AAC EBP Group

The many environments of AAC

- Which are most effective?

Presented by:Trisha Khatri (ADHC Hurstville)Clare Thomson (ADHC Parramatta)

How we decided what to CAT

● 2013: Investigated the barriers and facilitators to AAC use, but did not do a CAT.

● 2014: o Group members all conduct AAC intervention in

different environments.o Decided upon an extension of 2013’s topic as it

covered a large area of research that is of interest to all members of the group.

o Investigated environmental factors in more detail● We also investigated some of the benefits of AAC, but

did not do a CAT for this topic.

Clinical QuestionIn children learning to use Augmentative and Alternative Communication, which environment is most conducive to successful implementation?

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Literature Search● Databases used: Medline, Proquest, ERIC, Psychinfo,

OVID, EBSCO, Google Scholar, Scopus, Cinahl and Pubmed.

● Search terms used: clinic, school, home, respite, community access, preschool, child care, early intervention, AAC, augmentative and alternative communication, low technology AAC, high technology AAC, multimodal, functional approach, clinical approach, successful implementation.

● 36 papers were summarised.

● Light (1989) proposed that “communicative competence is the ability to functionally communicate within the natural environment and to adequately meet daily communication needs”

● The World Health Organizations’ (WHO) International Classification of Functioning, Disability and Health

● Many barriers and facilitators to AAC implementation are environmental factors.

Main points from literature search and clinical experience

Main points from background reading and clinical experience

● “Lots” of low level evidence in a number of environments.

● Very little evidence comparing environments.

● Is there a particular environment that appears to be most conducive to AAC implementation based on barriers and facilitators within it?

● Do different environments encourage the development of particular skills?

Results

6 papers were CAPped to answer the clinical question.

Reference Environment AAC method Level of Evidence

Van Der Schuit, Segers, Van Balkhom, Stoep & Verhoeven (2010).

Home and day care Manual sign systems, combination of speech and manual signs, graphic symbols, and VOCAs.

Level IV

Cosbey & Johnston (2006).

Inclusive Classroom Single switch voice output communication aid (VOCA).

Level III-3: (Multiple baseline probe design across 3 subjects)

Stoner, Angell & Bailey, (2010).

Inclusive school Dynawrite (VOCA) Single case study

Dodd & Hagge. (2014).

Intensive 2 week AAC camp.

Nonelectronic communicator displays, communication books, static display speech generating devices, manual signs, and picture symbols.

Level III-3

Clarke, McConachie, Price & Wood. (2001).

Participants only interviewed in school setting.

VOCAs, low-tech AAC including at least 20 symbols, pictures or written words.

Level IV: qualitative interviews

Brady, Thiemann-Bourque, Fleming & Matthews, (2013).

School and home Speech, Sign, PECS and Speech Generating Devices (SGD)

Level IV

Strengths & Limitations of Research

Strengths:● A broad range of disabilities were presented● A broad range of AAC was discussed● Stage of schooling of participants across the board

Limitations:● Low level evidence● Small sample sizes ● Limited statistical analysis● No cross comparative studies (ie: comparison of environments)

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● There has been no research that compares the most suitable environment for AAC intervention in children, however there has been low level research conducted in but not across a variety of environments with successful outcomes.

● It was noted that there were a range of other factors that appeared to impact successful implementation including a collaborative team approach, adequate communication partner training and input from AAC user.

Clinical Bottom Line

Recommendations

● There is no concrete evidence from articles appraised that would warrant using one environment over another for AAC intervention in children.

● More research evidence and evidence on clinical practice is required before further recommendations can

be made.

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Questions?http://computerwallpapers.org/question-mark-wallpaper-11.html

Next YearIn 2015 we will be trialling use of video conferencing in place of face to face meetings

For more information contact:

● Ashleigh Colombini: acolombini@cerebralpalsy.org.au

● Mitchel Hurdis: mhurdis@gmail.com

ReferencesIncluded in the CAT:

Brady, Nancy C; Thiemann-Bourque, Kathy; Fleming, Kandace & Matthews, Kris (2013) ‘Predicting Language Outcome for Children Learning Augmentative & Alternative Communication: Child and Environmental Factors’ Journal of Speech, Language & Hearing Research 56 (5) pp. 1595-612

Clarke, M., McConachie, H., Price, K., & Wood, P. (2001). Views of young people using augmentative and alternative communication systems. International Journal of Language and Communication Disorders, 36, 107-115.

Cosbey, J.E., Johnston, S., (2006). Using a single switch voice output communication aid to increase social acces for children with severe disabilities. Research and Practice for Persons with Severe Disabilities, 31(2), 144-156.

Dodd, Janet. L & Hagge, Darla. K (2014) ‘AAC camp as an alternative school-based service delivery model: A retrospective survey’ Communication Disorders Quarterly 35 (3) pp. 123-132.

Stoner, JB, Angell, ME & Bailey, RL (2010) ‘Implementing augmentative and alternative communication in inclusive educational settings: a case study’ AAC: Augmentative and Alternative Communication 26 (2) pp. 122-35

Van der Schuit, M., Segers, E., van Balkom, H., Stoep, J., and Verhoeven, L. (2010). Immersive communication intervention for speaking and non-speaking children with intellectual disabilities. Augmentative and Alternative Communication, 26, 203-220.

References for background question available on request.