AAC: Indirect Access

By: Margaret Edwards, SLP (speech-language pathologist)

Reading time: 3 minutes

During an initial AAC evaluation, there are many considerations. What type of device is best for the student? What features of an application are necessary? How will the student access the AAC? Access is a HUGE factor and is essential in making the student a successful AAC user.

So, what exactly is ‘access’? According to Beukelman and Mirenda (2013), there are two main access or selection options for AAC. The first and most common is direct selection. These authors describe direct selection as an access method where the AAC user directly indicates their selection by using physical contact or pointing without contact (such as eye-gaze).

If the student has significant motor issues which prevents direct access, then an alternate way to access AAC needs to be considered. This is called indirect access. Typically, this would be with the use of switches and scanning. Each of these two are huge topics, so for the purposes of this article I will only talk about use of switches. (I’ll tackle the subject of scanning next time!)

Here are three things to consider when thinking about alternate access and AAC:

Choose the best switch. There are many commercially available switches (like these from AbleNet, Inc.) that can be used with AAC communicators. When we hear the word ‘switch’ I think most of us default to the ‘BIGmack’ style. This type requires the user to apply pressure. However, when this is not possible, other options need to be explored. AbleNet, Inc. also carries a proximity switch that does not require the user to touch the switch. There are many, many types of switches and as many as possible should be trialed during the AAC evaluation.
Determine the appropriate ‘switch site’. The team of professionals working with the student should evaluate the student and determine the most reliable switch site. The OT and PT are critical team members and should give their input regarding positioning, access points, and muscle strength of the user. Consider that certain students will need more than one access point and that this may change daily, weekly, or monthly. Here is a YouTube video of a student using two switches mounted at his cheeks.
Model, model, model. I’ve always been challenged by how to model AAC use (Aided Language Input) for a student that is using alternate access. This is especially true when the student is using switches that are mounted near their head. I could use the switch with my hands, but this does not allow the user to see how they are to use the switches to navigate the AAC display. Most often, I use direct access when modeling and use the switches when possible. Another option is to allow the user to view YouTube video of a person using their same access method. This is powerful in building confidence for the AAC user.

I recently evaluated a 3-year-old student for AAC and it was determined that she would be using indirect access. With the help of the OT, we decided to position the switch near her left forehead area. We started the student on simple and fun cause-and-effect applications. With this, she was able to understand the purpose of the switch. During the initial evaluation, I was able to model use of the switch (using my head) to play the games. I recommended that the team have other students in her preschool play the games with the student and use the switch with their heads. I also recommended that the team start this student with scanning and switch(es) using an AAC application. I’m excited to return to work in September to see what progress this student is making.

This is a ‘short list’ of alternate access considerations. What processes do you consider when determining an access method for a student?