And Alternative Communication Users Research Articles

Including People Who Use Augmentative and Alternative Communication in Qualitative Research: Can You Hear Us?

People who use augmentative and alternative communication (AAC) are frequently excluded from research, yet their voices can significantly enhance the applicability, acceptability, and translation of qualitative research findings. Accessible and adapted research methods welcome and empower participants who use AAC, and enable meaningful involvement. In this article, we describe the collaborative development of a framework to conceptualise inclusive research and aspects of an accompanying inclusive research toolkit. The framework identifies balancing power as a critical factor, primarily achieved by ensuring that research methods and materials are accessible to people who use AAC. We propose that this is achieved through three interacting elements: collaboration with AAC users, skills and knowledge to achieve accessibility, and ensuring adequate time is available to achieve involvement. We identify five areas where applying these elements has impact for AAC users: recruiting AAC users, working with communication supporters, adapting research methods, securing ethics approval, and consent. In presenting the framework, we demonstrate how qualitative researchers can foster a research environment that values and actively includes AAC users, ultimately advancing the field towards more comprehensive and inclusive research practices. While our work is situated in the cerebral palsy and AAC communities, our proposed framework and toolkit can be applied by researchers seeking perspectives from individuals with communication disabilities more broadly. We have created a corresponding plain language video of this article as an additional means of optimising accessibility of the content. See supplemental material .

Nonverbal Communication through Expressive Objects

Augmentative and alternative communication (AAC) devices enable speech-based communication, but generating speech is not the only resource needed to have a successful conversation. Being able to signal one wishes to take a turn by raising a hand or providing some other cue is critical in securing a turn to speak. Experienced conversation partners know how to recognize the nonverbal communication an augmented communicator (AC) displays, but these same nonverbal gestures can be hard to interpret by people who meet an AC for the first time. Prior work has identified motion through robots and expressive objects as a modality that can support communication. In this work, we work closely with an AAC user to understand how motion through a physical expressive object can support their communication. We present our process and resulting lessons on the designed object and the co-design process.

Autistic Communication: A Survey of School-Based Professionals

Purpose: Access to communication is a basic human right, yet autistic adults have reported challenges fully and effectively expressing themselves throughout childhood. This may be due to the historical (and ongoing) focus and prioritization of speech skills as a barometer of communicative success. The result is a lack of support for other forms of communication for children who may speak but still require support to fully meet their communication needs. This study aimed to examine the knowledge, experience, and training of school-based professionals in order to better understand one possible barrier to early communication access for autistic children. Method: Using a participatory research method, we designed and administered a 35-question online survey. A total of 567 participants completed the survey, including 465 special educators, 71 speech-language pathologists (SLPs), and 31 other professionals. A segment of the survey data was analyzed in R. Comparisons between and within the largest groups (SLPs and special educators) were made with nonparametric statistics, including Fisher's exact, Wilcoxon signed-ranks, and Quade tests. Results: SLPs and special educators differed significantly on a variety of survey measures, including undergraduate coursework in augmentative and alternative communication (AAC) and autism, caseloads, and confidence related to working with autistic students and AAC users. Regardless of profession, most respondents reported completing what they considered to be an AAC assessment. Conclusions: Increasing school-based professionals' knowledge related to autism and AAC, as well as opportunities to improve skills, is critical to resolving access and opportunity barriers for autistic children who speak but may benefit from AAC. Partnering with autistic people to better understand autistic speech and careful collaboration among team members are recommended. Supplemental Material: https://doi.org/10.23641/asha.24299422

A proof-of-concept study for automatic speech recognition to transcribe AAC speakers’ speech from high-technology AAC systems

ABSTRACT Automatic speech recognition (ASR) is an emerging technology that has been used in recognizing non-typical speech of people with speech impairment and enhancing the language sample transcription process in communication sciences and disorders. However, the feasibility of using ASR for recognizing speech samples from high-tech Augmentative and Alternative Communication (AAC) systems has not been investigated. This proof-of-concept paper aims to investigate the feasibility of using AAC-ASR to transcribe language samples generated by high-tech AAC systems and compares the recognition accuracy of two published ASR models: CMU Sphinx and Google Speech-to-text. An AAC-ASR model was developed that transcribes simulated AAC speaker language samples. The AAC-ASR model’s word error rate (WER) was compared with those of CMU Sphinx and Google Speech-to-text. The WER of the AAC-ASR model outperformed (28.6%) compared with CMU Sphinx and Google when tested on the testing files (70.7% and 86.2% retrospectively). Our results demonstrate the feasibility of using the ASR model to automatically transcribe high-technology AAC-simulated language samples to support language sample analysis. Future steps will focus on developing the model with diverse AAC speech training datasets and understanding the speech patterns of individual AAC users to refine the AAC-ASR model.

Reflections on Building a Multi-Country AAC Implementation Guide.

Augmentative and Alternative Communication (AAC) implementation at any level is a multifaceted process that requires selection of relevant and appropriate systems to suit individual users who may have complex communication needs and other co-occurring difficulties. Careful and systematic action may be required to develop skills and abilities in the use of chosen technologies with suitable ongoing support within a wide range of settings. The wider milieu in which services are provided must also be considered in order to provide a firm foundation for capacity building alongside considerations for multilingual and multicultural factors. UNICEF with the Global Symbols team supported by local professionals working with AAC users, their families and carers set out to collaboratively provide an implementation guide based on their experiences in several Eastern European countries. The aim of the guide was to illustrate work already being undertaken in the area and to ensure the sharing of knowledge and resources where gaps were discovered. The result became a series of linked webpages in an online framework that covered practical aspects for the development of policies and procedures to support early intervention for those with severe speech, language and communication needs across countries of differing cultures and languages. The actual AAC implementation required ingenuity on all sides with translations for pictographic symbol and software adaptations with Cyrillic and Latin alphabets, new synthetic voices alongside deployment and capacity development. Considerable local support was forthcoming and captured with interviews by those working with AAC users as technology was introduced and outcomes measured. As the guide was completed several videos were shared publicly by carers with examples of AAC and assistive technology use. Policies and procedures were also shared in the form of tables, charts, symbol sets, communication boards and software that illustrated not only the occurrence of knowledge transfer and the use of open licenses, but also differences in strategies and the way they were adapted to suit the range of settings in the various countries.

Making a voice heard: evaluation of a new service delivery in augmentative and alternative communication through qualitative interviews with people without natural speech

ObjectiveDue to communication barriers, people without natural speech who use augmentative and alternative communication (AAC) are rarely interviewed about their healthcare needs, expectations, and experiences. This qualitative interview study aims to investigate how AAC users evaluate a new service delivery (nSD) in AAC care in Germany.ResultsWe conducted 8 semi-structured qualitative interviews with 8 AAC users. The results of the performed qualitative content analysis show a positive evaluation of the nSD among AAC users. Contextual factors were identified that seem to hinder the achievement of the intervention goals. These include caregivers' prejudice and inexperience with AAC and an unfavourable environment in which AAC is used.

Graduate Students' Perceived Preparedness and Confidence to Work With Individuals Who Use Augmentative and Alternative Communication.

Previous research shows that practicing speech-language pathologists do not feel confident working with augmentative and alternative communication (AAC) users. Studies examining the content of speech-language pathology graduate programs show that there has been an increase in AAC coursework and experiences offered during graduate training. What has not yet been determined is whether these requirements have influenced students' feelings of preparedness to work with AAC users. The purpose of this study was to examine speech-language pathology master's students' perceived preparedness and confidence to work with AAC users in relation to their educational experiences. A total of 726 graduate students completed a 25-item survey that solicited descriptions of their AAC training, coursework, and clinical experience, as well as their preparedness and confidence to work with AAC users after graduation. Analyses revealed statistically significant relationships between types and number of types of training experiences with feelings of preparedness and confidence. Results indicated that many participants did not feel prepared or confident to work with AAC users after graduation and that those with a greater variety of training experiences felt more prepared and confident to work with AAC users after graduation. The results enhance our understanding of the types and number of types of clinical experiences that might increase students' preparedness and confidence to work with AAC users.

The prayer experience of youngsters using augmentative and alternative communication in haredi (Jewish ultra-orthodox) educational settings

ABSTRACT This study examines the prayer experience of haredi (ultra-orthodox) youngsters who are unable to speak because of complex developmental motor limitations. The participants in the study are assisted by augmentative and alternative communication (AAC) in order to communicate with their environment. AAC allows children and adults with complex communication needs to communicate with their environment by means of communication systems adapted to their own personal needs.This study seeks to characterize the prayer experience of youngsters studying in haredi institutions who use AAC. The study seeks to answer the following questions: 1) What is the prayer experience of AAC youngsters in religious schools? 2) What are the challenges and difficulties faced in prayer by youngsters using AAC? 3) How do youngsters who use AAC deal with their difficulties with prayer? The importance of this study lies in the rich and complex view it will provide educators and therapists of the inner world of AAC users. Findings can enable therapists and educators working with AAC users to become familiar with how the youngsters cope with prayer in the home and educational environment and to make this a more productive experience for them.

전의도적 의사소통 단계의 뇌성마비 자녀의 의사소통 발달을 위한 AAC 부모교육 효과

Background and Objectives: In people with cerebral palsy in the pre-intentional stage, parents are the main communication partners and they need to understand the communication characteristics of their children and how to facilitate communication development with Augmenetaive and Alternative Communication(AAC). However, studies on AAC parental education for parents with children with cerebral palsy in the pre-intentional communication stage are limited. Therefore, this study aimed to conduct AAC parental education for parents with children with cerebral palsy in the pre-intentional communication stage and to verify its effect on the parents’ and children’s communication behavior Method: Parental education was conducted for mothers of children with cerebral palsy in the pre-intentional communication stage, and the results were analyzed by conducting pre and post-test before and after education. Results: After AAC parental education, the post-test results of communication behavior of mothers and children with disabilities were higher than those of the pre-test. Conclusion: First, AAC parental education had a positive effect on mother’s communication behavior and helped to develop confidence in her interaction with the children. Second, the improvement of the mothers’s communication intervention skills facilitated the communication behavior of children with disabilities who are AAC users. Third, the contents of various parental education programs facilitated the active participation of mothers and increased educational satisfaction.

"Finding Common Ground" - Impact of a Complex Intervention on Collaboration in Augmentative and Alternative Communication Care of People without Natural Speech.

PurposeMany care settings are characterized by collaboration between a variety of stakeholders. People without natural speech who rely on augmentative and alternative communication (AAC) are often strongly dependent on the involved stakeholders and collaboration among them. Since collaboration can be challenged by many barriers, this study examines the impact of a complex intervention on collaboration in AAC care.MethodsIn a quasi-experimental mixed methods intervention study which include AAC training, AAC therapy and case management, caregivers of AAC users were surveyed at 3 time points to assess collaboration and case management in the intervention versus comparison group. In addition, semi-structured focus group interviews were conducted with caregivers in the intervention group. Quantitative data were analyzed descriptively and by comparison of means. Qualitative data were analyzed using qualitative content analysis.ResultsThe Mann–Whitney U-test showed significantly better collaboration in the intervention group with stakeholders that are more actively involved in AAC care, such as schools (p=0.026) and residential or social facilities (p=0.010), but not with passive stakeholders such as health insurance companies. Most aspects of case management were rated significantly better in the intervention group (p<0.001). The focus group results show mainly positive changes in collaboration with the active stakeholders, such as more commitment and openness toward AAC.ConclusionThe results show a positive impact of the intervention on the collaboration between stakeholders involved in AAC care – especially with active stakeholders. In particular, the organization of care and the accompanying case management by the AAC consultation centers seem to positively affect collaboration.

Telehealth experiences of providers and patients who use augmentative and alternative communication.

We explore the telehealth experiences of adults who use augmentative and alternative communication (AAC) and clinicians who work with people using AAC. We conducted semistructured, online interviews with 6 adults who use AAC and 8 clinicians who provide telehealth services to people who use AAC between July and September 2020. Participants were located in the United States and the United Kingdom. All participants had engaged in 2 or more telehealth visits in the past 6 months. We used an inductive, thematic approach to analyze the interview data. Our findings reveal that (1) telehealth is an essential service, (2) technology causes barriers, (3) policies meant to protect actually inhibit, and (4) remote monitoring devices have the potential to mitigate risks. Telehealth systems created for persons without disabilities do not provide equitable access to everyone. Telehealth should be flexible enough to allow patients to use the communication modality that best meets their needs. We suggest that healthcare systems think of the healthcare ecosystem as one which includes a variety of telehealth options in addition to traditional in-person clinical visits. The benefits of telehealth for people who use AAC are substantial and should be an option for ongoing health care. However, the accessibility of telehealth technologies needs to be improved. Designers should view telehealth as part of a broad healthcare ecosystem, which includes in-person, telehealth, and remote health monitoring technologies. Designers should also include AAC users in the design and development process. Telehealth policies should encourage multimodality access to health care and address funding concerns.

Sensitivity to Communication Partners During Naturalistic AAC Conversations in Cantonese Chinese.

Previous studies have shown that graphic-based augmentative and alternative communication (AAC) output tend to be short and simple in structure with non-canonical word order, and that AAC users may show differences when communicating with peers compared to professionals such as speech therapists (STs). However, there was a lack of report for graphic-based AAC in the Chinese context, and the effect of communication partners had not been investigated systematically. In this study with 34 AAC users and 10 STs, we reported common and distinct features of free conversations in Cantonese graphic-based AAC, relative to AAC in other languages. We also found that AAC users were sensitive to different types of communication partners. In particular, when conversing with peers, AAC users produced long messages with equal proportion of questions and responses, which suggested active and bi-directional exchanges. In conversations with STs, AAC users showed high diversity in expressive vocabulary, indicating access to more semantic concepts. Results suggested that the base language and the communication partner are both influential factors that should be considered in studies of graphic-based AAC. The mobile AAC system facilitated free conversations in users with complex communication needs, affording an additional channel for social participation.

Thinking without speaking: Neuropsychological testing with individuals who have communication impairments

ABSTRACT Purpose Cognitive ability may be masked by communication impairments. This study aimed to assess cognitive functioning using binary choice (i.e., yes/no) neuropsychological tests in patients with communication impairments. Four participants underwent neuropsychological testing. Two participants were in the minimally conscious state (MCS), one participant had locked-in syndrome and was an alternative communication user, and one participant was an augmentative communication user. There was better performance in all cognitive domains for the augmentative and alternative communication (AAC) users (who performed like the non-communication impaired normative data) compared to the MCS participants. However, using established yes/no communication methods, MCS participants performed above chance on a measure of memory and performance on measures of auditory comprehension was variable. Auditory comprehension appeared to be more influenced by working memory demands for the MCS participants than for the AAC users. For emotional functioning, the AAC users endorsed lower mood compared to the MCS participants. The results support the need to assess cognition, communication, as well as capacity in individuals with communication impairments with the consultation of a neuropsychologist and a speech-language pathologist.

“Everyone Deserves AAC”: Preliminary Study of the Experiences of Speaking Autistic Adults Who Use Augmentative and Alternative Communication

Purpose Autistic adults use a variety of communication methods, including both speech and augmentative and alternative communication (AAC); however, there has been limited, if any, academic research in this area. The purpose of this study was to examine the experiences of speaking autistic adults who use AAC. Method Using a participatory research method, we completed an online survey that included five demographic questions and 29 open-ended questions related to communication choice, communication access, attitudes, and recommendations. Six autistic adults who use AAC participated. The data were analyzed with thematic analysis using an inductive approach at the semantic level. Results Participants reported identifying AAC as a communication choice as adults, after using speech during childhood. They described how forced communication choices have greatly impacted their lives, both historically and today, and reported on the successes they experience when communication autonomy is promoted within a supportive environment. Participants further described what impacts their in-the-moment decision making related to use of different communication methods. Finally, they discussed the importance of normalizing AAC use and disability in general and provided recommendations for other AAC users, families, and professionals. Conclusions Historically, AAC intervention was considered a “last resort” for children who did not develop functional speech. Speaking autistic adults encourage families, professionals, and society to promote and accept all communication as equal—ensuring opportunities for all children to develop full and rich communication without delay and without stigma.

Deep Neural Network-based Speaker-Aware Information Logging (SAIL) for Augmentative and Alternative Communication

People with complex communication needs can use a high-technology Augmentative and Alternative Communication (AAC) device to communicate with others. Currently, researchers and clinicians often use data logging from high-tech AAC devices to analyze AAC user performance. However, existing automated data logging systems cannot differentiate the authorship of the data log when more than one user accesses the device. This issue reduces the validity of the data logs and increases the difficulties of performance analysis. Therefore, this paper presents a solution using a deep neural network-based visual analysis approach to process videos to detect different AAC users in practice sessions. This approach has significant potential to improve the validity of data logs and ultimately to enhance AAC outcome measures.

Collaboration between stakeholders involved in augmentative and alternative communication (AAC) care of people without natural speech

ABSTRACT Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration.

Talk Like Me: Supporting Students Who Are African American Using Augmentative and Alternative Communication

Purpose With the changing demographics, speech-language pathologists are increasingly supporting diverse caseloads. Research and discussion within the profession often look at culturally and linguistically diverse populations as a monolith and may provide heightened focus on the complexity of bi/multilingual communicators who require augmentative and alternative communication (AAC); however, an exclusive focus on African Americans who use AAC is limited within the published body of research. This article aims to open discussion around the unique and specific supports needed to provide ethical services for African Americans who require AAC systems. Method A review of published literature across disciplines, including communication disorders, health and medicine, education, and social sciences across the last two decades was synergized with analysis of government and professional organization data sets, and professional reflection based upon clinical experience. Results Speech-language pathologists developing a practice embedded with cultural competence and client advocacy will support not only just the AAC user but also their family as primary communication partners. Analysis of the institutional barriers, and how to mitigate the impact, will lead the clinician to culturally responsive intervention strategies. Conclusions It is imperative to use culturally responsive techniques from the stage of referral through the assessment and into intervention. Clinicians engaging in a culturally responsive practice will help reduce institutional barriers for African Americans using AAC, while also increasing the participation and engagement of both the person who uses AAC and their family communication partners. Evidence-based practices already being implemented for supporting African Americans with communication disorders can be extrapolated to support the specific subgroup who require AAC for functional communication.

Augmentative and Alternative Communication (AAC) Use Among Patients Followed by a Multidisciplinary Cleft and Craniofacial Team.

To establish preliminary data describing the number of patients who visit a multidisciplinary cleft and craniofacial team who use augmentative and alternative communication (AAC) supports. This retrospective study consisted of chart reviews for all patients who visited a single site's multidisciplinary cleft and craniofacial team for 1 calendar year. A single multidisciplinary craniofacial team at a tertiary teaching hospital. Four hundred sixty-four patients met the inclusion criteria for this study. Of these, 59.9% (n = 278) were male and 40.1% (n = 186) were female. Of the sample population, 6.9% (n = 32) were AAC users as they received AAC intervention in a therapeutic context, while 93.1% (n = 432) were not. The AAC group had a mean age of 5.1 years (standard deviation [SD]: 4.2) and was 68.8% (n = 22) male. The non-AAC group had a mean age of 6.3 (SD: 4.9) and was 59.3% (n = 256) male. Within the AAC group, 40.6% (n = 13) were found to have an identified syndromic diagnosis in comparison to 17.6% (n = 76) of the non-AAC group (P = .003). This is the first study to report the prevalence of AAC use among patients in the care of multidisciplinary cleft and craniofacial teams. Our findings suggest that a subset of craniofacial team patients may have complex communication disorders that require AAC supports. Craniofacial teams should be aware of resources available for these patients so that the patients' communication needs are met in the hospital, in school, and in the community.

CommBo: Modernizing Augmentative and Alternative Communication

• Development of speech-generating Augmentative and Alternative Communication (AAC) tool. • Emphasis on support for those with low-income or internet connectivity concerns. • Interface adapts to user ability and preference and offers intelligent suggestions. • Usability evaluated by three target users versus traditional methods using NASA TLX. • Extended study with non-target users including function and design considerations. For every 100,000 people, there are 536 individuals with speech impairments who can benefit from the use of Augmentative and Alternative Communication (AAC) devices (Creer et al., 2016). Existing AAC devices can suffer from the shortcomings of being difficult to adjust to the user’s specific needs or simply being expensive to own and maintain. We aim to reduce the impact of these problems with CommBo: a web-based, speech-generating picture communication board meant to alleviate some major difficulties commonly experienced by AAC users. CommBo offers customizability beyond that of a physical picture board and leverages machine learning to provide intelligent suggestions. It supports heightened communication that can be brought to a multitude of computing devices, including those that are low-cost or have limited internet access. CommBo is designed for those with autism spectrum disorder (ASD) and patients suffering from any trauma that impacts the person’s ability to communicate effectively, e.g., stroke-induced aphasia. Across two studies, target and non-target participants evaluated CommBo in terms of functionality and usability, and results showed significant benefits of the system.

Speech-Language pathologists’ decisions when designing an aided AAC display for a compilation case study of a beginning communicator

Purpose The current study sought to identify decisions speech-language pathologists (SLPs) make and their rationale for those decisions when designing an AAC display for a hypothetical school-aged child who was a beginning communicator. Augmentative and alternative communication (AAC) displays support communicative interactions for children who are unable to use spoken language to meet their communication needs. Children who are at the early stages of learning language, often termed beginning or emerging communicators, may rely heavily on the AAC display to support comprehension and expression. Thus, it is important for speech-language pathologists (SLPs) to design a display that facilitates beginning communicators’ communication development. Methods This paper reports on the answers related to a specific case study presented in an online survey completed by 77 SLPs with experience in AAC. Results Data illustrated design decisions driven by child-specific characteristics and informed by research regarding type of layout, representation, and the importance of various design features. Conclusions Suggestions for future research are provided, including identifying goals and communicative functions best supported by different types of displays, clinicians’ challenges/successes growing a system with the child, and determining the importance of symbol arrangement and organisation in communicative tasks by AAC users. Implications for Rehabilitation Identification of current practices reported by speech-language pathologists given a case study to develop and implement future research. A gap between research and practice suggests the need for better dissemination and application of research supporting the inclusion of people engaged in the event depicted in a visual scene display. Foundations for future research to provide guidance regarding best design of and communication goals supported by visual scene displays and grid-based displays.