Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis

Parents' Perspectives on Tele-AAC Support for Families with a New Speech Generating Device: Results from an Australian Pilot Study

Telepractice is rapidly gaining popularity as a cost-effective and convenient alternative to in-person services for a range of speech-language pathology (SLP) applications. To date, there has been little research investigating the use of telepractice to support families with a new speech generating device (SGD). This paper reports on the outcomes of a novel online training and support program, trialed with 4 underserviced Australian families of children with a new SGD. The program consisted of 6 video-narrated lessons on SGD use, along with an online supervision and practice component conducted via videoconference. Semi-structured interviews were undertaken with parents following their completion of the program. Parents noted the telepractice support model offered a range of benefits, including convenient service access and flexible learning options. Challenges included technology limitations and increased pressure on parents to coordinate home practice. Overall, parents reported that the telepractice program was a positive experience for them and their children. Findings indicated that telepractice is a promising mode of service delivery for those learning to use a new SGD. Further research in this area is warranted.

Putting people first: re-thinking the role of technology in augmentative and alternative communication intervention

Current technologies provide individuals with complex communication needs with a powerful array of communication, information, organization, and social networking options. However, there is the danger that the excitement over these new devices will result in a misplaced focus on the technology, to the neglect of what must be the central focus - the people with complex communication needs who require augmentative and alternative communication (AAC). In order to truly harness the power of technology, rehabilitation and educational professionals must ensure that AAC intervention is driven, not by the devices, but rather by the communication needs of the individual. Furthermore, those involved in AAC research and development activities must ensure that the design of AAC technologies is driven by an understanding of motor, sensory, cognitive, and linguistic processing, in order to minimize learning demands and maximize communication power for individuals with complex communication needs across the life span.

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

PURPOSE

The purpose of this study was to identify barriers and facilitators to children's use of speech-generating devices (SGD).

DESIGN AND METHODS

Interviews with 14 mothers were analyzed with content analysis to identify barriers and facilitators to SGD use.

RESULTS

This study identified a number of specific barriers and facilitators to successful and sustained SGD use by children with complex communication disorders.

PRACTICE IMPLICATIONS

Nurses can use the list of barriers and facilitators provided here as a springboard to discuss the families' experiences with device use.

Two Men with Advanced Amyotrophic Lateral Sclerosis Operate a Computer-Aided Television System through Mouth or Throat Microswitches

This study assessed a simple technology to enable two men affected by amyotrophic lateral sclerosis, in an advanced stage (i.e., with pervasive motor disabilities and lack of speech), to operate a computer-aided television system. The technology included microswitches, a portable computer, an interface connecting the microswitches to the computer, a commercial software package to allow the possibility of watching television via computer, and specific software to allow microswitch activations to be recorded as forward commands for channel change. The participants (a) gained control over the television programs to watch or not to watch (i.e., through channel changes) and (b) showed increased attention to the programs (i.e., an increase in their watching time). The practical relevance of the findings, the integration of the technology used in this study within the participants' wider recreation and communication program, and ways of extending the research were discussed.

Occupation and communication programs for post-coma persons with or without consciousness disorders who show extensive motor impairment and lack of speech

These two studies were aimed at extending the assessment of technology-aided programs for post-coma persons with extensive motor impairment and lack of speech. Specifically, Study I assessed a new program arrangement, in which stimulation access and caregiver attention could be obtained with variations of the same response (i.e., single- versus double-hand closure) by three participants who were diagnosed at the upper level of the minimally conscious state at the start of the study. Study II was aimed at enabling two persons who had emerged from a minimally conscious state to engage in leisure activities, listen to audio-recordings of family members, and send and receive messages. The responses selected for these participants were hand pressure and eyelid closure, respectively. The results of both studies were positive. The participants of Study I increased their responding to increase their stimulation input and caregiver interaction. The participants of Study II managed to successfully select all the options the program included (i.e., the leisure options, as well as the family and communication options). General implications of the programs and the related technology packages for intervention with post-coma persons with multiple disabilities 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.

Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

In 1989, Light defined communicative competence for individuals with complex communication needs who require augmentative and alternative communication (AAC) as a dynamic interpersonal construct based on functionality of communication; adequacy of communication; and sufficiency of knowledge, judgment, and skills. Specifically, Light argued that, in order to demonstrate communicative competence, individuals who required AAC had to develop and integrate knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. In 2003, Light expanded this definition and argued that the attainment of communicative competence is influenced by not just linguistic, operational, social, and strategic competencies but also a variety of psychosocial factors (e.g., motivation, attitude, confidence, resilience) as well as barriers and supports in the environment. In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field. In this paper, we review the preliminary definition of communicative competence, consider the changes in the field, and then revisit the proposed definition to determine if it is still relevant and valid for this new era of communication.

Clinical overview of the need for technologies for around-the-clock monitoring of the health status of severely disabled autistic children

Despite the growing incidence and costs of autism, little has been done to apply technology advancements to the challenges faced by autistic individuals. The recent introduction of digital data collection to track the progress of treatment interventions has been an important contribution, but there are many other opportunities for technology to facilitate the development of autistic children and to assist the clinical staff who work with them. The realization of wearable devices to identify and track behaviors would significantly reduce the manual input of data into digital devices, and wireless physiological monitoring has the potential to provide predictors of unwanted behaviors. The development of such tools would change the intervention paradigms that currently exist.

Perceptions of the design of voice output communication aids

BACKGROUND

Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC). In recent years, rapid developments in technology have resulted in an explosion of devices available commercially, yet little research has been conducted into what people who use VOCAs think about them.

AIMS

The aim of this research was to explore the perceptions of communication aid design from the perspective of end users and AAC professionals, with the objective being to inform and influence the design of future devices.

METHODS & PROCEDURES

A two-part study was conducted: interviews were undertaken with people who use VOCAs, and questionnaires were distributed to those who use aided communication and to AAC professionals. Analysis of the interview data was carried out using a qualitative method based on framework analysis, whilst descriptive statistics were generated from the questionnaire data. Interview participants were an opportunity sample of VOCA users within a defined region of the UK. Those recruited were over the age of 12 years and able to engage in the interview process; they were identified through the caseloads of local Speech and Language Therapists specializing in AAC. The questionnaire was marketed to the AAC community throughout the UK. Respondents were self-selecting as those using aided communication, their carers and AAC professionals.

OUTCOMES & RESULTS

Eighteen people participated in the interviews. Questionnaires were completed by 43 people who use aided communication and 68 AAC professionals. The data suggest that current devices are considered to be neither reliable nor durable by users and professionals. Although features given a higher importance ranking are more likely to be perceived as available, a number of important design deficits are identified by users and/or professionals. Simplicity of design (and use) and the desire for devices which support communication that is as fast and spontaneous as possible also emerge as key requirements. Synthesis of the data produced a framework with three main themes covering the range of issues which influence the successful use of a VOCA: specific aspects of the design of a device; the consideration of the wider picture around the person; and the personal context in which someone uses their device.

CONCLUSIONS & IMPLICATIONS

Although the original aim of the project was to establish the user requirements of VOCA design, the data indicate that the characteristics of the device cannot be considered in isolation. Those factors uncovered highlight questions about whether the design of communication aids is truly effective in meeting the needs of the people who use them. Based on these data, an initial specification for future device design is proposed.

Crucial design issues for special access technology; a Delphi study

PURPOSE

To develop and demonstrate a method to involve professional users of assistive technology (AT) in the development process of customisable products. Employing the ideas of user participation and mass customisation, this research addresses the need for reduced product costs and optimised product flexibility.

METHOD

An adaptable six-question Delphi study was developed to establish consensus among AT professionals on design issues relating to a specified AT domain requiring innovation. The study is demonstrated for the special access technology (SAT) domain. A modified morphological matrix structures the application of the study results to the product design process.

RESULTS

Fourteen professionals from the Republic of Ireland and the UK participated. Consensus was reached on prevalent parts of SAT that malfunction, primary reasons for SAT malfunction, characteristics of clients associated with SAT selection, client needs regarding SAT use and training, desirable traits of SAT and clinicians' frustrations with SAT.

CONCLUSION

The study revealed a range of problems related to SAT, highlighting the complexities of successful SAT adoption. The questions led to differentiated insights and enabled design solution conceptualisation from various perspectives. The approach was found to help facilitate efficient generation and application of professional users' knowledge during the design process of customisable AT.

The Domesday dataset: linked open data in disability studies

Augmentative and alternative communication (AAC) devices provide the ability for many people with disabilities to make themselves understood. For the large proportion of users with an intellectual disability, these devices may be their only means of communication. Estimates of the number of AAC devices in use are vague and lack transparency. This prevents researchers from answering key questions like 'How many people per 1000 are using electronic AAC?' and 'On average, how much money would fund a person's AAC use for 12 months?'. This work presents the 'Domesday dataset', which allows researchers to answer research, policy, and prevalence questions on the landscape of AAC use within the United Kingdom. This dataset was constructed by making several hundred Freedom of Information requests. These requests asked public bodies who purchase AAC devices in the United Kingdom to supply details of every AAC purchase since 2006 including make, model, and year of purchase.