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JCPSLP
Volume 19, Number 3 2017
Journal of Clinical Practice in Speech-Language Pathology
Long term-outcomes for individuals
learning to use PAS
Communication autonomy
An autonomous communicator can say whatever they
want, to whoever they want, whenever they want (Farrall,
2015; Porter, 2012). Autonomous communication is not the
same as independent communication for individuals who
use alternative access methods. PAS is a strategy for
access to communication that may support autonomous
language development of learners with CPCSN by
providing:
•
a smart communication partner
– who can read subtle movement
– change the speed of presentation
– use context to co-construct messages;
•
opportunities for language expression with minimal
demand on visual or physical abilities;
•
opportunities to encourage visual interaction; and
•
support to maintain attention to the AAC tool (Porter,
2012).
Communication accessibility
Accessible communication refers to the people in the social
environment who will scaffold, support and understand
aided language as it is learnt and used. PAS supports
accessible communication by sharing the responsibility for
communication between the communication partner and
the individual with CPCSN. Family members, carers,
professionals and friends must be familiar with the skills
needed to provide AAC support, including how to:
•
operate the scan
– differentiate between scanning voice and social
interaction voice
– present items as a list, rather than a series of
questions
– present items consistently in a systematic order;
•
recognise the movements that indicate selection or not;
•
keep an open mind about what will be selected; and
•
sometimes interpret the meaning of the message
depending on context.
Communication accessibility also recognises that
communication happens all the time, and that access to
AAC is required at any time. PAS enables and supports this
belief (Porter, 2012). Training of communication partners in
the operational use of the AAC system, the access method
that the learner will use, as well as how to maximise the
linguistic, social and strategic learning for the individual is a
key component of AAC intervention.
Communication competence
Some communication partners will need to become very
competent AAC users themselves, in order to gain enough
linguistic, operational, social and strategic knowledge of the
AAC system for it to be natural and intuitive, and for them
to pass this knowledge on (Porter, 2012). This reflects the
way typically developing children learn language in natural
everyday contexts. Usually parents and other family
members, and teaching staff are the key communication
partners who model aided language. Aided language
modelling is well documented as an effective intervention
strategy to teach linguistic skills to individuals who use
direct access (Sennott et al., 2016). For example, training of
parents and other communication partners to use a range
of intervention strategies that facilitate early communication
and language skills using programs such as ImPAACT, have
learning the physical skills for electronic access to high
technology AAC may better be spent on interacting,
developing language, playing and socialising (Drager et al.,
2003). Some individuals with CPCSN may benefit from
separating learning of physical skills from the language
development task. PAS can support language learning
whilst physical access can be learnt in parallel during other
tasks (Burkhart, 2016).
Visual skills
Cerebral palsy (CP), a neurodevelopmental disorder of
movement and posture, is one of the leading causes of
physical disability in childhood (Cerebral Palsy Society of
New Zealand, 2017). CP is commonly associated with
vision impairments. Research suggests up to 80% of
people with cerebral palsy will have ocular or cortical visual
impairments, and that the incidence increases according to
the severity of physical impairment (Alimovi ´c, 2012). Visual
and/or auditory impairments have a significant impact on
language learning in typically developing children, and an
even more profound impact on individuals who require AAC
(Kovach & Kenyon, 2003).
The work of Roman Lantzy and Blackstone (2014)
on assessment and intervention has provided principles
for guiding improvement of vision and development of
language for individuals who have CVI and CCN. They
include PAS as a strategy that may work to support both
language development and functional vision. Providing clear
and consistent modelling to enhance visual and auditory
patterns is paramount, as the individual becomes familiar
with the visual associations related to language (Roman
Lantzy & Blackstone, 2014). During PAS, the availability of
a smart communication partner who pays close attention
to the individual’s responses and timing may support
language development to move ahead of visual or auditory
skills. Familiarity and confidence with aided communication
provides a natural context for developing other sensory
skills within the process of conversation (Burkhart, 2016).
Clinical implications
AAC intervention starts with traditional and dynamic
assessment, to gain knowledge about the individual and
the people supporting them. This is to ensure that informed
decisions are made about the:
•
adequacy of the individual’s current communication
needs and skills;
•
their future communication needs;
•
the AAC techniques and strategies that may be most
useful;
•
and also considers the people (parents, teachers,
other professional staff and peers) who support the
individual with CPCSN, who will build a supportive
AAC environment (Beukelman & Mirenda, 2013; Farrall,
2015).
Practitioners and supporters need to keep in mind three
long-term outcomes for individuals who are learning to use
AAC:
•
communication autonomy
•
communication accessibility
•
communication competence (Porter, 2012).
A supportive aided language environment and PAS
provides opportunities to develop each of these areas.
Communication partners need to be trained in how to
use PAS to maximise the outcomes for the individual with
CPCSN.