Laura J. Ball

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.

An AAC personnel framework: adults with acquired complex communication needs.

A personnel framework designed to support people who rely on augmentative and alternative communication (AAC) because of acquired medical conditions and those who assist them is described. The roles of AAC finders, general practice clinicians, AAC intervention specialists, AAC facilitators, and AAC experts are summarized. These roles are described in detail for people with amyotrophic lateral sclerosis, brainstem impairment, and severe chronic aphasia. The personnel preparation needs for each of these support personnel groups are identified.

Acceptance of Augmentative and Alternative Communication Technology by Persons with Amyotrophic Lateral Sclerosis

A review of the use of augmentative and alternative communication (AAC) technology by 50 persons with amyotrophic lateral sclerosis was completed over the course of 4 years. Ninety-six percent of the participants in this study accepted AAC technology, either immediately (90%) or after some delay (6%), and only 4% (n = 2) rejected AAC technology. None of the participants discontinued use of their AAC technology. Reasons for acceptance decisions were discussed in interviews with study participants and the results are presented.

A protocol for identification of early bulbar signs in amyotrophic lateral sclerosis

The purpose of this project is to identify characteristics that may be of assistance in establishing the diagnosis and monitoring early progression of bulbar dysfunction in patients with Amyotrophic Lateral Sclerosis (ALS). Early identification of bulbar dysfunction would assist in clinical trials and management decisions. A database of 218 clinic visits of patients with ALS was developed and formed the basis for these analyses. As a framework for the description of our methodology, the Disablement Model [World Health Organization. WHO International classification of impairment, activity, and participation: beginners guide. In: WHO, editor. Beta-1 draft for field trials; 1999] was utilized. Our data identified that the strongest early predictors of bulbar speech dysfunction include altered voice quality (laryngeal control), speaking rate, and communication effectiveness. A protocol for measuring these speech parameters was therefore undertaken. This paper presents the protocol used to measure these bulbar parameters.

Kinematics of disease progression in bulbar ALS

UNLABELLED The goal of this study was to investigate the deterioration of lip and jaw movements during speech longitudinally in three individuals diagnosed with bulbar amyotrophic lateral sclerosis (ALS). The study was motivated by the need to understand the relationship between physiologic changes in speech movements and clinical measures of speech performance such as speaking rate and speech intelligibility. Movements of the lip and jaw were quantified with respect to their size speed, and duration. The data revealed several changes in lip and jaw movement that coincided with ALS progression. In two out of three speakers, the changes in measures of path distance and speed anticipated the drop in speech intelligibility by approximately 3 months. With disease progression, increases in movement duration coincided with declines in speech intelligibility. Overall, the movement measures appeared to be sensitive to disease progression in ALS. LEARNING OUTCOMES By the end of the manuscript, the reader should be able to: (1) describe the changes that occur in articulatory movements of the jaw and lower lip in ALS; (2) understand the relationship between physiologic measures of movement and speech intelligibility and speaking rate; (3) identify critical points in the disease progression and understand which quantitative measures reveal the state of the bulbar system at these time points.

Input framework for augmentative and alternative communication

Traditionally, the field of augmentative and alternative communication (AAC) has focused on enhancing the expressive communication of users. However, a number of authors have also described strategies to augment the input provided to AAC users during communication interaction or during instruction in AAC use. The AAC Input Framework (AACIF) described in this paper represents an attempt to clarify the processes of input that occur in AAC by exploring how existing techniques are relevant to AAC users and their partners. Four components—augmenting the message, mapping language and symbols, augmenting retention, and developing a pool of response options—are described. Connections to existing augmented input literature are presented, and clinical examples are provided.

Personnel Roles in the AAC Assessment Process

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

Improving AAC use for persons with acquired neurogenic disorders: understanding human and engineering factors.

The first section of this report focuses on those factors that influence augmentative and alternative communication (AAC) use by adults with acquired disability, including the natural course of the acquired neurogenic condition, use of multiple modes of communication, changing capabilities, communication patterns of adults, changing social roles, transitioning among environments, attitudes of AAC users and others, and instructional constraints. The second section provides recommendations about future technical and intervention innovations involving message management, alternative access strategies, and learning demands.

Generic talk use by preschool children

The frequency and type of generic talk produced by typically developing preschool children was studied to support intervention decisions for children who use augmentative and alternative communication (AAC) systems. Generic talk requires little knowledge about communication partners (person or topic) to prompt interactions. Ten children ranging from 4:0 to 5:2 years participated in the study. They were intelligible speakers with normal language development. Communication samples were collected at preschool and home. No statistical differences were observed in generic talk use at home and school. Nearly half of all utterances produced across the two settings were classified as generic talk. The unique utterances to preschool children were categorized as confirmation/negation, comments, environmental control, and continuers. On the basis of these results, AAC specialists are encouraged to consider the inclusion of generic talk in AAC devices for young children.