Designing AAC Research and Intervention to Improve Outcomes for Individuals with Complex Communication Needs

The application of the family of participation-related constructs (fPRC) framework to AAC intervention outcomes in children with complex communication needs: a scoping review

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework.

Teaching South African center-based caregivers to implement augmentative and alternative communication strategies

In South Africa, many children with extensive support needs-including children who require AAC-are accommodated in care centers rather than the public schooling system. Caregivers employed at these centers need training in order to support children's communication using augmentative and alternative methods. A total of 29 center-based caregivers took part in this study. A single group pretest-posttest design was used to evaluate the effect of a 5-day training workshop on caregivers' ability to demonstrate and implement five AAC strategies. The effect of the workshop on caregivers' perceptions of their own skills as well as the social validity of the training were also evaluated. Results suggest that the workshop effectively taught caregivers to demonstrate the skills in a simulated roleplay situation. A proportion of caregivers also supplied video footage after the workshop that suggests the ability to implement the strategies in the care center contexts. Caregivers also perceived their own skills to have improved post workshop, and evaluated the training positively.

Picture book videos incorporating key word signing for children who require AAC and their families: design and evaluation of a multimedia-enhanced setting

Key word signing (KWS) is an unaided form of augmentative and alternative communication (AAC) and is frequently used by children with cognitive impairments and their families. Successful implementation of KWS requires a family environment that provides aided language input by modeling the signs. However, families face challenges implementing the signs in their everyday lives. KWS requires effort and sustained parental commitment. Users may also struggle with finding good learning resources and stimulating and enjoyable shared contexts for communication. Signed videos of popular children's books may help to implement KWS and create a signing environment which exposes children and their families to KWS in meaningful ways. The aim of this study was to create videos of this type and investigate whether and how they might serve as an attractive medium of support for families' KWS experience. Three families tested the videos. A triangulated qualitative study incorporating interviews and participant observation explored the families' experience of using these videos as a context for shared communication. The findings suggest that picture book videos supplemented by KWS may be appropriate resources for the use of KWS in everyday family life. They serve as a child-centered activity involving KWS exposure, in which children and their families can participate joyfully and naturally.

Leveraging Communication Partner Speech to Automate Augmented Input for Children on the Autism Spectrum Who Are Minimally Verbal: Prototype Development and Preliminary Efficacy Investigation

PURPOSE

Augmentative and alternative communication (AAC) technology innovation is urgently needed to improve outcomes for children on the autism spectrum who are minimally verbal. One potential technology innovation is applying artificial intelligence (AI) to automate strategies such as augmented input to increase language learning opportunities while mitigating communication partner time and learning barriers. Innovation in AAC research and design methodology is also needed to empirically explore this and other applications of AI to AAC. The purpose of this report was to describe (a) the development of an AAC prototype using a design methodology new to AAC research and (b) a preliminary investigation of the efficacy of this potential new AAC capability.

METHOD

The prototype was developed using a Wizard-of-Oz prototyping approach that allows for initial exploration of a new technology capability without the time and effort required for full-scale development. The preliminary investigation with three children on the autism spectrum who were minimally verbal used an adapted alternating treatment design to compare the effects of a Wizard-of-Oz prototype that provided automated augmented input (i.e., pairing color photos with speech) to a standard topic display (i.e., a grid display with line drawings) on visual attention, linguistic participation, and (for one participant) word learning during a circle activity.

RESULTS

Preliminary investigation results were variable, but overall participants increased visual attention and linguistic participation when using the prototype.

CONCLUSIONS

Wizard-of-Oz prototyping could be a valuable approach to spur much needed innovation in AAC. Further research into efficacy, reliability, validity, and attitudes is required to more comprehensively evaluate the use of AI to automate augmented input in AAC.

Augmentative and alternative communication with children with severe/profound intellectual and multiple disabilities: speech language pathologists' clinical practices and reasoning

PURPOSE

Augmentative and alternative communication (AAC) is recommended to be included in communication interventions directed at children/youth with severe/profound intellectual and multiple disabilities (S/PIMD). Even so, the evidence base for AAC practices with children with S/PIMD is limited. Also, little is known about how frequently AAC is implemented with this target group, which AAC tools and methods are applied, and the related clinical reasoning of speech-language pathologists (SLPs). This study aimed to explore SLPs' beliefs, clinical reasoning and practices in relation to AAC implementation with children/youth with S/PIMD.

MATERIALS AND METHODS

In this sequential, mixed-methods study, 90 SLPs working with children with disabilities within habilitation services in Sweden participated in an online survey. The survey answers were statistically analysed. Subsequently, focus group data were collected from seven SLPs and analysed using thematic analysis.

RESULTS AND CONCLUSIONS

Despite AAC being highly prioritized, SLPs found it challenging and complex to implement with this target group. A wide variety of AAC methods and tools were considered and implemented. Clinical decision-making was a balancing act between competing considerations and was mainly guided by the SLPs' individual, clinical experiences. The resources, engagement and wishes of the social network surrounding the child were considered crucial for clinical decision-making on AAC. Implications for research and practice are discussed.Implications for rehabilitationSpeech-language pathologists (SLPs) seemingly find a wide variety of Augmentative and Alternative Communication (AAC), ranging from unaided methods to assistive technology of various complexity, to be potentially suitable for children/youth with severe/profound intellectual and multiple disabilities (S/PIMD).The motivation and preferences of the social network surrounding the child with S/PIMD seem to influence SLPs' clinical decision-making on AAC to a high degree. Sometimes this may be considered an even more important factor than the abilities of the child.SLPs' clinical decision-making on AAC for children/youth is guided by their individual, clinical experience to a high degree.An increase in family oriented AAC intervention research targeting individuals with S/PIMD could potentially strengthen the association between research and the current, experience-based clinical practice.

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.

"It's like a guessing game all the time": parent insights on barriers, supports, and priorities for children with cortical visual impairment and complex communication needs

Parents of children with both cortical visual impairment (CVI) and complex communication needs offer unique perspectives on their children's journeys to receiving proper diagnoses, supports, and interventions, such as augmentative and alternative communication (AAC). This study explored the lived experiences, supports, and barriers identified by parents through a qualitative phenomenological approach. Nine parents of children with both CVI and complex communication needs were interviewed virtually. Results indicated five themes descriptive of the parents' experiences: Challenges Piecing Together a CVI Diagnosis; Dealing with Low Expectations of Others; Parents Empowered to Take Action; Guessing Game to Determine Appropriate AAC to Accommodate CVI; and Aligning Professional Practice with Parent Priorities. Whereas some of these themes echoed the experiences of parents of children with complex communication needs (such as those with cerebral palsy) who were not specifically diagnosed with CVI, other themes were unique to this set of parents including the uncertainty of AAC design and intervention given the challenges of CVI and the necessity of more than one way for children to communicate given their visual challenges. This study highlighted the dire need for continued investigation to determine effective AAC interventions for individuals with CVI.

Strategies for highlighting items within visual scene displays to support augmentative and alternative communication access for those with physical impairments

PURPOSE

In contrast to the traditional grid-based display, visual scene displays (VSDs) offer a new paradigm for aided communication. For individuals who cannot select items from an AAC display by direct selection due to physical impairments, AAC access can be supported via methods such as item scanning. Item scanning sequentially highlights items on a display until the individual signals for selection. How items are highlighted or scanned for AAC access can impact performance outcomes. Further, the effectiveness of a VSD interface may be enhanced through consultation with experts in visual communication. Therefore, to support AAC access for those with physical impairments, the aim of this study was to evaluate the perspectives of experts in visual communication regarding effective methods for highlighting VSD elements.

METHODS

Thirteen participants with expertise related to visual communication (e.g., photographers, artists) completed semi-structured interviews regarding techniques for item highlighting.

RESULTS

Study findings identified four main themes to inform how AAC items may be highlighted or scanned, including (1) use of contrast related to light and dark, (2) use of contrast as it relates to colour, (3) outline highlighting, and (4) use of scale and motion.

CONCLUSION

By identifying how compositional techniques can be utilized to highlight VSD elements, study findings may inform current practice for scanning-based AAC access, along with other selection techniques where feedback or highlighting is used (e.g., eye-gaze, brain-computer interface). Further, avenues for just-in-time programming are discussed to support effective implementation for those with physical impairments.IMPLICATIONS FOR REHABILITATIONFindings identify multiple potential techniques to improve scanning through items in a photograph for individuals with severe motor impairments using alternative access strategies.Study findings inform current practice for scanning-based AAC access, along with other selection techniques where feedback or highlighting is used (e.g., eye-gaze, brain-computer interface).Avenues for just in time programming of AAC displays are discussed to decrease programming demands and support effective implementation of study findings.

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.

The Relationship Between Augmentative and Alternative Communication Use by Pediatric Psychiatric Inpatients With Autism Spectrum Disorder and Interfering Behaviors

PURPOSE

Previous research conducted by Williams et al. (2018) using data from the Autism Inpatient Collection (AIC) found a weak and inconsistent association between verbal ability and the severity of interfering behaviors; however, adapting/coping scores were significantly associated with self-injury, stereotypy, and irritability (including aggression and tantrums). The previous study did not account for access to or use of alternative forms of communication in their sample population. This study uses retrospective data to investigate the association between verbal ability and augmentative and alternative communication (AAC) use and the presence of interfering behaviors in individuals with autism who have complex behavioral profiles.

METHOD

The sample included 260 autistic inpatients, ages 4-20 years, from six psychiatric facilities, enrolled during the second phase of the AIC when detailed information about AAC use was collected. Measures included AAC use, method, and function; comprehension and production of language; receptive vocabulary; nonverbal IQ; severity of interfering behaviors; and the presence and severity of repetitive behaviors.

RESULTS

Lower language/communication abilities were related to increased repetitive behaviors and stereotypies. More specifically, these interfering behaviors appeared to be related to communication in those individuals who were candidates for AAC but who were not reported to have access to it. Although the use of AAC did not predict a decrease in interfering behaviors, receptive vocabulary scores-as measured by the Peabody Picture Vocabulary Test-Fourth Edition-were positively correlated with the presence of interfering behaviors in participants with the most complex communication needs.

CONCLUSIONS

The communication needs of some individuals with autism may be unmet, prompting the use of interfering behaviors as a form of communication. Further investigation of the functions of interfering behaviors and the related functions of communication skills may provide greater support for an increased focus on the provision of AAC to prevent and ameliorate interfering behaviors in individuals with autism.

Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities

PURPOSE

Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities.

METHOD

Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board.

RESULTS

Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended.

CONCLUSIONS

These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

The Unspoken Voice: Applying John Shotter's Dialogic Lens to Qualitative Data from People Who have Communication Difficulties

As speech and language therapists, we explored theories of communication and voice that are familiar to our profession and found them an inadequate basis on which to generate deep and rich analysis of the qualitative data from people who have communication difficulties and who use augmentative and alternative communication. Expanding our conceptual toolkit to include the work of John Shotter allowed us to reconceptualise voice and where it is emergent in dialogue. Reimaging voice will inform clinical and research praxis with people who have communication difficulties as it allows practitioners to attend more closely to the complexity and nuance inherent in interactions with this population. Our proposition is exemplified with excerpts from a single participant who has communication difficulties to illustrate the value of dialogic theory in praxis. This article presents a provocation for the wider academy of qualitative health research; do we have the concepts and tools to develop meaning with people whose lived experiences may also be hard to voice in monologues?

Developing and sustaining a social media ecosystem in speech-language pathology: Using innovative qualitative methods to visualise and cultivate a social media garden

Purpose: Qualitative research methods, grounded in an inductive analytic paradigm, increasingly inform clinical practice in the field of speech-language pathology. Social media research, often including qualitative methods, provides a valuable way to connect and listen to the voices of people with communication disabilities. With growing empirical evidence on the ways that people with communication disabilities use social media, and recognition of both benefits and limitations of its use, it is important to consider what will support clinicians to translate this work conceptually and safely into clinical practice.Method: In this paper, we use the tools of metaphor and arts-based knowledge translation to promote the translation of evidence into social media practice.Results: With social media being an important ecosystem to grow and nurture in speech-language pathology, a "picturing a social media garden" metaphor is proposed to further research translation. The metaphor will be used to frame strategies for applying qualitative techniques for speech-language pathologists to consider how to use social media in clinical and professional practice, as well as citing supporting literature to guide further reading.Conclusion: The suggested approaches could augment existing methods of assessment and intervention for people with communication disabilities and provide support for clinicians who want to develop their own strategy for using social media, build a vibrant social media ecosystem, and integrate social media interventions into their clinical services.

Determinants of spoken language comprehension in children with cerebral palsy

PURPOSE

To identify determinants of spoken language comprehension (SLC) in children with cerebral palsy (CP).

MATERIALS AND METHODS

Cross-sectional data of 207 children with CP were included: 82 toddlers (18 months-3;11 years), 59 preschool children (4;0-5;11 years), and 66 schoolchildren (6;0-8;11 years), across all Gross Motor Function Classification System (GMFCS) levels. SLC was assessed using the Computer-Based instrument for Low motor Language Testing (C-BiLLT). Potential determinants were retrieved from medical files and through parental questionnaires. Per developmental stage, multivariable regression analyses were used to assess determinants of SLC.

RESULTS

Fifty-nine percent of the children showed below average SLC. Significant determinants for SLC differed per developmental stage. In toddlers: age, motor type, functional communication and speech function (R² = 0.637); in preschool children: functional communication, speech function and language activities (R² = 0.820), and in schoolchildren: functional communication, intellectual functioning and arm-hand functioning (R² = 0.807). For all developmental stages, functional mobility was not a significant determinant.

CONCLUSIONS

A large proportion of children with CP across all GMFCS levels have SLC impairments. Findings indicate that SLC is strongly determined by functional communication classified with CFCS. We recommend standardized assessment and monitoring of SLC in all children with CP. IMPLICATIONS FOR REHABILITATIONChildren across all GMFCS levels can experience difficulties in spoken language comprehension.At all developmental stages, functional communication (classified with CFCS) is an important determinant of spoken language comprehension.Standardized assessment and monitoring of spoken language comprehension, language production, speech, and communication of all children with CP, is strongly recommended.When children show below average performances, especially in spoken language comprehension, intervening with speech and language therapy and guidance for parents, is advised.

Facilitators and barriers to developing romantic and sexual relationships: lived experiences of people with complex communication needs

The aims of this study were to investigate the lived experiences of people with complex communication needs in developing romantic and sexual relationships, and identify and explore barriers and facilitators they encountered in pursuing these relationships. For the study, nine participants were interviewed. All were at least 21-years-old, used augmentative and alternative communication, and had physical and communication disabilities since childhood. A methodology employing critical hermeneutics, a form of interpretive phenomenology, and Feminist Standpoint Theory was utilized. The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) model (2013) was used to develop questions for the semi-structured interviews. Interview data were analyzed using reflexive thematic analysis, with the ICF model and the concept of ableism used to identify four main themes: (a) Attitudes of others (ableism), (b) Communication Within Intimate Moments, (c) Assistance of Support Workers, and (d) Additional Education Related to Sexuality and Disability. Most of the barriers participants encountered related to ableist attitudes they experienced from others. Facilitators included creative communication strategies for intimate moments and using dating websites. The participants' experiences bring attention to the need for changes in policies, practice, and research to further support people with complex communication needs in their quest to develop intimate relationships.

Applying Implementation Science to Support Active Collaboration in Noninvasive Brain-Computer Interface Development and Translation for Augmentative and Alternative Communication

PURPOSE

The purpose of this article is to consider how, alongside engineering advancements, noninvasive brain-computer interface (BCI) for augmentative and alternative communication (AAC; BCI-AAC) developments can leverage implementation science to increase the clinical impact of this technology. We offer the Consolidated Framework for Implementation Research (CFIR) as a structure to help guide future BCI-AAC research. Specifically, we discuss CFIR primary domains that include intervention characteristics, the outer and inner settings, the individuals involved in the intervention, and the process of implementation, alongside pertinent subdomains including adaptability, cost, patient needs and recourses, implementation climate, other personal attributes, and the process of engaging. The authors support their view with current citations from both the AAC and BCI-AAC fields.

CONCLUSIONS

The article aimed to provide thoughtful considerations for how future research may leverage the CFIR to support meaningful BCI-AAC translation for those with severe physical impairments. We believe that, although significant barriers to BCI-AAC development still exist, incorporating implementation research may be timely for the field of BCI-AAC and help account for diversity in end users, navigate implementation obstacles, and support a smooth and efficient translation of BCI-AAC technology. Moreover, the sooner clinicians, individuals who use AAC, their support networks, and engineers collectively improve BCI-AAC outcomes and the efficiency of translation, the sooner BCI-AAC may become an everyday tool in the AAC arsenal.

Individuals Who Use Augmentative and Alternative Communication and Participate in Active Recreation: Perspectives From Adults With Developmental Disabilities and Acquired Conditions

PURPOSE

The aim of the study was to gather the perspectives and lived experiences of 10 adults who use augmentative and alternative communication (AAC) and participate in active recreation. Active recreational participation includes individual sports such as adaptive skiing, surfing, and cycling, as well as unified team sports such as soccer, bocce, and basketball.

METHOD

This research involved a qualitative study with two separate asynchronous online focus groups each conducted over a 6-week span. The focus groups included literate individuals who use AAC and engage in active recreational pursuits across the United States. One focus group included five individuals with acquired conditions, and the other group included five individuals with developmental disabilities.

RESULTS

Thematic analysis of the data from both focus groups revealed five primary themes with corresponding subthemes: barriers (intrinsic and extrinsic), supports (intrinsic and extrinsic), benefits (intrinsic and extrinsic), communication (methods), and recommendations for communication partners and people who use AAC.

CONCLUSIONS

This study provides important information to individuals who use AAC and their communication partners about the benefits of active recreation and the supports needed to make these experiences successful. As a result of this study, speech-language pathologists, related professionals, and caregivers will gain a better understanding of how they can support recreational participation for people who use AAC with a specific focus on enhancing communication and expanding social networks. Supplemental Material https://doi.org/10.23641/asha.17701043.

Supporting Peer Interactions for Students with Complex Communication Needs in Inclusive Settings: Paraeducator Roles

PURPOSE

This clinical focus article presents a review of literature supporting the importance of fostering positive peer interactions for students with complex communication needs. A resulting template is included to help guide educational teams, including speech-language pathologists (SLPs), in planning for paraeducator training specific to supporting peer interactions for children with CCN. This article summarizes the current literature available on inclusion and peer relationships for students with CCN in general education classrooms, and paraeducator roles and training. The World Health Organization (WHO) International Classification for Functioning, Disability and Health Children and Youth (ICF-CY) framework was consulted to help establish considerations relevant to paraeducator training. With many demands on the time of SLPs throughout the school day, paraeducators may offer an often untapped resource to help support positive peer relationships for students with CCN.

CONCLUSIONS

This article provides an overview of challenges that may impede positive peer relationships from developing in inclusive classroom settings, including ones related to: (1) the student with CCN, (2) the peers, (3) the AAC systems, or (4) the environment. The readers will be provided with a template to guide educational teams and SLPs in collaborating with paraeducators to foster positive peer interactions, including the following steps: (1) define goals for the student with CCN and determine supports required from paraeducators; (2) determine content of training for paraeducators; (3) choose an effective instructional approach; (4) establish a feasible training format; (5) implement the paraeducator training and evaluate outcomes to ensure benefits for students with CCN and their peers.

Text messaging "Helps Me to Chat": exploring the interactional aspects of text messaging using mobile phones for youth with complex communication needs

This study explored the interactional aspects of text messaging on mobile phones for youth with complex communication needs. A qualitative case study design was used to investigate aspects such as reasons, place, timing of communication, content and communication partners. Data were gathered from seven youth with complex communication needs (primary participants) and one communication partner for each youth (secondary participants). In addition to using a questionnaire and tests to obtain participant background information, four data collection methods were used: (a) face-to-face interviews with the primary participants via text messaging, (b) researcher observations of these participants interacting via text messaging, (c) an asynchronous text-messaging focus group involving all seven primary participants, and (d) asynchronous interviews with the secondary participants via text messaging. The thematic data analysis highlighted numerous interactional benefits, most notably that text messaging offered the youth with complex communication needs a means of expressing themselves that was easier than face-to-face interactions. It also emphasizes interaction symmetry with a wide range of communication partners including groups, the privacy to interact with others beyond their often-restricted environments (absent presence), and a measure of anonymity and control over interactions. The study concluded that text messaging provides youth with complex communication needs with new communication possibilities.

Parenting individuals with intellectual and developmental disabilities in South India

PURPOSE

There is limited research on the needs and expectations of parents of children with Intellectual and Developmental Disabilities (IDD) and associated complex communication needs (CCNs) in South India. The current paper will present the findings from a study that explored parents' needs and expectations, including those related to rehabilitation.

METHOD

This study adopted an Interpretative Phenomenological Analysis framework to understand the needs and expectations of 16 parents of 15 children with IDD and associated CCNs. Data were analyzed for the whole group, and two subgroups: parents of children 12 years or younger, and parents of adults and adolescents older than 12 years.

RESULT

Data analysis highlighted the following: (1) unmet or undermet needs and expectations with regard to children's social participation, societal and familial support, childcare needs, financial requirements, and need for information; (2) changing needs and expectations of parents as their children grow older; (3) inadequacy of social participation and interaction opportunities for the participants' children.

CONCLUSION

It was concluded that rehabilitation providers including Speech Language Pathologists (SLPs) need to be aware of parents' needs and expectations and collaborate with the families to attain rehabilitation goals that facilitate social participation.

How Are Stakeholders With Autism Spectrum Disorder Included in the Social Validation of Augmentative and Alternative Communication Research? A Scoping Review

Introduction Social validation or the inclusion of stakeholders in the research process is beneficial, as it may decrease bias, increases efficacy, and prevents harm. For direct stakeholders such as individuals with autism spectrum disorder (ASD), social validation has mostly included participants who do not experience significant speech, language, and communication limitations while frequently omitting individuals with ASD who have complex communication needs (CCN). The presence of CCN indicates that augmentative and alternative communication (AAC) strategies are needed for individuals to express themselves. Social validation should not be limited to being participants in an intervention but should include involvement in the research process. This requires an understanding of the current trends, levels, and mechanisms of involvement in AAC research. Purpose This review aimed to identify and describe the inclusion of direct stakeholders with ASD in the social validation of AAC research. Method A scoping review was conducted following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews) methodology to identify AAC research that included stakeholders with ASD (direct and indirect) for social validation and to evaluate their level of involvement using the Typology of Youth Participation and Empowerment pyramid framework. Results Twenty-four studies were identified. Studies primarily included indirect stakeholders (e.g., caregivers) giving in-depth perspectives, while direct stakeholders were limited to being intervention participants. Conclusions Voices of direct stakeholders with ASD and CCN remain limited or excluded in research. Reasons for the exclusion of individuals with ASD and CCN from research and strategies for future inclusion are raised and discussed.

Engaging stakeholders to improve social validity: intervention priorities for students with complex communication needs

Many factors impact intervention implementation in everyday practice, including the social validity of these interventions. As a way of addressing social validity, this study aimed to understand the perspectives of multiple stakeholders of school-aged children and adolescents who use aided and unaided augmentative and alternative communication (AAC) on their key intervention priorities for these children. Semi-structured interviews were conducted with 19 parents and professionals, which included special education teachers, paraprofessionals, and speech-language pathologists (SLPs). Qualitative content analysis focused on (a) identifying a framework of intervention priorities for children with complex communication needs and (b) understanding stakeholders' underlying values and attitudes that influenced perceptions about these priorities. Participants shared many intervention priorities and several core values. These intervention priorities included approaches focused on improving children's intrinsic abilities (i.e., skills-focused) and on improving children's extrinsic supports and opportunities (i.e., environment-focused). However, participants often portrayed diverging attitudes about different aspects of intervention, particularly self-efficacy (e.g., persistence in the face of challenges; confidence about inclusive education) and perceptions of students (e.g., keeping high expectations). These findings have important implications for practice and future research related to how attention to social validity can help bridge the research-to-practice gap.

Using behavioural skills training via telehealth to increase teachers use of communication interventions and increase student use of speech-generating devices in a high school functional skills classroom

BACKGROUND

Behavioural skills training (BST) has demonstrated effectiveness in training teachers in evidence-based interventions to increase communication for children with limited repertoires. However, research has yet to extend to youth with developmental disabilities who are learning to communicate using speech-generating devices. The emergent use of telehealth technology in applied behaviour analysis has been associated with greater access to therapeutic services. Although the use of telehealth has been extended as an avenue for parents to access behavioural intervention services for their child, fewer studies have evaluated the use of telehealth for teacher behavioural consultation or with adolescents and young adults with complex communication needs.

METHOD

In the present study, four teaching staff were trained via telehealth to implement communication facilitation strategies with augmentative and alterative communication users in a high school functional skills classroom. During the coaching sessions, the staff were provided BST on the basic behaviour analytic teaching strategies (e.g. assessing preference, environmental arrangement, and reinforcement strategies). Independent adapted ABAB designs were used to evaluate the effectiveness of modified BST delivered via telehealth on increased teaching staff-implemented communication opportunities within the functional skills classroom and the effectiveness of staff-implemented communication intervention on increased speech-generating device mands for four adolescents/young adults with developmental disabilities.

RESULTS

The results indicated that the improved staff fidelity of the communication interventions was associated with the increased level of independent student mands for each dyad. Lastly, social validity data suggest that the procedures were acceptable and feasible. These data indicate that the use of telehealth may be a viable model for specialised classroom consultation.

CONCLUSION

The use of a telehealth delivery model to train classroom staff may be a viable option when specialised support is necessary, but access is limited.

Terapia ocupacional e comunicação alternativa: intervenção colaborativa com os parceiros de comunicação de uma criança com paralisia cerebral

Resumo Introdução A terapia ocupacional pode utilizar dos recursos de comunicação alternativa, numa perspectiva sistêmica, para o engajamento ocupacional de crianças com paralisa cerebral que possuem limitações na comunicação oral e/ou escrita. Objetivo Descrever procedimentos de intervenção colaborativa em terapia ocupacional com uso da comunicação alternativa executados por parceiros de comunicação de uma criança com paralisia cerebral. Método Trata-se de uma pesquisa aplicada, de natureza experimental e de abordagem qualitativa. Participaram da pesquisa os parceiros de comunicação (mãe, estagiária do curso de graduação em terapia ocupacional e professora) de uma criança com paralisia cerebral. Utilizou-se instrumentos indicados no Programa Comunica_PC, para identificação das habilidades comunicativas iniciais da criança, caracterização dos participantes, seleção das figuras para a prancha de comunicação, análise das filmagens e análise da percepção dos interlocutores sobre os procedimentos de intervenção. A coleta e análise foram estruturadas em 5 fases: Fase 1: Conhecimento inicial dos participantes; Fase 2: Capacitação Teórica; Fase 3: Capacitação Prática; Fase 4: Confecção do recurso de comunicação alternativa; e Fase 5: Percepção dos interlocutores após a implementação da comunicação alternativa. Resultados Obteve-se a formação teórica e prática dos parceiros de comunicação, incluindo a sua sensibilização por meio da dinâmica e capacitação prática. Tais procedimentos se constituíram em elementos fundamentais para a aprendizagem dos parceiros de comunicação perante o uso dos recursos de comunicação alternativa. Conclusão O Programa Comunica_PC consistiu numa estratégia motivadora como meio de aprendizagem dos interlocutores para uso da comunicação alternativa em criança com paralisia cerebral.

Effect of online instruction on volunteers who support people with complex communication needs in active recreation

This study was conducted to teach and evaluate the effectiveness of an online training called The CAPTURE & Share program. The program was taught using online instruction in an asynchronous manner with six volunteers who facilitate recreational participation for individuals with complex communication needs. The online training focused on teaching volunteers how to support opportunities for individuals to capture photos and videos from recreation and then share them across their social networks. The first aim of the study was to teach the volunteers about implementation and use of the 8-step CAPTURE & Share program while the second aim was to evaluate the programs' overall effectiveness. Two multiple baselines designs across three participants each were used to evaluate the volunteers' written responses to probes delivered during baseline, intervention, maintenance, and generalization phases. Additionally, social validation data were collected. Results indicated that volunteers were not only successful in learning the program, but were also highly satisfied with the online training methods. Implications for using online instruction are discussed for speech-language pathologists, caregivers, individuals with complex communication needs, and recreational professionals.

Communication Support Needs in Adults with Intellectual Disabilities and Its Relation to Quality of Life

Research suggests that individuals with intellectual disabilities (ID) experience difficulties in communication, ranging from intelligibility issues to more severe problems in the use and comprehension of spoken, written or sign language. Despite the negative effects that the inability to communicate have on quality of life (QoL), not much research has explored the relationship between communicative competence and QoL in the adult population with ID. The aim of this study was to describe the global communication profile of a sample of 281 adults with ID recruited from Grupo AMÁS Social Foundation, who differed in their level of communication support needs (CSN). The relationships between communicative competence and CSN with QoL were further examined. The results showed lower QoL indices for those participants characterized by their limited use of discourse and inability to exhibit certain communicative purposes, with the largest differences in the dimensions of self-determination, social inclusion, interpersonal relationships, emotional wellbeing and personal development. Overall, low levels of QoL were found for all participants, with even lower scores for the group identified as having CSN. A multiple regression model revealed that having speech/discourse competence is a powerful predictor of QoL, along with the level of disability and having the communicative competences to express likes and preferences or to establish new relationships. This clear relationship between communication and QoL is an important argument for disability support services when it comes to setting communication supports as a priority and as an important preventive step towards the protection of those at risk of exclusion.

Definitions of Nonverbal and Minimally Verbal in Research for Autism: A Systematic Review of the Literature

This systematic review examined definitions of "nonverbal" or "minimally verbal" and assessment measures used to evaluate communication in intervention studies focusing on improving expressive verbal communication in children with autism spectrum disorder (ASD). We reviewed sample size, number of participants, participant age, and male/female representation. Our analysis yielded relatively few studies with non/minimally verbal children with ASD focusing on verbal expressive communication. Further, we found large inconsistencies in measures used, definitions of "nonverbal" and "minimally verbal", and ages targeted. Guidelines are suggested to create a more uniform assessment protocol with systematic descriptions of early communication learners as a foundational step for understanding the heterogeneity in this group and replicating research findings for this subgroup of children with ASD.

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.

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.

Communication access in the retail environment for people with complex communication needs

Purpose: To identify what facilitates retail communication access for people with complex communication needs, and the impact of communication in this context on social inclusion.Materials and method: Seven adults with lifelong or acquired complex communication needs who used augmentative and alternative communication devices (AAC) and nine retailers participated in interviews to determine factors that contributed to communication access and inclusion. Interview data were analysed using the grounded theory method within an ecological model of social inclusion.Results: Retail participants did not differentiate between disabilities and their lack of understanding of complex communication needs was a barrier to inclusion. Participants with complex communication needs had received little preparation from speech-language pathologists on how to use AAC effectively when shopping. Communication access was achieved predominantly through participants' individual self-advocacy.Conclusions: Organisational and systemic measures are needed to better inform retailers about their responsibilities toward people who use AAC. Business prioritisation of communication access, government programs that differentiate and support people with lesser-known disabilities such as complex communication needs, and speech-language pathology support to use AAC in the retail environment is likely to improve communication access and social inclusion.Implications for rehabilitationThere is an urgent need to consider.Social policy that differentiates people with complex communication needs and contributes to public awareness of their communication needs.Directly-delivered training for retailers on adjustments for communication access for people with CCN.Support from local disability advocates, speech-language pathologists and disability services for self-advocacy with retailers by people with CCN.Early training aimed at all stakeholders by speech-language therapists in the use of speech generating devices when retail shopping.

From conversation starters in the front yard to talking to God: the sensory ethnography of communication access

Aims: The nature and quality of communication access in the home can vary considerably depending upon such things as where one lives, social affiliations, and access to technology. Using findings from an in-depth study of the meaning of home for people with severe communication impairment the study sought to investigate features of communication access.Method: Data obtained from sensory ethnographic journal entries, interview, and video field notes were collected to create a communication inventory. Specific communication themes were identified and coded for frequency and intensity and then analysed with participant home type (independent living, living with immediate family, or living in a group home).Results: Findings across the three types of dwellings suggest a relationship between home type and communication access.Conclusions: With communication being an integral element of rehabilitation, issues of communication access hold implications for both service delivery and research practice across the field of rehabilitation. The contribution of sensory ethnography and its potential use in rehabilitation was also a significant outcome of the study.Implications for rehabilitationCommunication is an important element of rehabilitation but despite the epidemiology of communication disorders among service recipient, it has not received adequate attention from across the field of rehabilitation.This study highlights how environmental factors can greatly shape communication access for many people with significant communication disability.By increasing awareness of communication access, practitioners and researchers of rehabilitation are invited to reflect upon and improve communication corridors; ultimately leading to better health outcomes.The study successfully combines it with the innovations of sensory ethnography with strong potential for development across rehabilitation.In challenging the notion of augmentative and alternative communication (AAC) as belonging to speech pathology, the study contributes to arguments for increased capacity building and interdisciplinary practice across all of rehabilitation.

Teaching Preschoolers With Down Syndrome Using Augmentative and Alternative Communication Modeling During Small Group Dialogic Reading

Purpose This study evaluated the effect of aided augmentative and alternative communication modeling (AAC-MOD) on the communication skills of children with Down syndrome (DS) during small group dialogic reading. Method Four children with DS between 3;1 and 5;3 (years;months; M = 4;5) and 5 typically developing peers between 3;5 and 5;9 (M = 4;3) participated. Effects were examined using a multiple probe across behaviors design with 4 children with DS. To simulate typical dialogic reading routines in inclusive classrooms, a strategy called Read, Ask, Answer, Prompt (Binger, Kent-Walsh, Ewing, & Taylor, 2010) was applied during the baseline and intervention sessions. Results A functional relation was demonstrated between (a) AAC-MOD and percentage of correctly identified symbols for 3 participants, (b) AAC-MOD and rate of symbolic communication for 2 participants, and (c) AAC-MOD and number of different words for 2 participants. Increases in number of multiple word combinations occurred for 2 participants. All 4 children maintained their percentage of correctly identified symbols. Increases in rate of symbolic communication did not generalize to thematic play contexts, a distal measure of response generalization. Conclusion AAC-MOD is an effective strategy for teaching target vocabulary and increasing rate of symbolic communication in young children with DS. Supplemental Material https://doi.org/10.23641/asha.10093538.

Assistive technologies for children with cognitive and/or motor disabilities: interviews as a means to diagnose the training needs of informal caregivers

PURPOSE

The present study seeks to survey information and training needs of informal caregivers related to the use of assistive technologies at home, so as to, in the near future, try to meet them. Therefore, the full aim of this study is to contribute to reducing technology abandonment and to enhancing its use in the family setting by children with cognitive and/or motor limitations.

MATERIALS AND METHODS

Content analysis of a set of ten interviews with informal caregivers of children and youngsters with cognitive and/or motor disabilities.

RESULTS

Assistive technologies open a wide range of opportunities, mostly to students whose learning skills diverge from standard development. They promote communication, independence as well as inclusion of children with cognitive and/or motor disabilities. Despite the human and material resources available, the implementation of assistive technologies in many family settings is still a struggling task. The results reveal a perspective on (i) the interaction between those caregivers and their children, (ii) children's skills in using assistive technology, (iii) caregivers' digital literacy and (iv) their training needs.

CONCLUSIONS

The present paper highlights the fact that carrying out interviews with informal caregivers leads to obtaining significant data for a diagnosis of the use of assistive technologies in the family setting and to assess the needs of informal caregivers. From this study, the need to provide caregivers with further training on assistive technologies emerges as preponderant, and to improve caregivers' skills in the search for and access to practical information.Implication for RehabilitationCognitive and/or motor disabilities impact on communication, independence and also on the full inclusion of children, especially when efforts developed at school do not have any follow up at home.Endowing informal caregivers with the knowledge and skills to use assistive devices with their children is a step forward to their full development.Interviews conducted with informal caregivers are a means to gaining insights into understanding the reasons behind assistive technology abandonment at home.

An online community of practice to improve intervention for individuals with complex communication needs

Collaboration and information sharing are essential in the fast moving world of augmentative and alternative communication (AAC). This paper describes communities of practice, justifies their need in AAC, and introduces the Communication Matrix Community of Practice (CMCoP)-an online community of practice for professionals and family members supporting individuals at the earliest stages of communication development. Stakeholders share the goal of advancing language and communication intervention for individuals with complex communication needs. Features of the CMCoP include a community forum for discussing and sharing information; collections of posts by professionals and nonprofessionals on various topics; an events calendar of AAC-related activities relevant to stakeholders; and a shared science section offering portraits of the communication skills of various populations with severe communication disorders. The utility of these and other CMCoP features in supporting the implementation of AAC assessment and intervention strategies is discussed.

Exploring participation experiences of youth who use AAC in social media settings: impact of an e-mentoring intervention

The contribution of cross-age peer e-mentoring on reported experiences of participation during online conversations using social media was explored in this pre-experimental study. Young people (n = 4, aged 13; 4-18;3 [years; months]) who used augmentative and alternative communication (AAC) participated in an e-mentoring intervention. Two mentors who also used AAC had regular conversations with the participants via Facebook ¹ , email, or Skype ² . It was predicted that the mentoring support would contribute to experiences of participation in online conversations outside of the e-mentoring intervention. Reported experiences of participation in online conversations with communication partners other than the mentor were measured at four time points. The Self-Reported Experiences of Activity Settings was used for this purpose because it consists of five domains: Personal Growth, Psychological Engagement, Social Belonging, Meaningful Interactions, and Choice and Control. These domains are associated with the construct of involvement in activity settings. Results showed varied scores between participants and across the domains. Reported experiences of choice and control increased slightly across time. Despite some variation in self-ratings, the participants reported experiencing choice and control, psychological engagement, and social belonging in online conversations. There is need for more research in this emerging area.

Training Education Professionals to Use the Picture Exchange Communication System: a Review of the Literature

The Picture Exchange Communication System (PECS) is a popular augmentative and alternative communication strategy. Like many communication interventions, the successful use of PECS is dependent on the skills of the communication partner. This article provides a systematic review of the published research on teaching education professionals (EPs) to use PECS. Training of EPs was usually conducted during individual or small group sessions and included a description of the PECS strategy, practice on implementation of PECS, and feedback on performance. Instructional activities typically resulted in an immediate increase in the quality and/or quantity of PECS opportunities provided by the EP; however, mixed findings are reported for maintenance and generalization. Implications for future research and practice are discussed.

An Upgraded Smartphone-Based Program for Leisure and Communication of People With Intellectual and Other Disabilities

Background: People with intellectual disability and sensory or sensory-motor impairments may display serious problems in managing functional daily activities as well as leisure activities and communication with distant partners. Aim: The study assessed an upgraded smartphone-based program to foster independent leisure and communication activity of eight participants with mild to moderate intellectual disability, sensory or sensory-motor impairments, and limited speech skills. Method: The upgraded program was based on the use of (a) a Samsung Galaxy A3 smartphone with Android 6.0 Operating System, near-field communication, music and video player functions, and Macrodroid application, and (b) special radio frequency-code labels. Participants requested leisure and communication activities by placing mini objects or pictures representing those activities and containing frequency-code labels on the smartphone. The smartphone, via the Macrodroid application, read the labels (i.e., discriminated the participants' requests) and provided the participants with the activities requested. Results: During the baseline (i.e., in the absence of the program), the participants failed to request/access leisure and communication activities independently. During the post-intervention phase of the study (i.e., using the program), they succeeded in requesting/accessing those activities independently and spent about 70-90% of their session time busy with those activities. Conclusion: The upgraded smartphone-based program may be highly functional for people like the participants of this study.

Augmentative and Alternative Communication – Scoping Review / Unterstützte Kommunikation – Scoping Review

Introduction

The effective use of Augmentative and Alternative Communication is challenging, not only for persons with complex communication needs, but also for their significant others. There is a need, therefore, for interprofessional collaboration in order to effectively assess, provide, and evaluate services.

Aim

The aim of this scoping review was to summarize current evidence in the field of Augmentative and Alternative Communication and reveal the demands for further research.

Method

We searched in the electronic databases Pubmed, AMED, and CINAHL using following keywords child*, disability, cerebral palsy, augmentative and alternative communication, intervention, and therapy to identify relevant literature. We summarised the content of the included studies.

Results

We included 16 literature reviews and 36 studies in this review. The 36 studies included 11 intervention studies, 20 descriptive studies, two experimental studies, and three studies evaluating assessments. Most of the studies were focussing on children with cerebral palsy and autism in the contexts of home, hospital, and primary school. There were no intervention studies, focusing on secondary and/or tertiary level of education or work. Moreover, we have not found any evidence from German speaking Europe.

Conclusion

In order to support the use of Augmentative and Alternative Communication and to enable participation of persons with complex communication needs, various endeavours are needed: in the practice of care settings interprofessional collaboration is required. Further research is needed in order to evaluate the effectiveness of interventions, focussing on youth and the contexts of secondary and/or tertiary education or work, or on assessments.

A systematic review of the barriers and facilitators to the provision and use of low-tech and unaided AAC systems for people with complex communication needs and their families

PURPOSE

Speech-language pathologists may introduce augmentative or alternative communication (AAC) systems to people who are unable to use speech for everyday communication. Despite the benefits of AAC systems, they are significantly underutilized by the people with complex communication needs. The current review aimed to synthesize the barriers and facilitators to the provision and use of low-tech and unaided AAC systems.  Materials and methods: Relevant literature was identified via a systematic search strategy. Included articles (n = 43) were evaluated using the Critical Appraisal Skills Programme. Qualitative framework analysis was then completed with reference to the International Classification of Functioning, Disability, and Health (ICF).  Results and conclusion: Most barriers and facilitators were coded as contextual factors within the ICF. Of most prominence were environmental factors, including attitudes of and supports provided by professionals, family members, and the society at large. Themes were also identified which related to the personal factors, including the user's own attitude, socioeconomic status, and culture. Beyond these contextual factors, the remaining codes related to body functions such as cognition and movement. There are numerous barriers to the provision and use of low-tech and unaided AAC systems, which may contribute to the inadequate use of these systems by people with complex communication needs. Suggestions for reducing these barriers are presented with regards to the person with complex communication needs, their family, and the professionals involved in their care. Implications for Rehabilitation AAC systems can reduce participation restrictions for people with complex communication needs. The provision and use of AAC systems is influenced by environmental factors, personal factors, and features of a person's body function. SLPs may need to collaborate with a large multidisciplinary team to successfully introduce AAC systems. SLP, teaching, and nursing students require theoretical and practical experience in AAC throughout their training to enable the provision and use of these systems.