Augmentative and Alternative Communication and Hippotherapy

 

According to the American Speech-Language and Hearing Association (ASHA), augmentative and alternative communication (AAC) includes all of the ways we share our ideas and feelings without talking. There two main types of AAC: unaided and aided. Unaided AAC refers to any nonverbal communication that does not require anything other than your own body. This includes pointing, gesturing, facial expressions, and body language. It is quite simple and natural to incorporate unaided AAC into the equine environment. In fact, most people use unaided AAC naturally in their day-to-day communication without any thought or planning. Aided AAC refers to a tool, device, or system that a person uses to augment their verbal and unaided communication.

This is often broken up into 3 main categories:

1. No-tech or low-tech systems: This refers to things such as pen and paper, communication boards, picture exchange communication system (PECS) books, or pointing to pictures or letters on a board. These systems do not offer voice output, nor do they have an electronic component.

2. Mid-tech systems: This refers to voice output devices and systems such as single buttons with a pre-recorded message on them, or a grid of buttons that can be recorded with various messages and picture overlays.

3. High-tech systems: This refers to systems that are essentially computers. They can be found in app form, on personal computers, or on tablets. Some are equipped with advanced technology that responds to the user’s movement in the absence of switches or touch activation, such as eye gaze systems.

It can be difficult to identify an appropriate AAC system for a client with speech and language difficulties. Identification and implementation of AAC is generally led by a licensed speech-language pathologist. However, a team of individuals may be involved in selecting the best access method for the client and making adaptations to ensure that the client has access to the system. The intent of AAC is for the system to be utilized across environments and communication partners so the user can make his or her wants and needs known, ask questions, and express thoughts and ideas. Having the opportunity to practice AAC use as often as possible with different communication partners in a variety of places outside of the home and school environments is critical. Even if you are not a speech langauge pathologist, if your client utilizes AAC it is ideal for you to make it possible for them to access their AAC system during your treatment whether that treatment takes place on or off of a horse. Consult with your client’s speech-language pathologist about the best way for you to use AAC in your sessions. As a speech-language pathologist, you may find that therapy incorporating equines, equine movement, the equine environment, and the presence of a treatment team offers numerous unique opportunities for modeling and teaching AAC use.

But incorporating AAC use into the equine environment and during a therapy session incorporating hippotherapy does present therapists with some unique challenges. Having the client wear the device on their neck, shoulder, or torso puts them at risk of having the device get caught on something. Having the client hold the device while on the horse does not allow them to use their hands for other activities and creates a potential for the device to be accidently dropped or thrown. Having a sidewalker or the therapist carry the device means that they will not have both hands free to support the client. Recruiting an extra team member just to carry the device around may not be realistic, and likely will limit the client’s access because the device will not be right in front of them or easily accessible. Bringing the device to the client is considered a prompt to use it and does not foster independence. To address these challenges, consider making some affordable and simple adaptations that can make lowtech, mid-tech and high-tech AAC use while on the horse easy and readily accessible for your client.

Low-tech options:

1. Consider football playbook wrist bands to hold low-tech options such as communication boards, letter boards, or core vocabulary boards. The client can wear this on their forearm or thigh, and the Velcro closure can keep it shut when it is not in use.

2. Consider using a wedge with a strap that can hold PECS books or other communication books, eliminating the need for the client to wear the book or for someone to carry it.

 

 

Mid-tech options:

1. Attach single-message buttons such as a “big mac” to a surcingle, wedge, or other piece of equipment using Velcro or a switch mount. Be sure to consider placement based on hand dominance and access when the client is not on the horse.

 

2. Consider attaching grids or other mid-tech devices to a wedge or mount that holds the device securely on the horse, or building them into a bolster.

 

 

 

High-tech options:

1. Utilize a wedge that creates an appropriate angle for your client to see and access the screen. Attach a tablet mount that will hold the device securely in place. Hard foam wedges work well for this, as they are easy to cut through while still being sturdy enough to support the device.

2. For clients who use auditory scanning to access vocabulary within a high-tech device, place the switches or buttons in an appropriate location using Velcro, a wedge, or switch mounts, and then place the device in a backpack that can be worn by the therapist or another team member. Turn up the volume to ensure that the client can hear the scanning voice.

 

 

Other considerations for AAC use in the equine environment:

1. Being outdoors creates the potential for sun glare on the screen, particularly for laminated communication boards and hightech devices. This may make it difficult for the client to see the icons. Consider treating in an indoor arena or shaded arena. You can also use anti-glare screen covers and turn up the brightness on the screen. These tips will help your client any time they are using AAC outdoors.

 

 

2. Be sure that the horse you work with is comfortable with your client’s AAC system and any adaptations you make, such as wedges, switch mounts, communication boards, and Velcro before you use them within a therapy session. Any devices, pictures, or picture based systems should be secured so they do not blow in the wind or move around as the horse moves. As with any props or items we introduce, communication boards or picture icons can be dropped, thrown, or blown in the wind. It is important that the horse you are working with is comfortable with that and will not be startled if it occurs.

3. If you don’t have the ability to keep AAC available while on the horse, ask the client’s speech-language pathologist to teach them to sign, gesture, raise a hand, or point when they need to access their device. This will be a functional skill for the client to acquire for other environments and activities as well.

4. Any vocabulary or AAC systems implemented in the equine environment should be functional and appropriate for communication in other settings and generalized to other locations.

5. For clients with motor deficits, have the horse stop while the client is accessing the device to increase accuracy.

6. Be sure that any AAC systems placed on the horse do not irritate the horse’s withers or back.

Conclusion

Communication happens everywhere. Including and encouraging communication in all contexts and environments is critical to success for AAC users. Speech-language pathologists and other professionals should support AAC use with the client's communication system whenever possible. If you are not a speech language pathologist, contact your client’s speech-language pathologist to ask how you can best support communication.

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