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Apps for AAC Adding iPads to your AAC Toolkit Jane Farrall, Janelle Sampson and Kelly Moore

Apps for AAC - Adding iPads to your AAC Toolkit Part 1

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Pre-conference workshop presented at the AGOSCI Conference 2013

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Page 1: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Apps for AAC Adding iPads to your AAC Toolkit

Jane Farrall, Janelle Sampson and Kelly Moore

Page 2: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Outline – ‘til morning tea….

�  What we know

◦  Evidence base in AAC

◦  Key Frameworks

◦  Relevant research to consider

�  Benefits and Limitations of the iPad

�  Types of Apps

�  A process for selecting and setting up apps

�  Review – the good, the bad and the ugly.

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What do you love about your favourite app?

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What frustrates you about any apps you have used.

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What we know (AAC)….. � Evidence base ◦ Approximately 40 year history

◦  Significant body of evidence on which we base our practice (incl. published systematic reviews)

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•  Non-electronic forms are also important

•  Communication is multi-modal

•  Important considerations for vocabulary selection and arrangement

•  Core and fringe

•  Pragmatic functions

•  Visual considerations

•  Scanning v’s direct access

•  Attitudes, skills and knowledge of communication partners is important.

•  Voice output supports speech development

What we know about supporting communication…

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•  A system needs to be for today and tomorrow. (Beukelman & Mirenda,

2005)

•  Nothing is perfect before you use it

•  Not limited to face to face communication (Raghavendra et. al., 2012)

•  Needs vary depending on partner and situation (Blackstone and Hunt-Berg,

2003)

•  MODEL MODEL MODEL – Aided Language Stimulation (Goossens’,

Crain & Elder, 1992)

•  MAKE IT REAL!!!! (Participation focus)

What we know about supporting communication…

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Key Frameworks �  Participation Model – Beukelman and Mirenda (2005) along with

COPM (Law et. Al., 2000) or other discussion of preferences for

activities and interests

�  Janice Light’s definition of communicative competence (1989) –

operational, linguistic, social, strategic - (AAC Profile. Kovach,

2009)

�  Social Networks assessment (Blackstone and Hunt-Berg, 2003)

�  Pragmatic Profile – (Dewart and Summers, 1995).

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• The aim of any communication system is for the person to meet his/her varied communication

requirements as

• Intelligibly – easy for communication partners to understand and listen..

• Specifically – to make the exact message clear (near enough is not always good enough)

• Efficiently – time, ease of access, likelihood that others will take listen

• Independently

• In as socially valued manner as possible – being part of the group, regarded by others .

• To understand others and to be understood. -

• Porter, G, (1997).

Key Frameworks

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Research: Success versus Abandonment of AAC

Factors impacting long-term success

�  Person who uses AAC system experiences success 91.76%

�  Degree to which the system is valued by the user and partners as a means of communication 90.58%

�  System serves a variety of communicative functions 89.85%

�  System is used for communication, not just as a toy or therapy tool (Real communication) 87.20%

�  Other areas:

◦  Appropriate device selected

◦  Support for system

Johnson, et al. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC

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Research: Success versus Abandonment of AAC

Factors leading to inappropriate abandonment.

�  Communication partners believe they can understand message without AAC (not solving anything) - 77.75%

�  Insufficient opportunities - 76.80%

�  User prefers a simpler means of communication (effort higher than outcome) 70.02%

�  Vocabulary does not meet individualized daily living needs 67.70%

�  Other areas ◦  Lack of support – training, time for programming, knowledgeable

professionals,

◦  Time!!!!

◦  Motivation

Johnson, et al. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC

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Communication challenges? �  If technology (or any kind of AAC) is not being used to meet a

communication challenge, it is not going to be used.

�  Don’t solve a problem that doesn’t exist. Who really needs Picnic Pants????

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Research: ‘‘When I First Got It, I Wanted to Throw It Off a Cliff ’’: (reflections from adults who use AAC)

�  Discusses the importance of: ◦  Autonomy

◦  Real life experiences

◦  Not just requesting!!!

◦  Communication Partners

◦  Practice, learning and opportunities

◦  Role models/modelling

Rackensperger, et. al. (2005). ‘‘When I First Got It, I Wanted to Throw It Off a Cliff ’’: The Challenges and Benefits of Learning AAC Technologies as Described by Adults who use AAC

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Opinion Papers: Mobile Devices �  RERC White Paper: ◦  “partnering will serve the AAC professional

better than resistance”

◦  “There is a real danger of succumbing to the media’s interest in smaller, faster, more powerful devices, and ignoring the other features (customizability, learnability, durability, supports for training) that are critical to successful use of AAC”

Mobile Devices and Communication Apps. (2011). White Paper. Gosnell, J., Costello, J. & Shane, H. (2011). Using a Clinical Approach To Answer “What Communication Apps Should We Use?.

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Assistiveware survey - Taking the Pulse of Augmentative and Alternative Communication on iOS

�  Showed that AAC apps for iPad led to improvements in communication but with the following challenges:

Niemeijer, Donnellan & Robledo, (2012).. Taking the Pulse of Augmentative and Alternative Communication on iOS http://www.assistiveware.com/taking-pulse-augmentative-and-alternative-communication-ios

•  Professional support (availability and knowledge/skills).

•  Limited use of pragmatic functions –eg.

starting and changing a conversation.

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Bottom line……. �  We know what we are doing in AAC but not all

developers look at this when creating apps.   �  There is a need for better implementation of

AAC apps to ensure positive outcomes.

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APPles and Oranges.. �  Example 1 ◦  We know that category based AAC organisation slows down communication

and impedes the development of language and communication skills ◦  We have known this since the 80s ◦  Despite this, around 60 of the AAC Apps on the App store (at the time of

writing) are straight category based apps �  Example 2 ◦  We know that voice output encourages speech development ◦  Some app developers don't include speech in their AAC Apps claiming that

this is because speech output will impede speech development �  Example 3 ◦  We know that providing an AAC system at all times and modelling use of the

system throughout the day in multiple situations leads to maximum language development and best outcomes

◦  In the instructions for several AAC Apps users are advised to allow access to the user only a couple of times a week until they become more competent

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So, don’t let the APPle fall too far from the tree!

�  Although apps are cheap, we are not just wasting money with the wrong apps.

◦  Time… Valuable time!

◦  Opportunities

◦  Attitude – user and communication partners

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Benefits of mobile devices… •  Cool factor and general acceptance

•  “There’s an app for that!!” – over 290 apps for AAC

•  Real life models of use – much more than other devices

•  Always with you – for other uses

•  Portable

•  Battery life

•  Other uses

•  Relatively cheap

•  No Gatekeepers

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Limitations and disadvantages •  Distractions

•  Speakers

•  Apps don’t ‘link’……yet.

•  Durability

•  Some limits in accessibility features

•  Ongoing change

•  Attractiveness to other kids (good and bad)

•  No gate-keepers (good and bad)

•  Less documentation and R&D behind them

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Types of Apps Comprehensive AAC Apps ◦  Symbol based only ◦  Symbol and text based. ◦  Text only

Specific situations or activities ◦  Eg. Phone calls, games, etc.

Pre-planned or sequenced messages �  Eg. Reciting, counting, social scripts

Initiating or encouraging interaction ◦  Eg. Intro strategy, getting attention, partner focussed questions, conversation starters

Fringe vocabulary ◦  Movies, friends, maps

Sharing information and chat books ◦  Specific for this purpose or mainstream eg. iMovie

As the activity itself Comprehensive apps can usually do most of these

functions too

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A Process for Selecting Apps

Created 12/09/2012 : Janelle Sampson - [email protected]

CHOOSING APPS FOR COMMUNICATION

What do you want to do? (goal or

communication challenge)

What communication is required and with

who?

How do you envisage your (or your child's)

participation?

What can you/they already do?

What do you/they need to add?

Priorities and compromises.

(See attached list)

Is the iPad the best way to acheive this?

I need an app that does .........

List possible apps and pros and cons. Use feature comparison

charts. Select app for trial.

Set up preferred app and prepare for situation.

MODEL, ROLE PLAY AND PRACTICE USE , Modify, update, USE

Consider preferences, issues, breakdowns, compare with others,

etc

Is the iPad the best option? What other modes might be used for

participation in this setting.

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Summary of key points and how they relate to selecting apps. � 

◦ 

�  Consider social networks

�  Consider practicalities and other realities

�  Multi-modal

�  Meet communication challenges

�  Feature matching

�  Vocabulary considerations

�  MODEL MODEL MODEL

�  Learn in natural contexts - practice and modify

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Summary of key points and how they relate to selecting apps.

�  Need to address participation needs and pragmatic functions

� 

�  Consider practicalities and other realities

�  Multi-modal

�  Meet communication challenges

�  Feature matching

�  Vocabulary considerations

�  MODEL MODEL MODEL

�  Learn in natural contexts

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Page 27: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps. �  Need to address participation needs and pragmatic

functions �  Consider social networks � 

�  Multi-modal �  Meet communication challenges �  Feature matching �  Vocabulary considerations �  MODEL MODEL MODEL �  Learn in natural contexts

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Page 29: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps. �  Need to address participation needs and pragmatic

functions �  Consider social networks �  Consider practicalities and other realities � 

�  Meet communication challenges �  Feature matching �  Vocabulary considerations �  MODEL MODEL MODEL �  Learn in natural contexts - practice and modify

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Page 31: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps. �  Need to address participation needs and pragmatic

functions �  Consider social networks �  Consider practicalities and other realities �  Multi-modal � 

�  Feature matching �  Vocabulary considerations �  MODEL MODEL MODEL �  Learn in natural contexts

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Page 33: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps. �  Need to address participation needs and pragmatic

functions �  Consider social networks �  Consider practicalities and other realities �  Multi-modal �  Meet communication challenges � 

�  Vocabulary considerations �  MODEL MODEL MODEL �  Learn in natural contexts

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Page 35: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps.

�  Need to address participation needs and pragmatic functions

�  Consider social networks �  Consider practicalities and other realities �  Multi-modal �  Meet communication challenges �  Feature matching � 

�  MODEL MODEL MODEL �  Learn in natural contexts

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Page 37: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps. �  Need to address participation needs and pragmatic

functions �  Consider social networks �  Consider practicalities and other realities �  Multi-modal �  Meet communication challenges �  Feature matching �  Vocabulary considerations �  MODEL MODEL MODEL – Aided Language Stimulation �  Learn in natural contexts

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Page 39: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

Summary of key points and how they relate to selecting apps.

�  Need to address participation needs and pragmatic functions

�  Consider social networks �  Consider practicalities and other realities �  Multi-modal �  Meet communication challenges �  Feature matching �  Vocabulary considerations �  MODEL MODEL MODEL � 

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Page 41: Apps for AAC - Adding iPads to your AAC Toolkit Part 1

User preferences �  Voice

�  Symbol set

�  Learning style and vocabulary organisation

�  Preconceived notions and experience

�  Importance of user buy-in

�  Opportunities to trial

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“How do you like them APPles….”

�  Select a couple of apps

�  Have chat or simulate a common activity for an individual you know

�  Review the ‘What to look for’ list and Flowchart and rate the app

depending on the needs of that person.

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References �  Beukelman, D., & Mirenda, P (2005). AAC: Supporting children and adults with complex communication needs, 3rd Edition, Paul H.Brookes.

�  Blackstone, S., & Hunt Berg, M. (2003). Social networks: A communication inventory for individuals with complex communication needs and their communication partners-manual

& Inventory Booklet. Monterey, CA: Augmentative Communication, Inc

�  Dewart, H & Summers, S (1995) The Pragmatics Profile of Everyday Communication Skills in Children. wwwedit.wmin.ac.uk/psychology/pp/children.htm

�  Gosnell, J., Costello, J. & Shane, H. (2011). Using a Clinical Approach To Answer “What Communication Apps Should We Use?. Perspectives on Augmentative and Alternative

Communication. Vol. 20(3). 87-96

�  Johnson, J.M., Inglebret, E., Jones, C., & Ray, J. (2006). Perspective of Speech Language Pathologists Regarding Success versus Abandonment of AAC,

Augmentative & Alternative Communication, 22:2, 85-99.

�  Law, M., Baptise, S., Carswell, A., McColl, M. A., Polatajko, H., & Pollock, N. (2000). Canadian Occupational Performance Measure. CAOT Publications, ACE

�  Kovach, T.M.(2009). Augmentative and Alternative Communication Profile: A Continuum of Learning. LinguiSystems. Inc.

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References �  Mobile Devices and Communication Apps. (2011). Retrieved from

http://aac-rerc.psu.edu/documents/RERC_mobiledevices_whitepaper_final.pdf

�  Musselwhite, C.R., & Burkhart, L.J. (2001). Can we chat? Co-Planned sequenced social scripts, A make it/Take it book of ideas and adaptations. Eldersburg, MD.

�  Niemeijer, Donnellan & Robledo, (2012). Taking the Pulse of Augmentative and Alternative Communication on iOS http://www.assistiveware.com/taking-pulse-augmentative-and-alternative-communication-ios

�  Porter, G, (1997). Integrating AAC into programs applying the principles of conductive education. Conductive Education News, 12 (3), 2-8.

�  Rackensperger, T., Krezman, C., McNaughton, D., Williams, M.B., & D’Silva, K. (2005). ‘‘When I First Got It, I Wanted to Throw It Off a Cliff ’’: The Challenges and Benefits of Learning AAC Technologies as Described by Adults who use AAC. Augmentative and Alternative Communication, VOL.21 (3), 165-186.

�  Raghavendra, P., Olsson, C., Sampson, J.,McInerney, R., & Connell, T (2012). School Participation and Social Networks of Children with Complex Communication Needs, Physical Disabilities, and Typically Developing Peers. Augmentative and Alternative Communication, 2012; 28(1): 33–43

�  Raghavendra, P., Wood, D., Newman, L., Grace, E., & Connell, T. (2012). Strategies for supporting Internet use to increase social participation of adolescents with complex communication needs. Proceedings of the 15th Biennial Conference of the International Society for Augmentative and Alternative Communication, Pittsburgh, USA.

�  Tatenhove, G.M. (1994) What is Minspeak? Prentke Romich Company, Wooster, USA

�  http://www.janefarrall.com/html/ipad.html