RESNA 27th International Annual Confence
Evaluation of an AAC Group Program for Students and Their Educational Assistants (EA)
Three augmentative communication device users and their EAs received communication training in the use of Unity Enhanced Minspeak. Language samples were collected over three of five full-day classes during both a story and conversational activity. Each student was videotaped during these two activities and the amount and type of device use was recorded on a Language Activity Monitor. Language output was affected by the amount of support provided by the EAs. Language output was transcribed and analysed to determine changes in student MLU and level of cueing provided over time by each EA. Overall, the language output of each student varied between story and conversational activity. MLUs increased in the conversational activity compared with the story activity and all students created more independent utterances during both activities.
augmentative communication, Minspeak, group instruction, educational assistant instruction
Research is needed to establish best practice, maximize outcomes, ensure accountability and justify costs of treatment in the field of AAC [1,2,3]. Currently, no research exists where the aides of the students are included in a group AAC treatment outside the classroom. This Minspeak Class was designed for elementary students learning to use a Minspeak Unity Enhanced augmentative communication system. Students were at various stages of learning Minspeak, with some students using the One-Hit Program and others with more familiarity using the Full-Core Program. The class consisted of five full-day sessions for seven students and their EAs. Involvement by their teacher and professional support personnel was strongly encouraged.
There are various methods of data collection for AAC studies ranging from video transcription to on-line data collection. The use of the Language Activity Monitor (LAM) to collect the utterances produced by users of AAC allows the researcher to record, store and access any utterance produced while the recorder is turned on [2]. The LAM can also be used as a cross-reference for the accurate transcription of utterances obtained from videotape. Hill and Romich [2] suggest a comprehensive list of possible methods of analysis of communication performance using LAM derived data. These include: total utterances, Mean Length of Utterance in words (MLU (w)), and in morphemes (MLU (m)) and number of total words. Rating scales and questionnaires can be an effective means of evaluating data of a given treatment. The effectiveness of a parent-training program was evaluated using a parent satisfaction questionnaire and a rating scale [4].
Three of the seven students in the class were included in the study. All were females, aged 7-10 with a primary diagnosis of cerebral palsy. None used speech as a primary means of communication, and all were in integrated classroom settings. At the beginning of the class all three subjects were largely responsive in their communication and rarely initiated with unfamiliar partners. A previous AAC assessment determined that the students would benefit from a Minspeak based communication system.
Five AAC training classes were held over a period of approximately 4 months. During each session, students were provided with opportunities to become familiar with “core” vocabulary, learn and demonstrate conversational skills, and learn and demonstrate creative use of vocabulary available (i.e., risk taking through generative use of vocabulary available). Techniques used to teach target skills included demonstration of device use by the class facilitator, observation of peers and multiple opportunities for individuals to practice within simulated classroom activities. The instructor taught by building on a theme using storybooks and elaborated activities. The classes included conversational practice, writing practice, games and group activities.
Several means of data collection were used to evaluate the training program including video transcription, LAM recorders and questionnaires. These data were analyzed in terms of length and quality of utterance and amount of assistance given by the EAs to the students. Data from language samples collected by video transcription, and LAM recording were analyzed using the Systematic Analysis of Language Transcripts (SALT) [5], and EA questionnaires. The level of cueing was also determined from the video transcriptions.
All three participants showed improvements in the use of their devices over the course of the AAC classes. They produced utterances more independently and were more active participants in group activities. All students showed an increase in MLU during the conversational tasks (Table 1). For two of the 3 students the amount of cueing decreased while for the third student cueing levels remained the same between sessions 2 & 3. For the story activity (Table 2), while cueing levels decreased, MLUs dropped during session 3 and started to rise during session 5 but did not reach the baseline level from session 1.
|
Class 1 |
Class 3 |
Class 5 |
||||||
|---|---|---|---|---|---|---|---|---|---|
Conversation |
Jane |
Kelly |
Jackie |
Jane |
Kelly |
Jackie |
Jane |
Kelly |
Jackie |
Total Utterances |
7 |
9 |
10 |
16 |
|
15 |
8 |
10 |
10 |
Statements |
7 |
9 |
6 |
10 |
|
13 |
8 |
10 |
10 |
Questions |
0 |
0 |
4 |
6 |
|
2 |
0 |
0 |
0 |
Responses to questions |
0 |
0 |
3 |
3 |
|
2 |
0 |
0 |
0 |
Responses to intonation prompts |
0 |
0 |
0 |
0 |
|
0 |
0 |
0 |
0 |
Imitations |
1 |
0 |
0 |
0 |
|
0 |
0 |
0 |
0 |
1 word utterances |
0 |
0 |
1 |
3 |
|
2 |
0 |
0 |
3 |
MLU (in words) |
4.29 |
4.44 |
3.4 |
2.81 |
|
4.47 |
8.0 |
6.2 |
5.7 |
Brown's stage |
Late V |
Late V |
Early IV |
III |
|
Late V |
Post V |
Post V |
Post V |
| Early I = 16-26 months Late I = 18-31 months II = 21-35 months III = 24-41 months Early = IV 28-45 months Late V = 37-52 months Post V = 41+ months |
|||||||||
|
Class 1 |
Class 3 |
Class 5 |
||||||
|---|---|---|---|---|---|---|---|---|---|
Story Activity |
Jane |
Kelly |
Jackie |
Jane |
Kelly |
Jackie |
Jane |
Kelly |
Jackie |
Total Utterances |
14 |
16 |
23 |
16 |
|
14 |
13 |
14 |
13 |
Statements |
14 |
16 |
22 |
16 |
|
14 |
13 |
14 |
13 |
Exclamations |
0 |
0 |
0 |
0 |
|
0 |
0 |
0 |
0 |
Questions |
0 |
0 |
1 |
0 |
|
0 |
0 |
0 |
0 |
Responses to questions |
11 |
10 |
13 |
8 |
|
11 |
9 |
12 |
9 |
Responses to intonation prompts |
0 |
1 |
2 |
0 |
|
0 |
1 |
1 |
1 |
Imitations |
2 |
3 |
2 |
0 |
|
0 |
0 |
0 |
0 |
1 word utterances |
1 |
3 |
0 |
12 |
|
7 |
9 |
8 |
3 |
MLU (in words) |
3.14 |
2.56 |
2.74 |
1.25 |
|
2.21 |
1.62 |
1.71 |
2.46 |
Brown's stage |
Early IV |
III |
III |
Early I |
|
II |
Late I |
Late I |
II |
Questionnaires were administered to the EAs prior to the beginning of class, on the last day of class and three months after the last class. Results from the questionnaires indicated the EAs' perception that device use and language type increased between Class 1 and Class 5. The EAs all judged the devices to be more effective after Class 5 compared with Class 1. At five month follow-up, the results were mixed: one participant no longer had access to her device, the second used her device well and the third used her device rarely.
The Participation Model provides a useful framework for evaluating barriers to successful AAC use [6]. The two main categories of barriers are opportunity and access. Opportunity barriers are limitations of society (e.g., attitudes, policies, practices) and support systems (e.g., skills and knowledge of people who support AAC users). Access barriers refer to the abilities and limitations of the individual AAC user themselves. Carryover to the classroom of the student's confidence and abilities using their devices was confounded by two main factors. First, two of the three students were assigned new EAs when the last questionnaire was administered. This means that the students no longer had the knowledge, skills or support from their EAs. Second, one of the three participants did not yet have her own device when generalization was assessed. This lack of regular access to the devices is not a factor that was anticipated (but one that does occur often), and it had a major impact on her success as an augmented communicator.
The Minspeak classes offered instruction that addressed many of the access barriers such as providing the necessary adaptations for the students to use their devices (overcoming access barriers) and teaching operational skills to both the students and their aides (overcoming opportunity barriers). The class also taught specific linguistic skills through exposure to vocabulary, categories themes, conversation and story discussions. The EAs were also provided with instructions prior to each class in order to assist their students as needed. All three of our participants showed improvements in the use of their devices over the course of the AAC classes.
A limitation of the LAM is that it does not segment the output into defined utterances nor does it omit unwanted utterances such as revisions or restarts or those generated by other people (e.g. the EA). This may cause a discrepancy between what the LAM shows and what the child wanted the listener to hear. The LAM is a tool to measure AAC output quantitatively, but it should not be used alone or taken out of context. To address this problem, the LAM recordings were primarily used to verify the utterances taken from video transcription.
In summary, the Minspeak classes were of benefit to the students and to the EAs. The students benefited from classes that included their regular EA. They were able to become more independent and confident users of their devices with positive effect on language output measures such as MLU.
Albert M. Cook, Dean,
Faculty of Rehabilitation Medicine,
Room 348 Corbett
Hall,
University of Alberta,
Edmonton, Alberta, Canada T6G 2G4.
Phone 1-780-492-5991,
al.cook@ualberta.ca.