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Thursday, October 10, 2013

Augmentative and Alternative Communication (AAC) Evaluation - Sample

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.” 

PROMPT therapy
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. 

PECS Book
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:
  1. Voice output
  2. Capacity to store messages for multiple communication pages/overlays (i.e., up to 5 levels to record different pages sets).
  3. 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.
  4. Device with keyguard overlay to separate buttons and symbols.
  5. Use Boardmaker symbols beginning with nouns and verbs in a field of 8.  Additional parts of speech may be introduced in smaller fields.
  6. 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. 

RECOMMENDATIONS:
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

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