A proof-of-concept study for automatic speech recognition to transcribe AAC speakers' speech from high-technology AAC systems

Automatic speech recognition (ASR) is an emerging technology that has been used in recognizing non-typical speech of people with speech impairment and enhancing the language sample transcription process in communication sciences and disorders. However, the feasibility of using ASR for recognizing speech samples from high-tech Augmentative and Alternative Communication (AAC) systems has not been investigated. This proof-of-concept paper aims to investigate the feasibility of using AAC-ASR to transcribe language samples generated by high-tech AAC systems and compares the recognition accuracy of two published ASR models: CMU Sphinx and Google Speech-to-text. An AAC-ASR model was developed that transcribes simulated AAC speaker language samples. The AAC-ASR model's word error rate (WER) was compared with those of CMU Sphinx and Google Speech-to-text. The WER of the AAC-ASR model outperformed (28.6%) compared with CMU Sphinx and Google when tested on the testing files (70.7% and 86.2% retrospectively). Our results demonstrate the feasibility of using the ASR model to automatically transcribe high-technology AAC-simulated language samples to support language sample analysis. Future steps will focus on developing the model with diverse AAC speech training datasets and understanding the speech patterns of individual AAC users to refine the AAC-ASR model.

STAACS3: Simulation Tool for AAC with Single-Switch Scanning

Communication for people with motor impairments is a difficult, yet necessary, task in daily activities. To do so, soft keyboards, digital counterpart of physical keyboards, are used. Depending on their features, several designs can be considered, however their thoughtful evaluation in real-life is not feasible. Therefore, it becomes necessary to filter the possible configurations wisely, taking advantage of simulation tools. This paper presents STAACS3, a Simulation Tool for AAC with Single-Switch scanning, that allows to model and simulate the performance of any type of scanning keyboard regardless of its keys configuration, scanning strategy or prediction systems.

Reflections on Building a Multi-Country AAC Implementation Guide

Augmentative and Alternative Communication (AAC) implementation at any level is a multifaceted process that requires selection of relevant and appropriate systems to suit individual users who may have complex communication needs and other co-occurring difficulties. Careful and systematic action may be required to develop skills and abilities in the use of chosen technologies with suitable ongoing support within a wide range of settings. The wider milieu in which services are provided must also be considered in order to provide a firm foundation for capacity building alongside considerations for multilingual and multicultural factors. UNICEF with the Global Symbols team supported by local professionals working with AAC users, their families and carers set out to collaboratively provide an implementation guide based on their experiences in several Eastern European countries. The aim of the guide was to illustrate work already being undertaken in the area and to ensure the sharing of knowledge and resources where gaps were discovered. The result became a series of linked webpages in an online framework that covered practical aspects for the development of policies and procedures to support early intervention for those with severe speech, language and communication needs across countries of differing cultures and languages. The actual AAC implementation required ingenuity on all sides with translations for pictographic symbol and software adaptations with Cyrillic and Latin alphabets, new synthetic voices alongside deployment and capacity development. Considerable local support was forthcoming and captured with interviews by those working with AAC users as technology was introduced and outcomes measured. As the guide was completed several videos were shared publicly by carers with examples of AAC and assistive technology use. Policies and procedures were also shared in the form of tables, charts, symbol sets, communication boards and software that illustrated not only the occurrence of knowledge transfer and the use of open licenses, but also differences in strategies and the way they were adapted to suit the range of settings in the various countries.

A Visual Interactive Narrative Intervention (VINI) for aphasia education: Can digital applications administer augmented input to educate stroke survivors with aphasia?

OBJECTIVE

Persons with aphasia (PWA) face additional barriers to proper healthcare due to inadequate patient education by health professionals unequipped to use augmentative and alternative communication (AAC). The current study examines a digital application that evokes and sustains health information processing through AAC specifically aimed at increasing comprehension with augmented input (AI).

METHODS

A digital application designed to educate PWA about their health condition was compared to a video-recorded doctor providing oral-only education. Sixteen PWA received both education interventions in a crossover manner. Health information processing was assessed through heart rate (HR) and skin conductance levels (SCL), which were collected continually during each administration of education interventions.

RESULTS

PWA demonstrated greater cognitive processing of health information via HR and SCL indices during the digital application compared to the typical oral-only education intervention. The oral-only intervention led PWA to disengage with health information.

CONCLUSION

By combining visuographic materials and adapted language into a customizable narrative structure, digital applications can utilize AI to educate PWA about basic health information (i.e., diagnosis and prognosis).

PRACTICE IMPLICATIONS

The current study's AAC requires minimal training and can be used as an aided support in conjunction with other techniques that increase PWA's access to health information.

An mHealth Platform for Supporting Clinical Data Integration into Augmentative and Alternative Communication Service Delivery: User-Centered Design and Usability Evaluation

BACKGROUND

The recent trend of increasing health care costs in the United States is likely not sustainable. To make health care more economically sustainable, attention must be directed toward improving the quality while simultaneously reducing the cost of health care. One of the recommended approaches to provide better care at a lower cost is to develop high-quality data collection and reporting systems, which support health care professionals in making optimal clinical decisions based on solid, extensive evidence.

OBJECTIVE

The objective of this project was to develop an integrated mobile health Augmentative and Alternative Communication (AAC) platform consisting of an AAC mobile app and a Web-based clinician portal for supporting evidence-based clinical service delivery.

METHODS

A questionnaire and interviews were used to collect clinicians' ideas regarding what constitutes their desired "clinically relevant" data. In response, a Web-based portal was designed by combining mobile and Web technologies with an AAC intervention to create an integrated platform for supporting data collection, integration, and reporting. Finally, a usability study was conducted with health care professionals.

RESULTS

A Web-based portal was created and integrated with a tablet-based AAC mobile app and data analysis procedures. In the usability study, all participants agreed that the integrated platform provided the ability to collect comprehensive clinical evidence, automatically analyze collected data in real time, and generate clinically relevant performance measures through an easily accessible Web-based portal.

CONCLUSIONS

The integrated platform offers a better approach for clinical data reporting and analytics. Additionally, the platform streamlines the workflow of AAC clinical service delivery.

The feasibility of improving discourse in people with aphasia through AAC: Clinical and functional MRI correlates

AIMS

The purpose of this study is twofold: (1) to examine the feasibility of providing high-tech augmentative and alternative communication (AAC) treatment to people with chronic aphasia, with the goal of evoking changes in spoken language; and (2) to identify evidence of AAC-induced changes in brain activation.

METHOD & PROCEDURES

We employed a pre- post-treatment design with a control (usual care) group to observe the impact of an AAC treatment on aphasia severity and spoken discourse. Further, we used functional magnetic resonance imaging (fMRI) to examine associated neural reorganization.

OUTCOMES & RESULTS

Compared to the usual care group, the AAC intervention trended toward larger treatment effects and resulted in a higher number of responders on behavioral outcomes. Both groups demonstrated a trend toward greater leftward lateralization of language functions via fMRI. Secondary analyses of responders to treatment revealed increased activation in visual processing regions, primarily for the AAC group.

CONCLUSIONS

This study provides preliminary guidance regarding how to implement AAC treatment in a manner that simultaneously facilitates language recovery across a variety of aphasia types and severity levels while compensating for residual deficits in people with chronic aphasia. Further, this work motivates continued efforts to unveil the role of AAC-based interventions in the aphasia recovery process and provides insight regarding the neurobiological mechanisms supporting AAC-induced language changes.

The cost of not addressing the communication barriers faced by hospitalized patients

Preventable adverse events (AEs) lead to poorer patient outcomes, added patient suffering and dissatisfaction, longer hospital stays, and billions in additional annual healthcare spending. Patients facing barriers to communication are three times more likely to experience a preventable adverse event than patients who faced no communication barriers. National data on hospital admissions, incidence and cost of preventable AEs, and the odds ratio regarding the risk of preventable AEs in people facing communication barriers were used to estimate potential benefits of improving patient communication. Reducing communication barriers could lead to an estimated reduction of 671,440 preventable AE cases and a cost savings of $6.8 billion annually. Facilitating patient-provider communication is an ethical and financial imperative. A multi-pronged approach, including increased awareness of and support for speech-language pathology services, is essential to creating a communication-friendly hospital culture, reducing patient suffering, and decreasing the financial cost of preventable AEs. Speech-language pathologists and allied healthcare professionals play a critical role in facilitating patient-provider communication and improving patient outcomes.

Silent Speech Recognition as an Alternative Communication Device for Persons with Laryngectomy

Each year thousands of individuals require surgical removal of their larynx (voice box) due to trauma or disease, and thereby require an alternative voice source or assistive device to verbally communicate. Although natural voice is lost after laryngectomy, most muscles controlling speech articulation remain intact. Surface electromyographic (sEMG) activity of speech musculature can be recorded from the neck and face, and used for automatic speech recognition to provide speech-to-text or synthesized speech as an alternative means of communication. This is true even when speech is mouthed or spoken in a silent (subvocal) manner, making it an appropriate communication platform after laryngectomy. In this study, 8 individuals at least 6 months after total laryngectomy were recorded using 8 sEMG sensors on their face (4) and neck (4) while reading phrases constructed from a 2,500-word vocabulary. A unique set of phrases were used for training phoneme-based recognition models for each of the 39 commonly used phonemes in English, and the remaining phrases were used for testing word recognition of the models based on phoneme identification from running speech. Word error rates were on average 10.3% for the full 8-sensor set (averaging 9.5% for the top 4 participants), and 13.6% when reducing the sensor set to 4 locations per individual (n=7). This study provides a compelling proof-of-concept for sEMG-based alaryngeal speech recognition, with the strong potential to further improve recognition performance.

An Explorative Study Examining Augmentative and Alternative Communication Training in the Field of Music Therapy

Background

Music therapists work with many people who require Augmentative and Alternative Communication (AAC). As communication goals are central to music therapy practice, many music therapists would benefit from training in AAC.

Objective

The purpose of this survey study was to determine the state of AAC education for music therapists at the university level, how AAC is being used in music therapy sessions, and how practicing music therapists are trained in AAC.

Methods

Music therapy faculty and credentialed music therapists in North America and Europe were invited to complete an online survey. Descriptive statistics were used to analyze survey data from each group of respondents.

Results

With regard to training in AAC at the university level, results indicate that almost half of music therapy faculty (44.66%) provided some training. The primary reason given for not providing training was a lack of educator knowledge in this area. Results indicate that a majority (81.77%) of music therapy clinicians are familiar with AAC and slightly over half (55.08%) reported that they work with clients who use AAC. Sixty-two percent of music therapists reported using AAC to promote expressive language, and 49% to increase receptive language. Over 80% of clinicians stated they would benefit from additional AAC training.

Conclusions

Although a majority of music therapists are familiar with ACC, results indicate that ACC competency could be enhanced through university-level instruction and continuing professional development courses.

SOLICITING BCI USER EXPERIENCE FEEDBACK FROM PEOPLE WITH SEVERE SPEECH AND PHYSICAL IMPAIRMENTS

Brain-computer interface (BCI) researchers have shown increasing interest in soliciting user experience (UX) feedback, but the severe speech and physical impairments (SSPI) of potential users create barriers to effective implementation with existing feedback instruments. This article describes augmentative and alternative communication (AAC)-based techniques for obtaining feedback from this population, and presents results from administration of a modified questionnaire to 12 individuals with SSPI after trials with a BCI spelling system. The proposed techniques facilitated successful questionnaire completion and provision of narrative feedback for all participants. Questionnaire administration required less than five minutes and minimal effort from participants. Results indicated that individual users may have very different reactions to the same system, and that ratings of workload and comfort provide important information not available through objective performance measures. People with SSPI are critical stakeholders in the future development of BCI, and appropriate adaptation of feedback questionnaires and administration techniques allows them to participate in shaping this assistive technology.