Assistive Technology

This section is a clearinghouse of information, everything about Augmentative & Alternative Communication (AAC) Devices is right here, etc, etc. Please follow the links below.

AAC Devices defined

Augmentative & Alternative Communication (AAC) devices are electronic devices that provide treatment for severe Dysarthria, apraxia and aphasia, when, due to those communication impairments, an individual is not able to meet the communication needs that arise in the course of current and projected future daily activities.

AAC devices are very effective in providing functional communication when speech is no longer intelligible. Users of AAC devices have a high degree of satisfaction with the communication opportunities they provide. AAC devices enable individuals to engage in the ordinary communication that arises in the course of daily activities. In general, speech-language pathology services are provided with the acknowledgement that an individual's functional goals may range from speech that permits expressions of wants and needs to a caregiver to full conversational communication.

AAC devices include electronic devices that are:

  • Dedicated communication devices GRAPHIC/SUPPLIER
  • Portable computers GRAPHIC/SUPPLIER that have been modified with hardware and software to serve as an individual communication device. These types of AAC devices also continue to serve their original purpose (e.g., writing, financial management, on-line access)

An AAC device should be covered by Medicare and other private insurance plans as an item of durable medical equipment or prosthetic device when all of the following are met:

  • The AAC device is recommended by a speech-language pathologist in a narrative report based on a complete assessment
  • It is incorporated into a speech-language pathology treatment plan stating the functional communication goals to be achieved with the AAC device
  • It is prescribed by an individual's physicia
  • It is supported by a completed certificate of medical necessity COMPLETED BY WHOM.

AAC Devices are reasonable and necessary

AAC devices provide treatment for specific, severe communication disabilities, and provide significant functional improvements in an individual's communication abilities. They are reasonable and necessary treatment for individuals with Dysarthria, apraxia and aphasia, when these conditions are of such severity that, without an AAC device, an individual will lack "functional" or "meaningful" communication, i.e. when these speech (dysarthria, apraxia) and language (aphasia) disabilities interfere with an individual's ability to meet the communication needs arising in the course of current and projected daily activities through natural communication techniques, such as speech, writing, and/or gestures. Other severe communication disabilities arise among small numbers of individuals with primarily physical impairments of amyotrophic lateral sclerosis (ALS) or Lou Gehrig's Disease; cerebral palsy; locked-in-syndrome; multiple sclerosis; Parkinson disease; brain-stem stroke; cortical stroke; progressive aphasia; and traumatic brain injury. For individuals with progressive impairments, the recommendation for an AAC device often will be preceded by a period of speech language pathology (SLP) treatment directed to natural communication methods. However, due to the progression of the impairment, those communication methods are no longer sufficient to enable the individual to meet his daily communication needs. In addition, effective communication is essential for individuals to successfully negotiate routine daily activities, particularly when other physical or mental disabilities are present in addition to a severe communication impairment. In order to obtain medical care for those other conditions, AAC devices provide an effective way to communicate about these topics and access effective treatment for any other health conditions. Finally, for those individuals who can achieve functional outcomes through AAC device use, there is no alternate means of treatment that offers comparable benefits.

The speech-language pathology assessment process considers AAC interventions only after a determination has been made that treatment related to improved natural communication methods will not be effective. Thus, when an AAC device is recommended for an individual, there is no medically effective alternative form of treatment that will be of benefit.

AAC Devices are safe and effective

For the past 16 years, AAC devices have been classified by the FDA as "powered communication systems" and thus meet its standards for safety and effectiveness, or "efficacy."

AAC Devices recognized by the medical and professional community
The clinical professionals who provide other rehabilitation services to and who advocate for individuals with severe disabilities recognize AAC interventions that enable effective communication as essential treatment tools. As an example, Neurologists, the physicians most directly responsible for managing the care of individuals with ALS, recognize AAC intervention as the appropriate standard of care for individuals who have developed severe dysarthria or anarthria secondary to ALS. (Sufit 1997, Mitsumoto, Chad, & Pioo 1998). Speech language pathologists (SLPs) recognize AAC intervention as the appropriate standard of care for individuals with severe Dysarthria, apraxia and aphasia, regardless of etiology. In addition, the American Medical Association's, "Guidelines for the Use of Assistive Technology: Evaluation, Referral, Prescription" incorporate AAC interventions as treatment options that must be considered for these individuals. (AMA, 1994).

The general acceptance of AAC interventions as essential and effective treatment tools by the professional medical community is further demonstrated through the volume of research and clinical practice research that has been published in peer-reviewed journals. AAC interventions also are a common seminar topic at continuing professional education conferences sponsored by international, national, regional, state and local organizations, including USSAAC, ASHA, RESNA, and UCPA. In addition, AAC interventions are the subject of numerous books and treatises used by practicing professionals. They are also used as teaching aids in both undergraduate and graduate level courses in pre-professional training programs for SLPs and other disciplines which provide treat individuals with severe disabilities.

A wide range of uses and effectiveness
Because of the nature of severe communication disabilities, the functional level achieved by individuals who use AAC devices incorporate a wide range of communication abilities. Such range is identical to the range expected for all recipients of AAC treatment services and the functional outcomes that are associated with appropriate and professional SLP services:

  • Give a consistent "yes" or "no" response
  • Demonstrate a competency in naming objects using auditory/spoken cues
  • Communicate basic physical needs and emotional status
  • Communicate self-care needs
  • Receptively and expressively use a basic spoken vocabulary and/or short phrases
  • Engage in social communicative interaction with immediate family or friends
  • Carry out communicative interactions in the community
  • Regain conversational language skills

AAC Devices are cost effective and appropriate

The Medicare Act LINK TO MEDICARE ACT (DOES THE MEDICARE ACT ACTUALLY PAY FOR ANYTHING OR JUST MANDATE THAT AAC DEVICES SHOULD BE PAID FOR BY "OTHER SOURCES"?) and other funding sources (SUCH AS?) pay for items or services that are "reasonable and necessary for the treatment of illness or injury or to improve the functioning of a malformed body member."

Reasonable and necessary?
Individuals who may benefit from AAC treatment are given an assessment by a speech language pathologist (SLP) and, at times, by other relevant professionals, such as an occupational or physical therapist. The assessments are conducted independent of any AAC device vendor or supplier and are then submitted to an individual's treating physicians for review. AAC assessments, as well as the subsequent training and support for AAC device usage, are not setting-dependent. These tasks may be conducted at an individual's home or in a professional office setting.

SLPs conduct functional assessments of an individual's ability to meet the communication needs arising in the course of daily activities. They recommend AAC interventions only when both of the following are met:

  • Some type of treatment is necessary to achieve that goal; and
  • Treatment intended to improve natural speech methods will not be sufficient.

Thus, AAC interventions are recommended and prescribed only when there is no medically appropriate or realistically feasible alternative pattern of care.

The cost factor
The appropriateness of AAC devices also can be measured by existing standards for "reasonableness". AAC devices satisfy all of these "reasonableness" criteria. According to Medicare guidance, the reasonableness of an item or device is based on the following factors:

  • Would the expense of the item to the program be clearly disproportionate to the therapeutic benefits which could ordinarily be derived from use of the equipment?
  • Is the item substantially more costly than a medically appropriate and realistically feasible alternative pattern of care?
  • Does the item serve essentially the same purpose as equipment already available to the beneficiary?

AAC Devices are durable medical equipment

Durable Medical Equipment (DME) is defined as equipment furnished by a supplier or home health agency that has the following four characteristics:

  • Can withstand repeated use
  • Is primarily and customarily used to serve a medical purpose
  • Generally is not useful to an individual in the absence of illness or injury
  • Is appropriate for use in the home

Based upon the treatment role of AAC devices, and the specific device characteristics, AAC devices meet all of these criteria.

AAC related organizations and research

The "general medical community" for AAC intervention includes speech language pathologists (SLPs), the clinical professionals most directly responsible for treatment of severe communication disabilities. Since 1981, the American Speech-Language-Hearing Association has recognized AAC intervention as an accepted methodology that is within the scope of practice for SLPs (ASHA, 1981; 1991). The acceptance of AAC intervention among speech-language pathology professionals is further demonstrated by the numerous professional standards and policy statements that ASHA has developed for AAC intervention, (ASHA 1989, 1996, 1997), as well as the establishment of AAC-focused specialty societies, including the International Society for AAC (ISAAC), established in the mid-1980s; a United States national chapter, USSAAC; an ASHA AAC Special Interest Division; and an AAC Special Interest Group within RESNA, the Rehabilitation Engineering and Assistive Technology Society of North America. ASHA, USSAAC and RESNA are among the organizations on whose behalf this Formal Request is being submitted.

In 1986, ASHA, the American Association on Mental Retardation, American Occupational Therapy Association, and American Physical Therapy Association and other organizations formed the National Joint Committee for the Communicative Needs of Persons with Severe Disabilities to promote research, demonstration and education efforts directed to helping individuals with severe disabilities to communicate effectively. In 1992, this consortium produced "Guidelines for Meeting the Communication Needs of Persons with Severe Disabilities", intended to educate professionals in all of these disciplines of about the fundamental importance of providing an effective means of communication, including, as necessary, AAC interventions, to individuals with severe disabilities. These guidelines identify the core areas of knowledge and skill these professionals must possess, including AAC interventions, in order to provide effective treatment to these individuals. (ASHA, 1992).

Ongoing AAC intervention research is funded by the National Institutes of Health, the National Institute of Deafness and Other Communication Disorders (Beukelman & Ansel 1995), as well as by the Department of Veterans Affairs (NeuroReport, 1998), and the National Institute on Disability and Rehabilitation Research. For more than a decade, NIDRR has supported an AAC Rehabilitation Engineering Research Center, whose research activities currently are being coordinated by David Beukelman, Sarah Blackstone, and Kevin Caves, who all were significant contributors to the preparation of this Formal Request.

SLP research has demonstrated that health-related issues are no more frequent a topic of conversation than others among older individuals (Stuart et al, 1993), or among individuals who use AAC devices. (Beukelman, Yorkston, Poblete, & Naranjo, 1984). Moreover, there is no established health related lexicon, such as an agreed upon list of medically-related words; there is no connection between the characteristics and capabilities of AAC devices and specific words; and there is no effective way to limit the content of speech produced by AAC devices. No currently available AAC device offers fixed, pre-set vocabulary; rather, all devices, in every category, allow for the user to select the vocabulary. In addition, any device that allows a user to construct vocabulary by spelling, whether the speech output is digitized or synthesized, automatically offers access to the entire English language.

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