Use this AAC Report Template to help you write the report.   You need the data first though to put in it: Get background information, test the patient's skills in person, order at least one trial device (simply call a company for one), and have the patient try several different AAC methods (writing, pointing, pressing buttons on an SGD, etc.). 

AAC EVALUATION

HISTORY (PLOF, Story of what happened; physician, health insurance, HHC/Hospital/facility)


CURRENT COMMUNICATION IMPAIRMENT (and Medical DX causing it, code, date of onset, severity)


- Why natural language isn’t adequate for functional communication:

- Motor speech/intelligibility (weakness, groping, volume, etc.)

- Cognitive Communication (alert, processes, recognizes, remembers, motivated, etc.)

- Auditory Comprehension (understanding, following directions)

- Expressive Language (word-finding, syntax, self-correcting)

- Reading (word, sentence, paragraph, follows written instructions)

- Writing (draw, copy, word, sent, paragraph)



OTHER ABILITIES 

- Cognition (generalizes info, learns from modeling/demo, good focus, pays attention, desire to communicate)

- Physical skills (WFL, hemiparesis, can select/activate icons, arm/hand motor function, ambulation, needs wheelchair/walker)

- Vision (WFL, glasses, needs large letters/icons)



DAILY COMMUNICATION NEEDS AND EFFECTIVENESS WITH NATURAL COMMUNICATION

- Gestures (for yes, no, confusion, refuse, accept, request things not in view, emotions).  Ineffective for___.

- Natural Speech (to tell medical info, safety info, social interactions, daily wants/needs, initiate topics/conv, ask Qs to get info)



ANTICIPATED COURSE OF SPEECH IMPAIRMENT / PROGNOSIS (stable, chronic, deteriorating)  

-If don't have SGD device, pt will have: frustration, medical risk, safety risk, social isolation, problems w/ family or friend relationships.



TREATMENTS ATTEMPTED / CONSIDERED FOR FUNCTIONAL COMMUNICATION (Traditional TX, Scripting, MIT, VNeST, etc.)

-(List each of the treatments attempted or considered, and why they were judged insufficient to attain adequate communication)

FUNCTIONAL COMMUNICATION GOALS

- Reduce medical risks by communicating: physical symptoms, medical info, pain, Qs re: med condition.

- Reduce safety risks by communicating: info in a crisis, requests for help, personal needs/concerns, directives.

- Reduce social isolation risks by communicating: social introductions, common social messages, opinions, tell life stories.

- Increase com effectiveness by talking on phone, asking Qs, ans Qs, making clarifications, reporting past events, stating personal goals & wishes.





AUGMENTATIVE COMMUNICATION TRIALS

- 4 High Tech AAC devices considered (at least ONE is required to be trialed - simply call a company for it), and reasons why one is liked and others are ruled out (size, weight, vocabulary, ease of use, portability, user-friendliness, age appropriateness, patient-specific communication, etc.) ( “High-Tech Rule-out means you have put clinical consideration as to why a device was not appropriate for your patient.”    Must rule out 2 devices from other venders)

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-Apps considered and reasons why they were ruled out (navigation, not enough vocab, limited personalization, pediatric, poor icon inference, etc.) (Proloquo2Go, Coughdrop, LAMP, etc.  Many companies allow free trials before buying the app)




-Low-Tech AAC considered and reasons why ruled out (no voice, limited vocab, can’t write, can’t use it to call for help, difficult to customize, can’t use phone with it, too cumbersome, etc.) (Spelling/alphabet board, writing pad/Boogie Board, PECS, Pictures on paper, white board, etc.)




RECOMMENDED DEVICE 

- Which one and Why it is selected (portable, adult language, designed for aphasia, user-friendly, easy to personalize, represents vocab)

- Examples of how pt used it:  communicated medical info or safety info, requested food, asked Qs, socially connected, told past events, talked about the future, told their thoughts/ideas, expressed their feelings, etc.).  SOME QUOTES using the device: 




-Accessories needed (and WHY):  case, joystick, bluetooth keyboard, mouse, speakers, stylus, head pointer, mount, etc.


-Purchase info (Model #, SKU, cost, tax, shipping, total cost, address, website, company phone #)




RECOMMENDED TREATMENT PLAN AND TRAINING SCHEDULE (list # of sessions)

- Operation of the device & message selection

- Communication Partner Training

- Device programming / customization.  



NON-CONFLICT OF INTEREST STATEMENT (not an employee, no financial relationship, no compensation for sale of device.  Follow ASHA code of ethics, license, ID#).



Possible codes:  [92605 Non-Speech Devices Eval  1st hr.   92606  Non-Speech Devices TX.  

92607 SGD Eval.     92608 SGD Eval add’l 30 min.      92609 SGD TX]