ITHACA

Supporting Families of Children Who Use AAC

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

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.

Background and aims: Adults with acquired neurological disorders (stroke, Traumatic Brain Injury ...) develop their verbal communication and literacy capabilities as typical speakers and writers. They use these skills to participate academically, vocationally, recreationally, and socially. Depending upon their neurological condition, they gradually or suddenly lose their speech or language capabilities and are required to rely on Augmentative and Alternative Communication (AAC) systems to meet their communication needs. In addition to the loss of their spoken communication, the impact of their neurological condition on their participation patterns is potentially profound with reduced ability to care for themselves, a reduction or loss of employment, and usually a sudden or gradual restriction of their social networks. AAC is an umbrella term that encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. During the past five decades, AAC technologies have been developed to compensate for these natural communication losses. Stroke is one of the main causes of disability in the world. About 20% of stroke patients experience aphasia, with 20-30% of these individuals exhibiting severe communication deficits for at least a portion of their recovery period. Augmentative and Alternative Communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production of spoken or written language. Specifically designed Human Computer Interfaces (HCI), as an assistive technology, provides new channels of communication for patients with aphasia, dysarthria, and dyspraxia, when accompanied by movement impairments. In this workshop after stating a science review of the following types of issues: AAC acceptance (individually, culturally); AAC availability; AAC use patterns; AAC limitations are main issues, an AAC technology for post-stroke patients will be presented which developed by a knowledgebase company in Iran. The system allows patients with communication and motor impairment to state their intentions and feelings by a minimum movement in their body, or just by moving their eyes. Different sensors and switches are available to adopt based on the limited ability of the patients. For detecting eye movements, a novel wearable miniaturized system has been developed that is worn as a headband and detects eye movements based on processing electro-oculogram. A high performance graphical user interface has been developed to type letters and numbers in Persian language. The system also provides words prediction, text to speech conversion with natural voice, and sending/receiving messages in the mobile networks for a convenient communication experience. The developed system has been tested successfully by more than 20 patients with different disabilities, and is now commercially available.The proposed system can also help the severely disabled people with amyotrophic lateral sclerosis, quadriplegia, muscular dystrophy or cerebral palsy to communicate with others and mention their intentions, needs and feelings. This low-cost wearable device assures high level of comfort for the user without fatigue and do not need long time training. The system can also be adapted for the patients who can speak, but could not move their hands, to work with the computer and enjoy using the internet.

Augmentative and Alternative Communication (AAC) emerged as a combination of methods or strategies that constitute any device, such as Speech Generating Device (SGD), Program (mobile applications), Procedure (PECS, Picture Exchange Communication System), which enhances individual’s communication ability. Autism Spectrum Disorder (ASD) is a spectrum of comprehensive neurodevelopment disorder that leads to speech impairments, repetitive behavior, and social communication difficulties; therefore, it is imperative to underscore that at the core of all impediments are communication impairment. This article represents a systematic review of research initiatives that investigate multi-modal AAC strategies and functionality, features of mobile applications to reinforce communication and communal skills in verbally challenged ASD children because other researches are focused only on low or high-tech AAC or interventions to provide insights on ASD children respond to a particular approach. Following the PRISMA method, a total of 60 (January 2015 to October 2020) research articles were reviewed, indexed by Springer, Science Direct, Scopus, ACM, IEEE databases, and published in the AAC journal. The selected research articles are categorized into different themes where most of them focused on interactive mobile applications to improve emotional, social, learning, and overall communication skills in verbally challenged ASD children. This systematic review provides an outline of the paradigm shift in AAC modalities from PECS to Artificial Intelligence (AI), Machine Learning (ML), and Augmented Reality (AR) based applications. It opens up underline future opportunities to integrate intelligent analytics features in mobile applications to strengthen communication skills in verbally undermined ASD children.

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

Background and Objectives: The purposes of this study were (1) to conduct both Korean Augmentative and Alternative Communication Assessment Protocols(KAAP) and Korean Augmentative and Alternative Communication Intervention Protocols (KAIP) and (2) to provide directions to AAC assessment and intervention for young adults who use AAC in the workplace. Method: One transitional-age youth with intellectual disability who uses augmentative and alternative communication(AAC) participated in this study. KAAP and KAIP were conducted to the student in the working environment. Results: The members of AAC team for the student were parents, a SLP, a special education teacher, and managers. The student was able to sit in a chair and point to the picture representing the message. He also was able to use conventional modes of communication such as leading, gestures, verbals, and vocalization. Visual supports were provided to anticipate the steps and rules in the workplace. A communication necklace and comma AAC were provided to communicate with communication partners in the workplace. Conclusion: The student increased the accuracy of functional communication skills and participated more frequently in the workplace after AAC intervention. AAC intervention should be explained to employers in the working environment to have more job opportunities for AAC users.

Augmentative and alternative communication (AAC) is the study of the compensatory strategies for augmenting, supporting, or replacing communication via speech, e.g. speech generating devices (SGDs) and communication books. Because provision of AAC services (such as evaluation, treatment, and AAC system or device determination) is part of the scope of practice for speech and language pathologists (SLPs), it is important that students entering this field feel competent in their AAC knowledge. The purpose of this study was to examine the impact of additional components of AAC education (i.e., workshops and clinical practica) on SLP students’ preservice confidence levels in providing these services. An online survey was distributed via email to 49 SLP graduate students attending a large metropolitan university. The survey included questions in which students were asked to identify their education experiences, and then rate their levels of confidence in providing AAC services for individuals with complex communication needs (CCN). The results show trends indicating that additional clinical practica in AAC impacted student’s confidence levels in treating individuals with CCN and in determining appropriate AAC systems for the student. In conclusion, it is likely that required pre-service education in AAC needs to be more robust, especially in the area of device/system determination.

Prior research has highlighted the positive impact of augmentative and alternative communication (AAC) on speech and language development for children who cannot use speech alone. However, little is known about AAC use specifically for children with childhood apraxia of speech (CAS). Therefore, the purpose of this scoping review was to identify and synthesize twenty years of research investigating AAC use in children with CAS and determine gaps. A systematic search strategy was employed to identify relevant literature in five databases. and full-text screening was conducted by all authors. Forward and backward citation chaining was completed resulting in a total of 11 eligible studies. Study results were synthesized within three categories: therapy focused, profile and perspective studies. All studies highlighted that early AAC intervention may optimize communication outcomes for children with CAS. Therapy focused studies demonstrated that AAC fulfills a complementary role in the management of CAS. Perspective studies demonstrated that there are a variety of factors which influenced a SLP’s decision making surrounding AAC implementation for children with CAS. While prior systematic reviews have demonstrated the positive impact of AAC on speech production broadly, this review uniquely focuses on AAC use in children with CAS.

배경 및 목적: 말실행증을 동반한 표현성 실어증 환자는 말 산출에 어려움을 보여 일상생활에서 의사소통에 심한 어려움을 보이지만 보완대체의사소통(augmentative and alternative communication; 이하 AAC)을 적용하면 기능적인 의사소통 능력을 향상시킬 수 있다. 본 연구는 3명의 실어증 환자를 대상으로 AAC를 적용한 과정과 경과를 보고하고, 실어증에 서 AAC의 적용가능성에 대해서 알아보고자 하였다. <BR> 방법: 고려대학교 안암병원 언어치료실에서 심한 표현성 실어증으로 치료를 받던 3명의 환자를 대상으로 2013년 3월부터 2013년 9월까지 AAC 프로그램인 마이토키를 사용하여 훈련하였다. 사례 1은 72세 남자로 파라다이스`한국판-웨스턴실어증검사에서 실어증지수 10.8점, 사례 2는 52세 여자로 실어증지수 28.8점이었으며, 우뇌 병변 후 발생한 교차성 실어증이었다. 사례 3은 40세 남자로 실어증지수 16.2점으로 대상자 모두 브로카 실어증이었으며, 말실행증을 동반하고 있었다. 각 사례에 대해 개별적인 프로그램에 따라 AAC를 적용하였고, 훈련과정에서 환자의 반응과 치료 전후 의사소통능력의 변화를 기술하였다. <BR> 결과: 사례 1와 2은 각각 15회기와 17회기의 AAC훈련을 적용하였고, 치료 상황에서 자발적으로 간단한 의사표현을 하는 데에는 훈련이 가능하였다. 그러나 일상생활에서 의사소통기능의 변화는 관찰되지 않았고 사지실행증과 보속증으로 인해 프로그램을 학습하고 조작하는데 지속적인 어려움을 보였다. 사례 3은 총 8회기의 치료를 시행하였으나, AAC에 대한 요구도가 낮아 훈련을 지속하지 못하고 언어 이해와 말 산출 능력의 향상을 위한 언어치료로 전환하여 시행하였다. <BR> 논의 및 결론: 많은 실어증 환자는 언어기능 외에도 집행기능을 포함한 인지기능의 손상을 흔히 동반하게 된다. 실어증 환자에서 성공적으로 AAC를 적용하기 위해서는 실어증의 심한 정도 외에도 환자의 동기와 요구도, 인지기능의 손상여부, 실행증의 유무 등에 대한 평가를 통해 환자를 선별하는 절차가 필요하며, 실어증 환자의 특성에 따라 체계적으로 적용할 수 있는 AAC 훈련방법의 개발과 적절한 치료 전후의 변화 측정, 치료사에 대한 전문적인 교육 등이 중요할 것으로 생각된다.

BackgroundAugmentative and alternative communication (AAC) is a therapeutic approach and modality of expression for patients with limited or no expressive language. Speech-language pathologists and phoniatricians need to be competent in AAC to treat patients with complex communication needs. For knowledge acquisition and enhancement in AAC, a significant number of e-learning tools are available. To improve e-learning in AAC, it is essential to understand the attributes of these tools, such as formats, content areas, learning styles, or learning goals. However, these structures have yet to be investigated.ObjectiveWith this study, we aimed to (1) explore free access AAC e-learning tools that are appropriate for students and professionals of phoniatrics and speech-language pathology; (2) gain insight into formats, content areas, learning styles, and learning goals; and (3) investigate structural differences within and between basic and advanced learner level.MethodsIn 2023, we conducted a systematic web-based search with defined search terms in PubMed, peDOCS, Google Scholar, Google, the Apple App Store, and the Google Play Store in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines and piloting a protocol for data abstraction and validation. Inclusion criteria were free access, a mandatory minimum AAC content, and the use of the English or the German language. Social networks, video-sharing platforms, blogs, and forums were excluded. We analyzed formats (websites, online courses, apps, and podcasts), content areas (types of AAC, diagnostics, therapy, and other content areas), learning styles (visual, auditory, and audio-visual), and learning goals (receptive and performative) within and between basic and advanced level tools.ResultsWe identified 131 tools, of which 57 (43.5%) were basic level and 74 (56.5%) were advanced level. Of these 131 tools, 105 (80.2%) were websites, 21 (16%) were online courses, 3 (2.3%) were apps and 2 (1.5%) were podcasts. Only 12 out of 74 (16.2%) tools for advanced learners offered performative tasks. For basic learners no such tasks could be identified. For learning style, all basic tools and most of the advanced level tools were “visual (text)” (57/57, 100% basic vs 66/74, 89.2% advanced). In terms of content, advanced level tools pertained more often to “diagnostics” (28/57, 49.1% basic vs 65/74, 87.8% advanced) and “therapy” (17/57, 29.8% basic vs 64/74, 86.5% advanced). Advanced level courses were more likely online courses (2/57, 3.5% basic vs 19/74, 25.7% advanced) and more often showed audio-visual learning styles compared with basic level tools (5/57, 8.8% basic vs 27/74, 36.5% advanced).ConclusionsOur study showed that free-access AAC tools for phoniatrics and speech-language pathology varied in formats, content areas, learning styles, and learning goals. Furthermore, we found differences within and between learner levels. Thus, we established a basis for future research in e-learning in AAC.

Purpose Augmentative and alternative communication (AAC) has been shown to support communication and quality of life for persons with aphasia (PWA), yet its use in Jordan remains underexplored. This mixed-methods study aimed to investigate the perspectives of Jordanian speech-language pathologists (SLPs) towards the use of AAC for PWA. Materials and Methods Phase 1 involved a nationwide survey of 142 SLPs, with 101 responses analysed descriptively. Phase 2 of the study comprised two focus group discussions with 10 SLPs whose caseloads predominantly included PWA. Results From Phase 1 of the study, it was noted that only 18.8% of respondents had introduced AAC to PWA, most commonly via mobile applications and gestures. While the majority believed AAC to be beneficial, some SLPs continued to have misconceptions about AAC. Qualitative content analysis of the transcripts from the focus group discussions revealed three themes, which were: (i) views about AAC, (ii) challenges faced when using AAC, and (iii) hopes for the future. Conclusion Jordanian SLPs expressed a strong interest in learning more about AAC and called for its inclusion in pre-service education and ongoing professional development. Findings highlight the need for culturally and linguistically appropriate AAC resources, caregiver training, and professional capacity building to promote AAC adoption in Jordan.

Background: Increasingly, computerised communication aids are used by people with severe, chronic aphasia. Although the candidacy for these devices is relatively unknown, it has been hypothesised that cognitive deficits have a negative impact on the functional use of Augmentative and Alternative Communication (AAC). Deficits of executive functioning are assumed to be particularly important, but other functions, such as memory and semantic processing, may also be relevant. In a previous study (van de Sandt‐Koenderman, Wiegers, Wielaert, Duivenvoorden, & Ribbers, in press) we reported the functional effect of TouchSpeak (TS), a computerised communication aid, in a group of stroke patients with severe aphasia. The successful participants showed different levels of proficiency. Some were able to use the system independently and creatively in many situations, some used it independently for trained situations, and others remained partner dependent in using TS. Aims: To find factors associated with the functional success of TS in people with severe aphasia, focusing on memory, executive functioning, semantic processing, and communication skills. Methods & Procedures: The data of 30 patients with severe aphasia were analysed retrospectively. All were trained to use TS in two self‐chosen communicative situations. Four outcome levels were differentiated: no use, dependent use, independent use, and extensive use of TS. Pre‐training assessment included memory, executive functioning, semantic processing, and communication skills. The four outcome groups were compared regarding age, time post onset, gender, and aphasia type. The role of the cognitive variables was analysed with univariate ANCOVAs with contrast analysis, with correction for age, gender, aphasia type, or time post onset in case of significant differences between the groups on these variables. Outcomes & Results: Seven participants were classified as extensive users of TS, five were independent TS users, and five were partner dependent. In 13 cases there was no functional use of TS. Extensive users were younger than the other outcome groups. Independent of this age effect, there was an effect of semantic processing; the no‐use group scored significantly lower on semantics than all other groups. Conclusions: Only a minority of patients with severe aphasia may be expected to become independent, flexible users of high‐tech AAC. The finding that functional success was related to semantic processing is clinically important. Prospective studies are needed to support the predictive value of semantic processing for high‐tech AAC use. The importance of intact executive functioning is not supported in this study. The broad concept of “executive functioning” needs to be studied in more detail in relation to aphasia.

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.

PurposeThe purpose of this paper is to document augmentative and alternative communication (AAC) training provision by clinical services in England.Design/methodology/approachA questionnaire was used to obtain the following information concerning AAC training provision; frequency, length, type, content and cost, trainee occupations and numbers, and future training priorities, and information concerning training providers – service type, geographical area.FindingsIn total, 98 clinical service training providers in England responded. Services commonly reported providing AAC training to speech and language therapists, teaching assistants and teachers. Training around “use of specific AAC products, systems and technology” and “introducing/awareness raising of AAC products” were rated as high priority for future training and were two of the three subject areas where services reported the highest percentage of training. Training was predominantly provided at a foundation (basic) level.Originality/valueThere is no consensus on the amount or content of AAC training which professionals in England must receive. Evidence suggests that AAC training for pre-qualification professionals is limited and this paper has identified variation in the amount and type of post-qualification AAC training. While knowledge concerning specific AAC systems is necessary, focussing training primarily on this area may not address critical gaps in knowledge. There is a need for specific recommendations regarding AAC training for professionals in this field, to ensure professionals can fully support people who use AAC.