The conversation about AAC in aphasia evaluation has shifted in the last decade. The old framing — we'll consider AAC if speech doesn't return — has been replaced by AAC supports communication participation while speech is recovering. Most adult-track SLPs now agree, but turning that agreement into a workflow that fits a 60-minute eval is a different problem.
This is a practical workflow for adding an AAC trial to a standard aphasia evaluation, designed to be additive rather than disruptive. We use Aacoris for SLPs as the example because it's free and works on whatever device the patient or caregiver has, but the pattern translates to any low-tech AAC app.
Why integrate AAC into the eval at all
Three reasons:
- It changes what you can observe. Watching a patient interact with AAC tells you things the standardized batteries don't — strategic communication behaviors, comprehension under low pressure, motivation, and family dynamics.
- It accelerates carryover. A patient who leaves the eval with a working tool starts using it that day. Compare that to "we'll discuss AAC later," which often means three weeks later.
- It documents need. A documented in-session AAC trial supports later recommendations for high-tech AAC if those become appropriate.
Pre-eval prep (10 minutes)
Before the patient arrives:
- Pre-install Aacoris on a clinic tablet. Have a clean profile ready — no other patient's phrases pinned. Optionally, pre-load a small set of generic medical and daily-needs phrases.
- Have a printed one-page handout for the patient or caregiver explaining what AAC is, what the app does, and where to find help installing it on their own device.
- Block 10 minutes at the end of the eval slot for the AAC trial. Don't try to squeeze it in — protect the time.
During the eval (10–15 minutes for the AAC portion)
The AAC trial doesn't replace your standard battery. It runs at the end, after you have a working impression of the patient's aphasia profile.
Step 1 (2 minutes) — Demonstrate
Sit at the same eye level as the patient. Tap two or three pre-loaded phrases yourself so the patient hears the voice and sees the interaction pattern. Don't lecture; just show.
Step 2 (3 minutes) — Hand over the device
Let the patient explore. Watch:
- Do they navigate categories or stay on the home screen?
- Do they read text, look at icons, or both?
- How do they respond to hearing the synthesized voice?
- Do they look at you for permission or just go?
Take notes on a clipboard rather than the tablet — you don't want to be the one driving.
Step 3 (5 minutes) — Structured task
Pick a structured task at the patient's level:
- For mild aphasia: ask the patient to use the app to tell you about a picture or describe their morning.
- For moderate aphasia: ask three or four functional questions ("What do you want for lunch?", "How are you feeling?") and observe responses.
- For severe aphasia: hand the patient the Medical category and observe whether they can identify familiar concepts (medication, pain, family).
Document the response pattern. This is the data that supports the recommendation.
Step 4 (3 minutes) — Caregiver moment
If a caregiver is present, hand them the device and ask the patient a question via AAC. Observe:
- Does the caregiver wait for the response?
- Does the caregiver tap on the patient's behalf?
- How does the patient react to caregiver use?
This is often where you see the family dynamics that will determine whether AAC actually gets used at home.
Post-eval recommendations
The AAC recommendations come out of the same report as your other findings. Three patterns:
Recommend AAC as primary expressive support
When the patient has moderate-to-severe expressive aphasia, can navigate the app with cueing, and has a caregiver willing to help. Recommend:
- Daily AAC use across at least two structured windows
- Specific target phrases the SLP will revisit each session
- Revisit at 4 weeks for vocabulary review
Recommend AAC as bridge to high-tech AAC
When the patient's needs are clearly going to outgrow a low-tech app — significant motor impairment, complex language goals, eye-gaze access requirements. Recommend:
- Aacoris during the months of evaluation and procurement
- Concurrent referral for high-tech AAC evaluation
- Gradual transition once the high-tech device arrives
Recommend AAC as adjunct to speech therapy
When speech is recovering well and AAC is supplemental rather than primary. Recommend:
- AAC use during low-energy parts of the day (evenings, fatigued sessions)
- Specific target words the SLP introduces; the patient practices with AAC between sessions
- Optional, not required
Documentation that withstands chart review
The chart entry should make three things explicit:
- What you trialed. "Patient was trialed on Aacoris, a free low-tech AAC application running on a clinic tablet."
- What you observed. Concrete behaviors. "Patient navigated the Medical category independently, identified medication phrases, used AAC to request water during the session."
- What you recommended. "Recommend daily AAC use during meal times and family interactions. Recheck vocabulary at next visit."
Avoid vague entries like "patient may benefit from AAC." Specificity protects the recommendation if it's challenged later.
Common workflow problems and fixes
"I don't have a clinic tablet." A patient or caregiver phone works. Aacoris doesn't require a specific device.
"I don't have time for an extra 15 minutes." The trial replaces, not adds. The 15 minutes you save by skipping the standardized portion you weren't going to get to anyway is the 15 minutes you spend on AAC. Pick the battery items that matter and protect the AAC time.
"The patient doesn't want to use AAC." Note it explicitly in the chart, document the reason (often grief, denial, or fatigue), and revisit at the next visit. Resistance often softens over weeks.
"I'm not sure if AAC is going to be used at home." That's exactly what the caregiver moment in step 4 tells you. If the family dynamics suggest AAC won't get used, document that, recommend caregiver coaching, and recheck.
When to escalate to a formal AAC evaluation
Escalate when any of the following are true:
- The patient needs alternative access (eye-gaze, switch, head pointer)
- The patient's communication needs include complex sentence generation
- The patient is moving toward a long-term communication impairment that won't resolve
- Funded equipment is realistic and the patient's profile supports it
In all of those cases, the in-session AAC trial is still useful — it documents need and gives you data the formal evaluator can build on.
A note on the rest of the AAC pipeline
A 15-minute in-session trial isn't a substitute for a comprehensive AAC evaluation. What it is: the on-ramp. Most patients who end up with a long-term AAC system started with a low-tech trial in someone's eval. Making that trial standard rather than ad-hoc is one of the highest-leverage changes an adult-aphasia SLP can make in their workflow.
About the Author
Aacoris Team — Building a free AAC tool clinicians can recommend on day one of an aphasia evaluation.
Related guides
- AAC for SLPs — full pillar
- Overview for clinicians
- Technology for Speech-Language Pathologists
- AAC for Aphasia