A Proposed Standard for AAC and Writing System Data Logging
for Clinical Intervention, Outcomes Measurement, and Research

Katya J. Hill* and Barry A. Romich**
*University of Pittsburgh
Pittsburgh, PA 15260
**Prentke Romich Company
Wooster, OH 44691

Abstract
In the areas of augmentative and alternative communication (AAC) and assistive writing (AW), long-term monitoring of use for the purposes of clinical intervention, outcomes measurement, and research is being pursued (1). Information being recorded includes language activity, text generation, non-language functions, date, and time of day. The logged information is then edited and analyzed. In order to assure compatibility between various recording, editing, and analysis features and tools, standardization of the reporting protocol is being proposed.

Background
Principles of evidence-based practice and outcomes management emphasize the need for standardized outcome measures to support clinical decision-making and evaluate intervention services. With the shift toward accountability, improving databases as well as integrating them across service delivery sectors and geographic borders would have a tremendous impact on outcomes measurement (2). Currently, a validated, easily accessible, uniform data collection system does not exist that allows us to critically analyze the outcomes related to assistive technology device performance or clinical intervention (3). Clinicians, researchers and consumers could benefit from systematic monitoring of AAC and AW system performance within the clinical setting and daily environments to measure outcomes.

Statement of the Problem
Empirical data from device users are needed to substantiate the effectiveness of AAC models, technology and intervention strategies (4, 5). However, the impracticality and high cost of traditional language-sampling and observation methods restricts the monitoring of device use, especially within natural contexts and activities of daily-living. At this time, automated tools are are being developed for logging the language activity of AAC and AW devices (6, 7, 8). These tools may consist of monitor, editor, and analysis functions. As the acceptance of data logging grows, the compatibility of the various monitor, editor and analysis functions will be important.

Approach
The essential function of data logging is the recording of each event and the time that it occurs. A standardized monitoring protocol would facilitate the widespread application of actual user-performance data collection.

For a language event, the proposed protocol is:

hh:mm:ss "Any continuous text that is transmitted by the AAC device."

where hh:mm:ss represents the time of day in hours, minutes, and seconds using the 24 hour clock format. Characters following the hh:mm:ss and one space, inside quotation marks, are the characters that were selected on the AAC or writing system in a continuous sequence with no time between characters greater than 0.2 seconds.

For a non-language event, the proposed protocol is:

hh:mm:ss "*[NON-LANGUAGE INFORMATION IN CONTINUOUS TEXT]*"

For example, consider the individual using an AAC device who is thirsty at a loud party. If he is using a language representation method that can access the series of individual core vocabulary words and phrases "I need ", "something ", "to drink " (spaces included) and then spells "immediately " using word prediction, starting at exactly 8:37 PM, then the representation for that series output would be:

At the beginning of each day, a date notation is made:

*[YY-MM-DD = 98-10-12]*

Certain functional commands could be standardized. The system should provide the individual with method(s) for disabling and enabling the recording. It may be necessary to set the date and clock, such as at daylight savings time transitions or when changing time zones, or if the battery was allowed to fully discharge or needed replacement. Protocols for these functions are:

*DISABLE* Disables the recording.

*ENABLE* Enables the recording.

*HH-MM-SS = XX-XX-XX* Sets the clock

*YY-MM-DD = XX-XX-XX* Sets the date

Implications
The successful development and voluntary adoption of this proposed standard will facilitate the development and application of tools for monitoring AAC and AW system use. Standardized assessment tools will make it easier to accumulate and compare aggregate outcomes across various parameters (9). Standardization of the monitoring protocol will provide comparable, compatible and reliable quantitative data for a variety of clinical and research applications. This in turn will benefit people who rely on these systems through improved clinical intervention service, more consistent, periodic performance reporting, and more precise and effective outcomes management.

Discussion
One important issue in the use of any recording device is privacy. People whose communication is being monitored should be clearly informed, and public use of recorded communication should be anonymous.

Contributions to this standard development effort are invited.

References:
1. Hill, K., & Romich B. (1998]). Language Research Needs and Tools in AAC. Annals of Biomedical Engineering. The Biomedical Engineering Society. Cleveland, OH S-131.

2. DeRuyter, F. (1995). "Evaluating outcomes in assistive technology: Do we understand the commitment?" Assistive Technology 7: 3-16.

3. Hammel, J. (1996). What’s an outcome? Home Health Care: 87-90.

4. Miller, L.J., Demasco, P.W., Elkins, R.A. (1990). Automatic data collection and analysis in an augmentative communication system. Proceedings of the 13th Annual RESNA Conference. Washington, DC, 99-100.

5. Ahlsen, E. and Stromqvist, S. (forthcoming). ScriptLog: A tool for logging the writing process and its possible diagnostic use. Proceedings of the 1998 ISAAC Research Symposium (Dublin, Ireland, August 1998), John Clibbens, Filip Loncke, and Lyle Lloyd (editors). Whurr Publishers, London.

6. Copestake, A. and Flickinger, D. (forthcoming). Evaluation of NLP technology for AAC using logged data. Proceedings of the 1998 ISAAC Research Symposium (Dublin, Ireland, August 1998), John Clibbens, Filip Loncke, and Lyle Lloyd (editors). Whurr Publishers, London.

7. Bedrosian, J.L. (1996). AAC technology and communicative competence: Issues and directions for future research. Communication…Natuarlly. E. Bjorck-Ackesson, Lindsay, P. Vancouver, Canada, Malardalen University Press.

8. Grove, N., Clibbens, J., Barnett, S., Loncke, F. (1996). Constructing theoretical models of augmentative and alternative communication. Communication…Natuarlly. E. Bjorck-Ackesson, Lindsay, P. Vancouver, Canada, Malardalen University Press.

9. Jutai, J., Ladak, N., Schuller, R., Naumann, S., Wright, V., (1996). "Outcomes measurement of assistive technologies: An institutional case study." Assistive Technology 8: 110-120.

 

Katya Hill, M.A. CCC-slp,
Research Associate
Dept. of Rehab Science and Technology
Rm. 5064 Forbes Tower,
University of Pittsburgh,
Pittsburgh, PA 15260
Tel: 412-647-1289
Fax: 412-885-8548
Email: kjhill+@pitt.edu