AAC for high-tech communication

May 27, 2020

Guest blog: Charlotte Purcell, MS, CCC-SLP
Clinical Expertise

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Technology use has permeated just about every level of therapeutic practice, including the discipline of speech-language pathology.

For speech or language-impaired patients, we make use of a number of Augmentative and Alternative Communication (AAC) devices, and some of them are very low-tech! For example, gesturing, written language, and even symbols are all common forms of AAC. Other simple forms can include “Yes/No” boards and picture boards. They are used widely with acutely injured patients or as a stepping stone to more complex devices.

High-tech AAC gives patients a little more flexibility. Here at Siskin Hospital, we have excellent AAC devices, resources and education related to AAC, so patients often seek us out intentionally. Two of the more prominent device companies are Tobii Dynavox and Lingraphica.

Getting an AAC

Individuals can be referred to Siskin Hospital to complete an AAC evaluation by their doctor or the recommendation to pursue AAC can come directly from the speech-language pathologist. Candidates for AAC devices are screened for speech, language and cognition by an SLP, who then writes the evaluation and processes it with other paperwork provided by the SLP team and patient/family members. This paperwork is then faxed to the AAC provider of choice and the patient’s physician. Once the physician approves the recommendation for the device, the payor source is determined; AACs are considered medical devices and insurance may cover all or a portion of the cost.

Based on the patient’s diagnosis, there are certain devices that come to mind. For example, with an ALS patient, we would immediately be thinking about eye gaze devices because of the disease progression when upper limb movement might not be possible. A stroke patient with aphasia may need something smaller and lighter that they would be able to slip in their bag.

Learning how to use an AAC

Before a device can be used, some content onboarding is necessary by either a device company representative or a therapist. Often the therapist and patient will work on developing pages on an in-house device that can then be uploaded to the patient’s device when it arrives. It frequently takes a lot of coordination for a patient to first learn the device, especially in situations of reduced communication skills. Caregivers also need training to develop pages that are most functional according to the patient’s interests and enjoyment.

Generally we utilize games so as to make learning how to use the device more engaging for the patient. We’ll start with something simple and move to something more complex over time: memory games, popping bubbles, finding animals. More adult games might involve playing cards or playing a word game. We might start at a smaller page set or a smaller set of options, and then gradually build how much we’re linking pages and increasing the communication challenge in treatment.

Some of the therapy games are built in and some we develop. Right now I’m seeing a wonderful patient with an amazing family who have built in a game that the patient loves already, so that’s been really fun and motivating for her to use her device more frequently.

More than once a week

To make the best progress, patients are given homework to do at home between office visits. Sometimes it’s as simple as having a conversation about what’s for dinner or describing the day’s events to a family member. Sometimes it’s creating new pages for given upcoming situations, like holidays or doctor’s appointments. The best assignments fit patients’ lifestyles and circumstances.

A challenge patients often experience is dealing with a lot of other distracting stimuli. In an office setting, therapy sessions take place in a quiet environment. At home, it may not be quiet at all. Focusing on the task, despite external distractions, can make the assignment more functional.

Getting the most out of an AAC device

Like most things in life, perseverance and hard work is key to successful AAC device use. It’s not an easy undertaking to get accustomed to alternative forms of communication. Having supportive families or caregivers who have also learned the new technology is helpful. Using the device in areas of life most significant to the patient and using it as much as possible will increase progress. It requires some discipline to use the device as a reinforcement tool; so even if the patient did say the word or phrase out loud, we recommend pushing the button, too.

AAC can act almost like an orthotic for some individuals. For instance, an aphasia patient might develop more language with this extra modality of language by continually practicing. They’ll point at something on the screen, saying the word with it, and it can act to increase the language output. By stimulating and generalizing the device’s use, patients are selecting what they want, and that is continuously motivating!