Name: John Smith
Date of Birth: xx/xx/xxxx
Chronological Age: 2 years 10 month
Date of Evaluation: xx/xx/xxxx
Evaluator: XXX XXX, MEd,
CCC-SLP/TSHH
Medical Diagnosis: Global
delays and low muscle tone.
REFERRAL:
John was referred for an
Augmentative and Alternative Communication (AAC) Evaluation by his Early
Intervention Speech-Language Pathologist (SLP), XXX XXX and his mother, XXX
XXXX. This evaluation was undertaken to
determine the most appropriate AAC system that will meet John’s current and
future language and communication needs.
John presents with a medical
diagnosis of global delays and low muscle tone.
He receives speech and language therapy 5 times per week through the New
York State Early Intervention services. John resides at home with his mother and gradmather.
COMMUNICATION STATUS AND LIMITATIONS:
John communicates primarily by
reaching, grabbing and attempting to obtain items he wants on his own. If he is unable to obtain an item
independently he will gesture and/or point to the object. He will also use sign language
approximations, facial expressions and/or vocalizations to communicate his
wants and needs. As reported by John’s
mom he will shake his head to indicate “no” and nod his head to indicate
“yes.”
As reported by John’s SLP, XXX
XXXX, John has been receiving speech and language therapy since xx of xxxx. Initially he received speech and language
therapy 3 times a week for 60 minutes each session. However, after only three months, services
were increased to 5 times a week for 60 minutes a session upon recommendation
by his SLP. John’s speech
and language therapy has focused on increasing his vocal and verbal productions
by using oral motor therapies and PROMPT.
However, despite receiving intensive speech and language therapy John has
only recently begun to babble and is still unable to produce intelligible
verbalization consistently. As reported
by John’s mom and his SLP John’s inability to effectively communicate his wants
and needs frequently results in John having temper tantrums possibly due to
increased frustration. John presents
with severely restricted expressive communication.
SPEECH, LANGUAGE AND COGNITIVE ABILITIES:
John presented with delays in the
areas of expressive and receptive language.
However, John’s receptive language abilities appeared to be greater than
his expressive language abilities. John
demonstrated an awareness of others in his environment; however John’s limited
expressive language abilities ultimately affected his overall ability to
readily interact with others. As
reported by his mom and SLP John can often become frustrated when he is unable
to accurately convey his message to his communication partner.
During the evaluation John
demonstrated a good understanding of cause and effect, as demonstrated when
using switch activated toys and no-technology voice output communication aids
(VOCA/S). For example, John learned to
touch the picture on a VOCA to request the desired item (i.e., John activated
the voice output by pressing the picture to receive the play dough). John was also able to learn the sequence of
actions required to activate a VOCA. As
reported by John’s mom and SLP, John is frequently able to learn how to
complete a sequence of actions and/or routines after it is modeled for
him. This was evident when John learned
the sequence of actions required to activate a VOCA after visual modeling and
hand-over-hand assistance were initially provided. By the end of the evaluation John performed
the sequence of actions a few times independently.
John also demonstrated the
ability to follow 1-step verbal directions throughout the evaluation. However, this ability was often affected by
his high distractibility. John’s overall
attention was determined to be fair. He
demonstrated fleeting attention to people, objects and pictures within his
immediate environment characterized by walking throughout the room from one
object to the next without spending a significant amount of time in any one
location or with any one object.
As reported by John’s SLP and
mother, John currently uses the Picture Exchange Communication System (PECS)
while at home to communicate his wants and needs throughout the day. John is able to flip through the pages of his
PECS book, scan
through a field of 8 pictures per page, and locate the desired Boardmaker icon
of the item he wants. John has also
recently begun to combine two pictures together to create a short phrase. However as also reported, John will
frequently point to the picture of the object he wants to request rather than
picking the picture up off of the page and exchanging it with his communication
partner. This may become limiting for John
do to his limited independent initiation of communication. In many settings his request may go unheard,
which may also result in continued frustration for John secondary to his
limited ability to express himself effectively.
John was observed to produce some sign language approximations, however
this is not always noted to be consistent.
John will shake his head “no” or push an item away to reject and will
nod his head “yes” or smile to demonstrate enjoyment.
John did not demonstrate clear
verbalization or word productions during the evaluation. John presented with delayed speech
acquisition. As reported, John’s speech
productions continue to be emerging slowly, however he rarely attempts to use
speech as a mode of communication. In conclusion, John does not demonstrate an
effective way to communicate his wants and needs on a daily basis.
SENSORY FUNCTIONING:
Auditory: John’s hearing is
reported, by his mom, to be within normal limits. He responded appropriately to conversational
level speech and the voice output communication devices trialed throughout the
evaluation.
Visual: John’s vision is
reported, by his mom, to be within normal limits. He does not wear glasses or known to have any
visual deficits.
COMMUNICATION NEEDS OF PATIENT:
John will benefit from an
augmentative and alternative communication (AAC) system. An AAC system will provide John with an
effective means to communicate his wants and needs, call attention to specific
persons, share information, and interact socially with his family and
therapists. It will also provide John with
the means to learn and use language while participating in therapeutic and
educational activities in one-on-one and group settings. Therefore, John needs an AAC system that will
meet his current and future speech and language needs. He requires a system that provides him with sample
vocabulary and meets his communicative needs over a variety of settings and
environments.
DURING THE EVALUATION
John’s mom and Early Intervention
SLP were present for this early intervention evaluation. All information was obtained via parent and
therapist report and through formal observations during the evaluation. John’s mother stated that John’s performance
during today’s evaluation was a “typical” portrayal of his behaviors and
interaction with others on a daily basis.
POSTURAL/MOBILITY STATUS:
John demonstrated the ability to
walk unassisted throughout his environment, however he demonstrated
unsteadiness and occasionally required tactile assistance to maintain his
balance. This may be due to his low
muscle tone and decreased perceptual skills of his immediate environment. John was able to sit unassisted on a floor
mat, however due to his distractibility and frequent movement throughout the
room John benefited from sitting between the legs of his mom. This helped him to maintain his focus on the
objects presented and remain in a seated position for the duration of the
evaluation.
ACCESS:
John was evaluated to determine
which device features best match his access needs and abilities. John presented with adequate upper extremity
coordination and strength to depress the buttons on each of the voice output
communication aids (VOCAS) that were presented (i.e., The 7-Level Communication
Builder, The Go-Talk 9+, and The SpringBoard Lite). John was able to isolate his pointer fingers
on both his right and left hands and no miss activations were observed. John seemed
to become distracted by the external buttons on all of the devices and
frequently pressed them, however he was easily redirected using a tangible
reinforcing item.
The 7-Level Communication Builder
The Go-Talk 9+
The SpringBoard Lite
John was able to cross mid-line
to access all buttons presented and occasionally switched hand usage from his
left hand to his right hand. No hand preference was observed, and as reported
in a progress note written by John’s Occupational Therapist, he may be
ambidextrous. During the evaluation John’s
hand usage seemed to directly correlate to which hand held his play dough. For example, when he held the play dough in
his right hand he used his left hand to activate the VOCA and vice versus. John discriminated between real pictures and
Mayer-Johnson Boardmaker symbols and was able to accurately activate pictures
ranging in size from 5”x7” to 2”x2.”
DELINIATION OF FEATURES OF COMMUNICATION SYSTEM:
The following is a list of
features of an augmentative and alternative communication system required by John
at this time:
- Voice output
- Capacity to store messages for multiple communication
pages/overlays (i.e., up to 5 levels to record different pages sets).
- Device with 9 buttons, 3 buttons that remains
constant across different page sets, that ranges in size from 2”x2” to
1.5”x 1.5” that activate upon direct access.
- Device with keyguard overlay to separate buttons and
symbols.
- Use Boardmaker symbols beginning with nouns and verbs
in a field of 8. Additional parts
of speech may be introduced in smaller fields.
- The device should be portable, durable and easy to
transport and manage
COMMUNICATION SYSTEM MEETING KINGSTON’S
CURRENT NEEDS:
During the evaluation, the Go
Talk 9+ by Attainment Company, Inc. (with multiple levels) was found to meet
all of the features that are needed in a communication device for John at this
time. The device has 9 keys each 1 ¾” x
2 ¼” in a quadrant layout which was determined to be appropriate for John’s
access and visual scanning abilities.
The Go Talk 9+ also has five recording levels and three “core messages”
which remain the same on each level. The
built-in overlay storage enables the overlay pages to be easily changed between
levels and also allows John the opportunity to change the overlays
independently in the future. The Go Talk 9+ also enables John to expand his
vocabulary of nouns and verbs, as well as additional parts of speech. Therefore, enabling him to combine two to
three pictures together to structure short phrases and sentences and allowing
for the development of syntax.
ABILITY TO LEARN AND USE COMMUNICATION SYSTEM/COMPONENTS:
During the evaluation John demonstrated
the potential to learn to effectively use the Go Talk 9+ by Attainment Company,
Inc. to interact with others and express wants and needs across a variety of
settings. John was able to learn and use topical communication pages ranging
from 2 to 9 Boardmaker symbols on a 7-Level Communication Builder, a Tech Talk
and the Go Talk 9+ (all with overlay options and levels). John was able to learn and most efficiently
use the Go Talk 9+ to participate in the activity by making choices and
requesting activities, items, and actions within the activity. John required initial hand-over-hand
prompting and visual modeling to become familiar to new overlay pages, however
after becoming accustomed he was able to independently access the buttons to
communicate his wants and needs. After
making a selection, John consistently made eye contact with the examiner to
show his communicative intent and to receive a response from the listener.
Based on the results of the
evaluation the Go Talk 9+ by Attainment Company, Inc. with page overlay options
and multiple levels meets John’s current language and communication needs. A Go Talk 9+ will help to enhance John’s
communication and language abilities in a variety of settings including, but
not limited to, home and therapies. It
will also help him to engage in a communicative exchange with family members
and therapists ultimately decreasing John’s frustration level. The Go Talk 9+ also enables John to expand
his vocabulary of nouns and verbs, as well as additional parts of speech. Therefore, enabling him to combine two to
three pictures together to structure short phrases and sentences and allowing
for the development of syntax. John demonstrated
the ability to learn and use the voice output communication aid with minimal
difficulty and initial visual and tactile modeling and prompting. Therefore, he is a good candidate for the
purchase and use of the Go Talk 9+ by Attainment Company, Inc.
______________________________
XXX XXX, M.Ed., CCC-SLP/TSHH
Speech-Language Pathologist
NYS License # xxxxxxxxxxx
