Our guest chat host tonight on October 23, 2000 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. She is currently
investigating attitudes towards AAC held by adults with acquired
disorders, communication partners, and caregivers. Tonight Dr. Lasker will
chat about augmentative and alternative communication (AAC).

<Adrienne> What is Beukelman known for?
<Dr. Lasker> He's kind of an AAC guru.
<Dr. Lasker> Robin - I don't know who the AT person is at Univ. of CA.
<Robin> Dr. Lasker, are you familiar with RIATT?
<Dr. Lasker> No, I've never heard that acronym.
<Robin> Research Institute for Assistive Training and Technology
<Dr. Lasker> Robin - Where is RIATT based?
<Adrienne> sounds similar to AAC
<Robin> out west, I think....Arizona?  I think they have interactive on-line
    learning courses
<Dr. Lasker> To a lot of people, AAC is one component of the larger
    field of Assistive Technology
<Adrienne> so what would AAC include?
<Robin> is that how you would define it?
<Dr. Lasker> AAC stands for augmentative and alternative communication
<Dr. Lasker> it includes any compensatory strategy that helps people with severe communication impairment
    that might mean children or adults
<Dr. Lasker> anyone who has a severe problem understanding or
    expressing themselves
<Dr. Lasker> Are you all familiar with the term AAC?
<Dr. Lasker> I think there are some common misconceptions about what
    AAC is
<Dr. Lasker> Partly because the exposure to AAC is so different in different parts of the country
<megan> different  how?
<Dr. Lasker> Basically we're talking about any strategy or technique that can be used by adults or children
    who have temporary or permanent communication impairment
<megan> ok
<Adrienne> it doesn't have to be a tool?
<Adrienne> like a computer or communication board?
<Dr. Lasker> No, no, no.
<Dr. Lasker> That is the single biggest misconception re: AAC
<Ana> You make it sound so general. Do you consider sign language a form
    of AAC?
<Dr. Lasker> Many people only think about AAC as a "talking  box
<Dr. Lasker> but there's so much more to what AAC specialists can do
<Ana> I guess sign isn't Augmented
<Dr. Lasker> Great point, Ana
<Dr. Lasker> There's some controversy about that
<Ana> or is it?
<Dr. Lasker> Basically we think of some sign approaches as AAC
<Dr. Lasker> Generally, ASL and other very formal sign languages
    are viewed as somewhat separate from the field of AAC but Signed English
    and less formal signs are frequently incorporated into AAC systems
<Ana> I start working with my first client next week...he's has PDD and we'll
    be implementing some signs to help his expressive language. I never
    considered that as AAC, but it makes sense
<Dr. Lasker> Think of AAC as a constellation of strategies that help someone
    who is having severe difficulty communicating
<Dr. Lasker> This might mean that with your client, Ana
<Dr. Lasker> you will use some sign, some speech, some symbols all in a communicative context
<Ana> yes
<Ana> that's the plan
<Ana> I am very nervous
<Ana> but so excited
<Robin> how do you keep up with all the new technology?
<Dr. Lasker> The technology is important
<Dr. Lasker> only to the extent that you know the "type" of machine, tool, etc.
    you're working with
<Dr. Lasker> Ana - I bet you'll do great with your client
<Adrienne> you sound like you have been preparing Ana, it will be thrilling!
<Ana> Thank you !!
<Dr. Lasker> Especially if you think of it as language therapy to the extreme!
<Robin> what are the industry "standards" ?
<Dr. Lasker> Not sure what you mean, Robin?
<Ana> haha...language therapy to the extreme...I like that viewpoint
<Dr. Lasker> I try to stay abreast of anything truly new that's coming out
<Robin> well, there must be so many choices of equipment...is there a
    particular device that you find yourself recommending?
<Adrienne> are there journals or workshops, how do you do that?
<Dr. Lasker> I do that by attending conferences a lot
<Adrienne> for any area of slp for that matter
<Dr. Lasker> and there is an AAC journal that helps
<Dr. Lasker> also frequent workshops
<Dr. Lasker> in terms of a specific device to recommend
<Dr. Lasker> no, I don't find myself recommending only one
<Dr. Lasker> because the clients are so so so different
<Robin> Will there be many presentations at ASHA in this area?
<Dr. Lasker> Yes, there's a special interest division (XII) in ASHA focusing on
<Robin> I remember working with someone years ago with an eye gaze
<Dr. Lasker> Yes, those used to be about $17,000
<Adrienne> WOW
<Dr. Lasker> Are you talking about the ones that took pictures of your pupil as
    it moved to locations on a computer screen?
<Dr. Lasker> The main thing about AAC technology is to not get too obsessed about it.
<Ana> that is one of my therapy goals for this little guy
<Dr. Lasker> You need to know the basic sorts of things that are out there
<Dr. Lasker> That is what I try to teach in my class
<Dr. Lasker> So, all students get exposure to PRC devices that use Minspeak keyboard based devices
<Robin> it was very simple.....just using his eye movement to get to target
    letters to spell out a message....
<Dr. Lasker> simple digitized devices
<Dr. Lasker> Robin - So you were using what we would call a "low-tech"
<Adrienne> Becky, Megan- do you have any experience with ACC devices?
<megan> no not yet..
<Robin> very low tech....he couldn't handle anything else
<Dr. Lasker> The devices can be alluring to lots of folks and scary to many others
<Dr. Lasker> Becky - It's great to be familiar with it
<Dr. Lasker> It makes you very marketable
<Dr. Lasker> At least that is what I found
<Dr. Lasker> If CAMA comes to your area
<Adrienne> what is CAMA?
<Dr. Lasker> that's a great conference to explore devices
<Dr. Lasker> Communication Aids Manufacturers Association
<Adrienne> what if a client cannot afford a device that you recommend?
<Dr. Lasker> Most school systems are required to purchase the technology
    for students
<Adrienne> to use at home too?
<Dr. Lasker> However, this doesn't always happen
<Dr. Lasker> Some states purchase 2 systems
<Dr. Lasker> one for home and one for school
<Adrienne> wow
<Dr. Lasker> Other states don't do that and I know of one case in which
    the student was forbidden to take the device home!
<Adrienne> what about elderly population?
<Dr. Lasker> Medicaid funds devices as do some private insurers
<Robin> what if the SLP in the school setting is not familiar with all the AAC
    devices...what would you recommend he/she do?
<Dr. Lasker> For the school SLP, I would suggest that she find out if there's a technology team in her school district
<Dr. Lasker> Sometimes we work with school SLPs to help them feel more comfortable with a device or technology
<Dr. Lasker> I've done that both in rehab. and in the university clinics
<Dr. Lasker> Has anyone out there heard that AAC impedes speech
<AlliKat> no-
<megan> no I haven't
<AlliKat> we thought it helped it
<robin> thats interesting!
<Dr. Lasker> That's a common misconception
<Dr. Lasker> You're right, AAC does actually promote more speech
<Dr. Lasker> because the individual views themselves as a communicator
<Dr. Lasker> In children, there's lots of research to support this
<Dr. Lasker> In adults, like in people with aphasia, we need more empirical
<Becky> at what age would you consider giving a child one of these devices
<Adrienne> I could see how you could think communication boards eliminate
    the need to actually vocalize speech
<Dr. Lasker> AAC doesn't impede speech! That's a common
<Dr. Lasker> Becky - In terms of ages, you can never start too early
<Dr. Lasker> But you wouldn't give a 2-year old a device before he or she
    is beginning to understand something about nonsymbolic communication
<Becky> that would make sense
<Adrienne> do you use similar devices for young and old clients?
<Dr. Lasker> Adrienne - I have used some devices for both old and young
<robin2> is a voice amplifier considered an AAC device?
<Dr. Lasker> Yes, a voice amplifier could be.
<Adrienne> Dr. Lasker- what types of disorders in elderly populations use
<Dr. Lasker> Lots of people with motor speech difficulties can benefit from
<Dr. Lasker> Wow, that's my area
<Dr. Lasker> Basically two types of disorders: acquired and congenital
<Dr. Lasker> Someone with CP who is older may use an AAC device
<Dr. Lasker> For older people, I also think about it
<Adrienne> I thought CP didn't have a long life expectancy?
<Dr. Lasker> in terms of motoric problems and cognitive/linguistic problems
<Dr. Lasker> Motor problems include ALS
<Adrienne> makes sense
<Dr. Lasker> Parkinsons, time in an ICU, other physical problems
<Dr. Lasker> Cognitive-linguistic stuff could be
<Dr. Lasker> aphasia
<Dr. Lasker> dementia
<Adrienne> my favorites
<robin2> Yes, I was looking into voice amplifiers for a Parkinson's pt
<Dr. Lasker> Adrienne - Some studies have shown that adults with CP
<Dr. Lasker> have a shorter life expectancy
<Dr. Lasker> although some of that is changing
<Adrienne> ok
<AlliKat> How does one qualify for a communication board?
<Dr. Lasker> No one really "qualifies" for a board
<Dr. Lasker> There are no prerequisites to using AAC
<AlliKat> Is it ever covered by insurance companies?
<Dr. Lasker> Rather we think about unmet communication needs
<Dr. Lasker> Yes, insurance does cover for many adults
<AlliKat> so can you just request one and from whom
<Dr. Lasker> To receive an AAC device, you must be evaluated by a licensed SLP
<Dr. Lasker> who preferably has some experience with it
<Dr. Lasker> Then she fills out the forms for the funders
<Dr. Lasker> It's a whole project!
<AlliKat> Is it more difficult for children to get?
<Dr. Lasker> No, in fact it's easier to get AAC for kids than for adults
<robin2> have you used the chattervox before?
<Dr. Lasker> No, I'm not familiar with the chattervox. What's it like?
<Anonymous2315> it is a voice amplifier by Servox.....
<Dr. Lasker> In an AAC evaluation, it's very helpful to have lots of types
    of devices around to have the client try out to see if they're really appropriate
<Dr. Lasker> Servox makes good stuff!
<Dr. Lasker> We're doing an evaluation next week here at FSU
<Adrienne> can you give some examples besides picture boards?
<Dr. Lasker> Sure, do you want brand names or device types?
<Adrienne> types
<Dr. Lasker> There are simple "talking boxes" where a user can press a
    button and speech comes out
<Dr. Lasker> The speech has been prerecorded by someone else
<Dr. Lasker> These might be MessageMates, TechTalks, etc.
<Dr. Lasker> There are devices that have dynamic computer screens that change when a user pushes on them
<Adrienne> are those portable Dr. Lasker?
<Dr. Lasker> They often produce a computer generated voice
<Dr. Lasker> Yes, they can be
<Dr. Lasker> We have one in our lab called a DynaVox
<Becky> can they construct original sentences, sorry if that question is too
<Dr. Lasker> But there are also DynaMos and DynaMytes that are smaller
<Dr. Lasker> No question is too basic!
<Adrienne> good question Becky
<Dr. Lasker> Yes, they can construct original sentences on the ones that have dynamic screens
<Dr. Lasker> But only if the user can do that. Lots of users have problems with that.
<Becky> if not they just use the ones that are already put together
<2robin> what devices have you used with parkinsons pts?
<Dr. Lasker> 2robin - For Parkinson's patients, I
<Dr. Lasker> have had lots of success using pacing boards, and alphabet
<Dr. Lasker> That means pointing to the first letter of the each word said
<Dr. Lasker> In addition to continued speech therapy (the Lee Silverman
    technique is good)
<Dr. Lasker> and also a voice amplifier
<2robin> yes, I took the Silverman course
<Dr. Lasker> How was it?
<2robin> which voice amplifiers do you like?
<Dr. Lasker> Oh, gosh, I don't know
<2robin> the course was very interesting, but most of the techniques I was
    already using
<Dr. Lasker> one that works consistently and is not too expensive?
<Adrienne> I don't understand the first letter of the word said part
<Dr. Lasker> Adrienne - one of the problems that Parkinson's patients
<Dr. Lasker> have is that they mumble, speak softly, and talk too quickly
<Dr. Lasker> If you place an alphabet board in front of them sometimes they have to slow down
    to hit the first letter of the word they are saying
<Dr. Lasker> A pacing board accomplishes the same thing and may be less cognitively taxing
<Adrienne> cool
<Dr. Lasker> So what else do you all want to know?
<AlliKat> Dr. Lasker, Are there any schools that you would recommend for
    interests in AAC
<Becky> how often do SLP in schools run across the need to use these
<Anonymous7416> tell me about voice amplifyers
<Dr. Lasker> AlliKat, I think that for graduate school you would want to
<Dr. Lasker> places that have AAC labs
<Dr. Lasker> University of Nebraska, Kansas, Purdue, Southwest Missouri
    State, Duquesne
<Adrienne> are you starting an AAC lab at FSU?
<Dr. Lasker> All those are place some of my colleagues work at.
<AlliKat> Thanks
<Dr. Lasker> Becky - The statistics for school SLPs are amazing
<Becky> really, I thought it might be rare
<Dr. Lasker> You are more likely to see a kid with an AAC device than a kid
    who stutters
<Becky> oh my gosh
<Adrienne> wow
<Dr. Lasker> I know. But the data show that out of a district of 1000 students
    certified for special ed 40 of them will require some AAC
<AlliKat> who would have thought
<Dr. Lasker> That may mean a device or it may mean other nonsymbolic approaches
<Anonymous7416> hmmmmmm...do large districts have AAC specialists?
<Becky> wow, I NEVER would have guessed that it was so common
<Dr. Lasker> Like basic communication work on turn-taking, and joint
<Dr. Lasker> Yes, many school districts do have AAC specialists and teams
<Dr. Lasker> It is common and that's why so many graduate schools are
<Dr. Lasker> offering AAC courses as a standard part of the curriculum
<Becky> would this team consist of regular classroom teachers?
<Dr. Lasker> The team would vary from place to place.
<Dr. Lasker> Hopefully it would contain SLPs, OTs, and PTs but in many places the
    AAC team is an SLP, a teacher, a paraprofessional
<Dr. Lasker> Generally, in schools, you need to think of the team as including many
    folks - the parents, the teacher, the SLP, the para, the OT for the district
<Dr. Lasker> often the school psychologist
<Becky> I guess you would want everyone involved, that would provide the
    best chance for success
<Dr. Lasker> Absolutely. If it's not a team approach, it won't work.
<Dr. Lasker> Because people communicate in all environments
<Dr. Lasker> Home, school, the car, daycare, and if they are AAC users, they need to
<Dr. Lasker> be able to practice their systems for communication in a variety
    of settings
<Becky> I suppose in all therapy you want the team approach really
<Adrienne> if a child learns  one type of device, do they ever "outgrow" it and
    change types?
<Dr. Lasker> Adrienne - It's not uncommon for people to move from one sort
    of device to another
<Dr. Lasker> We are having a speaker in AAC class who  has CP
<Dr. Lasker> She started out using Blissymbols (a symbol system on a
    series of boards)
<Dr. Lasker> Moved to a dynamic display system
<Dr. Lasker> And is now using Minspeak on a Prentke Romich device
<Adrienne> symbols like pictures?
<Dr. Lasker> Actually the Blissymbols are highly abstract, but there are other
    symbols systems that are just like pictures that are very concrete and realistic
<Dr. Lasker> She began with Bliss because that symbol system allows a user to "generate" new utterances easily.
<Dr. Lasker> For many people, though, Bliss is like learning a 2nd language
<Dr. Lasker> Also in cases of ALS, or Lou Gehrig's disease, people gradually lose physical
    function so their systems need to change as their physical limitations increase.
<Dr. Lasker> Has anyone seen Tuesdays with Morrie?
<robin3> yes
<Jennifer76> No, I haven't.
<Dr. Lasker> Or read it?
<Adrienne> no, but I'm going to assume it has to do with AAC
<Jennifer76> I want to read it soon.
<Dr. Lasker> That guy had ALS and I think he chose not to use AAC at the end
    of this life
<Dr. Lasker> But many people with ALS, die speechless.
<Dr. Lasker> That is an adult population which really requires fast and efficient
    AAC intervention
<Dr. Lasker> There's no time to futz around
<Dr. Lasker> We need to get them what they need
<Dr. Lasker>  and keep reevaluating as their abilities change
<robin3> yes, since their condition can change rapidly
<Adrienne> I am confused,
<Adrienne> you can't teach them after a certain stage in the disease?
<Dr. Lasker> People with ALS have a purely motor disease
<Dr. Lasker> Their cognition is intact, so essentially they are gradually losing
    control over their bodies but their minds are intact so the AAC approaches
    need to be accessed differently depending on what their bodies can still do
<Becky> are health care suppliers willing to purchase more than one system?
<Dr. Lasker> Becky - Health care suppliers are reluctant to purchase more
    than one thing
<Dr. Lasker> So we often use "lending libraries" for equipment for ALS
<Adrienne> can you buy used AAC?
<Dr. Lasker> Adrienne -I think you can in some places, but the model is really one of loaning out
<Dr. Lasker> until the person dies
<Becky> would this be through a hospital?
<Dr. Lasker> Many lending libraries are based in hospitals or universities
<Dr. Lasker> University of Washington has one
<Dr. Lasker> So does Arizona State
<Dr. Lasker> We're trying to start one here at FSU
<Becky> will they send something from FSU to Nevada for example, or is that
    person out of luck
<Dr. Lasker> Unfortunately, it's usually a local thing
<Becky> I figured
<Dr. Lasker> Many times the ALS Society in the nearest major city can direct some one
    to an appropriate resource. The rural folks have a tougher time.
<Adrienne> it seems like so much time is devoted to acquiring and learning
    how to use a device,
<Becky> are there many outdated AAC devices being lent out?
<Dr. Lasker> Outdated devices? Not really
<Becky> that's good
<Dr. Lasker> Many devices don't last for that many years
<Dr. Lasker> I've seen 5-8 year old devices in lending libraries
<robin3> what is the average cost of an AAC device?
<Dr. Lasker> There really is no average.
<robin3> how about a range?
<Dr. Lasker> Devices range from $100 to $7000 depending on the device
<Adrienne> do people/families ever get tired of switching?
<Dr. Lasker> Adrienne - Switching from one device to another, you mean?
<Dr. Lasker> I think that people want to communicate especially people at the end of their lives
<Adrienne> yes
<Dr. Lasker> so they are frequently willing to do whatever they need to do
<Dr. Lasker> if that means moving from a computer with speech to a more low-tech
    communication board, or to handwriting
<Dr. Lasker> they'll do it
<Adrienne> I guess as long as they can still communicate somehow
<Dr. Lasker> because they want to share closeness with the people they care about
<Dr. Lasker> Yes.
<Becky> do older people tend to shy away from computers because of a lack
    of exposure?
<Dr. Lasker> Great question, Becky! My research topic for my dissertation
    was on this.
<Dr. Lasker> I looked at potential communication partners for people with aphasia.
<Dr. Lasker> I found that unfamiliar strangers over the age of 60 much preferred to
    communicate using a device that had voice output vs. communicating with an aphasic
    individual who was hard to understand
<Dr. Lasker> So it was a big surprise.
<Dr. Lasker> We all thought that older people were just opposed to
<Becky> yes, I was trying to picture my grandmother touching anything like a
<Adrienne> that's what I would assume
<Dr. Lasker> It's different, I think, when an older person is related to the AAC
<Dr. Lasker> But for those people who live in retirement communities
<Dr. Lasker> who meet people who have aphasia or dysarthria they want to
    communicate easily
<Dr. Lasker> so they prefer AAC
<Adrienne> I can also imagine older people showing off their new toy
<Becky> you can never under estimate people
<Dr. Lasker> Yes, some people do show off the new technology
<Dr. Lasker> kind of like a high-tech walker.
<Adrienne> lol
<Dr. Lasker> I think we need to do more research on the attitudes of
    people who use AAC and their families
<Becky> yes, that would be very beneficial when dealing with them
<Adrienne> their family's attitudes or outsider's attitudes?
<Dr. Lasker> Both the family and strangers
<Dr. Lasker> That's a perfect master's or undergraduate thesis project.
<Becky> I'll save that for the future
<Tayler060> has anyone heard of a device called MCTOS?
<Dr. Lasker> The MCTOS? No, never heard of it.
<Dr. Lasker> Too many acronyms in this field!
<Dr. Lasker> What is the MCTOS like?
<Tayler060> I actually heard about it from reading a story on the message
    board of this web page
<Dr. Lasker> Any idea what MCTOS stands for?
<Tayler060> it is a mind controlled device that uses brain waves to control
    anything that can be operated with a switch
<robin3> interesting
<Adrienne> you are kidding
<Dr. Lasker> Oh, yeah, I've actually tried that at the ISAAC convention.
<Dr. Lasker> That's the international AAC organization.
<Dr. Lasker> I found it difficult to use and I can't imagine that it could be
    widely used at this time given the state of the technology by people with
    severe physical impairment
<Tayler060> there is a woman in las vegas that is using it with approximately
    80 of her 130 students
<Adrienne> wow
<Dr. Lasker> Then maybe I'm thinking of something else.
<Becky> that sounds very Sci-Fi
<Dr. Lasker> Do her students have physical impairments?
<Tayler060> it has used with people that are "locked in"
<Dr. Lasker> Yes, and also with the severely involved ALS folks
<Tayler060> I emailed this woman and she just responded yesterday
<Dr. Lasker> It requires a lot of focus and you can make something move on the computer
<Tayler060> most of them have no muscle control at all
<robin3> amazing
<Dr. Lasker> Yes, it's meant to work with brain waves.
<Dr. Lasker> Didn' t work all that well with mine:~)
<Tayler060> exactly, they can supposedly teach people in as quickly as five
    minutes to use it
<Adrienne> what if you use the wrong brain waves??
<Dr. Lasker> Yes, I flunked it at the ISAAC convention.
<Tayler060> people that have not been able to communicate in years
<robin3> that is an amazing story Tayler
<Dr. Lasker> I think that all this new technology is marvelous
<Dr. Lasker> because the more widespread it becomes the better off it will be for the AAC users
<Dr. Lasker> We need it to become less expensive and widely accessible.
<Adrienne> thank you so much for explaining everything to us Dr. Lasker!
<robin3> that is a big challenge
<Dr. Lasker> Taylor060 - I'd love to get that woman's email or web page.
<Dr. Lasker> No problem. I'm glad to do it.
<Tayler060> just a second I'll get it for you Dr. Lasker
<Adrienne> I think it shows that people are realizing how important
    communication is
<Adrienne> I wish healthcare would catch on
<Dr. Lasker> I think that this is a hopeful time for AAC.
<Tayler060> her email address is dotnewman@lvcm.com
<Dr. Lasker> Lots of attention is being paid to it in the field.
<Dr. Lasker> And slowly people are coming to understand exactly what it is.
<Tayler060> and if you'd like to read the article click on the message board
<Dr. Lasker> Thanks Taylor060.
<Tayler060> and it is entitled "No Subject" be Anonymous and the date is

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