Presented by Patricia Ourand, MS, CCC-SLP, on September 27, 2013 at the fourth annual Center for Health Literacy Conference: Plain Talk in Complex Times.

1. More than Words:
AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
PATRICIA OURAND, MS, CCC-SLP
SPEECH-LANGUAGE PATHOLOGIST
ASSOCIATED SPEECH & LANGUAGE SERVICES, INC.
BALTIMORE, MD
WWW.ASLSINC.COM
POURAND@ASLSINC.COM

2. The Big Picture
The Power of Communication
"If all my possessions were taken from me
with one exception, I would choose to
keep the power of communication, for by
it I would soon regain all the rest“
— DanielWebster

3. Communication
• Identify, demonstrate, and
discuss strategies that facilitate
communication nonverbally,
using expressions, gestures,
symbols, photographs and/or
illustrations, and text, among
others RFS’s copy of a B, which he is able to see
clearly, and an 8, which he sees only as a
jumble of lines with color in the background

4. Case Study:
• RFS is a 61-year-old geological engineer with a progressive
neurological disease
• In October 2010 he suddenly found himself unable to perceive Arabic
digits, such as 4 or 8
• Since that time, he sees digits only as uninterpretable jumbles of lines
(which he calls ‘spaghetti’)
• RFS can perceive most, but not all letters normally
• He has been diagnosed with AlphanumericVisual Awareness
Disorder (AVAD)

5. Visual Strategies
• Newly devised digit character set • Calculator app using new characters

6. Imagine …
• your power of speech never works well for you.
• you are nearly always misunderstood, not heard, not noticed, not
considered part of a conversation.
• you are often ignored because you can’t do this simple thing (i.e.,
speak) that everyone else around you seems to do so well and so fast.
• when you try to write a note to a friend or a term paper for a class,
you can’t, either because you don’t know how or because your hands
and arms won’t perform the writing and typing movements that
everyone else does so effortlessly.

7. This discussion is about how people
communicate.
• It’s about how we can augment, support, and often compensate for
communication abilities that have not developed functionally or that
are lost at some point in an individual’s life due to injury, illness, or
some other acquired disorder.
• How we augment spoken and/or written communication and how we
use alternative methods to get the message through will be discussed
throughout this discussion.

8. AAC within the realm of: Assistive Technology (AT)
• Augmentative and Alternative Communication (AAC)
• AdaptedComputer Access
• Devices to Assist Listening and Seeing
• Environmental Control and Manipulation
• Adapted Play and Recreation
• Wheeled and Powered Mobility
• Seating and Positioning
• Prosthetics
• Rehabilitation Robotics
• Integration ofTechnologies
Church & Glennen (1992), King (1999),
Cook & Hussey (2002), Scherer (2003)

10. Talking or “saying” is communication
SOME PEOPLE USE THEIR SPEECH TO TALK. OTHER
PEOPLE USE GESTURES, OBJECTS, PICTURES AND/OR
ELECTRONIC DEVICES TO TALK.

11. The Dance
• To communicate one person must “say”
something by using: any combination of
speech, gestures, writing, pictures, and/or
objects.
AND
• To communicate at least one person must
“understand” what is meant by the: speech,
gestures, writing, pictures, and/or objects.

12. Communication across
environments and over time
LOCATION, LANGUAGE, ABILITIES, LITERACY LEVELS, AND CULTURE

13. Barriers to information access:
• language that is too complex
• text that is not accessible
• lack of availability of alternative languages and formats (e.g., Braille,
large print, audio, and electronic formats)
• use of disabling language
• the physical inaccessibility of various hard copy formats (Newel 1994)

14. Goals of AAC
• provide a
temporary
means of
communication
Temporary
• provide a long-
term means of
communication
Long-term
• facilitate the
development of
natural, spoken
communication
Therapeutic

15. • provide a
temporary
means of
communication
Temporary

16. • Communication is central to human life.
• Everyone communicates ...

17. Additional Goals
• availability of written communication across multiple formats and
environments
• control of the environment using speech, writing, and/or other
gestural movements
• concept and skill development, maintenance, or re-development

18. Recommendations addressing some
written communication barriers:
1. Simplify language and terminology
2. Include alternative formats
3. Print should be a font size larger than 12
4. Use full name / words / word combinations instead of acronyms
5. Incorporate colors that provide contrast between the text and the
background
6. Use photos, graphics, and pictures that make document interesting
and enhance accessibility to the text-based message

19. Health Literacy
Literacy in these terms refers to the ability of the individual and his or
her family to obtain, process, and understand the basic information
and services necessary to make adequate and appropriate decisions
about care.
It has been noted that individuals with speech-language and hearing
disorders are at risk for poor health literacy.

20. Communication, while basic, is also
a complex, multifaceted, multi-
modal process shared among
humans and others.
Volkmann (2002) noted, if you have a heartbeat,
you communicate.

21. Paramedic & EMS Symbol Board

22. LINKS AND BRIEF DESCRIPTIONS TO USEFUL
WEB SITES FOR PEOPLE WITH DISABILITIES AND
FUNCTIONAL LIMITATIONS
http://www.patientprovidercommunication.org/
useful_information.htm

23. Communication: the way in which
we share information with others
through language. Although we all
like to think we're saying exactly
what we mean, that's not always
the case, especially when we're
talking to someone who uses a
communication style very different
from our own.
© 2011 SHERRIE BOURG CARTER

24. Communication is
more than “talking”
IT ENCOMPASSES A HOST OF ENVIRONMENTS, TECHNOLOGIES,
AND STRATEGIES. NEW KNOWLEDGE COMING FORWARD WILL
ASSIST WITH THE IDENTIFICATION OF NEW AND ADDITIONAL
AAC TECHNOLOGIES, STAKEHOLDERS, AND FINDERS.

25. American Speech-Language-
Hearing Association (ASHA)
HEALTH LITERACY RESOURCES