Tackling the Exam's "Aug Comm" Monster

Of all the parts of the ATP exam that worry me - and there is a good handful - the one that scares me silly is augmentative communications. I majored in English in school, but ironically - aside from briefly working with a young boy with aphasia when I was in college a hundred years ago - I had no formal training in the basics of language, speech or the seemingly infinite ways we humans use to communicate with each other every day.

Defining Augmentative Communications

I won't paraphrase all of Cook & Hussey's and Michelle Lange's pages on aug comm - about 50 pages' worth (see Resources sidebar) - but I will touch on the high points to give you an idea of what the suggested exam textbooks cover.

To paraphrase Cook & Hussey, augmentative and alternative communications are designed to provide a way for people with speech and language difficulties to effectively communicate via assistive technology. The reasons for needing aug comm devices vary widely. Some people acquire the need through injury or medical conditions later in life; others are born with a disability. Some people, like clients with CP or ALS, know what they want to say, but have difficulty forming the sounds needed to express their thoughts. Others, like the little boy I worked with, have no problems vocalizing, but have problems coordinating their speech to accurately reflect their thoughts.

Major Aug Comm Topics Covered

Here's an outline of the aug comm themes covered in the Cook & Hussey and Lange textbooks:

• Different augmentative & alternative communications (AAC) solutions exist for different needs. For instance, an adult who spoke normally before having a stroke and is now having difficulty pronouncing words still has a strong understanding of language. That's not the case for a toddler who has never spoken.

• Assessment. Just as with seating & mobility evaluations, potential clients are assessed for their readiness and ability to use AAC devices. Factors such as attention span and understanding cause and effect are crucial in finding the right AAC technology for a particular client. Clients are also accessed for "barriers to participation," what seating & mobility professionals commonly call "accessibility." Finally, clients' future needs are also considered - for instance, how will an ALS client continue to access his AAC equipment when his condition progresses and he can no longer press keys with his fingers? Does the system have "room to grow" as a young child's vocabulary expands and her language abilities improve?

• Types of AAC. From "no-tech" gestures to speech-generating devices (SGD), there are different options depending on a client's abilities, goals and environments. SGDs can use different sets of symbols, from concrete illustrations to more abstract signs.

• System's specs. The AAC system's weight, size, power supply and durability need to be considered in tandem with the client's environment and, if applicable, the seating & mobility system.

• Implementation & Training. AAC equipment needs to be set up - which can include mounting the system safely to a wheelchair without interfering with seating functions, visual field, etc. - and customized to the user's needs.

• Follow-Up. The AAC system is then reassessed and tweaked if necessary to ensure the goals of the client and the larger AAC team are being met.

Aug Comm Appreciation

As I was reading through the aug comm chapters, I recognized many parallels to seating & mobility - AAC systems, too, need to factor in growth and adapt as a client's condition or needs change.

I also have a greater understanding of how and why AAC systems "fit" into an exam for hopeful ATPs. Not only do ATPs need to be able to accommodate Dynavox SGDs on power chairs, but clients can offer so much more input about their seating & mobility systems if they can communicate well.

I still remember the little boy I worked with, and how he pointed at his math paper one day, asking me, "How old are you?" I answered, and he responded, "How old are you?" Around and around we went until I guessed, "That's not really what you want to say, is it?" Tearfully, he shook his head.

How much frustration could he have been spared if he'd had some AAC help?

About the Author

Laurie Watanabe is the editor of Mobility Management. She can be reached at lwatanabe@1105media.com.

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