An Augmentative Communication Evaluation, will be a natural extension of our current Language Evaluation, for functional therapy intervention, when a child is non verbal or minimally verbal. If a parent (or therapy plan) indicates the child would benefit from a specific Augmentative Communication Evaluation in order to request a "Personal Medical Device" in the form of a Dynamic Display Voice Output Device (Speech Generating Device) SGD, then a second evaluation will be conducted. This specific request is a REQUIRED component, in addition to a Device Trial with Objective Data collection, in order to request an insurance or Medicaid reimbursement for a (Speech Generating Device) SGD.

Augmentative Communication - ANY alternative form of communication other than speaking, is considered AAC - Alernative and Augmentative Communication.

Assistive Technology - Adaptive Equipment that allows a user an alternative means of access. Low tech assistive technology would include slant boards to improve visual perception for a student with a visual impairment such as convergence insufficiency. High tech assistive technology could include an eye gaze mechanism that supports a computer interface for a student than is unable to move their hands to access a keyboard or mouse.

Meghan Baulch MS CCC-SLP has received extensive training through the NCATP (North Carolina Assistive Technology Project), device companies (PRC- Prentke Romitch Company, and Dynovox Corporation) as well as continuing education classes to assist pediatric clients with a variety of medically complex conditions, in order to become an efficient evaluator and therapy provider for clients learning to use augmentative communication devices or assistive technology tools.

How do you evaluate a client for Augmentative Communication and Assistive Technology?

To determine equipment for a trial of Augmentative Communication, a thorough patient/client intake form is necessary in order to determine the client's needs, goals and strengths. Looking at the child's receptive language skills, ability to make point finger selections or hand grasp selections, and ability to scan a group of objects or pictures to make choices are the general abilities that need assessed. Some children can only make a selection by smiling when presented with a preferred object. Some children can only make a refusal by pushing or turning their head away from something they dislike. Not all children are ready to be presented with a set of pictures and make a choice. The child's everyday caregivers are often the ones that know "how to communicate," with the child, and it is very important to find out what the child does daily in his/her environment to make choices and indicate their needs.

Can you give examples of types of Augmentative Communication?

Augmentative Communication can be single message buttons, flat communication boards, or high tech voice output device software. 

Augmentative Communication can be picture-object exchange for preferred objects or picture exchange communication with core words/icons.

High tech voice output devices can be trialed that have a variety of size and number of picture/word icons. Some children need discrete trial training, which means only one icon (picture/word) can be shown at a time and paired with a meaningful activity.

In addition to trialing devices, we can use flat communication boards. These are actual printouts of device screens, to determine the number of icons a child can distinguish between.

In addition to trialing devices, we can use apps (LAMP-words for life, Proloquo2go) on a tablet to determine if the child is motivated by the auditory feedback. These apps can also be personalized and the icons/buttons can be enlarged or minimized for accuracy. 

What is Assistive Technology or Adaptive Equipment?

Assistive technology is adaptive equipment necessary to enable a child with a disability to access a medium (written/typed information, computer technology, use of daily equipment necessary for Activities of Daily Living). Assistive technology is determined for each functional task the child has difficulty with. Often, a referral to an Occupational Therapist and/or Physical Therapist is helpful in Adaptive equipment for Activities of Daily Living. I can assist with Eye Gaze and head control devices for access of a voice output device l as I have experience in use of these devices. Assistive technology for computer use, such as voice typing and word prediction software I can also provide therapeutic intervention for. However,  If the child needs extensive equipment for holding utensils, and a variety of hand held classroom tools as well, a referral to an OT would be warranted. 

Is there a standardized assessment tool for Augmentative Communication?

Yes, there are a few standardized assessment tools for determining an appropriate augmentative communication tool for a child. These, often checklists for parents or educational staff, do provide valuable information about the student's strengths and weaknesses.  However, it is often good to find one tool that is motivating, that meets the child's current intellectual level and can easily be manipulated as the child's language grows. 

If a child uses a text to speech, high tech communication app or device, will it stop their motivation to talk verbally?

No, use of a device encourages Verbal Behavior, the use of language to communicate or a function to get their needs met, and exposes a child to a repetitive set of CORE VOCABULARY. They will likely begin verbalizing, if there are no physical barriers to the motor skills required for verbal speech. It is important to allow young, non verbal, children the opportunity to initiate their communication needs. The device or low tech communication board provides that opportunity when their motor skill for speech production is delayed.