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.

Assistive technology for communication of older adults: a systematic review

OBJECTIVE

Describe the use of assistive technology to enhance communication opportunities for older adults.

METHODS

A systematic review was conducted in two databases, PubMed and Web of Science, by using two different searches in each. The search was limited to original articles, in English language, including people aged 60 years and older that used any type of assistive technology for communication. The articles found in the initial search were filtered by title, abstracts and the remaining articles were fully read.

RESULTS

Eighteen studies were included in this review after the reading of full-texts. Most of the studies included apparently healthy participants with communication limitations due to aging related changes and the others included people with some pathology that prevent them from normal communication.

CONCLUSION

Four categories of assistive technology were identified: assistive technology for people with speech problems; robot or videoconferencing systems; Information and Communication Technologies and, other types of assistive technology for communication, such as hearing aids and scrapbooks. Assistive technology for communication of older adults is not only used by people with disabilities that prevent them from usual communication. They are mostly for older adults without a pathological communication problem.

Manual signing throughout the day: Influence from staff's sign use and type of activity

BACKGROUND

Both individuals with intellectual disabilities (ID) and staff may be more inclined to use manual signs during formal than informal activities. In addition, the sign use of individuals with ID and staff is positively related. It is unclear if activity type and the sign use of staff interact as they shape the sign use of individuals with ID.

METHODS

Through non-continuous partial interval coding, we observed frequency of manual sign usage in adults with ID during communicative activities, non-communicative activities and mealtimes in four special schools and 4-day centres. Using loglinear analysis and partial associations, we measured how sign use varied by activity between the people with ID and the staff.

RESULTS

When staff used signs, clients and students did not vary their spontaneous signing rate between types of activities. When staff did not use signs, a differential influence appeared according to the type of activity: clients and students were significantly more likely to also refrain from using signs during mealtimes and leisure or work activities such as crafts (84% to 89% of the time) than during communicative activities such as signing sessions (65% of the time).

CONCLUSIONS

Reluctance of staff to model sign use seemed to hinder signing implementation by the people with ID. Future studies should take into account various levels of sign prompting and increasing pragmatic functions of individuals' sign use.

Breathing Pattern Interpretation as an Alternative and Effective Voice Communication Solution

Augmentative and alternative communication (AAC) systems tend to rely on the interpretation of purposeful gestures for interaction. Existing AAC methods could be cumbersome and limit the solutions in terms of versatility. The study aims to interpret breathing patterns (BPs) to converse with the outside world by means of a unidirectional microphone and researches breathing-pattern interpretation (BPI) to encode messages in an interactive manner with minimal training. We present BP processing work with (1) output synthesized machine-spoken words (SMSW) along with single-channel Weiner filtering (WF) for signal de-noising, and (2) k-nearest neighbor (k-NN) classification of BPs associated with embedded dynamic time warping (DTW). An approved protocol to collect analogue modulated BP sets belonging to 4 distinct classes with 10 training BPs per class and 5 live BPs per class was implemented with 23 healthy subjects. An 86% accuracy of k-NN classification was obtained with decreasing error rates of 17%, 14%, and 11% for the live classifications of classes 2, 3, and 4, respectively. The results express a systematic reliability of 89% with increased familiarity. The outcomes from the current AAC setup recommend a durable engineering solution directly beneficial to the sufferers.

Using peer-mediated instruction to support communication involving a student with autism during mathematics activities: A case study

This study employed an A-B singled subject design to explore the extent to which a peer-mediated intervention supported a first-grade student with autism's usage both in purpose and frequency of a speech-generating device (SGD) during mathematics activities. The intervention involved teaching a peer without a disability to encourage the student with autism to use the SGD during partnered mathematics activities. Our analysis involved visual and descriptive examination of trends and patterns over time, and comparison of means between and within phases. We found during the course of this study that (1) the student with autism's level of overall communication, which included the relevancy of these communicative behaviors, increased; (2) the student with autism's level of spontaneous communication acts increased; and (3) the peer became more independent with supporting the student with autism's communication. Implications for future research and practice are provided.

Minimally verbal school-aged children with autism spectrum disorder: the neglected end of the spectrum

It is currently estimated that about 30% of children with autism spectrum disorder remain minimally verbal, even after receiving years of interventions and a range of educational opportunities. Very little is known about the individuals at this end of the autism spectrum, in part because this is a highly variable population with no single set of defining characteristics or patterns of skills or deficits, and in part because it is extremely challenging to provide reliable or valid assessments of their developmental functioning. In this paper, we summarize current knowledge based on research including minimally verbal children. We review promising new novel methods for assessing the verbal and nonverbal abilities of minimally verbal school-aged children, including eye-tracking and brain-imaging methods that do not require overt responses. We then review what is known about interventions that may be effective in improving language and communication skills, including discussion of both nonaugmentative and augmentative methods. In the final section of the paper, we discuss the gaps in the literature and needs for future research.

The influence of matching and motor-imitation abilities on rapid acquisition of manual signs and exchange-based communicative responses

Establishing a relation between existing skills and acquisition of communicative responses may be useful in guiding selection of alternative communication systems. Matching and motor-imitation skills were assessed for 6 children with developmental disabilities, followed by training to request the same set of preferred items using exchange-based communication and manual signs. Three participants displayed both skills and rapidly acquired both communicative response forms. Three others displayed neither skill; 1 mastered exchange-based responses but not manual signs, and neither of the other 2 easily acquired either response form.