Speech-generating Device Research Articles

Intervention focus moderates the association between initial receptive language and language outcomes for toddlers with developmental delay

This ex-post facto study reanalyzed data from Romski et al. to examine whether intervention focus moderated the relationship between pre-intervention standardized measures of receptive language and post-intervention standardized measures of receptive and expressive language age and observations of expressive target vocabulary size. In all, 62 toddlers with developmental delay were randomly assigned to augmented communication-input (AC-I), augmented communication-output (AC-O), or spoken communication (SC) interventions. AC-I provided augmented language input via spoken language and a speech-generating device (SGD); AC-O encouraged the production of augmented output via an SGD; and SC provided spoken input and encouraged spoken output without using an SGD. Intervention focus moderated the impact of initial receptive language on expressive language age and expressive target vocabulary size. Participants in AC-I, when compared to those in the other two interventions, had a significantly stronger relationship between initial receptive language and post-intervention expressive language age. For expressive target vocabulary size, participants in AC-O showed a strong relationship and those in AC-I a slightly weaker relationship between initial receptive language and expressive target vocabulary size; no significant relationship was found in the SC group. Results emphasize that different interventions may have distinct outcomes for children with higher or lower initial receptive language.

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.

Technology-Aided Interventions for Individuals With Autism: Implications for Policy and Practice

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by pervasive difficulties in reciprocal social-communication skills and restricted, repetitive interests and behaviors. Advances in assistive technology can potentially improve the functional capabilities of individuals with ASD. This article reviews current legislation and professional standards related to educating students with ASD with an emphasis on technology and evidence-based practices. In particular, the article summarizes technology-aided interventions (e.g., speech-generating devices, computer-assisted instruction, video-based instruction, virtual reality, and robot-mediated interventions) that focused on social-communication skills among individuals with ASD. Implications and future directions of technology-aided interventions 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.

Considerations for Chinese text input methods in the design of speech generating devices: a tutorial

ABSTRACTMillions of Chinese-speaking people who have the most severe speech disorders could potentially benefit from using Speech Generating Devices (SGDs) to help them participate in society. Entering Chinese text into computer systems is complex, and the process itself requires a translation system from the small selection set of keys to Chinese characters, thus adding to the complexities of adaptive access to computers often required by people who rely on them for spoken and written communication. This paper examines two types of input method: those relying on phonetic principles, and those relying on logographic principles. It evaluates the potential pros and cons of each input method to specific populations with complex communication needs.

Voice Banking to Support People Who Use Speech-Generating Devices: New Zealand Voice Donors' Perspectives

Purpose Voice banking is the process of recording an individual's speech to create a personalized synthetic voice to use on speech-generating augmentative and alternative communication devices. This study set out to examine the experience of healthy voice donors during the ModelTalker voice banking process and to identify specific issues related to voice banking in the New Zealand context. Method Eight healthy adults and 2 children completed the ModelTalker voice banking protocol. All participants completed a questionnaire about their voice banking experience, including the length of time required as well as the ease and the technical aspects of the process. Results The median time taken to complete the voice banking process was 5 hr 30 min (range: 3 hr 10 min to 11 hr). Questionnaire responses included themes related to the voice banking process, such as increased awareness of voice banking and its benefits, positive features and challenges of the ModelTalker process, and potential adaptations for the New Zealand context. Conclusions The findings support the use of ModelTalker with New Zealand speakers and inform development of voice banking protocols. The voices created as part of this study are available for people using speech-generating devices who want to use New Zealand–accented voices. Future research is needed to investigate the voice banking experiences of clinical populations, such as people with amyotrophic lateral sclerosis.

Use of a speech generating device and various prompting procedures might facilitate vocalizations in minimally verbal children with autism spectrum disorder

Q Will a speech-generating device intervention package, including time-delay, differential reinforcement and an echoic prompt, increase the vocalizations of children with autism spectrum disorder (...

Language Preference of a Multilingual Individual With Disabilities Using a Speech Generating Device.

Individuals with disabilities who are English learners (ELs) and communicate using speech generating devices (SGDs) may demonstrate a preference for instructional language and language output of their SGDs. The influence of interventionist language on the preference of SGD language output and frequency of mands was examined using an alternating-treatments design with an embedded concurrent-chain arrangement with a 10-year-old with Down syndrome whose heritage language was Spanish. Language preference assessment for ELs is recommended because heritage language may be preferred for children with disabilities who use SGDs.

Assistive Technology to Support Communication in Individuals with Neurodevelopmental Disorders

This paper summarizes a number of studies using communication technology with people with neurodevelopmental disorders to (a) provide illustrative examples of the technology solutions available, (b) examine the communication skills addressed and the results obtained, and (c) discuss the affordability and accessibility of the technology solutions used. Most studies used basic speech-generating devices to support requesting behavior. Research has also focused on (a) use of more advanced speech-generating devices for supporting communication across different daily settings, (b) computer systems for supporting communication via text messages or telephone calls, and (c) smartphones and tablets for supporting people in making telephone calls or exchanging messages as well as in accessing leisure materials. Multiple technology solutions are available to support different forms of communication in people with neurodevelopmental disorders. The technologies that have been studied vary based on the communication skills targeted and on the participants’ functioning level and response repertoire. The technologies also vary based on developments occurring in the commercial area.

Establishing Peer Manding in Young Children with Autism Using a Speech-Generating Device

Impairment in social communication is a hallmark characteristic for individuals with a diagnosis of autism. As such, specific instructional strategies that incorporate the use of augmentative and alternative communication (AAC) system, such as an iPad® based speech-generating device (SGD) is often indicated. This study evaluated the use of the interrupted chain procedure in the establishment of peer manding for three young children with a diagnosis of autism. The procedures involved the presentation of a task related activity (i.e., puzzle) and the neuro-typical peer interrupted the behavioral chain of task completing by withholding the final piece needed to complete the task. An iPad® based SGD was used as an AAC for the participants to mand for the missing item needed to complete the task related activity from the peer. Additionally, a five-second-time delay with full physical prompts was used for instructional purposes. The results indicated that all three participants acquired the ability to mand for the missing item from the peer, and this skill was also found to maintain following training.

Multilingualism and augmentative and alternative communication in South Africa - Exploring the views of persons with complex communication needs.

BackgroundAugmentative and alternative communication (AAC) can assist persons with complex communication needs to communicate competently with a variety of communication partners in a variety of contexts. However, AAC systems and intervention often do not take multilingual aspects into consideration.ObjectiveThis small-scale exploratory study had three aims, namely: (1) to describe the self-reported language skills of multilingual South African adults using AAC, (2) to describe the languages and communication modalities they used in interaction and (3) to obtain their views regarding access to various languages.MethodsTwenty-seven adults using AAC were recruited via an empowerment programme, as well as an email list for persons interested in AAC, and provided responses to a questionnaire. To compensate for access and written language challenges, the questionnaire was administered with help and/or as a face-to-face interview where needed. Responses were analysed using mostly descriptive statistics.ResultsParticipants generally could not express themselves in all the languages they understood and were regularly exposed to. Speech-generating devices specifically gave access almost exclusively to English. Participants expressed a desire to increase their expressive language repertoire, and mentioned both limitations of communication technology as well as their own literacy skills as barriers to overcome in this regard.ConclusionIn order for multilingual South African adults using AAC to express themselves in multiple languages, appropriate AAC systems and interventions as well as literacy learning opportunities need to be developed and provided.Keywordsadult, augmentative and alternative communication; multilingualism; complex communication needs, language and communication skills; self-report, views.

Communication skills among children with spinal muscular atrophy type 1: A parent survey

ABSTRACT Spinal muscular atrophy is one of the most common fatal autosomal recessive disorders. Children diagnosed with SMA Type 1 (SMAT1) demonstrate severe oral motor weakness and flaccid dysarthria progressing to complete anarthria. A review of literature illustrates that little has been described regarding augmentative and alternative communication (AAC) use among these children, although communication has a critical impact on quality of life and participation in daily activities. Responses to an investigator-developed parent survey were obtained to appraise communication skills and opportunities among children diagnosed with SMA1. Results illustrate parent perception of greater receptive than expressive language ability and highlight the benefits of implementing speech-generating devices (SGD). Barriers to SGD acquisition and implementation, including access and funding, are reported and described. Overall, families indicated that SGD increases quality of life and provides valued improvements through expanded functional communication.

The emergence of clause construction in children who use speech generating devices

This study aimed to detect patterns in clause construction structural changes produced by four participants aged 9;5–13;7 (years;months) with motor speech disorders who used speech-generating devices. Sequences of adult–child interactions, drawn from the data of a larger study focused on enhancing vocabulary and grammar skills, were examined. This current study comprises a secondary analysis of a corpus of 29 conversations totalling 808.36 min, analysing clause structures by type, linguistic complexity, and intensity of adult prompts (number of turns). Results show that, over time, the participants’ clause structure complexity increased through addition of phrase-internal elements such as inflections, articles, and prepositions. Use of specific grammatical elements followed the developmental stages observed in children with typical development. For all participants, the personal pronoun I (first-person singular) emerged before she, he (third-person singular), and we or they (plural). Participants with the highest number of adult–child co-constructed clauses also had the highest number of well-formed clauses. The intensity of adult prompts increased as clause structures became more complex and as participants needed more support. Implications for practice and theory are discussed.

Further investigation of increasing vocalizations of children with autism with a speech‐generating device

We replicated and extended the findings of Gervarter et al. (2016) by using prompting and reinforcement to produce increased vocal speech with 3 young children diagnosed with autism spectrum disorder (ASD) who used a speech generating device (SGD). We extended Gervarter et al. by adopting a more robust experimental design, conducting session-by-session preference assessments, and measuring the emergence of novel vocalizations. The frequency of vocalizations increased for all 3 participants after the introduction of an echoic prompt. These results suggest that SGD-based interventions may lead to increased vocal output for children with ASD.

Caregivers’, teachers’, and assistants’ use and learning of partner strategies in communication using high-tech speech-generating devices with children with severe cerebral palsy

ABSTRACT Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners’ learning in how to use partner strategies. To describe communication partners’ use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners’ learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

Application of the Communication Complexity Scale in Peer and Adult Assessment Contexts for Preschoolers With Autism Spectrum Disorders.

Purpose The purpose of this study was to measure changes in communication of preschoolers with autism using the Communication Complexity Scale (CCS; Brady et al., 2012 ) and to examine the utility of the CCS in measuring pretreatment and posttreatment changes within peer and adult assessment contexts. Method The CCS was used to code preassessment and postassessment for 23 children with autism randomly assigned to a treatment that incorporated a peer-mediated approach and a speech-generating device and 22 assigned to a business-as-usual condition with untrained peers. Children were assessed in 2 structured 30-min contexts-1 with an adult examiner and 1 with a peer partner coached by an adult. Results Children in both groups showed significant changes in communication complexity CCS scores from pretreatment to posttreatment in the adult and peer contexts. At both occasions, CCS scores were higher with adult partners yet showed greater improvements over time with peer partners. Conclusions Results showed that the CCS was sensitive to change over time but did not discriminate changes in communication complexity associated with maturation versus treatment. It did show some differences based on interactions with peer versus adult partners. Outcomes provide preliminary support for using this scale to measure communication changes in different contexts. Supplemental Material https://doi.org/10.23641/asha.7408856.

The psychometric properties of the communicative competence scale for individuals with Aphasia using speech-generating devices

ABSTRACTBackground: Persons with aphasia (PWA) use augmentative and alternative communication (AAC) systems to access and create symbol-based messages. The purpose of this study was to (a) investigate the psychometric properties of the newly developed Communicative Competence Scale (CCS), and (b) to determine if any factors, or subcategories, exist within each scale of the scale. The CCS aims to assess the competence of PWA using AAC.Aims: Respondents were 55 undergraduate and graduate speech-language pathology students. The students were recruited to test the statistical properties of the CCS and Conversational Skills Rating Scale (CSRS). Prior to completing both instruments, respondents watched two videos of a PWA communicating with a speech-generating device. The messages were displayed using a grid display in one video and a scene display in the other.Main contribution: Concurrent validity was established between the CCS and the CSRS, and a moderate correlation was found. Reliability Coefficients revealed that the CCS and the CSRS had acceptable levels of internal consistency. Factor analysis revealed factor loadings or subordinate categories within the CCS and CSRS that were consistent with previous research.Conclusions: The CCS was found to be an internally consistent, reliable, and valid measure of perceived communicative competence of PWA using aided AAC. Clinical implications are discussed.

AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND SPEECH PROSODY IN TURKISH-SPEAKING CHILDREN WITH DEVELOPMENTAL LANGUAGE DISORDERS: A RANDOMIZED CONTROLLED STUDY OF AWARENESS AND DEVELOPMENTAL LANGUAGE INTERVENTIONS

Objective: One of the most common child psychiatry and language speech therapy problems in the preschool age group is Developmental Language Delay (DLD)’s. Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC).This study aimed to evaluate effectiveness of AAC, using a VOCA device on language and emotion regulation of children diagnosed with developmental language disorders (DLDs). Methods: 44 children (36–72 months old), who were diagnosed with DLDs, were randomly placed in the experimental (n=22) or the control (n=22) group. The experimental group attended the AAC treatment while the control group received a routine treatment. Test of Early Language Development –Third Edition-Turkish (TELD 3-Turkish) was used to evaluate language profiles and emotion regulation skills were evaluated with the Emotion Regulation Checklist. Results: After the intervention, children who were assigned to the experimental AAC treatment group gained significant improvements in receptive and expressive language skills. The Mean Length of Utterances (MLU) and Language Sample Size (LSS) increased significantly for both the experimental and the control group, but the ratio of change was higher for the experimental group. When the values obtained from language skills and the subscales of emotion regulation before the intervention, a significant relationship between language delay and speech prosody was found. Conclusions: AAC can be useful for developing language skills of children with DLDs as well as supporting their emotion regulation. Our study is the first to be applied in the treatment of preschool age in terms of different models and practices that work to obtain successful results.

A pilot community-based randomized comparison of speech generating devices and the picture exchange communication system for children diagnosed with autism spectrum disorder.

A pilot community-based randomized controlled trial was conducted to compare the effects of the Picture Exchange Communication System (PECS) to a teaching sequence using a high-tech Speech Generating Device (SGD) to teach social communication behaviors. The two approaches were compared to evaluate the effectiveness of the newer, more high-tech intervention using technology to improve social and communicative behavior of children diagnosed with Autism Spectrum Disorder. A total of 35 school-age children were randomized to either a high-tech (SGD device) or low-tech (PECS cards) form of Augmentative and Alternative Communication (AAC). Study participants received 4 months of communication training delivered in their classrooms, and the primary outcome measures of the trial were several functional communication skills emphasized in the PECS teaching sequence. Results indicated that both high-tech and low-tech AAC approaches resulted in significant improvements in communication, and that these improvements did not differ significantly between the two approaches. These findings support the use of high-tech AAC, and highlight the need for evidence-based guidelines for its use as well as evaluation with individuals with a range impairments and disabilities. Autism Research 2018, 11: 1701-1711. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: This study compared the effectiveness of a free and open-source app for teaching social and communicative behavior to children with autism spectrum disorder (ASD) to traditional picture card approaches. Thirty-five children with ASD were randomized to a picture card or app-based intervention and both treatment approaches resulted in significant improvements in social and communicative behavior. These data indicated that both "high-tech" and "low-tech" interventions were effective for improving behavior and that there was not a significant difference between the two approaches.

Finding your voice and coping with a distressing diagnosis

Adults diagnosed with neurological conditions can face a time-limited future with few treatment options. Their experience of receiving a diagnosis is distressing, even when ‘given well’. Distress is exacerbated by waiting times, notions of illegitimacy, progressive and frightening symptoms. This paper draws on a number of studies, using phenomenological qualitative interviews of over 65 families across Scotland (around 15% of families who live with MND in Scotland) between 2011-18. The research draws on the social model of disability, to determine where barriers to being and doing are constructed for participants, and what can be done to remove them. It will reflect particularly on the added value to adults who face dysarthria: voice degradation through impairment (for example through Motor Neurone Disease (Also known as ALS/MND)), of using a voice recording of their own voice, to generate speech. Many rely on augmentative and alternative communication (AAC) to express themselves. However the use of voice output communication aids (VOCAs) while facilitating communication, cannot currently preserve the identity of the individual, as users are restricted to a limited set of impersonal synthetic voices. The Speak Unique project (Led by Dr Rewaj, Euan MacDonald Centre) has explored the value of producing a synthesized voice, built around a person’s own voice, (after recording of a finite number of sentences chosen for their ability to be deconstructed phonetically, for those phonetic building blocks to be reconstructed to produce infinite sentences). This paper draws on an evaluation of this work, amongst other studies into the lived experience of neurological conditions. A diagnosis of a neurological condition is sufficient to trigger a biographical disruption (Bury, 1982) but there are services that enable feelings of control and hope. The impact of recovering ‘their own’ voice was significant for families, impacting positively on well-being, social identity and intimacy. Keywords—ALS/MND, Disability, Impairment, Voice