Using LAM (language activity monitoring)
to Enhance Clinical Service Delivery

I was originally skeptical of using LAM because I thought I didn't need it. I thought I really knew my clients and that I had good relationships with their support teams. I thought I was getting an accurate picture of how the person was using the device and knew the SLP goals I should be working on. I was only about 50% right.

Of course I get informed consent from my clients and teach the clients and/or families or others how to turn LAM on and off. I have had no experience with clients not wanting me to use LAM to help them achieve improved communication

1. I keep the LAM on ALL the time and download the data once a month. I've been doing this consistently with about 10 clients for the past 3 years at least and have tons and tons and tons of data. I can't possibly look at all this data, but I have it for whatever reasons I might need to look at it.

2. I also ask several families to keep a "daily journal" - a handwritten journal of the basics of their day so that I can compare what I see in the LAM (which is 1-sided and NOT the complete picture at all) with what is going on in their family.

3. LAM Analysis - I upload the LAM data from the AAC devices once a month, so there is a lot of data. It is possible to cut and paste any amount from the text file. I analyze the data the old fashioned way - by hand. For example:

a. Hard copy of LAM data – I can print out the data in a word processor in 2-column format to save paper. This allows me, the parent or teachers to see more of the data on one sheet. Color highlighters can help code the communication activity you want to monitor.

b. Create a spreadsheet - With this method I can identify categories of activity I want to monitor, identify logfile content to enter, and tally results.

c. Reporting progress - A more complete quantitative AAC Performance Report can be generated using PeRT - Performance Report Tool. PeRT is most effective when collecting a language sample under specific situations or structured environments, such as therapy sessions, retelling a story, a 2-way conversation.

4. Using LAM Results - Below are some areas that I feel LAM data address and have been very beneficial in clinical decision making. Other methods of collecting data either have proven to be ineffective or would be impossible to capture the performance, because the time stamp and key selection are missing.

a. The BIG PICTURE of what is going on in this person's life - when do they talk the most, or the least, who seems to be their best communication partners and who are their worst, what topics do they talk about, what interests do they have in their lives, etc. This area really surprised me because I learned so much more about my clients.
NOTE: I NEVER NEVER NEVER found anything highly personal or felt I was intruding on their lives. Their lives were as boring as mine!

b. Vocabulary Encoding - I'm looking for words that they are spelling that they need to learn the codes for. I review the entire MONTH for this data, keeping a tick list of spelled words and how many times they spelled them. Then I prioritorize the list and start working on it. Then the next month I can see if our intervention is paying off (and I
can see if they are doing the homework that I gave them to work on.)

c. Morphology and Syntax Development - I generally calculate the person's mean length of utterance in morphemes based on 1 or 2 days worth of LAM samples. Then I try to find the BEST that they can do (usually when they are with me because I am a communication partner with HIGH expectations) and compare that to the worst that I see in their monthly sample (usually with a communication partner who has the least time and expectations for the person). This helps me show communication partners that THEY are a key factor in the person's language production.

d. I do all sorts of little mini-research and track it in the LAM sample. For example, I might in therapy be providing Aided Language Stimulation, targeting 2 or 3 core words. All I do is model these words when I talk TO the person using their device. Then I track how many models I have to do before the person just starts using that CODE and that WORD in their natural language. (Note: About 40 - 50 models)

There are just so so so many ways to look at the data you have....
1. What is the person doing in school all day?
2. What kind of interactions are they having with peers?
3. What are the results of specific intervention goals?

But, unless you have the LAM on and are harvesting this data, you can't really look at any of this objectively.

After doing this for 3 years, I think I have a much better handle on the skills, personalities, family structure, etc. of the clients I support. Plus, everyone is saying that they have made so much more progress over the last couple of years than they did before. That may be because we are "teaching to the test," meaning, I am teaching DIRECTLY to the spots where I see they have weaknesses. But the BIGGEST difference has been that I am spending so much more time doing Communication Partner Training. The LAM data clearly showed a HUGE difference between what happens when I am around versus when I am gone.

I hope that this helps you. I invite you to visit my web site (http://www.vantatenhove.com) and to contact me (gvantatenhove@cfl.rr.com) for additional information.