Monday, February 13, 2012

What to Expect in an AAC Assessment

A formal evaluation by a speech-language pathologist may be necessary before an appropriate augmentative and alternative communication(AAC) is acquired; e.g., if Medicare funding is necessary to cover the cost of the device. Assessments for AAC strategies are somewhat different for children and for adults. This article covers what to expect and look for in evaluations for either audience.

AACEvaluations for Children

The Individuals with Disabilities Education Act (IDEA) definition of assistive technology covers "[a]ny item, piece of equipment, product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities." According to the National Early Childhood Technical Assistance Center, this definition includes AAC. Because the IDEA definition of assistive technology also specifies the need for an evaluation, AAC evaluations are covered by IDEA.
The PBSParents Inclusive Communities website has a page on How to Get an AAC Assessment. Suggested resources include the child's school district and the speech/language therapy departments of local postsecondary institutions.
The University of Nebraska YaacK website suggest four basic questions that should be at the core of any AAC assessment:
  • "What are the child’s communication needs or goals?
  • "What are the child’s strengths and abilities?
  • "What barriers are preventing the child from achieving his or her full communication/participation potential?
  • "What aids and adaptations (e.g. AAC devices or systems, environmental modifications, policy changes, etc.) will best accomplish the child’s goals given his or her strengths and abilities, and current circumstances?"
The YaaCK site also points out that the mutable nature of a child's needs, including their growth, changing communication strategies, and expanding environments, should be taken into account when providing an assessment.
Michael Gamel-McCormick and Stacy Dymond have created a Augmentative Communication Assessment Protocol for Symbolic Augmentative Systems checklist which provides specific questions to be addressed during an evaluation. Most of the questions would also be relevant for an assessment for a text-based system.

AAC Evaluations for Adults

There are no general parallels to IDEA for adults in terms of requiring the provision of AAC devices or evaluations. For adults who are employed or seeking employment, AAC devices are likely to be considered "personal devices" on a par with wheelchairs, glasses, or hearing aids, and the employer therefore does not have an obligation to provide them.

In many cases, adults being evaluated for AAC use will have prior language skills but have acquired a disability that makes using these difficult. These disabilities can include stroke, traumatic brain injury, ALS, and multiple sclerosis. In other cases, the adult may have a congenital condition such as cerebral palsy but may not have had a prior opportunity for an evaluation. Evaluations are generally performed by a speech-language pathologist affiliated with a hospital or university or in private practice.

Once the need for a communication aid is determined, an evaluator needs to figure out what type of device will be most appropriate. The Augmentative Communication, Inc. website lists several considerations for adult evaluations, including the ability to independently generate messages, the need for storing preprogrammed messages, the optimal access strategy (e.g., whether switchuse is required), and whether the user is likely to benefit from a trial period using one or more device options. The Speech Pathology Guru site provides an example of one type of report that may be generated as the result of an adult AAC evaluation.

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