Current and future AAC research considerations for adults with acquired cognitive and communication impairments

Aphasia and high-tech communication support: a survey of SLPs in USA and India

PURPOSE

This survey was conducted to investigate American and Indian clinician's preference and usage of high-tech communication supports (HTCS) for aphasia rehabilitation to identify factors in each country that support the use of HTCS for improving post-aphasia communicative outcomes. In this study, HTCS include speech-generating augmentative and alternative communication (AAC) devices with varying methods of access.

METHOD

The survey exploring clinically practicing speech-language pathologists' (SLPs) training, assessment and aphasia rehabilitation practices using HTCS, was electronically distributed in both countries. The raw responses from the US SLPs (n = 56) and Indian SLPs (n = 43) were collected, segregated and then converted into percentages for all 41 survey questions.

RESULTS

The responses from SLPs indicated higher (70%) and lower use (58%) of HTCS for aphasia in a developed country (USA) and developing country (India), respectively. In the US, identifiable factors for successful use of HTCS for aphasia rehabilitation were familiarity in procuring and programming the device, caregiver training and effectiveness in reducing the time of communicating through the device. In India, factors leading to successful inclusion of HTCS were AAC coursework and clinical training for clinicians and availability of HTCS at affordable prices for clients.

CONCLUSION

There is a considerable difference in the educational and clinical practice of AAC as SLPs in the US tend to have more clinical AAC experience with a stronger network for device dissemination in comparison to SLPs in India leading to higher usage of high-tech AAC for aphasia rehabilitation in a developed country.Implications for RehabilitationFor the SLPs,Improve exposure to programming AAC devices in developed countries and increase coursework, clinical training and exposure to programming AAC devices in developing countries.Enhance awareness about integrating high-tech AAC devices in intervention programs.Improve efficiency by minimizing the time in message creation on high-tech AAC device in developed countries. For the bioengineers,Develop AAC application interfaces in regional languages for easier usage in developing countries.

A retrospective chart review of the patient population accessing augmentative & alternative communication at an urban assistive technology center

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the "most important" aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

Speech pathologists' perspectives on the use of augmentative and alternative communication devices with people with acquired brain injury and reflections from lived experience

BACKGROUND

Communication changes following acquired brain injury (ABI) may necessitate use of augmentative and alternative communication (AAC). Speech pathologists regularly assist people with ABI and their families with AAC assessment and recommendations, as well as education and training on AAC use. To date, there has been no Australian research investigating the perspectives of speech pathologists working in the field of ABI and AAC. This research aimed to 1) Explore speech pathologists' insights regarding enablers and barriers to considerations and uptake, and ongoing use, of AAC by people with ABI and 2) Understand their perspectives on AAC acceptance, abandonment and rejection.

METHOD

A qualitative research design, with semi-structured interviews, was used with seven speech pathologists working across three Australian states. Interviews were transcribed verbatim, and thematically analysed. To triangulate results, the lived experience reflections of one co-author, who has an ABI and uses AAC, were drawn on.

RESULTS

Seven themes were identified, relating to four of the five domains of the World Health Organization's assistive technology model. These included that AAC should be person-centred, with consideration of both products and personnel required, and with effective policy aiding AAC trial, uptake and use.

CONCLUSION

This research has highlighted considerations for AAC use by people with ABI, from the perspective of speech pathologists and aided by lived experience reflections. Speech pathologists need to understand the breadth of products, and good practice service steps, to ensure successful AAC use and skill development. Listening to the perspectives of people with ABI is central to that understanding.

Differences of Modality Use between Telepractice and Face-to-Face Administration of the Scenario-Test in Persons with Dementia-Related Speech Disorder

Telepractice is increasingly finding its way into the care of people with dementia. Web-based delivery of speech and language therapy (SLT) is feasible and has the potential to improve communication in people with dementia-related speech disorders. Although experts are discussing the strengths and weaknesses of telepractice, a precise analysis of the differences between analogue and digital communication for this heterogeneous group of patients is still missing. The three current single cases investigated verbal and nonverbal aspects of communication in a face-to-face (F2F) and digital setting through a qualitative research design. Using the scenario-test (ST) in person and via big blue button (BBB; video conferencing system), several decisive factors were detected, influencing the effectiveness of communication in a F2F compared to a digital setting. The most important results of the qualitative content analysis are described for each case individually. Additionally, the influence of person-related factors, such as age, diagnosis, presence of depression, and level of education, is presented. Perceptual, executive, and affective disorders, as well as aids of relatives, are considered separately. The results indicate that executive functions, affects, and perceptual deficits need to be taken into account if telepractice is to be applied. Age, education, and distinct forms of dementia might be decisive for successful telepractice as well.

Semantic Variant Primary Progressive Aphasia: Practical Recommendations for Treatment from 20 Years of Behavioural Research

People with semantic variant primary progressive aphasia (svPPA) present with a characteristic progressive breakdown of semantic knowledge. There are currently no pharmacological interventions to cure or slow svPPA, but promising behavioural approaches are increasingly reported. This article offers an overview of the last two decades of research into interventions to support language in people with svPPA including recommendations for clinical practice and future research based on the best available evidence. We offer a lay summary in English, Spanish and French for education and dissemination purposes. This paper discusses the implications of right- versus left-predominant atrophy in svPPA, which naming therapies offer the best outcomes and how to capitalise on preserved long-term memory systems. Current knowledge regarding the maintenance and generalisation of language therapy gains is described in detail along with the development of compensatory approaches and educational and support group programmes. It is concluded that there is evidence to support an integrative framework of treatment and care as best practice for svPPA. Such an approach should combine rehabilitation interventions addressing the language impairment, compensatory approaches to support activities of daily living and provision of education and support within the context of dementia.

First-Line Health Care Providers' Reported Knowledge of and Referrals to Speech-Language Pathologists for Clients With Mild Traumatic Brain Injury

Purpose People with mild traumatic brain injury (mTBI) may experience deficits in cognition or communication that go unnoticed by first-line health care providers (FHPs). Speech-language pathologists (SLPs) assess and treat these domains yet are often underrepresented on mTBI multidisciplinary teams. This study's aim was to evaluate FHPs' reported knowledge of and referral practices to SLPs for individuals across the life span with mTBI. Method Physicians, physician assistants, nurse practitioners, nurses, and athletic trainers (n = 126) completed an online survey, including two Likert scale questions and one free response question relating to SLPs' role in mTBI. Results More than half of FHPs rate their knowledge of the SLP's role in mTBI management as low (somewhat knowledgeable, 29%; not very knowledgeable, 23%). Similarly, nearly two thirds of FHPs indicated rarely (19%) or never (44%), referring to SLPs for management of patients with mTBI. The majority of FHPs' open responses on the role of the SLP in mTBI management were incomplete, with many including domains that were not relevant to an SLP's role in the management of mTBI (e.g., dysphagia). Within the article, we provide results overall and according to individual profession. Conclusions Results suggest a majority of FHPs lack knowledge in the role of the SLP in the management of mTBI, which may underpin the low referral patterns reported by FHPs for SLP services. Future educational efforts for FHPs regarding the role of SLPs in mTBI care are necessary.

Attending to Methodological Challenges in Qualitative Research to Foster Participation of Individuals with Chronic Critical Illness and Communication Impairments

Individuals with chronic critical illness experience multiple complex physiological disturbances including ongoing respiratory failure, requiring prolonged mechanical ventilation, and thus communication impairments. In conducting a qualitative interpretive description study, we sought to ensure that individuals with chronic critical illness themselves were included as participants. Our commitment to recruiting these individuals to the study and ensuring their data meaningfully informed the analysis and findings required us to reconsider and challenge some of the traditional notions of high-quality qualitative research and develop appropriate practical strategies. These strategies included: (1) centering participant abilities and preferences, (2) adopting a flexible approach to conducting interviews, (3) engaging in a therapeutic relationship, and (4) valuing "thin" data. In this article, we extend existing literature describing the complexities of conducting research with individuals with communication impairments and strategies to consider in the hopes of informing future research with other populations historically excluded from study participation.

Patient and nurse content preferences for a communication board to facilitate dialogue in the intensive care unit

OBJECTIVES

The main aim of this study was to identify patient and nurse content preferences for a communication board to facilitate effective communication (dialogue) in the critical care unit.

RESEARCH DESIGN

A qualitative research design focusing on explorative and descriptive components was used to address the aim of the research study. The study employed two participant groups. Semi-structured interviews and focus group discussions were conducted with critically ill patients (N = 10) and critical care nurses (N = 30).

SETTING

The study was conducted in four different private hospitals of the same hospital group in Gauteng, South Africa.

FINDINGS

Four distinct themes were identified in the research regarding the vocabulary items that participants would like to have included.

CONCLUSION

The findings suggest that patients perceive a communication board to be valuable in enhancing communication in the critical care unit; that cultural and linguistic diversity should be considered; and that patients and nurses have varying opinions on topics of priority during communication.

Preference and visual cognitive processing demands of alphabetic and QWERTY keyboards of individuals with and without brain injury

Following a severe brain injury (BI), some literate individuals who require augmentative and alternative communication (AAC) strategies to support communication may benefit from the use of onscreen keyboards to generate text. A range of layouts are available to these individuals within specialized communication software. However, a paucity of information is available to describe user preferences, user perceptions, as well as the visual-cognitive processing demands of such layouts. Such information is critical to guide clinical decision-making for keyboard selection and to provide patient-centered services. This study: (a) described the preferences and perceptions of two onscreen keyboard layouts (QWERTY and alphabetic) and (b) used eye-tracking analysis to investigate the visual-cognitive processing demands between these onscreen keyboards for individuals with and without BI. Results indicated participants in both groups held a strong preference for QWERTY keyboard interfaces and had extensive prior experience using the QWERTY keyboard layout on mobile devices. Eye-tracking analysis revealed less visual-cognitive processing demands using a QWERTY keyboard layout for both groups but were only statistically significant for those without BI. Results suggest that use of a keyboard layout that aligns with client preferences and prior experiences (i.e., the QWERTY keyboard for these participants) may lead to increased satisfaction with the communication experience and increased communication efficiency.

Care Staff Perspectives on Using Mobile Technology to Support Communication in Long-Term Care: Mixed Methods Study

BACKGROUND

Long-term care (LTC) homes provide 24-hour care for people living with complex care needs. LTC staff assist older adults living with chronic conditions such as Alzheimer disease, related dementias, and stroke, which can cause communication disorders. In addition to the complex cognitive challenges that can impact communication, further difficulties can arise from cultural-language differences between care staff and residents. Breakdowns in caregiver-resident communication can negatively impact the delivery of person-centered care. Recent advances in mobile technology, specifically mobile devices (tablets and smartphones) and their software apps, offer innovative solutions for supporting everyday communication between care staff and residents. To date, little is known about the care staff's perspectives on the different ways that mobile technology could be used to support communication with residents.

OBJECTIVE

This study aims to identify care staff's perspectives on the different ways of using devices and apps to support everyday communication with adults living in LTC homes and the priority care areas for using mobile technology to support communication with residents.

METHODS

This descriptive study employed concept mapping methods to explore care staff's perspectives about ways of using mobile technology with residents and to identify the usefulness, practicality, and probable uses of mobile technology to support communication in priority care areas. Concept mapping is an integrated mixed methods approach (qualitative and quantitative) that uses a structured process to identify priority areas for planning and evaluation. In total, 13 care staff from a single LTC home participated in this study. Concept mapping includes 2 main data collection phases: (1) statement generations through brainstorming and (2) statement structuring through sorting and rating. Brainstorming took place in person in a group session, whereas sorting and rating occurred individually after the brainstorming session. Concept mapping data were analyzed using multidimensional scaling and cluster analysis to generate numerous interpretable data maps and displays.

RESULTS

Participants generated 67 unique statements during the brainstorming session. Following the sorting and rating of the statements, a concept map analysis was performed. In total, 5 clusters were identified: (1) connect, (2) care management, (3) facilitate, (4) caregiving, and (5) overcoming barriers. Although all 5 clusters were rated as useful, with a mean score of 4.1 to 4.5 (Likert: 1-5), the care staff rated cluster 2 (care management) as highest on usefulness, practicality, and probable use of mobile technology to support communication in LTC.

CONCLUSIONS

This study provided insight into the viewpoints of care staff regarding the different ways mobile technology could be used to support caregiver-resident communication in LTC. Our findings suggest that care management, facilitating communication, and overcoming barriers are 3 priority target areas for implementing mobile health interventions to promote person-centered care and resident-centered care.

Mainstream technology to support basic communication and leisure in people with neurological disorders, motor impairment and lack of speech

OBJECTIVE

To assess a simple technology solution to support basic communication and leisure in people with neurological disorders, extensive motor impairment, and absence of speech.

DESIGN

The design was a non-concurrent multiple baseline across participants.

METHODS

The study included eight participants and assessed a technology setup including a Samsung Galaxy Tab S2 LTE tablet and a Samsung Galaxy A3 smartphone. The smartphone, automated via MacroDroid, presented the participant with leisure, messages, and caregiver options. Choosing leisure or messages (by activating the smartphone's proximity sensor) led the smartphone to present the alternatives available for that option and eventually verbalize the alternative selected. This verbalization triggered the tablet's Google Assistant and led the tablet to present a leisure event or start a message exchange. Choosing the caregiver led the smartphone to invite the caregiver to interact with the participant.

RESULTS

During baseline (i.e., when a standard smartphone was available), the participants did not activate any of the options. During intervention and post-intervention (i.e., with the technology described above), participants activated all options and spent most of the session time positively engaged with them.

CONCLUSIONS

The aforementioned technology seems to be a useful tool for individuals like those involved in this study.

New and emerging access technologies for adults with complex communication needs and severe motor impairments: State of the science

Individuals with complex communication needs often use alternative access technologies to control their augmentative and alternative communication (AAC) devices, their computers, and mobile technologies. While a range of access devices is available, many challenges continue to exist, particularly for those with severe motor-control limitations. For some, access options may not be readily available or access itself may be inaccurate and frustrating. For others, access may be available but only under optimal conditions and support. There is an urgent need to develop new options for individuals with severe motor impairments and to leverage existing technology to improve efficiency, increase accuracy, and decrease fatigue of access. This paper describes person-centred research and development activities related to new and emerging access technologies, with a particular focus on adults with acquired neurological conditions.

Innovations for Supporting Communication: Opportunities and Challenges for People with Complex Communication Needs

Individuals with complex communication needs have benefited greatly from technological innovations over the past two decades, as well as from social movements that have shifted focus from disability to functioning and participation in society. Three strands of technological innovation are reviewed in this paper: (1) innovations in the tools that have become available, specifically tablet technologies; (2) innovations in access methods (eye gaze technologies and brain-computer interfaces); and (3) innovations in output, specifically speech technologies. The opportunities these innovations offer are explored, as are some of the challenges that they imply, not only for individuals with complex communication needs, but also for families, professionals, and researchers.

A Life Participation Approach to Primary Progressive Aphasia Intervention

Primary progressive aphasia (PPA) is a clinical neurodegenerative dementia syndrome characterized by deficits in spoken and written word retrieval, word usage, and/or word comprehension. Currently, there are no effective treatments to reverse or halt the underlying disease process; however, speech-language therapy may be helpful. The Communication Bridge Care Model was developed to address the unique communication and quality of life needs of individuals living with PPA. The core elements include person-centered care with dyadic instruction for disease education, and counseling, along with tailored levels of impairment- and compensatory-based communication strategy training. Our multicomponent approach incorporates guidance from the Life Participation Approach for Aphasia, including client-directed assessment and interventions that aim to maximize functional communication and participation in desired life activities. The direct and indirect use of technology is integrated into our tailored model of care to facilitate achievement of the client's functional goals. Here, we describe how to practically apply the Communication Bridge Care Model across treatment settings, including case examples from the Communication Bridge research study. This approach to care provides an opportunity to maximize communication effectiveness and quality of life for individuals living with PPA throughout the course of disease.

Digital technologies for social inclusion of individuals with disabilities

Information technology can be an important facilitator of social inclusion for people with disabilities into society. However, the goals specified in this area by organizations such as the European Commission have not yet been achieved in their totality. The aim of this paper is to explore which types of information communication technology-based applications and/or digital services have been suggested to facilitate the social integration of people who suffer from different types of disabilities. We performed a literature review that included studies published during a period of 6 years (2010–2016). The results show that, in the data we have had access to, no concrete patterns can be identified regarding the type of technology or technological trends that can be used to support the social integration of individuals with disabilities. This literature review is of relevance to the identification of further research areas and to the identification of issues which have to be considered in the context of the development and implementation of technological innovations that are aimed at promoting or facilitating social inclusion of individuals with disabilities.

Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study

Objective

To gain insight into how communication vulnerable people and health‐care professionals experience the communication in dialogue conversations, and how they adjust their conversation using augmentative and alternative communication (AAC) or other communication strategies.

Methods

Communication vulnerable clients and health‐care professionals in a long‐term care institution were observed during a dialogue conversation (n = 11) and subsequently interviewed (n = 22) about their experiences with the conversation. The clients had various communication difficulties due to different underlying aetiologies, such as acquired brain injury or learning disorder. Results from the observations and interviews were analysed using conventional content analysis.

Results

Seven key themes emerged regarding the experiences of clients and professionals: clients blame themselves for miscommunications; the relevance of both parties preparing the conversation; a quiet and familiar environment benefitting communication; giving clients enough time; the importance and complexity of nonverbal communication; the need to tailor communication to the client; prejudices and inexperience regarding AAC. The observations showed that some professionals had difficulties using appropriate communication strategies and all professionals relied mostly on verbal or nonverbal communication strategies.

Conclusion

Professionals were aware of the importance of preparation, sufficient time, a suitable environment and considering nonverbal communication in dialogue conversations. However, they struggled with adequate use of communication strategies, such as verbal communication and AAC. There is a lack of knowledge about AAC, and professionals and clients need to be informed about the potential of AAC and how this can help them achieve equal participation in dialogue conversations in addition to other communication strategies.

Effects of multimodal communication program on patients with chronic aphasia: a single-subject A-B-A design study

Background and aim

Aphasia as a common consequence of stroke, is an acquired neurologic communication disorder that can affect symbol language processing. Different types of intervention approaches have been introduced. Multimodal Communication Program (MCP) is a new augmentative alternative communication approach in chronic aphasia. The aim of this study was to investigate the effect of MCP on communication skills of patients with chronic aphasia.

Methods

This prospective, single subject, A-B-A design study was done during 2016 in Semnan, Iran. Participants were two patients with severe aphasia with a single left-hemisphere stroke. Three phases, including baseline, intervention and follow-up were administered. The patients received nine-hour intervention, over 10 working days.

Results

Three different scores were calculated for each patient: verbal efforts, the frequency of each modality and the accuracy of switching between modalities and the reaction time. The frequency of verbal modality increased for both patients. They could switch between modalities more successfully than before the intervention. The results for the reaction time, however were challenging. The onset reaction time decreased for patient 1, and increased during switching between modalities, and patient 2 showed the opposite.

Conclusion

The MCP can improve the communication skills in patients with chronic post stroke aphasia. However, some factors, such as reduction of the patients’ reaction time is probably related to the amount of allocated resources during intervention.

Trial registration

The trial was registered at IRCT center with ID: IRCT2016032325194N3.

Funding

The study was financed by Semnan University of Medical Sciences (Grant no.: A-10-333-3).

La intervención de la comunicación aumentativa y alternativa en el traumatismo craneoencefálico

Las personas que sobreviven a un traumatismo craneoencefálico (TCE) pueden presentar trastornos significativos de la comunicación que dependen del tamaño y severidad de la lesión y del nivel resultante de funcionamiento cognitivo. Los trastornos comunicativos generan una restricción en la participación en las actividades diarias y en la reintegración familiar, social y laboral. Ante las necesidades comunicativas insatisfechas derivadas de estos trastornos, el uso de la Comunicación Aumentativa y Alternativa (CAA) es una opción a considerar a lo largo del proceso de recuperación para compensar las necesidades temporales o permanentes, y llevar al máximo potencial la comunicación para la interacción social. El objetivo de este artículo es presentar la variedad de herramientas y estrategias de CAA para una buena valoración e intervención de los supervivientes a un TCE, siguiendo el marco organizativo de estrategias de intervención que incluye los niveles de estimulación, de estructuración y compensatorio, y no las tradicionales fases del modelo de recuperación, y que ha sido descrito en esta área de trabajo por Fager y sus colaboradores (Fager, 2005; Fager y Beukelman, 2005; Fager y Karantounis, 2010; Fager, Doyle, y Karantounis, 2007). Con este trabajo se pretende realizar una contribución a la intervención logopédica, en tanto en cuanto no existen documentos en español que describan y resuman las diferentes estrategias de valoración e intervención de la CAA en población con daño cerebral por TCE.

How a diverse research ecosystem has generated new rehabilitation technologies: Review of NIDILRR's Rehabilitation Engineering Research Centers

Over 50 million United States citizens (1 in 6 people in the US) have a developmental, acquired, or degenerative disability. The average US citizen can expect to live 20% of his or her life with a disability. Rehabilitation technologies play a major role in improving the quality of life for people with a disability, yet widespread and highly challenging needs remain. Within the US, a major effort aimed at the creation and evaluation of rehabilitation technology has been the Rehabilitation Engineering Research Centers (RERCs) sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research. As envisioned at their conception by a panel of the National Academy of Science in 1970, these centers were intended to take a "total approach to rehabilitation", combining medicine, engineering, and related science, to improve the quality of life of individuals with a disability. Here, we review the scope, achievements, and ongoing projects of an unbiased sample of 19 currently active or recently terminated RERCs. Specifically, for each center, we briefly explain the needs it targets, summarize key historical advances, identify emerging innovations, and consider future directions. Our assessment from this review is that the RERC program indeed involves a multidisciplinary approach, with 36 professional fields involved, although 70% of research and development staff are in engineering fields, 23% in clinical fields, and only 7% in basic science fields; significantly, 11% of the professional staff have a disability related to their research. We observe that the RERC program has substantially diversified the scope of its work since the 1970's, addressing more types of disabilities using more technologies, and, in particular, often now focusing on information technologies. RERC work also now often views users as integrated into an interdependent society through technologies that both people with and without disabilities co-use (such as the internet, wireless communication, and architecture). In addition, RERC research has evolved to view users as able at improving outcomes through learning, exercise, and plasticity (rather than being static), which can be optimally timed. We provide examples of rehabilitation technology innovation produced by the RERCs that illustrate this increasingly diversifying scope and evolving perspective. We conclude by discussing growth opportunities and possible future directions of the RERC program.

Effect of Message Type on the Visual Attention of Adults With Traumatic Brain Injury

PURPOSE

The purpose of this investigation was to measure the effect of message type (i.e., action, naming) on the visual attention patterns of individuals with and without traumatic brain injury (TBI) when viewing grids composed of 3 types of images (i.e., icons, decontextualized photographs, and contextualized photographs).

METHOD

Fourteen adults with TBI and 14 without TBI-assigned either to an action or naming message condition-viewed grids composed of 3 different image types. Participants' task was to select/sustain visual fixation on the image they felt best represented a stated message (i.e., action or naming).

RESULTS

With final fixation location serving as a proxy for selection, participants in the naming message condition selected decontextualized photographs significantly more often than the other 2 image types. Participants in the action message condition selected contextualized photographs significantly more frequently than the other 2 image types. Minimal differences were noted between participant groups.

CONCLUSIONS

This investigation provides preliminary evidence of the relationship between image and message type. Clinicians involved in the selection of images used for message representation should consider the message being represented when designing supports for people with TBI. Further research is necessary to fully understand the relationship between images and message type.

The Use of Technology for Phone and Face-to-Face Communication After Total Laryngectomy

PURPOSE

The purpose of this article is to describe the characteristics and experiences of individuals who use technology to support telephone or face-to-face communication after total laryngectomy.

METHOD

An online questionnaire was used to identify potential participants. Seventeen individuals met inclusion criteria and participated in an in-depth survey. They were compared with a reference group matched for age, gender, and time postsurgery who did not use these technologies. Open-ended responses were summarized.

RESULTS

Compared with the matched reference group, individuals who used technology to support verbal communication had undergone more aggressive cancer treatment and used more communication methods. They were less likely to use an alaryngeal speech method, had greater difficulty over the telephone, and used more repair strategies in face-to-face communication. The 2 groups did not differ significantly in the frequency or success of their communication, however. Open-ended responses revealed great variety with regard to their reasons, purposes, and timing of technology use.

CONCLUSIONS

There is a subset of individuals using technology to support verbal communication very successfully after laryngectomy. Usage was not limited to those who were unable to communicate verbally and often continued long after the initial postoperative period in many settings, for various purposes, and in combination with other methods of communication.

Technology-aided leisure and communication: Opportunities for persons with advanced Parkinson's disease

OBJECTIVE

This study investigated whether simple technology-aided programs could be used to promote leisure and communication engagement in three persons with advanced Parkinson's disease.

METHOD

The programs included music and video options, which were combined with (a) text messaging and telephone calls for the first participant, (b) verbal statements/requests, text messaging, and reading for the second participant, and (c) verbal statements/requests and prayers for the third participant. The participants could activate those options via hand movement or vocal emission and specific microswitches.

RESULTS

All three participants were successful in activating the options available. The mean cumulative frequencies of option activations were about five per 15-min session for the first two participants and about four per 10-min session for the third participant.

CONCLUSION

The results were considered encouraging and relevant given the limited amount of evidence available on helping persons with advanced Parkinson's disease with leisure and communication.

Persons With Advanced Alzheimer’s Disease Engage in Mild Leg Exercise Supported by Technology-Aided Stimulation and Prompts

This study assessed whether nine persons with advanced Alzheimer’s disease would learn to engage in leg responses (exercise) with the support of a technology-aided program, which provided (a) preferred stimulation contingent on the leg responses and (b) verbal reminders/prompts in case of no responding. The study was conducted according to a non-concurrent multiple baseline design across participants and involved sessions of 5 min. During the baseline, the participants’ mean frequencies of leg responses ranged from zero to slightly above two per session. During the intervention, those frequencies ranged from nearly 10 to nearly 17 per session. The mean frequencies of prompts varied across participants from about two to more than seven per session. In addition to the increase in leg responses, participants showed an increase in signs of positive personal involvement (e.g., smiles and positive verbalizations) during the intervention sessions as compared with the baseline sessions. The applicability and potential benefits of the program in daily contexts are discussed.

Perspectives of a mobile application for people with communication disabilities in the community

Purpose To determine the perceptions of people with complex communication needs (CCN) and business staff regarding the uses and functionality of a mobile application to aid communication access. Method A qualitative study using thematic analysis of transcripts and field notes from focus groups and interviews of 19 people with CCN and nine business staff. Results Four themes and 10 subthemes were drawn from the data. Themes highlighted the desire for: increased communication strategies to support customer interactions, increased access to information, functionality of a mobile application to increase its utility, and preferred technical and visual features of mobile applications. Conclusion People with CCN and business staff perceived a mobile application as a useful tool to aid communication access. This research highlighted the importance of facilitating strategies to communicative interactions and information in the community as the fundamental goal of a mobile application developed to support communication access. Implications for Rehabilitation Mobile applications are widely accepted and used in modern customer service industries and have been identified as tools to increase communication access for people with complex communication needs (CCN). People with CCN identified accessibility, presentation, and customisation as important features of mobile applications for communication access. The diversity of user preferences and needs, and the rapid development of new technologies limit the applicability of a single design for mobile applications for people with CCN. People with CCN should be involved in application design and development. A mobile application for communication access would support customer-business interactions as well as enable more accessible information sharing about disability needs and services.

Cognitive Rehabilitation After Traumatic Brain Injury: A Reference for Occupational Therapists

Nearly 1.7 million Americans sustain a traumatic brain injury (TBI) each year. These injuries can result in physical, emotional, and cognitive consequences. While many individuals receive cognitive rehabilitation from occupational therapists (OTs), the interdisciplinary nature of TBI research makes it difficult to remain up-to-date on relevant findings. We conducted a literature review to identify and summarize interdisciplinary evidence-based practice targeting cognitive rehabilitation for civilian adults with TBI. Our review summarizes TBI background, and our cognitive remediation section focuses on the findings from 37 recent (since 2006) empirical articles directly related to cognitive rehabilitation for individuals (i.e., excluding special populations such as veterans or athletes). This manuscript is offered as a tool for OTs engaged in cognitive rehabilitation and as a means to highlight arenas where more empirical, interdisciplinary research is needed.

What We Write about When We Write About AAC: The Past 30 Years of Research and Future Directions

For the past 30 years, the Augmentative and Alternative Communication (AAC) journal has both documented and instigated change in the field of AAC. We reviewed the papers published in the AAC journal from 1985-2014 in order to identify trends in research and publication activities. Intervention research made up the largest proportion of the four types of research (i.e., intervention, descriptive, experimental, and instrument and measurement development) reported in the journal. Intervention research has most commonly focused on the individual with complex communication needs, and most frequently on younger individuals (aged 17 and younger) with developmental disabilities. While much has been learned in the past 30 years, there continues to be a need for high quality research in a large number of areas. There is a special need for reports of interventions with older individuals with complex communication needs as a result of acquired disabilities, and for information on effective interventions for the communication partners of persons with complex communication needs.

EXTENDING THE ASSESSMENT OF TECHNOLOGY-AIDED PROGRAMS TO SUPPORT LEISURE AND COMMUNICATION IN PEOPLE WITH ACQUIRED BRAIN INJURY AND EXTENSIVE MULTIPLE DISABILITIES

Intervention programs for people with acquired brain injury and extensive motor and communication impairment need to be diversified according to their characteristics and environment. These two studies assessed two technology-aided programs for supporting leisure (i.e., access to songs and videos) and communication (i.e., expressing needs and feelings and making requests) in six of those people. The three people participating in Study 1 did not possess speech but were able to understand spoken and written sentences. Their program presented leisure and communication options through written phrases appearing on the computer screen. The three people participating in Study 2 did not possess any speech and were unable to understand spoken or written language. Their program presented leisure and communication options through pictorial images. All participants relied on a simple microswitch response to enter the options and activate songs, videos, and communication messages. The data showed that the participants of both studies learned to use the program available to them and to engage in leisure and communication independently. The importance of using programs adapted to the participants and their environment was discussed.

Supporting communication in semantic dementia: clinical consensus from expert practitioners

Purpose

The purpose of this paper is to gain consensus regarding the clinical priorities and tasks required in supporting communication needs in those living with semantic dementia and their families, by specialist speech and language therapists (SLTs), working in clinical practice within dementia care settings in the UK.

Design/methodology/approach

A nominal group technique was used, followed by further exploration and refinement of issues using a modified Delphi technique with a group of six SLTs who specialised in dementia care and who had experience of working with individuals with semantic dementia and their families.

Findings

The findings in the study demonstrate a broader scope of practice than is evident within the research literature with this client group. Therapists identified a range of psychosocial issues for both the person with semantic dementia and their family, in particular finding ways to support activity and participation in conversation and explore barriers and facilitators within the communication environment.

Originality/value

This represents the first study to explore everyday practice in this rarer dementia and the information gathered here will be of use to a variety of health and social care professions interested in supporting those with semantic dementia and their families.

Supporting communication for patients with neurodegenerative disease

BACKGROUND

Communication supports, referred to as augmentative and alternative communication (AAC), are an integral part of medical speech-language pathology practice, yet many providers remain unfamiliar with assessment and intervention principles. For patients with complex communication impairments secondary to neurodegenerative disease, AAC services differ depending on whether their condition primarily affects speech and motor skills (ALS), language (primary progressive aphasia) or cognition (Alzheimer's disease). This review discusses symptom management for these three conditions, identifying behavioral strategies, low- and high-tech solutions for implementation during the natural course of disease. These AAC principles apply to all neurodegenerative diseases in which common symptoms appear.

OBJECTIVES

To present AAC interventions for patients with neurodegenerative diseases affecting speech, motor, language and cognitive domains. Three themes emerge: (1) timing of intervention: early referral, regular re-evaluations and continual treatment are essential; (2) communication partners must be included from the onset to establish AAC acceptance and use; and (3) strategies will change over time and use multiple modalities to capitalize on patients' strengths.

CONCLUSIONS

AAC should be standard practice for adults with neurodegenerative disease. Patients can maintain effective, functional communication with AAC supports. Individualized communication systems can be implemented ensuring patients remain active participants in daily activities.

Communication intervention in Rett syndrome: a survey of speech language pathologists in Swedish health services

PURPOSE

To investigate communication intervention that speech language pathologists (SLPs) provide to people with Rett syndrome.

METHODS

A web-based survey targeting all Swedish SLPs working with people currently receiving support from habilitation services.

RESULTS

The SLPs reportedly followed recommended practice in the following aspects: (1) Information on communicative function was collected from several sources, including observation in well-known settings and reports from the client s social network, (2) Multimodal communication was promoted and, (3) Responsive partner strategies were largely targeted in the intervention. However, few instruments or standard procedures were used and partner instruction was given informally. Most SLPs used communication aids in the intervention and their general impression of using communication aids was positive. Further, augmentative and alternative communication (AAC) was estimated to increase and clarify communicative contributions from the person.

CONCLUSIONS

Communication aids were reported to have a positive influence on communicative functions. Swedish SLP services followed best practice in several aspects, but there are areas with potential for development. Tools and best practice guidelines are needed to support SLPs in the AAC process for clients with Rett syndrome. [Box: see text].

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.

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.

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.

The iPad and mobile technology revolution: benefits and challenges for individuals who require augmentative and alternative communication

The iPad and other mobile technologies provide powerful new tools to potentially enhance communication for individuals with developmental disabilities, acquired neurogenic disorders, and degenerative neurological conditions. These mobile technologies offer a number of potential benefits, including: (a) increased awareness and social acceptance of augmentative and alternative communication (AAC), (b) greater consumer empowerment in accessing AAC solutions, (c) increased adoption of AAC technologies, (d) greater functionality and interconnectivity, and (e) greater diffusion of AAC research and development. However, there remain a number of significant challenges that must be addressed if these benefits are to be fully realized: (a) to ensure the focus is on communication, not just technology, (b) to develop innovative models of AAC service delivery to ensure successful outcomes, (c) to ensure ease of access for all individuals who require AAC, and, (d) to maximize AAC solutions to support a wide variety of communication functions. There is an urgent need for effective collaboration among key stakeholders to support research and development activities, and to ensure the successful implementation of mobile technologies to enhance communication outcomes for individuals who require AAC and their families.

Ethical issues in states of impaired communication with intact consciousness and language

Acute and chronic peripheral and/or central disorders of the voluntary motor system can produce profound paresis or paralysis, at times with ophthalmoplegia, while preserving consciousness and language function. Although at times appearing to be unconscious, these patients are awake and alert but unable to communicate, manipulate their environment, or participate in medical decision-making. Clinicians caring for these patients are ethically tasked with recognizing this clinical reality, enacting measures to facilitate communication, and abiding by ethical and legal principles that support autonomous patient-centered decision-making. This chapter reviews the various disorders that may cause this state while using three exemplary disorders - locked-in syndrome, caused by an anterior pontine lesion; high cervical spinal cord lesion; and amyotrophic lateral sclerosis - to discuss the management of these patients.

AAC to support conversation in persons with moderate Alzheimer's disease

Even though we know that external memory aids support communication in Alzheimer's disease, the components of the communication aids for individuals with Alzheimer's disease have not been studied systematically. The goal of these two pilot experiments was to examine differences in conversational performance of adults with Alzheimer's disease related to the presence and absence of an aid, the type of symbol embedded in the aid, and the presence or absence of voice output. In Experiment 1, 30 adults with moderate-to-severe Alzheimer's disease participated in 10-min conversations with and without personalized AAC boards. There was no effect of AAC, regardless of symbol type, and a deleterious effect of voice output. In Experiment 2, modified spaced-retrieval training preceded conversations, standardized prompts were presented, and semantically-based dependent variables were examined. For the 11 participants in the second experiment, there was a significant effect of AAC, showing that the presence of AAC was associated with greater use of targeted words during personal conversations. We discuss new information about the contribution of AAC for persons with Alzheimer's disease, and demonstrate how the applied research process evolves over the course of a long-term commitment to a scientific investigation.

Behavioural interventions for enhancing life participation in behavioural variant frontotemporal dementia and primary progressive aphasia

Primary progressive aphasia (PPA) and behavioural-variant frontotemporal dementia (bvFTD) are clinical syndromes under the umbrella term 'frontotemporal dementia' (FTD) and are caused by a neurodegenerative disease with an onset most typically in the productive years of adulthood. The cognitive and behavioural impairments associated with FTD interfere with successful engagement in typical life roles, such as parenting, working, and maintenance of interpersonal relationships. There are currently no treatments to stop or slow the degenerative process and there are only very limited medication options for the management of the cognitive-behavioural symptoms. However, alternative, non-pharmacological interventions may offer significant benefit to the quality of life of the diagnosed individual. The goal of this paper is to provide an overview of the approaches available through neurorehabilitation and community-based services that facilitate successful engagement in life activities and promote optimal quality of life for the individuals and families living with FTD. It is hoped that as medical providers become more familiar with behavioural interventions, referrals for services will increase thereby allowing individuals with FTD and their caregivers to learn ways to adapt, adjust, and participate in life to the fullest despite the impairments from this progressive disease.