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EMPRAC
6: ADJUNCT STRATEGIES IN OT PEDIATRIC PRACTICE II
| Term | Definition | Definition 2 | Definition 3 |
|---|---|---|---|
| OBESITY | ● Excessively high amount of body fat in relation to lean body mass ● Associated with a substantially increased risk of a number of health conditions | ||
| adipose tissue | high amount of body fat | ||
| Body mass index (BMI) | - accepted standard measure of overweight and obesity for children ○ Important unit for consideration because it would be proportionate for health risks | ||
| > 2 years old | weight in kilograms / height in meters squared | ||
| High BMI | = High risk for health conditions | ||
| Underweight | Less than the 5th percentile | ||
| Healthy Weight | 5th percentile to less than the 85th percentile | ||
| Overweight | 85th to less than the 95th percentile | ||
| Obesity | 95th percentile or greater | ||
| Children who are overweight or obese are at risk for the following: (CDC, 2015) | 1. High blood pressure and high cholesterol 2. Increased risk of impaired glucose tolerance, insulin resistance, and type 2 diabetes 3. Breathing problems, such as sleep apnea and asthma 4. Joint problems and musculoskeletal discomfort | 5. Fatty liver disease, gallstones, and gastroesophageal reflux 6. Psychological stress, behavioral problems, and issues in school 7. Low self-esteem and low self-reported quality of life 8. Impaired social, physical, and emotional functioning | |
| Joint problems and musculoskeletal discomfort | Due to amount of resistance being placed on joints that are bearing the weight | ||
| Psychological stress, behavioral problems, and issues in school | Bullying among peers | ||
| IMPACT OF CHILDHOOD OBESITY ON PARTICIPATION AND QUALITY OF LIFE | ● Marginalized and deprived of opportunities to participate due to size and stigma; occupational alienation (disconnectedness, isolation, emptiness) | ||
| IMPACT OF CHILDHOOD OBESITY ON PARTICIPATION AND QUALITY OF LIFE ● OT health issues: | cardiac, joint, and other physical issues, psychosocial consequences of obesity, such as being bullied and self-confidence | ||
| ROLE OF OCCUPATIONAL THERAPY | ● Evaluation of a child, including contextual factors ● Prevention and health promotion assessment and intervention | ● Innovative client- and occupation-centered program that promotes health, well-being, and quality of life ● Prevent occupational deprivation and alienation while promoting occupational justice | |
| Evaluation of a child, including contextual factors | ○ Holistic and comprehensive ○ Environment is crucial in developing the stigma, alienation, and deprivation that’s why we need to evaluate contextual factors. | ||
| Environment | is crucial in developing the stigma, alienation, and deprivation that’s why we need to evaluate contextual factors. | ||
| TARGETING OBESITY | ● Not specific for OT profession but principles could be important to think about how to incorporate it in our line of management | ||
| TARGETING OBESITY (1) | Implement comprehensive programs that promote the intake of healthy foods and reduce the intake of unhealthy foods and sugar-sweetened beverages by children and adolescents | a. Meal preparation, feeding, and eating activities | |
| TARGETING OBESITY (2) | Implement comprehensive programs that promote physical activity and reduce sedentary behaviors in children and adults | a. Includes screen time and repertoire of play materials, if we could capitalize on movement, socialization, and gross-motor activities for them to be agile | |
| TARGETING OBESITY (3) | Integrate and strengthen guidance for noncommunicable disease prevention (diabetes, heart disease) | a. Education approach for lifestyle modification to prevent risks | |
| TARGETING OBESITY (4) | Provide guidance on, and support for, healthy diet, sleep, and physical activity in early childhood to ensure children develop healthy habits | ||
| TARGETING OBESITY (5) | Implement comprehensive programs that promote healthy school environments, health and nutrition literacy, and physical activity in school-age children and adolescents | ||
| TARGETING OBESITY (6) | Provide family-based, multicomponent, lifestyle weight management services for children and young people who are obese | For children, if modeling in the family wouldn’t be there, particularly for the choice of food and lifestyle, everything that an OT do will not be effective. So family must be the good role model. | |
| OBESITY PREVENTION AND MANAGEMENT OF CHILDHOOD OBESITY | ● Community interventions ● School-based interventions ● Family-based interventions ● Primary healthcare | ||
| OBESITY COMMUNITY INTERVENTIONS | ● Incorporating policies and strategies aimed at reducing the population risk of obesity through legislation, modifications to the built environment, provision of accessible resources, and changes economic/pricing/food subsidies | ● Can involve the use of media, businesses (e.g., restaurants), community health services, community gardens, community or recreational centers, city planning, and the local governments | |
| OBESITY COMMUNITY INTERVENTIONS ○ In QC, | there is a posting of the calorie counts of food items to help the community become aware of their food choices | ||
| OBESITY SCHOOL-BASED INTERVENTIONS | ● Taking place during school hours or after-school hours for children in kindergarten through high school ● An entry point to improve the obesogenic environment (more physical activity, better school programs, nutritious food) | ● School-based interventions that used a multi-component approach of both physical activity and nutrition, with some intervention with families in the home had the largest effects | |
| OBSESITY ENHANCING TEACHER AWARENESS | ● Increasing awareness of teachers regarding the impact of obesity on learning ● Excess body weight can interfere with fine motor skills and grasp, and also impact postural control | ● Encourage the teachers to support the mental, physical and social health needs ● Involving teachers and counselors in the therapy plan | |
| Suggested interventions; Teachers and counselors ● Physical | ● Suggest games in which the entire family can participate | ● At school, OT contributed ideas in activities that would increase motor planning, group interaction & problem solving. This involved dividing the class into task "set up" & "clean up" teams. The success is based on the holistic approach to the activity. | |
| Suggested interventions; Teachers and counselors ● Academic | ● Teachers incorporated a "stretch and move" time into the academic blocks so that the children did not sit for long periods of time. | ||
| Suggested interventions; Teachers and counselors ● Psychosocial | ● Professional counselors at school facilitated group skill development and, if possible, the county nutritionist, over time, could be asked to lecture on and implement a 'healthy foods' programme. | Children can incorporate a healthy lifestyle log into the language arts academics. Microwave cooking in the classroom can help the children cook and served each other promoting social interactions, healthy meal prep and cooperation. | |
| OBESITY | ● Involving either passive or active parental involvement ● Considered one of the most powerful influences on children’s healthy behaviors and outcomes | ● Exhibit positive parenting practices ● Provide a healthy, supportive environment | |
| passive parental involvement | Let them read and process | ||
| active parental involvement | Co-facilitators/Co-facilitators in programs | ||
| Poor family functioning | has been linked with an increased risk of obesity, obesogenic behaviors, and adverse health outcomes | ||
| positive parenting practices | role modeling, limit setting | ||
| OBESITY PRIMARY HEALTHCARE | ● Health promotion or weight management programs conducted within or in close coordination with the primary healthcare system | ● The effective interventions actively involved parents in health education, group meetings, physical activity sessions, or behavioral therapy ● Occupational Therapy home program | |
| OBESITY OT INTERVENTION STRATEGIES | ● Integrate sustainable, health-promoting changes ● Adaptive strategies, energy conservation techniques ● Environmental modifications ● Addressing psychosocial barriers ● Managing family cooking styles and routines | ||
| sustainable, health-promoting changes | ○ Meal preparation ○ Budgeting ○ Physical Activity | ||
| Meal preparation: | be conscious of ingredients | ||
| Budgeting: | We need to have budget based on income, even in food expenses, in teaching our patients to be more conscious | ||
| Adaptive strategies, energy conservation techniques | Mobility, endurance and fatigue issues | ||
| Environmental modifications | ○ Reorganizing kitchen, standing desks (avoid sedentary behaviors), walking initiatives | ||
| OBESITY OT HOME PROGRAM | ● Presenting and sharing of nutritional information ● Delineating the parents’ processing styles for tolerating change ● Creating (meals) a variety of foods for increased health and mobility, participation in sports, etc.; | ● Using healthy ways of incorporating food for improved social skills to increase self-esteem /positive body image | ● Developing healthy habits for eating and for specific occupational role participation in the areas of student, family member, and friend ● Providing a ‘helpful hints’ handout |
| Helpful hints handout | Provided to parents to encourage them to make healthier choices and to help illustrate the hidden factors in some seemingly harmless selections. Please us this as a guide and not hard and fast rules. | ||
| Helpful hints handout | ● Look at saturated fat levels ● Re-think fast foods ● Things to avoid: a. Food labeled b. Deep fried c. Scalloped d. Cheese sauces e. Cream sauces f. Bread | ● Drink water instead of sodas ● Think about what you put on sandwiches ● You can special order! Ask for veggies instead of butter, meats broiled instead of fried ● Stop super-sizing meals | ● Be cautious of how much salt you use ● Substitute turkey bacon for regular bacon ● After you fill your plate at a buffet, WAIT 20 mins before going back. |
| no more than 2 grams of saturated fat per day | Recommendation from the American Heart Association for each person | French fries in fast food restaurants have more than 10g in just one serving | |
| 20 mins | It takes that long for the message to go from your stomach to your brain that you are full | ||
| Stress related occupational performance including, but not limited to, academic and social interaction | General suggestions: ● Manage bullying by providing role-play for the children on how to offset this | ||
| Decision making/problem solving skills | Case study specific ideas: ● Provide rationale for healthy activity choices | ||
| Attention/retention skills | Case study specific ideas: ● Have the children write in their journal the most important thing they did/learned that day. ● If children do not like to write, ask them to draw pictures of what they remember from the activity/task/story. | ||
| Organizational abilities | Case study specific ideas: ● Create healthy life habits. Have a paper place 'wheel' of healthy foods that can be eaten each day so that being aware is visual and easy to track | ● Calendar activities and when children play outside instead watching TV they can give them a sticker. Accumulated stickers equal a non-food reward such as a movie or a trip to the zoo | |
| Emotional components and self-esteem impacting participation | Case study specific ideas: ● Avoid scales and 'weigh ins' ● Increase confidence in decision-making around food portions ● | ||
| NICU CARE ENVIRONMENT | ● Parent presence at bedside and participation in care are pivotal factors in the developmental progress of infants | ||
| “Hybrid NICU” | ○ Standard NICU hours will be lesser and the infant will be moved to another room where increased participation from the parents will be there and implement programs | ||
| NICU CARE ENVIRONMENT ● Single-family room environment | ○ Protection from exposure to other patients ○ Infants who are vulnerable to stress ○ Parents may experience NICU care in privacy ○ Skin-to-skin holding, bedside pumping, and breastfeeding ○ Incorporates home-like atmosphere | ||
| THE NICU PATIENT | ● Full-term and preterm infants with medical and developmental conditions | ||
| Preterm infants | ○ Maternal health conditions ○ Gestational age (GA) at birth (typically 37 weeks) ○ Birthweight (BW) | ||
| BW Appropriate: | 2500 g to 5 kg | ||
| BW Low birthweight (LBW): | 1500 to 2500 g | ||
| BW Very low birthweight (VLBW): | 1000 to 1500 g | ||
| BW Extremely low birthweight (ELBW): | < 1000 g | ||
| BW Incredibly low birthweight: | < 750 g | ||
| as birth weight decreases | Certain functions and brain development are compromised (cardiac and respiratory) | ||
| Fetal growth | (symmetrical vs. asymmetrical growth) ■ At birth, the head is larger than the extremities. If that isn’t seen or maintained, it would be considered asymmetrical. | ||
| Childhood occupation for the NICU | – appropriate tasks and activities that are valued in either the family’s culture or the NICU culture, within which an infant is expected to participate | ||
| Acquisition occupations | (foundation for future skill development, e.g., exploring) ■ Sensation and awareness of environment | ||
| Apprentice occupations | (specific teaching-learning and practice, e.g., feeding) ■ Need participation of caregiver or parent | ||
| Caregiver’s role: | ○ Attend to the infant’s behavioral communication ○ Be receptive and responsive to the infant’s attempts to perform ○ Nurture the infant’s role performance. | ||
| OT’s role: | is to observe and assess the infant’s sensory responsiveness and neurobehavioral performance, and to help identify the infant’s thresholds for sensory aspects of NICU care, including positioning, handling, interaction, and feeding. | ||
| Anticipatory guidance: | There will be tendency for NICU patients to have problems in certain aspects; we try to avoid that and provide guidance | ||
| NEONATAL OCCUPATIONAL THERAPIST | ● Direct patient care ● Collaborative consultation with families and the medical team ● Staff and family support and education | ● Facilitation of system changes in the NICU environment ● Caregiving practices that are neuroprotective to the infant and supportive of the family | |
| SYNACTIVE THEORY OF DEVELOPMENT (AIs, 1982) ● 5 Components/Systems: | ○ Any strategies/programs would need to address any part of this system because it will lead to optimal development ○ Autonomic ○ Motor ○ State ○ Attentional/Interactive | ||
| APPLICATION TO OT | ● Interpreting behavioral cues across the subsystems ● Determining stress or stability ● Interventions are not exceeding neurological threshold | ||
| NEONATAL INTEGRATIVE DEVELOPMENTAL CARE (IDC) MODEL | ● “Universe of Developmental Care Model” ● Includes seven core measures, each with guidelines for intervention aimed at providing neuroprotective, developmentally supportive, and family-centered care in the NICU | ● Not exclusive to OTs, these are general and easy to adopt to OT | |
| 7 core measures of Neonatal IDC Model | 1. Healing environment 2. Partnering with families 3. Optimizing nutrition 4. Protecting skin 5. Minimizing stress & pain 6. Safeguarding sleep 7. Positioning & handling | ||
| ENHANCING NEURODEVELOPMENTAL OUTCOMES THROUGH SENSORY-BASED CARE | ● Safeguarding sleep ●Minimizing avoidable stress ● Protection of fragile skin and prevention of cold stress ● Provision of supportive touch and handling ● Avoidance of intrusive light and sound ● Supportive handling ● Family integrative care | ||
| EVALUATION OF THE INFANT (1) | 1. Assessment of neurobehavioral development of the infant | ||
| neurobehavioral development | (limitations in sensory responsiveness, feeding competency at breast and bottle, etc.) | ||
| EVALUATION OF THE INFANT (2) | 2. Acknowledge the nurse’s role in protecting the infant | ||
| EVALUATION OF THE INFANT (3) | 3. Begin with observation, initially undisturbed, followed by observation during routine care a. Resting posture b. Skin color c. Respiratory rate | d. Sleep-wake states e. Stress signals (finger splaying, hiccups) f. Self-regulation signals (hand-to-mouth patterns, tucking) | |
| EVALUATION OF THE INFANT (4) | 4. Joint clinical observation with the parent and nurse (co-assessments with other disciplines) | ||
| EVALUATION OF THE INFANT (5) | 5. Administration of structured observations and standard neonatal assessment tool (Test of Infant Motor Performance, Neonatal Network Neurobehavioral Scale) | ||
| EVALUATION OF THE INFANT (6) | 6. Serial assessments are recommended, as they accommodate the dynamic nature of the NICU patient | a. Not done once, but progressively to see improvements | |
| EVALUATION OF THE INFANT (7) | 7. Assessment of newborn infants (acutely ill, premature) requires years of experience and training as preparation | ||
| EVALUATION OF THE INFANT (8) | 8. Longitudinal follow-up of infants’ progress is essential for the development of sound clinical judgment | ||
| SPECIFIC THERAPEUTIC INTERVENTIONS IN THE NICU | 1. THERAPEUTIC POSITIONING AND NEUROMOTOR DEVELOPMENT 2. BREAST AND BOTTLE FEEDING 3. DEVELOPMENTALLY SUPPORTIVE FEEDING INTERVENTIONS 4. ENVIRONMENTAL MODIFICATION | ||
| THERAPEUTIC POSITIONING AND NEUROMOTOR DEVELOPMENT | ● Resting posture of preterm ● Elongated head shape, which contributes to head turning toward the side ● Use of swaddles, positioning aids, and promoting a tucked, flexed, and midline orientation | ● Gentle PROM for infants with structural limitations of movement (e.g., torticollis or contractures) who can tolerate therapeutic handling ● Splinting and/or therapeutic taping are rarely needed in NICU | |
| Resting posture of preterm: | extended and asymmetric, head turned to one side, and extremities abducted, ER, and resting completely with the bed surface (hypotonia) | ○ Such wouldn’t be facilitated in attainment of Gross Motor skills, exploration of the environment so we try to avoid any complications because of prolonged assumption of only one posture | |
| active movements are priorities in the NICU | Protecting skin integrity and encouraging organized, _______ | ||
| OPTIMAL POSITIONING IN SUPINE | ● Head at or near midline (within 45 degrees of anatomic neutral position) ● Containment of extremities in a gently flexed position ● Extremities in near neutral ab/adduction | ||
| OPTIMAL POSITIONING IN PRONE | ● Improve oxygenation and reduce stress ● Arms resting flexed at the side ● Gently rounded shoulders and absence of neck/back extension ● LE in a tucked flexed position ● Ankles resting over dorsal support | ||
| BREAST AND BOTTLE FEEDING ● For the first nutritive oral feeding experiences | Frequent skin-to-skin holding, nuzzling at the pumped breast, and offering the breast are all recommended for NICU infants prior to offering a bottle, even when the combination of breast and bottle feeding is the goal | ||
| BREAST AND BOTTLE FEEDING ● Suckling with swallowing and breathing | A trial of nutritive oral feeding at the breast prior to introducing the bottle allows the infant to practice coordination | ||
| BREAST AND BOTTLE FEEDING | ● Mothers are educated on the benefits of breastfeeding and are encouraged to begin pumping early to establish milk supply | ||
| COMPONENTS FOR SAFE, COMFORTABLE FEEDING | ● Anatomic Integrity ● Regulation of States of Arousal ● Reflexive and Active Swallow ● Airway Protection ● Appropriate Breathing Rate ● Oral-Motor & Postural Tone | ● Tolerance for Positioning and Handling ● Appropriate Timing of Sucking, Swallowing, and Breathing ● Endurance ● Motivation | |
| DEVELOPMENTALLY SUPPORTIVE FEEDING INTERVENTIONS | ● “Infant-driven” or “Cue-based co-regulated feeding” | ● Focuses on the infant’s behavioral and physiological readiness for feeding, development of feeding competencies, observing throughout the feeding for signs of fatigue or distress and providing care support | |
| Infant driven: | From infant itself | ||
| DEVELOPMENTALLY SUPPORTIVE FEEDING INTERVENTIONS ● Goal: | to ensure the safety and comfort of the infant and create a pleasurable context for feeding for both infant and caregiver | ||
| ENVIRONMENTAL MODIFICATION | ● Cycling lighting to promote circadian rhythm ● Incubator covers to reduce visual glare ● Quiet times | ||
| PARTNERING WITH FAMILIES IN NICU | ● Acknowledges that the family has the greatest influence over an infant’s health and well-being ● Parents should be encouraged to ask questions about what they understand and what they want to know | ● Expanding parents’ expertise by providing opportunities to practice caregiving skills, assisting them wherever required, and acknowledging their successes will build parent confidence and help define their role as the experts regarding their baby | |
| PROMPT | ● “PROMPTS for Restructuring Oral Muscular Phonetic Targets” ● Multidimensional approach targeting motor skills needed in the development of language for interaction ● Bridges sensory input, motor planning, and functional execution | ● Integrating all domains and systems towards a positive communication outcome ● May be used with varying intensity and focus, ● 6 months of age onward; 1-2x a week; 30-45 minutes per session | |
| USES OF PROMT | ● To develop an interactive awareness/focus for oral communication ● To develop integrated multi-sensory associative mapping for cognitive or linguistic concepts | ● To develop, balance, or restructured speech subsystems at the motor phoneme, word, or phrase level | |
| A. SOCIAL EMOTIONAL DOMAIN | ● Comprised of skills related to interacting with and learning from others in the environment. ○ Interpersonal interaction ○ Trust ○ Communicative functions | ||
| B. COGNITIVE-LINGUISTIC DOMAIN | ● Comprised of skills related to understanding and using language. ○ Concept formation ○ Perception, sensation ○ Discrimination, recognition | ||
| C. PHYSICAL-SENSORY DOMAIN | ● Comprised of skeletal structure, muscular tone and motor skills. ● Treatment focuses on improving the client’s ability to be understood by others by refining how the client uses their jaw, lips, and tongue to produce sounds, words, and phrases. | ○ Skeletal structure ○ Neuromuscular integrity ○ Sensation | |
| CONNECTION WITH OT PRACTICE | ● Reliance on tactile, kinesthetic, and proprioceptive cues to the client’s jaw, face, and lips, specifically for clients who cannot rely on auditory or visual cues ● Sequencing oral movements (ideation and execution) | ● Proximal stability for distal mobility (adequate postural control, breath support, head/neck stability) | |
| ORAL PLACEMENT THERAPY | ● Sara Rosenfield-Johnson ● Speech therapy ● It is a tactile-proprioceptive teaching technique which accompanies traditional therapy | ||
| ORAL PLACEMENT THERAPY ● Speech therapy which utilizes a combination of: | (1) auditory stimulation, (2) visual stimulation and (3) tactile stimulation to the mouth to improve speech clarity | ||
| OPT GOALS | ● To increase the awareness of the oral mechanism ● To normalize oral tactile sensitivity ● To improve the precision of volitional movements of oral structures for speech production ● To increase the differentiation of oral movements | ● To improve feeding skills and nutritional intake ● To improve speech sound production to maximize intelligibility | |
| Dissociation | – separation of movement, based on stability and adequate strength in one or more muscle groups. | ||
| Grading | – controlled segmentation of movement through space based upon dissociation. | ||
| Fixing | – an abnormal posture used to compensate for reduced stability, which inhibits mobility | ||
| CONNECTION WITH OT PRACTICE | ● Shift from mere visual/auditory processing to the somatosensory system ● “Just-right” challenges (TalkTools Straw Hierarchy or Horn Hierarchy) ● Core stability before dissociated movements of the distal articulators | ||
| AUGMENTATIVE AND ALTERNATIVE COMMUNICATION (AAC) | ● Integrated group of components, including symbols, aids, strategies, and techniques used by individuals to enhance communication | ||
| Symbols | – representations of vocabulary or messages | ||
| Aids | – devices used to transmit or receive messages | ||
| Techniques | – the way messages are transmitted | ||
| Strategies | – the ways symbols, aids, and techniques are used to maximize communication | ||
| FUNCTIONS OF AAC SYSTEM | ● An alternative communication system, substituting to some extent for a vocal mode ● A supplement to vocal communication for the client who has difficulty with formulation or intelligibility ● A facilitator of communication | ||
| AAC INTERVENTION | ● To improve quality of life ● To improve personal relationships by increasing interaction with others ● To increase independence ● To satisfy basic needs | ||
| AAC POPULATION | ● Persons who have the intent need, and desire to communicate but cannot do so thru standard means ● Cerebral Palsy ● Progressive diseases ● Autism spectrum disorder ● Speech/oral apraxia ● Acquired disability (E.g. TBI, CVA) | ||
| FUNDAMENTAL AAC TRAINING STRATEGIES | ● Provide the user with instructions in all four areas related to functional AAC use ● Monitor “loads” during initial training to increase the probability of success ● Introduce new vocabulary and symbols gradually | ● Conduct in-service for caregivers on system set-up and maintenance ● Teach caregivers how to solve simple device problems and consider providing written instructions | ● Teach how to interpret cues from communication partners ● Establish concrete and functional goals with the user |
| four areas related to functional AAC use: | ○ Basic operational skills ○ Language skills ○ Social skills ○ Strategies | ||
| Basic operational skills | ■ Turning on/off, programming, retrieving messages | ||
| Language skills | ■ Teaching vocabulary, syntax, or the use of language | ||
| Social skills | ■ Establishing a topic, giving listener feedback, eye contact | ||
| Strategies | ■ Shortening messages, using the most effective communication methods | ||
| TYPES OF AAC | ● Unaided Communication ● Aided Communication | ||
| Unaided Communication | ○ Rely on the user’s body to convey messages ○ Requires dexterity and motor skills as well as certain level of cognitive ability | ||
| Aided Communication | ○ Requires the use of tools or equipment in addition to the user’s body | ||
| UNAIDED COMMUNICATION | ● Refers to communication system that does not involve the use of external equipment or device ● Systems that enable communication that relies on the user’s body (language) to deliver messages. ● Use body parts to speak | ||
| SIGN LANGUAGE | ● American Sign Language or Ameslan ● Most common ● A complete, natural language that has the same linguistic properties as spoken languages, with grammar that differs from English. ● Has its own syntax that is different from that of English | ||
| EDUCATIONAL SIGN SYSTEMS | ● Developed to create a better grammatical correspondence between sign language and English ● Signing Exact English | ||
| Signing Exact English | h- most common system; composed of about 4000 signs that include about 70 common English prefixes, suffixes, etc. | ||
| AIDED COMMUNICATION | ● Uses equipment and/or devices to enable people with disability to communicate ● Can be electronic or non-electronic | ||
| Symbol systems | – form the basis of aided system, non-electronic system, and electronic system | ||
| Symbols | – play a similar role as spoken words by representing ideas and concepts – can vary level of abstraction, style, and size | ||
| NON-ELECTRONIC SYSTEMS | ● Often the first systems used with individuals who have severe speech problems because they are flexible and inexpensive ● Use picture displays that are customized for the user’s needs and desires | ||
| COMMUNICATION BOARDS | ● Traditional augmentative communication systems that are convenient enough to be placed on wheelchair lap trays. ● Contain single display of vocabulary words and phrases ● Contain as many words and phrases as can fit onto the device | ||
| COMMUNICATION BOOKS | ● A way of representing speech or sentences, usually containing a wide variety of symbols and words organized into different categories ● Help provide access to a large vocabulary compilation | ● Collection of mini-boards that occur as chapters and pages within the text | |
| ELECTRONIC DEVICES | ● More expensive and involve unique considerations in their selection ● Involves increased independence and options of speech output ● Require periodic maintenance | ||
| EYE GAZE DISPLAYS | ● Enables users to access hands-free communication without requiring any further body movement, allowing users to independently navigate their communication program of choice | ||
| STRATEGIES FOR YOUNG CHILDREN OR INDIVIDUALS WITH SEVERE DEVELOPMENTAL DISABILITIES | ● Train across environments within natural settings ● Model AAC components or strategies to help validate these methods of communication for the user ● Manipulate the environment to create the need for the user to use the communication system | ● Use symbols to represent the steps of a specific activity ● Introduce new language through cause and effect training with 100% reinforcement | ● Increase the likelihood that AAC components are used by providing easy accessibility to these components in all environments |
| EVALUATION USING THE FEATURES/CHARACTERISTICS APPROACH | ● Entails identifying features and characteristics required, needed, and desired in an AAC system, based on an individual's needs, abilities and preferences | ||
| EVALUATION USING THE FEATURES/CHARACTERISTICS APPROACH ● Features/Characteristics Category: | ○ Output (visual, written) ○ Feedback (auditory, visual, tactile) ○ Input Method (direct selection, scanning) ○ Symbol size ○ Symbol type (colored, photograph, black and white) | ○ Flexibility ○ Portability and Durability ○ Cost and Warranty ○ Manufacture support ○ Integration and compatibility with other assistive devices | |
| EVALUATION USING DECISION-MAKING APPROACH | ● Analyze communication needs and abilities and identify goals ● List the environments where individual spends time and needs to communicate ● Survey partners and identify communication goals | ● Identify current communication techniques and effectiveness ● Identify goals and expectations of technology ● Identify optimal positioning of body and materials ● Determine optimal motor access site | ● Assess vision and hearing ● Determine language and communication functioning ● Assess cognitive and memory skills as they relate to AAC |
Created by:
avemaria