Searching for evidence in augmentative and alternative communication: Navigating a scattered literature

Exploring augmentative & alternative communication assessment practices for children with limited functional speech & motor skills: a scoping review utilizing the Participation Model of AAC

Purpose: Children with limited speech and motor function, frequently subsequent to neurodevelopmental conditions, often require augmentative and alternative communication (AAC). Assessment practices to inform effective AAC interventions for these children can be challenging because of the considerable heterogeneity and range of factors that require consideration. An improved understanding of current assessment practices is imperative to optimize the provision of AAC.

Materials and Methods: We conducted a scoping review to identify the assessment practices used with children with limited speech and motor function subsequent to neurodevelopmental conditions (birth to 18 years) within the Participation Model of AAC.

Results: In total, 171 assessment practices were identified. Almost all were related to access supports and barriers, of which the majority focused on children's capabilities. Relatively few methods were identified to support the assessment of children's participation patterns and communication needs or opportunity supports and barriers. Twenty-three percent of identified formal assessment practices required modifications to established procedures, and 10% could not be completed by all child participants.

Conclusion: Identified assessment practices focused primarily on children and their abilities, whereas very few focused on external factors (e.g., environmental and opportunity supports and barriers). Additionally, identified assessment practices may inaccurately measure the abilities of children with limited speech and motor function, as the procedures often required modification.

IMPLICATIONS FOR REHABILITATIONWithout adequate practices to assess all areas of the Participation Model, clinicians may have difficulty providing comprehensive AAC servicesFuture research should focus on developing practices to assess children's opportunity and environmental supports and barriersThere is a need for practices that are more accessible to children with limited speech and motor function.

In dialogue with the body: a phenomenological exploration of the interrelationship between people who use AAC and their AAC devices

This paper explores the intricate relationship between people who use Augmentative and Alternative Communication (AAC) and their AAC devices. Drawing upon insights from phenomenology, I conducted a modified systematic review to explore the enduring phenomenon of low AAC device adoption and as a means to unravel the moments of embodiment and disembodiment experienced by people who use AAC with their devices. The discussion begins with an introduction to phenomenology as a philosophical inquiry and the guiding principles I employed to explore the phenomenon, namely, parte extra parte and object embodiment. Subsequently, I analyze the hegemony of a device-centric approach within the AAC landscape and delve into the first-person experiences of people who use AAC in living with their devices. Lastly, I discuss the embodiment and disembodiment of people who use AAC with their devices, conceptualize the interrelationship between them, and provide future directions for a more holistic and participatory AAC development and investigation that centers on the lived experiences of people who use AAC.

Intelligent assistive technology devices for persons with dementia: A scoping review

Assistive technology (AT) with context-aware computing and artificial intelligence capabilities can be applied to address cognitive and communication impairments experienced by persons with dementia (PwD). This paper aims to provide an overview of current literature regarding some characteristics of intelligent assistive technology devices (IATDs) for cognitive and communicative impairments of PwD. It also aims to identify the areas of impairment addressed by these IATDs.A multi-faceted systematic search strategy yielded records. Predefined criteria were applied for inclusion and data extraction. Thereafter data was thematically analysed and synthesised. This review demonstrates that almost all of the research involving IATDs has focused on cognitive impairments of PwD and has not yet evolved past the conceptual or prototype stages of development. Summaries of commercially available IATDs for PwD and relevant prototypes are provided at the end of this review.This research concluded that IATDs for PwD targeting cognition and communication problems primarily focus on social robots, and that they address cognitive impairments of attention, affect, and social-pragmatic communicative impairments. Future research endeavours concerning AT for PwD should explore collaboration between computer engineering and health practitioners to address the identified gaps. This may contribute to the available information for evidence-based decision making for PwD.

The application of the family of participation-related constructs (fPRC) framework to AAC intervention outcomes in children with complex communication needs: a scoping review

Participation is a fundamental human right, and being able to communicate is an essential component of participation in various life situations, such as at school, with peers, and in the community. Augmentative and alternative communication (AAC) interventions aim to facilitate communication and social interaction, independence, and participation in all aspects of life. The purpose of this study was to summarize and map the AAC intervention outcomes for children with complex communication needs onto the Family of Participation-Related Constructs (fPRC) framework. The scoping review identified 270 studies for inclusion, and the data gathered was extracted and mapped onto the fPRC framework. The results indicate that although many studies have reported on participation-related constructs such as activity competence and context, there is still insufficient focus on attendance and involvement, sense of self, and environment constructs. Hence, future research in the field of AAC is needed on the various constructs of participation proposed by the fPRC framework.

Effects of Interventions Involving Speech Output Technologies on Communication Outcomes for Individuals With Developmental Disabilities: A Scoping Review

PURPOSE

This scoping review aimed to map the literature on the effects of interventions involving speech output technologies on communication outcomes for individuals with developmental disabilities other than autism spectrum disorder.

METHOD

A scoping review methodology was used to limit bias in searching, selecting, coding, and synthesizing relevant intervention studies. This involved a multifaceted search for studies conducted between 1991 and March 2021 using various electronic databases, ancestry searches, and forward citation searches from selected articles. Studies had to meet stringent inclusion criteria. Each study was summarized in terms of authors, purpose, participants, design, speech output, outcomes, effectiveness, and quality appraisal.

RESULTS

Twenty-five single-case experimental design studies (88 participants) and one group design studies (62 participants) qualified for inclusion. Most of the participants had multiple diagnoses followed by a diagnosis of cerebral palsy and Down syndrome. Most studies focused on requesting behaviors and to a much lesser extent on syntactic structure and word identification. A dearth of high-quality studies was identified.

CONCLUSIONS

Overall, there is a paucity of high-quality research investigating the effects of speech output technologies for children with developmental disabilities. Additionally, several directions for future research are posited.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20468928.

The effects of COVID-19 on the rehabilitation of persons with aphasia: A scoping review

BACKGROUND

 The impact of the Coronavirus disease 2019 (COVID-19) pandemic was more pronounced on the well-being of persons with disabilities, especially in low- and middle-income countries. There is documented evidence of the rippling effects of COVID-19 on persons with disabilities. However, not much is known about the impact of COVID-19 on the rehabilitation of persons with aphasia.

OBJECTIVE

 The scoping review explores how COVID-19 affected the rehabilitation of persons living with aphasia.

METHOD

 A scoping review was conducted using Arksey and O'Malley's framework. A search was conducted on Science Direct, PubMed, Medline, Scopus, ProQuest and Google Scholar, to identify relevant studies published between 2019 and 2022. Data were analysed using thematic analysis.

RESULTS

 Most studies regarding the effects of COVID-19 on persons living with aphasia were conducted in the United Kingdom. Five themes emerged from the data, namely, (1) negative impact on rehabilitative care, (2) telehealth and its limitations, (3) impact on social participation, (4) compromised caregiver involvement and (5) mental health challenges.

CONCLUSIONS

 Findings highlight the need for healthcare professionals to pursue innovative ways in which aphasia rehabilitation and conversational support programmes can be made accessible to persons with aphasia, despite the limitations brought about by a pandemic. Telerehabilitation programmes need to be tailored to the needs of persons with aphasia if they are to be successful. This study highlights the importance and need for the prioritisation of mental health services for persons with aphasia and their caregivers during a pandemic.

The effects of augmentative and alternative communication interventions on the receptive language skills of children with developmental disabilities: A scoping review

PURPOSE

To map and synthesise research evidence of the effects that aided and unaided AAC interventions have on the receptive language of children with developmental disabilities.

METHOD

This scoping review used a four-pronged search strategy (electronic databases, dissertations and theses, hand search, ancestry searches) to identify germane studies. A total of 16 studies met the inclusion criteria. These studies were described in terms of the number of participants, participant characteristics, research design, AAC interventions, intervention outcomes, intervention effects, and quality appraisal.

RESULT

The review revealed positive associations between aided and unaided AAC, vocabulary acquisition and symbol comprehension.

CONCLUSION

AAC interventions may have merit for the development of receptive language skills in children with developmental disabilities. Specific gaps in relation to unaided AAC, aided augmented input strategies, morphological and syntax development, and discourse comprehension are highlighted.

The decision-making process in recommending electronic communication aids for children and young people who are non-speaking: the I-ASC mixed-methods study

Background

This project [Identifying Appropriate Symbol Communication (I-ASC)] explored UK decision-making practices related to communication aid recommendations for children and young people who are non-speaking. Research evidence related to communication aid decision-making is limited. The research aims were to increase understanding of influencers on the decision-making process in recommending electronic communication aids, and to develop guidance tools to support decision-making. An additional, post hoc aim was to evaluate the public involvement contribution to the I-ASC project. The research focused on the identification of attributes and characteristics that professionals, family members and those who use communication aids considered important in the recommendation process. Findings informed the development of guidance resources. The evaluation of public involvement focused on what could be learned from a nationally funded project with involvement from public contributors typically regarded as hard to include.

Methodology

For the clinical decision-making component, the methodological investigation adopted a three-tier approach with three systematic reviews, a qualitative exploration of stakeholder perspectives through focus groups and interviews, and a quantitative investigation surveying professionals’ perspectives. The public involvement evaluation adopted a mixed-methods approach. A total of 354 participants contributed to the decision-making data set, including professionals, family members, and children, young people and adults who use communication aids; 22 participants contributed to the public involvement evaluation. The literature review process followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thematic analysis and framework approach supported the analysis of qualitative data. Two stated preference surveys, a best–worst scaling and a discrete choice experiment, allowed the relative importance of factors in decision-making to be determined. Analysis was grounded in random utility theory.

Public involvement

Two public involvement co-researchers, an adult using a symbol communication aid and a parent of a communication aid user, were core members of the research team. The I-ASC public involvement resulted in an additional award to evaluate the impact of public involvement across the project.

Results

Factors influencing decision-making are not always under the control of the decision-makers, for example professional knowledge, referral criteria and service structure. Findings suggest that real clinical decisions contrast with hypothetical decisions. Survey responses indicated that children’s physical characteristics are less important than their language, communication and learning abilities; however, during real-time decision-making, the opposite appeared to be true, with access needs featuring most prominently. In contrast to professionals’ decisions, users and family members prioritise differing aesthetic attributes of communication aids. Time allocated to system learning remains underspecified. The research informed the development of decision-making guidance tools (https://iasc.mmu.ac.uk/; accessed 8 June 2020). A public involvement evaluation suggests that successful public involvement of individuals with disabilities requires significant resources that include staff time, training and personal support (https://iasc.mmu.ac.uk/publicinvolvement; accessed 8 June 2020).

Future work

Further research is needed in the areas of language assessment, communication aid attributes, types of decision-making episodes and service user perspectives. These data highlight the need for mechanisms that enable public involvement co-researchers to be paid for their contributions to research bid preparation.

Limitations

Individuals who benefit from communication aids are a heterogeneous group. We cannot guarantee that this study has captured all relevant components of decision-making.

Funding

This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 45. See the NIHR Journals Library website for further project information.

Understanding and Appraising Systematic Reviews and Meta-Analysis

Systematic reviews and meta-analysis seek to answer a pre-framed research question to lead to a valid answer through a systematic, explicit and reproducible method of locating; identifying, including and appraising appropriate trials. The results are synthesized considering the methodological rigor of included trials. While the meta-analysis quantitatively pools the results from individual included studies, the systematic review summarizes the findings as qualitative conclusions. These reviews are crux of evidence based dentistry for various stake-holders, i.e., clinicians, researchers and policy-makers. Although the meticulous methodology of systematic review and meta-analysis minimizes the elements of bias, yet the validity and reliability of their findings should be explored prior to translating their conclusions to practice. The goal of this paper is to familiarize readers with rationale, conduct and appraisal of systematic review and meta-analysis. Further, guidance is provided on tracing potential elements of bias in the review to enable readers to judge the quality of evidence generated from the review.

Text entry rate of access interfaces used by people with physical disabilities: A systematic review

This study systematically reviewed the research on assistive technology (AT) access interfaces used for text entry, and conducted a quantitative synthesis of text entry rates (TER) associated with common interfaces. We searched 10 databases and included studies in which: typing speed was reported in words per minute (WPM) or equivalent; the access interface was available for public use; and individuals with physical impairments were in the study population. For quantitative synthesis, we used only the TER reported for individuals with physical impairments. Studies also had to report the sample size, and the average and standard deviation for the TER data. Thirty-nine studies met the criteria for quantitative synthesis. Studies involved seven interface types: standard keyboard typing, on-screen keyboard (OSK) with cursor selection, OSK with scanning selection, automatic speech recognition (ASR), Morse code, brain-computer interface (BCI), and other. ASR, standard keyboard, cursor OSK, and scanning OSK had at least four studies and 30 subjects, with TER averaging 15.4, 12.5, 4.2, and 1.7 WPM, respectively. When combined with measurements of a particular client's text entry performance, the TER from this review can be used within an evidence-based decision-making process for selecting control interfaces.

Facilitated communication and authorship: a systematic review

Facilitated Communication (FC) is a technique whereby individuals with disabilities and communication impairments allegedly select letters by typing on a keyboard while receiving physical support, emotional encouragement, and other communication supports from facilitators. The validity of FC stands or falls on the question of who is authoring the typed messages--the individual with a disability or the facilitator. The International Society for Augmentative and Alternative Communication (ISAAC) formed an Ad Hoc Committee on FC and charged this committee to synthesize the evidence base related to this question in order to develop a position statement. The purpose of this paper is to report this synthesis of the extant peer-reviewed literature on the question of authorship in FC. A multi-faceted search was conducted including electronic database searches, ancestry searches, and contacting selected authors. The authors considered synopses of systematic reviews, and systematic reviews, which were supplemented with individual studies not included in any prior reviews. Additionally, documents submitted by the membership were screened for inclusion. The evidence was classified into articles that provided (a) quantitative experimental data related to the authorship of messages, (b) quantitative descriptive data on the output generated through FC without testing of authorship, (c) qualitative descriptive data on the output generated via FC without testing of authorship, and (d) anecdotal reports in which writers shared their perspectives on FC. Only documents with quantitative experimental data were analyzed for authorship. Results indicated unequivocal evidence for facilitator control: messages generated through FC are authored by the facilitators rather than the individuals with disabilities. Hence, FC is a technique that has no validity.

'Communicative competence' in the field of augmentative and alternative communication: a review and critique

BACKGROUND

Understandings of 'communicative competency' (CC) have an important influence on the ways that researchers and practitioners in augmentative and alternative communication (AAC) work toward achieving positive outcomes with AAC users. Yet, very little literature has critically examined conceptualizations of CC in AAC. Following an overview of the emergence of the concept of CC and of the field of AAC, we review seven conceptualizations of CC identified in the literature.

AIMS

To consider the contributions and potential shortcomings of conceptualizations of CC in AAC.

METHODS & PROCEDURES

We use a critical theoretical approach to review, critique and synthesize conceptualizations of CC in AAC, with a particular focus on uncovering 'taken for granted' assumptions. By historically situating the reviewed literature, we examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC and their potential impacts on practice.

MAIN CONTRIBUTIONS

We suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC might shift ways of thinking about CC in AAC which tend to focus on the individual who communicates differently, toward (re)location of CC as a shared, socially incorporated and performed communication construct.

CONCLUSION & IMPLICATIONS

We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC.

Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review

PURPOSE

This systematic review aimed to determine the effects of augmentative and alternative communication (AAC) intervention on speech production in children with autism or pervasive developmental disorder-not otherwise specified.

METHOD

A systematic review methodology was utilized to limit bias in searching, selecting, coding, and synthesizing relevant treatment studies. This involved a multifaceted search for studies written between 1975 and May 2007 using various bibliographic databases, dissertation databases, hand searches of selected journals and published compilations of AAC theses and dissertations, and ancestry searches. To be included, studies had to meet stringent criteria. A coding manual and form facilitated data extraction in terms of participant characteristics, treatment characteristics, design and measurement, and outcomes.

RESULTS

Nine single-subject experimental design (27 participants) and 2 group studies (98 participants) were included. Results indicated that AAC interventions do not impede speech production. In fact, most studies reported an increase in speech production. However, in-depth analyses revealed that the gains were rather modest.

CONCLUSIONS

Although AAC interventions do not appear to impede speech production and may result in increased speech production, the modest gains observed require realistic expectations among clinicians and other stakeholders. Future research should be more hypothesis driven and aim to identify predictive child characteristics, such as prior speech imitation and object exploration skills.

Asking well-built questions for evidence-based practice in augmentative and alternative communication

Evidence-based practice (EBP) is increasingly being advocated as the preferred approach to practice in augmentative and alternative communication (AAC). The EBP process involves multiple steps. The asking of a well-built question is the first step in the quest for answers. At the same time it is also often the first stumbling block for practitioners. To facilitate the asking of well-built questions it may be helpful to follow a template. The most frequently used template is PICO, which stands for patient, intervention, comparison, and outcome [Richardson, W., Wilson, M., Nishikawa, J., & Hayward, R. (1995). The well-built clinical question: A key to evidence-based decisions. ACP Journal Club, 123, A12-A13]. In this article, we examine the suitability of the PICO template for AAC in terms of the representativeness of the components, and the appropriateness of its subcomponents, and their terminology. Based on this analysis, we propose the PESICO template, which stands for person, environments, stakeholders, intervention, comparison, and outcome. This template is then illustrated with examples representing a range of decision-making areas in AAC. Finally, directions for future research are provided.

LEARNING OUTCOMES

The reader will be able to: (1) appreciate the importance of asking well-built questions, (2) name the shortcomings of the PICO template, and (3) describe the components of the proposed PESICO template for asking well-built questions.

The state of research and practice in augmentative and alternative communication for children with developmental/intellectual disabilities

Augmentative and alternative communication is a compilation of methods and technology designed to supplement spoken communication for people with limited speech or language skills, including children with developmental and intellectual disabilities. The field of AAC has evolved rapidly within the last 10 years, due to a combination of empirical advances from research as well as rapid changes in technology. This article reviews some of the most significant aspects of this growth as it relates to children with developmental disabilities. Major issues within the field, the evidence base available to practitioners and researchers, and promising areas of future growth are identified.

Use of information-seeking strategies for developing systematic reviews and engaging in evidence-based practice: the application of traditional and comprehensive Pearl Growing. A review

BACKGROUND

Efficient library searches for research evidence are critical to practitioners who wish to engage in evidence-based practice (EBP) as well as researchers who seek to develop systematic reviews.

AIMS

This review will propose the benefits of the search technique 'Pearl Growing' ('Traditional Pearl Growing') as well as an adaptation of this technique ('Comprehensive Pearl Growing'), until now ignored by the literature on EBP and systematic reviews, to aid in the retrieval of research evidence. These search techniques are illustrated with examples from the field of augmentative and alternative communication.

MAIN CONTRIBUTIONS

Traditional Pearl Growing is proposed as an important addition to the arsenal of EBP search strategies for practitioners. The literature on Traditional Pearl Growing is extended in that EBP presents a newly identified purpose for this technique and the benefits in identifying appropriate quality filter goes beyond its previously exclusive focus on keywords. Comprehensive Pearl Growing is projected as a new strategy for researchers searching for studies to be included in systematic reviews. Not only does it provide data-based guidance in selecting effective keywords and quality filters, but also it provides appropriate databases.

CONCLUSIONS

Although the techniques Traditional Pearl Growing and Comprehensive Pearl Growing are believed to be useful for locating research evidence in any field, it may be particularly important for interdisciplinary topics where the use of effective controlled vocabulary plays a greater role in bringing together evidence that may be scattered across databases.