How To Do An AAC Assessment For Adults: 12 Important Steps

AAC can offer a bridge to successful communication for people with limited speech or language.

In this article, you’ll learn:

• The types of AAC
• How to do an AAC assessment for adults
• Plus links to assessment templates

See The Evaluation Pack for print-and-go templates. And The Roadmap Course for step-by-step guides to assessments and AAC!

Types of AAC

Augmentative and alternative communication (AAC) are ways to communicate besides talking. 

The types of AAC can be categorized as unaided or aided (ASHA, 2024).

Unaided AAC is communication using just your body or voice.

Examples of unaided AAC:

• Gestures like pointing, nodding, shrugging
• Manual signs
• Fingerspelling
• Facial expressions
• Body language
• Vocalizations

Aided AAC uses external tools. It can be a pen and paper, an iPad, or a specialized speech-generating device. 

Low-tech, aided AAC are often low-cost. Examples include:

• Writing or drawing
• Alphabet board. Point to letters to spell out a word
• Communication boards. Point to words and/or pictures
• E-Tran board

High-tech, aided AAC options are communication devices, tablets, or computers. 

There are many high-tech AAC options. The best one for your patient will depend on their unique wants and needs. 

List of AAC Devices & Apps

Here’s a list of some high-tech AAC options. But tech changes quickly, so do your research!

Devices

• The patient’s tablet, cellphone, or computer
• PRC-Saltillo
• Tobii DynaVox
• Lingraphica®
• Megabee Assisted Communication and Writing Tablet
• FAB (Frenchay Alphabet Board) Keyboard
• GoTalk
• AbleNet, Inc.

Apps

• Verbally (free or premium)
• Co-Writer
• CoughDrop
• Speech Assistant
• Vocable AAC
• Weave Chat AAC
• Proloquo
• PredictAble
• LetMeTalk
• Flipwriter

Who Needs AAC?

Over 2 million people with impaired speech or expressive language use AAC (ASHA, 2024). 

Some have developmental disorders such as cerebral palsy or autism spectrum disorder. While others use AAC after acquired conditions like a stroke, ALS, Parkinson’s disease, TBI, prolonged intubation, or head and neck cancer (Hanson et al, 2011). 

Here are some clues that your speech therapy patient may need AAC:

• They can’t fully express their wants, needs, thoughts, and feelings by talking
• They have severe dysarthria or apraxia of speech and are not making substantial gains with traditional therapy
• Speech rate drops below 125 WPM (reduced comprehensibility)
• Intelligibility in conversation is less than 50% 
• They are fatigued or frustrated when communicating by talking
• They are willing and cognitively able to learn to communicate by modalities besides talking
• They have a dedicated facilitator (main communication partner and/or caregiver) who is willing and able to support their use of AAC

How To Do An AAC Assessment For Adults

AAC assessments are ongoing, especially for your patients with degenerative diseases like ALS or Parkinson’s disease. 

What you assess will depend on your patient’s case history and the underlying condition that caused them to need AAC.

Here are 12 important areas to consider when doing an AAC assessment for adults:

1. Language expression and comprehension
   • Reading, writing, spelling
2. Speech
   • Rate and intelligibility
   • Diadochokinetic rate
3. Voice
   • Vocal quality (including severity, roughness, breathiness, strain, pitch, loudness)
   • Maximum phonation time
4. Cognition
   • Memory, attention, executive functioning, awareness
   • Ability to identify symbols (can they match an object to a symbol, make association, etc.)
5. Technical skills
   • Skills, tolerance, and interest in learning new technology 
6. Motor abilities
   • Can they comfortably write, type, read, point, move their head, move their eyes
   • Energy conservation needs
7. Vision, hearing, and sensory needs
   • How well can they see and hear
   • Sensory-perceptual issues
8. Funding source
   • Funding options if they need a high-tech device plus training
   • How often a new device will be covered if they have a degenerative disease
9. Alternative access
   • To access their AAC, will they need a laser, eye-gaze, mount, etc. now or in the future
   • Do they need AAC with higher visual contrast or volume
10. How long they’ll likely need AAC
    • For a few weeks, the rest of their lives, until they need a higher-tech device, etc.
11. Support system
    • These people often become the AAC facilitators
12. Other diagnosis-specific areas of assessment
    • Cranial nerve assessment for ALS, xerostomia for head and neck cancer, visual neglect for stroke, etc.

Refer out to your talented healthcare team as needed.

For more assessment help, see The Evaluation Pack on our shop.

What Happens After The AAC Assessment?

Your AAC assessment doesn’t end on assessment day. Here’s what happens next:

1. Assess. Assessment day! Complete the case history, patient interview, and assessments.
2. Choose the modality. Decide what AAC modality is best for your patient.
   • Unaided, low-tech, high-tech, or speech-generating device.
3. Device trials. If a high-tech device is indicated, set up device trials. Work with the AAC company’s representative on device selection and funding.
4. Choose vocabulary. Identify what vocabulary to add to the AAC device, communication board, etc.
5. Add messages. Add and organize messages on the device, communication board, etc.
6. Train. Train facilitators.
7. Ongoing. Assess and train the patient in other modalities (speaking, writing, etc.) to assist with communication, if appropriate. Reassess as needed.

How Do You Know If The AAC Is A Good Fit?

You’ll know that the AAC modality is a good fit if your patient and their communication partners:

• Actually use it!
• Use it to communicate efficiently and effectively
• Navigate it with little or no frustration
• Show progress in speed/complexity of messages during the trial period

List Of AAC Evaluations For Adults

Here are some premade evaluation templates and kits you can use during an AAC assessment. Some are specific to a certain diagnosis (e.g. aphasia) or type of AAC (e.g. speech-generating devices).

• The Evaluation Pack by Adult Speech Therapy
• Augmentative and Alternative Communication Needs Assessment by Tobii Dynavox (Free)
• Aphasia AAC Assessments (Free)
• ALS Functional Rating Scale. Scroll to Table 1. Track communication and other functional skills (Free)
• Augmentative & Alternative Communication Profile™
• ASHA’s Speech-Generating Device Evaluation Template (Free)
• Functional Communication Profile™
• The Source® for Augmentative Alternative Communication
• Test of Aided-Communication Symbol Performance by Tobii Dynavox
• AAC Lite Tech Evaluation Kit

More Resources

See the AAC Pack and Evaluation Pack for premade templates. Included in The Starter Pack.

References

• American Speech-Language-Hearing Association (n.d.). Augmentative and Alternative Communication (Practice Portal). Retrieved August 2024 from www.asha.org/Practice-Portal/Professional-Issues/Augmentative-and-Alternative-Communication/.
• Bayley, M., Gargaro, J., et al. (2023). Canadian Clinical Practice Guideline for the Rehabilitation of Adults With Moderate to Severe Traumatic Brain Injury. Ontario Neurotrauma Foundation, Retrieved August, 2024 from https://kite-uhn.com/brain-injury/en.
• Beukelman, D., Fager, S., & Nordness, A. (2011). Communication Support for People with ALS. Neurology Research International, 2011. https://doi.org/10.1155/2011/714693
• Brewer, C., Aparo, M. (2021) The Adult Speech Therapy Starter Pack. Harmony Road Design Publishing.
• Burton, B., Isaacs, M., Brogan, E., Shrubsole, K., Kilkenny, M. F., Power, E., Godecke, E., Cadilhac, D. A., Copland, D., & Wallace, S. J. (2023). An updated systematic review of stroke clinical practice guidelines to inform aphasia management. International Journal of Stroke, 18(9), 1029-1039. https://doi.org/10.1177/17474930231161454
• Costillo, J. & O’Brien, M. Speech and Augmentative/Alternative Communication (AAC) in ALS. Medbridge. https://www.medbridge.com/course-catalog/details/speech-and-augmentative-alternative-communication-aac-in-als-john-costello-meghan-obrien/
• Hanson, E., Yorkston, K.M., & Britton, D. (2011). Dysarthria in Amyotrophic Lateral Sclerosis: A Systematic Review of Characteristics, Speech Treatment, and Augmentative. Journal of Medical Speech-Language Pathology, 10(3), 12-30.