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Non-electronic communication aids for people with complex communication needs
Abstract
Non-electronic communication aids provide one form of augmentative and alternative communication (AAC) for people with complex communication needs. The aim here was to explore non-electronic communication aids as one AAC option and research challenges. This aim was addressed by reviewing funding for the provision of AAC systems, data from an Australian pilot project providing non-electronic communication aids, an audit of aided AAC published studies (2000-2009), and discussion of the review literature. Combined, these sources indicate that although there is great demand for non-electronic communication aids, funding schemes, both in Australia and internationally, have focused on electronic communication aids. Such funding has usually failed to meet the total device costs and has not provided for adequate speech-language pathology support. Data from the pilot indicated the demand for non-electronic communication aids, and patterns suggest potential factors that govern the types selected. Despite the high demand for non-electronic aids, the research literature has tended to focus on electronic communication aids, including within intervention studies and addressing design features and long-term outcomes. Concerns about ensuring that AAC systems are chosen according to the assessed needs of individuals are discussed within the context of limitations in outcomes research and appropriate outcome measures.
... West et al.'s (2012) findings highlight the potential value of combining the personal reports of adults who use AAC, with the reports of others who know them well, in exploring the outcomes of AAC service provision. Such combined information is needed not only because having complex communication needs is likely to make it difficult for many adults with ASD to relate their experiences, but also because NECAS records indicate that most referrals for adults with ASD come from support workers and family members (Iacono et al., 2011. Consequently, their views, actions, and experiences are likely to be central to understanding the outcomes of AAC service provision. ...
... Presumably, learning to use and to support the use of a visual timetable is easier than learning to support the use of a comprehensive expressive communication system, particularly in the context of rapid staff turn-over, inadequate staff training, and a lack of external support as reported by participants. Communication partner instruction is known to be a critical component in successful AAC intervention (Kent-Walsh and McNaughton, 2005), and although the NECAS was co-ordinated by speech pathologists with expertise in AAC, they were unable to provide direct assessments of the individual needs of each person referred to the scheme or direct follow-up training (Iacono et al., 2011). The fact that key support workers and family members focused on the benefits of comprehension supports may, in part, simply reflect their preference for simple and easy to use systems in the absence of comprehensive assessments, and adequate training and support to implement the aids. ...
... The results reinforce the adage that simply providing communication aids is not enough, and that any attempt to support communication through AAC must also occur with consideration of barriers relating to organisational policies and practices, as well as the knowledge, skills, and attitudes of all key stakeholders (Trembath et al., 2010, Kent-Walsh and McNaughton, 2005, Mirenda, 2008. Further, the results provide a new perspective on these issues, given that all participants received communication supports through the same scheme, and delivered by speech pathologists with expertise in AAC, albeit being limited in the extent to which they could provide supports (i.e., the funding does not include direct assessments or follow-up, see Iacono et al., 2011). The different outcomes for individual participants illustrate the impact of barriers to using AAC: ...
Many adults with autism spectrum disorders have complex communication needs and may benefit from the use of augmentative and alternative communication. However, there is a lack of research examining the specific communication needs of these adults, let alone the outcomes of interventions aimed at addressing them. The aim of this study was to explore the views and experiences of support workers and family members regarding the outcomes of providing low-technology communication aids to adults with autism spectrum disorders. The participants were six support workers and two family members of six men and women with autism spectrum disorders, who had received low-technology communication aids. Using semi-structured, in-depth interviews and following thematic analysis, the results revealed strong support for, and the potential benefits of, augmentative and alternative communication for both adults with autism spectrum disorders and their communication partners. The results also revealed inconsistencies in the actions taken to support the use of the prescribed augmentative and alternative communication systems, pointing to the clinical need to address common barriers to the provision of augmentative and alternative communication support. These barriers include organisational practices and limitations in the knowledge and skills of key stakeholders, as well as problematic attitudes.
... Speech pathologists, occupational therapists, and special educators may be well versed in augmentative and alternative communication, or at least aspects of it. Augmentative and alternative communication systems are diverse, including sign language, letter or communication boards or books, small message cards, basic or complex electronic devices, and mainstream tablets with communication Apps (Iacono, Lyon, & West, 2011). ...
... In Australia, there is some funding for communication devices, and even for adults to obtain non-electronic aids -in Victoria only (Iacono et al., 2011). However, once a person gets a device, there is little if any public funding to help adults with disabilities to learn to program or use these devices. ...
... In line with wider technological advances, AAC options for people with ALS have changed profoundly over the past decade and continue to evolve, for example, in the use of eye gaze as a control strategy (Ball et al., 2010) and brain-computer interfaces (Huggins, Wren, & Gruis, 2011;Silvoni et al., 2009); however, non-electronic systems still play a signifi cant role in supporting day-to-day communication and interaction, including the use of handwriting (Iacono, Lyon, & West, 2011). ...
... It has already been noted that, despite the high demand for non-electronic aids, the research literature has tended to focus on electronic systems (Iacono et al., 2011). As a low-tech AAC system, the use of handwriting for face-toface communication, despite its familiarity and apparent simplicity, is worthy of investigation. ...
Abstract The aim of this study was to examine the use and practices of handwriting-in-interaction by people with amyotrophic lateral sclerosis/motor neuron disease (ALS/MND). Handwriting has previously been described as a viable and practical means of augmentative and alternative communication, particularly for adults with acquired progressive dysarthria and intact upper limb control. To date, however, there is extremely limited evidence documenting how handwriting is used within a conversational context. The analysis in this paper features data from two people with ALS/MND in conversation at home with their spouses. It is shown how recipient animation of an authored written contribution is an important element of handwriting-in-interaction, particularly in how the recipient reveals his or her stance or reaction to whatever has been written.
... If speech-language pathologists are to include this technology in therapy interventions, there is a requirement for research evidence to be readily accessible to support evidence-based practice regarding which devices should be provided for who and at which point in treatment. High tech AAC systems are expensive to purchase and repair, and funding may fail to meet total device costs, or include adequate speech-language pathology support [5]. The training of communication partners is also a neglected area for funding. ...
... Authors of these reviews have suggested that much available evidence regarding AAC is inconclusive, in particular in regard to generalisation and maintenance of use. Iacono et al. [5] reported that there has been a tendency to provide high tech aids when low tech aids may offer advantages. In addition, the definition of outcomes to be measured offers a considerable challenge when the goal of intervention encompasses enabling individuals to access life [8]. ...
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.
... Picture and object related tools as aids to augment and/or replace spoken language have been used extensively in rehabilitative contexts, [1,7,33,35,39,44,45,59,65,66,69,75,88,90] and are now increasingly being used in the legal context too (including gestures and nonverbal embodied communication) [15,37,46,61,62]. Visual representations of a concept are more concrete than speech alone [6] and hence often clearer and less ambiguous than words on their own [77]. ...
Establishing common ground in police investigative interviews is essential in preventing misperceptions and miscommunications, to enable a witness’s best evidence to be collected. However eliciting a consistent account of an allegation from individuals with an Intellectual Disability (ID) is dependent on the skill of the interviewing police officer and the communicative competence of a witness with ID. Acknowledging the specialist nature of this process, the Youth Justice and Criminal Evidence Act in England and Wales allows trained intermediaries to facilitate communication between vulnerable individuals in legal settings such as forensic interviews. Intermediaries i.e., communication specialists, often recruit legally permitted low technology communication aids such as line drawings to facilitate interviews. Typically, common ground is established through shared attention and talk but this article uses multimodality Conversation Analysis to analyse the manner in which common ground in intermediary-mediated police interviews is established in other ways, i.e., firstly, through recruiting and using low technology communication aids in real interviews, and secondly through the embodied physical actions associated with manipulating those aids. Line drawings are examined here, enabling the answers given by witnesses with an ID to be semantically aligned with the questions being asked by the interviewing officers, by establishing common ground. Aids are shown to bypass documented difficulties with attention and staying on topic that individuals with ID typically experience, thus enabling them to verbally provide investigation-relevant evidence.
... Using support skills is particularly important for communication partners who interact with children with severe communication impairments, including those who use augmentative and alternative communication (AAC) systems (Kent-Walsh et al., 2015). Common AAC systems include communication boards and portable devices with communication applications and voice output (Douglas et al., 2014;Iacono et al., 2011). Children who use AAC have multiple communication partners, including therapists, educators, peers, and families (Kent-Walsh et al., 2015;Senner et al., 2019). ...
Purpose:
This study aimed to explore the feasibility of a telepractice communication partner intervention for children who use augmentative and alternative communication (AAC) and their parents.
Method:
Five children (aged 3;4-12;9 [years;months]) with severe expressive communication impairments who use AAC and their parents enrolled in a randomized, multiple-probe design across participants. A speech-language pathologist taught parents to use a least-to-most prompting procedure, Read, Ask, Answer, Prompt (RAAP), during book reading with their children. Parent instruction was provided through telepractice during an initial 60-min workshop and five advanced practice sessions (M = 28.41 min). The primary outcome was parents' correct use of RAAP, measured by the percentage of turns parents applied the strategies correctly. Child communication turns were a secondary, exploratory outcome.
Results:
There was a functional relation (intervention effect) between the RAAP instruction and parents' correct use of RAAP. All parents showed a large, immediate increase in the level of RAAP use with a stable, accelerating (therapeutic) trend to criterion after the intervention was applied. Increases in child communication turns were inconsistent. One child increased his communication turns. Four children demonstrated noneffects; their intervention responses overlapped with their baseline performance.
Conclusions:
Telepractice RAAP strategy instruction is a promising service delivery for communication partner training and AAC interventions. Future research should examine alternate observation and data collection and ways to limit communication partner instruction barriers.
... AAC interventions can take many forms, but a common goal is to provide users with a way to select symbols (words, phrases, etc.) for purposes of communication. The field of AAC groups interventions into "low-technology" (i.e., printed) or "high-technology" (i.e., computerized) devices; both are commonly used, and there are a number of factors that go in to the decision of which device to use (Iacono et al., 2011;Light and Drager, 2007). In some cases, devices produce speech (or written language) based on those selections, whereas in other cases, the goal of the device is to support a user in producing their own speech. ...
Icon-based communication systems are widely used in the field of Augmentative and Alternative Communication. Typically, icon-based systems have lagged behind word- and character-based systems in terms of predictive typing functionality, due to the challenges inherent to training icon-based language models. We propose a method for synthesizing training data for use in icon-based language models, and explore two different modeling strategies.
... It is possible that clinical services are focussing on aided technology training and that the area of unaided or low tech training may be receiving less attention (Iacono et al., 2011). This would benefit from further exploration in future research. ...
Purpose
This paper documents augmentative and alternative communication (AAC) training provision by clinical services in England.
Design/methodology/approach
A questionnaire was used to obtain the following information concerning AAC training provision; (i) frequency, length, type, content and cost, trainee occupations and numbers, and future training priorities, and (ii) information concerning training providers - service type, geographical area.
Findings
Ninety-eight clinical service training providers in England responded. Services commonly reported providing AAC training to speech and language therapists, teaching assistants and teachers. Training around ‘use of specific AAC products, systems and technology’ and ‘introducing/awareness raising of AAC products’ were rated as high priority for future training and were two of the three subject areas where services reported the highest percentage of training. Training was predominantly provided at a foundation (basic) level.
Originality/value
There is no consensus on the amount or content of AAC training which professionals in England must receive. Evidence suggests that AAC training for prequalification professionals is limited and this paper has identified variation in the amount and type of post-qualification AAC training. While knowledge concerning specific AAC systems is necessary, focusing training primarily on this area may not address critical gaps in knowledge. There is a need for specific recommendations regarding AAC training for professionals in this field, to ensure professionals can fully support people who use AAC.
... 'Traditional' lower-tech aids may more suitable for some people who need help with communication, and often will be cheaper 345,346 . ...
... The hub and spokes received differing levels of funding with the hub being funded to provide leadership and support in the area of augmentative and alternative communication (AAC) and coordinate the strategic priorities for the RCS services. Staff at the hub initiated new service development strategies and conducted research including developing and evaluating a non-electronic communication aid service (Iacono et al., 2011(Iacono et al., , 2013; establishing validity of assessment tools (Iacono et al., 2009); investigating recruitment issues for speech pathologists (Iacono et al., 2007;Johnson et al., 2008); developing the Communication Access Symbol and processes (Bloomberg and West, 2012;Johnson et al., 2013;Solarsh et al., 2012) and examining the speech pathologist's role in capacity building (McLennan et al., 2006;McQueen, 2012). As the regional services became more established, the hub and spoke network identified the need to develop a clear and unified mission, vision and strategic priorities. ...
Purpose
– The purpose of this paper is to describe specific features of a Victorian (Australia) state-wide hub and spoke model of speech pathology provision established for adults with complex communication needs (CCN). Two case studies highlighting successful examples of services developed to enhance community inclusion will be described and the challenges discussed.
Design/methodology/approach
– The route to community inclusion is described through a case study illustration of one communication accessible community site and one disability service study. The disability service research involved focus groups, survey and interview data and demonstrated the efficacy and sustainability of a support worker training model.
Findings
– Sustainable change in the community and in disability services can occur through partnerships, training, and long-term commitment. Support workers who can facilitate interactions for people who have cognitive and communicative disabilities are an essential component of building the capacity of communities to include people with CCN. Collaboration between community members, specialised supports and people with disabilities enhances active community participation.
Originality/value
– This innovative, state-wide model has the capacity to be replicated elsewhere. On-going speech pathology services are integral to support adults with CCN providing both short-term individualised services, sustainable staff training and community engagement.
... The relative lack of recent evidence into the use of manual signs with children with ASD may reflect simply a tendency for the research literature to focus on aided, and in particular, high technology AAC. Iacono et al. [22] argued that the focus on high-tech AAC is at odds with the approaches most commonly used by speech pathologists, parents, and teachers in everyday practice Research into KWS is therefore needed to ensure that AAC intervention provides a more comprehensive multimodal approach than is afforded by offering high and low-technology aided systems only. ...
Objective:
The aim of this study was to examine the effect of Key Word Sign (KWS) intervention on the acquisition and generalization of manual signing among three children with Autism Spectrum Disorder (ASD), and to measure any changes in their production of spoken words and gestures following intervention.
Methods:
A multiple baseline single-case experimental design was used to measure changes for each of the three children.
Results:
All three children began using signs following the introduction of the KWS intervention, and generalized their use of some signs across activities. The introduction of the intervention was associated with either neutral, or statistically significantly positive, changes in the children's production of spoken words and natural gestures.
Conclusion:
The results provide preliminary evidence for the effectiveness of KWS for preschool children with ASD, which parents, therapists, and educators can use to inform clinical practice.
This is the third volume in a series of books designed to contribute and respond to growing interest in forensic linguistics or language and the law on the African continent. Drawing mostly on contexts where traditional African laws and Western laws are practised side-by-side, and where there are discontinuities between local knowledge systems, belief systems and language practices on the one hand, and official languages of law discourse, conceptualisation and jurisprudence documentation on the other, the chapters in this volume problematise, among other issues, the mediation practices (or lack thereof) of language and legal processes, discourse strategies and complexities in (mis)interpretations in second language court contexts and the miscarriage of justice that these may entail.
Systems-thinking is a useful approach to deepen our understanding of the linkages, relationships, interactions, and behaviours that, together, comprise and shape our health systems. Offering a comprehensive range of opinion and scholarship from experts located across the world (Europe, North-America, Africa, Asia, and Oceania), spanning a wide range of disciplines, this book presents a compilation of case studies, prescriptive or retrospective reflections, conceptual pieces, interventions, and methodological approaches to guide and inspire global health practitioners in their application of systems-thinking approaches across topics familiar to the field of Global Health including, but not limited to, maternal and child health, disability, social inclusion, malaria, TB, HIV, and other infectious diseases, tobacco control, mental health, human resources for health, healthcare decentralisation, health information systems, health in conflict and/or fragile contexts, health system strengthening, quality improvement, and nuclear disarmament.
Planning intervention for a person with severe intellectual disabilities is complex and involves integration of assessment findings within a number of frameworks to create functionally relevant and client-focused goals. Novice clinicians frequently find this process daunting and may be tempted by published packages which may be lacking in evidence of their effectiveness. The heterogeneity of the population means that not all intervention packages will be suitable for all. This paper proposes a taxonomy to support student and novice SLPs working with those with intellectual disabilities to develop holistic, ecologically valid goals and identify suitable intervention approaches.
Objectives: People with motor neurone disease (pwMND) experience communication impairments due to speech and motor dysfunction. Communication support in the form of Augmentative and Alternative Communication (AAC) in conjunction with Assistive Technology (AT) access methods are available, however, variation in provision care pathways exists across Scotland. We conducted a baseline study of communication support for pwMND in Scotland to inform and improve future service provision. Methods
:
A cross-sectional population-based study was undertaken. Anonymised demographic and clinical phenotypic data for all pwMND in Scotland were extracted from the Care Audit Research Evaluation of MND (CARE-MND) platform, the National MND Register for Scotland. Additional information for AT loans was provided by the third sector charitable organization MND Scotland (MNDS). Results
:
In total, 371 pwMND were included, 43% of all pwMND were recorded as having impaired speech (recent ALSFRS-R score assessment
≤
3) and 69% had been referred to Speech and Language Therapist (SLT) services, although there was variation in referral time from diagnosis date. AAC equipment had been acquired by 17.3% of all pwMND; most commonly iPads and the LightwriterTM speech generating device. Conclusions
:
Our data highlight a high prevalence of speech impairment in pwMND irrespective of the subtype diagnosis. We therefore recommend standardized care pathways and earlier access to coordinated SLT and Occupational Therapist services to enable prospective and personalized decision making. Our findings further highlight the need for qualitative research to understand the preferences and impact of such interventions from the perspective of the user and their communication partners.
Patients with amyotrophic lateral sclerosis (ALS) are known to demonstrate a variety of cognitive impairments, including writing disabilities.
In this study, we investigated Kana and Kanji writing abilities in patients with ALS (n＝14) . Furthermore, we tried to demonstrate responsible brain regions for Kana and Kanji agraphia using a correlation mapping method involving SPECT. As a result, 12 of 14 patients showed Kana agraphia and 8 of 14 patients demonstrated Kanji agraphia. Kana errors appeared more frequently when the patients attempted to write irregular words in which the numbers of syllables, morae, and Kanas were incongruent. Kanji agraphia was characterized by erroneous combinations of Kanji characters that were phonologically identical but wrong in meaning to the target words. The number of Kanji errors of this type correlated significantly with the results of a test in which a subject was required to discern semantic similarity of paired sets of Kanji words. The number of Kana errors associated significantly with regional cerebral blood flow (rCBF) of the left posterior part of the middle frontal gyrus, while that of Kanji errors correlated significantly with rCBF of the left dominant temporal poles.
We suggest that a certain proportion of patients with ALS do show Kana and/or Kanji agraphia. Kana and Kanji agraphia may be due to dysfunctioning of the left posterior part of the middle frontal gyrus and the left dominant temporal poles, respectively.
Purpose
– The purpose of this paper is to provide an overview of the communication applications (apps) that can be used with devices such as the iPad, iPod and iPhone to support augmentative and alternative communication (AAC).
Design/methodology/approach
– A brief discussion of the research into the use of high‐technology communication aids is followed by an introduction to the iPad, iPod and iPhone AAC apps.
Findings
– These devices and apps clearly have a role within the spectrum of AAC devices currently available. They may have some distinct advantages in cost, ease of use and acceptability but more research into their use is needed.
Originality/value
– This article starts with a model of communicative competence and presents some recent research into barriers in the use of high‐technology AAC. It suggests some ways in which AAC apps may address some of the barriers to implementation and functional use. Finally, the need for individual assessment to determine specific communication needs is stressed. These devices and apps may not always be the best solution for people with complex communication needs.
Purpose:
We explored the experiences of adults who received aids through the Non-Electronic Communication Aids Scheme (NECAS).
Methods:
Fifteen adults aged 21-74 years, with complex communication needs (nine males) associated with developmental (n = 10) or acquired disabilities (n = 5) who received NECAS aids, and 12 support people participated. Interviews provided data for thematic analysis.
Results:
Participants used multi-modalities, reflecting that there is more than one way to communicate, but differed in using their augmentative and alternative communication (AAC) aids according to time and place. How NECAS and other forms of AAC, including electronic devices, were meeting communication needs varied, and reviewing needs was needed. Participants reported being empowered through reducing frustration, increasing independence and facilitating relationships. There were varied preferences for low versus high tech, according to speed of communication and tolerance for breakdowns. They differed in being concerned about what other people think when aids were used in the community, and reactions and attitudes of others. Owning the process emerged through varying degrees of participation in developing and updating their NECAS and other aids.
Conclusions:
The results are discussed in terms of the benefits of multimodal options, consumer-desired outcomes in research into the effectiveness of AAC and need for ongoing supports. Implications for Rehabilitation AAC includes both high (assistive)-technology and low-technology options. In order to implement best practice, AAC provision of low- and/or high-tech options must be driven by individual needs rather than service limitations. In this qualitative study, the benefits of access to various low- and high-tech AAC options to address needs and preferences are demonstrated.
In this paper are the findings of a 3-year research project into communication between 15 people with Motor Neurone Disease (MND) and their closest communication partners, as the disease progressed. Data were collected through video recordings, narratives, and field notes. The purpose of the communication and the use of augmentative and alternative communication (AAC) according to the perceptions of people with MND and their partners were examined. For the people in this study, it appeared that AAC was less successful than anticipated. The participants gave a number of reasons, which were interpreted by the researcher to include (a) the need for social closeness, which may not be possible when using a device; and (b) the complexity of learning how to use a high technology device combined with inadequate training. Both theoretical and practical issues are raised for professionals who work with and provide services to families with MND.
Augmentative and alternative communication (AAC) holds the potential to enable people with severe oral communication impairments to participate more fully in society. However, despite the development of increasingly sophisticated communication aids, as well as recent UK policy initiatives aimed at improving access to them, some major obstacles stand in the way of the inclusory potential of AAC being realized to any significant degree. Drawing on findings of a research study that explored the experiences of people who use AAC, this paper looks at the various problems that people encounter in using communication aids. It identifies the lack of consistent, structured support as a key overarching issue. The author goes on to argue that for the potential of AAC to be realized attention needs to be given to the development of coordinated systems of support within the policy domains of education, health and social services.
Government policies in developed countries have emphasized the importance of community inclusion to improve the health and wellbeing of citizens. In order to achieve this, a reorientation of human services to include all people with disabilities has commenced with specialist disability services providing only limited supports. One vulnerable group of adult citizens are those with severe cognitive impairments. These citizens live either with their family or in small group homes supported by paid staff. Many of these people have little or no functional speech and are at an increased risk of social exclusion. This paper presents a discussion of the relevant literature underpinning the provision of mainstream speech-language pathology services to adults with severe cognitive disabilities. In particular we focus on practice considerations that might assist speech-language pathologists in providing effective and efficient services that support people with severe intellectual disability to live meaningful lives in the community. Five main considerations are discussed: (1) applying a holistic model to communication practice; (2) understanding terminology and the process of assessment; (3) considering the role of communication partners; (4) training communication partners; and (5) using communication supports to assist community inclusion.
The World Health Organization's (WHO) International Classification of Functioning, Disability and Health (ICF) (WHO, 2001) states that one of its five possible applications is for clinical use. The ICF is both a conceptual framework and a classification system with a complex numerical coding system and operational definitions. Thus, the practical and useful application of the classification system for recording assessment results could prove difficult. However, an agreed upon clinical interpretation of the ICF by clinicians is essential for it to be able to communicate complex clinical assessments to other professionals, third party payers, administrators, health care policy makers, and the consumers of our services. The American Psychological Association and the World Health Organization are working on finalizing the Procedural Manual and Guide for the Standardized Application of the ICF: A Manual for Health Professionals. This Procedural Manual is being designed to provide health professionals with directions for clinical use of the ICF, including additional information about the clinical interpretation of each code, to facilitate reliable and valid clinical use of the ICF. This article addresses issues discussed in the Procedural Manual and a range of complex issues regarding the clinical use of the ICF by speech-language pathologists.
Background: The American Speech-Language-Hearing Association Functional Assessment of Communication Skills (ASHA FACS) has established validity and reliability for individuals with aphasia. However, subtest scores are summed and averaged across subtests, making it difficult to describe individuals' communication behaviours. Item-response theory provides a methodology to assess the measurement properties of established assessments by transforming ordinal data into interval data, calibrated for both person ability measures and item difficulty on the same linear scale. The result is that behaviours can be ordered and described in ways that are more informative and useful than reporting raw scores. Aims: The study aimed to use Rasch analysis to determine the psychometric properties of the ASHA FACS Social Communication Subtest (SCS) and to demonstrate how the Key form (a visual representation of the measure that results from the Rasch analysis) could add meaning to scoring and tracking progress. Methods & Procedures: A total of 130 caregivers (76% female, 24% male) rated the performance of individuals with aphasia on the ASHA FACS SCS (21 items rated on a 7-unit scale). Participants' ages ranged from 31 to 88 years (M560.5, SD512.4). Rasch analysis was done by WINSTEP computer software.
To review literature specific to the use of AAC with adults who have severe aphasia.
The authors reviewed studies involving AAC interventions for adults with severe aphasia.
Published data support the use of aided and unaided AAC with adults with severe aphasia in controlled treatment contexts. Reported gains in communication typically have not generalized to everyday settings.
The application of AAC with persons with severe aphasia must address factors potentially limiting treatment success outside of training environments.
ABSTRACTS
This paper investigates some of the issues which contribute to the lack of use of Augmentative and Alternative Communication (AAC) systems. It presents findings from a two‐year research study which examined the communication of 93 adolescent and adult AAC users with cerebral palsy and 186 of their communication partners. The methods of data collection were questionnaires, interviews and field notes. The results show that some of the obstacles to effective use of AAC systems include lack of availability and accessibility of AAC systems, communication partners' lack of knowledge of AAC systems, insufficient amount of therapy provided, type of vocabulary in AAC systems and gther modes of communication available to AAC user.
Cet article examine certains problèmes qui contribuent au manque d'utilisation des systèmes de Communication Augmentative et Alternative (abréviation anglaise: AAC). Il présente les résultats de deux ans de recherches sur l'usage de l'AAC par 93 adolescents et adultes souffrant de paralysie cérébrale et par 186 de leurs partenaires en communication. La collecte des données s'est faite au moyen de questionnaires, les interviews et notes prises sur le terrain. Les résultats montrent que parmi les obstacles à un usage effectif des systèmes d'AAC on peut citer leur manque de disponibilité et d'accessibilité le manque de connaissance de l'AAC de la part des partenaires en communication, l'insuffisance de la thérapie, le type de vocabulaire des systèmes AAC et la présence d'autres modes de communication à la disposition de l'usager.
In diesem Aufsatz werden einige Punkte erörtert, die zu mangelnden Einsatz unterstützender und alternativen Kommunikationssysteme (AAC = augmentative and alternative communication systems) beitragen. Es werden Ergebnisse aus einer zwei jährigen Studie präsentiert, die das Kommunikationsverhalter von 93 pubertären und erwachsenen AAC‐Benutzern mit spasticher Motorstörungen und 186 ihrer Kommunikationspartner untersuchte. Die Datenerhebungsmethoden bestanden aus Fragebögen, Gesprächer und Feldnotizen. Die Ergebnisse zeigen, daß Hindernisse gegen der effektiven Einsatz von AAC‐Systemen unter anderem darin bestehen, daß sie schwer erhältlich und schwer zugänglich sind, daß die Kommunikationspartner wenig darüber wissen, daß zu wenig Therapie geboten wird. Probleme entstehen auch durch das Vokabular, das in AAC‐Systemen und anderen Kommunikationsmodi verwendet werden, die dem AAC‐Benutzer zur Verfügung stehen.
The study examined the perspectives of augmentative and alternative communication (AAC) users and their 'formal' and 'informal' communication partners in relation to two areas of relevance to AAC: firstly, communication strategies, and secondly, advantages and disadvantages of AAC systems. With respect to communication strategies, it was found that formal communication partners thought that more vocabulary for communicating social purposes was actually available to AAC users and they were less aware of daily routines within day and residential environments. With respect to advantages and disadvantages, three main areas of concern emerged: the effect of the AAC system on the users' communication; features of AAC systems; and the effect of AAC on the users' quality of life. Both high- and low-technology AAC systems were seen as having advantages and disadvantages. This study demonstrates the important contribution to be made by AAC users in the provision of a new set of priorities based on their user experiences.
This study examined the cognitive demands of 2 selection techniques in augmentative and alternative communication (AAC), direct selection, and visual linear scanning, by determining the memory retrieval abilities of typically developing children when presented with fixed communication displays.
One hundred twenty typical children from kindergarten, 1st, and 3rd grades were randomly assigned to either a direct selection or visual linear scanning group. Memory retrieval was assessed through word span using Picture Communication Symbols (PCSs). Participants were presented various numbers and arrays of PCSs and asked to retrieve them by placing identical graphic symbols on fixed communication displays with grid layouts.
The results revealed that participants were able to retrieve more PCSs during direct selection than scanning. Additionally, 3rd-grade children retrieved more PCSs than kindergarten and 1st-grade children. An analysis on the type of errors during retrieval indicated that children were more successful at retrieving the correct PCSs than the designated location of those symbols on fixed communication displays.
AAC practitioners should consider using direct selection over scanning whenever possible and account for anticipatory monitoring and pulses when scanning is used in the service delivery of children with little or no functional speech. Also, researchers should continue to investigate AAC selection techniques in relationship to working memory resources.
Over the past 20 years, there have been many advances in the field of augmentative and alternative communication (AAC). Despite these advances, there are no data on the long-term outcomes of AAC interventions. This study evaluated the long-term outcomes for a group of seven young men (ages 19-23 years) who had used AAC systems for at least 15 years and were part of the first generation to have received AAC services since they were in preschool. Outcomes were measured in the following domains: (a) receptive language; (b) reading comprehension; (c) communicative interaction; (d) linguistic complexity; (e) functional communication; (f) educational and vocational achievement; (g) self-determination; and (h) quality of life. The outcomes for the group were diverse, with individual variations across all measures. Evaluation of the data raised many issues surrounding the challenges of outcomes measurement; these are discussed with suggestions for future research.
This study evaluated the communicative interaction skills of seven young men (ages 19-23 years) who had used AAC systems for at least 15 years. Turn-taking patterns, use of communicative functions, and linguistic complexity were analyzed. Current performance was compared to the participants' skills when they were preschoolers and participated in another study of interaction skills (Light, 1985; Light, Collier, & Parnes, 1985a,b,c). Results indicated that the turn distribution between partners was more equitable than it had been when the participants were preschoolers; five of the participants approached reciprocity in turn taking during at least two of the interactions observed. During interactions with their caregivers, the participants fulfilled most of their obligatory turns and more than half of their non-obligatory turns. The communicative functions used most frequently by the participants were confirmations/denials and provisions of information. Three of the participants demonstrated the ability to use complete and complex syntax and committed few errors in grammar, while the other four participants demonstrated many syntactic errors. The results are discussed with implications for clinical practice and directions for future research.
Augmentative and alternative communication (AAC) services for people with complex communication needs in New Zealand were investigated by surveying speech-language therapists. Two separate survey forms were developed and mailed to speech-language therapists who worked with either students or adults. In both survey forms, information was requested about (a) the provision of AAC intervention, (b) the professional needs of speech-language therapists providing AAC services, and (c) demographic information about students with complex communication needs. Low-tech communication options and sign language were the most commonly reported AAC strategies used by adults and students with complex communication needs. Students aged 5 – 10 years received the most AAC intervention. Cerebral palsy, intellectual disabilities and autism spectrum disorders were the most commonly reported etiologies of students who used AAC. A total of 86% of the respondents indicated a desire for further AAC information or training.
This synthesis aimed at determining the effectiveness of interventions in augmentative and alternative communication with particular emphasis on strategies that induce generalization and/or maintenance. Fifty single-subject experimental studies, including 232 comparisons of experimental phases, yielded quantitative outcome measures. Interventions were effective in terms of behavior change, generalization, and, although to a lesser degree, maintenance. Using predefined quality indicators to arrive at a best evidence data set, interventions remained effective in changing behavior, whereas generalization and maintenance data could not be interpreted due to the small n. This lack of sufficient best evidence data, along with the prominence of “train and hope” approaches, calls for training of clinical researchers in the breadth of available strategies and training as to how these strategies may be incorporated into treatment procedures. Directions for future research are presented based on identified research gaps and methodologic issues.
The present survey shows that in 1991–1992 there were 72 children, 37 adolescents, and 107 adults with cerebral palsy in Scotland who used some form of an augmentative and alternative communication (AAC) system. Among these, 61% were males and 39% were females. There has been a substantial increase in the use of AAC systems over the last 3 years and, indeed, over 50% of users have had their AAC systems no longer than 1 year. The AAC systems identified in this study were broadly divided into low-technology and high-technology systems. Although the data show a tremendous increase in the use of high-technology systems, the low-technology systems still accounted for more than 50% of all AAC systems used at present. There were a variety of methods of access both with low- and high-technology systems, indicating that a considerable proportion of users must rely on methods of access other than hand pointing. The majority of high-technology systems had voice output and all of the low-technology systems required listener interpretation (reading) of the message. It is important that, in addition to AAC systems, the users employed both their own idiosyncratic forms of nonverbal communication as well as other, more formalized, symbolic systems. Although the findings indicate that the great majority of users employed their AAC systems both in formal and informal situations, more investigations are necessary to establish why 22.2% of users employed their AAC systems only in formal (i.e., therapy and school) contexts.
Focus groups consisting of seven family members of children with disabilities provided information for identifying and understanding issues influencing augmentative and alternative communication (AAC) practices within a Mexican American community. The authors used a content analysis of the conversations to identify seven general perspectives: (a) Children understand the nonverbal communication of persons around them; (b) aided techniques are useful outside of the home; (c) families have great respect for professionals; (d) there is a need to focus on the human condition; (e) there is a preference for shared responsibility between the extended family members and professionals; (f) emphasis should be placed on the performance of simple tasks; and (g) devices in Spanish are needed. Emphasis is placed on qualitative research strategies that can provide cross-cultural awareness for practitioners providing AAC services.
Individuals with autism and other developmental disabilities often have severe communication impairment and are therefore candidates for augmentative and alternative communication (AAC). For these individuals, successful communication across a range of situations, settings, and communicative partners may depend on their type or mode of AAC. An aided AAC mode may be more effective under some circumstances, whereas an unaided mode may be more effective under other circumstances. This situation suggests the need to develop conditional use of multiple modes of AAC and to teach individuals when to use each mode. In this article we examine aspects of multimodal AAC and review instructional strategies for developing conditional use of aided and unaided AAC. This is followed by a case study involving an adolescent boy with developmental disability who acquired conditional use of aided and unaided AAC based on the presence or absence of an aided device. Results suggest that careful programming during intervention may promote conditional use of multiple modes of AAC.
This article provides a review of the empirical literature on a number of topics related to augmentative and alternative communication (AAC) and assistive technology as they have been used to support communication and learning in individuals with autism/PDD-NOS. The review is presented in six main topic areas: Assessment, Staff/ Family Training, Supports for Augmented Input, Supports for Augmented Input + Output, Supports for Augmented Output, and Assistive Technology for Communication and Learning. Finally, recommendations for future research are provided.
A demographic survey of speech pathologists was conducted in Australia to investigate the use of augmentative and alternative communication (AAC) with adults with acquired neurologic communication disabilities. Questionnaires were distributed to all speech pathologists who were members of the Australian Association of Speech and Hearing and listed themselves as working with an adult or mixed caseload. Questions related to the clinician's background, experience and interest in AAC, knowledge of and expertise with high and low technology systems, and factors related to successful outcomes for clients. Subjective data from the questionnaire were collated and the results and their implications are discussed.
PICTURE IT is a communication training package designed for carers of adults with severe and multiple disabilities. A trial of PICTURE IT was conducted with 16 carers of eight individuals with severe and multiple disabilities. The carers worked in pairs comprising a carer from the individual’s day setting and the other from the individual’s home. They participated in a 6‐month training course that involved attendance at six 1‐day training sessions, homework assignments and regular meetings with course leaders. Results from the administration of a series of assessments indicated limited changes in carers’ knowledge and attitudes about communication of people with significant communication impairment. Improved interactions were demonstrated by increased initiations and more appropriate responses to the individuals’ communication attempts by the carers. The individuals responded more frequently to the increased communication opportunities. The ability to formulate appropriate communication goals and to make some changes to the individual’s social environment were also noted. Changes to the individual’s physical environment were more anecdotal. Implications for the training of people working with individuals with severe intellectual disabilities and the usefulness of measurement tools used to evaluate project outcomes are discussed.
Two studies were conducted. In the first, a reliable and valid tool was developed for measuring the attitudes of elementary school-aged children in grades 1 to 5 toward their peers who use augmentative and alternative communication (AAC). In the second, this tool was used to determine the influence of the type of AAC technique used and the physical ability status of the AAC user on children's attitudes. No effects of AAC technique or physical status existed for children in grades 3 and 5. A significant interaction did exist, however, for children in grade 1. Developmental trends were also apparent. These results are discussed in terms of their implications regarding determinants and dimensions of children's attitudes toward peers who use AAC and in terms of their clinical implications.
This paper discusses methodologic issues in comparing the efficacy of two or more interventions in augmentative and alternative communication (AAC). The extant database of AAC interventions was searched for studies using comparative single-subject experimental designs. A brief content review of identified studies is presented. Next, methodologic issues related to the selected decision points in comparative evaluations are discussed and potential solutions are presented. This discussion and presentation of solutions are intended to assist clinical researchers in producing and consuming published comparative efficacy studies. Comparative investigations are posited as essential for the development of data-based recommendations about which interventions should be used to train specific individuals given certain communicative tasks and goals.
The influence of conversational phrase length on the attitudes of two groups of grade-schoolaged children (i.e., those familiar and unfamiliar with children with disabilities) was studied. Length did not influence the attitudes of familiar children but did influence the attitudes of unfamiliar children in grades 3 and 5. The unfamiliar children who saw a videotape of a child communicating with two- to four-word augmented messages had more positive attitude responses than did the children who saw a videotape of a child communicating with one-word augmented messages. Theoretical and clinical implications are discussed.
A study was conducted in Pennsylvania to determine the impact of augmentative and alternative communication (AAC) devices on families. Clinical experience and anecdotal reports suggest that families are important in achieving positive outcomes in AAC. Clearly, clinicians and educators need to understand how AAC devices affect not only the user but the entire family as well. The purpose of this study was to identify the impact on families and determine implications for intervention. A statewide survey was distributed to over 500 Pennsylvania families whose children had received AAC devices through the long-term equipment acquisition program of the Central Instructional Support Center, formerly known as the Pennsylvania Assistive Technology Center of Harrisburg, during the period of 1985 to 1996. Respondents reported the extent of the impact on users and family members from a parent's perspective. A total of 114 or 22% of the families responded to the survey. Families responded to 76 impact statements using a 5-point Likert scale. Items that received ratings of strongly agree and agree were combined and contrasted against those rated as disagree and strongly disagree. Those survey items for which over 50% of the parents responded either positively (strongly agree/agree) or negatively (disagree/strongly disagree) are highlighted. Implications for intervention and roles of professionals in working with families to promote positive AAC outcomes are discussed.
This article describes the results of three case studies of children diagnosed with developmental apraxia of speech (DAS) or suspected DAS. A multimodal augmentative and alternative communication (AAC) intervention approach using speech, gestures, manual signs, and various AAC aids was incorporated into each child's intervention plan. These included both lowtechnology aids (i.e., context-specific communication boards, remnant books, and symbol dictionaries) and high-technology aids (i.e., voice output communication aids and print output communication aids) in each child's intervention program. The AAC aids were designed to meet the unique communication needs of a preschooler, an elementary school-aged child, and a junior high school student. Previously, the children had been involved in a more traditional DAS intervention program primarily focusing on improving articulatory proficiency and supporting natural speech through sign language. The case studies describe how AAC aids and strategies successfully supplemented the child's natural speech and provided greater opportunities for facilitating language development, communicative competence, and academic achievement. Using AAC aids and strategies, the children had greater opportunities to initiate and maintain interactions as well as to repair communication breakdowns across various communication situations with both familiar and unfamiliar communication partners.
During the past 3 decades, the field of augmentative and alternative communication (AAC) has emerged as a major development for the benefit of individuals with little or no functional speech. This paper attempts to document the social and historic events that led to the emergence of the discipline of AAC and to identify some major milestones in its development. The paper outlines the trends and transitions that have occurred in the areas of aided and unaided communication, intervention, service delivery, consumer issues, and professional development. Although abundant information was only available about the course of development in a few countries, the authors have attempted to use available resources to present the major international events and developments that influenced the evolution of AAC from a North American perspective.
An evidence-based practice (EBP) approach to clinical and educational practice emphasizes the importance of integrating sound research evidence into the decision-making process. This paper provides a discussion of the relevance of EBP to the field of augmentative and alternative communication (AAC). Included is an examination of what is currently known about decision-making in AAC, as well as a brief history of EBP and its application in other fields. A definition of EBP in AAC is proposed and a schematic of the EBP process is described, including proposed design hierarchies of evidence. This process is then illustrated with a case example. Finally, key factors for the adoption of EBP in AAC are discussed.
A total of 971 speech pathologists from across Australia participated in a survey that investigated their knowledge of augmentative and alternative communication (AAC), their AAC practices, the AAC resources available to them, and their preferred format for further education. The results indicated that 98% of respondents had at least some knowledge of AAC and only 13% never recommended AAC in their practice. However, 29% had recommended a device they had never seen and 36% indicated that they would not recommend AAC for a client who was presymbolic. Access to resources appeared to be related to the location of respondents in relation to a capital city. Overall, there appeared to be a lack of AAC expertise within the profession in Australia. A lack of interest in obtaining further information on AAC and an unwillingness to enroll in further education highlighted the need for collaboration among the professional organization, training institutions, and employment bodies in ensuring adequate levels of knowledge and skills among speech pathologists.
Social validation is the process of assessing the social significance of the goals, methods, and outcomes of interventions. Despite the increasing emphasis on stakeholder accountability, social validation is far from commonplace in our journal, Augmentative and Alternative Communication(AAC). This paper proposes a conceptual framework to assist interventionists to socially validate interventions in AAC. The author draws from related fields and existing social validation efforts in AAC to arrive at this framework. This framework includes three main components: (a) Who: stakeholder perspectives (direct, indirect, immediate community, extended community), (b) What: intervention components (goals, methods, outcomes), and (c) How: methods (subjective evaluation, social comparison). Clinical examples and studies that exemplify the intersections of this framework are presented or selectively reviewed. Interventionists may find it useful to consult this framework in planning social validations of AAC interventions.
The majority of individuals with amyotrophic lateral sclerosis (ALS) benefit from augmentative and alternative communication (AAC) at some point during the disease process. Different AAC approaches are used, depending on functional status, communication purposes, familiarity of the communication partner, and the environment. Early, middle, and late stages of AAC intervention have been identified and reflect changes in an individual's functional status and subsequent changes in communication needs. Trends in the use of low- and high-technology AAC systems appear to correspond to these stages. In this article, case studies are used to demonstrate how individuals tend to rely on both unaided and low-technology AAC methods during the early stages of ALS, on high-technology systems during the middle stages of the disease, and again on unaided and low-technology AAC methods during the late stages of ALS.
The roles of school-based professionals serving students with augmentative and alternative communication (AAC) needs are changing in light of the inclusion movement. Focus group research methodology was used to investigate professional skills regarded by educational team members as necessary to support students who used AAC in general education classrooms. Educational teams consisted of speech-language pathologists, classroom teachers, inclusion support teachers, instructional assistants, and parents. All valued the ability to work collaboratively, provide access to the core curriculum, cultivate social supports, maintain and operate the AAC system, and create classroom structures to educate heterogeneous groups of students. Implications are discussed for AAC service delivery and the professional preparation of speech-language pathologists serving as members of AAC teams in inclusive classrooms.
Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alterna- tive) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communica- tion aids with people with autism?
Ethnographic methodologies were used to describe and interpret the experiences of four Mexican-American families of individuals with complex communication needs regarding the impact of using AAC devices. Findings suggest that the AAC devices were not perceived by family members to be useful for interactions with their children. Additionally, family members perceived that the fluency and complexity of the conversations with their children were not improved with the use of an AAC device because of language barriers and cultural preferences for speed and intimacy. All of the participating families valued and strongly supported the use of the device for educational purposes and in educational environments.
Seven individuals (aged 21 – 41 years) with cerebral palsy and who used speech generating augmentative and alternative communication (AAC) devices participated in a focus group discussion on the benefits and challenges of learning AAC technologies. The focus group was conducted on the Internet over a 9-week period. Five major themes emerged from the discussion: (a) selection of an AAC device; (b) knowledge and skills needed to use AAC technologies; (c) instruction and practice activities; (d) assessment of skill acquisition; and (e) advice to others. Participants reported that a consumer-driven assessment approach, which included the opportunity to discuss options with other individuals who used AAC, was key to the selection of an appropriate device. Participants identified a wide variety of important supports to learning how to make effective use of AAC technologies, including text and technological supports, individual exploration, learning from professionals, drill and practice, learning from peers, and opportunities for functional use in the community. For the participants, successful use of AAC technology was best assessed by functional use in the community.
Unlabelled:
This paper aims to provide a better understanding of the nature of functional communication activities so that assessment and treatment efforts are based on a theoretical framework and empirical data. Three sources of information are discussed. The first is the Activity/Participation dimensions of the World Health Organization's International Classification of Functioning, Disability, and Health. The second source is existing assessments of functional communication. The final source is data obtained from observational studies conducted in our research unit. The studies have observed the everyday communication of people with aphasia, people with Traumatic Brain Injury (TBI), and patients in hospital. The simplification of real-life communication in the WHO classification scheme, the variability of item sampling in existing assessments, and the complexity of communication observed in real-life settings has led to the conclusion that there are three levels of functional communication assessment: generic, population-specific, and individualized. Clinicians may choose which level suits their purpose. When clinicians routinely choose from a range of sophisticated functional assessments to inform their therapy, the seed that Martha Taylor Sarno planted and nourished for the past 30 years or more will truly flourish throughout the world of speech-language pathology.
Learning outcomes:
As a result of this activity, participants will (1) understand the theoretical framework and data base that motivates assessment and treatment of functional communication activities, (2) be able to discuss the World Health Organization's Classification of Functioning, Disability and Health and (3) gain information about functional assessment and observational sampling of real world communication activities across three levels.
In this article the authors discuss the use of augmentative and alternative communication (AAC) as used to enhance comprehension and expression of people with autism. A theoretical model for AAC assessment and intervention planning is presented. Application of the model is illustrated through a case report of a 6-year-old boy with autism who had severe expressive and receptive language impairments.
Speech pathology is a growth industry, but how this impacts on recruitment in Australia has not been explored in the research literature. The aim of this study was to investigate characteristics of advertised speech pathology positions and the ease with which they were filled, particularly for less attractive positions based in non-metropolitan locations or involving work with people with developmental disability. Contact persons for positions advertised mostly in newspapers over a 36week period were recruited. There were 108 positions advertised, with 89 contact people agreeing to participate in two telephone surveys, including one conducted approximately one month after application closing dates. Positions represented a range of employment sectors, with Grade 2 followed by Grade 1 positions most frequent. Most (75%) positions were filled, but for 55% at grades other than that advertised. There was no evidence that positions in non-metropolitan positions or those involving work with people with developmental disability were particularly difficult to fill, but they did attract relatively few applicants. The data did, however, point to a potential mismatch between successful applicants' level of experience and job requirements. Implications for support needs of isolated and inexperienced clinicians, and further research needs are discussed.
The International Classification of Functioning, Disability and Health (ICF) facilitates a wide range of research in speech-language pathology. In addition to framing the development of assessment tools and evaluating interventions, the ICF can also be used to evaluate concepts such as third party disability or environmental factors that prevent or facilitate communication accessibility. In this paper, a model proposed by Stucki and Grimby is used to describe research on a continuum from basic to professional, and from cell to society. We translate this model to speech-language pathology by using examples from our programme of research in the Communication Disability Centre. The model also allows the identification of broad gaps in speech-language pathology research to date. The paper concludes with recommendations for a research agenda for the ICF in speech-language pathology. In particular, it is argued that unless speech-language pathology researchers fully understand the constructs of the ICF as applied to communication disability, valid measures for professional practice research cannot be developed.
Speech-language pathologists (SLPs) working in early childhood intervention are expected to have knowledge and skills across a number of areas and to engage in evidence-based practice. We explored the knowledge and perceptions of SLPs working with young children within Australian early childhood settings about augmentative and alternative communication (AAC), evidence-based practice, and barriers to such practice. Fourteen clinicians participated in group or individual interviews. Thematic analysis of the transcripts of these discussions revealed that they had a broad view of AAC and its benefits. Their reported assessment and intervention approaches reflected best practice as documented in the literature. The exception was in the implementation of family-centred practice. Although the participants involved families in their children's intervention, many appeared to use a directive approach. There was also evidence of struggling with families' negative attitudes about the use of AAC. A major barrier for these clinicians in implementing AAC and best practice was limited time in light of the many demands and expectations. Despite some frustration, these participants were passionate about their work and belief in the benefits of AAC for young children with varied communication difficulties. The results suggest that many expectations placed on clinicians within early childhood intervention settings may fail to take into account the everyday demands on their time, in a context of varied resources and support.
This metadata relates to an electronic version of an article published in Augmentative and alternative communication, 2004, vol. 20, no. 4, pp. 194-208. Augmentative and alternative communication is available online at informaworldTM at http://www.tandf.co.uk/journals/titles/07434618.asp Anecdotal and research evidence suggest that professionals may not fully understand the perspectives of families of children who need or use AAC. The parents/carers of 11 children in Britain, who were in the early stages of using AAC, were recruited to take part in this study. Ethnographic interviewing was used to access rich descriptions of parents’ experiences and views about having a child who needs to use AAC. The interviews were transcribed verbatim and thematically analyzed. Analysis revealed three global themes: the child’s communication or interaction, wider societal issues, and parents’ views and experiences. One organizing theme, demands on parents, is discussed in greater depth. The findings are discussed with reference to previous research and the implications for professional practice are considered.
Few tools are available to assess the communication skills of adults with severe and multiple disabilities functioning at unintentional to early symbolic levels. An exception is the Triple C: Checklist of Communicative Competencies. In this study, aspects of support worker and clinician agreement, internal consistency and construct validity of a revised version of the Triple C were explored.
Triple C checklists were completed for 72 adults with severe intellectual disabilities (ID) by 118 support workers and stages were assigned by the researchers. Two support workers completed checklists for each of 68 adults with ID. Three researchers also conducted direct observations of 20 adults with ID.
The average support worker agreement for items across the five stages of the Triple C ranged from 81% to 87%; agreement for stage assignment based on first and second support worker checklists was moderate to high (k = 0.63). Internal consistency was high (KR20 = 0.97); the stages were found to tap one factor (accounting for approximately 74% of variance), interpreted to be unintentional to early symbolic communication. Agreements between stages based on researcher observations and support worker-completed checklists were 35% and 71% across first and second support workers.
The revised Triple C provides a reliable means of gathering data on which to determine the communication skills of adults with severe and multiple disabilities. The results support a collaborative use of the Triple C, such that a speech-language pathologist or other communication specialist works with a support worker to ensure understanding of the skills observed and development of appropriate intervention strategies.
This study investigated the effects of four different voice synthesizers on attitudes of nondisabled individuals toward an augmented communicator. Subjects (N = 284) viewed one of four videotapes depicting an adult VOCA (voice output communication aid) user having a conversation with a normal-speaking individual. The voice synthesizers used in the respective videotapes were ArticR65B male voice, Smoothtalker 3.0 male voice, RealVoice female, and DECtalk "Beautiful Betty." The Attitudes Toward Nonspeaking Persons Scale (ATNP) was used as the primary dependent variable. Results showed that attitudes toward the augmented communicator are more favorable in terms of evaluation and potential interaction when the synthetic voice is "easier to listen to." Gender-appropriate voice did not produce more favorable attitudes than gender-inappropriate voice. Implications of these findings for technological development of augmentative devices are discussed.
Although advancements in technology have expanded the use of augmentative and alternative communication (AAC) devices for children with disabilities, the use of AAC devices in school and home settings is often inconsistent. The purpose of this study was to examine family members' perceptions regarding the use of AAC devices. Factors that were perceived to affect student's use of AAC devices, family expectations, and benefits of AAC device use were explored.
Semistructured interviews were conducted with 6 family members (primary caregivers) of 7 youth who primarily use AAC devices to communicate in the school environment. The interviews were analyzed using cross-case analysis.
A variety of common perspectives emerged from the data, including four thematic categories: expectations, facilitators, barriers, and benefits of AAC device use.
Information gained in this investigation may be used to improve professional-family and teaming relationships and serve to benefit AAC users in school and home settings.
The purpose of this study was to document augmentative and alternative communication (AAC) acceptance and use patterns of 25 adults with traumatic brain injuries (TBI) who used either high- or low-tech AAC devices or strategies at some point during their recovery. Specifically, the purposes were to (a) document acceptance of AAC system recommendations, (b) identify AAC use patterns by persons who accepted the recommendation and for whom AAC intervention was implemented, (c) identify AAC access patterns for message formulation and encoding, and (d) document the kind of communicative functions that different AAC strategies supported. Information was gathered via a questionnaire from speech-language pathologists who provided AAC assessments and interventions at six different sites. The speech-language pathologists provided information about individuals with TBI from their clinics for whom they had recommended AAC. Results revealed that these adults generally accepted both high- and low-tech AAC recommendations and used their AAC systems for extended periods of time. Most utilized letter-by-letter message formulation strategies. When AAC technology was abandoned, it was usually a reflection of a loss of facilitator support rather than a rejection of the technology.
The Communication Aids Project (CAP) was a 4-year initiative by the UK Department for Education and Skills to provide communication equipment for students who were unable to speak in order to facilitate their access to education. Each child was given three goals or targets which were then evaluated after 6 months of provision of the communication aid.
We evaluated the targets of 60 children, between the ages of 3 and 18 years. Six months after receipt of equipment, the targets were mailed to the initial referrer who was requested to record whether the child had achieved, partially achieved or not achieved each target. Evidence and explanations of these outcomes were also requested. Data were analysed using descriptive statistics, and the explanations were grouped into common themes using a keyword analysis.
Sixty-three per cent of targets were not achieved and 36% were achieved. We investigated any possible associations to attempt to explain some of the possible reasons for the children's non-achievement of targets. Targets were grouped into operational, linguistic, social and academic, but there were no differences between the successes because of target type. Age may be an influence on success, but neither school placement or type of communication aid influenced success. The explanations for non-achievement highlighted the misunderstanding or interpreting of the underlying skills of the communication aid user as a potential cause.
The CAP raised the profile of children with Augmentative and Alternative Communication needs within education. However, only one-third of the targets of children using the equipment were achieved. The reasons for this include inappropriate provision of equipment, demands of the equipment, lack of appropriate support and targets. The major consequence, however, is the need for detailed assessment and provision appropriate to the individual needs of each child. There is a need for research into the best methods of providing communication aids and the support needed for successful communication.