Speech-generating Device Research Articles

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

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

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.

Augmentative and alternative communication (AAC) in pediatric cochlear implant recipients with complex needs: A scoping review.

Augmentative and alternative communication (AAC) encompasses all forms of unaided and aided modes of communication, but typically excludes codified language such as spoken words or American Sign Language (ASL). In pediatric patients with a documented additional disability (population of interest), deficits in communication may pose a barrier to language development. While forms of AAC are frequently mentioned in the literature, recent innovations have permitted the use of high-tech AAC in the rehabilitation process. Our objective was to review the implementation of AAC in pediatric cochlear implant recipients with a documented additional disability. A scoping review of existing literature examining the use of AAC in pediatric CI recipients was conducted in the PubMed/MEDLINE and Embase databases. Studies with pediatric cochlear implant recipients with a concomitant diagnosis requiring additional therapeutic intervention outside the scope of standard post-CI follow-up care and rehabilitation from 1985 to 2021 met inclusion criteria (population of interest). Studies limited to spoken or formal sign language (e.g., American Sign Language, ASL) as communication modalities were excluded. Four hundred twenty studies were screened of which 29 were included. 13 were prospective, 10 were retrospective, 1 was cross-sectional, and 5 were case reports. Of these 29 studies, 378 patients met the inclusion criteria (age <18, CI user, additional disability, utilized AAC). Fewer studies (n=7) utilized AAC as the primary intervention for investigation. Autism spectrum disorder, learning disorder, and cognitive delay were frequently mentioned as additional disabilities in conjunction with AAC. Unaided forms of AAC included gesture/behavior, informal sign, and signed exact English, while aided AAC included a Picture Exchange Communication System (PECS), Voice Output Communication Aids (VOCA), and touchscreen programs such as TouchChat® HD. Various audiometric and language development outcome measures were mentioned, most commonly the Peabody Picture Vocabulary Test (PPVT) (n=4) and the Preschool Language Scale, Fourth Edition (PLS-4) (n=4). There is a gap in the literature regarding the use of aided and high-tech AAC in pediatric CI users with a documented additional disability. Given the use of multiple different outcome measures, additional exploration of the intervention of AAC is warranted.

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.

A comparison between the use of two speech-generating devices: A non-speaking student's displayed communicative competence and agency in morning meetings in a compulsory school for children with severe learning disabilities

This study examines the displayed communicative competence and agency of a non-speaking student at a compulsory school for children with severe learning disabilities. The use of two different speech-generating devices (a single-message versus a multi-message speech-generating device) and the assignment of participation role (having the role of ‘student’ or ‘teacher’) were compared in two morning meetings. The two interactional sequences ‘question-answers’ and ‘repair actions’ were chosen because they provide participants with opportunities to display communicative competence and agency. The analysis showed that the displayed communicative competence and agency of the non-speaking student differed in relation to the kind of speech-generating device and the associated participatory role. Furthermore, the displayed communicative competence and agency was a product of the close collaboration between the student and the assistant and teachers who scaffolded the process. The study shows that teachers and assistants can influence the communicative competence and agency of non-speaking students.

A qualitative study exploring the effect of communicating with partially intelligible speech

Few studies have investigated how individuals with partially intelligible speech choose to communicate, including how, when, and why they might use a speech-generating device (SGD). This study aimed to add to the literature by exploring how this group of individuals use different communication strategies. Qualitative interviews were carried out with 10 participants with partially intelligible speech with the aim of investigating participants’ perceptions of modes of communication and communication strategies. Transcripts were analyzed using Framework Analysis to investigate the role of SGDs alongside other communication strategies. Factors that influence why, when, and how a person chooses to communicate were identified and these were interpreted as an explanatory model of communication with partially intelligible speech. Participants described how they made the decision whether to attempt to communicate at all and then which communication method to use. Decision-making was influenced by the importance of the message, how much time is available, past experience, and the communication partner. Each communication attempt adds to an individuals’ experience of communicating and influences subsequent decisions. This study suggests that individuals with partially intelligible speech are at risk of reduced communication environments and networks and that current SGDs may not be designed in a way that recognizes their particular needs.

Voice banking to support individuals who use speech-generating devices: development and evaluation of Singaporean-accented English synthetic voices and a Singapore Colloquial English recording inventory

Voice banking involves recording an inventory of sentences produced via natural speech. The recordings are used to create a synthetic text-to-speech voice that can be installed on speech-generating devices. This study highlights a minimally researched, clinically relevant issue surrounding the development and evaluation of Singaporean-accented English synthetic voices that were created using readily available voice banking software and hardware. Processes used to create seven unique synthetic voices that produce Singaporean-accented English, and the development of a custom Singaporean Colloquial English (SCE) recording inventory, are reviewed. The perspectives of adults who spoke SCE and banked their voices for this project are summarized and were generally positive. Finally, 100 adults familiar with SCE participated in an experiment that evaluated the intelligibility and naturalness of the Singaporean-accented synthetic voices, as well as the effect of the SCE custom inventory on listener preferences. The addition of the custom SCE inventory did not affect intelligibility or naturalness of the synthetic speech, and listeners tended to prefer the voice created with the SCE inventory when the stimulus was an SCE passage. The procedures used in this project may be helpful for interventionists who wish to create synthetic voices with accents that are not commercially available.

Differences in Sibilant Perception between Gender Expansive and Cisgender Individuals

Acoustic cues of voice gender influence not only how people perceive the speaker's gender (e.g., whether that person is a man, woman, or non-binary) but also how they perceive certain phonemes produced by that person. One such sociophonetic cue is the [s]/[ʃ] distinction in English; which phoneme is perceived depends on the perceived gender of the speaker. Recent research has shown that gender expansive people differ from cisgender people in their perception of voice gender and thus, this could be reflected in their categorization of sibilants. Despite this, there has been no research to date on how gender expansive people categorize sibilants. Furthermore, while voice gender expression is often discussed within a biological context (e.g., vocal folds), voice extends to those who use other communication methods. The current study fills this gap by explicitly recruiting people of all genders and asking them to perform a sibilant categorization task using synthetic voices. The results show that cisgender and gender expansive people perceive synthetic sibilants differently, especially from a "nonbinary" synthetic voice. These results have implications for developing more inclusive speech technology for gender expansive individuals, in particular for nonbinary people who use speech-generating devices.

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.

Teaching Multi-step Requesting and Social Communication to Five Autistic Children Using Speech-Generating Devices and Systematic Instruction

ObjectivesWe evaluated a systematic instructional package for teaching a four-step SGD-based requesting and social communication sequence. Of interest was whether intervention would lead to accurate performance of the sequence, as well as generalization, maintenance, and discriminated/functional use.MethodsFive minimally verbal autistic children received systematic instruction to complete a four-step sequence on an iPad®-based SGD. The sequence involved (a) saying hello, (b) making a general request, (c) making a specific request, and (d) thanking the listener. The effects of instruction, which consisted of practice sessions, time delay, prompting, and reinforcement, were evaluated in a multiple-baseline across participants design.ResultsAll five participants reached 100% correct performance during intervention. This high level of correct responding generalized to a novel interventionist and was maintained at follow-up. Discriminated/functional use of the communication icons was evident.ConclusionsThe systematic instructional package was effective in teaching a four-step SGD-based requesting and social communication sequence to five minimally verbal autistic children.

Views of Speech-Language Pathologists on Telepractice for Children Who Use Augmentative and Alternative Communication.

Telepractice has become increasingly utilized in disability services, particularly with recent and ongoing measures to slow the spread of the novel coronavirus (COVID-19). In this study, 361 speech-language pathologists (SLPs) responded to a national, web-based survey about their views on utilizing telepractice with children aged 3 to 21 who used aided augmentative and alternative communication (AAC), such as picture symbols or speech-generating devices. The views of SLPs varied, and SLPs who received training on AAC telepractice within the last 12 months had more positive views about telepractice than those who did not. Several factors were associated with when and how SLPs thought telepractice was beneficial to serve children who use aided AAC, including SLPs' foundational perspectives about telepractice, service delivery options, considerations related to the child and family, and broader resources and constraints.

Teaching Children with Autism Spectrum Disorder to Answer Questions Using an iPad-Based Speech-Generating Device.

This study investigated whether a systematic instruction package was effective in child acquisition of question answering using an iPad-based speech generating device (SGD). The study was conducted with two children with autism using a multiple probe across behaviors design. Results demonstrated that the systematic instruction package consisting of graduated guidance, discrete trial teaching, time delay, and reinforcement resulted in acquisition of answering all questions. Follow-up data were collected one, three, and five weeks after instruction ended. For all participants, skills maintained during follow-up and generalized to novel settings and skills. Social validity data were also collected and indicated that teachers without experience using SGDs found them to be effective and feasible for teaching communication skills.

A recent survey of augmentative and alternative communication use and service delivery experiences of people with amyotrophic lateral sclerosis in the United States

Purpose The objective of this study was to explore and describe current trends in the augmentative and alternative communication (AAC) use and service delivery experiences of people with amyotrophic lateral sclerosis (PALS) in the U.S. Methods Cross-sectional data were collected from 216 PALS via an anonymous online questionnaire in 2021. Results Over 70% of participants reported at least some detectable speech disturbance, and approximately half used aided communication during face-to-face interactions. Among respondents with severe speech impairment, over 90% reported using speech-generating devices, and just over half reported using low-tech AAC. Most participants had met with an SLP to discuss speech and communication, but varied in both timing of the initial intervention and frequency of ongoing intervention. Fewer than half reported that their family members or other important people had received education or support related to communication for PALS. Participants also shared their use of and experiences with telephone and video calls, access methods, mounting systems, word prediction and stored phrases, and message and voice banking. Conclusions Results highlight the importance of early referral for AAC intervention, ongoing re-evaluation and treatment, involvement of communication partners and support for multimodal communication and adaptation to changing needs.

Noun Production in Persons with Chronic Aphasia Using a Speech Generating Device with Increased Dosing

<h3>Research Objectives</h3> This investigation aimed to determine the effect that repeated trials using a speech-generating device (SGD) have on the production of nouns in persons with chronic expressive aphasia. <h3>Design</h3> The study design used was an ABAB single-subject research design with intervention two times per week for four weeks. <h3>Setting</h3> "Home". <h3>Participants</h3> A 76-year-old male, 8 years post-stroke; a 72-year-old male, 2 years post-stroke; and a 61-year-old male, 8 years post-injury. <h3>Interventions</h3> Baseline probes were administered via telepractice using 20 stimuli photos. Intervention – B¹- icons appeared one per page, for five trials per stimulus word. The participant repeated the word. Withdrawal - A² participants repeated identical probes completed in A¹, confrontationally naming photographs without the device. Intervention – B² the same 20 stimuli pictures were presented using the TouchTalk device. <h3>Main Outcome Measures</h3> All three participants showed improved naming accuracy during the intervention phases. The outcome was measured by the performance in the intervention phases when compared to the performance when the intervention was removed. <h3>Results</h3> Participant one exhibited an average increase in performance of 31.7% from Baseline Phase A1 to Intervention Phase B1 and a 20% increase from Withdrawal Phase A2 to Intervention Phase B2. Participant two exhibited an average increase in performance of 28.2% in Baseline Phase A1 to Intervention Phase B1 and a 24.5% increase from Withdrawal Phase A2 to Intervention Phase B2. Participant three had a 33.7% increase from Baseline Phase A1 to Intervention Phase B1 and a 33% increase from Withdrawal Phase A2 to Intervention Phase B2. <h3>Conclusions</h3> The results of this study support other findings that visual images help to stimulate language and word meanings (Collier and Dietz, 2014; DeLong et al., 2015; Griffith et al., 2014; Harnish et al., 2014; McKelvey et al., 2010; Off et al., 2015). <h3>Author(s) Disclosures</h3> Dr. Shawnise Carter does have a financial relationship with Lingraphica and as a full-time employee thereby receives compensation. Dr. Sandra Combs does not have a financial relationship with Lingraphica.

Social Validity, Cost, Acceptability, and Feasibility of Augmentative and Alternative Communication Devices Used for Individuals With Autism Spectrum Disorder and Intellectual Disability: A Systematic Review

Purpose: The authors conducted a systematic review of single-case experimental designs that included individuals with autism spectrum disorder and/or intellectual disability who used speech-generating devices (SGDs) for communication. The purpose of this study was to review subjective and normative pre- and post-intervention social validity data, in addition to the cost, acceptability, and feasibility of the SGDs used in the studies. The authors also studied trends in the reporting of pre- and post-intervention data over time. Method: A systematic review of 7,327 articles resulted in 86 articles that met design quality criteria and included participants who used SGDs. A group of raters completed interrater reliability for all stages of the review. Results: Researchers reported more subjective than normative data. Few studies reported on the price of the SGD or the person who purchased the SGD. More researchers reported using an SGD with more than one use, but few solicited feedback about the SGD used during the intervention. Few researchers reported information about the portability of the device or the operation effort. Conclusions: Reporting on social validity represents a substantial limitation in experimental studies. Future work incorporating less biased/more objective measures is important for the creation of socially valid interventions.

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.

Comparing Response Modes During Functional Communication Training: Efficacy of Acquisition and Preference for Students with Autism

This study evaluated acquisition, preference, and generalization of two forms of augmentative and alternative communication (AAC) during functional communication training (FCT) with two students with autism spectrum disorder (ASD). Acquisition of FCT responses, using a picture-based communication system and speech-generating device (SGD; Apple iPod Touch with the Proloquo2Go), was compared. Following acquisition, preference of response mode was evaluated for each participant. Both AAC systems were made available simultaneously during FCT sessions, and data were collected on participants’ initiation of functional communication (FC) on each modality. Findings indicated FC responses with the picture-based communication system and the SGD were acquired with similar rates by both participants. Furthermore, both participants demonstrated a consistent preference for the SGD as compared with the picture-based communication system. Both participants generalized the preferred FCT mode (i.e., SGD) to their classroom setting with their classroom teacher. Results indicate it is important to assess both acquisition efficiency and preference when selecting AAC systems for individuals with autism.

Challenges and Responsibilities of Critical Care Nurses in the Weaning Process from Mechanical Ventilation for Patients Post-Cardiothoracic Surgery: A Qualitative Study

Background: The responsibilities of critical care nurses for mechanical ventilation (MV) management may differ among countries, particularly in the weaning process. Aim: To identify nurses' perceptions, roles, and challenges regarding the weaning process for patients in intensive care units (ICUs) in Denmark, Egypt, and the Kingdom of Saudi Arabia (KSA). Methods: This study was a qualitative study using a phenomenological-hermeneutic design. Results: Nurses in Egypt and the KSA were more likely to independently adjust ventilator settings. They used body language, facial expressions, and eye contact to communicate with patients. They prepared patients for the weaning process following physicians' orders. They provided routine nursing care with no specific nursing guidelines or protocols for the weaning process. In contrast, the nurses in Denmark checked the ventilator settings frequently, assessed the consistency of secretions, and frequently performed endotracheal suctioning. They used body language, facial expressions, and eye contact, and they used low technology devices (e.g. word or picture charts, alphabet boards and rewritable magnetic boards) and advanced technological devices (e.g. electronic voice output communication aids through a computer) to communicate with their patients. Moreover, the criteria for weaning and the protocol were used to wean patients from MV. Unfortunately, no protocol was applied for patients with long-term MV. Therefore, the weaning of these patients was conducted by consultation between the nurses and physicians. Conclusion: The use of weaning protocols in Danish settings is an excellent example of collaborative teamwork to apply the best practices in MV weaning processes. It is recommended that nurses in Arab countries apply this experience.