Susan Fager

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.

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.

Access Interface Strategies

ABSTRACT Individuals who rely on augmentative and alternative communication (AAC) devices to support their communication often have physical movement challenges that require alternative methods of access. Technology that supports access, particularly for those with the most severe movement deficits, have expanded substantially over the years. The purposes of this article are to review the state of the science of access technologies that interface with augmentative and alternative communication devices and to propose a future research and development agenda that will enhance access options for people with limited movement capability due to developmental and acquired conditions.

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.

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.

Augmentative and Alternative Communication for People with Progressive Neuromuscular Disease

Individuals with progressive neuromuscular disease often experience complex communication needs and consequently find that interaction using their natural speech may not sufficiently meet their daily needs. Increasingly, assistive technology advances provide accommodations for and/or access to communication. Assistive technology related to communication is referred to as augmentative and alternative communication (AAC). The nature of communication challenges in progressive neuromuscular diseases can be as varied as the AAC options currently available. AAC systems continue to be designed and implemented to provide targeted assistance based on an individuals changing needs.

AAC Technology Learning Part 3: Regular AAC Team Members

The specific purposes of this article were (a) to study the computer technology interest levels, achievement goal orientation, self-efficacy, and learning mode preferences regarding AAC technology in AAC team members; and (b) to study the relationships among these variables to understand factors related to, and predictive of, learning mode preference. The companion articles focused on AAC intervention specialists and on pre-professional students. AAC team members reported relatively low interest in computer technology per se. They reported high mastery achievement goal orientation with a somewhat lower performance orientation and a relatively low social orientation. As a group the AAC specialists and regular AAC team members who participated in this investigation did not report strong learning mode patterns. However, the correlation analysis revealed some interesting trends. Self-efficacy was highly correlated with technology learning mode preference. Those with relatively high self-efficacy preferred to learn technology alone and did not prefer direct, step-by-step instruction. Those with relatively low self-efficacy preferred learning via step-by-step instruction over learning alone.

Communication Supports for People with Motor Speech Disorders.

Communication supports for people with motor speech disorders can include strategies and technologies to supplement natural speech efforts, resolve communication breakdowns, and replace natural speech when necessary to enhance participation in all communicative contexts. This article emphasizes communication supports that can enhance participation, as described in the World Health Organizations International Classification of Functioning, Disability and Health. The article begins with a discussion of partner and patient-reported assessments to evaluate participation levels and barriers to participation. Then, it provides an overview of communication supports for speakers with motor speech disorders, organized by the status of the disorder as stable, improving, or degenerative. The article includes nine case examples to illustrate principles and provide examples of how to address stable and changing needs.

Representation of Potential Communication Items in Medical Settings: An Intervention Note

Current augmentative and alternative communication (AAC) devices require individuals in medical settings to spell, locate symbols or phrases, or use non-verbal communication to express health and personal information to family and medical staff. The purpose of this initial investigation was to examine the type (personal, family, staff, procedural, or health status), form or representation and frequency of items that could be used to represent communication content for people in inpatient rehabilitation settings. Results revealed that potential communication items within the personal or procedural categories were consistently represented in participants’ rooms. Information related to medical staff was the least consistently represented and appeared to change frequently. The use of items to support the communication of patients with unmet communication needs is discussed.