Making Evidence-Based Decisions about Speech Generating Devices and Apps Celeste Helling, M.A., CCC-SLP, ATP North Carolina Assistive Technology Program Elizabeth (Libby) S. Rush, MA, CCC-SLP, CPM AAC & AT Consultant in Private Practice
Session Agenda
Apps and AAC Culture SGD Selection Process Evidence Based Practice How Does iApp Consideration Fit In? Resources
On The CD Complete Presentation Documents
• • • • • •
AAC App Review Worksheet AAC Apps Feature Comparison (Crawford & Watson) iPhone/iPad Apps for AAC (Jane Farrall) Resources for AAC and other Apps (Libby Rush) Mobile Devices & Communication Apps An AAC-RERC White Paper 12 Benefits Of An “All-inclusive” AAC Device Provided By AAC Manufacturers
Website Links
• • • • •
AAC Apps for Android Apps for Special Needs AppsForAAC Going Mobile - Apps for Life iPhone/iPad Apps for AAC : Spectronics - Inclusive Learning Technologies • Apps for Children with Special Needs
Pre-Session Q&A Who of us are currently using AAC Apps? Who of us have clients bringing in their apps to them
and asking for support? Who of us have had consumers or their families purchased mobile technology and AAC apps even though it is not the appropriate system for the them? Do you see Apps as FAB or FAD? Are your clients having success with Apps? How many are having difficulty keeping up with apps?
Apps and AAC Culture The introduction of AAC apps on mobile
devices has dramatically changed the options available for persons with complex communication needs and their caregivers. Parents, consumers and caregivers are empowered to make isolated decisions regarding what AAC system to be considered and able to take charge with obtaining the equipment as an affordable alternative to traditional speech generating devices (SGD”S).
Apps, App Design and AAC Culture Vendors of traditional SGD’s are creating Apps
that are extensions of their AAC products and expertise and therefore their designs reflect their language representation models. As mobile technology platforms have changed the developers of Apps must have a commitment to maintaining compatibility to current technologies and platforms. Some developers are making Apps accessible to interventionists.
Apps and AAC Culture AAC evaluations should never set out to
answer, “Which app is the best” but rather “What augmentative communication tools and strategies will best meet the needs of the individual” This means that AAC apps are included as a part of the options to be considered and evaluated during the feature match process
Apps and AAC Culture The goal of augmentative and alternative
communication is about enhancing the communication capability of a person with complex communication needs, not the hardware. The augmentative communication needs of an individual with complex communication needs must be evaluated on a case-by-case basis using clinically based assessment methods Keeping a clinically sound perspective of AAC and new technologies is crucial to clinical outcomes and consumer satisfaction.
Apps and AAC Culture “Communication for people using AAC devices must be more than just functional. It must be built on language”.
Gail Vantatenhove
Question For AAC Teams What are the features between traditional SGD’s and Apps that AAC teams should be looking at as part of the evaluation process?
Traditional SGD’S Language Representation Considerations • Researched based language systems such as Unity, Word Power, Gateway, InterAACt • Communication rate improved for generative communicators • Language systems typically follow a developmental model • Consumer growth can occur by incrementing the display complexity instead of relearning new display organization and/or hardware • Include comprehensive syntax and morphology components
Traditional SGD’S Language Foundation For Literacy • Commercial products for integrating AAC and literacy development Teaching Tools
• Hide/show keys • Vocabulary Builder • Emulation software for creating teaching materials and cued support • Comprehensive Libraries • AAC Language Lab • Dynavox Teaching Tools
Traditional SGD’S Access Considerations • Multiple Access Methods • Support industry available access devices, such as common switch I/O, virtual mouse (HeadMouse, Tracker) • Keyguards are available for ALL configurations • Generally able to accommodate changing access needs • Support for wide range of mounting systems for diverse and unique positioning needs
Traditional SGD’S Sensory Considerations
• Screen size • Auditory selection feedback • Auditory Scan • Preview button selection
• Visual selection feedback • Magnified highlight • Frame highlight • Inverse highlight
• Custom size & layout for perception, discrimination, neglect issues
Traditional SGD’S Environmental Controls
• IR and X-10 control options accessible within the communication display • Telephone accessible within the communication display using a mobile card OR speaker phone • Higher quality speech output • Better volume options for telephone
Traditional SGD’S Hardware Features • SGD hardware is considered to have better durability and longer average use span • Touch screens engineered for environmental stress • Highly durable casing • Bracket options for industry standard mounting
Traditional SGD’S Dedicated SGD’s Meet DME
Criteria For Funding • Computer functions are “locked out” • Not able to install or use other software
Traditional SGD’S 12 BENEFITS of an “ALL-INCLUSIVE” AAC DEVICEPROVIDED BY
AAC MANUFACTURERS Compiled by the ATIA – AAC SIG
• Define “All-Inclusive AAC devices” or SGD’s • Traditional SGD’s • • • • • • • • • •
Based on extensive research and development. provide a variety of access and input methods. Manufacturers usually provide funding assistance and support. Manufacturers usually provide long – term customer and technical support /training. Manufacturers usually have local support. Most SGD’s include a variety of premade vocabulary /communication applications. Many manufacturers provide support and training for programming and customizing vocabularies. Hardware upgrades and available accessories enhance communication. Most AAC device manufacturers have been in business for at least 5 years, and some longer than 30+ years. AAC manufacturers work closely with SLP’s to meet the requirements of many funding source.
Pro’s of Mobile Tech & Apps Easy to obtain Highly portable Relatively low cost Empowers family and consumer Based on mainstream technology Intuitive to use across age and
disability
Pro’s of Mobile Tech & Apps Use is considered to be more “peer-like” and
“peer accepted” Can be very motivating especially with the wide variety of Apps that engage user and support use of the technology One part of “arsenal of assistive technology” Can be used either as a complete or supplemental SGD Useful for a range of assistive needs, from picture schedule systems to GPS tools, minimizing the need for multiple AT items.
Con’s of Mobile Tech & Apps Durability Limited accessibility Quality control issues “Buyer Beware” purchase Does not meet criteria for DME Lack of technical support and training Multiple functions can be distracting for some Limited growth potential within individual apps Generally less customizable than dedicated
SGD’s
Con’s of Mobile Tech & Apps Loss of time in language development or rehabilitation Purchases made without clinical recommendation or
guidance Limited opportunities for “hands on” evaluation of hardware & apps Even the most competent apps involve a very high burden for programming and customization. Impression that the system is so inexpensive, it is disposable – can lead to poor decision making / uninformed purchases When AAC is not successful, begins to lay the foundation for disinterest and feelings of being unsuccessful - disinterest
SGD’s, Mobile Tech & Apps
What does all this mean to the AAC Evaluation Process?
SGD’s, Mobile Tech & Apps
Not As Much As You Would Think!
Components Of AAC Assessment Developing a language representation
model Identification of communication needs/barriers Evaluate / determine current communication methods Past experiences using AAC symbols, strategies, boards, or devices Environmental and communication partners factors Speech Generating Device (SGD) feature match
EBP In AAC Assessment Evidence Based Practice (EBP)
Decision Making Process • • • •
Focus on developing a well-built question Selecting evidence sources Examining and synthesizing the evidence Applying the evidence
EBP In AAC Assessment Evidence Based Practice In AAC
Requires Three Types Of Information • Knowledge about the client • Knowledge about best practices • Knowledge about devices, technology and systems
EBP In AAC Assessment Evidence Based Decision-Making
Includes: • Clinician’s expertise • Consumer’s values and preferences • Current research evidence
Feature Matching In The AAC Assessment Predictive assessment that attempts
to match: • The language representation and hardware features of AAC systems • The access methods of AAC system • The feedback methods of an AAC system • To the current and future capabilities and needs of individuals with complex communication needs
Feature Matching In The AAC Assessment AAC Feature Matching: Features To
Consider • Type and number of messages, vocabulary size, coding •
•
• • • •
system, symbol sets, message retrieval. Size, layout, system memory, optical indicators, auditory prompts, rate enhancement, programmability, computer compatibility. Type of input method (e.g., switches, mouth stick, head pointer, alternative keyboard, and direct selection, scanning, encoding). Type of output (e.g., speech, print, LCD, Braille). Mounting and portability. Extent of training required to use the system and availability of training and technical assistance for its use. Availability of customer service by manufacturer or supplier.
Feature Matching In The AAC Assessment How Does Feature Matching Fail The AAC
User? • Focus is solely on current needs and abilities without considering anticipated future needs and capabilities. • AAC team overemphasizes (caught up) with device features. • Fails to take into account the user’s preferences while negotiating a device recommendation that will support current or future abilities for generative communication.
AAC Apps In The Feature Match Process Identify the person’s strengths and needs (current
and future) and match to the most appropriate tools and strategies. If assessment outcome supports consideration of iDevice platform as a primary or secondary communication tool then: • Clinician’s must know available communication apps and be able to compare features of communication apps. • Clinician feature matches the person’s needs and strengths to the specific features of all available communication apps. • Functional evidence based clinical trial is conducted to assess the appropriateness of selected app(s) to communication needs. Gosnell, Jessica, Costello, John, Shane, Howard Using a Clinical Approach To Answer "What Communication Apps Should We Use?” Perspectives on Augmentative and Alternative Communication 2011 20: 87-96
Mobile App Features Speech Output
• Digital • Synthesized • Combination Selection Feedback
• Auditory • Visual • Magnified Highlight • Frame Highlight • Inverse Symbol Highlight
Mobile App Features Language Representation
• • • •
Photographs Clip Art Internet Art Import Symbol Set • PCS • SymbolStix • Other
Spelling Methods
• Rate Enhancement Techniques • Text Completion • Word Prediction • Abbreviated Expansion
Mobile App Features Communication Display • Single Message • Sequential Messages • Grid Display • Fixed • Static • Dynamic
• Customizable • Static • Dynamic
• Visual Scene Display • External Editing Availability • Page / Content Sharing
Mobile App Features Access Methods Supported
• Touch • Touch Enter • Touch Release
• Scanning Methods • Linear Scan • Step Scan • Auditory Scan
• Mobile apps do not support virtual or alternative mouse interfaces
Mobile App Features Needed Accessories • Stylus • Keyguard • Protective Case • External Speaker • Mounting / Positioning • Switch Interface / Switches • Optional or Others Platform • IOS iPod /iPhone • IOS iPad • Android • Windows Mobile
Tools For Decision Making www.aactechconnect.com has reviewed 100+ AAC
Apps and narrowed down the number to quality Apps which meets the following criteria: • Must use voice output. • Must be an App to augment communication with pictures &/or • • • • • •
spelling. Must be customizable (i.e. able to add pictures for picturebased Apps and phrases for spelling Apps). Must have a website with easy to locate information about the specific App. Must currently be available on iTunes. Developers must respond to questions emailed to them. Meets most of the criteria and is judged to be a unique and valuable App to consider. Absence of negative technical reviews.
Tools For Decision Making Overview of iOS AAC Apps, Jennifer Marden, MA
CCC-SLP www.technicallyspeaking-slp.com AAC Apps: The Good, the Bad, the Ugly-Fall 2011, Nick Weiland, M.A., CCCSLP, Ohio Center for Autism and Low Inciden ce Sorting through AAC Apps, 2011 * Fonner & Marfilius * www.scottmarfilius.com * www.kellyfonner.com i-gotta i-product & i-wanna talk!, 2011 * www.kellyfonner.com * www.scottmarfilus.com Resources for AAC and other Apps, Libby Rush App Review Worksheet, Celeste Helling & Libby Rush
After The Device Recommendation Goals for communication intervention • Family supports • Community supports • Educational supports • Occupational, physical, speech therapies Identify communication
partners Methods needed to support communication partners AAC follow-up and follow along services
Post-Session Q&A How can interventionists provide clinical input to
the App developers? How do interventionists forge relationships with families, caregivers and consumers to assure that those with complex communication needs seek out assistance from trained professionals? Where and how can interventionists gain and update knowledge about these technologies? How do interventionists support formal investigation into the efficacy of mobile technology, Apps and additional technology supports?
References
Crawford, Stephanie, and Phyllis S. Watson. "AAC Apps Feature Comparison." Web. 15 Sept. 2011. Farrall, Jane. "IPhone/iPad Apps for AAC | The Spectronics Blog." Spectronics - Inclusive Learning Technologies. Web. 15 Sept. 2011. . "MOBILE DEVICES & COMMUNICATION APPS An AAC RERC White Paper." AACRERC. Web. 15 Sept. 2011. Beukelman, D.R., & Mirenda, P. (2005). Augmentative and alternative communication: Supporting children and adults with complex communication needs (3rd ed.). Baltimore: Paul H. Brookes Publishing Co. Gosnell, Jessica, Costello, John, Shane, Howard Using a Clinical Approach To Answer "What Communication Apps Should We Use?” Perspectives on Augmentative and Alternative Communication 2011 20: 87-96 Helling Celeste and Rush Elizabeth (Libby). New Ways to Jump Start Your AAC Evaluation Process: Including a Free Evaluation Protocol and Cost Effective Items for an Updated Toolkit. Closing The Gap 2010 Schlosser, R. W. (2004, June 22). Evidence-Based Practice in AAC. The ASHA Leader. Helling, C. and Rush E., Making Evidence-based Decisions About Speech Generating Devices And Apps. Closing The Gap Solutions. Scheduled for publication Dec. 2011/Jan 2012. Brady, L. (2011) Apps for Autism: An Essential Guids to Over 200 Effective Apps for Improving Communication, Behavior, Social Skills and More. Arlington, TX: Future Horizons, Inc.
Celeste Helling, M.A., CCC-SLP, ATP North Carolina Assistive Technology Program
[email protected] Elizabeth (Libby) S. Rush, MA, CCC-SLP, CPM AAC & AT Consultant in Private Practice
[email protected] © 2011
