Augmentative and alternative communication in pCMS

Abstract

We thank Ludovica Primavera and colleagues for their comments on our paper on ‘’Post-operative cerebellar mutism syndrome: rehabilitation issues” [1]. The authors of this letter to the editor justly emphasize the importance of applying augmentive and alternative communication (AAC) strategies in the mute phase of the postoperative cerebellar mutism syndrome (pCMS). AAC options not only aim to replace spoken language (i.e., as an alternative to speech), but also to supplement (i.e., augment) an individual’s speech and facilitate language development [2]. AAC specialists mainly but not exclusively are Speech and Language Pathologists who use a comprehensive and holistic approach to assess speech and/or language impairment and find appropriate alternatives varying from unaided communication such as facial expression, gestures, or body language to aided variants which are supported by books or technological solutions. They may acquire the necessary information from parents, teachers, paraprofessionals, peers, ancillary therapists, and (school) psychologists [3]. The method of data collection may vary from patient to patient and setting to setting and in a clinical setting requires a strong and supportive multidisciplinary team. Early rehabilitation, including restoration of the ability to communicate non-verbally in children with pCMS, has of course the highest priority. Using AAC techniques in the early days of pCMS may be quite helpful. However, starting AAC in these children is frequently hampered by behavioral deficits such as severe agitation or withdrawal which prevents the child from fully participating in interactive activities. The duration of the mute phase varies between patients and during recovery until speech onset, indicating that strategies may have to change rapidly during the weeks or months before speech onset. We agree with [4]. that AAC in pCMS patients should be a dynamic process with communicative support appropriate to the child’s functioning profile and the communication needs of the moment. To date, case studies have been the main method used to evaluate AAC services [5]. A meta-analysis of studies on high-technology AAC for individuals with intellectual and developmental disabilities and complex communication needs indicated overall low to moderate positive effects on social-communication [6]. In pCMS patients, recovery of speech after speech onset is often remarkably fast [7]. Although in most children speech and language problems remain long-term to a certain extent, spoken language and