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 ID: 698264
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Slide1
AAC EBP GroupThe many environments of AAC - Which are most effective?
Presented by:
Trisha Khatri (ADHC Hurstville)
Clare Thomson (ADHC Parramatta)Slide2
How we decided what to CAT
2013: Investigated the barriers and facilitators to AAC use, but did not do a CAT.
2014:
Group members all conduct AAC intervention in different environments.
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.
Investigated environmental factors in more detail
We also investigated some of the benefits of AAC, but did not do a CAT for this topic.Slide3
Clinical Question
In children learning to use Augmentative and Alternative Communication, which environment is most conducive to successful implementation?
http://www.marion.k12.fl.us/dept/ssp/trn/
https://picasaweb.google.com/Soniasnucelo/ManualDeLaMaestraPreescolar#5405287584932050786
http://web.up.ac.za/Default.asp?ipkCategoryID=9751&subid=9751
http://becuo.com/nice-beach-houses-clipartSlide4
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.Slide5
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 experienceSlide6
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?Slide7
Results6 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 IVSlide8
Strengths & Limitations of Research
St
rengths:
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)
http://sample.campusmag.in/2014/03/20/invest-in-your-strengths-and-delegate-your-weakness/Slide9
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 LineSlide10
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
.
http://sidelinesportsreport.com/this-weeks-thumbs-up-and-thumbs-down-in-sporting-news/Slide11
Questions?
http://computerwallpapers.org/question-mark-wallpaper-11.htmlSlide12
Next Year
In 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
Slide13
References
Included 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.