Article

Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis

School of Health and Related Research, University of Sheffield, Sheffield, UK.
International Journal of Language & Communication Disorders (Impact Factor: 1.39). 03/2012; 47(2):115-29. DOI: 10.1111/j.1460-6984.2011.00090.x
Source: PubMed

ABSTRACT There has been a rapid growth in recent years of available technologies for individuals with communication difficulties. Research in the area is currently underdeveloped with practitioners having a limited body of work on which to draw to guide the process of intervention. Concerns have been raised that this newly developed technology may have limited functional usage.
This review aims to investigate the potential barriers and facilitators to high-technology AAC provision and its ongoing use. The aim of the analysis is to explore factors underpinning use rather than effectiveness, thus it synthesized data from predominantly qualitative and survey studies reporting the views and perceptions of AAC users or staff providing the devices.
The review highlights the range of factors that can impact on provision and use of high-technology AAC, which practitioners should consider and address as appropriate in the intervention process. These include: ease of use of the device; reliability; availability of technical support; voice/language of the device; decision-making process; time taken to generate a message; family perceptions and support; communication partner responses; service provision; and knowledge and skills of staff. The work outlines how qualitative synthesis review methods may be applied to the consideration of published material that is not reporting outcomes data, and how this may provide valuable information to inform future studies.
Practitioners should be aware of barriers and facilitators to successful use when making recommendations, and consider how barriers where present might be overcome. Aspects of service delivery such as ongoing technical support and staff training may require further consideration. The synthesis of evidence describing views of users and providers, and the implementation of high-technology AAC systems, can provide valuable data to inform intervention studies and functional outcome measures.

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    • "Augmentative and Alternative Communication (AAC) is a field of assistive technologies which focuses on tools to help people to communicate better. Commonly, computer-based AAC systems are limited to communication boards, with set of symbols or pictograms through navigation menus, for composing messages and synthesizing them [2]. However, computers can in principle do more than this. "
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    ABSTRACT: Recommendation decision-making in complex scenarios. They are based in grasping knowledge from the user and his environment to personalize applications according to a specific domain. However, the complexity of each domain and the dynamic relations between different items and criteria can be challenging. In Alternative and Augmentative Communication (AAC), assistive technologies have been envisaged to help people with neuro-linguistic disorders in stories construction. Nevertheless, there are still many problems to overcome, related to the algorithms and their application. In this work, we present an original approach based on knowledge domain modelling, user archetypes, learning strategies and multi-criteria planning to assist the user in managing a set of decisions. The proposed algorithm was applied in the context of AAC systems, aimed to help aphasic persons in the construction of coherent and semantically correct stories about their daily activities. The system was validated by an aphasic person and several healthy individuals, in terms of the precision and efficiency of the method, compared with other approaches. The results demonstrate that the presented method has a good precision in the recommendation, allows faster decisions and is well adapted to AAC and can be extended to similar applications.
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    • "The work encompassed both quantitative interventions studies and qualitative papers reporting views of service users and providers. Findings regarding the qualitative studies are reported elsewhere [11]. "
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    ABSTRACT: Background/Aims: In the last 20 years the range of high-technology augmentative and alternative communication (AAC) aids has rapidly expanded. This review aimed to provide a 'state of the art' synthesis, to provide evidence-based information for researchers, potential users and service providers. Methods: Electronic databases were searched from 2000 to 2010, together with reference lists of included papers and review papers. The review considered work of any design which reported an intervention using high-tech AAC with people who have communication difficulties (excluding those with solely hearing or visual loss) published in peer-reviewed journals. Results: Sixty-five papers reporting interventions using high-tech AAC were identified. There was evidence that high-technology AAC may be beneficial across a range of diagnoses and ages. The evidence, however, is currently drawn from studies using designs considered to be at high risk of bias. Conclusion: The review suggests that the high level of individual variation in outcome requires a greater understanding of characteristics of clients who may or may not benefit from this technology. Also, the wide range of outcomes measured requires further work in the field to establish what a 'good outcome' from intervention may be.
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    • "Taking the example of voice output communication aids, there is a high level of consideration in the literature around features of design, for example within a recent systematic review of the literature in the last 10 years [3] a thematic analysis of the papers identified 11 themes of which 'ease of use', 'reliability', 'voice/language of the device', 'time generating a message' can be considered predominately design considerations and in addition 'technical support' and 'making decisions' which can be considered ancillary to design. A recent survey of communication aid users [4] identified a framework of considerations around the design of communication aids across three domains of 'device design', 'wider picture' and 'personal context' and found that there was a significant gap between users' expectations around the design of devices and the devices available for them to use. "
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