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Romich, B. and Hill, K. (1999). A language activity monitor for AAC and writing systems: clinical intervention, outcomes measurement, and research. In Proceedings of the RESNA 1999 annual conference. pp. 19-21. Atlanta, GA: RESNA Press.
A LANGUAGE ACTIVITY MONITOR FOR AAC AND WRITING
SYSTEMS:
CLINICAL INTERVENTION, OUTCOMES MEASUREMENT, AND RESEARCH
Barry A. Romich* and Katya J. Hill**
*Prentke Romich Company
Wooster, OH 44691
**University of Pittsburgh
Pittsburgh, PA 15260
ABSTRACT
Clinical intervention, progress measurement, and research play important roles
in leading to successful outcomes for people who rely on augmentative and alternative
communication (AAC) and/or assistive writing (AW) systems. The Language Activity
Monitor (LAM) was developed to allow actual language activity to be the basis
for clinical decision-making, research and outcomes measurement. The LAM records
characters transmitted on the serial port of the AAC or AW device and adds a
time stamp to each character or character string. The recorded information can
be uploaded periodically to a computer for analysis.
BACKGROUND
Improved spoken and written communication is the main goal for recommending
an AAC or AW device. Monitoring outcomes for the expressive communication of
an AAC or AW device user begins with a collaborative team approach (1). Current
best practice emphasizes the need for systematic clinical data collection by
teams to infer outcomes (2, 3). Systematic data collection should include objective
measures on language and non-language parameters of device performance by consumers.
Objective language measures document information collected from traditional
language sampling and observational procedures. Language sampling provides information
relative to the semantic and syntactic structures used in context as well as
information on mean length of utterance (MLU) and developmental levels. Objective
non-language measures involve identifying access method and rate. Systematic
data collection of device performance can contribute to research on the identification
of system features and intervention methods that produce the most desired results.
Clinical intervention, periodic progress reporting and research all can be enhanced
through monitoring the daily language activity of individuals using AAC and
AW devices.
STATEMENT OF THE PROBLEM
Traditional methods of monitoring AAC and AW device use are based on clinical
observation and video or audio recording with subsequent observation, timing
and/or transcription (4, 5). The cost of this approach is high because of the
human time investment. Also, the information is not immediately available for
use. Consequently, professionals seldom perform language-sampling procedures
to collect data on the actual daily environmental use of AAC and AW systems.
Therefore, little research or empirical data exist on AAC and AW device performance
by consumers to substantiate the clinical intervention process, report progress
and evaluate outcomes.
RATIONALE
A solution to this situation is the automation of the language data collection
and analysis processes. Efforts made in this area to date are all integral to
specific communication or writing systems (6, 7, 8). Some commercially available
AAC devices have included limited features that monitor use, but none have incorporated
time information or provided the function for automated text editing. For example,
the Liberator allows communication to be recorded in a notebook and the DynaVox
counts the number of times a given key has been selected. The LAM was developed
to log actual language activity of AAC and AW consumers in clinical and/or natural
environments. The logged data becomes the basis for clinical intervention, outcomes
measurement, and research. As shown in Figure 1, the LAM connects to the serial
output of an AAC or AW device. It records characters being transmitted and adds
a time stamp to each character or character string. The recorded data can be
uploaded periodically to a computer for editing and analyzing. A total system
would consist additionally of an editor, language analysis program(s), and clinical
intervention program(s).
Figure 1: Illustration representing LAM connection
DESIGN
The design was a team effort, including contributions and surveyed responses
from professionals and consumers with clinical speech-language pathology (SLP),
research and technical expertise. Design features of the LAM that were identified
initially included:
· Universal application across many devices
· RS-232c input and output
· Sufficient memory for meaningful data logging
· Real Time Clock for time stamp
· Battery power with a charge life of at least one week
· Simple Enable, Disable, Upload, and Erase controls
· Both pushbutton and serial input function commands
· Small size for attachment to AAC devices
DEVELOPMENT
The LAM has been developed around a ZWorld LP-3100 low power controller using
the ZWorld Deluxe Dynamic C development tools. C programming provides for ease
of development and maintenance and the potential transport to other hardware.
The use of this hardware precluded the necessity of a hardware development project
and the delays associated with that process. However, limitations may be encountered
on the amount of available data memory and the consumers’ need to set
baud rates for compatibility. Additional development criteria have focused on
simplicity of use such as ease of attaching and connecting the LAM to the AAC
device, and ease of disabling the LAM.
EVALUATION
At the time of this writing, evaluation has not been completed. The evaluation
plan includes beta testing and the comparison of the LAM automated data collection
method with traditional language sampling methods from the perspectives of accuracy,
effectiveness and cost. In addition, consumer feedback will be solicited during
the Evaluation phase for modifications in the final product.
DISCUSSION
A component of the development process was the establishment of a protocol for
reporting test-retest results and outcomes. Later phases of the project involve
development of editing and analysis tools that use the output of the LAM. As
LAM functions are analyzed, specific features may be designed into future AAC
and AW devices. Therefore, a need for standardization of the protocol is critical
for future application (9).
One important issue in the use of any recording device is privacy. For example, the LAM used with an AAC device can be disabled three ways to control for privacy. Individuals whose communication is being monitored should be clearly informed, and public use of recorded communication should remain anonymous.
REFERENCES:
1. Lloyd, LL, Fuller, DR, & Arvidson, HH (1998). Augmentative and Alternative Communication: A Handbook of Principles and Practices Des Moine, IA: Allyn & Bacon.
2. 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.
3. Kane, R. (1997). "Improving outcomes in rehabilitation: A call to arms (and legs)." Medical Care 35(6): JS21-JS27.
4. Beukelman, D.R., J. R. S., Rowan M. (1989). "Frequency of word usage by non disabled peers in integrated preschool classrooms." Augmentative and Alternative Communication: 243-249.
5. Stuart, S., Beukelman, D.R., King, J. (1997). "Vocabulary use during extended conversations by two cohorts of older adults." Augmentative and alternative communication 13: 40 -47.
6. 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.
7. 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.
8. 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.
9. 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.
Barry A. Romich, P.E.
Prentke Romich Company
1022 Heyl Road
Wooster, OH 44691
Tel: 330-262-1984 ext. 211
Fax: 330-263-4829
Email: bromich@aol.com