

Level IV
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AAC Design clinical bottom line

• The search results yielded insufficient evidence
  to guide clinicians in regards to this question.
• The level III and IV evidence found during the
  search suggested the following
• There is a need for the AAC system to be engaging
  and to be used for multiple purposes e.g. play,
  games and communication.
• The use of schematic layout / contextual scenes
  (schema) design with personally relevant content
  for both dynamic and static displays may be
  useful.
• Colour may be useful in designing AAC systems. In
  a natural scene or schematic layout it may
  assist in segmentation, to highlight contrasts
  between objects or to highlight detail and as a
  means of cueing memory.

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AAC Design clinical bottom line

• Location markers or use of specific and
  consistent placement of symbols in an AAC system
  may assist in providing a reminder or prompt
• In the case of simple quick communication it
  may be useful to use a small vocabulary on a
  single level chart.
• The points highlighted above must be interpreted
  with caution as the level of evidence is not
  high. As highlighted in many of the articles
  there is a need for future research into the
  design and layout of AAC systems for young
  children.

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Impact on clinical practice

• Future CATS have commenced on
• The usefulness of AAC systems with schematic
  layout for adults or children who have
  communication disabilities
• The use of core vs fringe vocabulary in relation
  to AAC design
• Investigation as to whether use of colour /
  taxonomic layout makes it easier for the
  communication partner to find vocab therefore
  provide better modelling for the AAC user
  therefore provide more help to learn the system

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Greater numbers of trials of schematic layouts
for dynamic display systems
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Impact on clinical practice

• Need for research
• As the standard of research is not high in this
  area clinicians are encouraged to write up any
  case studies or simple research studies as these
  would contribute significantly to the evidence
  base.

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AAC Dyspraxia (DAS)

• Special thanks for the contributions of all the
  members of AAC EBP Group

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Answerable question

• Is the use of AAC effective in facilitating
  communication in people who have dyspraxia /
  apraxia?

Ovid, Web of Science, PubMed, Handsearching
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Results 5 Articles
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CAP Lane, V Samples, J.(1981)

• Objective
• This study investigated a group of four
  individuals
• and their ability to use Bliss symbols as a
  technique
• for facilitating communication and to learn Bliss
  in a
• group setting
• Results
• This paper found the effectiveness of using Bliss
  
• symbols to facilitate communication was highly
• individualised and time consuming.

Level IV
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CAP Patte, C., Von Berg, S. Ghezzi, P. (2006)

• Objective
• Single case study of a 57 year old female who has
  primary progressive
• aphasia and apraxia of speech
• Trialled both American Sign Language and use of a
  Text to Speech AAC system.
• This study investigated the effect of the above
  on her communicative output
• Results
• The results showed better performance in relation
  to ASL and this was reflected
• in the participants preference for this form of
  AAC. This was a poorly designed
• study.

Level IV
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AAC DAS clinical bottom line

• The search results yielded insufficient evidence
  to guide clinicians in regards to this question.

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Impact on clinical practice

• Continue to use fundamental AAC practices with
  this population until more is known
• Highlight this population as a key area for
  research
• Write up case studies

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NEXT TOPIC.

• Answerable question
• Does use of AAC technology support the
  development of literacy skills?

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• THANK YOU

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AAC design references

• Bredosian, J., Hoag, L. McCoy, K. (2003).
  Relevance and speed of message delivery
  trade-offs in augmentative and alternative
  communication, Journal of Speech, Language, and
  Hearing Research, 46 (4) 800
• Downey, D., Daugherty, P., Helt, S. (2004).
  Integrating AAC Into the Classroom Low-tech
  strategies. The ASHA Leader (36) pp 6-7
• Drager, K. (2003). The Performance of typically
  developing 2 ½ year olds on dynamic display AAC
  technologies with different system layouts and
  language organizatioins, Journal of Speech,
  Language, and Hearing research, 46 (2) 298
• Drager, K. (2004). Learning of Dynamic Display
  AAC Technologies by Typically Developing
  3-Year-Olds Effect of Different Layouts and Menu
  Approaches, Journal Of Speech, Language, and
  Hearing Research, 47 (5) 1133
• Fallon, K., Light, J. Achenbach, A. (2003). The
  Semantic Organization Patterns of Young Children
  Implications for Augmentative and Alternative
  Communication, Augmentative and Alternative
  Communication, 19 (2) 74-85

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AAC design references

• Hochstein, D., McDaniel, M., Nettleton, S.
  Neufeld, K. (2003). The fruitfulness of a
  nomothetic approach to investigating AAC
  Comparing two speech encoding schemes across
  cerebral palsied and non-disabled children,
  American Journal of Speech-Language Pathology, 12
  (1), 110
• Hochstein, D.,McDaniel, M Nettleton, S. (2004).
  Recognition of Vocabulary in Children and
  Adolescents with Cerebral Palsy A Comparison of
  Two Speech Coding Schemes, Augmentative and
  Alternative Communication, 20 (2) 45-62
• Hudson, P. (1979), Recommitment to the Fitzgerald
  Key, American Annals of the Deaf, 124 (3) 397-9
• Light, J. Drager, K, D. (2002), Improving the
  Design of Augmentative and Alternative
  Technologies for Young Children, Assitive
  Technology, 14, 17-32
• Light, J. Drager, K. (2005), R3 Improving AAC
  Technologies for Young Children with Significant
  Communication Disorders, http//www.aac-rerc.com/a
  rchive_aac-rerc/pages/ProjectSite/R3.htm Last
  accessed September 2005

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AAC design references

• Light, J., Drager, K., McCarthy, J., Mellot, S.,
  Millar, D., Parrish, C., Parsons, A., Rhoads, S.,
  Ward, M. Welliver, M. (2004). Performance of
  Typically Developing Four-and Five-Year-Old
  Children with AAC Systems using Different
  Language Organization Techniques, Augmentative
  and Alternative Communication, 20 (2) 63-68
• Light, J., Drager, K. Nemser, J. (2004).
  Enhancing the Appeal of AAC Technologies for
  Young Children Lessons from the Toy
  Manufacturers, Augmentative and Alternative
  Communication, 20 (3) 137-149
• Light, J. Lindsay, P. (1991), Cognitive Science
  and Augmentative and Alternative Communication,
  (7), 186 202
• Mizuko, M. (1987), Transparency and Ease of
  Learning of Symbols Represented by Blissymbols,
  PCS, and Picsyms, Augmentative and Alternative
  Communiction, 129-135
• Mizuko, M., Reichle, J., Ratcliff, A. Esser, J.
  (1994). Effects of Seclection Techniques and
  Array Sizes on Short-Term Visual Memory.
  Augmentative and Alternative Communication, 10,
  237-244.

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AAC design references

• Oxley, J. Norris, J. (2000). Childrens Use of
  Memory Strategies Relevance to Voice Output
  Communication Aid Use, Augmentative and
  Alternative Communication, 16 94
• Reichle, J., Dettling, E., Drager, K., Leiter, A.
  (2000), Comparison of Correct Responses and
  Response Latency for Fixed and Dynamic Displays
  Performance of a Learner with Severe
  Developmental Disabilities, Augmentative and
  Alternative Communiction, 154-163
• Schlegel, R., Spencer, R. Whitbeck, C. (1988).
  Keyboard interface of a speech synthesizer for
  the physically handicapped, Applied Ergonomics,
  19.1, 67-70
• Sevcik, R.A., Romski, M.A. Wilkinson, K.M.
  (1991). Roles of Graphic Symbols in the Language
  Acquisition Process for Persons with Severe
  Cognitive Disabilities. Augmentative and
  Alternative Communication, 7, 161-170.
• Stuart, S. (2000). Understanding the Storytelling
  of Older Adults for AAC System Design,
  Augmentative and Alternative Communication, 16,
  1-12

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AAC design references

• Wilkinson, K. Jagaroo, V. (2004), Contributions
  of Principles of Visual Cognitive Science to AAC
  System Display Design, Augmentative and
  Alternative Communication, 20, (3) 123-136

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AAC DAS References

• Ballard, K., Granier, J. Robin, D. (2000)
  Understanding the nature of apraxia of speech
  Theory, analysis and treatment, Aphasiology, 14
  (10), 969-995
• Bornman, J., Alant, E. Meiring, E. (2001) The
  use of a digital voice output device to
  facilitate language development in a child with
  developmental apraxia of speech a case study,
  Disability and Rehabilitation, 23 (14), 623 - 634
• Hall, P, K. (2000) A letter to the parent(s) of a
  child with Developmental Apraxia of Speech,
  Language, Speech and Hearing Services in Schools,
  179
• Lane, V Samples, J.(1981) Facilitation
  Communication in adult apraxics Application of
  Blissymbols in a group setting, Journal of
  Communication Disorders,14. 157 167

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AAC DAS References

• Ogar, J., Slama, H., Dronkers, N., Amici, S.
  Gorno-Tempini, M.L., 1985, Apraxia of Speech An
  overview, Neurocase,11, 427-432
• Pannbacker, M. 1988, Management Strategies for
  Developmental Apraxia of Speech A review of
  literature, Journal of Communication Disorders,
  21, 363-371
• Patte, C., Von Berg, S. Ghezzi, P. (2006),
  Effects of alternative communication on the
  communicative effectiveness of an individual with
  a progressive language disorder, International
  Journal of Rehabilitation Research, 29151153
• Sevcik, R.A., Romski, M.A. , Adamson, L.B.
  (2004) Case Study Research directions in
  augmentative and alternative communication for
  preschool children. Disability and
  Rehabilitation, 26 (21/22), 1232-1329

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AAC DAS References

• Wambaugh, J.L., (2002), A Summary of Treatments
  for Apraxia of Speech and Review of Replicated
  Approaches, Seminars in Speech and Language, Vol
  23 (4) 293-308