Simon Judge

Barriers and facilitators to the use of high-technology augmentative and alternative communication devices: a systematic review and qualitative synthesis

BACKGROUND There has been a rapid growth in recent years of available technologies for individuals with communication difficulties. Research in the area is currently underdeveloped with practitioners having a limited body of work on which to draw to guide the process of intervention. Concerns have been raised that this newly developed technology may have limited functional usage. AIMS This review aims to investigate the potential barriers and facilitators to high-technology AAC provision and its ongoing use. The aim of the analysis is to explore factors underpinning use rather than effectiveness, thus it synthesized data from predominantly qualitative and survey studies reporting the views and perceptions of AAC users or staff providing the devices. MAIN CONTRIBUTION The review highlights the range of factors that can impact on provision and use of high-technology AAC, which practitioners should consider and address as appropriate in the intervention process. These include: ease of use of the device; reliability; availability of technical support; voice/language of the device; decision-making process; time taken to generate a message; family perceptions and support; communication partner responses; service provision; and knowledge and skills of staff. The work outlines how qualitative synthesis review methods may be applied to the consideration of published material that is not reporting outcomes data, and how this may provide valuable information to inform future studies. CONCLUSIONS Practitioners should be aware of barriers and facilitators to successful use when making recommendations, and consider how barriers where present might be overcome. Aspects of service delivery such as ongoing technical support and staff training may require further consideration. The synthesis of evidence describing views of users and providers, and the implementation of high-technology AAC systems, can provide valuable data to inform intervention studies and functional outcome measures.

Interventions Using High-Technology Communication Devices: A State of the Art Review

Background/Aims: In the last 20 years the range of high-technology augmentative and alternative communication (AAC) aids has rapidly expanded. This review aimed to provide a ‘state of the art’ synthesis, to provide evidence-based information for researchers, potential users and service providers. Methods: Electronic databases were searched from 2000 to 2010, together with reference lists of included papers and review papers. The review considered work of any design which reported an intervention using high-tech AAC with people who have communication difficulties (excluding those with solely hearing or visual loss) published in peer-reviewed journals. Results: Sixty-five papers reporting interventions using high-tech AAC were identified. There was evidence that high-technology AAC may be beneficial across a range of diagnoses and ages. The evidence, however, is currently drawn from studies using designs considered to be at high risk of bias. Conclusion: The review suggests that the high level of individual variation in outcome requires a greater understanding of characteristics of clients who may or may not benefit from this technology. Also, the wide range of outcomes measured requires further work in the field to establish what a ‘good outcome’ from intervention may be.

Head-Up; An interdisciplinary, participatory and co-design process informing the development of a novel head and neck support for people living with progressive neck muscle weakness.

Abstract This paper presents the Head-Up project, that aims to provide innovative head support to help improve posture, relieve pain and aid communication for people living with progressive neck muscle weakness. The initial focus is motor neurone disease. The case study illustrates collaborative, interdisciplinary research and new product development underpinned by participatory design. The study was initiated by a 2-day stakeholder workshop followed by early proof-of-concept modelling and patient need evidence building. The work subsequently led to a successful NIHR i4i application funding a 24-month iterative design process, patenting, CE marking and clinical evaluation. The evaluation has informed amendments to the proposed design refered to here as the Sheffield Support Snood (SSS). The outcome positively demonstrates use and performance improvements over current neck orthoses and the process of multidisciplinary and user engagement has created a sense of ownership by MND participants, who have since acted as advocates for the product.

Perceptions of the design of voice output communication aids.

BACKGROUND Voice output communication aids (VOCAs) are a key form of aided communication within the field of augmentative and alternative communication (AAC). In recent years, rapid developments in technology have resulted in an explosion of devices available commercially, yet little research has been conducted into what people who use VOCAs think about them. AIMS The aim of this research was to explore the perceptions of communication aid design from the perspective of end users and AAC professionals, with the objective being to inform and influence the design of future devices. METHODS & PROCEDURES A two-part study was conducted: interviews were undertaken with people who use VOCAs, and questionnaires were distributed to those who use aided communication and to AAC professionals. Analysis of the interview data was carried out using a qualitative method based on framework analysis, whilst descriptive statistics were generated from the questionnaire data. Interview participants were an opportunity sample of VOCA users within a defined region of the UK. Those recruited were over the age of 12 years and able to engage in the interview process; they were identified through the caseloads of local Speech and Language Therapists specializing in AAC. The questionnaire was marketed to the AAC community throughout the UK. Respondents were self-selecting as those using aided communication, their carers and AAC professionals. OUTCOMES & RESULTS Eighteen people participated in the interviews. Questionnaires were completed by 43 people who use aided communication and 68 AAC professionals. The data suggest that current devices are considered to be neither reliable nor durable by users and professionals. Although features given a higher importance ranking are more likely to be perceived as available, a number of important design deficits are identified by users and/or professionals. Simplicity of design (and use) and the desire for devices which support communication that is as fast and spontaneous as possible also emerge as key requirements. Synthesis of the data produced a framework with three main themes covering the range of issues which influence the successful use of a VOCA: specific aspects of the design of a device; the consideration of the wider picture around the person; and the personal context in which someone uses their device. CONCLUSIONS & IMPLICATIONS Although the original aim of the project was to establish the user requirements of VOCA design, the data indicate that the characteristics of the device cannot be considered in isolation. Those factors uncovered highlight questions about whether the design of communication aids is truly effective in meeting the needs of the people who use them. Based on these data, an initial specification for future device design is proposed.

Evaluating a novel cervical orthosis, the Sheffield Support Snood, in patients with amyotrophic lateral sclerosis/motor neuron disease with neck weakness

Abstract Current practice and guidelines recommend the use of neck orthoses for people with amyotrophic lateral sclerosis (ALS) to compensate for neck weakness and to provide surrogate neck control. However, available options are frequently described by patients as restrictive and unsuitable and there was a need for a new device that addressed the needs of people with ALS. This project utilized a co-design process to develop a new neck orthosis that was more flexible yet supportive. Following development of a prototype device, a mixed methods cohort study was undertaken with patients and carers, in order to evaluate the new orthosis. Twenty-six patients were recruited to the study, with 20 of these completing all phases of data collection. Participants described the impact of neck weakness on their life and limitations of existing supports. Evaluation of the new orthosis identified key beneficial features: notably, increased support while providing a greater range of movement, flexibility of use, and improved appearance and comfort. In conclusion, the results of this evaluation highlight the value of this alternative option for people with ALS, and potentially other patient groups who require a neck orthosis.

User involvement in the early development of assistive technology devices

Objective. The importance of user involvement in design, development and diffusion of all devices is widely accepted; however, the methods of achieving true user contribution to a design or development process are challenging. The challenges are increased when the target consumers for the device have disabilities that can make traditional methods of gaining user involvement at best difficult, and at worst impossible. The objective of this paper is to evaluate the effectiveness of a number of user involvement techniques employed on projects carried out by the authors. Main Content. Devices for Dignity (D4D), is one of two pilot Healthcare Technology Cooperatives (HTCs) set up in January 2008. The principle for HTCs is to bring together health professionals, industry, academia and end users to create ‘technology pull’ and technology transfer into the National Health Service and as such, user involvement is a core element of D4Ds approach [1]. When embarking on a new project, D4D considers the most effective user involvement method and tailors the information gathering to the user population. Four delivery methods that have been used are discussed in this paper: Focus Groups; Online Surveys; Qualitative Interviews [2]; and Design Workshops [3, 4]. The approach taken to differentiate these common delivery methods to the needs of the HTC and to ensure that the methods used were appropriate for the intended participants will be discussed. The effectiveness of the methods in extracting appropriate data will also be evaluated. Results. The authors have successfully used the four delivery methodologies highlighted to: provide evidence for unmet needs; develop specifications for new devices; progress from specification to early design ideas; and evaluate early designs. Conclusion. User involvement in device design, development and diffusion is important; however, it requires careful consideration and differentiation of the appropriate methodology when working with potential consumers who have disabilities. The authors are formulating a strategy to ensure effective and timely user involvement in projects as this is key to ‘technology pull’ and technology transfer within a healthcare technology co-operative.

Ambiguous keyboards for AAC

Purpose – “Ambiguous keyboards” and “disambiguation processes” are becoming universally recognised through the popularisation of “predictive text messaging” on mobile phones. As this paper shows, although originating in the AT and AAC fields, these terms and techniques no longer appear to be widely understood or adopted by practitioners or users. The purpose of this paper is to introduce these techniques, discussing the research and theory around them, and to suggest them as AT and AAC strategies to be considered by practitioners and users.Design/methodology/approach – This is a conceptual paper that describes the use of ambiguous keyboards and disambiguation. The hypothesis of the paper is that ambiguous keyboards and disambiguation processes offer potential to increase the efficiency and effectiveness of AAC and should thus be considered further in research and practice.Findings – The two broad methods for removing the ambiguity from the output of an ambiguous keyboard are presented. A summary of the li...

Communication aid requirements of intensive care unit patients with transient speech loss.

Abstract Alert and transiently nonvocal intensive care unit (ICU) patients are dependent on augmentative and alternative communication (AAC). Unfortunately, the literature demonstrates that existent AAC devices have not been widely adopted, and unaided methods are often the primary modalities used despite being insufficient, and frustrating. We present the results of a qualitative semi-structured interview study with 8 ex-ICU patients, 4 ICU patient relatives, and 6 ICU staff, exploring their AAC needs and requirements. Participants identified important AAC hardware, software, and content requirements. Salient factors impacting on AAC adoption in the ICU setting were also highlighted and included the need for staff training and bedside patient assessment. Based on the study results, we propose a series of recommendations regarding the design and implementation of future AAC tools specifically targeted at this group.

Provision of powered communication aids in the United Kingdom

Abstract AAC service provision in the United Kingdom (UK) has evolved since the first service dedicated to the provision of communication aids opened in 1986. Within the UK, many health and care services are provided via government funding; however, the assessment and provision of AAC and specifically of speech-generating devices (SGDs) is inconsistent and inequitable. The study reported in this paper aimed to collect information on levels of current provision of powered communication aids (the term used in the study to refer to SGDs) by UK service providers in 2013 with the intention of improving future estimates for need of services. A questionnaire survey was designed and data were obtained from 98 AAC services across the UK. Service providers reported the number of individuals known to be using powered communication aids and the mean value reported was 0.0155% of the services’ catchment populations. However levels of service provision reported were highly variable. Although the data reported must be treated with caution, it adds to the sparse literature on the topic, informs AAC service design and delivery in the UK, and acts as an indicative baseline measure for future service development.

What is the potential for context aware communication aids

Abstract Use of voice output communication aids (VOCAs) can be a very effective strategy to assist people with speech impairments in communicating. Despite this, people who use communication aids often express frustration with VOCAs—desiring devices that are simpler, quicker and more effective to use. Whilst it is not possible to resolve all these issues with technology, it is argued that significant progress can be made. The use of contextual information is one development that could improve the simplicity and effectiveness of communication aid design. Improving the effectiveness of communication aids, including through the use of context support, is a goal of the NIHR Devices for Dignity Assistive Technology Theme. This discussion paper examines the potential for creating ‘context aware’ communication aids. Three projects in which the authors have been involved are described to illustrate different approaches to the use of contextual information.