Parimala Raghavendra

Evidence-Based Practice in Augmentative and Alternative Communication

An evidence-based practice (EBP) approach to clinical and educational practice emphasizes the importance of integrating sound research evidence into the decision-making process. This paper provides a discussion of the relevance of EBP to the field of augmentative and alternative communication (AAC). Included is an examination of what is currently known about decision-making in AAC, as well as a brief history of EBP and its application in other fields. A definition of EBP in AAC is proposed and a schematic of the EBP process is described, including proposed design hierarchies of evidence. This process is then illustrated with a case example. Finally, key factors for the adoption of EBP in AAC are discussed.

School participation and social networks of children with complex communication needs, physical disabilities, and typically developing peers.

The aim of the study was to describe and compare the school participation and social networks of children with physical disabilities and complex communication needs (Group CCN), children with physical disabilities only (Group PD), and children with typical development (Group TD). The 39 participants, 10–15 years of age, were observed for 4 hours at school. School staff and the parent and/or child provided information on children’s social networks. A striking observation was that, while participants in Group TD continuously conversed and socialized with peers inside and outside classrooms; those in Group CCN rarely used aided AAC, were provided with limited communication opportunities at school, and had fewer acquaintances and friends. Findings warrant intervention at the participation level at school and in the community.

The World Health Organization's international classification of functioning, disability and health: implications for clinical and research practice in the field of augmentative and alternative communication

In 2001, the World Health Organization (WHO) ratified and published a new classification system, the International Classification of Functioning, Disability and Health (ICF). There has been a varying amount of discussion and debate across the health and disability fields about what the ICF means and what it has to offer. However, there has been little discussion of its use and value in the field of augmentative and alternative communication (AAC). This article describes the earlier International Classification of Impairments, Disabilities, and Handicaps (ICIDH), upon which the current ICF was based; and outlines the ICF and the preliminary, derived Child and Youth version of the ICF (ICF-CY). The article also proposes what the ICF has to offer the AAC field, from both a clinical and research perspective; and concludes with a discussion of the advantages and challenges of using the ICF.

Activity participation of children with complex communication needs, physical disabilities and typically-developing peers

Objective: To describe and compare the context of participation of children with physical disabilities and complex communication needs (Group CCN) in out-of-school activities with children with physical disabilities only (Group PD) and typically-developing peers (Group TD). Method: A cross-sectional, matched, multi-group design was used. Thirty-nine participants between 10–15 years of age were administered the Childrens Assessment of Participation and Enjoyment. Results: Kruskall-Wallis analyses revealed that there were significant differences among the three groups for overall location, enjoyment of the activities and with whom they did the social and self-improvement activities with. Mean trends showed that Group CCN participated in activities closer to home rather than in the community, were restricted in social participation and reported higher levels of enjoyment in activity participation than the other two groups. Conclusions: Group CCN appeared to experience differences in participation when compared to peers with and without disability.

Time demands of caring for children with cerebral palsy: what are the implications for maternal mental health?

Aim  To examine the relationship between maternal mental health problems and the time required by mothers to care for children with cerebral palsy (CP).

An investigation of different degrees of dysarthric speech as input to speaker-adaptive and speaker-dependent recognition systems

This study describes the feasibility of using speech recognition as a text input method for speakers with different degrees of dysarthria. The project investigated two different types of speech recognition systems: Prototype Swedish DragonDictate (PSDD), a speaker-adaptive phoneme-based system, and Infovox RA, a speaker-dependent, whole-word pattern-matching system. Individuals with mild and moderate dysarthria trained and then used 45 command words to input text independently into the PSDD. The results indicated that the PSDD system adapted well to the speech of individuals with mild and moderate dysarthria, but the recognition scores were lower than for a natural speaker. The PSDD system also adapted to the speech of two participants with different degrees of severe dysarthria, but they were unable to use this system independently. On the Infovox RA system, there was a wide range in the mean recognition scores for participants with dysarthria, whereas the natural speaker reached almost 100%. The recognition score for the participant with very severe dysarthria increased substantially with an adapted vocabulary on the speaker-dependent Infovox RA system. The results are discussed in terms of factors that should be considered before selecting a suitable speech recognition system for speakers with different degrees of dysarthria.

'I could never do that before': effectiveness of a tailored Internet support intervention to increase the social participation of youth with disabilities.

BACKGROUND Youth use the Internet for a variety of purposes including social networking. Youth with disabilities are limited in their social networks and friendships with peers. The aim was to investigate the effectiveness of tailored one-on-one support strategies designed to facilitate social participation of youth with disabilities through the use of the Internet for social networking. METHODS Eighteen youth aged 10-18 years with cerebral palsy, physical disability or acquired brain injury received support, training and assistive technology at their home to learn to use the Internet for building social networks. The Canadian Occupational Performance Measure (COPM) and Goal Attainment Scale (GAS) were used to evaluate objective changes in performance and satisfaction. Interviews with the youth identified subjective changes they experienced through participation in the programme and to determine whether and how the intervention influenced their social participation. RESULTS Youth showed an increase in performance and satisfaction with performance on identified goals concerning social networking on the COPM; Paired T-test showed that these differences were statistically significant at P < 0.001. GAS T-scores demonstrated successful outcomes (>50) for 78% of the youth. Interviews showed that youth were positive about the benefits of hands-on training at home leading to increased use of the Internet for social networking. CONCLUSIONS The Internet could be a viable method to facilitate social participation for youth with disabilities. Youth identified the benefits of one-to-one support at home and training of the family compared with typical group training at school. Despite its success with this group of youth, the time and effort intensive nature of this approach may limit the viability of such programmes. Further longitudinal research should investigate whether Internet use is sustained post intervention, and to identify the factors that best support ongoing successful and safe use.

Participation and Social Networks of School-Age Children with Complex Communication Needs: A Descriptive Study

Social participation becomes particularly important in middle childhood, as it contributes towards the acquisition and development of critical life skills such as developing friendships and a sense of belonging. However, only limited literature is available on the impact of communication difficulties on social participation in middle childhood. This study compared the participation patterns of school-age children with and without physical disabilities and complex communication needs in extracurricular activities. Participants included five children between 6–9 years of age with moderate-severe physical disability and complex communication needs, and five matched peers. Findings showed that children with physical disability and complex communication needs engaged in activities with reduced variety, lower frequency, fewer partners and in limited venues, but reported higher levels of enjoyment and preference for activity participation, than their matched peers. These children also had fewer same-aged friends, but more paid workers in their social circle. This small-scale descriptive study provides some preliminary evidence about the impact of severe communication difficulties on participation and socialization.

Participation of children with disabilities: measuring subjective and objective outcomes

There will be a special issue of Child: care, health and development in 2013 devoted to papers on measuring the participation of children, youth, and young adults with disabilities (from birth-25 years) in home, school, and/ or community settings. The aim of this issue is to provide an international and diverse perspective on participation measurement and participation interventions that include measurement. The focus will also be on subjective and objective measures, and measurement from multiple perspectives, including child/youth, parents/caregivers, teachers, and other key stakeholders.

Learning to use the Internet and online social media: What is the effectiveness of home-based intervention for youth with complex communication needs?

Youth with complex communication needs (CCN) face increased barriers to their social participation due to limited communication abilities and opportunities. Youth today use the internet as a social tool and youth with CCN may also benefit from internet use to increase their social participation. Five youth between the ages of 10–18 with CCN who are unable to use speech for everyday communication and require augmentative and alternative communication were provided with assistive technology and a tailored 1:1 intervention at home to learn to use the internet for connecting with others. Pre and post assessments measured changes in performance on internet use goals, social networks, loneliness and self-concept. Multiple measures were used to examine the impact of internet use for social networking on a range of outcomes and to gather emerging evidence in this area. Results showed that the intervention was effective in increasing performance and satisfaction with goals for increasing internet use to connect with others and for increasing the number of online communication partners. There was no significant change in loneliness or self-concept. This study shows that the internet may be a viable tool in increasing the social participation of youth with CCN. However, some youth and their families required intensive support and technical assistance to gain confidence in internet use and in use for social purposes.