Hill, K. and Romich, B. (1999). A proposed standard for AAC and writing system data logging for clinical intervention, outcomes measurement, and research. In Proceedings of the RESNA 1999 annual conference. pp. 22-24. Atlanta, GA: RESNA Press.
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 could 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. 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. 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. The Liberator and Dynavox are examples of AAC devices that
have limited monitoring capabilities. However, the limitations of the monitoring
features preclude wide spread application for outcomes measurement. At this
time, automated tools integral to specific AAC and AW devices are being developed
for logging language output (3, 4, 5). Finally, the Language Activity Monitor
(LAM) device and tools are being developed which will consist of monitor, editor,
and analysis functions. As the promulgation and 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. In order
to facilitate widespread application, the manual editing of raw logged data
needs to be eliminated. A standard protocol would ensure outputs that are: 1)
readily interpretable by clinicians and researchers using non-technical comparison
procedures, and 2) suitable for use by standard language analysis programs.
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 or she 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:
20:37:00 “I need”
20:37:05 “*[VOLUME UP]*”
20:37:06 “*[VOLUME UP]*”
20:37:07 “*[VOLUME UP]*”
20:37:14 “something”
20:37:16 “to drink”
20:37:19 “i”
20:37:20 “m”
20:37:24 “m”
20:37:28 “ediately”
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 (6). Standardize assessment tools will make it easier to accumulate
and compare aggregate outcomes across various parameters (7). Standardization
of the monitoring protocol will provide comparable, compatible and reliable
quantitative data for a variety of clinical and research applications. A standardized
protocol would guarantee that converted text can be easily compared across samples
for criteria such as word counts, length of utterance, and contextual use. In
addition, standardization of a protocol with time stamps would provide the opportunity
to define a method of communication rate measurement. The widespread advancement
of language activity monitoring will benefit people who rely on AAC and AW systems
through improved clinical intervention service, more consistent, periodic performance
reporting, and more precise and effective outcomes management.
DISCUSSION
Language activity monitoring has the potential to significantly impact on the
collection of quantitative data regarding the daily communication activity of
users of dedicated AAC devices. For the first time, AAC stakeholders will have
tools to identify systematically the scope and sequence of expected AAC outcomes
for providers, payers and consumers. In addition, the opportunity for comparing
and quantifying device feature usage and/or language representation systems
will be more reliable. Consequently, the inclusion of a variety of AAC stakeholders
in developing the definition of a standard data logging protocol is desirable.
Contributions to this standard development effort are invited.
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.
REFERENCES:
1. Hill, K., & Romich B. (1999 accepted]). AAC language activity monitoring
and analysis for clinical intervetnion and research outcomes. C-SUN, Los Angeles,
California.
2. DeRuyter, F. (1995). "Evaluating outcomes in assistive technology: Do we understand the commitment?" Assistive Technology 7: 3-16.
3. 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.
4. 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.
5. 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.
6. Hill, K. and Romich, B. (1998). Language Research Needs and Tools in AAC. Annals of Biomedical Engineering. The Biomedical Engineering Society. Cleveland, OH. S-131.
7. 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