And Alternative Communication Devices Research Articles

Multilingualism and Augmentative and Alternative Communication: A Review of the Literature

Purpose: Individuals from culturally and linguistically diverse backgrounds who use augmentative and alternative communication (AAC) are often offered English-only AAC systems that do not meet their language needs. The aim of this review article was to describe the research published on multilingual AAC, define any emerging best practices, and highlight gaps in the literature that exist to ensure equal language access for all learners. Method: The authors reviewed the literature by searching relevant databases using a variety of search terms. Following our inclusionary and exclusionary criteria, 15 articles were yielded for coding and then patterns were reported. Results: The authors found that more than half of the included articles were expert opinion papers on AAC delivery, barriers to AAC and multilingualism, and code-switching using AAC. The included qualitative studies aimed to summarize the perceptions on AAC services—their impact, facilitating and limiting factors in communication, and the importance or relevance of using an AAC device. Only two quantitative studies were included. Conclusions: Practitioners have an obligation to support multilingual clients who use AAC across all languages they speak at school, at home, and in the community. Much of the literature supports encouraging multiple languages, but limited access to multilingual AAC systems are available. There is also a dire need for empirically based studies and more perspectives by way of interviews or surveys.

Speaking across cultures: decolonization and disability in a multilingual world

This qualitative study, inspired by a decolonizing Advaita (non-dualistic) perspective, examines the intricate relationship between language, literacy, and disability. It centers on my daughter Kalika, a child with Rett syndrome who is medically categorized as “nonverbal” and navigates communication through eye-tracking Augmentative and Alternative Communication (AAC) technology. This journey illustrates the challenges and triumphs of integrating the Bengali language and cultural identity within a diasporic context using AAC. The study employs Saraswati Puja, the celebration of the Hindu goddess of learning, as a metaphor to investigate disability in language learning, pushing the boundaries of traditional notions of literacy. It highlights an urgent need for AAC devices that are not only technologically adept but also culturally attuned and linguistically diverse. Ultimately, this research contributes to the dialogue on literacy and disability, advocating for a non-dual approach that values the entire spectrum of human communication and interaction.

Teacher perspectives on the use of augmentative and alternative communication systems for learners with complex communication needs

For learners with complex communication needs (CCN), teachers in special schools are encouraged to use a variety of communication techniques to help them participate in various classroom activities. Studies show limited data on the use of effective augmentative and alternative communication (AAC) strategies in special schools. The primary purpose of this study was to describe teacher perspectives on the use of AAC devices that they use in their classrooms in rural areas. We employed a qualitative methodology that included in-person interviews and focus groups. The focus group and face-to-face sessions each had 3 and 8 participants, respectively. Three main themes, namely modes of communication, training, and challenges and 12 subthemes were identified. We found that teachers employed pictures to improve communication of learners with CCN. We also discovered that since teachers didn’t use speech generating devices (SGD) frequently, they had trouble using them. The use of SGDs, one of the assistive technology tools that could be used to improve communication of learners with CCN, requires extensive teacher training, according to research. Further research is required to establish the efficacy on the use of AAC devices in special schools in rural areas.

Increasing linguistic and prelinguistic communication for social closeness during naturalistic AAC instruction with young children on the autism spectrum

This study examined the effects of an intervention package using high-tech augmentative and alternative communication (AAC) with Naturalistic Instruction (NI), time delay, and prompting during social routines for preschoolers on the autism spectrum. The AAC was a communication application on a tablet programmed with color photo representations of participants and communication partners engaged in social routines. The primary dependent measure was a linguistic communication turn on the AAC device completing the instructor’s cloze phrase related to the routine. A secondary dependent measure was prelinguistic communication –nonspecific vocalizations and smiling – within each turn of the routine. Results indicated that all communication types increased and maintained for all three participants with two participants meeting mastery criteria within the minimal number of sessions. These results are significant in providing additional evidence for the effectiveness of AAC intervention beyond teaching simple object requests and in teaching more socially meaningful communication to children on the autism spectrum. Additionally, this study supports the use of color photo representations to promote social interaction. Future research should continue to evaluate such interventions on a larger scale and include naturally occurring communication partners, such as siblings and peers.

Using longitudinal qualitative research to explore the experience of receiving and using augmentative and alternative communication.

People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. To inform the development of a patient-reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south-west of the UK. Four semi-structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross-case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. What is already known on this subject We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient-reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work? This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across.

Experiences of Parents Supporting Their Young Children Who Use Speech-Generating Devices

Despite evidence for the usefulness of augmentative and alternative communication (AAC) for young children with complex communication needs (CCN), several barriers prevent children from accessing AAC intervention. This qualitative study is focused on understanding the lived experiences of parents accessing and learning how to use speech-generating devices with their young children (3-6 years) with CCN. Findings generate insight into the similarities and differences across families’ experiences through several categories and themes: (a) foundational perspectives (determination and resilience; finding balance); (b) experiences getting access to an AAC device (initiating access; navigating barriers); (c) experiences using an AAC device (learning and navigating challenges; supporting their child’s communication at home and in the community; seeing progress); and (d) surrounding factors (family structure, informal supports, and demands; access to services and professional supports; the COVID-19 pandemic). Implications for practice and policy are discussed related to how to improve AAC access and intervention.

A speech-to-symbol app for supporting communication partner to model and improve vocabulary

In order to meet the communication needs of individuals who use Augmentative and Alternative Communication (AAC) devices, communication partners are often responsible for the programming of the AAC devices. However, the prolonged learning time and operational demands of AAC devices are often barriers to an efficient use of time during a therapy session. We developed a prototype app for iPad, called Speech-to-Symbol that decreases the programming time by finding pictures stored in the app using speech-to-text technology. We compared our solution to the TalkTablet app during AAC sessions with children with different communication disabilities. The aims of this study were 1) to compare the time to program both apps, 2) to identify the type of vocabulary used, and 3) to assess the usability of the two apps. Results showed that the reduced operational demands of our Speech-to-Symbols app allow communication partners to expose children to a larger and more diverse vocabulary. In addition, the communication partners gave our Speech-to-Symbols app a higher usability rating. Implications for clinical and educational settings and directions for future research are also discussed.

Promoting Simple and Engaging Brain-Computer Interface Designs for Children by Evaluating Contrasting Motion Techniques.

There is an increasing focus on using motion in augmentative and alternative communication (AAC) systems. In considering brain-computer interface access to AAC (BCI-AAC), motion may provide a simpler or more intuitive avenue for BCI-AAC control. Different motion techniques may be utilized in supporting competency with AAC devices including simple (e.g., zoom) and complex (behaviorally relevant animation) methods. However, how different pictorial symbol animation techniques impact BCI-AAC is unclear. Sixteen healthy children completed two experimental conditions. These conditions included highlighting of pictorial symbols via both functional (complex) and zoom (simple) animation to evaluate the effects of motion techniques on P300-based BCI-AAC signals and offline (predicted) BCI-AAC performance. Functional (complex) animation significantly increased attentional-related P200/P300 event-related potential (ERP) amplitudes in the parieto-occipital area. Zoom (simple) animation significantly decreased N400 latency. N400 ERP amplitude was significantly greater, and occurred significantly earlier, on the right versus left side for the functional animation condition within the parieto-occipital bin. N200 ERP latency was significantly reduced over the left hemisphere for the zoom condition in the central bin. As hypothesized, elicitation of all targeted ERP components supported offline (predicted) BCI-AAC performance being similar between conditions. Study findings provide continued support for the use of animation in BCI-AAC systems for children and highlight differences in neural and attentional processing between complex and simple animation techniques. https://doi.org/10.23641/asha.24085623.

Canadian manufacturer and technician perspectives on the design and use of augmentative and alternative communication technology

Purpose Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. Materials and Methods To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. Findings Three major themes resulted from analysis, which reflect MaT’s views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. Conclusions This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Language modeling using an augmentative and alternative communication device during virtual schooling: A single case study

Aided augmentative and alternative communication (AAC) modeling is an important approach to facilitating language learning for individuals with complex communication repertoires. This study examines the implementation of this approach during COVID-19 virtual schooling. Key implementation challenges are identified, along with implications for educational practice to facilitate language learning. We conducted a qualitative case study of a 5-year-old child with Rett syndrome, a rare neurological disorder, who used an eye-tracking AAC device. We collected and triangulated data using participant observation of three one-on-one story reading sessions involving the child, her caregiver, and her teacher during virtual schooling as well as a semi-structured interview with the teacher. The study identified key steps for successful language modeling during virtual sessions. These included: ensuring access to the device, promoting attention through gestural and verbal prompts, providing modeling of AAC symbols, confirming responses, providing feedback, using visual supports, a collaborative approach, and positive reinforcement. Our findings suggest these strategies can help facilitate effective language development for children using AAC devices in online schooling contexts. The virtual context presented significant barriers to the practice of aided AAC modeling. Active participation of caregivers and teacher–caregiver collaboration is essential for effective implementation of aided AAC modeling during such schooling.

Wearable augmentative and alternative communication (wAAC): a novel solution for people with complex communication needs

Communication is a vital skill of a human’s life. People with different types of disabilities may have Complex Communication Needs and may need a wearable device to help them to communicate. Augmentative and Alternative Communication (AAC) is a term which refers to the methods of facilitating or replacing people’s communication abilities. Brain–computer interfaces (BCI) and Eye-Gaze Technology (EGT) are two widely used access technologies in AAC devices. However, there are only a few studies that have investigated the utilisation of these technologies in a Virtual Reality (VR) or Augmented Reality (AR) environment. VR and AR are both modern technologies which provide immersive environments. In addition, the Mixed Reality (MR) environment combines virtual reality with real life and may offer extra benefits such as better immersion, better interaction, and more information. This paper proposed an MR-based wearable AAC device and compared the usability and acceptability between its Eye-Gaze (EG) and BCI interaction options. Eight neurotypical participants and two participants with cerebral palsy participated. The result showed high usability (accuracy = 93.30%, the information transfer rate was 8.55 selections per minutes) and acceptability (QUEST 2.0 = 4.30, NASA-TLX = 2.14) in the EG session. In contrast, the usability of the BCI system in the current design was questionable. This novel interaction method using Electroencephalogram signals is not sufficiently exploited at the moment, and more research is suggested in the future.

“Why don't they talk to our daughter?”: Eye-tracking AAC and medical communication in Rett syndrome

This investigation explores medical advocacy for Rett syndrome—a rare neurological disorder causing loss of speech and hand function—through the lens of eye-tracking augmentative and alternative communication (AAC) technology. We gathered data from five individuals with Rett syndrome and their caregivers, encompassing semi-structured virtual interviews, video analyses of AAC device usage, and examination of AAC pageset screenshots. The findings reveal diverse AAC strategies employed to express discomfort or illness and highlight caregivers' pivotal role in processing medical information. Notwishstanding challenges like cost, time limitations in medical contexts, training needs, and the lack of standardized AAC symptom descriptions, eye-tracking AAC technology has the potential to enhance symptom assessment, foster patient autonomy, and facilitate personalized medical care. This study illuminates the transformative power of this AAC technology in medical communication, showcasing its promise in tackling communication challenges and underscoring its capacity to enhance quality of life for those with Rett syndrome and similar health conditions.

Perceptions of families with adolescents utilizing augmentative and alternative communication technology: A qualitative approach

PurposeAlthough family involvement is critical to successful augmentative and alternative communication (AAC) device utilization, little is known about how families adapt to technology. The aim of this qualitative study was to explore parent-reported factors contributing to family adaptation among families with adolescents diagnosed with autism and/or Down syndrome (DS) utilizing AAC technology. This study describes families' experiences related to several interacting variables of the Resiliency Model, including demand, type, appraisal, resources, and problem-solving/coping, that helped shape the outcome of adaptation to AAC technology. Nurses are well-positioned in a variety of practice settings to assess vulnerable families and assist with identifying resources and navigating complex service systems. Design and methodsSemi-structured interviews were conducted with eight parents of adolescents with autism and/or DS (aged 13–18) recruited through online research registries, support organizations, and a social networking site. Recorded interviews were transcribed, and two independent reviewers coded and analyzed the data. Comparisons across all families' thematic summaries were examined for patterns. ResultsFive themes described aspects of family adaptation: Contextual Strains and Influences, Continuum of Person-First Approach, Opening Doors, Facilitators of Support, and Planning Is Key. ConclusionsFindings highlighted the challenges and demands associated with raising an adolescent using an AAC device, as well as the attributes, resources, perceptions, and strategies that either contributed or hindered family adaptation. Practice implicationsAAC technology is readily available for adolescents with developmental disabilities. It is essential that nurses assess key adaptation components to support families in integrating and using the technology.

A decision support system for selecting augmentative and alternative communication devices

The goal of this research is to improve access to services for patients in need of augmentative and alternative communication (AAC). The specific aim of this paper is to develop a decision-making model that evaluates an exhaustive list of AAC devices and recommends the best alternative(s) for the patient. The model maximises a best-fit function that considers the patient's disability profile and the capabilities of each device. Currently, there are multiple private and government companies that offer a large variety of devices targeting patients in need of AAC. However, the decision-making process of what device to try on the patient is largely based on the health professional's experience and familiarity with specific companies. The proposed decision-model has the capability of improving patient experience of care by reducing the assessment time required to find the best device.

임상간호사의 보완대체 의사소통에 대한 인식, 요구 및 사용 실태에 대한 조사연구

Purpose: The purpose of this study is to identify awareness and needs on augmentative and alternative communication (AAC) in critical care nurses. Methods: 316 critical care nurses from five hospitals participated in the survey. Data were collected using self-reported questionnaires consisting of AAC knowledge, needs, and experience via Google Forms from January to April 2022. The data were presented in frequency and percentage. Results: 28.9% of critical care nurses answered that they knew about AAC, indicating low awareness of AAC. Among critical care nurses, intensive care unit nurse showed high awareness of AAC. The most frequently encountered AAC method was written methods using paper, board, and whiteboard, which took more time compared to other methods. The nurses reported educational needs on AAC interventions and strategies as well as support for AAC devices. Conclusion: The results of this study showed that awareness on AAC in critical care nurses were low. Considering that communication problems can reduce patient safety and treatment satisfaction, it is suggested to improve awareness on ACC by providing educational intervention programs. In addition, institutional support for ACC is needed.

Using the ICF Framework to Assess Communicative Competence in Dyadic Communication among Children and Adolescents Who Use Augmentative and Alternative Communication Devices in Taiwan.

Augmentative and alternative communication (AAC) devices enable children and adolescents (CAD) with communication disorders to communicate competently and develop friendships through communicative competence (CC). Existing assessment tools are unable to indicate whether CAD aged 0 to 18 years would competently use the subsidized AAC devices provided by the Ministry of Health and Welfare in Taiwan. This study, thus, aimed to develop an assessment tool by using the International Classification of Functioning, Disability and Health (ICF) to measure CC in dyadic communication among CAD using AAC devices. Five speech-language pathologists (SLPs), five special education teachers, and four AAC experts (14 in total) selected codes relevant to the four domains of CC via the Delphi method. Next, they categorized the selected codes into one of the four domains of CC through a face-to-face expert panel. A total of 112 codes were listed in the tool and fully classified into the four domains of CC. Among these, seven codes were concurrently placed under two domains of CC. Consequently, this study developed an assessment tool by employing the ICF for children and youth core set using universal qualifiers to measure the relative levels of CC in dyadic communication among CAD who use AAC devices in their daily life.

Writing Blindly in Incomplete Locked-In Syndrome with A Custom-Made Switch-Operated Voice-Scanning Communicator—A Case Report

Locked-In Syndrome (LIS) is a rare neurological condition in which patients' ability to move, interact, and communicate is impaired despite their being conscious and awake. After assessing the patient's needs, we developed a customized device for an LIS patient, as the commercial augmentative and alternative communication (AAC) devices could not be used. A 51-year-old woman with incomplete LIS for 15 years came to our laboratory seeking a communication tool. After excluding the available AAC devices, a careful evaluation led to the creation of a customized device (hardware + software). Two years later, we assessed the patient's satisfaction with the device. A switch-operated voice-scanning communicator, which the patient could control by residual movement of her thumb without seeing the computer screen, was implemented, together with postural strategies. The user and her family were generally satisfied with the customized device, with a top rating for its effectiveness: it fit well the patient's communication needs. Using customized AAC and strategies provides greater opportunities for patients with LIS to resolve their communication problems. Moreover, listening to the patient's and family's needs can help increase the AAC's potential. The presented switch-operated voice-scanning communicator is available for free on request to the authors.

Aphasia and high-tech communication support: a survey of SLPs in USA and India

Purpose This survey was conducted to investigate American and Indian clinician’s preference and usage of high-tech communication supports (HTCS) for aphasia rehabilitation to identify factors in each country that support the use of HTCS for improving post-aphasia communicative outcomes. In this study, HTCS include speech-generating augmentative and alternative communication (AAC) devices with varying methods of access. Method The survey exploring clinically practicing speech-language pathologists’ (SLPs) training, assessment and aphasia rehabilitation practices using HTCS, was electronically distributed in both countries. The raw responses from the US SLPs (n = 56) and Indian SLPs (n = 43) were collected, segregated and then converted into percentages for all 41 survey questions. Results The responses from SLPs indicated higher (70%) and lower use (58%) of HTCS for aphasia in a developed country (USA) and developing country (India), respectively. In the US, identifiable factors for successful use of HTCS for aphasia rehabilitation were familiarity in procuring and programming the device, caregiver training and effectiveness in reducing the time of communicating through the device. In India, factors leading to successful inclusion of HTCS were AAC coursework and clinical training for clinicians and availability of HTCS at affordable prices for clients. Conclusion There is a considerable difference in the educational and clinical practice of AAC as SLPs in the US tend to have more clinical AAC experience with a stronger network for device dissemination in comparison to SLPs in India leading to higher usage of high-tech AAC for aphasia rehabilitation in a developed country. Implications for Rehabilitation For the SLPs, Improve exposure to programming AAC devices in developed countries and increase coursework, clinical training and exposure to programming AAC devices in developing countries. Enhance awareness about integrating high-tech AAC devices in intervention programs. Improve efficiency by minimizing the time in message creation on high-tech AAC device in developed countries. For the bioengineers, Develop AAC application interfaces in regional languages for easier usage in developing countries.

Multicultural considerations in augmentative and alternative communication

ABSTRACT Little is known about how well high-tech augmentative and alternative communication (AAC) systems accommodate language variation to meet the needs of people and families who are culturally and linguistically diverse. The purpose of this study was to investigate how high-tech AAC device manufacturers consider language variation and multilingualism in device design and language files, whether there is a difference in the modifications available on default language files on a dedicated AAC device as compared to communication applications on tablets, and the availability of these modifications. A coding schema was developed to assess features available that enabled user modification of default language files across four language domains: semantics, morphosyntax, phonology, and pragmatics. The results indicated that more changes were possible in semantics and phonology on default language files. There were not significant differences between language files offered on a dedicated AAC device or an application on a tablet. There were significant differences in the capabilities of the device to make modifications and in the ease of programming, but not in the resources provided to families. Based on these findings, it appears that device manufacturers have just begun to address the needs of families and users who are culturally and linguistically diverse.

Animation in AAC: Previous research, a sample of current availability in the United States, and future research potential

ABSTRACT Animation has been studied in the augmentative and alternative communication (AAC) literature regarding increasing transparency of symbols and decreasing operational demands of the interface design. This study investigated a sample of AAC devices to determine the presence and purpose of animation in the systems. We found that the majority of the animation found on AAC devices serve the function of providing feedback to the user. Future exploration of the use of animation in AAC through capitalizing on previous research, new technology, and as a method to foster linguistic and operational competence are considered. Clinical and research implications of these findings are discussed.