Aided Nonverbal Communication through Physical Expressive Objects

Supporting Families of Children Who Use AAC

Access to Justice: An SLP’s Guide to Helping Persons with Complex Communication Needs Voice Their Case

BackgroundAlzheimer’s disease and related dementias (ADRD) are leading causes of disability and often result in communication deficits that can complicate ADRD caregiving and clinical care. Augmentative and Alternative Communication (AAC) devices have been shown to provide assistance in communication for persons with ADRD, although many of these devices have been criticized for limited ability to customize content or design, and not addressing the impact of communication deficits on the larger family unit. This program of research has been informed by related theoretical frameworks: person‐centered (PCT) and family‐centered theories (FCT).MethodAn interdisciplinary team working with stakeholders are designing a novel information technology prototype with a touchscreen to promote communication and personhood for persons with ADRD. This improved ACC device is best described as an AAC Plus. The AAC Plus goes beyond traditional AAC in that it can be integrated into an existing healthcare delivery system and provide real‐time clinical data and health trends to the healthcare provider for early detection, intervention, and monitoring of clinical symptoms. In addition, the AAC Plus: (1) is designed to promote engagement and communication for interactions between the caregiver and person with ADRD using ubiquitous touchscreen technology; (2) facilitates tracking of behavioral and other clinical information about the person with ADRD, such as sleep and appetite; (3) has easily customizable interfaces for the caregiver and person with ADRD.ResultUsability and feasibility will be tested using common use case scenarios, user experience testing, alpha testing, and beta testing methodologies to evaluate ease‐of‐use and cognitive ergonomics for both caregivers and persons with ADRD. This will include evaluating the design layout, user flow, and integrated content for the device’s interfaces. Once usability and feasibility is established, the team will conduct a randomized trial of the AAC Plus, in collaboration with Memory Centers in the United States (R01 AG068572‐01).ConclusionThis presentation will provide content on the process of development and human‐computer interaction methodologies used to develop an evidence‐based, innovative technology for people with ADRD and their caregivers. Attention will also be given for developing technologies for ADRD care that integrate person and family‐centered design.

Patients with dementia (PWD) often face challenges with daily activities due to communication challenges, which may lead to negative outcomes for those with dementia and their family caregivers alike. Augmentative and alternative communication (AAC) devices have demonstrated to be feasible in supporting communication among PWD (May et al., 2019) through text, graphics, and/or sound. Traditional AAC devices have been non‐electronic memory and communication aids (May et al., 2019). However, in recent years many primary caregivers of PWD are seeking out mobile applications to address this challenge using their smartphone or tablet. However, mobile applications addressing communication skills specifically for dementia care are scarce despite their potential to improve quality of life (Ambegaonkare et al., 2021; Brown et al., 2023). To better understand the current landscape of AAC mobile applications, this systematic review identified and evaluated the features and design of commercially‐available mobile applications. A total of 27 AAC apps were identified through searches on the Apple IOS store and Google Play, after excluding duplicates and apps that targeted primarily children. Four research team members were involved in cataloging features and evaluating the apps using a modified version of the Mobile App Rating Scale (Stoyanov et al., 2015). The price of apps varied, though many listed as being free or low‐cost often required higher‐priced subscriptions or licensing fees. All apps were compatible for English speakers, though several were available in multiple languages. It was found that the apps varied in their potential for engagement, functionality, aesthetics, and information. It was also found that many apps are limited in their potential to support caregiving activities (e.g., mealtime, dressing) for those with communication barriers related to cognitive impairment. Apps that are limited in their ability to customize the interface to the user’s preferences for daily care may impede person‐centered care practices for PWD. Implications for practice, policy, and research are discussed.

This case study focused on skill generalization following instruction of an adolescent girl with multiple disabilities using two augmentative and alternative communication (AAC) devices: a simple pictographic display and a voice output communication aid (VOCA) with an identical display used as an overlay. An alternating treatments design was used to assess community members' response latency, focus of attention, and comprehension of requests made via the two AAC devices. Skill generalization occurred for both devices, with similar rates of efficiency. These findings underscore the importance of the use of multiple modalities and of incorporating individual preferences to enhance the communicative competence of individuals who use AAC in natural environments.

Smart Predict is a novel two-tablet application developed to improve conversational efficiency for people who use augmentative and alternative communication (AAC) devices. The Smart Predict system consists of two distinct applications that were built for use with two Android tablets and/or phones with Bluetooth® capability. One application is referred to as the AAC User app and the second application is called the Partner app. Smart Predict integrates vocabulary supplementation from communication partners in real-time while persons who rely on AAC generate text and maintain full control to choose words within a word prediction line. Using single-case research designs with adapted alternating treatments under two counterbalanced treatment conditions (AAC User app alone versus AAC User app + Partner app), we examined message efficiency with persons who rely on switch scanning for on-screen keyboards. User experience questionnaires were administered to determine satisfaction and workload, and to provide feedback for future development efforts. Three adults with complex communication needs and motor impairments conversed with research staff about fourteen movie trailers. Characters per minute and switch selections per character produced by the person with complex communication needs and motor impairments were measured during 15-minute interviews to represent communication speed and effort. Results indicate that message efficiency increased with the dual-tablet Smart Predict, indicating faster message generation with the vocabulary supplementation system. User satisfaction increased and perceived effort decreased under the Smart Predict conditions. Given these results within a research and development framework, the Smart Predict concept is a viable feature that could be considered within smart AAC technologies.

Communicating at a natural speed is a significant challenge for users of augmentative and alternative communication (AAC) devices, especially when input is provided by eye gaze, as is common for people with ALS and similar conditions. One way to improve AAC throughput is by drawing on contextual information from the outside world. Toward this goal, we present SceneTalk, a prototype gaze-based AAC system that uses computer vision to identify objects in the user's field of view and suggests words and phrases related to the current scene. We conducted a formative evaluation of SceneTalk with six people with ALS, in which we evaluated their preference for user interface modes and output preferences. Participants agreed that integrating contextual awareness into their AAC device could be helpful across a diverse range of situations.

The current study researches the impact of voice output communication aids (VOCA) on the language acquisition of toddlers and school-aged children with developmental disabilities. There are a wide variety of augmentative and alternative communication (AAC) devices available to nonverbal individuals, making the decision of parents, teachers, and speech pathologists of which to use and implement a substantial task, one that needs the guidance of research based evidence. SPSS software was used to conduct a series of analyses with secondary data from Nancy Brady’s study Language Development of Non-verbal Children Age 3 Years through 7 Years, 2007 to 2012, looking specifically at the increase in total words rate of children using various AAC interventions over a year’s time. Total words rate scores were determined using the number of different words each child spoke, signed, or selected during observations and assessments completed by researchers. A multitude of T-tests and a multiple regression equation were run, comparing the outcomes of participants based on their use of a VOCA and presence of an autism diagnosis. Results found participants using other forms of augmentative communication to have a higher total words rate at time 2 than those using VOCA, though these findings were not significant. Gender and autism were not found to be significant predictors of language acquisition, though being male was positively correlated with total words rate scores. Analyses also concluded that participants with an autism diagnosis using VOCA had a slightly higher total words rate at time 2 than those with other developmental disabilities using VOCA, though these findings were also not significant. Future research should consider looking at a randomly selected sample with a wider quantitative range of expressive vocabulary, as well as obtaining the identification of the type and severity of a child’s diagnosis to further clarify the evidence-based benefits of VOCA with specific populations.

With ongoing advancements in eye-tracking technology, more individuals with complex communication needs (CCN) and who have limited arm and hand movements are exploring the use of eye-gaze technology for accessing their augmentative and alternative communication (AAC) devices. This chapter outlines the various factors that need to be taken into account when evaluating an individual’s ability to use this technology; many of these relate to the roles and functions of an occupational therapist as a member of a multidisciplinary team. Clinical research examining the suitability of eye-gaze technology for various populations is limited; documentation of its effectiveness is based on individual’s testimonials or reports. A case study highlights the role of the occupational therapist in conducting eye-gaze trials with a girl with Rett syndrome.

Objective. Various augmentative and alternative communication (AAC) devices have been developed in order to aid communication for individuals with communication disorders. Recently, there has been interest in combining EEG data and eye-gaze data with the goal of developing a hybrid (or ‘fused’) BCI (hBCI) AAC system. This work explores the effectiveness of a speller that fuses data from an eye-tracker and the P300 speller in order to create a hybrid P300 speller. Approach. This hybrid speller collects both eye-tracking and EEG data in parallel, and the user spells characters on the screen in the same way that they would if they were only using the P300 speller. Online and offline experiments were performed. The online experiments measured the performance of the speller for sixteen non-disabled participants, while the offline simulations were used to assess the robustness of the hybrid system. Main results. Online results showed that for fifteen non-disabled participants, using eye-gaze in a Bayesian framework with EEG data from the P300 speller improved accuracy (, , for estimated, medium and high variance configurations) and reduced the average number of flashes required to spell a character compared to the standard P300 speller that relies solely on EEG data (, , for estimated, medium and high variance configurations). Offline simulations indicate that the system provides more robust performance than a standalone eye gaze system. Significance. The results of this work on non-disabled participants shows the potential efficacy of hybrid P300 and eye-tracker speller. Further validation on the amyotrophic lateral sceloris population is needed to assess the benefit of this hybrid system.

Cerebral Palsy (CP) is a common neurodevelopmental condition encountered by pediatricians. The condition may present itself in many different kinds of classification. In many cases, the cause of CP may not be apparent. Cerebral Palsy is always showing many deficits such as mental retardation, speech and language and oral motor problems. This project inspired from Elisya, a nine-year-old kid that has CP since born and she have the communication problems since she cannot speak to express her opinions and desires. The main focus on this project is to help to improve the communication issues among CP children. In order to assist the people with CP, the assistive tool is required to help them to communicate or interact with people around them. Assistive technology includes equipment, devices and software solutions that increase functional capabilities of people with disabilities and improve the quality of their lives. There are several Augmentative and Alternative Communication (AAC) devices for people with Cerebral Palsy that are not able to speak. One of the ways to make this happen is to implement the AAC technology with mobile technology by developing a mobile application named as Make Me Speak and React Native technology in order to build the cross platform for this application since the application should be run on IOS and Android platform so it’s easier for other people to bring it anywhere and use it at any time. It also involves CP centres and school to do experimental studies for this project. There are several studies shows that AAC technology can help in enhancing the speech and language development and in this project, the suggested mobile application should be friendly to our language and culture of our nation, Malaysia and the project is in line with the social innovation in the Eleventh Malaysia Plan (RMK-11).

Difficulty with social interactions is a feature of Autistic Spectrum Disorder (ASD) and can be present in children who have other developmental disorders. A novel application using computer technology was designed by Callaghan Innovation to improve social interaction in this population by assisting casual conversation between two people with minimal external facilitation. We compared the application with the children’s existing Augmentative and Alternative Communication (AAC) devices and Picture Communication Symbols (PCS™). A sample of three pairs (n = 6) of adolescents, who have a diagnosis of ASD or another developmental condition affecting their social interaction and communication, were videotaped and analysed using all three modes. The new application provided better social interaction, attention, independence and enjoyment than the existing systems.

Children with autism spectrum disorder (ASD) show differences in their communication development when compared to children who are typically developing and other clinical populations. In addition, children with ASD show divergence and delays in their expressive language when compared to each other, and a reported 30% do not develop spoken language even with access to early intervention. In order to support children with ASD in their communication development, there is a critical need for (a) detailed accounts of the emergence of expressive language for children receiving early intervention, (b) investigation of factors that might explain differences in expressive language abilities, and (c) investigation of sensitive predictors of expressive language change for children receiving early intervention. Children with ASD are often recommended augmentative and alternative communication (AAC) as part of early intervention to augment existing communication abilities, thus providing a complementary communication system while supporting early language development. Augmentative and alternative communication can be introduced as a focused intervention to target communication specifically, or it can be introduced as part of a comprehensive intervention program targeting multiple domains of learning. When used as part of a comprehensive intervention program, AAC is believed to support communication development broadly, including children’s use of spoken language. Despite emerging evidence for its effectiveness as a focused intervention and potential to support spoken language development within the context of comprehensive interventions, little research exists examining the mechanisms underpinning outcomes of AAC interventions. The current project aimed to address this gap by investigating both the emergence of expressive language in children with ASD, and factors underpinning concurrent and longitudinal expressive language abilities for children receiving an AAC-infused comprehensive intervention program. This research was conducted as a series of three studies: Study 1 investigated the communication profiles of 246 children with ASD upon entry and exit to a comprehensive early intervention program; Study 2 investigated mechanisms underpinning concurrent expressive language abilities, and Study 3 investigated predictors of longitudinal expressive language abilities, in 48 children with ASD receiving an AAC-infused comprehensive intervention program. The findings from Study 1 documented that 58.7% of children who started early intervention as minimally verbal remained minimally verbal after approximately 12 months of intervention, while 41.3% went on to develop phrase speech (using two-word phrases), highlighting an as yet unmet clinical need, as well as research need to understand these differences. The findings from Study 2 challenged previously held beliefs regarding word learning abilities in children with ASD, and extended on previous research by investigating the relationship between symbolic word learning and expressive language level. By focusing on processes that might be relevant to children’s development within interventions incorporating AAC, the findings from Study 3 provided preliminary data on the characteristics of children who might experience the largest gains in spoken language within AAC-infused comprehensive interventions. This research demonstrated a novel approach to investigating variability in expressive language development in children with ASD. The findings from this research demonstrate potential to explain some of the variability through analysis of social-cognitive learning processes that might help predict change within intervention. Finally, the findings of this research have potential to inform how researchers and clinicians approach individual differences in all children who present with complex developmental profiles.

Using a descriptive quantitative approach, this study examined the role of caregiver self-perceived comfort level (SPCL) in the success of augmentative and alternative communication (AAC) system implementation. The role of SPCL as a mediator variable affecting the relationship between the predictor variable (caregiver training resources) and the outcome variable (AAC use) was investigated. Related factors examined as covariates include caregiver demographics (gender, education level, and setting), the primary disability of the child or youth with complex communication needs, the type of AAC system (low-technology vs high-technology), and caregiver involvement in system selection. To examine the contribution of these variables to AAC use, the innovation decision model was used as a guide to propose a new framework describing how these factors are related as well as how they directly or indirectly impact AAC use. Data from a pre-administered Caregiver Training Survey was analyzed to answer the research question. There were 291 participants who completed the original survey. An inspection of the initial data revealed that 52.86% of the overall data was missing. Following Multiple Imputation using the fully conditional specification method, the data was analyzed including test of model fit, and multiple regression to test the direct and indirect effects of the independent variables on the dependent variable. For low-technology AAC, there was no statistically significant direct or indirect effect observed between the study variables. Thus, SPCL cannot be said to mediate the relationship between training resources and low-technology AAC use. For high-technology AAC, although SPCL cannot be said to mediate the relationship between training resource and AAC use, there were statistically significant direct and total effects of training resource on AAC use. The results suggest that SPCL does not mediate the relationship between caregiver training resources and AAC use for both low-technology and high-technology AAC. However, there were a few limitations that must be considered when interpreting the results. The significant amount of missing data meant that there was a significant inability to detect the studied effects using statistical analysis. This was further compounded with the fact that the survey was pre-administered and causal relationships between the variables in the study could not be established before a mediation analysis was conducted. Conducting a mediation analysis with observational data leaves room for multiple confounding variables. These limitations notwithstanding, the role of training resources in the communicative outcomes of children and youth with complex communication needs was established. The nature of this relationship should be further investigated, including the role of SPCL as a moderator that strengthens or weakens the observed relationship between training resources and AAC use.

An alternative and augmentative communication (AAC) device replaces or supplements a person’s natural speech. Speech-Language Pathologists (SLPs) collaborate with a team of healthcare professionals in the process of identification and use of the right AAC device for a person with complex communication needs (CCN). In the Philippines, occupational therapists (OTs) and SLPs are more likely to collaborate in the treatment of their clients due to their interprofessional education (IPE) experience. However, most Filipino SLPs do not engage in interprofessional collaboration (IPC) when rendering AAC services. Thus, there is a need to identify existing literature that tackles collaborative practices to raise the quality of service and care. Hence, this study aimed to identify and discuss existing literature that documented IPE and IPC strategies between OTs and SLPs in the field of AAC. The structure of this literature review was guided and adapted from the topics outlined in the preferred reporting items for systematic reviews and meta-analyses (PRISMA). Literature archived in two databases (Pubmed and Scopus) were reviewed. Two articles out of five studies were included in this review. Strategies found were “case based learning approach” for post-graduate students and the “Beyond Access model” in supporting practitioners. In conclusion, there is a dearth of literature on IPC practices among OTs and SLPs in the field of AAC. There is a need to report IPE and IPC efforts in the Philippines to provide applicable strategies to the local healthcare landscape.