Use Of Speech-generating Devices Research Articles

Aided-speaking students’ unsolicited questions in teacher-fronted classroom talk: the use of speech-generating devices to ask questions

ABSTRACT Using the framework of conversation analysis, this paper examines aided-speaking students’ unsolicited speech-generating device (SGD)-mediated questions in teacher-fronted classroom talk. The analysis draws on a corpus of 18 h of video-recorded classroom interactions including 23 aided-speaking students using SGDs or picture-based communication boards. In all, 5% of the students’ contributions were unsolicited questions, produced by three students. The students were found to orient to turn transition relevance places, but due to prolonged production time their questions risked sequential and topical misplacement in the ongoing classroom talk and were vulnerable to misunderstandings. To address this problem, students activated the synthetic voice before finalising the question, claiming the interactional floor while securing time to complete their utterance. They also refrained from activating the synthetic voice and instead made the question visually available for the teacher to read, thereby transferring the responsibility for answering the question to the teacher when sequentially and topically relevant. The study demonstrates the complex interactional process of formulating SGD-mediated questions, sometimes requiring that the teacher, assistants, and students engage in repair work and scaffolding to establish the meaning of a student’s utterance. The findings imply that the treatment of non-speaking students’ contributions as questions requires designated teacher work.

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

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

A large-scale comparison of two voice synthesis techniques on intelligibility, naturalness, preferences, and attitudes toward voices banked by individuals with amyotrophic lateral sclerosis

Amyotrophic lateral sclerosis (ALS) commonly results in the inability to produce natural speech, making speech-generating devices (SGDs) important. Historically, synthetic voices generated by SGDs were neither unique, nor age- or dialect-appropriate, which depersonalized SGD use. Voices generated by SGDs can now be customized via voice banking and should ideally sound uniquely like the individual’s natural speech, be intelligible, and elicit positive reactions from communication partners. This large-scale 2 x 2 mixed between- and within-participants design examined perceptions of 831 adult listeners regarding custom synthetic voices created for two individuals diagnosed with ALS via two synthesis systems in common clinical use (waveform concatenation and statistical parametric synthesis). The study explored relationships among synthesis system, dysarthria severity, synthetic speech intelligibility, naturalness, and preferences, and also provided a preliminary examination of attitudes regarding the custom synthetic voices. Synthetic voices generated via statistical parametric synthesis trained on deep neural networks were more intelligible, natural, and preferred than voices produced via waveform concatenation, and were associated with more positive attitudes. The custom synthetic voice created from moderately dysarthric speech was more intelligible than the voice created from mildly dysarthric speech. Clinical implications and factors that may have contributed to the relative intelligibilities are discussed.

The influence of classroom context on AAC device use for nonspeaking school-aged autistic children

Purpose: Language learning, including on a speech-generating device (SGD), relies on having communication opportunities to use language. Yet, children who use SGDs do not consistently use their devices throughout the day. As a first step towards increasing device use, it is important to determine how the numerous contexts (e.g. recess, lunch, academic) that exist throughout the school day impact the frequency and type of communication opportunities that children have. Within this study, we used complex adaptive systems theory to investigate whether there were differences in how frequently nonspeaking autistic children classified as emerging communicators (i.e. children who do not consistently produce two-word utterances independently and do not communicate for a variety of communicative functions) used their SGDs to communicate and the type of communication they produced (i.e. spontaneous, prompted, or imitation) across different classroom contexts. Method: Fourteen autistic children who use an SGD as their primary mode of communication were videotaped up to nine times throughout different school days. The videos were coded for the type of device use (i.e. whether the child’s use of the device was spontaneous, prompted, or imitation) and classroom context, which were categorised by the inherent level of support and directiveness. Result: There was a significant difference in SGD use across classroom contexts. Overall, the children communicated more and engaged in more spontaneous, prompted, and imitated communication in classroom contexts with high levels of structure (e.g. tabletop work) compared to contexts with low levels of structure and directiveness (e.g. free play). Conclusion: This study highlights the need to increase communication opportunities across all school contexts. Creating appropriate communication opportunities in all contexts, especially those with less structure, will help ensure that communication does not become context-bound.

Perceived Factors That Facilitate or Prevent the Use of Speech-Generating Devices in Bilingual Individuals With Aphasia.

The aim of this study was to explore practicing speech-language pathologists' (SLPs') perceptions of factors that could facilitate or prevent the use of speech-generating devices (SGDs) in bilingual individuals with aphasia. Specifically, this exploratory study sought to identify the facilitators and barriers to SGD use in individuals with culturally and linguistically diverse backgrounds. An online survey was distributed to SLPs through an e-mail listserv and social media of an augmentative and alternative communication company. This article focused on the results of the survey items related to (a) the presence of bilingual individuals with aphasia on an SLP's caseload, (b) training related to SGD or bilingual aphasia, and (c) barriers and facilitators to SGD use. A thematic analysis was conducted to analyze the barriers and facilitators to SGD use reported by the respondents. A total of 274 SLPs who met the inclusion criteria had experience in implementing SGD for people with aphasia. Regarding relevant training, our results indicated that very few SLPs received bilingual aphasia intervention training (17.22%) or bilingual SGD training (0.56%) in graduate school. The results from our thematic analysis revealed four major themes of barriers and facilitators to SGD use, including (a) hardware and software, (b) cultural and language content, (c) SLP's cultural and linguistic competency, and (d) resources. Practicing SLPs reported several barriers to SGD use in bilinguals with aphasia. Most notably, language barriers for monolingual SLPs were seen as the greatest barrier to language recovery in individuals with aphasia whose primary language is not English. Several other barriers were consistent with previous research, such as financial factors and insurance disparities. The top three most important factors that facilitate SGD use in bilinguals with aphasia, as identified by the respondents, include user-friendly symbol organization, personalized words, and ease of programming.

Parent-implemented augmented communication intervention and young children with Down syndrome: an exploratory report.

Young children with Down syndrome (DS) present with speech and language impairments very early in childhood. Historically, early language intervention for children with DS included manual signs, though recently there has been an interest in the use of speech-generating devices (SGDs). This paper examines the language and communication performance of young children with DS who participated in parent-implemented communication interventions that included SGDs. Specifically, we compared the functional vocabulary usage and communication interaction skills of children with DS who received augmented communication interventions (AC) that included an SGD with those children with DS who received spoken communication intervention (SC). Twenty-nine children with DS participated in this secondary data analysis. These children were part of one of two longitudinal RCT studies investigating the effectiveness of parent-implemented augmented communication interventions in a larger sample of 109 children with severe communication and language impairments. There were significant differences between children with DS in the AC and SC groups in terms of the number and proportion of functional vocabulary targets used and the total vocabulary targets provided during the intervention at sessions 18 (lab)and 24 (home). Overall, the AC interventions provided the children with a way to communicate via an SGD with visual-graphic symbols and speech output, while the children in the SC intervention were focused on producing spoken words. The AC interventions did not hinder the children's spoken vocabulary development. Augmented communication intervention can facilitate the communication abilities of young children with DS as they are emerging spoken communicators.

Finding the right fit: what contributes to the successful use of speech generating devices?

ABSTRACT Many conditions can lead to a result in communication difficulties in both children and adults. One intervention utilized by rehabilitation professionals to overcome the problem is the use of speech-generating devices. Although the majority of users benefit from these tools, it is reported that roughly one third eventually abandon them. Existing literature suggests a variety of factors that lead to abandonment, yet the phenomenon continues. This study seeks to understand what constitutes successful device use through a qualitative study that examines the experiences of self-reported speech generating device users to identify commonalities to offer practitioners guidance in prescribing these devices. The data from this study resulted in three preliminary themes: 1) match between user and device attributes, 2) presence of communication partner support, 3) value of occupational roles and routines and their motivational benefit for device use.

Comparing Interventions With Speech-Generating Devices and Other Augmentative and Alternative Communication Modes: A Meta-Analysis.

Optimal augmentative and alternative communication (AAC) systems for children with complex communication needs depend in part on child characteristics, child preferences, and features of the systems themselves. The purpose of this meta-analysis was to describe and synthesize single case design studies comparing young children's acquisition of communication skills with speech-generating devices (SGDs) and other AAC modes. A systematic search of published and gray literature was conducted. Data related to study details, rigor, participant characteristics, design information, and outcomes were coded for each study. A random effects multilevel meta-analysis was performed using log response ratios as effect sizes. Nineteen single case experimental design studies with 66 participants (M age = 4.9 years) met inclusion criteria. All but one study featured requesting as the primary dependent variable. Visual analysis and meta-analysis indicated no differences between use of SGDs and picture exchange for children learning to request. Children demonstrated preferences for and learned to request more successfully with SGDs than with manual sign. Children who preferred picture exchange also learned to request more easily with picture exchange than with SGDs. Young children with disabilities may be able to request equally well with SGDs and picture exchange systems in structured contexts. More research is needed comparing AAC modes with diverse participants, communication functions, linguistic complexity, and learning contexts. https://doi.org/10.23641/asha.22111181.

The effect of responsiveness to speech-generating device input on spoken language in children with autism spectrum disorder who are minimally verbal †

The use of speech-generating devices (SGD) in early interventions for children with autism spectrum disorder (ASD) can improve communication and spoken language outcomes. The purpose of this study was to describe children’s responsiveness to SGD input modeled by a social partner during adult-child play interactions over a 24-week intervention trial and explore the effect of that responsiveness on spoken language growth. This secondary analysis consisted of 31 children with less than 20 functional words at study entry who received a blended behavioral intervention (JASPER + EMT) as part of a randomized controlled trial. Significant improvements were seen in rate of responsiveness to both adult SGD models and adult natural speech models; only rate of responsiveness to SGD models at entry was a significant predictor of frequency of commenting and was a more robust predictor of number of different words post-intervention. Lastly, at entry, children with more joint attention and language responded to SGD models at significantly higher rates. Attention and responsiveness to SGD output may be important mechanisms of language growth and children who have more joint attention skills may particularly benefit from use of an SGD.

Mobilizing device-mediated contributions in interaction involving beginner users of eye-gaze-accessed speech-generating devices

Interaction mediated by speech-generating devices (SGDs) may promote participation and independence for non-speaking children, but developing skills to use the SGD is time consuming and demanding. The present conversation analysis study aimed to identify features of interactional projects that mobilized SGD-mediated responses by two children with intellectual disability who were beginner-level users. The children and their professional communication partners were video recorded when interacting in an institutional setting. The analysis shows that SGD-mediated responses were mobilized by multimodal and sequentially organized actions combining different types of spoken initiatives, SGD modelling, and embodied resources that facilitated SGD use and hence participation. These results indicate a need for communication partners to use a wide range of practices to facilitate SGD-mediated interaction.

Within arm’s reach: The role of proximity in speech generating device use of ambulatory children with autism

Purpose: Augmentative and Alternative Communication (AAC) provides an alternative means of communication for individuals who are unable to effectively communicate using spoken language. The present study seeks to investigate the role of proximity in facilitating AAC (specifically Speech Generating Devices; SGD) use in a homogeneous population: ambulatory school-aged children with autism spectrum disorder (ASD). Method: Twelve school-age children with ASD who use an SGD as their primary mode of communication participated in the study. The percentage of time the child was within the proximity of their device was calculated over nine videotaped sessions and data logging provided information regarding device use over an 18-week period. Result: Children were in proximity to their device 65% of the time. There was a significant positive correlation between percentage of time in proximity to device and the average minutes of device use on the day video recorded. Exploratory analyses revealed that communicative abilities may be more connected to proximity than school context. Conclusion: These results support the importance of developing a program for assuring device proximity in order to encourage consistent device use in minimally verbal ambulatory school-age children with ASD.

Effects of Peer-Mediated Instruction With AAC on Science Learning and Communitive Responses of Students With Significant Cognitive Disabilities in Taiwan

This study examined the effects of an intervention that integrated peer-mediated instruction (PMI) with augmentative and alternative communication (AAC) using speech-generating devices (SGDs). Nine trained peer tutors without disabilities taught science concepts and modeled use of SGDs following a script to three elementary school students with significant cognitive disabilities in Taiwan. Using a multiple baseline across participants design, results showed the PMI with AAC intervention was effective in improving participants’ targeted science knowledge. In addition, participants increased their communicative interactions with peers and increased the use of different communication modes during the science experiment activities with the implementation of PMI with AAC, when compared to the communication responses during the general teaching strategy.

Feasibility and Preliminary Efficacy of Direct Instruction for Individuals With Autism Utilizing Speech-Generating Devices.

Direct instruction (DI) is an evidence-based approach to education that has been shown to be effective across a wide variety of student populations. Growing evidence suggests that DI may be an efficacious strategy for individuals with autism spectrum disorder (ASD). The current study aimed to evaluate the feasibility of using DI with students with ASD who utilize speech-generating devices (SGDs); 3 students with ASD whose primary mode of communication was an SGD were exposed to the Language for Learning Curriculum, Lessons 1-10. Student performance on pre- and posttests was measured, as well as student performance on exercises within each lesson. The average time to complete an exercise, number of repetitions, number of terminated sessions, and student affect were also evaluated. Results indicated that all 3 students could participate and complete exercises with some modifications to support SGD use. The students demonstrated improved performance, positive affect, and overall timely completion of exercises. Taken together, these findings suggest that DI may be feasible for some students with ASD who utilize SGDs.

Interacting With Persons Who Have ALS

Individuals with amyotrophic lateral sclerosis (ALS) in later stages may rely on a variety of modalities to communicate. The current study used conversational analysis techniques to examine naturalistic face-to-face interaction between a man with late-stage ALS and his wife to understand the types of accommodations they made to ensure that successful meaning was established. Three extracts of talk were selected from a corpus of 30 videotaped interactions between a man with ALS interacting either with his wife or the first author of the study. The extracts were examined for the type of communicative resources used and the ways in which conversants worked together to maintain the temporal–sequential demands of in-person interaction. Conversants used a variety of communication modalities during their social interactions including voice, body, gestures, a speech-generating device (SGD), and the SGD screen to construct utterances for one another, establish meaning, and stay in-time. The pair were successful and maintained conversation expectations in many ways similar to those with nonimpaired voices and bodies. Conversations including an SGD are a highly coordinated and interactive affair that is experienced jointly by all conversants. In this study, the conversational partners were aware of, and sensitive to, the temporal–sequential demands of in-person interaction and the modality restrictions associated with SGD use. Clinical and device design recommendations are discussed.

Issues Related to AAC and SGD Use by Adolescents and Adults with Autism Spectrum Disorder

The use of technology, especially speech-generating devices (SGDs), has generated a great deal of attention. In order to assess the quality and effectiveness of such strategies, many issues related to terminology and teaching require careful attention. The first section begins with a discussion about functional communication, including long-term goals, from a behavioral perspective. Key issues will include speaker vs. listener distinctions, functional units, and factors related to expanding communication repertoires. The next section reviews SGDs, their popularity, and concerns such as distinguishing between toy use vs. communication device and the role of the audio output. Next, factors related to demonstrations that a user knows the meaning of words in different modalities will be considered. There follows a look at some research examples related to both SGD and picture use by adolescents and adults with ASD regarding functional communication. This section includes examples of studies that appear to have overestimated functional outcomes as well as noting the overall paucity of research demonstrating a robust gain in repertoire size and complexity. Lastly, suggestions are offered associated with determining how clinicians can assure that efforts to teach functional communication to individual teenagers and adults will result in effective outcomes.

Effects of parent instruction in partner-augmented input on parent and child speech generating device use

Effects of parent instruction in partner-augmented input on parent and child speech generating device use

Naturalistic Speech-Generating Device Interventions for Children With Complex Communication Needs: A Systematic Review of Single-Subject Studies.

This article presents a systematic review that aimed to synthesize single-subject-design studies that have examined naturalistic interventions for teaching the expressive use of speech-generating devices (SGDs) to children with complex communication needs. Specifically, this review describes what intervention strategies are most commonly applied in studies with positive effects and minimal methodological flaws and examines the populations and outcomes for which these strategies have been effective. A systematic approach was used to qualitatively code variables of interest to this review. Results were summarized via both visual analysis and effect size methods, and a certainty of evidence methodology was adopted to describe the quality of the evidence. Thirty-two unique studies met inclusion criteria, with 19 having consistent positive results and meeting minimum requirements for certainty of evidence. Although studies used a variety of titles to describe intervention packages (e.g., milieu teaching, interaction strategies), certain strategies were common across studies. These included (a) creating and capturing communication opportunities via methods such as time delay and questioning; (b) providing feedback via methods such as reinforcement of requests, praise, or expansions; (c) prompting (verbal, physical, gestural); (d) modeling; and (e) training communication partners. Findings regarding these intervention components help to provide practical guidelines for naturalistic SGD intervention. Limitations of the current body of research (e.g., need to include more home-based studies and more intermediate to advanced SGDs, need to critically analyze the most critical intervention components) provide suggestions for future research. https://doi.org/10.23641/asha.6615332.

Teaching two children with autism spectrum disorder to use a speech-generating device

ABSTRACTMany children with autism spectrum disorder have minimal speech and are therefore candidates for learning to use speech-generating devices. Previous research has mainly focused on teaching children to use speech-generating devices to request preferred objects. While this is an important communication function, it would seem equally important for children to learn other communication functions, such as learning to reject non-preferred objects and learning to request breaks from non-preferred activities. The purpose of the present study was to evaluate procedures for teaching two children with autism spectrum disorder to use speech-generating devices for these different communication functions. The first child was taught to request preferred foods and reject non-preferred foods. The second child was taught to request a preferred toy and request a break from learning activities. Intervention involved creating opportunities for communication and then applying time delay, graduated guidance, and contingent reinforcement procedures. With intervention, both children learned to use the speech-generating device to perform their two respective communication responses. The results suggest a promising approach for teaching multifunction use of speech-generating devices to children with autism spectrum disorder.

An exploration of motor learning concepts relevant to use of speech-generating devices

ABSTRACTFor individuals who rely on speech-generating devices (SGDs) to complement and substitute for spoken language, speed, and accuracy of access to the device are paramount for effective communication. There is some evidence that application of motor memory principles may improve effectiveness of SGD-based communication. This article reviews motor learning models and principles, including learning stages, types of practice, and environmental factors that affect learning, and highlights the potential applications of these principles in dynamic display SGD design, intervention, and research.

Comparing Single Case Design Overlap-Based Effect Size Metrics From Studies Examining Speech Generating Device Interventions.

Meaningfully synthesizing single case experimental data from intervention studies comprised of individuals with low incidence conditions and generating effect size estimates remains challenging. Seven effect size metrics were compared for single case design (SCD) data focused on teaching speech generating device use to individuals with intellectual and developmental disabilities (IDD) with moderate to profound levels of impairment. The effect size metrics included percent of data points exceeding the median (PEM), percent of nonoverlapping data (PND), improvement rate difference (IRD), percent of all nonoverlapping data (PAND), Phi, nonoverlap of all pairs (NAP), and Tau(novlap). Results showed that among the seven effect size metrics, PAND, Phi, IRD, and PND were more effective in quantifying intervention effects for the data sample (N = 285 phase or condition contrasts). Results are discussed with respect to issues concerning extracting and calculating effect sizes, visual analysis, and SCD intervention research in IDD.