And Alternative Communication Systems Research Articles

Mobile Interaction for Augmentative and Alternative Communication: a Systematic Mapping

Verbal communication is essential for socialization, meaning construction and knowledge sharing in a society. When verbal communication does not occur naturally because of constraints in people’s and environments capabilities, it is necessary to design alternative means. Augmentative and Alternative Communication (AAC) aims to complement or replace speech to compensate difficulties of verbal expression. AAC systems can provide technological support for people with speech disorders, assisting in the inclusion, learning and sharing of experiences. This paper presents a systematic mapping of the literature to identify research initiatives regarding the use of mobile devices and AAC solutions. The search identified 1366 potentially eligible scientific articles published between 2006 and 2016, indexed by ACM, IEEE, Science Direct, and Springer databases and by the SBC Journal on Interactive Systems. From the retrieved papers, 99 were selected and categorized into themes of research interest: games, autism, usability, assistive technology, AAC, computer interfaces, interaction in mobile devices, education, among others. Most of papers (57 out of 99) presented some form of interaction via mobile devices, and 46 papers were related to assistive technology, from which 14 were related to AAC. The results offer an overview on the applied research on mobile devices for AAC, pointing out to opportunities and challenges in this research domain, with emphasis on the need to promoting the use and effective adoption of assistive technology.

Language-Model Assisted And Icon-based Communication Through a Brain Computer Interface With Different Presentation Paradigms.

Augmentative and alternative communication (AAC) is typically used by people with severe speech and physical disabilities (SSPI) and is one of the main application areas for brain computer interface (BCI) technology. The target population includes people with cerebral palsy (CP), amyotrophic lateral sclerosis (ALS) and locked-in-syndrome (LIS). Word-based AAC systems are mainly faster than letter-based counterparts and are usually supplemented by icons to aid the users. Those iconbased AAC systems that use binary signaling methods such as single click can convert into a single input BCI systems such as ERP detection. Matrix speller paradigm are typically used to help users identify their target icon on the screen, however it ties screen space to vocabulary size and navigation complexity, which may require users to make repetitive head, neck, or eye movements to visually locate their intended targets on the screen. Rapid serial visual presentation (RSVP) is an alternative interface that minimizes required movement by displaying all icons at a fix location, one at a time. IconMessenger is an icon-based BCI-AAC system that combines ERP signal detection with a unified framework for different presentation paradigms including RSVP, matrix speller row&column presentation (RCP) and matrix speller single character presentation (SCP). Icon- Messenger also take advantage of a unique sem-gram language model, incorporated tightly in the inference engine. In this study, we assess the ERP shape, classification accuracy and typing performance of different presentation paradigms on 10 healthy participants.

Augmentative and Alternative Communication use: family and professionals' perceptions of facilitators and barriers.

To investigate the facilitators and barriers involved in the use of Augmentative and Alternative Communication (AAC) by people with complex communication needs in social and therapeutic environments under family members/caregivers and speech-language pathologists (SLP) perceptions. This is a transversal quantitative and qualitative study with 20 family members/caregivers (FCG) and 20 SLP (SLPG). The data was collected by semistructured interviews with specific questionnaires for each group; recorded and transcribed for further analysis. Data was categorized in thematic axes, categories and subcategories, using recurrent and salient criteria. The two most important topics were: barriers and facilitators. Both groups indicate as barriers: high material cost, using other ways to communicate, family member as interpreter, language and cognitive deficits, acceptance of AAC for users and family members, lack of comprehension of AAC and family perceptions of AAC as speech suppress. As facilitators, both groups indicate the use of high technology, versatility and availability of AAC systems, family adherence and engagement, contextualized use of AAC outside of therapeutic contexts and the importance of therapeutic setting and team support. In this way, the main interlocutors in AAC implementation, professionals or family members can be barriers when they make it difficult for users to exercise their autonomy in communication, or facilitators when they encourage and use AAC with users.

Development of an electrooculogram-based human-computer interface using involuntary eye movement by spatially rotating sound for communication of locked-in patients

Individuals who have lost normal pathways for communication need augmentative and alternative communication (AAC) devices. In this study, we propose a new electrooculogram (EOG)-based human-computer interface (HCI) paradigm for AAC that does not require a user’s voluntary eye movement for binary yes/no communication by patients in locked-in state (LIS). The proposed HCI uses a horizontal EOG elicited by involuntary auditory oculogyric reflex, in response to a rotating sound source. In the proposed HCI paradigm, a user was asked to selectively attend to one of two sound sources rotating in directions opposite to each other, based on the user’s intention. The user’s intentions could then be recognised by quantifying EOGs. To validate its performance, a series of experiments was conducted with ten healthy subjects, and two patients with amyotrophic lateral sclerosis (ALS). The online experimental results exhibited high-classification accuracies of 94% in both healthy subjects and ALS patients in cases where decisions were made every six seconds. The ALS patients also participated in a practical yes/no communication experiment with 26 or 30 questions with known answers. The accuracy of the experiments with questionnaires was 94%, demonstrating that our paradigm could constitute an auxiliary AAC system for some LIS patients.

Comparison of Four Control Methods for a Five-Choice Assistive Technology.

Severe motor impairments can affect the ability to communicate. The ability to see has a decisive influence on the augmentative and alternative communication (AAC) systems available to the user. To better understand the initial impressions users have of AAC systems we asked naïve healthy participants to compare two visual (a visual P300 brain-computer interface (BCI) and an eye-tracker) and two non-visual systems (an auditory and a tactile P300 BCI). Eleven healthy participants performed 20 selections in a five choice task with each system. The visual P300 BCI used face stimuli, the auditory P300 BCI used Japanese Hiragana syllables and the tactile P300 BCI used a stimulator on the small left finger, middle left finger, right thumb, middle right finger and small right finger. The eye-tracker required a dwell time of 3 s on the target for selection. We calculated accuracies and information-transfer rates (ITRs) for each control method using the selection time that yielded the highest ITR and an accuracy above 70% for each system. Accuracies of 88% were achieved with the visual P300 BCI (4.8 s selection time, 20.9 bits/min), of 70% with the auditory BCI (19.9 s, 3.3 bits/min), of 71% with the tactile BCI (18 s, 3.4 bits/min) and of 100% with the eye-tracker (5.1 s, 28.2 bits/min). Performance between eye-tracker and visual BCI correlated strongly, correlation between tactile and auditory BCI performance was lower. Our data showed no advantage for either non-visual system in terms of ITR but a lower correlation of performance which suggests that choosing the system which suits a particular user is of higher importance for non-visual systems than visual systems.

Speech and language therapists’ views about AAC system acceptance by people with acquired communication disorders

Objective: Some adults with acquired communication disorders are faced with an inability to communicate coherently through verbal speech with their communication partners. Despite the fact that a variety of augmentative and alternative communication (AAC) aided systems is available to assist them in communicating, not all adults accept them. In Cyprus, there is scant research focusing on the factors that are linked to AAC system acceptance and abandonment. Methods: To address this gap, this research involves exploring the experiences of six speech and language therapists supporting adults with acquired communication disorders, who could benefit from the use of AAC systems. The main research question is: What are the factors that influence AAC system acceptance or abandonment? The method used for data collection, was semi-structured interviews and the transcripts were analyzed thematically.Results: The findings show that a number of factors influence the acceptance of AAC systems. These include the time since onset and acceptance of disability, the person’s attitude towards communication facilitators, and the perceptions about AAC systems. These findings indicate that the process of accepting an AAC system is multi-layered and these layers are interrelated.Conclusions: More research is warranted focusing directly on the experiences of people with acquired communication disorders and their communication partners.Implications for RehabilitationThe different myths about AAC systems need to be challenged such that awareness about their usefulness is raised.AAC specialists need to find ways to spread the message that AAC systems can actually support language, speech and communication through different dissemination avenues, such as articles in newspapers and talks through the media.

AAC services for multilingual populations: South African service provider perspectives

BackgroundIn South Africa, many persons in need of augmentative and alternative communication (AAC) come from multilingual backgrounds. There is as yet a limited evidence base (locally and internationally) for the provision of AAC services to multilingual populations. The perspectives of service providers can assist in gaining an understanding of current practices and the factors that influence these. AimsThe study aimed to obtain the perspectives of AAC service providers about practices in providing AAC systems and AAC intervention to clients from multilingual backgrounds. Methods & proceduresFifteen AAC service providers were purposefully chosen to participate in one of three focus groups – two face-to-face and one online focus group. Data from the face-to-face focus groups was transcribed verbatim. Thematic analysis was used to identify themes and subthemes in the data. Outcomes & resultsFour overarching themes were identified, namely (a) current practices, (b) factors influencing current practices, (c) service provides’ orientation towards different language options in AAC intervention, and (d) needs and desired developments regarding AAC technology. This paper reports on the first three themes. Service providers reported their practices to range from a focus on L1 exclusively, L2 exclusively, to a multilingual (sequential or simultaneous) approach. The South African language context, family language preferences and choices, service provider skill and knowledge, as well as AAC technology were identified as factors influencing their practices. Although many viewed access to multiple languages through AAC as positive, they also expressed concerns and reservations about providing multilingual AAC services. Conclusions & implicationsAlthough service providers in general saw the need to give clients from multilingual backgrounds access to multiple languages using AAC, this did not always translate into multilingual AAC practices. Both extrinsic factors (e.g. the lack of appropriate AAC devices, software and apps giving access to non-English languages) and intrinsic factors (service providers’ language competency and their beliefs about the cognitive demands of multilingual AAC systems) influenced their practices and choices. Appropriate AAC service delivery to multilingual populations in South Africa would require not only appropriate AAC technology developments, but also research evidence to establish the efficacy of multilingual AAC interventions for clients with a variety of characteristics.

Methodological advances, opportunities, and challenges in AAC research

Since its inception in 1985, the AAC journal has been publishing scientific articles related to the field of augmentative and alternative communication (AAC) that (a) report research concerning assessment, treatment, rehabilitation, and education of people who use or have the potential to use AAC systems and (b) cover theory, technology, and systems development relevant to AAC. The journal has maintained a consistent focus on the science and practice of AAC while also advancing in varied and impressive ways. Among the many developments apparent in AAC over the years, methodological advancements emerge as pivotal within the evolution of the science of AAC. This report examines the state of the science in behavioral AAC research with specific regard to changes and opportunities in research methodology. Illustrations from articles published in Volume 1 (1985) and Volume 32 (2016) of AAC are used in this paper to frame commentary on (a) contextual consideration in conducting AAC research, (b) types of research design, (c) considerations of procedural rigor, and (d) future methodological directions and resources. If the AAC field is to meet the goal of ensuring that all individuals with complex communication needs achieve their full potential, meaningful questions must be posed to address key problems, and rigorous scientific methods must be employed to answer these questions.

Effects of dynamic text in an AAC app on sight word reading for individuals with autism spectrum disorder

The purpose of this study was to investigate the effects of Transition to Literacy (T2L) software features (i.e., dynamic text and speech output upon selection of a graphic symbol) within a grid display in an augmentative and alternative communication (AAC) app, on the sight word reading skills of individuals with autism spectrum disorders (ASD) and complex communication needs. The study implemented a single-subject multiple probe research design across one set of three participants. The same design was utilized with an additional set of two participants. As part of the intervention, the participants were exposed to an AAC app with the T2L features during a highly structured matching task. With only limited exposure to the features, the five participants all demonstrated increased accuracy of identification of 12 targeted sight words. This study provides preliminary evidence that redesigning AAC apps to include the provision of dynamic text combined with speech output, can positively impact the sight-word reading of participants during a structured task. This adaptation in AAC system design could be used to complement literacy instruction and to potentially infuse components of literacy learning into daily communication.

Professional perceptions of the effectiveness of visual communication systems and their applications for functional communication interventions for individuals with Autism Spectrum Disorder

Background & aims This study investigated the perceptions of educational professionals in regard to the effectiveness of visual communication systems and their applications as a functional communication intervention for individuals with Autism Spectrum Disorder (ASD). Methods One hundred and one individuals from diverse educational backgrounds, school districts, educational services, and various states were surveyed for this study. All participants in this study served individuals with Autism Spectrum Disorder in a clinical and/or school setting. Results The study found that aided augmentative and alternative communication (AAC) systems were widely utilized, and participants perceived these systems as the most effective for individuals with Autism Spectrum Disorder. It also found that the use of low level tech aided augmentative communication systems such as Picture Exchange System and high level tech systems such as voice output systems that were strictly computer based, were dependent on the individual's abilities and needs. Finally, the study found that the use of photography and photo journaling techniques had positive outcomes for individuals diagnosed with Autism Spectrum Disorder and other students in the learning environment. Conclusions The results revealed that the overall consensus of educational professionals that serve individuals with ASD agreed that aided AAC systems were more effective methods to foster and enhance functional communication. In terms of effectiveness of the level of technology utilized within the system, it depends on the needs and abilities of the individual with ASD. Participants, however, did agree that photography and photo journaling techniques may provide positive attributes to all students and not only those diagnosed with ASD. Implications The ability to modify or alter the ways in which AAC systems are created and implemented may address the need to individualize the systems in terms of the needs and abilities of the individual with ASD. The results inform educational practices as they highlight that a majority of the professionals that participated in this study need further professional development with the understanding and application of these systems in order to better understand their benefits and what they have to offer individuals with ASD. The results also provided a lens through the professionals' experiences into the classrooms by providing information from professionals that utilize and implement these systems daily including their successes in aiding communication effectively.

Testing an AAC system that transforms pictograms into natural language with persons with cerebral palsy

ABSTRACTIn this article, we describe a compansion system that transforms the telegraphic language that comes from the use of pictogram-based augmentative and alternative communication (AAC) into natural language. The system was tested with four participants with severe cerebral palsy and ranging degrees of linguistic competence and intellectual disabilities. Participants had used pictogram-based AAC at least for the past 30 years each and presented a stable linguistic profile. During tests, which consisted of a total of 40 sessions, participants were able to learn new linguistic skills, such as the use of basic verb tenses, while using the compansion system, which proved a source of motivation. The system can be adapted to the linguistic competence of each person and required no learning curve during tests when none of its special features, like gender, number, verb tense, or sentence type modifiers, were used. Furthermore, qualitative and quantitative results showed a mean communication rate increase of 41.59%, compared to the same communication device without the compansion system, and an overall improvement in the communication experience when the output is in natural language. Tests were conducted in Catalan and Spanish.

AAC services in schools: a special educator’s perspective

Objectives: Students with intellectual and developmental disabilities often require augmentative and alternative communication (AAC) to fully meet their academic and social potential. AAC supports can be challenging for some educators to implement. This study sought to bring light to these challenges.Methods: A qualitative interview approach was utilized to examine the perspectives of 14 special education teachers who supported students using AAC systems. Participants described their experiences regarding providing AAC services.Results: Despite receiving some supports, the majority of teachers identified challenges, including inadequate training, lack of comprehensive assessment, inadequate preparation time, and inconsistent AAC implementation across team members.Conclusion:This study highlighted key factors that impacted AAC access and outcomes of students with complex communication needs. Practical implications and future research needed to enhance the communication outcomes of students were discussed.

Augmentative and alternative communication practices: a descriptive study of the perceptions of South African speech-language therapists

Speech-language therapists (SLTs) have direct contact with a wide variety of individuals who require augmentative and alternative communication (AAC) and they are therefore considered to have a primary role in the assessment, selection, and implementation of AAC symbols, techniques, aids, and strategies. Limited information is available with regard to SLTs’ practices in the field of AAC, and there is a particular paucity of information about developing country contexts such as South Africa. The aim of this study was to determine how South African SLTs perceive their current AAC practices. Specifically, the study aimed to investigate SLTs’ assessment and intervention practices, their choice and use of graphic symbols, and display layouts for aided AAC systems. An online survey was developed, using the Qualtrics Research Suite™ online survey software. The survey included open-ended questions (analyzed using thematic analysis) and closed questions (analyzed using descriptive statistics). The responses indicated that SLTs in South Africa currently use a limited variety of assessment and intervention approaches. The data suggest that current practices are informed by previous experience with various technologies and AAC systems and that the primary caseloads of SLTs do not appear to inform specific approaches to assessment and AAC implementation.

Augmentative and alternative communication (AAC) training provision for professionals in England

PurposeThe purpose of this paper is to document augmentative and alternative communication (AAC) training provision by clinical services in England.Design/methodology/approachA questionnaire was used to obtain the following information concerning AAC training provision; frequency, length, type, content and cost, trainee occupations and numbers, and future training priorities, and information concerning training providers – service type, geographical area.FindingsIn total, 98 clinical service training providers in England responded. Services commonly reported providing AAC training to speech and language therapists, teaching assistants and teachers. Training around “use of specific AAC products, systems and technology” and “introducing/awareness raising of AAC products” were rated as high priority for future training and were two of the three subject areas where services reported the highest percentage of training. Training was predominantly provided at a foundation (basic) level.Originality/valueThere is no consensus on the amount or content of AAC training which professionals in England must receive. Evidence suggests that AAC training for pre-qualification professionals is limited and this paper has identified variation in the amount and type of post-qualification AAC training. While knowledge concerning specific AAC systems is necessary, focussing training primarily on this area may not address critical gaps in knowledge. There is a need for specific recommendations regarding AAC training for professionals in this field, to ensure professionals can fully support people who use AAC.

Fusion of P300 and eye-tracker data for spelling using BCI2000

Objective. Various augmentative and alternative communication (AAC) devices have been developed in order to aid communication for individuals with communication disorders. Recently, there has been interest in combining EEG data and eye-gaze data with the goal of developing a hybrid (or ‘fused’) BCI (hBCI) AAC system. This work explores the effectiveness of a speller that fuses data from an eye-tracker and the P300 speller in order to create a hybrid P300 speller. Approach. This hybrid speller collects both eye-tracking and EEG data in parallel, and the user spells characters on the screen in the same way that they would if they were only using the P300 speller. Online and offline experiments were performed. The online experiments measured the performance of the speller for sixteen non-disabled participants, while the offline simulations were used to assess the robustness of the hybrid system. Main results. Online results showed that for fifteen non-disabled participants, using eye-gaze in a Bayesian framework with EEG data from the P300 speller improved accuracy (, , for estimated, medium and high variance configurations) and reduced the average number of flashes required to spell a character compared to the standard P300 speller that relies solely on EEG data (, , for estimated, medium and high variance configurations). Offline simulations indicate that the system provides more robust performance than a standalone eye gaze system. Significance. The results of this work on non-disabled participants shows the potential efficacy of hybrid P300 and eye-tracker speller. Further validation on the amyotrophic lateral sceloris population is needed to assess the benefit of this hybrid system.

Access to communication technology for children with cerebral palsy

Abstract Children with a diagnosis of cerebral palsy (CP) may experience difficulties in producing clear speech and may benefit from the use of augmentative and alternative communication (AAC) systems. Such systems may include the use of high-tech hardware and software to allow the selection of words or symbols, to be transmitted to a communication partner through digital or synthesised voice. Children whose movement disorders are more severe may experience difficulties using standard human interface devices such as a mouse and keyboard and may require modified or specialised solutions to access and control their AAC systems. This review discusses contemporary definitions of access and outlines considerations for assessment and selection of such systems. The International Classification of Functioning, Disability and Health (ICF) is suggested as a helpful framework for decision-making. Given the complex presentation of many children with CP, a multi-disciplinary approach is emphasised.

AAC technologies with visual scene displays and “just in time” programming and symbolic communication turns expressed by students with severe disability

ABSTRACTBackground: The current study investigated the impact of an intervention that included aided augmentative and alternative communication (AAC) technologies on the frequency of symbolic communication turns of school-age children, adolescents, and young adults with severe disability.Method: Nine students ages 8–20 were engaged in interactive activities using an aided AAC system with visual scene displays (VSDs; concepts embedded within a photograph of a naturally occurring event), and “just-in-time” (JIT) programming (the capability to add new contexts “on the fly”). Effectiveness was evaluated using a single subject multiple probe across participants design.Results: All participants demonstrated increases in symbolic communication turns upon introduction of the AAC technologies with VSDs using JIT technology.Conclusions: AAC with VSDs and JIT programming may be effective in increasing symbolic communication for students with severe developmental disability. The fast and easy creation of VSDs and hotspots to provide communication may be a valuable tool for interventionists.

The availability and accessibility of basic concept vocabulary in AAC software: a preliminary study

Core vocabulary lists obtained through the analyses of children’s utterances include a variety of basic concept words. Supporting young children who use augmentative and alternative communication (AAC) to develop their understanding and use of basic concepts is an area of practice that has important ramifications for successful communication in a classroom environment. This study examined the availability of basic concept words across eight frequently used, commercially available AAC language systems, iPad© applications, and symbol libraries used to create communication boards. The accessibility of basic concept words was subsequently examined using two AAC language page sets and two iPad applications. Results reveal that the availability of basic concept words represented within the different AAC language programs, iPad applications, and symbol libraries varied but was limited across programs. However, there is no significant difference in the accessibility of basic concept words across the language program page sets or iPad applications, generally because all of them require sophisticated motor and cognitive plans for access. These results suggest that educators who teach or program vocabulary in AAC systems need to be mindful of the importance of basic concept words in classroom settings and, when possible, enhance the availability and accessibility of these words to users of AAC.

Decoding of intended saccade direction in an oculomotor brain–computer interface

Objective. To date, invasive brain–computer interface (BCI) research has largely focused on replacing lost limb functions using signals from the hand/arm areas of motor cortex. However, the oculomotor system may be better suited to BCI applications involving rapid serial selection from spatial targets, such as choosing from a set of possible words displayed on a computer screen in an augmentative and alternative communication (AAC) application. Here we aimed to demonstrate the feasibility of a BCI utilizing the oculomotor system. Approach. We developed a chronic intracortical BCI in monkeys to decode intended saccadic eye movement direction using activity from multiple frontal cortical areas. Main results. Intended saccade direction could be decoded in real time with high accuracy, particularly at contralateral locations. Accurate decoding was evident even at the beginning of the BCI session; no extensive BCI experience was necessary. High-frequency (80–500 Hz) local field potential magnitude provided the best performance, even over spiking activity, thus simplifying future BCI applications. Most of the information came from the frontal and supplementary eye fields, with relatively little contribution from dorsolateral prefrontal cortex. Significance. Our results support the feasibility of high-accuracy intracortical oculomotor BCIs that require little or no practice to operate and may be ideally suited for ‘point and click’ computer operation as used in most current AAC systems.

New Car, Same Principles: Using Language Development Theories to Drive the Design of Supportive Augmentative and Alternative Communication System Interfaces

Innovations in technology have resulted in increased use of tablets, mobile devices, and applications as augmentative and alternative communication (AAC) systems for children with complex communication needs (CCN). Although research has been conducted on the specific characteristics of AAC technologies, many interfaces remain replications of prior communication devices with little consideration of the features of newer platforms. A greater concern is that these interfaces may not be based on empirical evidence or derived from key developmental language theories. As such, these interfaces may place additional demands on children with CCN instead of supporting their development of language content, form, and use. The purpose of this paper is to discuss potential interface supports for AAC systems that capitalize on current technologies and draw upon key tenets of developmental theory.