AAC: An Open Door for Communication in Music Therapy
Sharing a thought
Making a choice
Waving hello
Paying a compliment
Singing a lyric to your favorite song
Saying “I love you” to your mom
Communication fills our lives yet is something we often have the privilege to take for granted.
Music therapists see a variety of clients whose communication is impacted by their diagnosis and use music to give them opportunities to express themselves. Sometimes, music therapists work on speech goals by prompting their clients to sing along or speak in rhythm. However, other times communication comes in a different way – augmentative or alternative communication (AAC).
Introduction to AAC
Augmentative or Alternative Communication (AAC) is any method of communicating that adds to or is a substitute for speech. Augmentative means to add onto someone’s speech. For example, a client may be able to speak some, but not all, words that they want to express because of a difficult motor skill or mouth movement. One of my current clients presses a button on her AAC, hears the sound it makes, then is able to replicate the sound by speaking out loud. Alternative means “in place of”. A client will use this instead of speaking, and this is their primary method of communication.
There are many forms of AAC, including low tech, mid tech, and high tech. Low tech AAC operates without batteries or voice output, mid tech AAC uses batteries but may have programming limitations, and high tech AAC uses batteries and is capable of wider programming.
Below are three examples of AAC my clients frequently use in our sessions:
Letterboard Communication: In this form of AAC, a client will use their index finger or sometimes a pencil to tap a sequence of letters onto a board which contains all the letters of the alphabet. This is especially helpful for clients who have difficulty with the fine motor movements associated with speech but can practice the gross motor movements of pointing with their arm and finger. A communication and regulation partner, or CRP, is trained to hold the letterboard in front of the client and provide necessary support to communicate and regulate or keep the body in a calm state, ready to go. Having a full range of letters to communicate with gives the individual a wide vocabulary because they can communicate with any words that they want to rather than being limited to the buttons on an AAC app. Some individuals who use letterboard communication may be “open,” meaning they have the motor skills to communicate whatever phrases they desire. Other individuals may be in a “closed”, or learning, stage, where they are currently able to communicate an answer to a question or a thought from a set of limited options. This may be because they are with a new communication partner who is learning how to support them or that they, like any of us, can benefit from more structured options in a decision making process.
Chatterboards: This is a free app that I use to create personalized vocabulary boards customized with my own text, colors, images, and audio playback! I have created boards to communicate colors and numbers, choose words to add into affirmations (statements that encourage and build ourselves up), express emotions, and choose preferred instruments and songs. The benefit of the boards being customizable is that it adapts to include individual preferences; for example, one of my clients loves Taylor Swift, Lady Gaga, Elton John, Katy Perry, and Queen. With Chatterboards, I can add all those options to one board with pictures of each artist on the buttons so she can choose one confidently.
Proloquo2Go and Proloquo4Text: Proloquo2Go and Proloquo4Text are two linked apps that some of my clients choose to use as they progress one into the other. Proloquo2Go uses buttons with individual words or phrases on them (like “rock music,” “hello,” and “piano”), usually accompanied by a small picture or icon. In contrast, Proloquo4Text displays a keyboard on the screen equipped with word and sentence prediction capabilities and a single screen layout. Both programs use voice output, so when clients type or tap each button, the program reads the typed word or statement aloud.
AAC in Music Therapy
Although AAC may be primarily viewed as a tool to work on communication goals, it is an imperative tool to promote individuals’ autonomy and choice in sessions, express emotions, facilitate social greetings, and compose music!
Here are a few examples of how music therapists might utilize AAC in their sessions:
Songwriting and Composition: Writing original songs or choosing musical components to add to a composition provides lots of communication opportunities. In past sessions, clients have written original lyrics, chosen instruments, picked tempo or dynamic components, or selected a particular style to write in. Recently in our summer music groups, our participants made several stylistic choices to create several original songs based in different genres. Some of them communicated openly, spelling out specific lyrics, while others communicated with options like choosing the first, second, or third looping chord pattern played by the facilitating music therapist.
Choice in Session Routine: Leaving space for clients to choose which songs and instruments they would prefer to use is important in giving them a voice, especially when they have fought for autonomy from day one. One of my clients has several musical options on his AAC, so he can choose whether he wants to learn a rock, classical, or country song. I have also created Chatterboards with the songs we have learned so far so that the client can choose a song to work on as a review. Some songs may be dysregulating for clients, so giving them the time to reliably communicate what their body needs is important.
Fill in the Blank: I often practice using AAC with clients by asking them to sing words that “fill in the blank” of their favorite song’s lyrics. For example, I asked a client to fill in the words to “You Are My Sunshine” using the words “sun,” “happy,” “gray,” and “love”, while one of our other MT-BCs recently used the song “Fly Me to the Moon” to practice using space themed words on her client’s AAC.
Affirmations: By creating an AAC board of affirming adjectives or words like “brave,” “kind,” “friendly,” “growing,” and “learning,” I give clients the opportunity to choose words to create their own affirmation statements to improve confidence and self-esteem.
Rhythms: In rhythmic activities, I will teach clients about three or four different rhythmic values, including eighth notes, quarter notes, half notes, and quarter rests. Then, I will create a google slide or markerboard with each rhythm present and ask them to point to the rhythm they want to practice or play. I may have them create a sequence of four rhythmic values, and afterwards, they can practice playing the sequence using a percussion instrument or clapping.
Emotional Expression: Clients can use AAC to express nuanced emotions using words they cannot yet sign or speak. For example, I have a Chatterboard with eight feeling words that I use with a client who is nonspeaking and signs using ASL. He is able to select the emotion he feels the most by looking at the icons, and then we can practice signing the emotion using ASL. Expressing how one feels is important as a human for connection and mental health. It also helps to start the session with the therapist understanding where the client is at emotionally, so that the therapist can match the mood with the music they bring in or slowly adapt and adjust the mood throughout the
Social Greetings: At the beginning and end of the session, I usually implement a hello and goodbye song! These song lyrics are typically repetitive; for example, “Everyone’s here and it’s time to say hello” repeated three times before a concluding final line. This gives three different opportunities for the client to practice saying the word “hello” by finding it on their AAC device. Especially for clients with motor goals or developing reliable communication methods, repetitive practice is quite helpful in getting their body where it needs to go each time.
If you know someone who is looking for a new way to incorporate using AAC or work on communication goals, music therapy could be a motivating, engaging, and new way to address those goals!
Reach out to us by phone at (727) 350-7897 or email leadership@mtsp.com to learn more, and we look forward to hearing from you.
