Use Of Voice Output Communication Aids Research Articles

An analysis of the effects of functional communication and a Voice Output Communication Aid for a child with autism spectrum disorder

The purpose of this study was to examine the effects of Functional Communication Training (FCT) and a Voice Output Communication Aid (VOCA) on the challenging behavior and language development of a 4-year-old girl with autism spectrum disorder. The participant's mother implemented modified functional analysis (FA) and intervention procedures in Kerri's home. A multiple probe design across activities was used to analyze intervention effectiveness. FCT with a VOCA successfully decreased Kerri's challenging behavior and increased VOCA use. A secondary analysis revealed that Kerri increased her use of correct pronouns. Kerri's mother implemented modified FA and intervention procedures with a high level of fidelity. Social validity data indicated that Kerri's mother believed the intervention to be acceptable and effective.

Interaction between children with cerebral palsy and their peers 1: Organizing and understanding VOCA use

This paper is the first in a series of two that use the principles and practices of Conversation Analysis (CA) in an examination of voice output communication aid (VOCA) use in two conversations, each involving a child with cerebral palsy with complex communication needs who used a VOCA and a peer without complex communication needs. The primary theme of this paper concerns how VOCA use is incorporated into children's peer interactions. A significant feature of each dyad is the way in which naturally speaking partners organized specific locations within the conversation for the production of VOCA-mediated turns. Such practices provide frameworks within which VOCA-mediated contributions can be understood. Issues concerned with asymmetries in children's peer interaction are discussed.

Using a Single-Switch Voice Output Communication Aid to Increase Social Access for Children with Severe Disabilities in Inclusive Classrooms

Three young children with severe, multiple disabilities were taught to utilize a voice output communication aid (VOCA) to request access to preferred items and/or peers during play activities. Acquisition of VOCA use resulted from a naturalistic intervention strategy that consisted of creating communication opportunities, prompting the participant to engage in the target behavior via a full physical prompt, and facilitating access to natural consequences for appropriate participant responses. Intervention occurred in the context of naturally occurring free-choice activities in inclusive classrooms. Results showed that the intervention strategy was effective in teaching all three participants to use a VOCA to request access to items and/or peers. The peers generally responded to the participants with either positive or neutral responses. Survey data on the acceptability of the intervention to classroom staff are also discussed.

Teaching VOCA use as a communicative repair strategy.

Students with developmental disabilities often rely on prelinguistic behavior (e.g., reaching, leading) to communicate. When listeners fail to attend to prelinguistic behaviors, students may benefit from responding with an alternative form of communication to repair the breakdown. In the present study, we taught two students with developmental disabilities to repair communicative breakdowns by using a voice-output communication aid (VOCA). Intervention occurred at morning snack time when the students had the opportunity to access preferred items through prelinguistic behavior (e.g., reaching, guiding). Breakdowns occurred when the listener failed to attend to the student's initial request. Effects of the intervention were evaluated in a multiple-baseline design across subjects. Both students learned to use the VOCA to repair communicative breakdowns. As VOCA use was acquired as a repair strategy, the students also began to use the device to initiate requests when there had been no breakdown in communication. The intervention appeared to be an effective approach for supplementing prelinguistic behaviors with an additional option for communicating a request.

Electronic voice-output communication aids for temporarily nonspeaking patients in a medical intensive care unit: a feasibility study

Background The inability to speak during mechanical ventilation is recognized as a terrifying and isolating experience that is related to feelings of panic, insecurity, anger, worry, fear, sleep disturbances, and stress among critically ill patients. Alternative methods of communicating with temporarily nonspeaking patients in the intensive care unit (ICU) have received little study. Although electronic voice output communication aids (VOCAs) are available for disabled children and adults, the effectiveness of VOCA systems with adult medical ICU patients who may have multisystem illness, prolonged intubation, and longer ICU stays has not been explored. Objectives The purpose of this pilot study was to describe (1) the characteristics of intubated MICU patients who use VOCAs, (2) the usage patterns (message categories, frequency, assistance required), (3) communication quality (ease, user satisfaction), and (4) barriers to communication with VOCAs. Methods This pilot study used participant observation, semi-structured interviews, questionnaires, and clinical record review in a complementary design to obtain data on communication events and VOCA use with 11 critically ill adults. Results Study participants, 45.5 ± 16.0 years of age with 13 ± 1.9 years of education and moderately severe illness (APACHE III = 27.5 ± 16.1), used the VOCA for 5.7 ± 4.6 days. Ease of Communication Scale measurements showed significantly less difficulty with communication after device use (t > 2.62; P = .047). Almost half ( n = 5) of the participants demonstrated some independent use of the device. VOCAS were used in one quarter of observed communication events. Patients used VOCAs most often to communicate with family visitors and initiated communication interactions more often when VOCAs were used than when communicating by other nonvocal methods. Poor device positioning, deterioration in patient condition, staff time constraints, staff unfamiliarity with device, and complex message screens were primary barriers to VOCA use. Conclusions This study showed that use of VOCAs is possible with selected critically ill adults and may contribute to greater ease of communication during respiratory tract intubation particularly with family members. Further clinical research using control or comparison groups is needed.

Improved comprehension of object names following voice output communication aid use: Two case studies

This paper describes two case studies of children learning to use voice output communication aids (VOCAs). Both children were under 6 years of age and had severe cognitive disabilities. Intervention consisted of teaching the children to use their VOCAs in joint activity routines to request items. We measured the participants' comprehension of targeted vocabulary before and during intervention. Both participants learned to request a total of six different objects using their VOCAs. In addition, they showed evidence of increased comprehension skills for the names of the objects requested. These results suggest the need for further research demonstrating a causal relationship between VOCA use and gains in speech comprehension.

Children's use of memory strategies: Relevance to voice output communication aid use

Memory strategies are implicated in the use of voice output communication aids. They are necessary to facilitate the memorization and subsequent recall of information, including preprogrammed vocabulary (i.e., single words and longer texts) and codes that retrieve vocabulary programmed under several keys (e.g., in Minspeak™-based applications). The augmentative and alternative communication field could benefit from existing research that has examined the development of memory strategy use in young children. Memory strategies differ in terms of their functional properties, such as automaticity, reliance on symbolic mediators, and overall complexity. Developmental constraints are reflected in predictable performance errors. Adults can help children become insightful about when, how, and why to apply a memory strategy. This insight, called metamemory, can motivate a child to complete boring tasks (e.g., memorizing codes).