Speech-generating Device Research Articles

Three children with autism spectrum disorder learn to perform a three-step communication sequence using an iPad®-based speech-generating device

BackgroundMany children with autism spectrum disorder (ASD) have limited or absent speech and might therefore benefit from learning to use a speech-generating device (SGD). The purpose of this study was to evaluate a procedure aimed at teaching three children with ASD to use an iPad®-based SGD to make a general request for access to toys, then make a specific request for one of two toys, and then communicate a thank-you response after receiving the requested toy. MethodA multiple-baseline across participants design was used to determine whether systematic instruction involving least-to-most-prompting, time delay, error correction, and reinforcement was effective in teaching the three children to engage in this requesting and social communication sequence. Generalization and follow-up probes were conducted for two of the three participants. ResultsWith intervention, all three children showed improvement in performing the communication sequence. This improvement was maintained with an unfamiliar communication partner and during the follow-up sessions. ConclusionWith systematic instruction, children with ASD and severe communication impairment can learn to use an iPad-based SGD to complete multi-step communication sequences that involve requesting and social communication functions.

Acquisition, Preference, and Follow-up Data on the Use of Three AAC Options by Four Boys with Developmental Disability/Delay

We compared how quickly four boys with developmental disability/delay learned to use manual signing (MS), picture exchange (PE), and a speech-generating device (SGD) to request the continuation of toy play. Opportunities to choose to use MS, PE, and SGD were included to determine if the boys showed a preference for using one of these options. Follow-up sessions occurred at 12, 15, and 18 months post-intervention. With intervention, three of the four participants learned to use each option, but one child only learned to use PE. Trials to criterion across children ranged from 22 to 28 for the SGD, from 12 to 60 for PE, and from 21 to 64 trials for MS. For the three participants who reached criterion with each AAC system, maintenance results were best for PE and SGD. Preference assessments during follow-up showed that participants most often chose the SGD, indicating a preference for that option. The findings suggest there may be value in assessing a child’s preference for different AAC options as part of the post-intervention follow-up process.

The Potential Influence of Stimulus Overselectivity in AAC: Information from Eye Tracking and Behavioral Studies of Attention with Individuals with Intellectual Disabilities

This paper examines the phenomenon of stimulus overselectivity, or overselective attention, as it may impact AAC training and use in individuals with intellectual disabilities. Stimulus overselectivity is defined as an atypical limitation in the number of stimuli or stimulus features within an image that are attended to and subsequently learned. Within AAC, the term stimulus could refer to symbols or line drawings on speech-generating devices, drawings or pictures on low-technology systems, and/or the elements within visual scene displays. In this context, overselective attention may result in unusual or uneven error patterns such as confusion between two symbols that share a single feature, or difficulties with transitioning between different types of hardware. We review some of the ways that overselective attention has been studied behaviorally. We then examine how eye tracking technology allows a glimpse into some of the behavioral characteristics of overselective attention. We describe an intervention approach, differential observing responses, that may reduce or eliminate overselectivity, and we consider this type of intervention as it relates to issues of relevance for AAC.

VocaliD: Personal voices for augmented communicators

The goal of the VocaliD project (for vocal identity) is to develop personalized synthetic voices for children and adults who rely on speech generating devices (SGDs) for verbal communication. Our approach extracts acoustic properties related to source, vocal tract, or both from a target talker’s disordered speech (whatever sounds they can still produce) and applies these features to a synthetic voice that was created from a surrogate voice donor who (ideally) is similar in age, size, gender, etc. The result is a synthetic voice that contains as much of the vocal identity of the target talker as possible yet the speech clarity of the surrogate talker’s synthetic voice. To date, we have deployed several synthetic voices using this technology. Three case studies will be presented to illustrate the methods used in voice generation and the results from three pediatric SGD users. We will also describe plans to greatly extend our database of surrogate voice donor speech, allowing us to better match regional/dialectical features to the needs of the target SGD users.

Barriers and facilitators to children's use of speech‐generating devices: a descriptive qualitative study of mothers' perspectives

The purpose of this study was to identify barriers and facilitators to children's use of speech-generating devices (SGD). Interviews with 14 mothers were analyzed with content analysis to identify barriers and facilitators to SGD use. This study identified a number of specific barriers and facilitators to successful and sustained SGD use by children with complex communication disorders. Nurses can use the list of barriers and facilitators provided here as a springboard to discuss the families' experiences with device use.

Communication Interventions for Minimally Verbal Children With Autism: A Sequential Multiple Assignment Randomized Trial

This study tested the effect of beginning treatment with a speech-generating device (SGD) in the context of a blended, adaptive treatment design for improving spontaneous, communicative utterances in school-aged, minimally verbal children with autism. A total of 61 minimally verbal children with autism, aged 5 to 8 years, were randomized to a blended developmental/behavioral intervention (JASP+EMT) with or without the augmentation of a SGD for 6 months with a 3-month follow-up. The intervention consisted of 2 stages. In stage 1, all children received 2 sessions per week for 3 months. Stage 2 intervention was adapted (by increased sessions or adding the SGD) based on the child's early response. The primary outcome was the total number of spontaneous communicative utterances; secondary measures were the total number of novel words and total comments from a natural language sample. Primary aim results found improvements in spontaneous communicative utterances, novel words, and comments that all favored the blended behavioral intervention that began by including an SGD (JASP+EMT+SGD) as opposed to spoken words alone (JASP+EMT). Secondary aim results suggest that the adaptive intervention beginning with JASP+EMT+SGD and intensifying JASP+EMT+SGD for children who were slow responders led to better posttreatment outcomes. Minimally verbal school-aged children can make significant and rapid gains in spoken spontaneous language with a novel, blended intervention that focuses on joint engagement and play skills and incorporates an SGD. Future studies should further explore the tailoring design used in this study to better understand children's response to treatment. Clinical trial registration information-Developmental and Augmented Intervention for Facilitating Expressive Language (CCNIA); http://clinicaltrials.gov/; NCT01013545.

Effect of Number of Graphic Symbols, Levels, and Listening Conditions on Symbol Identification and Latency in Persons with Aphasia

This study investigated the ability of persons with aphasia to complete a series of experimental tasks involving single symbol and subject-verb-object sentence identification on a speech-generating device (SGD) in the presence/absence of competing stimuli. In all, 10 persons with Broca's aphasia and 10 persons in the control group were compared on accuracy and response latency of symbol identification across three listening conditions. Persons with aphasia identified fewer symbols accurately and had longer response latencies than persons in the control group. Number of symbols on the screen and location level had a significant effect on accuracy and latency for both groups. Persons with aphasia perceived tasks to be more difficult than persons in the control group. Results indicate that effective use of SGDs by persons with aphasia may depend on several message organization factors including location and number of symbols per screen.

Within Stimulus Prompting to Teach Symbol Discrimination Using an iPad® Speech Generating Device

This study evaluated the effects of within stimulus prompting and prompt fading to teach four preschool children with autism picture symbol discrimination using an iPad® and the Proloqu2Go application as a speech-generating device. Participants were taught to discriminate between a progressively more complex field of picture-symbols depicted on the screen of an iPad with a five-phased training procedure. All participants acquired discrimination between picture-symbols while using the iPad to mand for preferred items in a field of four picture-symbols. The results provide tentative support for a procedure to teach children with autism to discriminate between picture symbols while manding using a handheld speech-generating device.

An examination of the effectiveness of video modelling intervention using a speech-generating device in preschool children at risk for autism

Objective: To investigate whether preschool children at risk for autism would learn to request a preferred object using a speech-generating device (SGD) following a video modelling (VM) intervention and generalize requesting behaviours to preferred objects across stimuli and communication partners. Method: A single-subject multiple baseline design across participants (n = 3) was used to assess the effects of VM intervention on requesting behaviour. Intervention consisted of having each participant view a VM of two adults demonstrating the requesting of a preferred object using the SGD. Additionally, a least-to-most-prompting technique was employed to facilitate the production of a correct response. Results: All three participants demonstrated the ability to request preferred objects following the intervention and were able to generalize the newly acquired requesting behaviour across stimuli and people. Conclusions: Study findings indicate that a VM treatment package is effective in facilitating communication in children with little or no functional speech.

Manual motor-plan similarity affects lexical recall on a speech-generating device: Implications for AAC users

Language production via high-tech alternative/augmentative communication (AAC) devices involves use of motor sequences that are determined by the visuo-spatial characteristics of a particular device. The current study uses traditional short-term memory tasks with device-based output to demonstrate that typical talkers show a trend toward device-specific modality interference in short-term device-based recall. The theoretical implications of these early findings with regard to models of working memory and the clinical implications are discussed.Learning outcomes: (1) Describe two modalities of non-phonological short-term storage, (2) List a potential effect of SGD-based output on modality of short-term word storage, (3) Describe a theoretical implication of device-based representations with regard to models of working memory, and (4) Describe a clinical application of the concept of motor memory in AAC.

‘Happy and excited’: Perceptions of using digital technology and social media by young people who use augmentative and alternative communication

Young people are using digital technology and online social media within their everyday lives to enrich their social relationships. The UK government believes that using digital technology can improve social inclusion. One well-recognized outcome measure for establishing social inclusion is to examine opportunities for self-determination. Individuals with physical disabilities and complex communication needs who use forms of augmentative and alternative communication (AAC) have lower social participation opportunities. The integration of mainstream digital technology into high-tech forms of AAC (voice output communication aids), and the recent appearance of voice output applications, or ‘apps’, on Apple and Android products, has provided increased opportunities for people who use AAC to engage with digital technology. Research exploring this area, especially in regard to online social media, with people who use AAC is extremely limited, and a specific gap for self-reported experiences exists within the UK. This article describes qualitative, interview-based, grounded theory research with 25 adolescents and young adults who use AAC about their use of digital technology and online social media. The data presented here are part of a larger study, and the findings within this article suggest that participants have a desire to use the internet and online social media as it is perceived to increase opportunities for self-determination and self-representation whilst enriching friendships. The wide diversity of literacy and language skills amongst participants, as well as accessibility challenges, mean collaborating with others and receiving technical support from educational settings, families and friends are vital.

Augmentative and Alternative Communication for Individuals with Autism Spectrum Disorder and Intellectual Disability

Many individuals with autism spectrum disorder and intellectual disability are candidates for augmentative and alternative communication (AAC). We review two current trends in AAC research involving persons with ASD and intellectual disability. The first trend is the use of smartphone and tablet devices in AAC interventions. The second trend is the direct comparison of the relative efficacy of differing AAC options, for example comparing the use of manual signs versus picture-based communication systems versus speech-generating devices. Studies in the first group suggest that this new technology can be effectively used in AAC intervention. Studies in the latter group have found differences in how quickly some individuals have learned to use different options and differences in preference for the various options. These research trends suggest a possible new direction for AAC intervention that incorporates aspects of self-determination.

Comparing acquisition of and preference for manual signs, picture exchange, and speech-generating devices in nine children with autism spectrum disorder

Objective: To compare how quickly children with autism spectrum disorder (ASD) acquired manual signs, picture exchange, and an iPad®/iPod®-based speech-generating device (SGD) and to compare if children showed a preference for one of these options.Method: Nine children with ASD and limited communication skills received intervention to teach requesting preferred stimuli using manual signs, picture exchange, and a SGD. Intervention was evaluated in a non-concurrent multiple-baseline across participants and alternating treatments design.Results: Five children learned all three systems to criterion. Four children required fewer sessions to learn the SGD compared to manual signs and picture exchange. Eight children demonstrated a preference for the SGD.Conclusion: The results support previous studies that demonstrate children with ASD can learn manual signs, picture exchange, and an iPad®/iPod®-based SGD to request preferred stimuli. Most children showed a preference for the SGD. For some children, acquisition may be quicker when learning a preferred option.

Policy Analysis: Medicare Speech-Generating Devices Classified as Rent-to-Own

You have accessThe ASHA LeaderPolicy Analysis1 Jan 2014Policy Analysis: Medicare Speech-Generating Devices Classified as Rent-to-Own Mark Kander Mark Kander Google Scholar More articles by this author https://doi.org/10.1044/leader.PA4.19012014.np SectionsAbout ToolsAdd to favorites ShareFacebookTwitterLinked In Medicare Speech-Generating Devices Classified as Rent-to-Own Speech-generating devices provided under Medicare will be classified as rent-to-own beginning April 1, 2014, according to a final rule released by the Centers for Medicare and Medicaid Services in November. Despite ASHA’s concerns about the rule, CMS made no changes to the proposed rule [http://www.asha.org/Publications/leader/2013/130901/Policy-Analysis--Rent-to-Own-May-Be-Only-Option-for-Medicare-Speech-Generating-Devices.htm], which classifies each of the six types of speech-generating devices—as well as 74 other pieces of durable medical equipment—as “capped rental” rather than purchased equipment. Under this rent-to-own rule, Medicare pays the supplier (105 percent of the purchase price) over 13 months. The beneficiary’s cost is the standard 20 percent copay of the total rental payments. After 13 months, ownership is immediately assigned to the patient. ASHA submitted comments to CMS emphasizing the danger posed by the Medicare requirement, which might prevent a beneficiary from keeping the device if the beneficiary spends time in a hospital, hospice or skilled nursing facility. The supplier may allow the patient to keep the SGD during inpatient stays, but will receive no monthly payment. ASHA objected to the continual use requirement, noting that under this policy a patient could lose functional communication as an inpatient—when the ability to communicate is critical. The device supplier’s obligations remain the same as current rental requirements: · The supplier must maintain the SGD in good working order for five years. · The SGD cannot be issued unless the physician presents an order accompanied by an evaluation from a certified speech-language pathologist. CMS staff encourage beneficiaries to examine rental contracts carefully if the supplier does not accept Medicare assignment. Contracts often allow the supplier to bill for extra services or features that are not medically necessary. For more information, see the final regulation [www.ofr.gov/OFRUpload/OFRData/2013-28451_PI.pdf].Capped rental rules appear in Chapter 20,Sections 30.5–50, of the Medicare Claims Processing Manual[www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c20.pdf]. Advertising Disclaimer | Advertise With Us Advertising Disclaimer | Advertise With Us Additional Resources FiguresSourcesRelatedDetails Volume 19Issue 1January 2014 Get Permissions Add to your Mendeley library History Published in print: Jan 1, 2014 Metrics Downloaded 69 times Topicsasha-topicsleader_do_tagleader-topicsasha-article-typesCopyright & Permissions© 2014 American Speech-Language-Hearing AssociationLoading ...

Technology-based intervention programs to promote stimulation control and communication in post-coma persons with different levels of disability

Post-coma persons in a minimally conscious state and with extensive motor impairment or emerging/emerged from such a state, but affected by lack of speech and motor impairment, tend to be passive and isolated. A way to help them develop functional responding to control environmental events and communication involves the use of intervention programs relying on assistive technology. This paper provides an overview of technology-based intervention programs for enabling the participants to (a) access brief periods of stimulation through one or two microswitches, (b) pursue stimulation and social contact through the combination of a microswitch and a sensor connected to a speech generating device (SGD) or through two SGD-related sensors, (c) control stimulation options through computer or radio systems and a microswitch, (d) communicate through modified messaging or telephone systems operated via microswitch, and (e) control combinations of leisure and communication options through computer systems operated via microswitch. Twenty-six studies, involving a total of 52 participants, were included in this paper. The intervention programs were carried out using single-subject methodology, and their outcomes were generally considered positive from the standpoint of the participants and their context. Practical implications of the programs are discussed.

Reviewer Thank you list

This study used a standard touchscreen computer with a newly developed Communication Request and Automatic Response Assistive Program (CRARAP) software package to evaluate whether two people with autism spectrum disorders (ASDs) would be able to actively perform communication requests to continue their preferred environmental stimulation. The CRARAP software was specifically developed for this study to combine the functions of a standard touchscreen computer with a speech-generating device (SGD) and the feature of automatic response to requests. A multiple probe design across participants was adopted in this study. The results show that both participants significantly improved their target responses in terms of performing the correct alternative communication request during the intervention phase, and retained this effective performance in the maintenance phase. The practical and developmental implications of the findings are discussed.

Australian parents’ experiences of speech generating device (SGD) service delivery

Objective: To explore parents’ perceptions of existing support for families with a new speech generating device (SGD).Method: Six Australian parents of school-aged children who used an SGD participated in semi-structured interviews about their experiences of SGD support. Data were explored and compared using narrative analysis.Results: Participants discussed barriers to service access, including long waiting lists, service exclusion policies and limited therapist expertise in SGD practice. They emphasized the value of ongoing service coordination for families. Finally, participants discussed the nature of role boundaries and responsibilities for parents vs. therapists in the intervention process and the impact that intervention approaches had on parent autonomy, empowerment and confidence.Conclusion: Having an SGD at home generates ongoing support needs, which had not been well met for some parents in our study. Results suggest that timely, well coordinated and family-centred support may enhance service experience for families with a new device.

Exploring the Impact of Cognition on Young Children's Ability to Navigate a Speech-Generating Device

This study examined the impact of cognition on young children's ability to navigate a speech-generating device (SGD) with dynamic paging. Knowledge of which cognitive factors impact navigational skills could help clinicians select the most appropriate SGD for children who have complex communication needs. A total of 65 typically developing children aged 48–77 months were assessed using the Leiter International Performance Scale-Revised (Leiter-R) and the Automated Working Memory Assessment (AWMA). Although significant correlations were found between the ability to navigate an SGD (using a taxonomic organization) and all cognitive factors except for cognitive flexibility, a stepwise linear regression revealed that sustained attention, categorization, and fluid reasoning were the most pragmatic set of factors to predict navigational skills. Future studies are needed to further understand the factors that impact children's navigational skills.

The Effects of Peer Assisted Communication Application Training on the Communicative and Social Behaviors of Children with Autism

Non-verbal children with autism are candidates for augmentative and alternative communication (AAC). Augmentative and Alternative Communication is defined as systems that either supplement or replace existing communication when speech impairments are present, such as the case with non-verbal children with autism (Mirenda, Language Speech and Hearing Services in Schools 34(3), 203–216, 2003). One type of AAC device is a speech-generating device (SGD). The primary drawbacks of past SGDs, which are portable electronic devices that produce digitized speech were their expense and portability. Newer iPod-based VOCAs alleviate these concerns. This study sought to evaluate an iPod-based SGD and a peer mediated intervention to teach children with autism more sophisticated communication skills. Using a multiple baseline design, four children with autism were taught through peer assisted communication application (PACA) training how to mand using a two-step sequence and respond to the questions, “What do you want?” and “What is your name?” using a two-step sequence. Data were taken on the number of independent mands and independent responses. Results indicated that three of the four participants were able to acquire communicative skills. The implications are analyzed in regards to the effectiveness of peer assisted communication application training to teach sophisticated communication skills.

Preference-Enhanced Communication Intervention and Development of Social Communicative Functions in a Child With Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) who exhibit limited speech can learn to communicate using augmentative and alternative communication (AAC) systems. We describe the case of Ian, a 10-year-old boy with ASD who had learned to use an Apple iPod®- and iPad®-based speech-generating device (SGD)Note 1, picture exchange (PE), and manual signing (MS) for functional communication (e.g., requesting), but had difficulty in using these AAC systems for spontaneous and socially oriented functions of communication. His difficulties were originally conceptualized as reflecting the social interaction and communication deficits characteristic of ASD. Alternatively, we suggest that the intervention did not allow for the development of more advanced communication. A preference-enhanced intervention was introduced with Ian’s chosen AAC system only, that is the iPad®-based SGD. Opportunities for communication were created using highly motivating activities and behavioral strategies. Results suggest that the approach facilitated development of spontaneous and socially oriented communication.