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Augmentative and alternative communication

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Augmentative and alternative communication (AAC) is communication for those with impairments or restrictions on the production or comprehension of spoken or written language.[1]

Aided and Unaided AAC

AAC is used by individuals with communication disorders for whom speech is temporarily or permanently inadequate to meet all or some of their communication needs. Speech may be replaced or augmented by using a variety of modes including body language, gesture, vocalizations, manual sign, writing and/or augmentative communication aids.

Unaided AAC

Unaided AAC systems are those that do not require any external device for their use.[2] They consist of nonverbal means of natural communication such as gestures, signed languages and systems, and vibrotactile codes.[3] In general, unaided forms of communication require adequate fine-motor coordination abilities.[3] Their use also necessitates the communication partner to be aware of the system.[3]

Gestural systems can be both informal and formal.[2] Informal gestures use body movements, facial expressions and postures to convey meaning. These are also often used to some extent by individuals as a complement to fully functioning natural speech. [2] Formalized gestural codes are systems which lack a base in a naturally occurring language.[2] These are found most commonly in nursing homes, hospitals and residential centers, but have also been used by children with profound cognitive disabilities.[2] In the United Kingdom, the common gestural code is Makaton while the only formalized gestural code used in North America is Amer-Ind.[2] Users of formalized gestural codes have approximately 2500 words at their disposal.[2]

As forms of AAC, signed systems and signed languages have been used alone or in conjunction with speech.[2] Manually coded forms of English (such as Signing Exact English, Pidgin Signed English) are not native to any speaker and are considered systems rather than languages. In contrast to formalized gestural systems and signed systems, signed languages (such as American Sign Language and British Sign Language) are naturally occurring languages and are used by Deaf language communities.[2] Prior to 1990, sign languages was used more commonly than other unaided AAC systems.[2] Sign languages are far less transparent in meaning than gestural codes and also require more fine-motor coordination to execute.[4] Additionally, sign languages are generally acquired at a later stage in development that gestural codes.[2] For these reasons, sign languages are more difficult to acquire than gestures, especially by those with upper-extremity impairments.[2]

Aided AAC

An AAC aid is any "device, either electronic or non-electronic, that is used to transmit or receive messages".[2] The skills, areas of difficulty and communication requirements vary greatly within the AAC user community, and so an equally diverse range of communication aids exists to meet these demands.

Low Tech

Low-tech communication aids are defined as those that do not need batteries or electricity to meet the user's communication needs.[5] These are often very simple aids created by placing phrases, letters, pictures or symbols on a board or in a book. Depending on physical abilities and limitations, users can access the device by pointing to the appropriate message with their fingers, a non-electronic pointer, such as a head or mouth stick, or by eye gaze.[5]

Low-tech aids are limited in terms of the amount of messages they can convey: only so many messages can be placed on communication board or in a communication book. In comparison, natural speech can convey infinite messages, and many high-tech aids are only limited in terms of their memory store.

High Tech

Stephen Hawking, physicist and AAC user

High-tech AAC aids are electronic devices that permit the user to communicate with others by producing digitized or synthesized speech, or by typing out messages.[5][6] These devices can also be referred to as Speech Generating Devices (SGDs) or Voice Output Communication Aids (VOCAs).[5] A diverse array of such electronic devices is available and each user is matched with the device that is most suitable for their needs, skills and abilities. Some devices can be simple electronic communication boards that produce a word, phrase or story that is stored under a given symbol when it is selected. Other devices can say the words or the letters that are typed by the user.[5] On static display device all the symbols are in a matrix form and are constantly visible on the device. On more sophisticated electronic dynamic AAC device, multiple pages of symbols are possible, and thus only a portion of the symbols available are visible at any one time, with the communicator navigating the various pages. Research has shown that devices with static display can be used with young children while the dynamic displays should be introduced once children have mastered abstract vocabulary and categorical organization.[7] Users of dynamic devices may be able to switch from the communication program to the general operating system in order to access internet, email, games, word processors and other standard computer software.[8]

High-tech devices vary in price, size, and amount of information they can store. They also vary in portability, with some devices being smaller and lighter than others. Devices can generally be mounted on a wheelchair if necessary. There are frequently multiple ways access the device, including touch screens, switches, joysticks, head-operated mouses or programs which track the eye gaze of the user. The specific choice of access method will depend on the skills of the communicator.[6] Since electronic devices operate on batteries which need to be frequently changed or charged, and may breakdown, users usually also require access to a low-tech communication system.[5]

Symbols

Some people who use AAC can read and spell; others cannot, and need communication aids on which language elements are represented by pictures or graphic symbols such as Picture Exchange Communication System (PECS). Symbols are also used within a complete linguistic system in Blissymbols.[citation needed]

Access

Traditional communication is accessed through the mouth (by speaking), the ears (by hearing), the eyes (by seeing) and the brain (by appropriately processing meaning). People with impairments to any of these organs may require augmented or alternative access to communication.

Some people with severe communication impairments can use their hands; others cannot, and have to use alternatives, such as mouth sticks, headsticks, switches or eye-pointing. In AAC terminology, Direct Selection refers to when an individual can point to the desired symbol using a finger or alternative pointing technique (i.e., headpointer, eyegaze, joystick, mouse). An example of an indirect selection technique is Scanning, when an individual is offered an array of symbols, which are scanned by the communication system or partner. The AAC user indicates his/her desired choice by using the alternative selection technique (i.e. switch access, head nodding) to select the desired symbol.[citation needed] User's visual acuity and visual-perceptual discrimination skills will affect the presentation of the symbol system (e.g. size of the graphic symbols and background-figure contrast) on the AAC device.[9]

Rate enhancement strategies

Augmentative and alternative communication is generally slower than speech.[10] Rate enhancement strategies increase the user's rate of output, and as a result enhance the efficiency of communication. There are two main options for increasing the rate of communication for AAC devices: encoding and prediction.[10]

Encoding is the way a user is able to produce messages using the device. If an entire word, phrase or sentence can be retrieved with a one or two symbol or letter code, communication will occur faster.[10] Some examples of encoding rate enhancement strategies are as follows: Iconic Encoding which uses pictures, line drawings, or shapes to represent frequently used concepts. This is especially useful for non-literate users, as it gives them access to large vocabularies while requiring fewer keystrokes and minimal spelling or reading abilities. For example, a picture of a toilet may represent “I need to use the bathroom”.[11] There can also be Semantic Compaction (Minspeak) that uses icons with multiple meanings which are sequenced together. The meaning of the message is then dependent upon each icon in a particular sequence. For example, typing “food + yellow + B” may represent “banana”.[11][12] Letter Encoding/Abbreviation-Expansion stores words, phrases or sentences as abbreviations, which eliminates having to type complete words or phrases. For example, typing “HH” may represent the greeting, “Hello, how are you?”.[12] Finally there is Alpha-numeric/Numeric Encoding which stores messages under combinations of letters and/or numbers. For example, typing “G1” may represent "Greeting 1", producing "Hello, how are you?”.[11]

Prediction refers to the ability of the device to guess the word that is being typed by the user and to provide choices in message output. When the prediction is correct, the user selects it and no longer has to type the entire word. The user is also provided with additional choices to select in case the initial guess is incorrect. The word prediction software may determine the possible choices offered based on frequency in language, word association, past choices, or grammatical suitability.[10][12] Some examples of prediction rate enhancement strategies are the following: Word Completion which allows the device to predict the end of a word based on the first letters typed and a menu of likely words is offered based on the user’s initial keystrokes. If the desired word is offered, the user can select it without the need to continue typing the rest of the word. For example, if the user types “h-e”, “hello" or "help” may be offered as choices to complete the word.[10][11][12] There is also a strategy called Next Word Prediction that allows the device to predict words based on word pairings and/or grammatical rules of the words occurring before it. For example, if the user types, “I am”, the device may offer typical responses to this sequence of words such as “going", "feeling".[10] Lastly, there is Linguistic Prediction, and this is a method that allows the device to offer words that agree in tense, case and number based on previous words in the message. For example, if the user has typed “tomorrow”, only words in the future tense will be offered as choices.[10]

Team

A comprehensive evaluation of a user's unique abilities and requirements is necessary in order to implement appropriate intervention and match the user with the most appropriate AAC device. AAC evaluations are conducted by specialized multidisciplinary teams consisting of a speech-language pathologist, occupational therapist, physiotherapist, social worker and a physician.[13][9] The assessment team conducts interviews with the user, family members, caregivers and/or teachers in order to obtain additional information about the user's behaviour and skills in different settings. The team also assesses the user's motor abilities, communication skills, cognition and vision.[13]

During the intervention process, the occupational therapist assists with the positioning and seating adaptations for convenient AAC access. The physiotherapist works on motor development training. The speech-language pathologist's role is to teach the user and their communication partners how to use the AAC device, encouraging the use of natural speech when possible. In selecting and adapting the AAC device for the user's individual needs, the speech-language pathologist must ensure that the AAC device can be used in different contexts with different communication partners.[9]

Specific groups of AAC users

Whenever possible, AAC devices should be designed for Dynamic Diversity [14], where the interface is accessible not only to “typical” AAC users, but also to minority populations who need to use the device.

Cerebral Palsy

Cerebral palsy is a developmental neuromotor disorder that is the result of a non-progressive abnormality of the developing brain.[9] The motor deficits associated with cerebral palsy (CP) cause speech disorders in 31% to 88% of CP patients.[9] In addition to communication needs, practitioners must also consider the particular motor challenges of the individual when planning the set-up of the AAC device. With this population, professionals such as occupational and physical therapists, orthotic specialists and rehabilitation engineers are essential in the assessment process. They need to consider specific positioning and seating adaptations so that the individual can have the best access to the AAC system. For example, an individual with spastic arm movement might need a keyguard on top of a keyboard or touch screen to minimize the chance of selecting a wrong button. Those with athetoid CP who have difficulty regulating movements may benefit most from an AAC device with an eye tracker.[9]
This population often faces an additional communication challenge, in which family members and peers tend to direct and control conversations. Consequently, children with CP may not use their AAC aids as often. This has the potential to lead to delays or failure to develop the full range of communication skills such as initiating or taking the lead in conversation, using complex syntax, asking questions, making commands, or adding new information.[15][16] It is essential for the AAC team to prevent the development of learned helplessness in children with CP that can result from being passive communicators.[9] Early intervention with the speech language pathologist targets situations which teach children with CP how to develop their conversational skills, how to effectively communicate with others, and how to control their environment through communication. It is also important for children with CP to have extensive practice using their AAC system for making choices, decisions and mistakes.[9]

Developmental dyspraxia

Developmental dyspraxia is a childhood motor speech disorder involving impairments in the motor control of speech production, typically causing impairments in motor programming and execution. Major symptoms include difficulties with speech imitation, a reduced ability to produce rapid, repeated oral movements, problems initiating movements for speech, as well as difficulties producing sounds in sequence.[17]

The speech of children with developmental dyspraxia may be unintelligible to the point that daily communication needs cannot be met and that the child experiences great amounts of frustration. In such cases, AAC can be seen as a secondary strategy to support successful communication attempts in these children, with the hope that speech will improve with time and one day be able to meet daily communication needs. Research indicates that AAC use with this clientele does not reduce speech skills, and that it may improve it with time.[18] AAC interventions in this population are made alongside more traditional speech therapy to improve natural speech production.[18]

A wide variety of AAC systems have been used with children with developmental dyspraxia.[19] Manual signs or gestures are the most frequently seen unaided AAC system introduced to these children, and can include signing unintelligible target phonemes (using fingerspelling) in concert with speech. Articulation and sequencing errors in speech have been shown to decrease in these children with the use of manual signs.[18] While advantages of this system include its portability and unlimited vocabulary potential, disadvantages include potential problems with fine and gross motor skills, as well as the fact that most of the people these children will be interacting with will not be able to understand the signs being produced.[19] With familiar communication partners, total communication approaches may be beneficial for these children, such that signs and words are used simultaneously.[18] With total communication, the child has the ability to be understood through sign, while continuing to attempt to successfully produce speech.

The main aided systems used with children with developmental dyspraxia include picture symbol communication boards or books, and voice output devices.[19] While communication boards (or books) are portable and can be tailored to meet the needs of various communicative contexts, they present the user with the limited ability to communicate about topics made available by the board.[20] Voice output devices provide the user with a much greater vocabulary and ability to converse about a wider range of topics. In addition, they allow the user to generate grammatical sentences, rather than pointing to single pictures at a time.[18]

A multimodal approach is often chosen, such that more than one AAC option is introduced to the child. This way, the child is not only given the opportunity to experiment with various AAC systems (aided and unaided), but can also take advantage of the fact that certain options may be better than others in certain contexts.[18] For example, voice output devices may work well during dinner, but the child may need to make use of manual signs while in the bath.

Visual impairment

High and low tech AAC systems require modification in order to make them accessible to AAC users who are blind or who have visual impairments. Modified visual output includes large print and/or clear simple graphics, and can be of benefit to AAC users with some residual vision.[14] Tactile/tangible symbols are textured objects, real objects or parts of real objects which may be included on an AAC device for individuals with visual impairment.[21] Braille is an example of a tactile/tangible reading and writing system. Tactile/tangible symbols should be considered meaningful to the AAC user, thus allowing them access to language. They can be used on low or high tech displays and switches. A limitation of using tactile/tangible symbols is that they may decrease the number of symbols available to the AAC user at one time.

Auditory symbols are those which produce a meaningful sound when activated, and are thus useful for AAC users who have vision impairments. Morse Code is an example of an auditory symbol system, where long and short tones represent letters, words, and phrases. There are some AAC devices that can convert Morse code into text or speech.[citation needed] Speech is another example of an auditory symbol which can be integrated with assistive technology for the blind and visually impaired.[21] Auditory scanning is an access method which presents options to the user by pronouncing them out loud. Users then select the desired option upon hearing it. This can be helpful for users with visual impairments who are unable to scan options presented visually.[22]

Amyotrophic lateral sclerosis

Amyotrophic Lateral Sclerosis (ALS) is a progressive condition whereby the motor neurons required for smooth, voluntary movements slowly break down, leading to weakness and eventual paralysis. Approximately 75% of people with ALS will become unable to speak by the time of their death.[23] Given the rapid progression of the disease, those diagnosed with ALS require information about various AAC options as early as possible in order to acclimatize to the device before it replaces natural speech.[24] Generally, AAC is necessary when speech intelligibility becomes inconsistent, especially in adverse listening conditions (i.e.: noisy restaurant).[23] In most cases, this happens when speaking rate drops to 100 words per minute.[25] In the early stages of ALS, AAC may only be necessary to augment natural speech with unfamiliar partners (for example: using an alphabet board to cue the listener to the first letter of the word being spoken). In the later stages of ALS, AAC may become the main communicative method although familiar conversation partners may understand a limited amount of specific spoken words.[24] The choice of device takes into account both present and future needs. Because ALS is degenerative in nature, a device may be selected that can be modified to accommodate the changing motor abilities of the individual, rather than changing the device as the disease progresses.[23]

In general, the ideal AAC device will depend on severity of speech impairment, functional status and communication needs in particular environments.[24] Lifestyle also influences the choice of device; if the person with ALS is working outside of the home, portability, durability and powered mobility are important considerations.[26] If the user spends most of their time in a home with numerous floors, noisy children or pets, considerations about amplification become important.[26] As cognition and vision are unaffected in ALS, writing and typing systems tend to be the most recommended and preferred devices because they allow unlimited expression.[24] The means by which the device is accessed depends on the type and severity of the disease. In the spinal form of ALS, the limbs are affected from the onset of the disease. As a result, high-tech devices are often most helpful as they can be modified to accommodate physical impairments through head or eye tracking.[27] Head tracking technology is improving, but a limited range of head movement may affect calibration.[28] Eye-tracking technology is also improving, however its performance is not yet ideal in all lighting and postural conditions.[28] Low-tech systems such as eye gazing or partner assisted scanning are considered for situations when electronic devices are unavailable (i.e.: during bathing).[24] In the bulbar form of ALS, speech is affected before the limbs. As a result, handwriting is often the first course of AAC. As the disease progresses and starts affecting hand movement, writing or typing VOCA devices may be optimal as these require less manual dexterity while still offering full freedom of expression. In the final stages of the disease, eye gaze and partner assisted scanning may be used, and carry the added benefit of promoting social closeness.[24]

Autism

Autism is a disorder distinguished by qualitative impairments in communication and social interactions. Children with autism may exhibit both receptive and expressive language difficulties, yet it is more challenging to acquire expressive communication than receptive communication.[29][30] Children with autism may have no spoken language or may exhibit a delay in use of spoken language or gestures. The role of AAC for this population is to improve and enhance the child’s current functional communication, not to replace what already exists.[31]

It has been found that some children with autism will express protests and requests, while joint attention or social communicative intentions are usually lacking. A child may be motorically capable, yet lack the prerequisites to language or the social communicative base on which language is built.[29] Therefore, if a child presents with an uneven developmental profile, it is important to first begin intervention by targeting the prerequisites for language (joint attention, verbal and motor imitation, turn-taking, etc) and begin to establish some form of functional communication.[2][29] It is vital to steer AAC intervention towards the linguistic and social abilities of the child.[2] If an AAC approach has begun before the child has established the precursor language skills, it will most likely result in stereotypical, non-functional behaviors and inappropriate use of the AAC device. Therefore, it is important that some functional communication exist to set the groundwork for communication and to make the best use out of the AAC device.[31] It has been found that children with autism who have established joint attention and who can also point are able to deal with at least 50 symbols on a communication board. If joint attention has yet to be established, they can handle 2 to 6 symbols on a communication board.[32] Some goals of the AAC device include providing the child with a concrete means of communication, as well as facilitating the development of interaction skills.[29][31]

An AAC device is recommended for any nonverbal child, since all individuals need to be able to communicate. It has also been shown that speech acquisition by the time children enter school is one of the most significant predictors of outcome for children with autism.[29] Thus, early intervention with an AAC system is key, and it is important to keep it simple and easy.[2][31] Children with autism have also been found to have strong visual-processing skills, making them ideal candidates for an AAC device.[31]

AAC systems for this population will generally begin with object or picture exchanges (for instance, Picture Exchange Communication Systems (PECS)), and also communication boards. AAC methods can be used in conjunction with other methods, such as direct speech therapy. There currently exists little empirical evidence related directly to speech treatment.[29]

There has been much debate in the field about which AAC device is most appropriate for this specific population. Son, Sigafoos, O’Reilly, and Lancioni (2006) compared the use of a voice-output communication aid (VOCA) to a picture-exchange system and found that each were plausible options for children with autism, as the ease and speed of acquisition of both systems was similar among all participants.[33] It is important to consider the child’s preference when AAC intervention is to begin.


Effect on speech development

Very young children who are candidates for AAC may present with an extremely wide range of developmental delays and disorders; therefore, the effect that an AAC program or device will have on speech development will vary widely. A child who is not physically capable of producing speech, due to muscular or neurological deficits, will not develop speech using AAC. However, there has been some evidence in the literature that programs like the Picture Exchange Communication System (PECS) can promote speech development in certain populations; specifically, in children with autism spectrum disorders (ASD). Ganz and Simpson (2004) found that nonverbal (vocabulary of less than 20 words) children between the ages of 3 and 7 with ASD who were formally trained according to PECS specification used more intelligible words, increased the complexity of their sentences, and generalized these skills to use with a variety of adults in the later stages of PECS training.

Literacy

Many children who use AAC devices have difficulties learning to read and write due to severe speech, cognitive, or physical impairments. These barriers and their effects on emergent literacy vary across AAC users. Users with motor impairments, such as cerebral palsy or spinal cord injuries tend not to experience significant cognitive or learning delays that contribute to communication difficulty.[34] AAC users who have an additional language delay are at risk for poor literacy since they do not have the necessary knowledge of language to act as a foundation for emergent literacy. Young AAC users who enter school with limited language knowledge are at risk for falling behind their typically developing peers.[35] It has been well established that children become more successful in literacy learning when they have engaged in rich language and literacy experiences before entering school. These experiences help foster vocabulary development, discourse skills, and phonological awareness. Many children who use AAC experience difficulty across language domains, including vocabulary delays, short utterance length, poor syntax, and impaired pragmatic skills.[36] Another significant barrier to literacy is that individuals with these limitations are often given fewer opportunities to engage in reading and writing activities.[37] For AAC users, the the amount of time, range, and quality of experiences devoted to teaching reading and writing tends to be restricted in the classrom setting.[38] Moreover, many people have false beliefs that individuals with these impairments are not capable of learning to read or write.[39][40]

Most children who use AAC do not become functionally literate. Those who do often do not achieve literacy skills beyond the second grade level.[41] The individuals who use AAC who do become functionally literate into adulthood often report abundant access to reading and writing material at home and in school during childhood.[42] Current research suggests that with direct and explicit reading instruction, AAC users can better develop their reading skills to participate in academic, vocational, and community activities.[43][44] For AAC users, literacy skills facilitate self-expression and social interaction in face-to-face conversation and provide opportunities to participate in home, work, school, and social settings.[45] Furthermore, literacy provides access to educational and vocational opportunities and can help foster independence.[46]

History of AAC

Although AAC can trace its roots back to the early days of Ancient Rome, with the first use of augmentative strategies for the Deaf, its modern inception began in the 1950’s. At this time, AAC devices were mainly implemented for those with disrupted laryngeal anatomy due to surgical procedures such as laryngectomies and glossectomies. There was little thought given to the use of AAC strategies for those with severe communications impairments resulting from other origins. Despite this, manual languages proliferated naturally with the Deaf community. Members of the community began to actively pursue their right to be taught using American Sign Language (ASL) during the 1960’s, coinciding with the United States Civil Rights Movement. This activism helped increase public and governmental awareness of the issues related to AAC. At this time, the first academic text to discuss ASL as a true language, Sign Language Structure, was released and Total Communication, an educational approach for the Deaf, was developed.[47]

During the late 1960’s, it became acceptable to use manual sign languages with individuals who suffered from hearing impairments alongside cognitive impairments. The use of AAC devices was also prevalent among those for whom it seemed that intelligible speech would likely never be possible, including those with severe dysarthrias, cerebral palsy and amyotrophic lateral sclerosis. In most cases however, it was still common practice to employ AAC strategies only after traditional speech therapy practices had failed, as many felt hesitant to provide intervention to those who might be able to learn to communicate verbally.[47][48]

This view continued to dominate the field until the 1970’s, when several governmental acts helped expand the application of AAC strategies. In 1975, the Education for All Handicapped Children Act (P.L. 94-142) (later renamed the Individuals with Disabilities Education Act (IDEA)) sanctioned the provision of educational services for all school-aged children with disabilities. As a result, many children with disabilities entered the public school systems, compelling classroom teachers to find ways in which to assist communicative exchanges. The 1986 Education of Handicapped Act Amendments (P.L. 97-457) promoted the use of technological devices to help accomplish the aforementioned goal.[47][48]

During the beginning of the 1980’s, AAC became an area of professional specialization. Articles, newsletters, and textbooks on the matter were published as well as the first international conferences. The American Speech-Language-Hearing Association published a position paper regarding AAC as a field of practice for speech-language pathologists in 1981, and in 1983, the International Society for Alternative and Augmentative Communication(ISAAC) was founded.[47]

The Technology-Related Assistance for Individuals with Disabilities Act (P.L. 100-407) was announced in 1989 and declared that all states make every possible effort to provide access to assistive devices and technologies to citizens, regardless of age, disability, or location of residence. A variety of other acts at the time sought to highlight the importance of disseminating information regarding assistive technologies and the right to their access to the general public. In 1992, the Communication Bill of Rights, set forth by the National Joint Committee for the Communication Needs of Persons with Severe Disabilities, stated that all individuals with severe communication disabilities have a right to use AAC devices at all times as well as a right to information and the opportunity to have and make choices.[47][48]

Since the 1990’s, there has been an increase in in-class and natural education techniques (as opposed to traditional pull out methods), which has led professionals to seek ways for children with disabilities to participate more comprehensively and successfully in classroom activities. This inclusion model promotes the enrichment of functional skills taught within a natural context. The 1997 amendments to the Individuals with Disabilities Education Act (previously the Education for Handicapped Children Act) mandated individual assessment of children’s assistive technology needs, including augmentative communication as well as consideration of these needs in students' Individualized Education Program. The field of AAC now follows a participation, or universal model, believing that anyone can communicate and benefit through the use of AAC devices and methods.[47][48]

User's Experience with AAC

When adults with complex communication needs enter hospitals, they are often faced with communication difficulties with hospital staff members. There are many communication barriers in a hospital setting, such as not having a way to communicate (e.g. bed-ridden, can't access the AAC, or the AAC is not in the hospital), not having the opportunity to communicate (e.g. perceived as time consuming to communicate with a patient with AAC), lack of understanding by hospital staff members of the patient's communicative attempts, and not responding to these attempts.[49] Family members tend to take over and speak on behalf of the patient to the doctors and nurses. One study that interviewed adults with cerebral palsy (CP), it was expressed that doctors would speak to the family instead of the patient, since the patients needed time to communicate using AAC. It was also felt that the doctors were too busy. One patient recounted a success story where his brother taught the nurse how the patient communicates with the AAC and then the patient used the AAC to communicate with the nurse directly.[50] The implication of this scenario is that communication is possible as long as hospital staff members are aware of other communication modes (AAC), family members are willing to be less-protective and patients are confident enough to speak for themselves. The consensus of these interviews is that adults with complex communication needs wish to be treated like adults in hospital and they would like to be involved in decision making about their health care. They also want to be involved in the education of hospital staff members about AAC communication.[50] Doctors and nurses need to become familiar with AAC systems and have some knowledge/skills on how to interact with patients with complex communication needs.[49]

Terminology Used in AAC

Symbol: Something used to represent another thing or concept. For example, a picture or line drawing of a dog to represent dog.

Symbol Set: A set of symbol that is closed in nature; symbol set can be expanded, but it does not have clearly defined rules for expansion (e.g., Picture communication symbols).

Symbol System: A set of symbol; includes rules or a logic for the development of symbols (e.g., Blissymbols).

Speech Generating Device: An electronic assistive device that produces speech (e.g., Dynavox, Mercury).

VOCA: Voice Output Communication Aid; other term for electronic assistive device producing speech.

AAC System: An integrated network of symbols, techniques, aids, strategies, and skills.

Input Method: Technique used to select representations of the wanted utterances from an electronic device (e.g., touchscreen selection, eyegaze pointing, switch access).

See also: Blissymbolics.

References

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  19. ^ a b c Weitz, Cynthia. "AAC and Children With Developmental Disabilities". The Handbook of Augmentative and Alternative Communication. pp. 395–405. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ^ Cumley, Gary (1999). "Augmentative and Alternative Communication Options for Children with Developmental Apraxia of Speech: Three Case Studies". Augmentative and Alternative Communication. 15: 110–125. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ a b Beukelman, D., Mirenda, P., Franklin, K. & Newman, K. (1992). Persons with visual and dual sensory impairments. In D. Beukelman & P. Mirenda, Augmentative and alternative communication: Management of severe communication disorders in children and adults. Baltimore: Brookes, 291-309.
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  27. ^ Mathy (2000). "Augmentative Communication for Individuals with Amyotrophic Lateral Sclerosis". In Beukelman, Yorkston, Reichle (ed.). Augmentative and Alternative Communication Disorders for Adults with Acquired Neurologic Disorders. Baltimore: P.H. Brookes Pub. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: multiple names: editors list (link)
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  35. ^ Sturm, J.M. (2004). "Augmentative and alternative communication, language, and literacy: Fostering the relationship". Topics in Language Disorders. 24 (1): 76–91. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
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  37. ^ Erickson, K.A. (1995). "Developing a literacy program for children with severe disabilities". The Reading Teacher. 48 (8): 676–684. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  38. ^ Koppenhaver, D. (1993). "Classroom literacy instruction for children with severe speech and physical impairments (SSPI): What is and what might be". Topics in Language Disorders. 13 (2): 143–153. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  39. ^ Erickson, K.A. (1995). "Developing a literacy program for children with severe disabilities". The Reading Teacher. 48 (8): 676–684. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  40. ^ Light,, J. (1993). "Literacy and augmentative and alternative communication (AAC): The expectations and priorities of patents and teachers". Topics in Language Disorders. 13 (2): 33–46. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: extra punctuation (link)
  41. ^ Sturm, J.M. (2006). "What happens to reading between first and third grade? Implications for students who use AAC". Augmentative and Alternative Communciation. 22 (1): 21–36. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  42. ^ Koppenhaver, D. (1991). "Childhood reading and writing experiences of literate adults with severe speech and motor impairments". Augmentative and Alternative Communication. 7: 20–33. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  43. ^ Fallon, K.A. (2004). "The effects of direct instruction on the single-word reading skills of children who require augmentative and alternative communication". Journal of Speech, Language, and Hearing Research. 47: 1424–1439. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  44. ^ Blischak, D.M. (1995). "Thomas the writer: Case study of a child with severe speech and physical impairments". Language, Speech, and Hearing Services in Schools. 25: 11–20.
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  46. ^ Light,, J. (1993). "Literacy and augmentative and alternative communication (AAC): The expectations and priorities of patents and teachers". Topics in Language Disorders. 13 (2): 33–46. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)CS1 maint: extra punctuation (link)
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  48. ^ a b c d Hourcade, J., Pilotte, T.E., West, E. & Parette, P. (2004). A history of augmentative and alternative communication for individuals with severe and profound disabilities, Focus on Autism and Other Developmental Disabilities, 19,235-244.
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Works Cited

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