Our guest chat host tonight on October 1,  2001, is Dr. Joanne Lasker from
Florida State University.  Joanne Lasker, Ph.D., CCC-SLP is an
assistant professor in the Communication Disorders department at FSU.
Her primary areas of specialty are adult neurogenic communication
disorders and augmentative and alternative communication (AAC). 
She has been involved in the assessment and treatment of people with
severe communication disorders for the past 10 years. Dr. Lasker is currently
investigating attitudes towards AAC held by adults with acquired
disorders, communication partners, and caregivers. She is on the
2001 ASHA Convention Program Committee for Augmentative and Alternative
Communication. Dr. Lasker will be making five presentations
at the upcoming ASHA convention, "AAC Equipment Decisions for Medicare
Enrollees: Selecting & Funding Devices", "Age Effects on Attitudes Toward
AAC Use in Aphasia", "Selecting & Combining Communication Techniques for
People With Aphasia", "Literacy Intervention Approaches for AAC Users With Autism",
and "Unexpected Evidence of Reading Comprehension During Oral Reading in Dementia".
Tonight Dr. Lasker will chat about augmentative and alternative communication (AAC).
A list of references from Dr. Lasker can be found at the bottom of the transcript.

<Robin> Welcome Dr. Lasker!
<Adrienne FSU> For those of you who don't know, Dr.Joanne Lasker is a
    professor at Florida State University. She works with AAC devices and
    also has done research concerning caregiver interactions using AAC.
<Adrienne FSU> She also made major headway getting Medicare to pay for some AAC
<Robin> Dr. Lasker is on the 2001 ASHA Convention Program Committee for
    Augmentative and Alternative Communication
<Anonymous6861> Are any of your research results published and if so, where?
<Anonymous6861> I also work in nursing homes so
    information along that line concerning AAC would be beneficial.
<Anonymous6861> Any help is greatly appreciated.
<Dr. Lasker> the research I've published has to do with attitudes toward and
    acceptance of AAC by adults with acquired disorders
<Anonymous6861> Where can I find that research?
<Dr. Lasker> One article is in the journal of Clinical Aphasiology and some is in the
    AAC journal. Other stuff is in book chapters.
<Adrienne FSU> 14 and 17, re you students?
<Dr. Lasker> I also have stuff on line at the University of Nebraska web site on AAC -
    that's a great resource
<Anonymous14> I am
<Anonymous17> hello, ACU student
<Robin> Dr. Lasker, perhaps you could share those references with us and we can
    post it with the chat transcript
<Dr. Lasker> Sure Robin I'd be glad to do that and I'll also add the Nebraska website
<Robin> great!
<Adrienne FSU> I'm glad you could come, do you have any questions about AAC
<Dr. Lasker> I'd be  very interested for the students on line to talk a bit about what they
    "think of" when they hear the term AAC.
<Anonymous14> I think of devices that can be more of a problematic barrier than a
    communication tool
<Dr. Lasker> one of the issues I frequently encounter is that people view AAC as only
    "electronic boxes"
<Adrienne FSU> I know it's stereotypical, but I think of communication boards or other
    actual machines
<Dr. Lasker> When I teach about AAC, I view it as a whole set of strategies, including
    everything from gestures to a high-tech computer
<Dr. Lasker> I think lots of SLPs "do AAC" on a regular basis and don't define it as AAC
<Dr. Lasker> For example, when you work on compensatory strategies with a person
    who has a significant communication disorder, I believe that you are using AAC
    approaches - strategies to improve the quality of communication
<JenniferJoy> How eager are the majority of your population to use AAC?
<JenniferJoy> I have found so many of my adult population would rather not use
    separate devices to communicate
<Dr. Lasker> The issue of "eagerness" to use AAC is huge. As you can imagine, it can
    be difficult for a 70 year old man who has had a stroke to accept any tool to
    communicate other than their "natural speech
<Anonymous17> what is the best way to determine the most appropriate AAC system?
<Dr. Lasker> The issue of assessment in AAC is huge, but one big piece of it needs to
    consider the attitudes of the potential user and the potential communication partners
<Dr. Lasker> Lots of adults just want to "go back" to the way things were before they
    lost the ability to communicate
<Dr. Lasker> As AAC practitioners, I think we need to "time our approach" well. I've had
    adults who rejected anything external initially, but came to accept it later on.
<Adrienne FSU> how can you explain that probably won't be happening?
<Dr. Lasker> I don't think our role is to be the one who "predicts" outcome. We are
    educators who are responsible for demonstrating the power and efficacy of AAC.
<Dr. Lasker> I usually show them what's out there and then let them come to the
    "place and time" when they are ready to consider the options.
<Adrienne FSU> are there AAC support groups, or places where they can see the
    devices working in action?
<Dr. Lasker> Great question. There are groups of people with aphasia who use AAC in
    the conversation groups - e.g. at FSU.
<Dr. Lasker> I make a point of showing my "potential users" what's possible and how
    they can effectively communicate with a tool, device, board, etc. If it doesn't work well
    when you first show it, chances are it will be rejected.
<Adrienne FSU> makes sense
<Anonymous17> What about the issue of using AAC with he Alzheimers population?
<Dr. Lasker> Dr. Michelle Bourgeois at FSU has been using  memory books with people who have
    dementia and has marvelous results. A recent article of hers is in the latest AAC journal.
    She's found that memory books really improve the quality of conversation of people with dementia
<Dr. Lasker> She had not been calling her approach "AAC" but it really is. It has a lot in
    common with communication books in aphasia
<Dr. Lasker> Someone asked about assessment and I think that's really important.
    How do you tell what device/system might work best for somebody?
<Adrienne FSU> I had asked earlier about people with progressive diseases... how do
    you alter the AAC as they decline?
<Adrienne FSU> Can they try out a couple before deciding?
<Dr. Lasker> I do a lot of work with people who have progressive disease, such as
    ALS (Lou Gehrig's disease).
<Dr. Lasker> As their disease progresses, the device/system needs to change which
    is why these folks need to see a clinician on a periodic basis. We sometimes move
    from a letter board to a talking typewriter kind of device to a switch-based system
    (when their movement degenerates to only a small useful motion).
<Dr. Lasker> And yes, we need to have people try out AAC before acquiring it.
<Adrienne FSU> thanks
<Dr. Lasker> For some people, that can be a problem when they don't have devices in
    a lab that they can see in their area.
<JenniferJoy> Are insurances willing to cover the expenses of the devices?
<Anonymous17> How much can an AAC device cost & does insurance cover the cost?
<Adrienne FSU> and speaking of acquiring it, what have you figured out with Medicare
    about paying for it?
<Dr. Lasker> Yes, this is the big news! Medicare is now paying for devices. And many
    private insurances are also.
<Dr. Lasker> Generally, as of 1/1/01, Medicare pays 80% of device cost for anyone who
    receives Medicare Part B benefits.
<Adrienne FSU> that's great!
<Dr. Lasker> The other 20% is covered often by a secondary insurance. Sometimes
    the consumer needs to pay it. . .
<Dr. Lasker> It's a huge change from the time when Medicare considered AAC
    "convenience items."
<Anonymous6861> And does Medicare call them AAC or SGD?
<Adrienne FSU> what's SGD?
<Dr. Lasker> Yes, Medicare calls them SGDs -speech generating devices
<Adrienne FSU> thanks
<Dr. Lasker> They classify them into categories according to capabilities of the device
    and cost
<Dr. Lasker> The other impact this has is that people who have been on disability
    from their job for 2 years can qualify for Medicare benefits.
<Dr. Lasker> This means that people who are younger (not over 65) might also be
    able to get a device through Medicare
<Dr. Lasker> I have several younger clients with aphasia who have received devices in
    this way
<Anonymous6861> That's wonderful. Does Medicare require any special documentation for
    SGDs other than a 700?
<Dr. Lasker> Medicare requires a pretty formal report structure that is available at
    another website - I can also give that to Robin for you to access - it includes a report
    and evaluation report as well as frequently asked questions
<Anonymous6861> Thanks.
<Dr. Lasker> For children it can be different. Funding may come through schools
<Adrienne FSU> would you use the same devices just different programing for kids?
<Anonymous6861> How does one or where does one look for funding for AAC grants?
<erika> thank you Dr. Lasker
<Dr. Lasker> Both kids and adults use similar machines. Often software differs, but
    the mechanics are the same really.
<Adrienne FSU> ok
<Dr. Lasker> So you could have both an adult with aphasia and a kid in school using a
    DynaVox, for example.
Adrienne FSU> hmm, neat
<Dr. Lasker> When you "prescribe a device" you need to consider the person, the
    technology itself and the environment it will be used in. What I put in a device for one
    setting may be really different than in another
<Dr. Lasker> One cool thing is that people are becoming much more techno-savvy.
    Lots of adults are coming in with computer experience.
<Dr. Lasker> They're not as frightened by the keyboard and by a computer screen.
<Dr. Lasker> 6861 - what kind of AAC grants were you talking about?
<Anonymous6861> Grants for research in the area of AAC
<Dr. Lasker> Oh, gosh - that's not my strong suit. Some people have gotten funding for
    AAC research through NIDDR - part of the NIH focusing on Disability Research and
    Rehabilitation. Others have gotten funding through the Department of Education
<Dr. Lasker> Some people get funding for supplying their laboratories and loaning
    libraries through foundations and private donors.
<Anonymous6861> Thanks, I'll check those sources out.
<Adrienne FSU> I know the AAC lab at FSU has been helpful to the student clinicians!
<Dr. Lasker> I had an amazing client with what's been tentatively diagnosed as ALS
    who really illustrated the importance of "time and acceptance" in device acquisition.
<Dr. Lasker> He was a sportscaster on T.V. - young guy, 41, with a family who began to
    lose the ability to walk and talk
<Dr. Lasker> His wife came to see me and I showed her some devices. She brought
    them home to show her husband who tried them and rejected them.
<Dr. Lasker> When his condition worsened, 4 months later, I went out to their house
    with the devices. He ended up getting a device through Medicare and is now using
    a Lightwriter.
<Adrienne FSU> that's great!
<Dr. Lasker> He is still denying that he has ALS, but is interested in communicating so
    he wanted a device.
<Adrienne FSU> geez
<JenniferJoy> that's great
<Dr. Lasker> I think it can be hard to accept a degenerative disease process especially
    when you're "in the prime of your life."
<Robin> I'll say
<Dr. Lasker> But his wife told me that he programmed in "I love you" first thing on that
<Adrienne FSU> awww
<Dr. Lasker> And that she cried when she heard it.
<JenniferJoy> that's so sweet
<Dr. Lasker> AAC really has the power to change people's lives in meaningful ways. . .
<Robin> Will there be a lot of AAC presentations at the ASHA convention?
<Dr. Lasker> Yes, there will be a whole slew of them. It's a separate division in the
    ASHA program. Which, BTW, also has a web site.
<Dr. Lasker> I'm presenting on Saturday morning of ASHA for 3 hours on Medicare
    Funding for AAC - with a bunch of other folks doing Medicare applications throughout
    the country.
<Anonymous6861> There are many presentations on AAC listed in the schedule; most
    of them sound very interesting.
<Robin> I noticed that you are on the 2001 ASHA Convention Program Committee for
    Augmentative and Alternative Communication
<Dr. Lasker> Yes, I did help select the papers, so if they're bad, you can blame me.
<Tina & Carol ACU> What about presenting at TISHA?
<Dr. Lasker> What state is TISHA?
<Anonymous6861> Texas Speech and Hearing Association
<Dr. Lasker> Oops - sorry I didn't know that.
<Anonymous6861> That's quite all right!
<Robin> we have a group participating in this chat tonight from Abilene Christian
<Dr. Lasker> I don't know of what's being presented there this year. My colleague,
    Delva Culp, is in Texas. She's doing great work with adults who have acquired
    disorders and with kids.
<Dr. Lasker> If you want to ask me to come to Texas, I'd be glad to make the trip! :~)
<Dr. Lasker> Do you have an AAC class at Abilence Christian?
<Anonymous6861> Sounds great, want to come to Abilene Texas and speak to my
    class? We would love that!
<Anonymous6861> Barry Romich came last year and spoke to the class.
<Dr. Lasker> Yes, the PRC stuff is fascinating.
<Anonymous6861> I teach a course in AAC at ACU
<Dr. Lasker> Oh, great. Do you have an AAC lab in which you can "play with" different
    systems and devices?
<Anonymous6861> No, actually that's why I asked you about grants
<Dr. Lasker> Oh, I see.
<JenniferJoy> How would we be able to go about creating an "AAC Lab"?
<Anonymous6861> I have some ideas
<Dr. Lasker> I was lucky in that when I was hired at FSU, they wanted me to start a lab
    in AAC and alloted some money for that.
<Anonymous6861> That's great. I really would like to have an AAC lab and some
<Dr. Lasker> But I know a lot of my colleagues who have gotten money from different
    private organization and foundations.
<JenniferJoy> We don't have THAT much money at Texas Woman's University :(
<Anonymous6861> Well, I am going to do some searching in the areas you suggested
<Dr. Lasker> Also, many companies (Don Johnston, PRC, DynaVox) will loan out
    devices for the course so your students can learn them.
<JenniferJoy> That's cool
<Dr. Lasker> The cost is less prohibitive than buying outright.
<Adrienne FSU> good investment
<Anonymous6861> Thanks for the information
<Anonymous6861> Buying outright is totally prohibitive with my budget.
<Dr. Lasker> Frankly, I would find it hard to teach the class without giving the students
    lots of hands-on. They all are required to learn at least 8 pieces of equipment.
<Dr. Lasker> But I certainly can see why it's hard to afford a lab.
<Anonymous6861> It is extremely difficult to teach a course without hands on
    experience. We take field trips to other places that use AAC and practice on their
    equipment. Not the same as having your own.
<Dr. Lasker> I think that if you could get a PC and a MAC  and a switch - you'd be able
    to do some of the minimal stuff.
<Anonymous6861> That's true, will give it some thought. Perhaps I can chat with you
    via e-mail or perhaps at ASHA if you have time.
<Dr. Lasker> That would be great.
<Adrienne FSU> Well, it's getting late... any last questions for Dr. Lasker?
<Anonymous6861> Thanks, Well good night
<Dr. Lasker> Okay. Thank you all.
<Adrienne FSU> Thanks for chatting with us!
<Robin> Thank you, Dr.Lasker, for sharing your insights about AAC with us
<erika URI> I didn't have much to say, but I watched (listened to) the information..
<Robin> thank you all for coming....we will have the edited transcript of this chat posted
    in our chat archives in the next week.

References from Dr. Lasker on AAC Acceptance:

Lasker, J. P., & Bedrosian, J. L. (2001). Promoting acceptance of
augmentative and alternative communication by adults with acquired
communication disorders. Augmentative and Alternative Communication,
17(3), 141-153.

Lasker, J. P. & Bedrosian, J. L. (2000). Acceptance of AAC by adults with
acquired disorders (pp. 107-136).  In D. Beukelman, K. Yorkston, & J.
Reichle (Eds.), Augmentative Communication for Adults with Neurogenic and
Neuromuscular Disabilities. Baltimore, MD: Paul H. Brookes Publishing Co.

Two excellent AAC websites:

1. The site from University of Nebraska-Lincoln. Lots of good resources.


2. The site from AAC-RERC re: Medicare funding protocol. Click on  Medicare
Funding Information.