David R. Beukelman

AAC for adults with acquired neurological conditions: A review

The purpose of this review is to describe the state of the science of augmentative and alternative communication (AAC) for adults with acquired neurogenic communication disorders. Recent advances in AAC for six groups of people with degenerative and chronic acquired neurological conditions are detailed. Specifically, the topics of recent AAC technological advances, acceptance, use, limitations, and future needs of individuals with amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), brainstem impairment, severe, chronic aphasia and apraxia of speech, primary progressive aphasia (PPA), and dementia are discussed.

Communication Support for People with ALS

Almost all people with amyotrophic lateral sclerosis (ALS) experience a motor speech disorder, such as dysarthria, as the disease progresses. At some point, 80 to 95% of people with ALS are unable to meet their daily communication needs using natural speech. Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate augmentative and alternative communication (AAC) intervention; therefore, appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision-making issue. AAC acceptance and use have increased considerably during the past decade. Many people use AAC until within a few weeks of their deaths.

Augmentative and Alternative Communication use and acceptance by adults with Traumatic Brain Injury

The purpose of this study was to document augmentative and alternative communication (AAC) acceptance and use patterns of 25 adults with traumatic brain injuries (TBI) who used either high- or low-tech AAC devices or strategies at some point during their recovery. Specifically, the purposes were to (a) document acceptance of AAC system recommendations, (b) identify AAC use patterns by persons who accepted the recommendation and for whom AAC intervention was implemented, (c) identify AAC access patterns for message formulation and encoding, and (d) document the kind of communicative functions that different AAC strategies supported. Information was gathered via a questionnaire from speech-language pathologists who provided AAC assessments and interventions at six different sites. The speech-language pathologists provided information about individuals with TBI from their clinics for whom they had recommended AAC. Results revealed that these adults generally accepted both high- and low-tech AAC recommendations and used their AAC systems for extended periods of time. Most utilized letter-by-letter message formulation strategies. When AAC technology was abandoned, it was usually a reflection of a loss of facilitator support rather than a rejection of the technology.

Peers' perceptions of storytelling by an adult with aphasia

This study explored potential partners willingness to participate in storytelling conversations with communicators who have aphasia. We investigated adult peers perceptions of a communicator with aphasia as he told autobiographical stories using three communication modes - natural speech, AAC notebook and AAC digitized speech. Participants rated the communicator on five dependent measures, ranked the three storytelling modes and participated in a focus-group discussion. Analysis of variance revealed a significant main effect for storytelling mode. Specifically, participants rated AAC digitized speech highest of the three storytelling modes on all dependent measures. In the ranking task, a majority of peers ranked AAC digitized speech as their most preferred storytelling mode and natural speech as their least preferred storytelling mode. Rating and ranking scores were influenced by the understandability of the story and the perceived effort required to transmit and receive it. Other issues raised in the fo...

Navigation of a Dynamic Screen AAC Interface by Survivors of Severe Traumatic Brain Injury

The researchers examined the effect of cognitive flexibility, image contextualization, and prompt type on accuracy and speed when adults with severe traumatic brain injury (TBI) navigated dynamic screen augmentative and alternative communication (AAC) interfaces. Eighteen participants formed two groups based on cognitive flexibility status. Given matching informative versus uninformative prompts and three image contextualization conditions, participants located words on 3-level AAC systems. ANOVA computations revealed differences between groups and between prompt types for navigation accuracy; differences occurred among image conditions and between prompt types for navigation speed. Analyses using responses from participants with cognitive flexibility challenges revealed inter-subject variability regarding error types. Overall, findings suggest cognitive flexibility may predict who may and may not need explicit training to master AAC device navigation.

Evaluation of a Speech Recognition Prototype for Speakers with Moderate and Severe Dysarthria: A Preliminary Report

This study described preliminary work with the Supplemented Speech Recognition (SSR) system for speakers with dysarthria. SSR incorporated automatic speech recognition optimized for dysarthric speech, alphabet supplementation, and word prediction. Participants included seven individuals with a range of dysarthria severity. Keystroke savings using SSR averaged 68.2% for typical sentences and 67.5% for atypical phrases. This was significantly different to using word prediction alone. The SSR correctly identified an average of 80.7% of target stimulus words for typical sentences and 82.8% for atypical phrases. Statistical significance could not be claimed for the relations between sentence intelligibility and keystroke savings or sentence intelligibility and system performance. The results suggest that individuals with dysarthria using SSR could achieve comparable keystroke savings regardless of speech severity.

Noun Representation in AAC Grid Displays: Visual Attention Patterns of People with Traumatic Brain Injury

Abstract Clinicians supporting the communication of people with traumatic brain injury (TBI) must determine an efficient message representation method for augmentative and alternative communication (AAC) systems. Due to the frequency with which visual deficits occur following brain injury, some adults with TBI may have difficulty locating items on AAC displays. The purpose of this study was to identify aspects of graphic supports that increase efficiency of target-specific visual searches. Nine adults with severe TBI and nine individuals without neurological conditions located targets on static grids displaying one of three message representation methods. Data collected through eye tracking technology revealed significantly more efficient target location for icon-only grids than for text-only or icon-plus-text grids for both participant groups; no significant differences emerged between participant groups.

Communication supports in pediatric rehabilitation

This article introduces the roles of parents and rehabilitation professionals in the provision of communication supports for children who cannot meet their communication needs through natural speech alone, also referred to as individuals with complex communication needs (CCN). The authors present a personnel framework, introduce intervention models of augmentative and alternative communication (AAC) services, and address issues parents face in preparing to provide communication supports to children with CCN using AAC and assistive technology (AT).