Category Archives: AAC

Oral Histories and Legacies

Leaving an oral history or legacy is something that can be important to those with life limiting conditions.  Our team works with people with communication difficulties who rely on AAC systems to communicate and I (Nicola) was curious to investigate what services are available for people with life limiting conditions to leave a legacy for friends and families. I have had client’s that have left letters and planned their funerals using AAC systems that family have found subsequent to their death.  I have also had requests that family copy information that is stored on the systems to remember the person by.  However, I had felt that I was unable to support or guide people to services if they do want to leave something for their friends and family, so I went to find out more.

Legacy Service

My self and our team’s clinical psychologist met with the organiser from a local hospice, who coordinate a team of volunteers who support people with life limiting conditions to create an oral history for friends and family. This service has been running since 2013 when it was set up as part of a research project by the University of Sheffield and Macmillan Cancer Support.

The Macmillan service will support people referred to their service to create an audio recording. They do this in a number of different ways and will be guided by the individual.  They offer an interview, desert island discs, personal histories and memory boxes.  They use a crib sheet, but it is very much what the person wants to talk about and the facilitator just offers encouragement.

To do this, the service uses high quality recording equipment, funded by donations, the microphones on the system are small and frequently the person will forget that they are using them.  Recordings can be done either  on site or at the person’s home.  They need a quiet room and the service will offer emotional support.  The service then uses software called “audacity” to edit the audio together – so that the person does not need to do it in one go.  The service reported finding that the process can be beneficial for the person as a reflective exercise.

The Macmillan service have discussed using video with clients – however feedback so far has been that this would not be positive, including for reasons that the person could see physical changes in themselves. This may change in the future as younger people live their lives through social media.

Once completed, the person signs a consent form for who they want to access the recording. A CD is produced or people can have it in a digital format.  They can also consent to have the recording saved with the University of Sheffield as part of the research project to develop a growing oral social history to help future generations connect with real people from the past.  There is very little other research on the topic of leaving oral histories and legacies by people with life limiting conditions.  The research reported benefits for the participants and the importance of it being their voice.

Legacy using AAC

The service in Sheffield does support people with communication difficulties and have found that this takes more planning.  They did have one person referred to their service who used a communication aid, but following discussions this person did not follow through as she felt that the voice was not hers.

I now feel that I can discuss and offer sign post to services that will enable our clients to complete this, if that is what they want to do. It is a very personal thing and is not for everyone. When possible it should be offered prior to deterioration or loss of speech, but this is not always possible.  The hospice now feels that the local AAC service can support them if they have issues support people who use AAC to access the service.  For client’s using AAC it may be a matter of leaving the information in other ways such as in writing, videos, photographs as well as through their communication aid.  If you work with people using AAC I would urge you to offer and support people to enable them to leave a legacy behind and not be held back by their communication issues.

Specialised Services for AAC and Environmental Control: An Update

There have been big changes within the Barnsley Assistive Technology Team over the past three years, we have been steadily recruiting more team members as we expand our services across the Yorkshire and Humber region as part of the staged roll-out of Specialised Services for AAC and Environmental Controls. You can read more about the history of this process on our website.

We are now almost at the end of this process. We currently cover most areas within Yorkshire and Humberside and will be accepting referrals from all CCG’s by the end of the year. Information regarding our care pathway and how we work with local services can be found on our website:

Supporting Local Services

We are keen to work with local services to support them through this transition period and beyond. We have already visited lots of teams to talk about our service and how we can work with each other to support people using AAC and Environmental controls.

We also offer a wide range of free training courses which can be delivered in your local area. Details of our curriculum are also on our website: www.barnsleyhospital.nhs.uk/assistive-technology/services/training-courses/

We are also trying to bring together local services to share and learn from each other. This includes setting up and arranging the Yorkshire and Humber AAC Clinical Excellence Network meeting which has been running for almost a year now. The group meets every four months to discuss a range of Assistive Technology issues and serves as a useful forum for networking and CPD.

Also on our website is a range of resources, including our popular ‘local services resource pack’ which details products and resources which local professionals will find useful: www.barnsleyhospital.nhs.uk/assistive-technology/services/resources-and-information/

NHS England have also recently published guidance about AAC provision from local and specialised services. This is a useful reference for local commissioners and managers when considering AAC provision: www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2016/03/guid-comms-aac.pdf


We have received lots of positive feedback so far and are enjoying getting to know the professionals across the region supporting AAC and Environmental Controls. If you have any questions about our service or would like to arrange for us to visit your team, please email barnsley.at@nhs.net

To receive further updates and news from the Barnsley Assistive Technology Team, please sign up to our mailing list (we send a message or two per month).

Multi Sensory Keyguide

Working with clients with visual impairments offers challenges within the field of AAC that are unique and can require imaginative solutions to enable the client access to their device.

After supporting  a young child with no functional vision for numerous months, progress  in terms of his ability of navigating through the ‘pages’ of his language package on his communication aid was limited. This child was  accessing  his 45 location Wordpower language package set via a standard key guard and appeared initially to be making good progress in terms of remembering where specific vocab items were located.

As a navigation strategy, the child was supported to place his hand at the top left of his  device and then move down the columns and then from  left to right across the rows. He was able to press a few  cells  before his chosen cell and used the auditory feedback to cue him in as to where he was on the page. However after a period of use of this method  his progress appeared to have plateaued and his targeting  was not getting more accurate.

After discussion with one of our mechanical techniologists a multi sensory keyguide was developed using the department’s new laser cutter. This keyguide was layered – the top layer splits the page into eight sections and then on the bottom layer within each section six shapes (circle, star, square, triangle, diamond, oval) are cut. In this way the child is provided with a sensory code/cue for each cell of the vocabulary package and this should allow himself to orientate himself and more easily learn the use of the system.

Keyguard_annon_sm

Multi sensory keyguide showing layered shapes

Multi sensory Keyguide showing vocabulary

Multi sensory Keyguide showing vocabulary

We are looking forward to reviewing this child and seeing if this multi sensory keyguide has supported his ability to learn his AAC language package more effectively.

Local Service Resource Pack – update

Following the well received publication of our Local Service Resource Pack last year, an updated version has now been produced, including even more information about Augmentative and Alternative Communication, Environmental Control and Computer Access devices, software, hardware and other resources.

The pack is designed as an easy to use resource and is hoped to be particularly useful for supporting those working in local services within the Yorkshire and Humber Region, who may be expected to provide and support clients with using assistive technology that does not come under the remit of the Barnsley Assistive Technology Team. This may include local Speech and Language Therapists, Occupational Therapists, Teachers and Teaching assistants.

The guide includes ideas including communication aids and apps, computer access equipment, simple devices for environmental controls as well as details of assessments, software and other resources that may prove useful.

Local Sercvice Resource Pack

Local Service Resource Pack

The pack is available from our website at  http://www.barnsleyhospital.nhs.uk/assistive-technology/services/resources-and-information/

We hope that the resource will be useful and welcome any feedback, including any other products that you feel it would be useful to include. We hope to continue to update the resource on an ongoing basis.

Some low-tech AAC suggestions

We have been spreading the message about mainstream products that can help people communicate.  These are products that can be useful for people who require augmentative communication, and can be easily sourced by local therapy teams to support individuals they meet. Here we describe two examples:

E-Writers:

Boogie Board E-Writers, for example the Boogie Board, have been a particularly popular suggestion. An e-writer is an LCD board with a stylus for writing messages or drawing pictures. The image can be erased when it is finished with. This is a low-cost, portable low-tech AAC solution which may be preferable to using large amounts of paper.

E-writers are available in a range of sizes and styles, with some models saving your images and transferring them wirelessly to a phone, tablet or computer. They are suitable for clients who are able to use handwriting or drawing to support their spoken communication.

The Pen Torch:

PentorchOne of our clients, a gentleman with MND, explained that as one means of communication he used a stylus to point to an alphabet board. Unfortunately deterioration in his hand function meant that he was finding it increasingly difficult to point the stylus accurately. His conversation partners were often having to guess approximately where on the board he was pointing. This was effortful and time-consuming for all involved.

We suggested that a small pen torch might be helpful to more accurately highlight the letter he wanted without requiring increased hand movement. This piece of kit was easily purchased from the High Street and he found that it made a great difference to his ability to communicate via low-tech AAC. This solution was considered alongside other possible technology (e.g. eyegaze etc). The photo shows it successfully being used in action!

Previously this has been achieved using laser pens (see this great sheet on making one from Margaret Cotts, an Assistive Technology Specialist in the US ), these do carry a small risk in use however.  With the advance in LED technology, pen torches are now so bright that they can work just as well in some situations.  The use of a light seems easier to ‘read’ than pointing, and can be more relaxing/require smaller movements.

More Resources

We have created a Local Services Resource Pack  with lots more detailed information. This pack has been developed as a guide for local professionals and contains one page profiles on AAC (communication) and Environmental Control products and resources.

Have you got some techniques/mainstream products that have worked well for low tech communication support?  Please let us know!

Creating a Personalised Synthetic Voice (Voice Banking)

‘Voice banking’ has been discussed quite a lot within the AAC field recently and so, as a team, we have been exploring this and other similar techniques in more depth.

As the team member volunteered to test out the packages available to create a personalised synthetic voice I have spent what feels like weeks recording countless phrases! I have now created two personalised voices, one using ModelTalker and one using My-Own-Voice.  This post is a summary of the experience of creating these voices (including example recordings of the result).  We also have a fact sheet on our website with information about the options.

ModelTalker

Last week it was fantastic to finally hear the results of all the hours of recording into the ModelTalker voice recorder. The process has been frustrating to say the least! I have good quality voice, had access to the quiet surroundings required and a decent microphone and was pretty competent in the IT stuff needed to set up the ModelTalker recordings – but even so it wasn’t plain sailing. At times it seemed impossible to get a “green” light recording  with all parameters at an acceptable level, and so, individual phrases had to be re-recorded numerous times, even though as far as I was aware all environmental factors, recording volume and voice quality were unchanged. The tiring factor, even for me with a robust voice, was telling, and it was difficult to record successfully for more than a couple of hours at a time. Connection at times was lost, and at times the programme froze, which again  slowed the recording process and sometimes meant that the time set aside to record could not be used.

The ModelTalker documentation suggests that the recordings can be completed in 6-8 hours. However, it took me far longer than this and a lot of my phrases were submitted as an “amber” recording; meaning acceptable, but not perfect. Consequently, it is very evident that for most of our clients a comprehensive level of support during the recording process would probably be needed to get the best outcome.

However, on hearing the final product I can safely say that the voice that has been created definitely sounds like me – and creating and using this voice is currently completely free! The speech produced can be a little disjointed at times, irregular English spelling patterns create it some pronunciation difficulties and the intelligibility decreases in longer utterances, but the overall quality definitely shows features of my voice

Alongside this process I have begun working with a client, Greg, who, with support from his local therapist, Jennifer Benson, has created his own ModelTalker voice which he now uses on Predictable. To hear about the process I had just undertaken, from a client’s perspective, has been fascinating . Greg came across similar frustrations to those I have highlighted during the recording process and the tiring effect was very significant for him. However, for Greg, the pay off of having his own voice on his communication app seems to outweigh any of the difficulties he encountered.in creating his voice.  Greg has made a video about his voice banking experience at: https://youtu.be/DYdSTNDYBWE.

My-Own-Voice

After the hours taken to record my voice using the ModelTalker platform, the creation of a personalised voice using “My-Own-Voice” seemed  a lot less time consuming. Although the total number of phrases needed to be recorded were similar to ModelTalker, the “My-Own-Voice” only  took around 5 hours to make. The re-recordings needed were minimal and generally the process was less disrupted, with the recording working consistently each time I attempted to record a phrase. The navigation through the phrases as I recorded them seemed a lot more intuitive and I was able to seamlessly record one phrase after another.

Once more the voice created does sound like me, although there are some definite issues! Certain speech sounds do not sound at all like they should, particularly  word endings and some word initial consonant blends. In connected speech, intonation patterns can sound a little odd at times and the boundaries between words sound quite slurred which definitely has a negative impact on intelligibility.

The My-Own-Voice process is free to record and create  a voice, but you then need to apply  for a costing to use the voice you have created on  a communication aid.

Comparing the Results

For the purposes of comparison, I recorded a phrase as a direct voice recording and then created it using my personalised synthetic speech with “ModelTalker” and “My-Own-Voice”. You can compare the results for yourself by listening below, the phrase I used was “I am sat here, writing this blog, to allow you to compare the personalised voices that can be created by two web based programmes; ModelTalker and My-Own-Voice”:

My recorded voice

ModelTalker synthesised speech.

My-Own-Voice synthesised speech.

FactSheet

Feel free to download the information sheet  we have produced about voice and message banking from our website. This summary includes some hints and tips to think about when considering  the process of  recording words and/or phrases or creating a synthetic personalised voice.

In a future post we will discuss the difference between Voice Banking, Message Banking and other approaches to retaining identity in the use of communication aids.  As we write this post, breaking news is that Amy Roman, an AAC specialist in the USA has created a resource for message banking – MessageBanking.Com . This is discussed on this thread on the fantastic AT ALS email  list.

Choosing the right vocabulary package – a Barnsley AT Team study session

Members of the Barnsley AT Team met recently to spend some time looking at the evidence behind several different vocabulary/language packages for communication aids. This is a key and frequent discussion within the team and we organised a session to help develop our thinking on this.  It also links with the forthcoming research project we will be involved with funded by the  National Institute for Health Research and in collaboration with Manchester Metropolitan University (more on this later!).

Vocabulary packages can broadly be grouped into: taxonomic (categories), schematic (activities), alphabetic, iconic encoding, visual scene displays and idiosyncratic (personalised). Some systems might use several of these methods to organise vocabulary. For this session we chose to looked at the evidence around Visual Scene Displays (VSDs) and considered the following literature (some published in peer reviewed journals, some ‘grey’ literature):

  • Drager, Light et al (2003) The Performance of Typically Developing 2½ Year Olds on Dynamic Display AAC Technologies with Different System Layouts and Language Organizations
  • Drager & Light (2010) Designing effective visual scene displays for young children. 

This work suggest that visual scene displays may:

  • be most beneficial for young children and people with significant cognitive or linguistic difficulties (e.g. Learning Disability, Aphasia, Brain Injury);
  • provide a high level of contextual support;
  • enable communication partners to engage and support the person with communication needs by providing a framework and context from which they can scaffold a conversation;
  •  support real life events and experiences as they happen, by providing a supportive narrative;
  • be highly personalised/replicate real life experiences;
  • provide language in context;
  • shift the focus away from expressing wants and needs and towards social interaction and exchange of ideas and information;
  • reduce cognitive demands by reducing visual processing;
  • access linguistic concepts via episodic memory not semantic memory;
  • exploit human capacity for rapid visual processing of visual scenes.

The above studies also discuss the limitations of VSDs suggesting that:

  • Children with motor difficulties may find it harder to access hotspots on a VSD than symbol grids.
  • VSDs may be more visually complex than evenly spaced symbols in a grid.
  • VSDs are labour intensive to produce and maintain.
  • Jackson, Wahlquist and Marquis (2011), found children performed better with a grid layout and made more mis-hits with VSDs.

We also looked at the paper: “Critical Review: Which Design Overlay is Better Suited for Early Assisted AAC Intervention in Preschoolers: Visual Scene Displays or Traditional Grid Layouts? ” Kaempffer (2013).

Kaempffer reviewed the literature on VSDs and found results of studies looking at VSDs to be inconclusive and limited. Kaempffer was also critical of methodology and statistical analysis used in studies into VSDs. Only one study has included children with communication needs and some studies have suggested grid layouts may be more appropriate.

Our team concluded that VSDs should still be considered as part of the AAC assessment process. However although the literature suggests that emergent AAC users and adults with cognitive impairments may benefit from VSDs, from this session we could not see strong evidence to suggest particular groups of individuals or situations in which VSDs may be most useful.

A number of software packages are available that support VSDs, these include:

  • Tobii-DynaVox Compass, Sono Primo
  • MultiChat 15/Touch Chat HD app
  • Therapy Box Chatable & Scene and Heard

Have you used VSDs with a communciation aid user, have we missed some important literature? We would love to hear about your experience!

References:

Drager, K., Light, J., Speltz, J., Fallon, K., Jeffries, L. (2003). The Performance of Typically Developing 2½ Year Olds on Dynamic Display AAC Technologies with Different System Layouts and Language Organizations. Journal of Speech, Language, and Hearing Research, 46(2), 298-312.

Jackson, C., Wahlquist, J., Marquis, C. (2011). Visual Supports for Shared Reading with Young  Children: the Effect of Static Overlay Design. Augmentative and Alternative Communication, 27 (2), 91-102.

Kaempffer, A (2013) Critical Review: Which Design Overlay is Better Suited for Early Assisted AAC Intervention in Preschoolers: Visual Scene Displays or Traditional Grid Layouts? Poster presentation at University of Ontario. Unpublished/peer reviewed, but available as PDF.

Light, J., Drager, K., & Wilkinson, K. (2010, November). Designing effective visual scene displays for young children. ASHA Conference. Lecture conducted from Philadelphia, PA.. Conference presentation avaliable as a PDF.