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Assistive Technology/AAC Archive 2014

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Betsy A. Caporale, M.S. CCC-SLP-.
Speech-Language Pathologist
AAC/AT Specialist

Betsy has been working in the field of speech-language pathology for over 18 years, specializing in autism, augmentative communication and assistive technology. She has worked in a variety of settings, including public schools, private clinics, and hospitals. She received her certification as an Assistive Technology Specialist, Communication Services, from the University of South Florida, and earned a Certificate of Competency in Communication Assistive Technology Applications from the National Association of State Directors of Special Education.

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  • PECS and the iPad as communication tools

Question:

I am a part of the CAPTAIN Cadre and oversee several Speech Pathologists and am a Program Manager for 6 Special Day Classes in Siskiyou County. I have recently been getting requests for PECS training from both SDC teachers and OTs. Our Speech Pathologists who are experienced with PECS can train these staff members. But before I put together a large training program, I would like your opinion on the direction of the low-tech approaches, such as PECS, while iPads with the wonderful apps and (who knows what other devices are being developed) are becoming so prevalent. I would like to present a more complete overview of communication tools and prepare our staff for changes that may be coming. If you have any ideas or can point me toward any resources, I would appreciate it. Thanks.

Steve


Answer:

Hello Steve,

Ann England, our Assistant Director, passed this question on to me since you are inquiring about Augmentative and Alternative Communication (AAC). You specifically ask about the Picture Exchange Communication System, also known as PECS.

PECS is a very systematic approach to communication and is a product of Pyramid Educational Consultants, Inc. (http://www.pecsusa.com/). They are the exclusive source for PECS training. The PECS approach incorporates the use of applied behavior analysis to develop functional communication skills. PECS employs a standard protocol which must be overseen by a Certified PECS Implementer. One of the essential components of the PECS protocol is the “exchange” of a symbol with a communication partner. Unfortunately, the term PECS is often erroneously used to describe picture communication systems in general. A picture communication system (or PCS) is a low-tech AAC tool that can be implemented across any activity of the school day for a variety of communication purposes including; requesting, choice-making, answering questions or commenting. A picture communication system can be as simple as one or two icons on a single page, or as sophisticated as a multi-page book containing hundreds of icons. The complexity of the system depends on the skill level of the student. Low-tech communication tools such as these are invaluable for students who are not functional verbal communicators. They are practical, user-friendly, inexpensive, and easy to create. Picture systems can also be used as visual supports to help students transition, follow classroom routines, and complete tasks independently. Below are links to several helpful resources for picture communication systems and visual supports.

http://speechlanguageinfo.myefolio.com/notechlowtechaac

http://praacticalaac.org/praactical/5-great-resources-for-communication-boards/

https://www.bridgeschool.org/transition/multimodal/com_boards.php

You have also inquired about use of the iPad as a communication device. You are absolutely correct about the increasing prevalence of this tool for students with complex communication needs. There are now hundreds of AAC apps available from iTunes, ranging from very basic apps for emerging communicators, to apps with robust vocabularies and highly sophisticated language systems. Again, the complexity of the app will depend on the skills sets of the user. Here are two of my favorite resources for AAC apps:

http://www.appsforaac.net/

http://www.janefarrall.com/aac-apps-lists/

Keep in mind that AAC systems for students with complex communication needs should include a variety of modalities, including no-tech (i.e., signs or gestures), low-tech and high-tech. No one tool or device will meet all of the student’s needs across settings and environments.

Thank you for your inquiry Steve, and for being a member of the CAPTAIN Cadre!

Betsy


  • Eye Gaze Hardware

Question:

Hi Betsy:

Can you tell me about more about the portable eye gaze hardware that can be used on laptops and desktop computers? Does it work the same way as the eye gaze systems that are used with Speech Generating Devices? I’m also wondering if this hardware can be use on a Mac Book.

Brian


Answer:

Eye gaze hardware and software has become all the rage in the last couple of years as an alternative computer access method for individuals who do not have full function of their arms and/or hands. This technology allows them to access and control the computer directly with their eyes, a much more efficient method than switch scanning. I had the pleasure of working with a seven year old girl approximately nine years ago who was one of the first to use an augmentative alternative communication (AAC) device that was controlled with eye gaze, the MyTobii. The platform for this device was a personal computer, with specialized hardware and software to enable eye gaze control. Although the technology had been around for several years, Tobii was the first company to apply it to AAC. At that time the device cost approximately $20,000, about the same price as a new car! Fortunately, the technology has come down significantly in price since then, and considerable improvements have been made to both the hardware and software. Using the portable eye gaze hardware you referred to, along with specialized software, you can quickly and easily convert practically any Windows based PC, laptop or tablet computer into an eye gaze-controlled device.

I am familiar with two eye gaze solutions that are portable, easy to use, and relatively inexpensive:

  • Tobii PCEyeGo- this eye tracker replaces the standard mouse with an eye-gaze controlled navigation system. It attaches easily to a desktop screen or laptop using a magnetic mounting bracket and USB connection. Eye gaze tracking software allows you to perform eye calibration quickly and easily directly on the screen. Mouse control software provides a tool box from which to perform functions such as drag and drop, scroll, right/left click, etc. The user can select using a either a dwell feature or a blink feature. The cost for this system is $1995 USD when ordered through their webshop or Amazon. For more information visit their website at: http://www.tobii.com/ATI-pceye.
  • Inclusive EyeGaze Foundations – this eye tracker is available exclusively from InclusiveTLC, a company based in England. Their product runs $1695 USD including two software programs: Attention and Looking, and EyeMouse Play. Like the TobiiPCEyeGo, it is portable and takes just seconds to set up. Option menus allow for the creation of personal assessment and teaching tools. Product specifications can be obtained at: http://www.inclusive.co.uk/inclusive-eyegaze-foundations-p7063

You were also wondering about eye-gaze controlled systems for a MacBook. Unfortunately, this technology is not currently available for any Apple products. However, as many have suspected, they will likely be jumping on the bandwagon soon. In fact, Apple was recently granted a patent for an advanced eye gaze-tracking interface that is designed to be used in Macs, iPhones, iPads, and possibly even Apple TV! Here is the link to an article which describes this technology: http://www.macrumors.com/2015/01/20/apple-eye-tracking-patent/

Thank you for your inquiry Brian. This is an exciting technology trend that is truly life-changing for individuals with motor impairments!

Betsy


  • Process for getting an AAC device from Insurance

Question:

Hi Betsy,

Are you familiar with the process that one would go through to obtain an AAC device through insurance or Medi-cal? I'm not sure where to start with one of my students.


Answer:

Medicare and Medi-Cal (which is California’s version of Medicaid) will often fund Speech Generating Devices (SGDs), but it can be a lengthy process. You will need to work closely with California Children’s Services (CCS) if your student is a client. An Occupational Therapist and/or Physical therapist from CCS will likely be collaborating with you during the assessment process, as well as the CCS physician, who must provide a “prescription” for the device. The assessment report must be written and signed by a licensed speech-language pathologist, although best practice calls for a collaborative team approach. If the student is not a client of CCS and does not receive Medi-Cal, you’ll need to work with the student’s private physician and insurance company. The process is pretty much the same whether you go through private insurance or Medi-Cal. If your student has both private insurance and Medi-Cal you will need to go through the private insurance company first. If they only cover a percentage, Medi-cal will often pick up the difference. In any case, the student is required to trial three different devices to determine a feature match. Once a device has been selected there is a 30 day trial period that is required, and the results of that trial will need to be included in the AAC Evaluation Report. Once you have selected a device, the vendor can assist you with the report-writing and application process. Be aware that Medi-cal/Medicare has recently changed their funding policy. AAC devices must now be acquired on a rental basis initially, which is a bit complicated. I highly recommend that you visit this ASHA website which provides detailed information and helpful links regarding the funding process for SGDs:

http://www.asha.org/practice/reimbursement/medicare/sgd_policy/

My best advice is to work closely with the sales representative from the company that will be supplying the device.

Good luck, and let me know if you have any more questions!

Betsy


  • Augmentative and Alternative Communication (AAC) Roles and Responsibilities in the Schools

Question:

Hi Betsy,

In light of an increased number of requests for AAC assessment, we had a few questions come up in our district. There is not a lot of good information out there on what our roles and responsibilities are as school system employees and speech-language pathologists (SLPs) in regards to AAC assessment. Some sources feel that we are only responsible for evaluating a student's communication as it relates to progress towards IEP goals. Some sources state that we can (or sometimes must) assume the responsibility of evaluating communication needs across environments (school, home, medical, etc...).

My colleague and I feel that there is not a problem evaluating a student across environments and helping parents obtain a device through the appropriate venues, but some of our colleagues disagree. What are the laws on this? What do the experts say? Are there any accepted protocols out there? Any drawbacks we should know about?

My colleague has done a lot of research on this topic but we are having trouble finding any authoritative information. Our workplace does not have any specific guidelines on the topic and our supervisor, who is not an SLP, does not seem clear either.


Answer:

You are not alone in experiencing a significant increase in AAC assessment requests; this phenomenon is occurring in districts nationwide! The increased interest and awareness in AAC is exciting, but can be very daunting for school districts and IEP teams. It’s also problematic for SLPs, since AAC is” unchartered territory” for many of them. Although AAC clearly falls within their scope of practice, most SLPs have had minimal training or experience in this area, and don’t feel comfortable conducting assessments or making decisions regarding AAC.

You are right about the lack of research regarding the role of SLPs in the assessment and implementation of AAC in the school environment; however; ASHA does provide the following documents which offer guidelines and best practices regarding AAC:

I would encourage you to refer to these documents and share them with co-workers.

I would also encourage you to carefully read and share Sec. 300.105 of IDEA (Individuals with Disabilities Education Act) which specifically addresses the provision of Assistive Technology (including AAC) for students with disabilities:

Sec. 300.105 Assistive technology.

(a) Each public agency must ensure that assistive technology devices or assistive technology services, or both, as those terms are defined in Sec. Sec. 300.5 and 300.6, respectively, are made available to a child with a disability if required as a part of the child's--

(1) Special education under Sec. 300.36;
(2) Related services under Sec. 300.34; or
(3) Supplementary aids and services under Sec. Sec. 300.38 and 300.114(a)(2)(ii).

(b) On a case-by-case basis, the use of school-purchased assistive technology devices in a child's home or in other settings is required if the child's IEP Team determines that the child needs access to those devices in order to receive FAPE.

(Authority: 20 U.S.C. 1412(a)(1), 1412(a)(12)(B)(i) )

http://idea.ed.gov/explore/view/p/%2Croot%2Cregs%2C300%2CB%2C300%252E105%2C

I want to stress that an AAC assessment should never be about purchasing a device. Rather, AAC assessment and implementation are ongoing processes conducted collaboratively by the entire IEP team. The goal is to provide practical, functional tools and strategies which enable efficient communication across all environments. This calls for a multi-modality approach which incorporates no-tech, low-tech and possibly high-tech systems, contingent upon the distinct needs of the learner. Also bear in mind that best practice decisions are made by considering not only research, but also the clinical expertise and judgment of qualified professionals, as well as the individual needs and preferences of the student.

Thank you for inquiring about these important issues regarding AAC!

Betsy


  • Using Voice Amplification Systems in the Classroom

Question:

I am a teacher in a public high school in California. I recently received a demand for me to use voice amplification while I am teaching my biology class. My question is: Am I required by law to use a voice amplification device (I assume that is a wireless microphone) while teaching? If there is, could you please refer me to the article of legislation in which it is found?

Thank you in advance for your assistance.

Mike


Answer:

Hi Mike,

Thank you for writing regarding the use of voice amplification systems in classrooms. I’m assuming you have been asked to use an amplification system to accommodate the needs of a particular student (or students) in your classroom. Let me start with a brief description of the types of voice amplification, or frequency modulation (FM) systems typically used in classroom settings.

  • Personal FM System: transmits sound directly from the teacher’s microphone (worn as a headset, lapel, or lavaliere) to an earpiece or headset worn by to the student.
  • Sound field System: transmits sound from the teacher’s microphone to speakers placed strategically around the classroom.

There are benefits to both systems, and determining which one to use for a particular student is an IEP team decision based on the individual needs of the student. A student with a documented hearing loss will likely have specific FM system recommendations made by an audiologist. You will want to work closely with a Deaf and Hard of Hearing (DHH) Specialist to implement this type of system in the classroom.

Voice amplification may also be recommended for other students, including those with ADHD, Speech-Language Impairments, Specific Learning Disabilities, as well as English Language Learners. In fact, classroom amplification can benefit ALL students! There are many benefits for teachers as well, including reduced vocal fatigue and increased student focus.

Once the FM or Soundfield system is in place, it’s up to the classroom teacher and staff to comply with recommendations developed by the IEP team, with support from appropriate service providers (i.e., SLP, DHH Specialist, Audiologist). Bear in mind that if the use of a voice amplification system is written into the IEP, it’s mandated by law that the teacher comply with its use!!

In response to your question regarding legislation, I refer you to Sec. 300.105 of IDEA (Individuals with Disabilities Education Act) which specifically addresses the provision of Assistive Technology for students with disabilities:

Sec. 300.105 Assistive technology.

(a) Each public agency must ensure that assistive technology devices or assistive technology services, or both, as those terms are defined in Sec. Sec. 300.5 and 300.6, respectively, are made available to a child with a disability if required as a part of the child's--

(1) Special education under Sec. 300.36;

(2) Related services under Sec. 300.34; or

(3) Supplementary aids and services under Sec. Sec. 300.38 and 300.114(a)(2)(ii).

(b) On a case-by-case basis, the use of school-purchased assistive technology devices in a child's home or in other settings is required if the child's IEP Team determines that the child needs access to those devices in order to receive FAPE.

(Authority: 20 U.S.C. 1412(a)(1), 1412(a)(12)(B)(i) )

http://idea.ed.gov/explore/view/p/%2Croot%2Cregs%2C300%2CB%2C300%252E105%2C

I hope this helps answer your question Mike!

Betsy


  • Triennial AAC Assessment

Question:

Hi Betsy, 

I have a question regarding AAC system/ device use and Triennials. In the past my district has used a contract company who did an AAC assessment at every triennial. Now that we are moving towards in-house AAC with myself, what do you usually see regarding how to approach this? Do we provide another evaluation for each triennial? Or since the assessment is ongoing, is a progress summary sufficient?

Thanks!!


Answer:

Good question! Whenever I’m asked how long an AAC assessment takes my answer is always the same: Forever! As you know, best practice in AAC implementation requires an ongoing assessment process. The implementation and assessment processes are actually one in the same. The implementation of AAC tools and strategies is highly individualized. The IEP team must continually assess changes in an AAC user’s skills and access methods, while at the same time considering changes in environments and technologies. These considerations in turn help determine which changes, if any, are required in the student’s programming. An AAC assessment is very different than the typical assessment which is done to qualify a student for special education. A psycho-educational assessment is generally conducted using standardized tests to determine if a student is performing at age or grade level expectations. This is referred to as a “developmental approach”. Assessment (formal and/or informal) is done at regular intervals (at least every three years) to determine if the student is making progress and “catching up” to his or her typically developing peers. This will then help determine whether the student continues to require special education services. Alternatively, an AAC assessment is done using an “ecological” or “authentic” approach. The goal is not to “catch the student up” to typically developing peers, but rather to determine appropriate accommodations and modifications which allow the student to be as independent as possible in participating in the learning environment. There is no way this can be done once a year or every three years by a consultant who does not work with the student on a regular basis. AAC assessment and implementation is a collaborative team effort involving all of the people who work with that student, including the parents or caregivers. Hopefully, your student’s IEP team has a detailed AAC Implementation Plan in place. Since this is a “working document” which is updated regularly by the IEP team, it should help guide you in monitoring and assessing progress. I suggest that the best way to report out on the progress of your student is with a progress report based on the IEP goals, which should be closely aligned to the AAC Implementation Plan. A sample AAC Implementation Plan and template are available on our website, www.dcn-cde.ca.gov.

Betsy