This week, Chris and Rachel interview Joanna Holmes (@mummyvsaac on Instagram), the parent of an AAC user with Emanuel Syndrome. Emanuel Syndrome is a chromosomal disorder that disrupts normal development and affects many parts of the body, including the speech mechanism. Joanna has lots to share about her experience as the parent of an AAC user, including the journey to find the right access method, and having to work with team members who had limiting beliefs about her daughter.

Before the interview, Rachel and Chris ask the question: how often are we asking “wh-“ questions to students who are still emerging in their ability to answer “wh-“ questions? If they aren’t answering “wh-“ questions yet, then try and find another way to ask the student the same thing e.g., providing choices. For example, instead of asking the student “where do you want to go?”, you can ask them a series of more concrete questions, like, “Do you want to go to the park? Do you want to go to Target?” and so on. 

Key ideas this week:

🔑 When writing goals, remember that not all “wh-“ questions are the same level of difficulty. Often, students will have an easier time learning “what”, “where,” “when”, and “who” then they will “why” or “how”. Being specific with the “wh-“ words you want to target in a goal is typically a better practice so everyone will know which ones to teach.

🔑 It doesn’t make sense to gather data for a goal week after week if you are not first teaching the underlying skill the goal is measuring. According to the “80/20” rule, we should be teaching 80% of the time and assessing 20% of the time. For example, if you write a goal that a student will answer “where” questions, we should be teaching  how to answer “where” questions 80% of the time and measuring how they are doing on the goal only 20% of the time.

🔑 One idea for teaching how to answer “wh-“ questions  is to have a sorting activity where they student places different objects in the correct “wh-“ question folder, depending on if it is a person, place, or thing. 

🔑 As a parent, you should feel you’re on good ground if you’re basing your statements on information about AAC from high-quality sources like https://praacticalaac.org. If you’re getting pushback from members of your child’s team and you have good information, you can share that information with them to help them understand your perspective.  As a parent, you shouldn’t be afraid to be firm about what the next steps should be when you have good clinical evidence that supports your beliefs.

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This week, we share the recording of Chris and Rachel’s recent webinar with aaccessible.org in which they answer questions related to AAC assessment, the benefits of a team-based approach to assessment, selecting motivating assessment materials, and more!

Before the interview, Chris and Rachel discuss Chris’s recent discovery that a student he worked with who was very important for him professionally had passed away. They share about some of the challenges anyone can face working with people who have complex medical needs, including people passing sooner than we expect. They also highlight the importance of teaching students about their bodies and how to say they feel sick or pain and where things hurt. It can also be a difficult balance with encouraging communication when the family is struggling just to keep the child healthy.

Key ideas this week:

🔑 There is little logic to the traditional “three trials” AAC assessment - if you choose only a low tech option, it is potentially wasting everyone’s time. If you choose to trial three robust AAC systems, how to you pick which one is first? How do you determine that the trial is long enough to make a justified decision? A team based considerations approach to assessment that bypasses the three trials can be much more effective. 

🔑 When we are feature matching to determine if an AAC device is a good choice, a major consideration should be what AAC apps the team is already comfortable with. While we can always choose a different option, people are more likely to support a device they are already comfortable with.

🔑 A team-based approach to assessment is really helpful for building capacity with your team. If we have an expert model and don’t meet with the team to choose the device, then they will often not take ownership of implementation. If they are involved, often the team will be more likely to embrace the AAC tool and the implementation strategies.

🔑 When you find that a robust AAC system is not working for a student, it is most likely that you chose the correct device and the problem is related to issues related to modeling, training, and implementation.

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This week, Chris interviews Daniel Parker, Kathy White, and Stacy Duffy, individuals behind the creation of Assistive Technology Forward, a group that created a statewide “community of practice” to support Wisconsin assistive technology. ATF has recently begun a free program that provides “microcredentials” that are focused on a particular area of practice within assistive technology.  Learn more here. These modules can be completed in a few hours and many can be taken by parents, administrators, and others who are not as familiar with assistive technology. Chris chats with Daniel, Kathy, and Stacy about Assistive Technology Forward, how they came to create microcredentials, some of the benefits of microcredentials, and a discussion of the virtual “community of practice” that ATF has created for assistive technology! 

Before the interview, Rachel shares some thoughts about an upcoming assessment report that she has been asked to write. Chris and Rachel discuss preparing for a student who has aggressive behaviors, dealing with the pressure to have standardized assessments as part of a report, and some of the questions that Rachels asks when she begins an AAC assessment.

Key ideas this week:

🔑 Many people are frustrated with their jobs in education, and one reason is because they don’t feel supported or comfortable with what they are asked to do every day. Microcredentials can help people feel more confident in their jobs, which may increase overall job satisfaction.

🔑 It can be costly and very time prohibitive to go through a full, formal AAC certification program. While that may be a good choice for some people, micro transactions offer another way to learn about the technology thatAT specialists, educators, and others can use to become more effective in support assistive technology. 

🔑 ATF created an virtual, assistive-technology-focused “community of practice” i.e. a group of people who interact regularly to develop their skills. They often have meetings where a subject-matter expert facilitates a cooperative discussion with the group on topics related to assistive technology, which they record and save for other members of the community of practice. Some of these sessions can be viewed on You Tube here

🔑 Assistive Technology Forward has a number of online free learning modules that provide lots of free information about assistive technology, including training for people who are not as familiar with AAC.

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This week, we have the privilege of interviewing Hank Poore, an AAC user and Tobi Dynavox ambassador who has his own foundation, hankpoorefoundation.org. Hank shares about becoming a proficient AAC communicator, the AAC journey Hank took to come to his current eye gaze system, advice for looking for a job as an AAC user, work Hank does with his foundation, and more! 

Before the interview, Rachel and Chris discuss a breakthrough that Rachel had with one of her coaching clients. Her client’s Mom and Dad have been sending in videos of them working with their child, after which they watch the videos with Rachel and talk through how they can become more effective communication partners. Recently, when watching a video of a session, they noticed how anxious the AAC user was getting when asked a question that he doesn’t know the answer to. The family discussed with Rachel how they can switch from questions that have a “right” and “wrong” answer to questions that are more open ended to help their child feel less anxiety when asked a question. The family would never have noticed if it wasn’t recorded, so in this case, video was an excellent resource. 

Key ideas this week:

🔑 There is evidence to suggest that people with disabilities are asked more questions than people without disabilities - make sure that you are not turning a communication exchange into an interrogation. 

🔑 When we are selecting an AAC device for a user, sometimes we can get caught up in picking the one “best” tool. We shouldn’t focus exclusively on selecting the one tool or the primary tool that they will use - in some cases, like Hank’s, it may be that a combination of tools will be successful for a user.

🔑 Technology is changing and growing at such a fast rate, in some cases a tool that didn’t work years ago may have been improved. For Hank, he tried eye gaze years ago, but it was too difficult to use. However, when he tried it again more recently,  the technology had improved and it was much more effective for him.

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This week, Chris interviews Ken Hackbarth, Christine Baudin, and Micheal Dicpinigaitis about 3D printing custom items related to assistive technology, including keyguards! Ken, Christine, and Michael share about discuss Ken’s website volksswitch.org, which has resources for how to create files for 3D printers that tell it to build a keyguard that fits an iPad with AAC apps perfectly. 

Before the interview, Rachel and Chris talk about environmental core boards (e.g. “playground boards”) and some considerations to make before you install one, including making sure that the board is at the correct height for the students who will be using it.

Key ideas this week:

🔑 Keyguards are applicable in many instances where you wouldn’t initially recommend them.  They can help individuals with moderate motor control take advantage of larger language sets by helping them effectively select smaller buttons on an AAC device.  Volksswitch provides free, ready-to-print keyguard designs for a collection of popular AAC apps and popular iPad cases!

🔑 One great thing about volksswitch.org is that they provide an app that lets you customize your keyguard based on several common combinations of iPads, cases, and the most common AAC apps (e.g. LAMP WFL, Proloquo2go, TouchChat). This allows someone with limited coding and engineering experience to create and print a keyguard effectively. 

🔑 Michael sells 3D printed keyguards on his Etsy website, https://www.etsy.com/shop/AdaptedCreations. In addition to selling keyguards, he also sells cases that match the keyguards, switch adapted toys, and switch mounts.

🔑 One reason that keyguards were an obvious choice for 3D printing is the high cost of getting a keyguard professionally laser cut (approximately $80-$150). As as long as you have access to a 3D printer, you can make many keyguards for the price of one laser-cut keyguard.

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To listen to this episode, search "Talking with Tech" in your podcast player of choice or go to www.talkingwithtech.org/episodes/print-keyguards

This week, Rachel invites Gemma White back to TWT to talk about personal safety awareness and self advocacy for AAC users. Gemma recently gave a presentation at AAC in the Cloud, “Where is the Penis?: Equipping AAC Users to Discuss Personal Safety Awareness with Personal Safety Curriculum”. Gemma talks about this presentation, why words like “penis” and “vagina” should be in AAC users devices, ways that we can collaborate to support personal safety awareness, and other ways that we can empower AAC users to protect themselves from neglect and abuse.

Before the interview, Rachel and Chris discuss some comments made by an SLP who works with one of Rachel’s clients and focuses only on verbal speech. This client has Childhood Apraxia of Speech and is highly unintelligible. He has been making good progress with his AAC and is now choosing to use it more often. Recently, the other SLP commented that “AAC is holding back verbal speech” because the client chose to use his AAC more than verbal speech to communicate. Rachel shares how she responded, the reasons why the other SLP may have believed this, and why following the student’s lead is so important when accepting communication modalities.

Key ideas this week:

🔑 If your school or practice has a curriculum developed to teach children about personal safety awareness, then you can collaborate with the whole team to add language to AAC user’s devices that support what they’re learning about their bodies and safety.

🔑 A person’s gender does not always match the body parts they were born with - It’s important to separate words related to gender and labels for private parts to foster a more inclusive environment.

🔑 We need to focus on self-advocacy from the beginning, e.g. "no," "stop," and "all done." Often refusal and negation can be motivating, especially if we are asking a student to do something they don’t want to do.

Links from this Episode:

Gail van Tatenhove: The Power of Core: https://www.youtube.com/watch?v=QqfVAPuGzpI

Gemma White, AAC in the Cloud: “Where is the Penis?: Equipping AAC Users to Discuss Personal Safety Awareness with Personal Safety Curriculum” https://www.youtube.com/watch?v=X-kw4_HH6FI

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This week, Chris interviews Tami Altschuler, a medical-based SLP and graduate instructor who focuses on supporting AAC and communication in the hospital setting. She shares about her journey helping the doctors and nurses understand that communication is a medical necessity, and the patient and employee satisfaction improvements that have come from better supporting communication and AAC access for every patient that needs it. 

Before the interview, Rachel and Chris discuss one of Rachel’s clients who has optical nerve damage that makes visual processing difficult. The family is concerned that he is not able to access his coursework and reading materials due to his visual difficulties.  Rachel shares some of the assistive technology strategies she suggested, including voice typing in Google Docs, using Read & Write for Google Chrome, using text-to-voice using a camera, making text high contrast, and more! 

Key ideas this week: 

🔑 It was difficult to get initial buy in from physicians at her hospital to order SLP services for AAC and communication.Tami needs a doctor’s order to work with the patients - she can’t just work with a patient on her own initative. When Tami started at her hospital, the doctors didn’t know an SLP could help with a patient who can’t communicate (e.g. they are intubated). 

🔑 SLPs in the medical setting often focus more on feeding and swallowing than on AAC and communication. It took a lot of working through “barriers to participation” (Beukelman & Mirenda (2013)) - i.e. resources, attitude, skill, and knowledge. Had to break through those barriers to help the other medical SLPs understand the need to support AAC. 

🔑 The “Great Resignation” impacted the medical field in several ways, including the amount of knowledge nurses in Tami’s hospital have about AAC and communication. There was a mass exodus of pediatric nurses who had a lot of communication training, and the newer nurses were not as familiar. Tami’s hospital now has a process that trains nurses right away during new hire orientation about communication and AAC.

🔑 Writing a patient’s communication tools and strategies on the door outside the patient’s room can help the nurses know how a patient communicates before the enter the room. 

You can reach Tami on Twitter @tami_altschuler

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This week, we share Part 2 of TWT Live from Oregon! This week, Rachel and Chris talk with their audience about a range of topics, including getting buy in from teachers and staff and choosing which core words to start teaching!

Before the interview, Chris and Rachel answer a listener question, “Is putting a big poster with AAC symbols on the wall a good idea?” They point out the benefits of putting up AAC light-tech boards, and Chris describes why it is better to put up a poster of the kid’s core board than changing the symbols or moving them around.

Key ideas this week:

🔑 If an emergent communicator is struggling to learn how to use light-tech AAC, even with lots of modeling, you may want to try high-tech AAC. In some cases, using high-tech AAC can help him or her understand why and how we use AAC.

🔑 When dealing with a teacher or staff member who doesn’t want to use AAC, a “top down” approach that gets their administrator involved may cause push back in the long run and/or damage rapport. Try a “bottom up” approach first - ask probing questions to find out about that teacher’s challenges and point out where AAC can help (e.g. reducing difficult behaviors).

🔑 Celebrate the small wins for AAC users - if an emergent communicator make any progress towards independent communication, however small, make sure to celebrate and let everyone know! When someone makes a difference that impacts the life of another person, they are often inspired to do more!

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This week, we share Part 1 of a previously recorded Talking with Tech Live show with listeners from Oregon. This week, the listeners ask several questions related to conducting language and AAC assessments virtually, including how to make them more effective.

Before the interview, Chris and Rachel have a lively discussion about Gestalt Language Processing and how we can support AAC users who script. Rachel shares several ideas, including putting the student’s preferred scripts on their device as a way to make the device more interesting and motivating.

🔑 One tool that listeners suggested for virtual assessment is the Communication Matrix. https://communicationmatrix.org/ This assessment allows you to get input from caregivers through an online for. One benefit is it doesn’t require the chid to have to sit in front of a screen. 

🔑 When we are trying to observe a person’s communication skills virtually, it may be better to have the caregivers video the student at hoome communicating in the ways they normally communicate. It can be difficult to truely observe a child during Zoom sessions - the child may not communicate the same way on Zoom because there is greater pressure to “perform.” 

🔑 If we are considering a virtual assessment, it is important to consider training communication partners on how to optimize the virtual assessment. Is the student seated in their chair? What is the background noise situation? Preparing in this way can help the assessment go more smoothy.

Emily Quinn’s webinar on the Communication Matrix from Echo Voices https://drive.google.com/file/d/1-S-rVgOrozwa36mGxaW0ZQcNob2brWTx/view

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This week, we present Part 2 of Chris and Rachel’s interview with Sean Sweeney! Sean is a Speech-Language Pathologist and founder of SpeechTechie.com, a website that focuses on the intersection of speech therapy and technology. This week, he discusses his “FIVES” pneumonic to help evaluate if a resource (e.g. an app) is a worthwhile investment of time and money. 

Before the interview, Chris and Rachel share about their recent trip to Montana to do a presentation, and some of the highlights of the trip. They also answer an excellent listener question that asks “Regarding the least-to-most prompting hierarchy, if the student is new to the board/device and we jump to the last step and model without expectation, how long do we stay at that level?”

Key ideas this week:

🔑 The least-to-most prompting hierarchy is related more to an individual words than to a particular student student. The amount of prompting that a student needs will depend on the word, so a student isn’t ever at a certain “level” of the hierarchy 

for every word.

🔑 The symbols or pictures on an AAC system give users way to recognize the word(s) they want to say. Without the visual, it can be harder for students to construct an effective spontaneous utterance. 

🔑 Sean came up who the pneumonic “FIVES” to help evaluate resources that he is considering using for therapy. FIVES stands for Fairly priced, Interactive (decision making, create narrative), Visual, Educationally relevant, and “Speechie” (i.e., the app can be used to target specific clinical objectives)

🔑 Sean likes to take materials and items from a student’s hobbies and use them to target his clinical objectives. For example, he has a student who loves Pokemon, so he pulls story grammar and vocabulary from a Pokemon comic to make the lesson more engaging and interactive.

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