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

The development of synthetic child speech in three South African languages

It is well-known that children with expressive communication difficulties have the right to communicate, but they should also have the right to do so in whichever language they choose, with a voice that closely matches their age, gender, and dialect. This study aimed to develop naturalistic synthetic child speech, matching the vocal identity of three children with expressive communication difficulties, using Tacotron 2, for three under-resourced South African languages, namely South African English (SAE), Afrikaans, and isiXhosa. Due to the scarcity of child speech corpora, 2 hours of child speech data per child was collected from three 11- to 12-year-old children. Two adult models were used to "warm start" the child speech synthesis. To determine the naturalness of the synthetic voices, 124 listeners participated in a mean opinion score survey (Likert Score) and optionally gave qualitative feedback. Despite limited training data used in this study, we successfully developed a synthesized child voice of adequate quality in each language. This study highlights that with recent technological advancements, it is possible to develop synthetic child speech that matches the vocal identity of a child with expressive communication difficulties in different under-resourced languages.

How People Living With Amyotrophic Lateral Sclerosis Use Personalized Automatic Speech Recognition Technology to Support Communication

PURPOSE

Amyotrophic lateral sclerosis (ALS) is a progressive, ultimately fatal disease causing progressive muscular weakness. Most people living with ALS (plwALS) experience dysarthria, eventually becoming unable to communicate using natural speech. Many wish to use speech for as long as possible. Personalized automated speech recognition (ASR) model technology, such as Google's Project Relate, is argued to better recognize speech with dysarthria, supporting maintenance of understanding through real-time captioning. The objectives of this study are how plwALS and communication partners use Relate in everyday conversation over a period of up to 12 months and how it may change with any decline in speech over time.

METHOD

This study videoed interactions between three plwALS and communication partners. We assessed ASR caption accuracy and how well they preserved meaning. Conversation analysis was used to identify participants' own organizational practices in the accomplishment of interaction. Thematic analysis was used to understand better the participants' experiences of using ASR captions.

RESULTS

All plwALS reported lower-than-expected ASR accuracy when used in conversation and felt ASR captioning was only useful in certain contexts. All participants liked the concept of live captioning and were hopeful that future improvements to ASR accuracy may support their communication in everyday life.

CONCLUSIONS

Training is needed on best practices for customization and practical use of ASR technology and for the limitations of ASR in conversational settings. Support is needed for those less confident with technology and to reduce misplaced allocation of ownership of captioning errors, risking negative effects on psychological well-being.

A qualitative evidence synthesis of the experiences and perspectives of communicating using augmentative and alternative communication (AAC)

PURPOSE

This paper presents a review of the existing qualitative research literature concerning people's experience of communicating using augmentative and alternative communication (AAC). The aims of conducting this review were to find out more about the values and outcomes that are important to people about the AAC they use to support their communication. This review was conducted to provide a deeper understanding of these experiences to inform the development of a patient-reported outcome measure (PROM).

MATERIALS AND METHODS

A qualitative evidence synthesis of existing qualitative research literature was undertaken to explore and appraise current knowledge about the experiences of people who use AAC.

RESULTS

From 115 qualitative research reports 19 papers were identified that responded directly to the research question and aims of the review. Data were identified that could be organized within an a priori framework consisting of the constructs of values, outcomes, and context.

CONCLUSION

The review has resulted in a deeper, analytical understanding of the experiences of people who require AAC. The results indicate a set of concepts that can be used to inform the development of a PROM. A PROM can be used to assist clinicians and researchers to better understand the perspectives of people who require AAC and evaluate interventions. The results also encourage professionals to reconsider the terminology and methods used when working alongside people who require AAC and to reflect on the multidimensional factors that influence people's experience of communication.

Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: multi-stakeholder perspectives

Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training.

A Comprehensive Scoping Review of Caregivers' Experiences With Augmentative and Alternative Communication and Their Collaboration With School Professionals

PURPOSE

Parent engagement and involvement is essential for the successful implementation of augmentative and alternative communication (AAC) systems in the home. The purpose of the current study is to gain a deeper understanding of caregivers' experiences with AAC systems and their collaboration with school professionals during the implementation of AAC, which may have led to subsequent abandonment.

METHOD

This review intentionally included qualitative studies that employed semistructured interviews, focus groups, and ethnographic investigations that documented the experiences and perceptions of families implementing AAC at home. Electronic database search, ancestral search, and forward search procedures resulted in a total of 27 peer-reviewed studies portraying the voices of 319 caregivers.

RESULTS

An inductive analysis was conducted to record recurring themes into codes. The codes were thematically synthesized into three main themes: (a) the family unit, (b) the service providers, and (c) the AAC system.

CONCLUSIONS

The results emphasized the need for participatory practices of family involvement in co-constructing a collaborative AAC service provision. Future research directions should implement this practice and explore the outcomes of this process to validate its efficacy.

Possibilities of intelligent textiles in AAC - perspectives of speech and language therapists

PURPOSE

The growth of new high-technology devices in the field of augmentative and alternative communication (AAC) has been rapid. However, a vast number of individuals with complex communication needs are left without functional means to communicate in their lives. Intelligent textiles are one of the growing industries in health technologies yet to be explored for the possibility of implementation as an AAC solution. This study aimed to investigate the potential of intelligent textiles and their functions in daily life perceived by experienced speech and language therapists and to obtain data, which will offer direction on how to proceed with prototype development.

MATERIALS AND METHODS

Focus group discussions were conducted remotely within two groups of experienced speech and language therapists (n = 12). The data obtained from the discussions were analysed thematically.

RESULTS AND CONCLUSION

According to the stakeholders in question, intelligent textiles were perceived most useful for individuals with motor disabilities and those with severe intellectual disabilities. The most prominent themes for the purpose of using the intelligent textiles were social interaction and accessing meaningful activities independently. The participants also described how this technology could be used in terms of the textile, the input needed and the output the technology provides. The versatile results are discussed along with directions for future research.

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Speech-language pathologists' perceptions of augmentative and alternative communication in Thailand

Augmentative and alternative communication (AAC) systems are not well-known and broadly used in Thailand. To begin introducing AAC systems and interventions to children with complex communication needs in Thailand, understanding speech-language pathologists' (SLPs) perceptions toward various AAC systems is an important first step. This study assessed SLPs' perceptions of three AAC modalities: gestural communication, communication boards, and iPad1-based speech-output technologies. A total of 78 SLPs watched three video vignettes of a child using each mode and rated their impressions of intelligibility, ease of learnability and use, effectiveness, and preference. Then they were asked to rate factors on visual analog scales that provided additional insights into their rationales and their preferences for AAC modalities for nonverbal clients and for themselves if they were nonverbal. The results indicated that most of the SLPs rated iPad-based speech-output technologies as being the more intelligible, effective, and preferred mode of communication. Gestural communication was rated as the easiest mode to learn and use for a child with complex communication needs. Despite infrequent use of iPad-based speech-output technologies in Thailand, SLPs' ratings indicated high social acceptance of this modality for promoting communication abilities of children with complex communication needs. Results also revealed some biases and lack of knowledge about AAC systems in Thailand.

A scoping review of communication outcomes measures in augmentative and alternative communication

Although outcomes are a critical component of evidence-based practice, measuring augmentative and alternative communication (AAC) outcomes remains problematic. This is, in part, because there is no consensus on how to operationally define AAC communication outcomes. To gain greater insight into AAC communication outcomes, we used the communicative competence framework to determine which areas of AAC intervention have received the greatest attention and how these outcomes are being measured. The following data were charted from the 77 studies that met the inclusion criteria for the scoping review: study design, study participants, study communication target (e.g., language, word learning, etc.), and communication outcome measurements. Across the included studies, researchers used a variety of standardized and non-standardized measures to assess outcomes. Seventy-seven percent of the studies assessed social skills and 62% assessed linguistic skills. A limited number of studies measured operational (14%), strategic (4%), and psychosocial (18%) skills. Using the communicative competence framework enabled us to identify gaps in the research that has been conducted to date.

Exploring Classroom Factors and Augmentative and Alternative Communication Use in Qualitative Interviews

PURPOSE

This qualitative study explores classroom contextual factors influencing augmentative and alternative communication (AAC) use in early childhood classrooms.

METHOD

Semistructured interviews were conducted with six special education teachers, 13 speech-language pathologists (SLPs), and one SLP assistant. Interviews were analyzed inductively in a systematic, multistep coding process using the constant comparative method with member checking.

RESULTS

Seven themes were identified that affected AAC use in the classroom. Each theme was organized into three categories: individual-, classroom-, or school-level factors. Three themes were categorized as individual-level factors: Students' AAC systems are unavailable, professionals face challenges obtaining AAC knowledge and skills, and students' disruptive behaviors reduce access to AAC. One theme was a classroom-level factor: Classroom demands prevent AAC use. Finally, three themes were considered school-level factors: The culture of AAC influences AAC acceptance, team collaboration is essential for successful implementation, and teams need administrative support to deliver AAC interventions effectively. Conclusions: Teachers and SLPs felt that collaborative teams with AAC expertise, a school culture that endorsed AAC, and solid administrative support accelerated AAC adoption by normalizing AAC use in the classroom. Due to classroom demands, they struggled to use strategies such as aided AAC modeling and responsiveness during group instruction. Finally, participants emphasized that while it was necessary to customize AAC systems for each student, this individualization makes it harder for staff to learn each system and integrate them into classroom activities.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23681718.

Multicultural considerations in augmentative and alternative communication

Little is known about how well high-tech augmentative and alternative communication (AAC) systems accommodate language variation to meet the needs of people and families who are culturally and linguistically diverse. The purpose of this study was to investigate how high-tech AAC device manufacturers consider language variation and multilingualism in device design and language files, whether there is a difference in the modifications available on default language files on a dedicated AAC device as compared to communication applications on tablets, and the availability of these modifications. A coding schema was developed to assess features available that enabled user modification of default language files across four language domains: semantics, morphosyntax, phonology, and pragmatics. The results indicated that more changes were possible in semantics and phonology on default language files. There were not significant differences between language files offered on a dedicated AAC device or an application on a tablet. There were significant differences in the capabilities of the device to make modifications and in the ease of programming, but not in the resources provided to families. Based on these findings, it appears that device manufacturers have just begun to address the needs of families and users who are culturally and linguistically diverse.

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

INTRODUCTION

Augmentative and alternative communication (AAC) encompasses all forms of unaided and aided modes of communication, but typically excludes codified language such as spoken words or American Sign Language (ASL). In pediatric patients with a documented additional disability (population of interest), deficits in communication may pose a barrier to language development. While forms of AAC are frequently mentioned in the literature, recent innovations have permitted the use of high-tech AAC in the rehabilitation process. Our objective was to review the implementation of AAC in pediatric cochlear implant recipients with a documented additional disability.

METHODS

A scoping review of existing literature examining the use of AAC in pediatric CI recipients was conducted in the PubMed/MEDLINE and Embase databases. Studies with pediatric cochlear implant recipients with a concomitant diagnosis requiring additional therapeutic intervention outside the scope of standard post-CI follow-up care and rehabilitation from 1985 to 2021 met inclusion criteria (population of interest). Studies limited to spoken or formal sign language (e.g., American Sign Language, ASL) as communication modalities were excluded.

RESULTS

Four hundred twenty studies were screened of which 29 were included. 13 were prospective, 10 were retrospective, 1 was cross-sectional, and 5 were case reports. Of these 29 studies, 378 patients met the inclusion criteria (age <18, CI user, additional disability, utilized AAC). Fewer studies (n = 7) utilized AAC as the primary intervention for investigation. Autism spectrum disorder, learning disorder, and cognitive delay were frequently mentioned as additional disabilities in conjunction with AAC. Unaided forms of AAC included gesture/behavior, informal sign, and signed exact English, while aided AAC included a Picture Exchange Communication System (PECS), Voice Output Communication Aids (VOCA), and touchscreen programs such as TouchChat® HD. Various audiometric and language development outcome measures were mentioned, most commonly the Peabody Picture Vocabulary Test (PPVT) (n = 4) and the Preschool Language Scale, Fourth Edition (PLS-4) (n = 4).

CONCLUSION

There is a gap in the literature regarding the use of aided and high-tech AAC in pediatric CI users with a documented additional disability. Given the use of multiple different outcome measures, additional exploration of the intervention of AAC is warranted.

Perceptions of families with adolescents utilizing augmentative and alternative communication technology: A qualitative approach

PURPOSE

Although family involvement is critical to successful augmentative and alternative communication (AAC) device utilization, little is known about how families adapt to technology. The aim of this qualitative study was to explore parent-reported factors contributing to family adaptation among families with adolescents diagnosed with autism and/or Down syndrome (DS) utilizing AAC technology. This study describes families' experiences related to several interacting variables of the Resiliency Model, including demand, type, appraisal, resources, and problem-solving/coping, that helped shape the outcome of adaptation to AAC technology. Nurses are well-positioned in a variety of practice settings to assess vulnerable families and assist with identifying resources and navigating complex service systems.

DESIGN AND METHODS

Semi-structured interviews were conducted with eight parents of adolescents with autism and/or DS (aged 13-18) recruited through online research registries, support organizations, and a social networking site. Recorded interviews were transcribed, and two independent reviewers coded and analyzed the data. Comparisons across all families' thematic summaries were examined for patterns.

RESULTS

Five themes described aspects of family adaptation: Contextual Strains and Influences, Continuum of Person-First Approach, Opening Doors, Facilitators of Support, and Planning Is Key.

CONCLUSIONS

Findings highlighted the challenges and demands associated with raising an adolescent using an AAC device, as well as the attributes, resources, perceptions, and strategies that either contributed or hindered family adaptation.

PRACTICE IMPLICATIONS

AAC technology is readily available for adolescents with developmental disabilities. It is essential that nurses assess key adaptation components to support families in integrating and using the technology.

Supporting Families from a Distance: Implementing Routines-Based Home Visits via Telepractice

Early intervention is a system of services designed to strengthen child outcomes and build family capacity. One approach of service provision is the Routines-Based Model which implements adult-learning practices wherein service providers and caregivers partner to build family-mediated interventions for children. Owing to COVID-19 and the benefits of telepractice, more and more service providers are likely to incorporate a telepractice modality into service provision. Because the Routines-Based Model uses family consultation, these home-visiting practices translate well to telepractice. In addition to consultation techniques, however, service providers must use technology advantageously to ensure effective communication practices. This article discusses technology uses in telepractice that can be incorporated in the Routines-Based Model, Tele-Routines-Based Home Visits, and examples of Tele-Routines-Based Home Visits.

The effect of using illustrated materials for communication on the anxiety and comfort of cardiac surgery patients receiving mechanical ventilator support: A randomized controlled trial

BACKGROUND

Using illustrated communication materials with patients receiving mechanical ventilation support increases patient satisfaction and reduces communication difficulties. However, there are no randomized controlled clinical studies showing the effect of the use of these materials on patient care outcomes.

OBJECTIVE

To determine the effect of using illustrated communication materials on the anxiety and comfort levels of patients receiving mechanical ventilation support.

METHODS

In this controlled clinical trial, patients were randomly assigned to either the intervention group that used illustrated communication materials or the control group that used routine communication methods. In the first minute of contact with patients in the intensive care unit, then at 30 min and 60 min, patients' numerical pain-rating scale scores, hemodynamic values, and face-anxiety scale scores were recorded. Satisfaction with communication and perianesthesia comfort scale scores were obtained the day after operation.

RESULTS

After 30 min of communication, the percentage of face-anxiety points difference decreased in the intervention group (-14.16) compared to the control group (-6.11), and the difference was statistically significant (p < 0.05). In terms of perceived comfort during postoperative mechanical ventilation, the mean score of the patients in the intervention group (106.10) was higher than the control group (88.53), and the difference was statistically significant (p < 0.05). Furthermore, 90% of the patients in the intervention group and 30% of the patients in the control group were satisfied with the communication method used, and the difference between the groups was statistically significant.

CONCLUSION

Using illustrated communication materials reduces anxiety and increases patient satisfaction and comfort levels. In communicating with intubated patients, the use of illustrated communication materials is recommended.

Parents' perception on the use of augmentative and alternative communication by children with complex communication needs in Malaysia

PURPOSE

Children with developmental disabilities who have complex communication needs (CCN) frequently need to use augmentative and alternative communication (AAC) to communicate effectively and efficiently. Speech-language pathologists (SLPs) often work closely with parents and other professionals when deciding on the best AAC system to introduce to these children. This study aimed to describe the use of AAC by children with CCN in Malaysia as reported by their parents.

MATERIALS AND METHOD

An online survey distributed for this study was completed by 235 parents.

RESULTS

Most of the parents of children with CCN who participated in this study reported that their children used low-tech AAC systems. A majority of respondents were satisfied with their child's AAC system. Parental satisfaction was positively associated with the frequency of use and whether the use of AAC helped parents understand the child better. Challenges reported by parents when using AAC and the reason some families abandoned the use of AAC were similar. Examples of challenges include parents having limited time and the child lacking the motivation to use the AAC system.

CONCLUSION

The findings of this study suggest the importance of SLPs actively involving parents in the selection of their children's AAC system so they are agreeable with the system introduced and continuously supporting children and their families to encourage and sustain the use of AAC. Implications for rehabilitationSpeech-language pathologists (SLPs) can create communication opportunities for the child to use augmentative and alternative communication (AAC) and experience success, teach parents how to incorporate AAC into the family's daily routine and activities, and reduce the demands on parents by preparing the AAC materials and programming the AAC system where possible.SLPs can provide ongoing support to school teachers to equip them with the necessary knowledge and skills to support the use of AAC in the classroom.

"Finding Common Ground" - Impact of a Complex Intervention on Collaboration in Augmentative and Alternative Communication Care of People without Natural Speech

Purpose

Many care settings are characterized by collaboration between a variety of stakeholders. People without natural speech who rely on augmentative and alternative communication (AAC) are often strongly dependent on the involved stakeholders and collaboration among them. Since collaboration can be challenged by many barriers, this study examines the impact of a complex intervention on collaboration in AAC care.

Methods

In a quasi-experimental mixed methods intervention study which include AAC training, AAC therapy and case management, caregivers of AAC users were surveyed at 3 time points to assess collaboration and case management in the intervention versus comparison group. In addition, semi-structured focus group interviews were conducted with caregivers in the intervention group. Quantitative data were analyzed descriptively and by comparison of means. Qualitative data were analyzed using qualitative content analysis.

Results

The Mann-Whitney U-test showed significantly better collaboration in the intervention group with stakeholders that are more actively involved in AAC care, such as schools (p=0.026) and residential or social facilities (p=0.010), but not with passive stakeholders such as health insurance companies. Most aspects of case management were rated significantly better in the intervention group (p<0.001). The focus group results show mainly positive changes in collaboration with the active stakeholders, such as more commitment and openness toward AAC.

Conclusion

The results show a positive impact of the intervention on the collaboration between stakeholders involved in AAC care - especially with active stakeholders. In particular, the organization of care and the accompanying case management by the AAC consultation centers seem to positively affect collaboration.

Striving Toward Equity in Health Care for People With Communication Disabilities

PURPOSE

Approximately 10% of the U.S. adult population has a speech, language, and/or voice disability, collectively referred to as communication disabilities. An increasing number of studies demonstrate that persons with communication disabilities have worse health and health care outcomes as compared to those without communication disabilities. Understanding the state of the science, including potential contributing factors is critical to begin to address the disparities.

METHOD

Applying a historical lens and integrating multiple models of disability provide a comprehensive perspective of the health and health care outcomes of persons with communication disabilities.

RESULTS

Three phases for addressing health care disparities exist: detecting, understanding, and reducing. Results from a 2012 National Health Interview Survey provide compelling population-level results of the health and health care disparities experienced by persons with communication disabilities. To understand the disparities, factors within the health care system, such as availability of communication aids and services, as well as provider and staff biases, assumptions, and lack of knowledge need to be considered. To date, few interventions exist to address disparities in care for persons with communication disabilities. Consequently, researchers need to engage with stakeholders in innovative study designs and methods to facilitate the rapid development, implementation, and dissemination of interventions that address the disparities.

CONCLUSION

To ensure equity for the large and growing population of persons with communication disabilities, researchers, policy makers, patients, and health care systems need to collaborate in identifying and addressing the factors contributing to health and health care disparities. Presentation Video: https://doi.org/10.23641/asha.21215804.

AAC barriers and facilitators for children with Koolen de Vries syndrome and childhood apraxia of speech: parent perceptions

Despite the potential positive impact of augmentative and alternative communication, the literature suggests that many individuals with disabilities experience barriers in developing communication skills and access to appropriate supports. Parents can provide valuable insight into the barriers and facilitators experienced by their children with complex communication needs. Previous studies exploring parent perspectives of the complex communication needs of children with various disabilities have revealed similarities and differences in experiences. This supports the need to examine the barriers and facilitators experienced by different populations, including individuals with Koolen de Vries syndrome (KdVS). As a newly identified syndrome, information on individuals with KdVS is limited, and studies examining parent experiences in supporting the communication needs of children with KdVS have not been conducted. This study obtained parents' perspectives regarding the communication barriers and facilitators experienced by their children with KdVS. Fifteen parents participated in one of two focus group sessions. The data were analyzed through qualitative content analysis, resulting in 13 categories discussed in relation to previous research and conceptual frameworks. Research and practical implications for developing a deeper understanding of the barriers experienced by children with KdVS are proposed.

Within arm's reach: The role of proximity in speech generating device use of ambulatory children with autism

Purpose: Augmentative and Alternative Communication (AAC) provides an alternative means of communication for individuals who are unable to effectively communicate using spoken language. The present study seeks to investigate the role of proximity in facilitating AAC (specifically Speech Generating Devices; SGD) use in a homogeneous population: ambulatory school-aged children with autism spectrum disorder (ASD).Method: Twelve school-age children with ASD who use an SGD as their primary mode of communication participated in the study. The percentage of time the child was within the proximity of their device was calculated over nine videotaped sessions and data logging provided information regarding device use over an 18-week period.Result: Children were in proximity to their device 65% of the time. There was a significant positive correlation between percentage of time in proximity to device and the average minutes of device use on the day video recorded. Exploratory analyses revealed that communicative abilities may be more connected to proximity than school context.Conclusion: These results support the importance of developing a program for assuring device proximity in order to encourage consistent device use in minimally verbal ambulatory school-age children with ASD.

Development of a Manually Operated Communication System (MOCS) for patients in intensive care units

Nonvocal alert patients in the intensive care unit (ICU) setting often struggle to communicate due to inaccessible or unavailable tools for augmentative and alternative communication. Innovation of a hand-operated non-touchscreen communication system for nonvocal ICU patients was guided by design concepts including speech output, simplicity, and flexibility. A novel communication tool, the Manually Operated Communication System (MOCS), was developed for use in intensive care settings with patients unable to speak. MOCS is a speech-output technology designed for patients with manual dexterity impairments preventing legible writing. MOCS may have the potential to improve communication for nonvocal patients with limited manual dexterity.

Centering the family in their system: a framework to promote family-centered AAC services

Families are the most significant communication partners for an individual with complex communication needs. Even though family-centered approaches are recommended to support augmentative and alternative communication (AAC) services for an individual, it is difficult to establish a successful plan that fits each individual's family. A framework for practitioners is proposed to effectively obtain and understand information about a family's unique dynamics as part of service delivery to positively impact AAC device uptake and long-term use. The goal of using this model is to minimize the disruption to the family while maximizing the integration of the AAC system. This paper proposes and illustrates a framework to enrich AAC services through the integration of several theoretical models of family systems theory, family paradigms, and a procedure called the self-created genogram. This paper begins by reviewing ecological family systems theory and family systems to guide and provide a framework to support effective AAC implementation. The process of self-creating genograms is then introduced as a means to obtain a rich perspective on family characteristics and dynamics that is informed by the individual who uses AAC. All of this information allows professionals to provide relevant information and tailor options for the family. As a result, the family is able to make informed decisions about AAC intervention in a manner most consistent with how they typically operate. Finally, we apply this framework to a hypothetical case of a child with autism and complex communication needs across three timepoints (preschool, late elementary/early middle school, and high school/post-secondary transition) to demonstrate how this framework can be used in clinical practice.

Preferences for mHealth Technology and Text Messaging Communication in Patients With Type 2 Diabetes: Qualitative Interview Study

Background

Individuals with diabetes need regular support to help them manage their diabetes on their own, ideally delivered via mechanisms that they already use, such as their mobile phones. One reason for the modest effectiveness of prior technology-based interventions may be that the patient perspective has been insufficiently incorporated.

Objective

This study aims to understand patients’ preferences for mobile health (mHealth) technology and how that technology can be integrated into patients’ routines, especially with regard to medication use.

Methods

We conducted semistructured qualitative individual interviews with patients with type 2 diabetes from an urban health care system to elicit and explore their perspectives on diabetes medication–taking behaviors, daily patterns of using mobile technology, use of mHealth technology for diabetes care, acceptability of text messages to support medication adherence, and preferred framing of information within text messages to support diabetes care. The interviews were digitally recorded and transcribed. The data were analyzed using codes developed by the study team to generate themes, with representative quotations selected as illustrations.

Results

We conducted interviews with 20 participants, of whom 12 (60%) were female and 9 (45%) were White; in addition, the participants’ mean glycated hemoglobin A_1c control was 7.8 (SD 1.1). Overall, 5 key themes were identified: patients try to incorporate cues into their routines to help them with consistent medication taking; many patients leverage some form of technology as a cue to support adherence to medication taking and diabetes self-management behaviors; patients value simplicity and integration of technology solutions used for diabetes care, managing medications, and communicating with health care providers; some patients express reluctance to rely on mobile technology for these diabetes care behaviors; and patients believe they prefer positively framed communication, but communication preferences are highly individualized.

Conclusions

The participants expressed some hesitation about using mobile technology in supporting diabetes self-management but have largely incorporated it or are open to incorporating it as a cue to make medication taking more automatic and less burdensome. When using technology to support diabetes self-management, participants exhibited individualized preferences, but overall, they preferred simple and positively framed communication. mHealth interventions may be improved by focusing on integrating them easily into daily routines and increasing the customization of content.

Alternative and Augmentative Communication Technologies for Supporting Adults With Mild Intellectual Disabilities During Clinical Consultations: Scoping Review

Background

People with intellectual disabilities (IDs) face significant communication barriers when accessing health care services; they find it difficult to identify and describe conditions clearly enough to support practitioners in making an accurate diagnosis. In addition, medical professionals generally have little knowledge and understanding of the needs of people with ID, which may result in the use of consultation techniques that do not cater to their patients’ skills.

Objective

This review aims to identify and synthesize the literature on alternative and augmentative communication technologies that are used to support adults with mild ID during the exchange of information with medical practitioners.

Methods

We performed a scoping review of studies published in English that describe the technologies that are used to promote communication with patients with mild ID during medical consultations. The databases searched were PubMed, ACM Digital Library, and Google Scholar. A qualitative framework-based approach was used to synthesize the data and discern key recurring themes across the identified literature.

Results

Of the 1557 articles screened, 15 (0.96%) met our inclusion criteria. The bulk of the communication aids used focused on low-tech solutions, including patient passports, note-based prompts, Talking Mats, health diaries, and easy-read information sheets. Their influence on current practice ranged from advancing medical professionals’ knowledge of the health and communication needs of people with ID to increasing interagency collaboration, patient advocacy skills, and health promotion activities. The major barriers to the implementation of low-tech aids were a lack of portability and increased maintenance efforts. Only 3 studies explored the use of mobile apps to promote communication. Their findings indicated that high-tech solutions offer greater customization with regard to the accessibility and health care needs of people with ID.

Conclusions

Alternative and augmentative communication technologies have the potential to increase the quality of care provided to patients with mild ID; however, little work has been carried out in this area. Greater emphasis must be placed on (high-tech) two-way communication aids that empower patients to become involved in decisions regarding their care. Quantitative evaluation methods should be used to discern the true benefits of such aids, and researchers should describe their study protocols in depth to promote replication and generalizability.

Relation Between the Degree of Use of Smartphones and Negative Emotions in People With Visual Impairment

The use of smartphones has become commonplace, even among people with disabilities. The purpose of this study was to investigate the effect of smartphone use on the negative emotions of people with visual impairment. This study analyzed data from 30 respondents with visual impairments obtained from the 2016 Internet Overdependence Survey in South Korea. The analysis was based on partial least squares regression with information search, leisure, communication, and online transactions as independent variables, and negative emotions comprising depression, anxiety, and loneliness as the dependent variables. Among people with visual impairment, the use of smartphones as a means of communication decreased negative emotions while their use for leisure or information search was related to an increase in negative emotions such as depression and loneliness. Use for information retrieval was found to be associated with a low level of anxiety, and use for online transactions was associated with low loneliness. The results of this study showed that the use of the Internet can be a means of providing interaction opportunities and reducing negation emotions for people with visual impairment.

Naturalistic teaching approach to develop spontaneous vocalizations and augmented communication in children with autism spectrum disorder

Naturalistic developmental behavioral interventions (NDBI) have been shown to facilitate the development of spontaneous language in individuals with speech and language impairment. Several meta-analyses have reported a small number of studies that utilized naturalistic teaching approaches combined with augmentative and alternative communication (AAC) interventions to develop requesting skills in individuals with autism spectrum disorder (ASD). Therefore, the main purpose of this study was to determine whether a natural language paradigm (NLP) and time delay is effective in expanding vocal and augmented requesting skills in three children with ASD between the ages of 4 and 6 years. A concurrent multiple baseline design across participants was used to evaluate the effectiveness of the intervention. The results of the study demonstrated that the participants were successful in emitting vocal requests when both modalities were available and NLP combined with time delay was effective in increasing spontaneous vocal requests in all participants.

Augmentative and Alternative Communication for Children with Intellectual and Developmental Disability: A Mega-Review of the Literature

Establishing evidence- and research-based practices relies upon research synthesis of individual studies in reviews and meta analyses. Further summarizing scientific evidence about a specific topic by synthesizing reviews is an area of need to determine practices that have a strong evidence base and to identify areas of methodological weakness and gaps in the literature. A mega-review of literature reviews, systematic reviews, and meta-analyses on interventions using aided augmentative and alternative communication (AAC) interventions for children with intellectual and developmental disabilities from 2000 to mid-2020 was conducted. Participant and interventionist demographics, interventions, settings, outcomes, and recommendations of each review were reported and summarized. A MeaSurement Tool to Assess systematic Reviews Revised (AMSTAR 2; Shea et al., 2017) was used to examine the methodological rigor of 84 included reviews. Over the past 20 years, published reviews have increased slightly in methodological rigor but demonstrate a number of methodological weaknesses that detract from the strength of evidence for AAC interventions with this population. Suggestions for improving the methodological rigor of literature reviews and areas for future research specific to AAC interventions are discussed.

Speech language pathologists' responses to the rejection or abandonment of AAC systems

Purpose: This study aimed to explore the reported responses of speech-language pathologists (SLPs) to the rejection or abandonment of AAC systems for children with complex communication needs.Methods: Semi-structured in-depth interviews were conducted with 16 SLPs who worked with children with complex communication needs. Interviews were transcribed and coded using thematic analysis.Results: Four themes describing SLPs' responses were identified: (1) SLPs work with families; (2) SLPs respect families' wishes; (3) SLPs "push ahead" with AAC irrespective of families' wishes; and (4) SLPs reflect and acknowledge emotions.Conclusions: SLPs varied in the degree to which they remained family-centred and utilised clinical reflection following the rejection or abandonment of AAC systems for the children they worked with. SLPs also described experiencing a range of negative emotions following the rejection or abandonment of an AAC system, which could impact upon ongoing client care.Implications for RehabilitationIn this research SLPs reported variability in the degree to which they remained family-centred following the rejection or abandonment of an AAC system for the children they worked with.SLPs should reflect on their emotional responses to the rejection or abandonment of AAC systems by their clients.This research suggests that SLP services should consider monitoring the reflective practices of their clinicians to ensure ongoing clinical development and optimisation of client care.

Speech and language difficulties in Huntington's disease: A qualitative study of patients' and professional caregivers' experiences

BACKGROUND

Huntington's disease (HD) is a neurodegenerative disease characterized by a triad of motor, cognitive and psychological symptoms, leading to a gradual breakdown of communication skills. Few studies have investigated how people affected by HD and their professional caregivers, for example, medical doctors, physiotherapists and nurses, experience the patients' gradual loss of speech and language.

AIMS

To examine communication-related experiences of patients and professional caregivers. Experiences with speech therapy and the use of augmentative and alternative communication aids (AAC) were also investigated.

METHODS & PROCEDURES

Seven individuals with HD and seven professional caregivers were interviewed individually, using a semi-structured interview guide. Transcripts were analysed using a conventional content analysis, and the results presented in three main categories.

OUTCOMES & RESULTS

Most individuals with HD were aware of having communication difficulties, struggling with understanding others as well as being understood. This was confirmed by professional caregivers, who also raised ethical issues encountered when patients struggled with communication. Both groups talked about external factors (such as noise or crowded social settings) as disrupting communication, and shared recommendations on how people in general, and speech and language therapists (SLTs) in particular, could optimize communication. Very few patients had received information about communication aids, and none was using AACs. Professional caregivers underlined the importance of interdisciplinary collaborations, including SLTs, in order to optimize care.

CONCLUSIONS & IMPLICATIONS

Findings shed a light on everyday communication challenges faced by people with HD and their professional caregivers, and the lack of implementation of communication aids in this group. The dramatic impact of HD on patients' communication skills underscores the need to include SLTs in the follow-up of this patient group, ideally from the early stages of the disease, while the patient is still capable of voicing his/her own wishes and thoughts. Future research that explores how to optimize communication and implement the use of AACs for individuals with HD is needed. What this paper adds What is already known on this subject Although the ability to communicate gradually deteriorates in individuals affected by Huntington's disease (HD), there is little knowledge about how affected individuals experience the loss of speech and language skills. Interdisciplinary care is recognised as essential for this patient group. However, professional caregivers' thoughts and experiences of communicating with their patients have not been fully explored. Recent years have seen a rapid growth of available communication supporting technologies that could potentially be helpful for individuals with HD, but limited attention has been given to this subject. What this paper adds to existing knowledge What do we now know as a result of this study that we did not know before the results highlight that patients are aware of problems with speech and language even in early phases of the disease, and include patients' personal outlook on problems with communication. Professional caregivers raised ethical issues encountered when patients struggled with communication. Both groups described specific strategies that could facilitate communication. There was a significant lack of experience and knowledge about augmentative and alternative communication aids (AACs). What are the potential or actual clinical implications of this work? Clinical implications of this study. The introduction of communication aids in the follow-up of patients with HD needs to be discussed with the patients in the early phases of the disease, and implemented while the individual still has the capacity to learn and take advantage of alternative communication support. Results underline the importance of including speech and language therapists (SLTs) into multidisciplinary care of patients with HD. SLTs should be available also for professional caregivers who need advice on how to facilitate conversations and social interactions, in order to optimise care of patients with HD.

Collaboration between stakeholders involved in augmentative and alternative communication (AAC) care of people without natural speech

Collaboration among health care providers is intended to dissolve boundaries between the sectors of health care systems. The implementation of adequate augmentative and alternative communication (AAC) care of people without natural speech depends highly on collaboration among multiple stakeholders such as speech and language pathologists, teachers, or physicians. This paper examines existing barriers to and facilitators of collaboration from a stakeholder perspective. Five heterogeneous focus group interviews were conducted with N= 32 stakeholders including speech and language pathologists, AAC consultants, teachers, employees of sheltered workshops, parents, and relatives of AAC users, and other educational professionals (e.g., employees of homes for persons with disabilities) at three AAC counseling centers in Germany. Interview data were analyzed by structured qualitative content analysis. The results show very different experiences of collaboration in AAC care. Factors were identified that can have both positive and negative effects on the collaboration between all stakeholders (e.g., openness toward AAC, knowledge about AAC, communication between stakeholders). In addition, stakeholder-specific influencing factors, such as working conditions or commitment to AAC implementation, were identified. The results also reveal that these factors may have an impact on the quality of AAC care. Overall, the results indicate that good collaboration can contribute to better AAC care and that adequate conditions such as personnel, and time-related resources, or financial conditions need to be established to facilitate collaboration.

Caregivers', teachers', and assistants' use and learning of partner strategies in communication using high-tech speech-generating devices with children with severe cerebral palsy

Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners' learning in how to use partner strategies. To describe communication partners' use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners' learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

Voice banking for people living with motor neurone disease: Views and expectations

BACKGROUND

More than 80% of people living with MND (plwMND) develop difficulties with their speech, affecting communication, self-identity and quality of life. Most plwMND eventually use an augmentative and alternative communication device (AAC) to communicate. Some AAC devices provide a synthesized voice for speech, however these voices are often viewed as impersonal and a factor in AAC acceptance. Voice banking creates an approximation of the person's own voice that can be used in AAC and is argued to go some way to preserve a person's identity when natural voice is lost, but there has been little supporting research.

AIMS

To understand what plwMND consider when deciding whether or not to bank their voice, what their expectations are, and the expectations of significant communication partners.

METHODS

Semi-structured interviews were undertaken with plwMND who had either decided to bank their voice or had decided not to. Thematic analysis was used to provide a qualitative analysis of the data.

PROCEDURES

Participants were an opportunistic sample of plwMND within England recruited via an open advert distributed by the MND Association (MNDA).

OUTCOMES AND RESULTS

Twelve plwMND were interviewed with nine significant others. Nine participants had decided to bank their voice and three decided not to. The data suggest 'preserving identity' is the overarching motivation in decision making for voice banking. Participants who decided to voice bank considered it would help to maintain their identity and preserve their social and work networks. Participants deciding not to bank their voice highlighted it could not replace their natural voice or preserve their identity. However, few in either group showed an awareness of how a voice bank is used in AAC, and how communication using AAC is significantly different to natural speech.

CONCLUSIONS AND IMPLICATIONS

This research is the first study of its kind to examine the considerations for decision making around voice banking for plwMND. Preserving identity is central to decision making when considering whether or not to voice bank. However, the reality of using AAC and voice banking for communication is poorly understood. Professionals have a role to provide plwMND with more information about voice banking in the wider context of using AAC for communication. It may be that the process of voice banking itself is seen as a positive act for plwMND, independent of how it is used later. Further research with associated professionals and stakeholders is indicated. What this paper adds What is already known on this subject Voice banking creates an approximation of the person.s own voice that can be used in AAC, and is argued to go some way to preserve a person's identity when natural voice is lost. There is significant and growing interest in voice banking from the MND community, but there has been little supporting research. What this study adds This research is the first study of its kind to examine decision making surrounding voice banking. It shows how preserving identity is critically important in how people deal with a diagnosis of MND. For those choosing to voice bank, it is seen as an effective way of preserving their identity, a way of 'fighting back' and giving a positive psychological benefit. Those deciding against voice banking do not believe it could maintain their identity and cannot bring back the natural voice they once had. Clinical implications of this study The reality of using AAC and voice banking for communication may be poorly understood. It would be helpful for professionals to provide information about voice banking as part of a wider discussion about the range of options for communication as the condition progresses. It is important that this includes the opportunity to listen to a voice bank to support understanding of how it is used in a communication device, and how different it sounds to natural speech.

The decision-making process in recommending electronic communication aids for children and young people who are non-speaking: the I-ASC mixed-methods study

Background

This project [Identifying Appropriate Symbol Communication (I-ASC)] explored UK decision-making practices related to communication aid recommendations for children and young people who are non-speaking. Research evidence related to communication aid decision-making is limited. The research aims were to increase understanding of influencers on the decision-making process in recommending electronic communication aids, and to develop guidance tools to support decision-making. An additional, post hoc aim was to evaluate the public involvement contribution to the I-ASC project. The research focused on the identification of attributes and characteristics that professionals, family members and those who use communication aids considered important in the recommendation process. Findings informed the development of guidance resources. The evaluation of public involvement focused on what could be learned from a nationally funded project with involvement from public contributors typically regarded as hard to include.

Methodology

For the clinical decision-making component, the methodological investigation adopted a three-tier approach with three systematic reviews, a qualitative exploration of stakeholder perspectives through focus groups and interviews, and a quantitative investigation surveying professionals’ perspectives. The public involvement evaluation adopted a mixed-methods approach. A total of 354 participants contributed to the decision-making data set, including professionals, family members, and children, young people and adults who use communication aids; 22 participants contributed to the public involvement evaluation. The literature review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thematic analysis and framework approach supported the analysis of qualitative data. Two stated preference surveys, a best–worst scaling and a discrete choice experiment, allowed the relative importance of factors in decision-making to be determined. Analysis was grounded in random utility theory.

Public involvement

Two public involvement co-researchers, an adult using a symbol communication aid and a parent of a communication aid user, were core members of the research team. The I-ASC public involvement resulted in an additional award to evaluate the impact of public involvement across the project.

Results

Factors influencing decision-making are not always under the control of the decision-makers, for example professional knowledge, referral criteria and service structure. Findings suggest that real clinical decisions contrast with hypothetical decisions. Survey responses indicated that children’s physical characteristics are less important than their language, communication and learning abilities; however, during real-time decision-making, the opposite appeared to be true, with access needs featuring most prominently. In contrast to professionals’ decisions, users and family members prioritise differing aesthetic attributes of communication aids. Time allocated to system learning remains underspecified. The research informed the development of decision-making guidance tools (https://iasc.mmu.ac.uk/; accessed 8 June 2020). A public involvement evaluation suggests that successful public involvement of individuals with disabilities requires significant resources that include staff time, training and personal support (https://iasc.mmu.ac.uk/publicinvolvement; accessed 8 June 2020).

Future work

Further research is needed in the areas of language assessment, communication aid attributes, types of decision-making episodes and service user perspectives. These data highlight the need for mechanisms that enable public involvement co-researchers to be paid for their contributions to research bid preparation.

Limitations

Individuals who benefit from communication aids are a heterogeneous group. We cannot guarantee that this study has captured all relevant components of decision-making.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 45. See the NIHR Journals Library website for further project information.

Understanding AAC Usage and Needs through a Web Survey with Device Users and Families

Augmentative and alternative communication devices (AAC) can help support communication for millions of people who have differences in speech and language abilities. Existing commercial devices do not meet all the diverse needs of some individuals. Interviews and surveys were conducted with individuals who have speech or language challenges (n=4 interviews; n=15 survey respondents), or their loved ones (n=9 interviews, n=49 survey respondents). Summaries of communication practices, usage preferences, and ratings of hypothetical devices are shown. We consolidate and present qualitative feedback on user difficulties and likes for types of available commercial devices. The collected quantitative data has been de-identified and published and may be useful for others working with AAC devices and users. Building on our results, we discuss how three directions for impactful AAC development - customizable input, context-aware output, and personalized devices - could help meet the needs expressed by survey respondents in the context of technological advancements and research in the field.

Parent Perspectives on Augmentative and Alternative Communication Integration for Children With Fragile X Syndrome: It Starts in the Home

Many children with fragile X syndrome (FXS) have complex communication needs and may benefit from augmentative and alternative communication (AAC). This qualitative study explored how four mother-child dyads used AAC in the home. Data were collected using participant observations, open-ended interviews, and record reviews, and analyzed using grounded theory methods. Findings revealed that mothers found AAC to be a useful tool for addressing their children's complex communication needs, but practical and personal factors impacted its use in the home. This study sheds light on how mothers of children with FXS view and utilize AAC as a way to promote communication at home. Understanding parental perspectives can help to guide professionals in planning appropriate AAC interventions specific to FXS.

A survey of research trends in assistive technologies using information modelling techniques

BACKGROUND

Despite the rapid proliferation and emphasis on technology, the use of assistive technology among individuals with varying disabilities and age is different. This situation instigates the need for a systematic review to gain a realistic understanding of prominent issues, research trends and assistive technology applications with minimal bias.

OBJECTIVE

Identification of leading researchers and prominent publications in assistive technologies. Subsequently, semantic relation between qualitative and quantitative research literature on assistive technologies was explored to future research directions.

METHODS

A manual search across reputed research databases was done to find out relevant literature from January 2005 to April 2020. In this paper, latent semantic analysis (LSA) was done to develop an information model for achieving defined objectives.

RESULTS

A corpus of 367 research papers published during 2005-2020 was processed using LSA. Term frequency, inverse document frequency of high loading terms provided five major topic solutions. Marcia Scherer, Rory Cooper and Stefano Federici are most noticed authors in assistive technology research. "Smart Assistive Technologies" and "Wearable Technologies for Rehabilitation" came out as contemporary research trends within assistive technologies.

CONCLUSIONS

The manuscript concludes the fact that assistive technologies for rehabilitation are experiencing a transition from standalone mechanical devices towards smart, wearable and connected devices.Implications for RehabilitationCustomized assistive devices could be programmed for multiple uses.User data privacy and internet dependency of smart assistive technologies must be taken care of while designing smart assistive devices for rehabilitation.Fog devices could eliminate the latency issues associated with cloud-based rehabilitation services.

Development of consensus-based guidelines for managing communication of individuals with Rett syndrome

Difficulties with communication have a profound impact on the lives of individuals with Rett syndrome and their caregivers. Globally, many families report difficulty accessing appropriate and timely information and services from professionals with expertise in augmentative and alternative communication (AAC) as it pertains to Rett syndrome. To address this need, international consensus-based guidelines for managing the communication of individuals with Rett syndrome were developed by combining available evidence and lived experience with expert opinion. A two-phase Delphi survey was built on statements and recommendations extracted from a review of over 300 pieces of literature combined with survey responses from communication professionals and caregivers. All statements that reached a pre-determined threshold of ≥70% agreement were incorporated into guidelines that consist of 268 statements and recommendations relating to (a) rights of the individual; (b) beliefs and attitudes of communication partners; (c) professional knowledge and team work; (d) strategies to optimize engagement; (e) assessment; and (f) intervention (targets and goals, techniques), including the use of AAC. To date, this project is the largest of its kind, with 650 participants from 43 countries contributing to development of consensus-based guidelines for Rett syndrome.

Parent Education in Studies With Nonverbal and Minimally Verbal Participants With Autism Spectrum Disorder: A Systematic Review

Purpose The purpose of this systematic review was to identify parent education procedures implemented in intervention studies focused on expressive verbal communication for nonverbal (NV) or minimally verbal (MV) children with autism spectrum disorder (ASD). Parent education has been shown to be an essential component in the habilitation of individuals with ASD. Parents of individuals with ASD who are NV or MV may particularly benefit from parent education in order to provide opportunities for communication and to support their children across the life span. Method ProQuest databases were searched between the years of 1960 and 2018 to identify articles that targeted verbal communication in MV and NV individuals with ASD. A total of 1,231 were evaluated to assess whether parent education was implemented. We found 36 studies that included a parent education component. These were reviewed with regard to (a) the number of participants and participants' ages, (b) the parent education program provided, (c) the format of the parent education, (d) the duration of the parent education, (e) the measurement of parent education, and (f) the parent fidelity of implementation scores. Results The results of this analysis showed that very few studies have included a parent education component, descriptions of the parent education programs are unclear in most studies, and few studies have scored the parents' implementation of the intervention. Conclusions Currently, there is great variability in parent education programs in regard to participant age, hours provided, fidelity of implementation, format of parent education, and type of treatment used. Suggestions are made to provide both a more comprehensive description and consistent measurement of parent education programs.

A survey on the awareness, accessibility and funding for augmentative and alternative communication services and devices in Saudi Arabia

PURPOSE

To develop and distribute a survey to obtain information on the awareness, accessibility and funding for augmentative and alternative communication (AAC) services and devices within the Kingdom of Saudi Arabia (KSA).

METHOD

The survey targeted three groups of people which included individuals with disabilities and their families, healthcare providers such as medical doctors and nurses and the third group included community members. Survey preparation and administration were performed online via a survey website in order to access a wide range of participants across KSA.

RESULTS

Results revealed different awareness levels for AAC among the three groups (χ² = 45.053, p < .001) with healthcare providers showing a higher degree of awareness compared to the remaining two groups. Moreover, AAC services and devices were found to be accessible within KSA, with no differences in obtaining AAC services and devices among different regions (χ² = 14.204, p = .164).

CONCLUSION

Although numerous AAC users were able to obtain AAC devices, they identified barriers including a lack of sufficient awareness of the importance, associated expenses, funding constraints and a lack of Arabization of AAC devices. Implications for RehabilitationAugmentative and alternative communication (AAC) methods allow individuals with communication difficulties to interact and socialize with those around them.The general authority of statistics in Saudi Arabia has shown that Saudi Arabia has an increased number of individuals suffering from severe to extreme communication disorders compared to other countries around the world. Consequently, the need for AAC in Saudi Arabia cannot be underestimated.This study demonstrates the importance of the awareness of AAC among different stakeholders in Saudi Arabia including AAC users, healthcare providers and community members so that individuals with communication problems can receive maximum benefit from AAC.Given that most healthcare providers in Saudi Arabia are prescribing non-tech and low-tech AAC methods indicates the importance of training on AAC for healthcare providers serving patients with communication disorders.

'We were just kind of handed it and then it was smoke bombed by everyone': How do external stakeholders contribute to parent rejection and the abandonment of AAC systems?

BACKGROUND

There are multiple stakeholders involved in the introduction of augmentative and alternative communication (AAC) systems to children with complex communication needs. Stakeholders such as speech-language pathologists (SLPs) and teachers who are external to the family unit play a key role in planning and implementing interventions. If this intervention is unsuccessful, it can result in parent rejection or abandonment of the AAC system. However, no studies explore the contribution of external stakeholders to AAC rejection and abandonment from the perspective of parents who have experienced such unsuccessful interventions.

AIMS

To explore parents' perceptions of how external stakeholders may contribute to the rejection or abandonment of an AAC system.

METHODS & PROCEDURES

Data were collected as a part of a larger study that explored parent experiences of AAC rejection and abandonment. Within this study, semi-structured interviews were completed with 12 parents who had rejected or abandoned an AAC system introduced to their child with complex communication needs. Data related to external stakeholder contributions were extracted from the interview transcripts, and a thematic analysis was conducted.

OUTCOMES & RESULTS

Analysis revealed four themes that captured the role of external stakeholders in the rejection and abandonment of AAC systems: (1) parents were influenced by the attitudes and experience of professionals; (2) parents did not feel supported by SLPs; (3) communication between stakeholders was not effective; and (4) parents had difficulties using AAC without a supportive community.

CONCLUSIONS & IMPLICATIONS

This study highlights the importance of family-centred service delivery when introducing an AAC system to the parent of a child with complex communication needs. SLPs may support parent acceptance of AAC systems by using family-centred practices such as listening to parents, acknowledging their expertise and finding compromises.

Finding the best fit: examining the decision-making of augmentative and alternative communication professionals in the UK using a discrete choice experiment

OBJECTIVES

Many children with varied disabilities, for example, cerebral palsy, autism, can benefit from augmentative and alternative communication (AAC) systems. However, little is known about professionals' decision-making when recommending symbol based AAC systems for children. This study examines AAC professionals' preferences for attributes of AAC systems and how they interact with child characteristics.

DESIGN

AAC professionals answered a discrete choice experiment survey with AAC system and child-related attributes, where participants chose an AAC system for a child vignette.

SETTING

The survey was administered online in the UK.

PARTICIPANTS

155 UK-based AAC professionals were recruited between 20 October 2017 and 4 March 2018.

OUTCOMES

The study outcomes were the preferences of AAC professionals' as quantified using a mixed logit model, with model selection performed using a step-wise procedure and the Bayesian Information Criterion.

RESULTS

Significant differences were observed in preferences for AAC system attributes, and large interactions were seen between child attributes included in the child vignettes, for example, participants made more ambitious choices for children who were motivated to communicate using AAC, and predicted to progress in skills and abilities. These characteristics were perceived as relatively more important than language ability and previous AAC experience.

CONCLUSIONS

AAC professionals make trade-offs between attributes of AAC systems, and these trade-offs change depending on the characteristics of the child for whom the system is being provided.

Development of a new high sensitivity mechanical switch for augmentative and alternative communication access in people with amyotrophic lateral sclerosis

BACKGROUND

People with Amyotrophic Lateral Sclerosis (PwALS) in the advanced phase are critically affected by an almost total loss of mobility and severe communication problems. Scanning access based on the patient's interaction with a sensor (or switch) that intercepts even a weak body movement is a valid communication aid. However, its use becomes limited with the progressive decline of residual movements. To overcome this problem, we designed a new sensor, the Lever Magnetic-spring Mechanical Switch (LeMMS), allowing repeated activation/release cycles requiring a very small activation force.

METHODS

The LeMMS was applied and validated in a group of 20 PwALS in an advanced stage of disease. All subjects were regular users of communication aids employing other sensors, but which they could no longer operate their sensors (different from LeMMS). Patients were assessed at baseline (t0) and after one (t1), 6 (t2) and 12 (t3) months. Assessment at t0 included administration of standardized clinical scales, the Click-Test-30 counting the maximum number of LeMMS activations in 30 s, and thumb/fingers strength assessment with the Kendall scale. The QUEST 2.0-Dev questionnaire was administered at t1. Some use-related information and the Click-Test-30 were collected at t1, t2 and t3.

RESULTS

After one training session, all patients could operate the LeMMS with minimal residual movement of one finger. At t1, they used it on average 5.45 h/day. The mean score of the QUEST 2.0-Dev was 4.63, suggesting strong satisfaction with the LeMMS. Regarding Click-Test-30 scores, no significant difference was found between t0 and t1, but performance at t2 and t3 declined significantly (p < 0.005 vs. t0). At t3, 9/20 patients were still able to use their communication aid.

CONCLUSIONS

This new switch sensor can enable PwALS to use their communication aids for a prolonged time even in the advanced phase of disease. It is easy to use, reliable and cheap, thus representing an intermediate alternative to more sophisticated and costly devices.

Behind the Scenes of Noninvasive Brain-Computer Interfaces: A Review of Electroencephalography Signals, How They Are Recorded, and Why They Matter

Purpose

Brain-computer interface (BCI) techniques may provide computer access for individuals with severe physical impairments. However, the relatively hidden nature of BCI control obscures how BCI systems work behind the scenes, making it difficult to understand how electroencephalography (EEG) records the BCI related brain signals, what brain signals are recorded by EEG, and why these signals are targeted for BCI control. Furthermore, in the field of speech-language-hearing, signals targeted for BCI application have been of primary interest to clinicians and researchers in the area of augmentative and alternative communication (AAC). However, signals utilized for BCI control reflect sensory, cognitive and motor processes, which are of interest to a range of related disciplines including speech science.

Method

This tutorial was developed by a multidisciplinary team emphasizing primary and secondary BCI-AAC related signals of interest to speech-language-hearing.

Results

An overview of BCI-AAC related signals are provided discussing 1) how BCI signals are recorded via EEG, 2) what signals are targeted for non-invasive BCI control, including the P300, sensorimotor rhythms, steady state evoked potentials, contingent negative variation, and the N400, and 3) why these signals are targeted. During tutorial creation, attention was given to help support EEG and BCI understanding for those without an engineering background.

Conclusion

Tutorials highlighting how BCI-AAC signals are elicited and recorded can help increase interest and familiarity with EEG and BCI techniques and provide a framework for understanding key principles behind BCI-AAC design and implementation.

The use of assistive technologies among children with disabilities: the perception of parents of children with disabilities in Ghana

PURPOSE

Assistive technologies (ATs) are fundamental to the successful educational and societal inclusion of all children with disabilities. In particular, the use of ATs has been found to increase levels of independence in daily living and promote greater access to learning opportunities for children with disabilities. However, the knowledge base and baseline information on the use of ATs is limited in developing countries such as Ghana. In this study, we sought to explore the experiences of parents regarding the use of ATs by their children with disabilities in Ghana.

MATERIALS AND METHODS

We used a survey questionnaire consisting of both open- and closed-ended questions to explore the perspectives of parents with children with disabilities (n = 35) who were attending the rehabilitation unit of a referral hospital.

RESULTS

Although participants acknowledged the benefits of ATs for the development and participation of their children in society, they noted barriers to the usage of ATs by their children. Among several barriers, parents mentioned that they lacked funds to purchase assistive devices. Some parents also mentioned the high cost of ATs and rehabilitation services.

CONCLUSION

The need for government to include rehabilitation services and ATs in the National Health Insurance Scheme to ease the burden on participants and other implications of the findings for policymaking are extensively discussed. Implications for rehabilitationIn an environment where there is negative attitude towards children and parents with disabilities, ATs are expected to encourage the participation and acceptance in society.Although many participants were aware of the benefits of ATs to their children, they reported barriers to usage among their children with disabilities.This study shows that poverty, limited health facilities, unfriendly environment and stigmatisation were barriers encountered by parents.We conclude that the government should expand health and rehabilitation facilities to encourage access and participation.

Complex intervention in augmentative and alternative communication (AAC) care in Germany: a study protocol of an evaluation study with a controlled mixed-methods design

INTRODUCTION

The current practice of service delivery in Germany for people with complex communication needs (CCN) who are in need of augmentative and alternative communication (AAC) is characterised by diverse problems, including a lack of clarity in the responsibilities of the service providers involved. To address these issues a new service delivery model has been put in place, implemented in three AAC counselling centres for patients with a particular health insurance across Germany. The implementation of a new service delivery model aims to improve individualised service delivery. The model goes beyond standard care by adding case management, counselling, AAC training and, if needed, AAC therapy. This study aims to evaluate the effectiveness of this complex intervention.

METHODS AND ANALYSIS

In consideration of the complexity of the new service delivery model, formative and summative evaluation will be conducted. The formative evaluation will provide data based on qualitative and quantitative assessments of the competences and perspectives of all involved stakeholders, including a proxy measurement of persons with CCN. The summative evaluation will include a controlled study design as the new service delivery model will be compared against the service delivery in an existing contract and against data gathered from caregivers of AAC users provided with standard care. With the exception of the individual interviews the data will be collected from proxies-that is, informal and formal caregivers.

ETHICS AND DISSEMINATION

Data collection, storage and evaluation meet the currently valid data protection regulations. Consultation by the responsible data protection officer of the Oldenburg Medical School and a positive vote from its Ethics Committee were obtained prior to the start of the study. Dissemination strategies include the presentation of the obtained data and results in the form of publications and at conferences.

TRIAL REGISTRATION NUMBER

DRKS00013628.

Needs and preferences for psychological interventions of people with motor neuron disease

Background: There is a lack of knowledge about what factors may impede or facilitate engagement in psychological interventions in people with motor neuron disease (pwMND) and how such interventions can be adapted to best meet the needs of this population. Objectives: To explore the needs and preferences of pwMND with respect to psychological interventions, and how best to adapt such interventions for pwMND. Methods: A series of semi-structured interviews (n = 22) and workshops (n = 3) were conducted with pwMND (n = 15), informal caregivers of pwMND (n = 10), and MND healthcare professionals (n = 12). These explored preferences and concerns that would need to be considered when delivering a psychological intervention for pwMND. Three areas were explored: (i) perceived factors that may hinder or facilitate pwMND engaging with psychological interventions; (ii) ways in which such interventions could be adapted to meet the individual needs of pwMND; and (iii) views regarding the main psychological issues that would need to be addressed. Workshops and interviews were audio recorded and transcribed and thematic analysis was used to inductively derive themes. Findings: Data could be classified within four overarching themes: unfamiliar territory; a series of losses; variability and difficulty meeting individual needs; and informal support. Conclusions: Flexibility, tailoring interventions to the individual needs of pwMND, and encouraging autonomy are key attributes for psychological interventions with pwMND. Psychological interventions such as Acceptance and Commitment Therapy (ACT) could be acceptable for pwMND if adapted to their specific needs.