The Importance of Augmentative Alternative Communication Devices

WHAT IS AN AAC DEVICE?

An Augmentative Alternative Communication Device (AAC) is a communication tool for individuals that are non-speaking or minimally speaking. It can take many different forms: a tablet, picture cards, even certain apps on cell phones. Musical Bridges believes that all forms of communication are valid, and that a client’s preferred method of communication should always be presented to them in sessions. Because of this, we adapt our sessions to include multiple communication styles, including the use of AAC devices.

Different Programs

Tablets that are utilized for communication are fairly common in today’s climate. There are several different programs that can be used on these tablets, and often clients will try out several to decide what best suits their needs. These programs may look or sound slightly different from each other, but the general idea of them remains consistent: clients can tap on symbols, words, or letters, and the tablet will voice them aloud. In some cases, these tablets have eye-tracking capabilities for clients that are not ambulatory.

Choices are organized into a grid-like image, typically with the most common phrases and needs on the home page. This can include things like emotions, greetings, and favorite foods or toys. Some choices open to a new page. When working on identifying emotions, the client may choose “I feel,” and then be taken to a page with several emotion options. Depending on the client, many programs have a keyboard screen, exactly like you would find on a computer or a phone, where they can manually type out what they wish to communicate.

Picture Cards

As wonderful as AAC tablets are, they are not always the correct fit for an individual. Some people want or need a tactile object to communicate, and we find one of these options in picture cards. This is called Picture Exchange Communication System (PECS). Much like on a tablet, these cards contain symbols or images of objects, places, emotions, or people, and often are accompanied with a written label. PECS cards can be laminated and used on a board or laminated sheet with Velcro dots. They can be used to make choices, form sentences, or ask questions. We use these often at Musical Bridges, not only with non-speaking clients, but with nearly all of our clients. PECS cards are wonderful for making a visual schedule for sessions, and clients can remove activities from the schedule when they are completed.

HOW DOES AN AAC DEVICE WORK?

Symbols

Symbols and pictures are very common for AAC devices. Photos of common people in the client’s life or places can help the client to adjust into a new space. Many of our clients have tabs on their devices that have a picture of Miss Lydia, Miss Melissa, or Miss Proctor, and they can use those tabs to get their therapist’s attention in the same way you might call someone’s name. Our clients all have a page on their AAC device for music and music therapy, where they can request their favorite songs or instruments by tapping on its picture. We also have PECS cards for the instruments in the clinic.

Words and Phrases

A common goal area targeted at Musical Bridges is communicating in complete sentences. While many clients have the specific goal to speak these sentences, this is not always the case. AAC devices have the ability to communicate in full sentences, and as we believe in client preferred communication, we believe that these sentences are just as valid as spoken ones. A client may wish to communicate that they feel happy, in which case they can tap, “I feel,” and then, “happy.” If asked why they feel this way, they can tap, “I am playing,” and, “the piano.” If this is a goal area that a client is working on, we diligently make sure that their device has this capability in its program, or that we have the appropriate PECS cards available.

Spelling

As wonderful as AAC tablets are, they are occasionally difficult to navigate. There can be dozens of pages within their systems, and some that are nearly impossible to find without knowing the exact route to them. For this reason, many tablets have a “search” function. This can be utilized by the client or a caregiver to find the appropriate page. When entering the search function, you would find a keyboard to use. This keyboard may also be used to type out words, names, or responses that might not be on the tablet itself.

Assumed Competence

As with all things that are included in working with people with disabilities, when it comes to AAC devices, we must have an outlook of assumed competence. AAC devices are just as valid as verbal communication, and even though someone may communicate differently than someone else, it is not an indicator of intelligence or ability. Many people who use AAC devices are fully literate, intelligent, and highly communicative. Regardless of the means of communication, we must meet people where they are at recognize the things they are communicating to us as valid.

HOW WOULD AN AAC DEVICE BE USED IN MUSIC THERAPY?

Prompted Communication

As previously stated, we use AAC devices in music therapy to work on many goals. Prompted communication can take many forms: making choices, forming sentences, and academic skills being some of the most prominent. Just as we would prompt these kinds of phrases verbally, we prompt them for AAC devices. Clients can be given two choices that are presented via song, then indicate on the AAC device which choice they’d prefer. Clients may be prompted to identify colors, numbers, animals, or other academic skills on their AAC device as well.

Making a Schedule

A common strategy used with PECS cards is to create a schedule that clients can help make for a session, then remove cards from the schedule board after the task is complete. Clients are given a set of PECS cards that correspond to all of the therapeutic interventions that the therapist has planned, and then may choose the order that those cards are placed onto the board. As the session moves on, clients have a visual representation of their time within the session, and clear knowledge of what they will be participating in. This can be a great tool to help clients feel ownership over their own sessions.

These schedules come in many forms, and some clients prefer a token system. Clients will be given a physical timer and told at which intervals on that timer they will “earn” a token. As the session goes on and tokens are earned, we often place a “reward” PECS card at the bottom of the token board. Many clients choose to have this reward be time in the sensory swing, proprioceptive squeezes, or using a fidget. When the session is over and all tokens have been earned, clients get a couple of minutes for their reward to complete their therapeutic experience.

Spontaneous Communication

One of the most, if not the most, important things about having an AAC device is the ability to have spontaneous communication. Being able to state that you need help with something, that you are thirsty, or that you love someone is an incredibly important and powerful thing. These devices allow the user to communicate their spontaneous thoughts with their therapist and their loved ones. Clients will often tell us things that they enjoy, things they don’t want to do, or things they find funny with their AAC devices. The ability to request more time on an instrument, or for the therapist to play the guitar softer, is just as important as making prompted statements or having a visual schedule.

AAC devices are invaluable tools that empower individuals to communicate in ways that suit their unique needs and preferences. At Musical Bridges, we are dedicated to creating inclusive therapeutic environments where all forms of communication are celebrated. Whether through a tablet or picture cards, our clients gain the ability to express themselves, share their thoughts, and connect with others. By prioritizing spontaneous communication and client agency, we foster a sense of ownership and confidence in our clients. As we continue to support their journeys, we reaffirm our belief that every voice deserves to be heard.