Alternative Communication Systems Research Articles

Machine learning for predictive AAC: Improving speech and gesture-based communication systems

Augmentative and alternative communication (AAC) systems play a crucial role in supporting individuals with severe communication disabilities by providing accessible means of expression and engagement. However, many conventional AAC devices rely on manual input or basic predictive functions, which can limit communication efficiency and responsiveness. The application of machine learning (ML) to AAC offers new opportunities to enhance these systems, enabling them to provide faster, more accurate, and contextually relevant communication assistance. Advances in ML, particularly in predictive text, speech recognition, and gesture interpretation, allow AAC systems to adapt more intuitively to user needs, predicting intent based on usage patterns and multimodal data, such as voice and gestures. Current research highlights the potential of ML to address key gaps in AAC technology by creating more responsive, personalized systems that align with individual user behaviours. This study proposes a novel ML framework designed to integrate these capabilities, promising improvements in communication speed, user autonomy, and accuracy. By addressing the challenges and limitations of traditional AAC devices, this research aims to advance accessible communication solutions that empower users and improve quality of life.

Ethical Implications of AI-Driven AAC Systems: Ensuring Inclusivity and Equity in Assistive Technologies

This study investigates the ethical implications of Artificial Intelligence (AI) integration into Augmentative and Alternative Communication (AAC) systems, focusing on inclusivity, accessibility, and data privacy in assistive technologies. AI-driven AAC systems enhance communication for individuals with impairments by offering features like predictive text, speech recognition, and symbol-to-text translation. However, ethical challenges arise as these systems increasingly rely on sensitive user data, which could jeopardize privacy without strict safeguards. Furthermore, limitations in linguistic diversity within AI training data compromise inclusivity, potentially excluding users from varied cultural and linguistic backgrounds. Accessibility also remains an issue, as AI-driven AAC systems are often financially inaccessible for marginalized communities, exacerbating social inequities. Through a comprehensive analysis of current systems, including Proloquo2Go, Tobii Dynavox and Google’s Project Euphonia, this paper evaluates both the advancements and ethical shortcomings in AI-driven AAC technologies. The findings advocate for privacy-preserving AI practices, culturally diverse training datasets, and affordable AAC solutions to foster a more inclusive, accessible, and equitable digital communication environment.

Preparedness and Public Health: an Italian Local Health Authority plan for a mass gathering in 2023

Abstract Issue Mass gatherings represent an important Public Health challenge. The increased number of people present in a specific area puts local health systems under stress (i.e.workload of emergency services, environmental health and food safety) and at the same time it rises the risks of a potential mass casualty incident. Effective planning and disaster preparedness have to be achieved through collaboration among local health authorities(LHA) and other stakeholders (event planners, law enforcement, local transportation services). Problem Every year, for 3 days, the Italian Alpine troops gather in a different city to remember First World War fallen. During those days, the city centre transit is not allowed to car (in specific areas even to emergency vehicles).In May 2023 this event occurred in Udine, a city in the North East of Italy with almost 100.000 inhabitants. For that year at least 300.000 participants were expected. LHA had to reorganize preparing itself to manage a temporary quadrupled catchment area. Results In the previous months, local authorities met local health representatives and other stakeholders in order to define a single emergency response plan. For healthcare services it was decided to: institute first aid points within the city; reorganise patients’ emergency transport system; increase hospitals’ treatment capacity (beds, life support equipment); increase healthcare professional availability; empower drugstores (opening times, drugs procurement); strengthen human and animal health surveillances;activate alternative communication systems. During the event, LHA updated other authorities involved three times a day about hospital and emergency system situation. At the end of the event,a multiprofessional debriefing meeting was held and no critical situations were reported. Lessons Preparedness requires a great commitment in terms of resources and time, but it is confirmed to be essential to guarantee adequate assistance even in extraordinary conditions. Key messages • Mass gathering s events put under stress all the main areas of public health system. • Public health preparedness cannot be effective without a strong involvement of other public and private stakeholders.

Implications of Constraints on the Language of Emerging Aided Communicators and Intervention Decisions: A Tutorial

This tutorial offers speech-language pathologists (SLPs) an opportunity to consider the theoretical constructs of language acquisition theory and the multifactorial determinants that can impinge on the language acquisition process for children with complex communication needs. The system of constraints observed through the lens of optimality theory is discussed alongside intrinsic and extrinsic barriers associated with children who acquire their first language simultaneous to their introduction to aided augmentative and alternative communication (AAC) systems. This examination calls into question whether the language competence of emerging aided communicators may be masked by their ability to produce language that accurately represents their understanding of their native language. Specific to this question is whether vocabularies available to emerging aided communicators, opportunities to access aided language models, and intervention decisions made by SLPs may be implicated in the language acquisition and development process. Suggestions for clinical practice are offered as a means of mitigating adverse outcomes related to extrinsic constraints.

A proposal for a comprehensive protocol to develop and provide user-tailored assistive technology

BACKGROUND: Various models, frameworks, and systems have been established to support persons with disabilities in accessing assistive technology (AT). This paper highlights the commonalities and complementary aspects of these resources for the optimal selection of the most appropriate AT for a particular user. The selection process considers the user characteristics, abilities, needs, and environment. However, it does not provide a specific methodology for tailoring this technology to individual users. OBJECTIVE: This study reports on the experience of an interdisciplinary team formed in 2001 to develop user-tailored AT. The team established a systematic methodology, detailed as a step-by-step protocol. METHODS: A survey was conducted to validate the protocol’s effectiveness and assess the impact of user-tailored AT. Participants included users and stakeholders. Quantitative data were requested and complemented with qualitative information. RESULTS: Eighty-one participants were involved, with 92.6% reliant on augmentative and alternative communication (AAC) systems. A user-tailored AT was developed for this cohort, with a sustained usage rate of 56.4%. Quantitative analysis revealed a 40% reduction in reported difficulties, and Individually Prioritized Problem Assessment (IPPA) scores demonstrated a corresponding 40% improvement in overall effectiveness. The qualitative data corroborated these findings, highlighting positive user feedback and underlining the significance of family support and interdisciplinary collaboration. CONCLUSIONS: The proposed methodology offers a step-by-step protocol that complements current models and frameworks and aims to guide individuals and teams that develop user-tailored AT for persons with disabilities. Additionaly, this study reflects the importance of applying user-tailored AT to improve the quality of life of persons with disabilities.

Designing Cultural Adaptations of Caregiver-Implemented Interventions for Latinx Caregivers of Children Who Use Augmentative and Alternative Communication: Key Considerations.

Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families. Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers. This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.

Preliminary assessment of augmentative and alternative communication‐related stereotypy

AbstractImproving social communication and reducing challenging forms of restricted and repetitive behaviors (i.e., stereotypy) are often the focus of behavioral interventions for individuals with autism and other developmental disabilities. Interventions incorporating augmentative and alternative communication (AAC) systems are utilized to improve independent communication. However, using electronic AAC devices (e.g., iPads) may increase stereotypic behaviors (i.e., pressing the same icon on an AAC device two or more times within 2 s), which may impact the development and maintenance of communication skills. There is a shortage of research focusing on AAC‐related stereotypy, with only one study that includes a systematic assessment and treatment evaluation (Cook et al., 2017). The purpose of the current investigation was to conduct a functional analysis screening procedure that only included play and no‐interaction conditions to adequately assess the function of AAC‐related stereotypy. We sought to ask, how client‐specific modifications to functional assessment procedures affect the outcomes of functional assessments of AAC‐related stereotypy. Initial findings suggest that AAC‐related stereotypy is often automatically reinforced, but its occurrence can be sensitive to the presence/absence of specific environmental stimuli.

Shared Book Reading Experiences for Young Children Who Use Augmentative and Alternative Communication Systems

Shared Book Reading Experiences for Young Children Who Use Augmentative and Alternative Communication Systems

Assessment of communicative competence in adult patients with minimum response in intensive care units: A scoping review.

Few formal instruments exist to assess the communicative competence of patients hospitalized in intensive care units (ICUs). This can limit interventions by health professionals. To map the categories and instruments for assessing the communicative competence of adult patients with minimal response in ICUs. A scoping review was carried out following the Joanna Briggs Institute protocol between February and March 2022 and using the MEDLINE (PubMed), Scopus, Scielo, Business Source Complete (via EBSCOhost), Academic Search Complete (via EBSCOhost) and Web of Science databases, in Portuguese, English and Spanish. Eight studies met the inclusion criteria. The different communication and pain assessment protocols covered awareness, cognition, sensory capacity, motor capacity, language, speech and literacy. The present review offers a starting point for the construction of a formal assessment instrument to enable clinicians to implement an augmentative or alternative communication system (AACS) for the voluntary, independent and active participation of patients. What is already known on the subject Patients in ICUs are subject to various forms of treatment and continuous and intensive monitoring, compromising their capacity to communicate and actively participate (e.g., sharing symptoms and making decisions). Although there is some awareness of their disadvantage in such a regard, few protocols of assessment of communicative competence have been adapted to patients with a minimum response. What this paper adds to the existing knowledge The present review highlights different protocols for the assessment of communication and pain. They include the following categories: awareness, sensory capacity, auditory and visual acuity, positioning and motor capacity, language, speech, and literacy. The review offers a starting point for the construction of a formal assessment instrument encompassing the aforementioned categories, along with duly validated guidelines for its application. What are the potential or actual clinical implications of this work? Our formal assessment instrument takes into account the need to adapt to different patient profiles. It is hoped that it will provide speech therapists and other health professionals with the information required to implement an AACS in which patients participate actively.

A novel case of Takenouchi-Kosaki syndrome: Focus on hearing and language rehabilitation

Abstract Takenouchi-Kosaki syndrome (TKS) is a rare congenital condition, caused by a mutation in the cell division cycle 42 gene. This gene typo impacts various physiological processes, including hearing, hematopoiesis, immunologic functioning, and neurodevelopment. Despite the high prevalence of hearing impairment in TKS, existing literature has concentrated primarily on pharmacological treatments for hematoimmunologic diseases. This case report presents a novel case of TKS, highlighting the importance of audiological assessment and rehabilitating interventions in children with TKS. We discuss the case of a prematurely born boy who was diagnosed with TKS and who presented with profound bilateral sensorineural hearing loss and associated developmental delays. Following comprehensive audiological evaluation and intervention – including hearing aids, sign language, and alternative augmentative communication systems – a multidisciplinary approach was adopted to enhance his communicative abilities. From this study, it emerges the increasing need for tailored rehabilitation strategies for TKS patients to improve communication skills and overall quality of life. Further researches are needed to develop standardized protocols for assessment and treatment in patients with TKS.

내러티브 과제 유형에 따른 초등 학령기 아동의 어휘 사용 특성

Background and Objectives: The vocabulary of an augmentative and alternative communication (AAC) system should reflect the AAC user’s needs and desires for successful communication. The selection of vocabulary should be based on the vocabulary used by the child’s peers. This study aimed to examine vocabulary usage characteristics of children in lower primary grades according to the type of narrative task and to select core vocabulary for use in an AAC system. Methods: We collected utterances from 20 children in lower elementary school for four narrative tasks (personal experience story, storytelling, explanation, and procedural descriptions). Characteristics of high-frequency vocabulary, core vocabulary, and word class vocabulary by task were examined. Results: Of the total number of words, the total frequency of core words was 77.28% (n = 26,400). The total number of other words was 2,677 (10.98%). The most frequent words in the core vocabulary were ‘-e(-에)’, ‘-ga(-가)’, and ‘-neun(-는)’. Conclusion: The inclusion of high-frequency words and core vocabulary in the narrative task can be used as a basis for vocabulary selection for school-aged children who use AAC systems.

Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: multi-stakeholder perspectives.

Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training.

Speakezio Application as an Alternative and Augmentative Communication Media for Cerebral Palsy Students

The obstacle experienced by most children with cerebral palsy is limited communication skills. This is due to disorders of the speech organs or limitations in receptive and expressive language abilities experienced by children with cerebral palsy. So, when communicating, you need alternative augmentative media or communication systems (AAC) that can help you communicate. This research aims to develop the Speakezio application as AAC media. The method used is the RD (Research and Development) research method with a qualitative approach. This research involves one subject (single subject) which is used as a model in developing applications. This research obtained results in the form of the Speakezio application which was developed based on the results of assessments on target subjects and trials of the application as a media for the AAC system. The trial results show that this application can improve children's receptive and expressive language skills. Apart from that, this application can help communication between children and parents so that parents can more easily understand the messages conveyed by children.

OVERVIEW OF MODERN TECHNOLOGIES AND METHODS OF ORGANIZING THE INCLUSIVE EDUCATIONAL PROCESS FOR CHILDREN WITH DISABILITIES OF INTELLECTUAL DEVELOPMENT

The article highlights the importance of inclusion for ensuring the availability of education, raising the level of culture, tolerance of society, as well as the development of Ukraine as a democratic and legal state. It was emphasized that inclusive education provides more opportunities, ensures equality of all categories of the population. The works of scientists regarding the problems and prospects of inclusive education were analyzed, the technologies of teaching children with intellectual development disorders were considered. It has been established that the main result of the implementation of inclusive education is the involvement of people with special educational needs and with intellectual disabilities in particular, their education and training, whereas the effective means of implementing ideas are forms, methods and technologies aimed at taking individual characteristics into account. That is why it is expedient to use innovative technologies designed to ensure positive results in educational and correctional and developmental work. The author emphasized the importance of modern educational technologies and methods in working with children with intellectual disability and highlighted some of them. The technology «Creating a situation of success» aimed at relieving anxiety and relaxation is described; an alternative PECS communication system, which is proposed to eliminate communication problems was presented; TEASSN technology as an effective means of forming and developing understanding of other people; ABA therapy, which is a leading method of behavior correction; the «Human Doll» technique, designed for faster adaptation and socialization, understanding of personal feelings and emotions; computer technologies as a way of mastering technical means were described as well . Qualities that are necessary for successful pedagogy, principles, approaches, current directions of effective innovative activity in an inclusive environment are considered. The article concludes that the use of technology contributes to the modernization of the educational process, and also allows to obtain higher results in working with children with intellectual disabilities. It was emphasized that computer technologies are of great importance, as they have a positive impact on development of confidence and cognitive activity.

Resting state EEG assisted imagined vowel phonemes recognition by native and non-native speakers using brain connectivity measures.

Communication is challenging for disabled individuals, but with advancement of brain-computer interface (BCI) systems, alternative communication systems can be developed. Current BCI spellers, such as P300, SSVEP, and MI, have drawbacks like reliance on external stimuli or conversation irrelevant mental tasks. In contrast to these systems, Imagined speech based BCI systems rely on directly decoding the vowels/words user is thinking, making them more intuitive, user friendly and highly popular among Brain-Computer-Interface (BCI) researchers. However, more research needs to be conducted on how subject-specific characteristics such as mental state, age, handedness, nativeness and resting state activity affects the brain's output during imagined speech. In an overt speech, it is evident that native and non-native speakers' brains function differently. Therefore, this paper explores how nativeness to language affects EEG signals while imagining vowel phonemes, using brain-map analysis and scalogram and also investigates the inclusion of features extracted from resting state EEG with imagined state EEG. The Fourteen-channel EEG for Imagined Speech (FEIS) dataset was used to analyse the EEG signals recorded while imagining vowel phonemes for 16 subjects (nine native English and seven non-native Chinese). For the classification of vowel phonemes, different connectivity measures such as covariance, coherence, and Phase Synchronous Index-PSI were extracted and analysed using statistics based Multivariate Analysis of Variance (MANOVA) approach. Different fusion strategies (difference, concatenation, Common Spatial Pattern-CSP and Canonical Correlation Analysis-CCA) were carried out to incorporate resting state EEG connectivity measures with imagined state connectivity measures for enhancing the accuracy of imagined vowel phoneme recognition. Simulation results revealed that concatenating imagined state and rest state covariance and PSI features provided the maximum accuracy of 92.78% for native speakers and 94.07% for non-native speakers.

The Perceptions of Speech-language Pathologists toward Augmentative and Alternative Communication in China

The purpose of this study is to investigate the awareness and use of Augmentative and Alternative Communication (AAC) systems, as well as the related training received by speech therapists in China. A questionnaire survey was designed and distribute to speech therapists in hospitals, rehabilitation organizations and universities in China. A total of 50 valid questionnaires were returned. The results showed that 94% of the speech therapists had heard of various AAC tools. However, only 10% of the speech therapists considered themselves proficient in providing AAC assessment and intervention services. 30% of them had never received AAC training, 48% had attended seminars or lectures related to AAC but had not received systematic training, and 20% had only received less than 1 day of training. 80% of the speech therapists expressed a strong interest in participating in AAC training, and most of the speech therapists believed that the AAC tools helped improve their patients’ communication skills. This research provided insights into how Chinese speech therapists perceived AAC devices. However, the research also revealed a lack of training and experience with AAC in China.

A Randomized Controlled Trial Comparing Face-to-Face Versus Remote Delivery of Low-Tech Augmentative and Alternative Communication in Nonspeaking Children With Autism Spectrum Disorder.

Thirty percent of children diagnosed with autism spectrum disorder (ASD) do not develop spoken language. To provide a means of communication for this subset of the population, augmentative and alternative communication (AAC) systems are often utilized. Low-tech options have traditionally been delivered through the in-person modality. However, due to the COVID-19 pandemic, changes to service delivery models have been required. This randomized controlled trial was conducted in order to assess the efficacy of low-tech AAC delivered face-to-face versus remotely on communication outcomes in nonspeaking children with ASD. Both participant groups demonstrated similar gains in AAC proficiency, number and type of nonspeaking acts, and number of spoken communication acts. Remote delivery of low-tech AAC treatment is a viable alternative to face-to-face instruction.

Augmentative and alternative communication and deaf children with disabilities

ABSTRACT With recent data reporting approximately 40–50% of Deaf or hard of hearing (DHH) individuals as having a diability, complex communication needs are not uncommon within this population and can present unique communicative challenges. Implementing augmentative and alternative communication (AAC) systems can provide this population with an effective means of communication, assist them in developing specific language skills, and support them in effectively accessing their social environment. The purpose of this scoping review was to (a) identify the facilitators and barriers to AAC provision for this group of individuals, (b) discuss observable trends throughout studies, and (c) highlight areas for further research in AAC for this group of learners. This review compiles the results from seven studies within the last 10 years and focuses on the facilitators and barriers when implementing AAC systems for DHH individuals with a disability (DWD) and complex communication needs. The facilitators and barriers are categorised as interpersonal, intervention and assessment related. The trends that were identified included (a) the overall success of AAC, (b) the prevalence of speech-generating devices (SGD) use, (c) the lack of communication within interdisciplinary teams, (d) the lack of DHH-specific research, and (e) the lack of standardised methods for AAC selection.

Teachers’ perceptions on the role of augmentative and alternative communication systems

Resumen La escolarización de usuarios de sistemas aumentativos y/o alternativos de comunicación (SAAC) en escuelas ordinarias ha aumentado en los últimos años de acuerdo a los principios de la educación inclusiva. Las percepciones docentes sobre los SAAC repercuten considerablemente en las prácticas escolares y en la utilidad final de estos sistemas como herramienta comunicativa e inclusiva, facilitadora de la presencia, progreso y participación del alumnado usuario. El presente estudio persigue analizar estas percepciones y conocer si aspectos como la formación o la experiencia previa influyen en ellas. Para ello se realiza un análisis mediante el Cuestionario de Percepciones sobre la Inclusión del Alumnado usuario de SAAC en aulas ordinarias (PSIASAAC) con una muestra de 122 docentes de la Comunidad Valenciana. Los resultados muestran percepciones favorables a la inclusión de este alumnado. Sin embargo, se evidencian diferencias significativas entre los docentes con y sin formación y/o experiencia profesional en torno a la comunicación aumentativa y/o alternativa (CAA). La coincidencia con los hallazgos obtenidos por varios estudios previos llevados a cabo en diferentes contextos conduce a pensar que, si bien en líneas generales existen percepciones favorables a los estudiantes usuarios de SAAC, es necesario redoblar esfuerzos en la formación inicial y continua del profesorado y tratar de difundir experiencias prácticas exitosas en que el uso de SAAC contribuye a mejorar la inclusión educativa de los estudiantes usuarios.

Percepciones del profesorado sobre el papel de los sistemas aumentativos y alternativos de comunicación

Abstract The number of students using augmentative and alternative communication (AAC) systems in mainstream schools has increased in recent years, in line with the principles of inclusive education. Teacher perceptions of AAC significantly influence school practices and the overall effectiveness of these systems as a tool for communication and inclusion, which can enhance the presence, progress, and participation of students who use it. The present study seeks to analyze these perceptions and find out if aspects such as training or previous experience influence them. To this end, an analysis is conducted using the Spanish Questionnaire “Perceptions on the Inclusion of Students who use AAC in mainstream classrooms (PSIASAAC)” with a sample of 122 teachers from the Spanish Autonomous Community of Valencia. The results show favorable perceptions towards the inclusion of students who use AAC. However, there are notable differences between teachers with and without training and/or professional experience with AAC. The findings align with those of several previous studies conducted in different contexts. This leads us to believe that while there are generally positive perceptions of students who use AAC systems, it is important to intensify efforts in the initial and ongoing training of teachers. It is also crucial to share successful practical experiences demonstrating how the use of AAC systems contributes to improving the educational inclusion of the students who use it.