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Thursday, October 10, 2013

Augmentative and Alternative Communication (AAC) Evaluation – Sample 2

Name:  Sarah 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:  Hypoxic Ischemic Encephalopathy with extensive ischemic injury.

REFERRAL:
Sarah was referred for an Augmentative and Alternative Communication Evaluation by the Early Intervention Speech-Language Pathologist XXX XXX.  This evaluation was undertaken to determine the most appropriate augmentative and alternative communication system that will meet Sarah’s current and future language and communication needs.
Sarah presents with a medical diagnosis of Hypoxic Ischemic Encephalopathy.  She receives speech and language therapy through the New York State Early Intervention services.

COMMUNICATION STATUS AND LIMITATIONS:
Sarah communicates primarily by reaching, pointing and gesturing.  She also frequently uses facial expressions paired with vocalizations to communicate her wants and needs.  Sarah usually acquires an item she wants by getting it herself as long as it is within her reach.  As reported by Sarah’s mother, Sarah will occasionally approximate the word “no,” turn her head away and/or cry to protest or refuse.  She calls for the attention of others by gently touching the person and/or looking at them paired with vocalizations.  Sarah’s expressive communication is severely restricted. As reported by Sarah’s speech therapist, XXX XXX, Sarah’s willingness to communicate far surpasses her physical ability to do so.  She has a very limited repertoire of verbalizations and is unable to effectively communicate on a daily basis.

STATEMENT OF CANDIDACY:
During the evaluation process, Sarah demonstrated the ability to learn and understand the usage of a low-technology voice output communication device.  Using the voice output communication device Sarah was able to make choices, requests and participate more easily during pretend play activities.  Sarah demonstrated the potential to continue learning how to use the voice output communication device to enhance her communication and language abilities in a variety of settings including, but not limited to, home and therapies.

SPEECH, LANGUAGE AND COGNITIVE ABILITIES:
Sarah’s overall attention was determined to be good.  She demonstrates adequate attention to people, objects and pictures in her immediate environment.  She enjoys interactive toys and engaging in pretend play activities.  She demonstrates an inconsistent ability to follow one-step directions and benefits from visual modeling and hand-over-hand assistance to access a voice output communication device.
Sarah presents with delayed speech acquisition. Although it is reported that Sarah’s speech productions are emerging, she rarely attempted to use speech as a mode of communication during the evaluation.  Sarah demonstrates the ability to answer “yes” and “no” by smiling or shaking her head respectively however her reliability to answer these questions was judged to be fairly inconsistent.

SENSORY FUNCTIONING:
Auditory:  Sarah’s hearing is reported, by her mom, to be within normal limits.  She responded appropriately to conversational level speech and the voice output communication devices trialed during the evaluation.
Visual:  Sarah’s vision is reported, by her mom, to be within normal limits.  She does not wear glasses or known to have any visual deficits.

COMMUNICATION NEEDS OF PATIENT:
Sarah will benefit from a low-technology voice output communication device.  A low-technology voice output communication device will provide Sarah with an effective means to communicate her wants and needs, call attention to specific persons, share information, and interact socially with her family and peers.  It will also provide Sarah with the means to learn and use language while participating in therapeutic and educational activities and will allow her the ability to communicate with a variety of partners (e.g., family, therapists and peers) in one-on-one and group settings.  Therefore, Sarah needs a communication system (i.e., low-technology voice output communication device) that will meet her current and future speech and language needs.  She requires a device that provides her with ample vocabulary and meets her communicative needs over a variety of setting and environments.

DURING THE EVALUATION
Mother was present for this early intervention evaluation and stated that Sarah did not produce as many spontaneous vocalizations as she typically does. 

POSTURAL/MOBILITY STATUS:
Sarah benefits from holding the caregiver’s hand while walking to provide her with adequate support.  Sarah was seen sitting on a mat independently throughout the evaluation.

ACCESS:
Sarah was evaluated to determine which device features best match her access needs and abilities.  Sarah demonstrated the ability to isolate each pointer finger (on her left and right hands) and cross mid-line to access all buttons presented.  Sarah demonstrated a preference for using her right hand, but was able to use her left hand when necessary.

Sarah was able to access buttons ranging in size from 2”x 2” to 3” x 3” with an overlay keyguard separating each of the buttons by ¾”.  Sarah was able to discriminate between four, 2” x 2” and 3”x3,” real pictures and Mayer-Johnson Boardmaker symbols. Sarah demonstrated difficulty discriminating between eight, 2” x 2,” Mayer Johnson Boardmaker symbols.

DELINIATION OF FEATURES OF COMMUNICATION SYSTEM:
The following is a list of features of a communication device required by Sarah at this time:
1.      Voice output.
2.      Capacity to store messages for multiple communication pages/overlays (i.e., up to 7 levels for recording per page set).
3.      Device with 4 buttons 2” x 2” or 3” x 3” in size 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 3-4.  Additional parts of speech may be introduced in smaller fields.

COMMUNICATION SYSTEM MEETING SARAH’S CURRENT NEEDS:
During the evaluation, the 7-Level Communication Builder (with overlay option and levels) was found to meet all of the features that are needed in a communication device for Sarah at this time.  The device has four, 2” x 2” buttons in a quadrant layout which was determined to be appropriate for Sarah’s access and visual scanning abilities.  The overlay option on the 7-level Communication Builder enables a communication page or overlay to be placed under a removable keyguard.  This allows for pages to be easily changed between levels and also allows Sarah the opportunity to change the overlays independently in the future.  The 7-Level Communication Builder also enables Sarah’s language to grow in the future with the use of the additional windows that increase the presented picture array to a field of 8 or 16 pictures.  This will allow Sarah to expand her vocabulary (e.g., nouns and verbs), increase her sentence length (e.g., by including additional parts of speech) and eventually learn appropriate sentence structure. 

ABILITY TO LEARN AND USE COMMUNICATION SYSTEM/COMPONENTS:
During the evaluation process, Sarah used topical communication pages ranging from 2 to 8 Boardmaker symbols on The Cheap Talk-4 quadrant, 7-Level Communication Builder and The Tech Talk (all with overlay options and levels).  Sarah was able to learn and most efficiently use the 7-Level Communication Builder to participate in activities by making choices and requesting items and actions within an activity.  She required visual modeling and initial hand-over-hand prompting to become familiar with the overlay pages, however after becoming accustomed to the location of familiar symbols she was able to access the buttons and communicate her wants and needs independently.  After making a selection, Sarah consistently made eye-contact with the examiner or her mother to show her communicative intent and to receive a response from the listener.
The Cheap Talk-4 quadrant
7-Level Communication Builder
The Tech Talk

RECOMMENDATIONS:
Based on the results of the evaluation a low-technology voice output communication device, with overlay options, multiple levels and additional windows, meets Sarah’s current language and communication needs.  A variety of 4 picture overlays, made with Mayer-Johnson Boardmaker symbols, are recommended to accommodate Sarah’s communication needs across a variety of settings. 

Sarah demonstrated the ability to learn and use the 7-Level Communication Builder with moderate to minimal difficulty.  She benefited from verbal prompting, visual modeling and hand-over-hand assistance to initially learn the purpose of and how to use the presented device.  By the end of the evaluation Sarah was more familiar with the 7-Level Communication Builder voice output device and was able to access it independently to request different items and/or activities. 
Sarah seems to be a good candidate for the purchase and use of the 7-Level Communication Builder voice output device.  The 7-Level Communication Builder will assist Sarah in communicating her wants and needs across a variety of settings.  It will also facilitate future expansion of her vocabulary (i.e., understanding and usage), phrase length and sentence structure by using the additional windows that increase the presented picture array from 4 pictures to 8 or 16 pictures.  The additional windows with a larger picture array are recommended to be used when the speech-language pathologist who is treating Sarah on a consistent basis feels it is appropriate.  The purchase of Mayer-Johnson Boardmaker computer software is also recommended for the production of the overlays that Sarah will be using to communicate over a variety of settings.  A follow-up appointment is recommended, when the device is received, to provide education for the family and therapists on the usage of the 7-Level Communication Builder and the production of overlays using the Mayer-Johnson Boardmaker software.  

______________________________
XXX XXX, M.Ed., CCC-SLP/TSHH                                    
Speech-Language Pathologist                                    
NYS License # xxxxxxxxxxx

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