JCPSLP November 2017

Long term-outcomes for individuals learning to use PAS Communication autonomy An autonomous communicator can say whatever they want, to whoever they want, whenever they want (Farrall, 2015; Porter, 2012). Autonomous communication is not the same as independent communication for individuals who use alternative access methods. PAS is a strategy for access to communication that may support autonomous language development of learners with CPCSN by providing: • a smart communication partner – who can read subtle movement – change the speed of presentation – use context to co-construct messages; • opportunities for language expression with minimal demand on visual or physical abilities; • opportunities to encourage visual interaction; and • support to maintain attention to the AAC tool (Porter, 2012). Communication accessibility Accessible communication refers to the people in the social environment who will scaffold, support and understand aided language as it is learnt and used. PAS supports accessible communication by sharing the responsibility for communication between the communication partner and the individual with CPCSN. Family members, carers, professionals and friends must be familiar with the skills needed to provide AAC support, including how to: • operate the scan – differentiate between scanning voice and social interaction voice – present items as a list, rather than a series of questions – present items consistently in a systematic order; • recognise the movements that indicate selection or not; • keep an open mind about what will be selected; and • sometimes interpret the meaning of the message depending on context. Communication accessibility also recognises that communication happens all the time, and that access to AAC is required at any time. PAS enables and supports this belief (Porter, 2012). Training of communication partners in the operational use of the AAC system, the access method that the learner will use, as well as how to maximise the linguistic, social and strategic learning for the individual is a Some communication partners will need to become very competent AAC users themselves, in order to gain enough linguistic, operational, social and strategic knowledge of the AAC system for it to be natural and intuitive, and for them to pass this knowledge on (Porter, 2012). This reflects the way typically developing children learn language in natural everyday contexts. Usually parents and other family members, and teaching staff are the key communication partners who model aided language. Aided language modelling is well documented as an effective intervention strategy to teach linguistic skills to individuals who use direct access (Sennott et al., 2016). For example, training of parents and other communication partners to use a range of intervention strategies that facilitate early communication and language skills using programs such as ImPAACT, have key component of AAC intervention. Communication competence

learning the physical skills for electronic access to high technology AAC may better be spent on interacting, developing language, playing and socialising (Drager et al., 2003). Some individuals with CPCSN may benefit from separating learning of physical skills from the language development task. PAS can support language learning whilst physical access can be learnt in parallel during other tasks (Burkhart, 2016). Visual skills Cerebral palsy (CP), a neurodevelopmental disorder of movement and posture, is one of the leading causes of physical disability in childhood (Cerebral Palsy Society of New Zealand, 2017). CP is commonly associated with vision impairments. Research suggests up to 80% of people with cerebral palsy will have ocular or cortical visual impairments, and that the incidence increases according to the severity of physical impairment (Alimovi ´c, 2012). Visual and/or auditory impairments have a significant impact on language learning in typically developing children, and an even more profound impact on individuals who require AAC (Kovach & Kenyon, 2003). The work of Roman Lantzy and Blackstone (2014) on assessment and intervention has provided principles for guiding improvement of vision and development of language for individuals who have CVI and CCN. They include PAS as a strategy that may work to support both language development and functional vision. Providing clear and consistent modelling to enhance visual and auditory patterns is paramount, as the individual becomes familiar with the visual associations related to language (Roman Lantzy & Blackstone, 2014). During PAS, the availability of a smart communication partner who pays close attention to the individual’s responses and timing may support language development to move ahead of visual or auditory skills. Familiarity and confidence with aided communication provides a natural context for developing other sensory skills within the process of conversation (Burkhart, 2016). Clinical implications AAC intervention starts with traditional and dynamic assessment, to gain knowledge about the individual and the people supporting them. This is to ensure that informed decisions are made about the: • adequacy of the individual’s current communication needs and skills; • their future communication needs; • the AAC techniques and strategies that may be most useful; • and also considers the people (parents, teachers, other professional staff and peers) who support the individual with CPCSN, who will build a supportive AAC environment (Beukelman & Mirenda, 2013; Farrall, 2015). Practitioners and supporters need to keep in mind three long-term outcomes for individuals who are learning to use AAC:

• communication autonomy • communication accessibility • communication competence (Porter, 2012).

A supportive aided language environment and PAS provides opportunities to develop each of these areas. Communication partners need to be trained in how to use PAS to maximise the outcomes for the individual with CPCSN.

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JCPSLP Volume 19, Number 3 2017

Journal of Clinical Practice in Speech-Language Pathology