And Alternative Communication Strategies Research Articles

Alternative Augmentative Communication in paediatric dentistry: a mighty tool to amplify mother tongue's power.

The role of a child's mother tongue in shaping his/her identity and emotional development is crucial. In the context of paediatric dentistry, this principle should always be reminded. The child's right to effective communication, even when a language barrier exists, is a fundamental principle, as recently stated in the 'Rights from the Start' rights fact sheet. Preserving a child's native language in the dental setting, especially in the context of an increasingly diverse society with a significant number of refugee children, is essential. Augmentative and Alternative Communication (AAC) strategies can assist in bridging language gaps and improving treatment outcomes, blending with the traditional approaches used in paediatric dentistry. The article promotes flexibility, innovation, and empathy in paediatric dentistry to provide optimal care and ensure that every child's rights are respected. • The relationship with one's mother language plays a central role in children's growth and in the relationship they can develop with the world, "motherised" by the words of the caregiver. • The interaction between immigrant children from different linguistic and cultural backgrounds and dentists providing their care requires the integration of traditional paediatric dental techniques with AAC strategies that can compensate for deficient oral communication. • Dentists treating immigrant children should follow the suggestions proposed in this article to establish the best and most tailored paediatric setting for the child's specific needs.

“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.

Barriers and facilitators to accommodations in the workplace for adults who use augmentative and alternative communication (AAC): a systematic review

Workplace accommodations can reduce barriers to employment for people who use augmentative and alternative communication (AAC), however, the lack of accommodations continues to challenge participation in employment. This systematic review identified and analyzed barriers and facilitators to implementing workplace accommodations for adults (19 years and over) who use AAC. A systematic search of nine databases was conducted to identify relevant studies using the search terms “AAC” and “workplace accommodations” and variations of each term. Results were imported into Covidence. Seventeen studies met the inclusion criteria. Results were presented using the International Classification of Functioning, Disability, and Health (ICF) framework. The Oxford levels of evidence and Confidence in Evidence from Review of Qualitative Research (GRADE-CERQual) were used to assess the quality of the studies and confidence in findings, respectively. Environmental barriers related mainly to attitudes and technology, and personal barriers related to job qualifications, education, and work-related skills. A combination of facilitators such as personal strengths, access to technology, and supportive relationships contributed to successful implementation of accommodations. The findings of this review suggest that implementing workplace accommodations for adults who use AAC strategies is complex and further research is needed to advance practices and policies that support the implementation of workplace accommodations.

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.

Evaluation of the effectiveness of a training programme for nurses regarding augmentative and alternative communication with intubated patients using Kirkpatrick's model: A pilot study.

Communicating with conscious intubated patients who are unable to communicate verbally is one of the challenges faced by intensive care unit (ICU) nurses. The present study was conducted to evaluate the effectiveness of a training programme for nurses regarding augmentative and alternative communication (AAC) with intubated patients using Kirkpatrick's model. This study had a one-group, before-after, quasi-experimental design. Totally, 45 nurses working in ICUs participated in a blended training programme using AAC strategies to communicate with intubated patients. Their contribution was evaluated based on Kirkpatrick's model at four levels. The study data were collected using the "satisfaction and ease questionnaire," "observation checklist" and "communication knowledge test." Then, the data were analysed using the SPSS 22 software and p < 0.05 was considered statistically significant. Most participants were satisfied with the implementation of the programme. The nurses' mean score of communication knowledge increased after the intervention (p < 0.05). The results of evaluation of the third and fourth levels of Kirkpatrick's model also showed an increase in the success of communication, use of AAC, and satisfaction with and ease of communication (p < 0.001). Short-term and long-term effects of the blended training programme about AAC were investigated using Kirkpatrick's model. The results indicated the positive effect of the programme on the quality of the nurses' communication with intubated patients, their understanding of the patients' messages and meeting the patients' needs at a more desirable level. Thus, nurses and other staff are recommended to use this simple method of communication with patients to provide better services. In addition, further quantitative and qualitative studies are suggested to assess these communication strategies in other patients with impaired consciousness.

Using key-word signing to support learners in South African schools: a study of teachers’ perceptions

Key-word-signing (KWS), an unaided augmentative and alternative communication (AAC) strategy, has an important role to play in the education system. To date, limited research exists regarding the use of unaided AAC strategies in the school environment, especially in low- and middle-income countries. To address this research gap, the current study aimed to explore the perceptions of South African teachers toward the use of KWS strategies in the educational context. The study used a descriptive paper-based survey comprised of both closed and open-ended questions that was completed by 101 special education teachers. The sample was drawn from 10 public and independent schools for learners with special education needs in five urban school districts within South Africa’s Gauteng province. These schools accommodate students with a broad spectrum of disabilities and are likely to include learners with complex communication needs. The participants identified various factors and challenges that influenced the use of KWS within the education system (e.g., school culture, parents and other team members, community awareness, learner-related considerations, and training needs). These factors and challenges are assessed and discussed in relation to both local and international norms. Recommendations are made regarding expanding both an understanding and acceptance of unaided AAC strategies as a further means to support learning in the educational context.

Reproducibility and validity of the Functional Communication Classification System for young children with cerebral palsy.

To examine interrater agreement and validity of the Functional Communication Classification System (FCCS) for young children with cerebral palsy (CP) aged 2 or 3 years. Speech-language pathologist (SLP) and parent FCCS ratings for 31 children with CP (aged 2y, n=16; aged 3y, n=15; 18 males, 13 females) were examined for interrater agreement using a weighted Cohen's kappa statistic. Relationships between FCCS (SLP) ratings and: (1) concurrent validity with the Language Use Inventory, a standardized pragmatic assessment for children aged 18 to 47 months, (2) gross motor and fine motor function, (3) associated impairments (visual and intellectual), and (4) primary expressive communication mode were examined using Spearman's correlation coefficients. Almost perfect interrater agreement between SLP and parent FCCS ratings were found (kw =0.94). Correlations with FCCS (SLP) were excellent for pragmatic function (rs =-0.83,p<0.001), intellectual function (rs =0.89, p<0.001), and primary expressive communication mode (rs =0.92,p<0.001). Correlations were good for gross motor function (rs =0.72,p<0.001) and visual impairment (rs =0.70,p<0.001) and fair for fine motor function (rs =0.53,p<0.002). Analysis was unwarranted for epilepsy (n=1 out of 31) and hearing-associated impairments (n=0 out of 31). The FCCS has excellent interrater agreement and validity for communication classification of children with CP aged 2 or 3 years and is highly suitable for surveillance and research purposes. What this paper adds The Functional Communication Classification System (FCCS) is a valid instrument for children with cerebral palsy (CP) aged 2 or 3 years. Excellent agreement exists between speech-language pathologist and parent FCCS ratings. The FCCS has excellent correlation with intelligence, pragmatic function, and primary expressive mode. Stronger correlations with the Gross Motor Function Classification System and vision exist for children aged 2 or 3 years. Weaker correlations with manual ability exist when compared to older children with CP.

Technological Evolvement in AAC Modalities to Foster Communications of Verbally Challenged ASD Children: A Systematic Review

Augmentative and Alternative Communication (AAC) emerged as a combination of methods or strategies that constitute any device, such as Speech Generating Device (SGD), Program (mobile applications), Procedure (PECS, Picture Exchange Communication System), which enhances individual’s communication ability. Autism Spectrum Disorder (ASD) is a spectrum of comprehensive neurodevelopment disorder that leads to speech impairments, repetitive behavior, and social communication difficulties; therefore, it is imperative to underscore that at the core of all impediments are communication impairment. This article represents a systematic review of research initiatives that investigate multi-modal AAC strategies and functionality, features of mobile applications to reinforce communication and communal skills in verbally challenged ASD children because other researches are focused only on low or high-tech AAC or interventions to provide insights on ASD children respond to a particular approach. Following the PRISMA method, a total of 60 (January 2015 to October 2020) research articles were reviewed, indexed by Springer, Science Direct, Scopus, ACM, IEEE databases, and published in the AAC journal. The selected research articles are categorized into different themes where most of them focused on interactive mobile applications to improve emotional, social, learning, and overall communication skills in verbally challenged ASD children. This systematic review provides an outline of the paradigm shift in AAC modalities from PECS to Artificial Intelligence (AI), Machine Learning (ML), and Augmented Reality (AR) based applications. It opens up underline future opportunities to integrate intelligent analytics features in mobile applications to strengthen communication skills in verbally undermined ASD children.

Child-Parent-Provider Interactions of a Child With Complex Communication Needs in an Inpatient Rehabilitation Facility: A Pilot Study.

Purpose Children with complex medical needs often require extensive hospitalizations in the first years of life. Many of these children also experience complex communication needs and use augmentative and alternative communication (AAC) strategies to interact with health care staff. Unfortunately, suboptimal communication experiences have been reported among these children, their families, and hospital staff; however, no studies have described the patterns of interactions beyond measures of self-report. The purpose of this study was to describe child-parent-provider interaction patterns that occurred in an inpatient unit. Method Observational techniques were used to systematically describe the interactions of a 28-month-old child with complex communication needs, her parents, and 26 health care providers on an inpatient rehabilitation unit over 10 days. Results Results indicated that substantial variability in the child's routine occurred across days and providers. Interactions were generally short and occurred for only a small proportion of the child's waking hours. The child and her mother actively communicated to varying degrees across sessions, yet health care providers often dominated interactions. The child used multiple modes of communication in each interaction; however, no aided AAC systems were used despite availability. Conclusions Training is urgently required to equip health care providers to (a) incorporate the use of aided AAC strategies during inpatient interactions and (b) increase the active participation of both children with complex communication needs and their parents during these interactions. Supplemental Material https://doi.org/10.23641/asha.13345187.

Professional Training Needs for Using Augmentative and Alternative Communication in Inclusive Classrooms: Voices From Saudi Arabia

Research reveals that augmentative and alternative communication (AAC) can improve the communication competency of students who have complex communication needs. However, special educators often lack the competencies to effectively implement AAC strategies in the classroom. The present study aimed to explore the special educators’ level of need for professional training in AAC. Furthermore, it explored whether certain educator, student, and classroom characteristics were associated with the level of professional need for AAC training. In this descriptive study, 869 special educators in Saudi Arabia responded to a survey. The findings show that there is a high level of need for a wide variety of training areas in AAC. The findings indicate that participants differed significantly in their levels of need for professional AAC training depending on the participants’ previous training and experience, as well as the category of students taught, level of education, and grade level. Implications for how AAC training programs can be customized to effectively meet the diverse needs of educators and their students are discussed.

Revisiting the Role of Augmentative and Alternative Communication in Aphasia Rehabilitation.

Purpose The purpose of this article is to revisit the role of augmentative and alternative communication (AAC) in poststroke aphasia rehabilitation. The authors' intent is to provide a viewpoint that expands the use of AAC in poststroke aphasia rehabilitation. Specifically, we seek to clarify the role of AAC in restorative and participation approaches to aphasia rehabilitation while also considering the role of AAC in a comprehensive treatment plan. The authors support their viewpoint with citations from both the historic and contemporary literature on aphasia rehabilitation. Conclusions A thought-provoking viewpoint on the role of AAC in poststroke aphasia rehabilitation is proposed. More specifically, the versatility of AAC strategies is reviewed, with an emphasis on how AAC can be used to empower people with aphasia to fully participate and engage in life activities with increased independence. Moreover, we argue that AAC can be viewed as a dual-purpose tool that can simultaneously serve to drive intersystemic reorganization resulting in some improved language performance-and perhaps restoration of language function-while offering a communication alternative during inevitable anomic events.

Growing Up With Technology

The increasing integration of technology into the daily events and social interactions of our society present incredible opportunities for children with complex communication needs (CCN) who rely on augmentative and alternative communication (AAC) strategies. Children with CCN who utilize high-tech AAC options at an early age are essentially growing up with a technology that is inserted into interactions across multiple contexts for communication. An aided system can potentially create additional demands, serve a complementary role, or even be a platform to create a collaborative space for social interaction. This article discusses the impact of technology on contexts for communication and presents a progression from unaided AAC strategies to the use of aided systems for fostering expressive language skills and supporting participation. Augmentative and alternative communication strategies offer many possibilities in terms of access to communication; however, where a device is placed both physically and figuratively can make an important difference.

Communication Partner Training to Increase Interactive Communication Using Augmentative and Alternative Communication: A Case Study

Purpose The purpose of this clinical focus article was to assess the communication partner's (CP) perception regarding the effectiveness of a CP training model to support augmentative and alternative communication (AAC) use within a parent–adolescent dyad. Method This case study implements an adaptation of an 8-stage strategy instruction protocol for teaching aided language modeling across functional activities. Procedures for designing CP training to meet the specific needs of a particular CP and an individual using AAC (IUA) are offered. Pre- and posttraining questionnaires surveyed the CP's feelings and knowledge about using the AAC strategies and the IUA's AAC skill level. Results Quantitative and qualitative analyses of the CP's responses on the pre- and posttraining questionnaires revealed more confidence in supporting her son when using his device, increased knowledge of strategies to support AAC use, and increased understanding of the device operation. She also perceived that her son used his device more confidently and effectively in a variety of ways. Conclusion CP training that includes strategy instruction, along with practice and feedback, helps to increase the CP's and the IUA's understanding of the specific device and how to use it in more naturalistic, functional settings and situations. Since the CP's needs are similar across developmental and neurogenic groups, the direct strategy instruction described in this clinical focus article can be used by practicing clinicians working with pediatric or neurogenic populations to teach communication and operational skills. The results suggest that CP training should be included in treatment planning for speech-language pathologists working with individuals with complex communication needs who use AAC.

Review of AAC interventions in persons with dementia.

Communication is an important priority in dementia research. Communication strategies and scaffolds, specifically through augmentative and alternative communication (AAC), offer vital compensatory support for persons with dementia in an attempt to maintain the latter's quality of life and well-being through participation with others. To date, no research review has been published that synthesizes the current research of AAC in the field of dementia. To provide an overview of current AAC strategies and techniques used for supporting communication in dementia by surveying the literature base in a systematic manner, synthesizing the findings and highlighting trends and gaps. A multifaceted search strategy included nine electronic database searches, using specific keywords. Application of predefined selection criteria during screening procedures led to the inclusion of 39 studies. Data were extracted and studies synthesized according to communication partners; description of AAC strategies and techniques; outcome measures; and communication outcomes. This review shows that the majority of the research to date has focused on supporting the interactions of persons with dementia of the Alzheimer's type (DAT) using non-electronic memory and communication aids. Future research should focus on social participation and person-centred communication to optimize functional communication with AAC. Training programmes targeting dyadic interaction and supporting persons with dementia from diverse ethnic backgrounds are avenues for further research. Research trends and, more importantly, the gaps highlighted in this research review present speech-language therapists and researchers with a set of current priorities that are necessary for the advancement of the knowledge base.

Enhancing language in children who are deaf/hard-of-hearing using augmentative and alternative communication technology strategies

BackgroundDespite early identification and intervention, many children who are deaf/hard of hearing (D/HH) demonstrate significant gaps in language development which can directly impact social interactions. AimsThe objective of this pilot study was to determine whether integrating augmentative and alternative communication (AAC) core word language strategies into a speech-language therapy program for young children who are D/HH improves spoken language outcomes. MethodsEleven young children, median age 5 years 7 months (range 3y;11 m to 10y;8 m) with bilateral hearing loss were enrolled in a single-case experimental design and completed a 24-week intervention that incorporated high-tech AAC strategies into a traditional speech-language therapy model (technology-assisted language intervention or TALI). The goal of the TALI was to improve spoken language development in children who were D/HH. Language samples were collected throughout the study and pragmatic language was assessed pre and post intervention. ResultsAt the end of 24 weeks, children demonstrated a significant increase in their mean length of utterance, number of words spoken, and mean turn length according to language samples. Children also made gains in their pragmatic skills pre to post intervention. ConclusionsResults of this study suggest that using AAC core word language strategies delivered via iPad technology may support continued and rapid spoken language skill growth among young school-age children who are D/HH. By leveraging AAC technology, we are pioneering a structured and dynamic approach to language learning, building an effective foundation for concepts and grammar for children who are D/HH.

Augmentative and Alternative Communication Use by Individuals With Huntington's Disease: Benefits and Challenges of Implementation

Purpose The purpose of this article was to describe the complex symptoms associated with Huntington's disease (HD) and how they influence implementation of augmentative and alternative communication (AAC) services to address communication impairments. Three case studies with varied presentation, AAC recommendations, and overall outcomes are presented followed by a discussion on common challenges of AAC intervention for this population. Conclusion Providing AAC services to individuals with HD can be complicated due to variability in symptoms, access to services, funding, and communication partner support. It is important to understand HD and consider the complex presentation of symptoms that impact appropriate AAC strategies and intervention. Further research is needed to improve guidelines available to clinicians.

Augmentative and Alternative Communication for Speaking Autistic Adults: Overview and Recommendations.

What is augmentative and alternative communication?: Augmentative and alternative communication (AAC) describes the ways people communicate without, or in addition to, speech.What do we know about AAC for autistic adults who can speak?: Research on AAC and autism has focused on nonspeaking children. However, autistic adults who use AAC sometimes tell each other about AAC. This community knowledge includes reasons AAC is important, useful AAC strategies, and barriers to AAC use. This article talks about autistic community knowledge about AAC and then makes suggestions.Why is AAC important for autistic adults who can speak?: Autistic adults, including those who talk, may not always be able to meet all their communication needs with speech alone. Autistic people who use speech may experience intermittent, unreliable, and/or insufficient speech.What AAC strategies do speaking autistic adults use?: The three main ways that autistic adults report on using AAC include: (1)Free or low-cost tools that are not specific to AAC (e.g., online chat rooms, text messaging applications, or handwriting).(2)Mobile applications designed for communication support.(3)Signed languages such as American Sign Language.What are some common barriers to AAC use for speaking autistic adults?: Several barriers may prevent AAC use. These include the following: Knowledge of AAC optionsAttitudes about who AAC is useful forBeliefs that the use of AAC should be decreased if a person can speakCost of AAC devices and applications.What are our recommendations to autistic adults who might use AAC and their supporters?: Support autistics in defining their own communication needs, regardless of speech.Evaluate communication goals and match them with system features when making decisions about AAC.Prioritize all communication, not just speech.Explore a variety of options to support communication.Explore low- and no-cost options to support communication. What are some research questions that still need to be answered?: What communication strategies do autistic adults see as effective?What AAC strategies are being used, in what environments, and by whom?What prevents effective AAC use?How can AAC specialists and autistic adults best collaborate to promote and evaluate AAC use?How can communication supports be designed to better meet the needs of autistic adults?

Promoting positive communication environments: a service evaluation

PurposeThe purpose of this paper is to present an evaluation of a programme of training and support provided to staff, which aimed to encourage supported communication environments for people with learning disabilities.Design/methodology/approachTraining, monitoring and support for communication, specifically augmentative and alternative communication (AAC) strategies, was provided by speech and language therapy staff to two residential services over 46 weeks. Staff and service user communications were observed pre- and post-intervention.FindingsIn one provision there was an increase in service user initiations and the use of some AAC strategies by support staff. In the other provision there was no change in service user initiations and a decrease in the range of AAC strategies used. It appears that some forms for AAC remain challenging for staff to implement.Originality/valueThis evaluation explores ways of using specialist support services to improve communication environments for people with learning difficulties. Possible reasons for differences in the outcome of the intervention are discussed. Future research into the types of communication interactions experienced by people with learning disabilities across the range of communication styles may be useful so that support staff can be better helped to provide sustained and enriched communication environments.

Communication change in ALS: engaging people living with ALS and their partners in future research

Objective: To involve people living with amyotrophic lateral sclerosis (plwALS) in the scoping and identification of research priorities related to the changes in ALS communication including the use of augmentative and alternative communication (AAC).Methods: Two focus groups of plwALS at early and late stages of change to speech intelligibility were carried out as a patient and participant involvement exercise. The transcriptions of these groups were analyzed thematically and compared between groups.Results: Aspects of anticipation, preparation, adaptation and partnership were identified as key to dealing with communication change as a result of ALS. In particular the involvement of partners was clearly significant, as was the impact on them as well as the plwALS. PlwALS successfully contributed to focus groups and the process of group discussion about communication itself appeared constructive.Conclusions: Research and new interventions should focus further on how to support the partners of plwALS. Future research with plwALS should place AAC strategies and technology in the context of wider communication and investigate how best to support the anticipation, preparation and adaptation to communication change. Specific areas of research need relating to this support are suggested.IMPLICATIONS FOR REHABILITATIONPeople living with ALS (plwALS) are rarely involved in setting the research agenda in the areas of speech and augmentative and alternative communication (AAC).Enabling plwALS to contribute to research, even those with no speech, is feasible with appropriate support.Feedback indicates that communication change and AAC are experienced in different ways by plwALS.Research and intervention should focus on how to support the anticipation, preparation and adaptation to communication change for plwALS.

A modified multimodal communication treatment for individuals with traumatic brain injury

People living with the effects of traumatic brain injury (TBI) might use augmentative and alternative communication (AAC) due to cognitive-communication disabilities and/or co-occurring motor speech disorders. However, the most effective method for teaching people with TBI to use AAC strategies and resolve communication breakdowns is unknown. Prior research conducted with people with aphasia suggests an integrated multimodal treatment improved the use of AAC to resolve communication breakdowns. In this study, the researchers measured the effectiveness of a modified Multimodal Communication Treatment designed to increase communication breakdown resolution and use of AAC strategies by two individuals with TBI. A multiple baseline, single-case design was used to measure outcomes for the two participants who had motor speech disorders and cognitive-communication impairments. They completed four pre-treatment sessions, 20 treatment sessions, and three post-treatment sessions. Dependent variables included the number of AAC strategies produced during a modality probe task and two measures of communication breakdown resolution during a structured, functional task. Both participants increased use of AAC strategies during modality probes, but demonstrated minimal changes in communication breakdown resolution variables, potentially due to their impairments in executive function and memory. Results indicate that modifications to MCT may improve the use of AAC strategies for communication breakdown resolution for some people with TBI.