Speech Pathology: Guidelines about Augmentative and Alternative Communication (AAC)

This article discusses the guidelines for Augmentative and Alternative Communication (AAC) for speech impairment. It covers the types of AACs, when AAC assistance is required, and the type of communication assistance provided by AACs. It also includes a report on Work Health and Safety (WHS) policies and procedures relevant to the work of a speech pathologist.

Running head: SPEECH PATHOLOGY
Speech pathology
Name of the student:
Name of the University:
Author’s note

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Part 1
1. Information booklet
Title: Guidelines about Augmentative and Alternative Communication (AAC)
What is Augmentative and Alternative Communication (AAC)?
AACs are different types of communication techniques available to support a person with
speech impairment in making speech. The term ‘Augment’ in the ACCs system denotes
enhancements and the term ‘alternative’ suggest use of other communication systems to assist
client in the generation of speech. The types of ACCs may differ based on the use of equipments
to aid the communication.
Figure 1: Example of AAC devices used for people with speech impairment
Different types of AACs are as follows:
 No-tech communication system: It is the type of communication which is supported with
the aid of gestures instead of using additional equipments. Some examples of this form of
alternative communication includes use of gestures, eye pointing, facial expression or
vocalisation

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 Low tech communication system: It is the use of resource that does not need a battery to
operate. For example, equipments like pen, paper, communication charts, books with
pictures are used to aid the communication process. High-tech communication system: These are communication system that requires power
supply for use. Examples of this kind of devices include mobile devices or laptops.
When is AAC assistance required?
To be able to AAC system, it is necessary for speech pathology staffs to be aware about
communication needs of different client. The communication needs may differ based on
congenital, developmental, acquired and progressive disabilities in a client. AAC assistance is
needed for the following types of disabilities:
 Congenital/developmental conditions: People with development impairments like
intellectual disability, autism, laryngeal clefts, epilepsy, psychosis and Down syndrome
requires ACC assistance.
 Acquired conditions: People with acquired conditions like stroke, traumatic brain injury,
surgical conditions and neurological conditions like dementia results in speech and
communication impairment. ACC assistance is required for these groups of people.
As the above mentioned disabilities may be progressive in nature or severity may decrease
with time, the requirement for AAC system may change with time. Hence, same kind of AAC
system cannot be given to all clients. It is up to the discretion of the speech pathologist to define
whether high level or low level of assistance is required for particular client. Some clients may
required assistance for long-term whereas others may require temporary assistance.
Type of communication assistance provided by AACs:

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By the use of AAC system, diverse kind of communication needs of client can be
fulfilled. The following type of communication assistance can be provided:
1. Colour coding: Different colours can be used in AAC devices to help clients differentiate
between symbols.
Figure 2: Use of Fitzgerald key as a colour coding tool to classify different components of
speech
2. Facilitated communication: AAC system can be used to facilitate communication by
touching person with hand, elbow or keyboard to support clients to type or select
messages.

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Figure 3: An indication of facilitated communication by supporting clients to type or point to a
message
3. Vocabulary choice: AAC can be applied to work with children to support them in
education such as finding vocabularies. Commonly used vocabulary word can be used to
aid communication process. It can focus on using meaningful words that motivates the
client. While providing this type of communication assistance, it is necessary to use
vocabularies that can be regularly used and it is should be appropriate to the age, gender
and background of client.
Figure 4: An example of a device to teach vocabulary choice to clients
By the use of above mentioned devices, the following communication of needs of clients
can be fulfilled:
 AAC system can be used to assist client in education and learning new words
 It can be used to increase socialization and improve speech of client
 It can provide innovative means to assist client with speech development.

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 By increasing client’s ability to communicate, the self-efficacy of client in
communication process is improved and they are able to lead a high quality of life.
Example of typical AAC systems used in speech pathology settings:
Some examples of typical AAC systems that can be used with clients are as follows:
1. Gesturing: It is the strategy to use facial expression and pointing to communicate a
message to the client.
Figure 5: Use of pointing as a gesture to communicate message to the client
2. Communication books and boards: Object symbols or picture of common objects are
used in communication board to help a client point to those picture to convey a message.

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Figure 6: Example of a communication board used to assist in communication process
3. Spelling: many communication book uses spelling instead of pictures to support clients
to spell words. The below mentioned figure depicts how it can be used with a client with
speech impairment
Figure 7: Methods to help client to say a word using symbols

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4. Speech generation devices: These are high technology devices where people input
message into a speech generation and then the message is displayed on the wall’s screen
or it may be spoken by the devices.
Figure 8: An example of a speech generation device to aid communication process
Criteria used by speech pathologist to choose appropriate device for clients:
Speech pathologist follows certain process to identify specific types of AAC system
needed by different clients. The criteria followed to choose appropriate device are as follows:
 It is necessary to consider the type of speech impairment or disorder a client is
experiencing. This is essential to identify the whether AAC is needed to supplement or
replace speech
 Assessment of cognitive abilities should be done to identify whether a person can
recognize objects in communication board or use a speech generation device.

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 Assessment of fine motor skill is necessary to determine whether eye-pointing or
gesturing techniques are needed or not
 Assessment of visual abilities is essential to check whether images in the communication
boards are visible to the audience or not.
2. Report
Overview
Work Health and Safety (WHS) policies and procedures relating to the allied health
assistant’s role are of prime importance when implementing speech programs. It is crucial to
satisfy the WHS requirements pertaining to the role of a speech therapist since there are
professional, ethical and legal concerns that are to be addressed by the professionals. Previously,
each Australian State and Territory presents their own Occupational health and safety (OHS)
legislation). Nevertheless, in January 2012 different states and territories have worked
collaboratively for developing a harmonized OHS Act which is applicable across the
jurisdictions. The Work Health and Safety (National Uniform Legislation) Act 2011 includes the
Australian Capital Territory, New South Wales, the Northern Territory, Queensland and South
Australia. The Act brings forward different pieces of regulations and legislations. The present
report discusses the different WHS policies and procedures relevant to the work as a speech
pathologist. For each policy and procedure collected, the purpose of the same is highlighted
along with any legal or ethical requirements of the same and definition of any terms that are not
clear.
Duty of care

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An allied healthcare professional working as a speech therapist needs to abide by the
policy of duty of care that entails professionals to take necessary actions for avoiding causing
harm to the care consumers. Professionals have the duty of car towards the patients and in case
they fail to adhere to the expected standards, they are to be charged with negligence. The purpose
of the policy is to guide the professionals in a manner that prevents harm being done to the care
consumers. The professional therefore is required to be responsible for the patient’s care that
might be basic or complex in nature. The implication is that professionals are to provide
competent, ethical and safe care. Further, the professional’s personal judgments must not
interfere with the care delivery and compromise the care given. The policy has the ethical
requirement of providing best quality care to those in need.
Informed consent
Informed content is a vital procedure that is to be carried out at the initial stage of
provision of care. Informed consent is a significant document that acts as the instrument of
mutual communication between the patient and the care provider having the expression of
permission by the patient. As per the Code of Ethics of Speech Pathology Australia, the purpose
is to provide the patient with all the relevant details of the services that are to be provided. This
eliminates the chances of unreasonable demands from the service user’s end. The legal
requirement of the process of gaining informed consent is that no wrongful claim can be made
after the service has been delivered from the service user or service provider’s end. The ethical
requirement of the procedure is related to principles of basic human rights and patient autonomy.
Patient autonomy is referred to the right to engage in decision making pertaining to services
provided without any external influences on the process. The basic human rights pertain to
inform the care consumer about the care being delivered.

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Identification of risk to personal safety
Professionals must be identifying situations, environment and client-related factors that
might pose risk of hazards for individuals. Practical strategies are to be applied for minimizing
the identified risks. Any behaviors that pose concern in the context of the work being done are to
be identified appropriately. The ethical requirement is that clients are not to be subjected to any
risk of harms.
Documentation
Documentation is to be done by complying to the legal requirements included in the Health Care
Records – Documentation and Management Policy Directive. Implementation of services and the
consecutive outcomes are to be documented appropriately in a planned and accurate manner. The
information to be included should be according to the steps of the service delivered. Accurate
documentation ensures that client data is stored in a manner that meets professional and legal
requirements. The legal requirement of accurate documentation is that future care can be given
as per the needs of client. The ethical requirement of documentation is that care providers gather
comprehensive and truthful information of the client.
Manual handling considerations
Since there is a risk of mishandling of equipment, steps are to be taken to ensure that
mishandling of equipment do not lead to injury or hazard. A series of steps are to be taken that
ensure that the same is conferred to. All personnel are to be familiar with the condition of the
client and have experience of handling materials and equipment relevant to it. Handling of
instruments and equipment must be used following the manufacturer’s manual and guidelines of
the organization. While handling hazardous materials, safety requirements are to be followed.

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Duty to colleagues
Professionals must be treating other professionals with fairness, honesty, good faith and
respect. All workers must work in a cooperative manner for meeting the needs of the clients. The
ethical requirement is pertained to the need of acting as per the best interests of the client. Fellow
personnel are to be supported for reflecting on their professional conduct and practice.
Assistance is also to be provided for continuing professional development. Communication with
professionals must be transparent and two-way communication would be needed. Resolution of
conflicts is essential for making the service delivery process smooth and effective. Non-violence
in the workplace is also a key aspect of this policy since prevention of violence leads to a
suitable environment for service delivery.
Reporting of unfair incidents and risks of hazards
All professionals must be having a proactive approach in reporting unfair incidents in the setting.
A whistleblower approach is needed among the workers so that any undesired incidents can be
readily identified. Any potential risk of hazard is also to be pointed out and reported to the
concerned authority within the scope of practice. The term ‘worker’ refers to any individual who
carried out work in any particular capacity within a setting or undertaking. This includes an
employee, a trainee, a volunteer and an apprentice.
Part 2:
Answer 1
The four communication goals that a client may have while taking part in the speech pathology
program include the following:

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1. They can have the goal to reduce frustration and symptoms of depression in life due to
the problem in eating and swallowing of foods
2. As many clients struggle a lot in making speech particularly at public places, they have
the goal to get assistance with speech development at various situations
3. Another goal for client may be increase socialization or participation by achieving
improvement in speech and eating behaviour
4. For some clients, the ultimate goal will be to learn all technique to enhance the quality of
their life.
Answer 2
The following strategies can be taken to confirm a client’s communication needs with the
pathologist and liaise with other health professionals:
 It involves communicating with speech pathologist either by face-to-face communication
to confirm client’s requirement and expected outcomes of the programs.
 It is also necessary to confirm that all client needs are relevant to be fulfilled by the
organization.
 By speaking with speech pathologist and reading the client’s documentation, the client
can also get an idea about the rationale for implementing specific treatment within the
program.
 The same can also be done by communicating with speech pathologost in writing about
the client needs.
Answer 3
An interpreter for a speech pathology client may be required in the following situations:

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 If the client comes from a non-English speaking background and their language is very
different from that of the speech pathologist or other assistant staffs, then an interpreter is
required. This is needed because of difficulty in communicating a message to a third
party.
 Apart from addressing communication issues, interpreter may also be required when
there is a need to take informed consent from client. The interpreter can make client
aware about the language used in consent forms and the agreements in the form during
power of attorney matters or during residential care applications.
Answer 4
To get information about the scope of practice in the role of an assistance staffs, all
relevant information can be taken from the training institution, the employing organization and
the professional body. Awareness about organizational policies or procedure is essential to
understand boundaries of the role. It may also give guidance regarding taking part other task
such as supervision and consultation process. The duty of care document can also give the right
guidance regarding one’s responsibility while caring for client. The contact with professional
body can give idea regarding standards of care in the role which are in level with skills,
knowledge and experience required for the job.
Answer 5
While working as a staff in speech pathology program, one can encounter a situation
where ambiguities exist regarding the scope of practice in the organization. To address such
issues in practice, it will be necessary to contact an allied health professional to take advice
regarding the course of action in such situation. To work within the scope of practice, following

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the duty of care requirements can help to work as per expectation of the organization. Complying
with standards of care can ensure that now work is done that is beyond training course or
professional skills.
Answer 6
To identify possible resources for clients, the following needs to be confirmed with the
speech pathologist:
 The first step will be to identify existing communication resources used by the client
 After this, the nature of communication system and the implications for each resources
needs to be confirmed with the speech pathologist
 Assessment of client’s abilities should be done to identify appropriate resource for
clients. The assessment procedure should consider type of language impairment,
cognitive abilities, motor abilities and visual abilities of client.
 Client assessment can give the best idea about the use of best resource for client.
Answer 7
Communication resources may be used in an imaginative way as per client’s need in the
following ways:
 When the cognitive capacity and interest in new words increase, the client’s
communication board can be modified to add more questions like ‘why’ or ‘how’ to
improve thinking ability of client. It can also be used to support clients to express their
feeling or discuss about an interesting topic

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 When a client shows improvement in fine-motor abilities while using the keyboards,
more compact and smaller keyboard can be created so that the client learns new ways to
use the keyboard.
Answer 8
The examples of two resources that I can make for a client are:
1. I can make a communication book for client to ensure that she can express her thoughts
and feeling. I can include symbols related to feelings such as happy, sad, anger and
excitement. Then the client may be asked to express their feelings in different situation.
2. I can also modify the communication as per client’s liking to ensure that clients can
indicate about his/her needs and wants. Appropriate pictures and symbols can be used to
review whether client is hungry or feeling thirsty.
Answer 9
As per the WHS requirement, safety of resource is important to prevent any harm to
client. The safety considerations that are important while developing resources are as follows:
 To ensure that communication materials are made from non-toxic materials which do
cause any harm to client
 To ensure that there is no sharp edges in resource materials that leads to injuries
 The weight of the resource should also be kept in mind so that it does not become too
heavy for a client. This is also important for client with physical impairment.
Answer 10

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To identify the types of communication resources used by clients previously, it will be
important to speak with client’s family or the speech pathologist. The assistance staff can also
review client notes and other documentation to understand the devices that were using
previously. Knowing about these communication devices is also important to ensure that a
communication system familiar to client’s previous resource is used. This may help to identify
any complex systems used by client and the need to learn about them. The benefits for staffs is
that they can prepare to use new systems with they are not familiar with.
Answer 11
Power supply is needed for the operation of communications devices that require power
supply. For example speech generation devices require adequate power supply. Some devices
may also have specific power supply requirements. Hence, keeping the communication device
close to a wall socket or need for an extension cord should be considered. By assessing the
power supply availability of devices, charging requirement of devices can be maintained. This
approach will help in the optimal use of the communication systems.
Answer 12
The three considerations that are important while preparing a set out equipment for
clients are:
1. Firstly, the equipment should be set out in line with work health and safety procedures. It
should be ensured no wires or sharp edges increases chances of hazards for clients.
2. Secondly, setting out equipment as per the direction of the speech pathologist is
important. This is essential to ensure correct use of devices.

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3. Thirdly, a consideration about the accessibility of the equipment and correct positioning
of equipment is important so that client can easily reach and see the communication
system.
Answer 13
The three common modes of communications that can be effectively used with
clients are:
1. Linguistic and aural modes: It involves communication via verbal means such as via
telephone, face-to-face contact or video technology
2. The visual mode: It involves use of written communication process to convey message
to clients such as the use of alphabet boards, emails or letters
3. The gestural mode: It involves use of gestures or body language to convey message to
client.
Answer 14
When a client reports difficulties with the program, it will be necessary to report about
this to the supervising allied health professional such as the speech pathologist. This will help to
take relevant advice from the pathologist and take the best course of action to promote safety and
well-being of clients. The supervising health professional have the ability to interpret the
situation and determine the impact of the issues on the client. One can do this either by face-to-
face contact or by adapting formal mechanisms to approach the speech pathologist.
Answer 15
While participating in the supervision process, I will have the following responsibilities:

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 To become an active participant in the supervision process by engaging in the process
completely and openly expressing problems or learning needs to the supervisor. This is
also essential to fulfil continuous professional development criteria in the job.
 Another responsibility will be to create a positive relationship with the supervisor by
making an effort to ask question in a consider manner and discuss issues honestly with
the supervisor. This will help to make the process more meaningful.
 Another aim is to be open to all kinds of feedback and reflect on those feedback to take
the right course of action to improve knowledge and skills in specific areas.
Answer 16
It is essential to clean equipments according to the manufacturer’s requirement because to
ensure that there is no damage to the equipment during the cleaning process. It may also help to
protect material from corrosion or damage and prevent chances of injury during the cleaning
process. Cleaning equipment according to manufacturer’s requirement is also essential as per the
risk management protocols of an organization. It may help to effectively dismantle and
reassemble different parts during the cleaning process.
Answer 17
Materials and equipments used for communication with client should be stored according
to the nature of resource and the number of pieces of each equipment. For example, electronic
equipments should be kept in a cool and dry place. Very small equipments can be kept in
labelled boxes or separate shelves. In addition, the materials that are needed on a daily basis
should be kept in easily accessible locations. The location of storage should also be considered

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by deciding whether a material needs to be kept in a client’s residence or on the organization’s
premise.
Answer 18
If any fault has been detected while using the equipment, then it is necessary to report
about it to appropriate person. The person may include client or client’s family member, speech
pathologist or other allied staffs involved in the care of patient. In response to reporting about
faults, appropriate process can be implemented too address them and manage loss or damage to
communication equipment. Reporting about faults is also a part of the duty of care requirement
to identify sources that increase risk to the client.
Answer 19
Documentation of client’s information should be done according to accepted protocols and
organizational requirements. This is necessary to as per the duty of care requirement and the
legal requirements of speech pathology services. It may help to work in line organization’s
protocol and ensure that relevant format or template is used to document client’s information. It
also enables client to work according to organizational expectation and prevent issues of conflict.
Answer 20
Ten terminology that can be used during the documentation process includes the following:
Stuttering: A type of speech disorder which impairs the fluency of speech of a client
Dysphagia: Problems related to swallowing of food or drinks

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Dysarthria: Symptom of slow speech and unclear speech due to weakness of speech muscles
and paralysis
Aphasia: It is the symptoms of loss of voice caused due to damage or injury to the vocal cords
Aphonia: It is the partial or total loss of ability to comprehend ideas or written statements
Articulation disorder: It is the inability to produce create speech sounds
Assessment: Use of formal or informal procedures to assess symptoms or issues in a client
Oral motor: It is used to denote oral structures that are involved in making speech
Developmental disability: It is kind of disability where a child fails to achieve developmental
goals such as language and speech development
Intelligible: A term used to denote speech which can be easily comprehensible by others.

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