Using AAC video visual scene displays to increase participation and communication within a volunteer activity for adolescents with complex communication needs

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Strategies for highlighting items within visual scene displays to support augmentative and alternative communication access for those with physical impairments

PURPOSE

In contrast to the traditional grid-based display, visual scene displays (VSDs) offer a new paradigm for aided communication. For individuals who cannot select items from an AAC display by direct selection due to physical impairments, AAC access can be supported via methods such as item scanning. Item scanning sequentially highlights items on a display until the individual signals for selection. How items are highlighted or scanned for AAC access can impact performance outcomes. Further, the effectiveness of a VSD interface may be enhanced through consultation with experts in visual communication. Therefore, to support AAC access for those with physical impairments, the aim of this study was to evaluate the perspectives of experts in visual communication regarding effective methods for highlighting VSD elements.

METHODS

Thirteen participants with expertise related to visual communication (e.g., photographers, artists) completed semi-structured interviews regarding techniques for item highlighting.

RESULTS

Study findings identified four main themes to inform how AAC items may be highlighted or scanned, including (1) use of contrast related to light and dark, (2) use of contrast as it relates to colour, (3) outline highlighting, and (4) use of scale and motion.

CONCLUSION

By identifying how compositional techniques can be utilized to highlight VSD elements, study findings may inform current practice for scanning-based AAC access, along with other selection techniques where feedback or highlighting is used (e.g., eye-gaze, brain-computer interface). Further, avenues for just-in-time programming are discussed to support effective implementation for those with physical impairments.IMPLICATIONS FOR REHABILITATIONFindings identify multiple potential techniques to improve scanning through items in a photograph for individuals with severe motor impairments using alternative access strategies.Study findings inform current practice for scanning-based AAC access, along with other selection techniques where feedback or highlighting is used (e.g., eye-gaze, brain-computer interface).Avenues for just in time programming of AAC displays are discussed to decrease programming demands and support effective implementation of study findings.

A scoping review of communication outcomes measures in augmentative and alternative communication

Although outcomes are a critical component of evidence-based practice, measuring augmentative and alternative communication (AAC) outcomes remains problematic. This is, in part, because there is no consensus on how to operationally define AAC communication outcomes. To gain greater insight into AAC communication outcomes, we used the communicative competence framework to determine which areas of AAC intervention have received the greatest attention and how these outcomes are being measured. The following data were charted from the 77 studies that met the inclusion criteria for the scoping review: study design, study participants, study communication target (e.g., language, word learning, etc.), and communication outcome measurements. Across the included studies, researchers used a variety of standardized and non-standardized measures to assess outcomes. Seventy-seven percent of the studies assessed social skills and 62% assessed linguistic skills. A limited number of studies measured operational (14%), strategic (4%), and psychosocial (18%) skills. Using the communicative competence framework enabled us to identify gaps in the research that has been conducted to date.

Effect of Low-Tech Augmentative and Alternative Communication Intervention on Intentional Triadic Gaze as Alternative Access by School-Age Children With Multiple Disabilities

PURPOSE

Students with multiple disabilities who are beginning communicators require augmentative and alternative communication (AAC) to communicate during school and participate in its academic and social aspects. Triadic gaze is a method for accessing low-tech AAC that minimizes physical demands on access for students with limited mobility, such as students with multiple disabilities. Thus, this study evaluated an instructional protocol for teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities.

METHOD

Three students with multiple disabilities who were beginning communicators participated in a multiple baseline across participants design with three phases: baseline, treatment, and generalization and maintenance. Participants engaged in instruction around using triadic gaze to communicate by making selections on an eye gaze board.

RESULTS

Visual analysis showed that all three participants acquired the use of triadic gaze as a method of accessing low-tech AAC in response to instruction. Effect size estimations suggested instruction was effective. The participants also demonstrated that the newly acquired skill generalized to interactions with familiar communication partners after instruction ended.

CONCLUSIONS

These findings show that instruction can be effective in teaching triadic gaze as a low-tech AAC access method for students with multiple disabilities. Future research should explore the effects of using this access method on communicating across school contexts.

Integrating familiar listeners and speech recognition technologies into augmentative and alternative communication intervention for adults with down syndrome: Descriptive exploration

Many individuals with Down syndrome exhibit speech impairments that necessitate augmentative and alternative communication (AAC) intervention. AAC intervention allows for access to communication through means other than, or supplemental to, speech. This descriptive study provided initial insight into the feasibility of incorporating familiar listeners (e.g., family members) and speech recognition technology into AAC intervention to increase communication success for individuals with Down syndrome. Six adults with Down syndrome participated. The participants' intelligibility to a familiar listener, unfamiliar listeners, and speech recognition technologies (i.e., Google Speech-to-Text and Windows Speech Recognition) was evaluated. Additionally, consistency in word pronunciation was evaluated to examine the feasibility of future training of speech recognition technologies. The participating adults with Down syndrome experienced limited intelligibility to all listeners and technologies but were most intelligible to familiar listeners. The adults also demonstrated consistencies across their production of words, and across one another's productions. The findings suggest the promise in using familiar listeners as a current resource and speech recognition technology as a future resource in AAC intervention for adults with Down syndrome. However, intervention research and technological development are needed to thoroughly explore these approaches.

Impact of Assistive Technologies to Inclusive Education and Independent Life of Down Syndrome Persons: A Systematic Literature Review and Research Agenda

Since the beginning of the 21st century, the lifespan of people born with Down syndrome (DS) has increased. They now outlive their parents and rely on their relatives who usually sacrifice their own families to care for their disabled siblings. To reduce the pressure on families and the wider community, it is crucial to prepare DS people for independent life from early childhood. Emerging technologies can significantly support the process of acquiring the skills that are necessary for solving real-life problems at home and work. To assess their impact and estimate how much they are implemented in inclusive education, a review of 564 papers published after 2015 was done using the PRISMA review model. After gradual exclusion, 24 papers were used for the final review. Thematic analysis resulted in four themes with one common concept: variety. The results of examining the four research questions defined in the paper’s background confirm that the synergy of emerging assistive technologies and inclusive education has the potential of becoming a very effective strategy for creating an independent life for DS individuals. Many questions remain open, mainly related to a DS persons’ specific needs and capabilities. The acceptance of the proposed synergy will depend on them.

"Two Friends Spending Time Together": The Impact of Video Visual Scene Displays on Peer Social Interaction for Adolescents With Autism Spectrum Disorder

Purpose Social interaction poses many challenges for adolescents with autism spectrum disorder (ASD) and complex communication needs. The purpose of this study was to investigate the impact of video visual scene displays (video VSDs) on communication during interactions between adolescents with ASD and peer partners. Method This study used an across-participant multiple-baseline single-case experimental design. Four adolescents with ASD and complex communication needs were taught to use video VSDs, presented on a tablet-based app, during social interactions with peer partners in a high school setting. The video VSDs used during the interactions were selected (and programmed with vocabulary) based on the interests of the adolescent with ASD and their peer partner. Results Following the introduction of the video VSD intervention, all four adolescents with ASD demonstrated an increase in communicative turns compared to baseline (Tau-U= 1.0, 95% CI [0.56, 1]), and all four increased in modes of communication used. Increased use of speech also was observed for the three participants who made use of speech prior to the intervention. All participants with ASD (and their peer partners) expressed an interest in continued use of the video VSD app to support social interaction. Conclusion The use of video VSDs may be a viable option to increase the participation and communication of adolescents with ASD during social interactions with peer partners. Supplemental Material https://doi.org/10.23641/asha.16734532.

What's in a Photograph? The Perspectives of Composition Experts on Factors Impacting Visual Scene Display Complexity for Augmentative and Alternative Communication and Strategies for Improving Visual Communication

Purpose Visual scene displays (VSDs) can support augmentative and alternative communication (AAC) success for children and adults with complex communication needs. Static VSDs incorporate contextual photographs that include meaningful events, places, and people. Although the processing of VSDs has been studied, their power as a medium to effectively convey meaning may benefit from the perspective of individuals who regularly engage in visual storytelling. The aim of this study was to evaluate the perspectives of individuals with expertise in photographic and/or artistic composition regarding factors contributing to VSD complexity and how to limit the time and effort required to apply principles of photographic composition. Method Semistructured interviews were completed with 13 participants with expertise in photographic and/or artistic composition. Results Four main themes were noted, including (a) factors increasing photographic image complexity and decreasing cohesion, (b) how complexity impacts the viewer, (c) composition strategies to decrease photographic image complexity and increase cohesion, and (d) strategies to support the quick application of composition strategies in a just-in-time setting. Findings both support and extend existing research regarding best practice for VSD design. Conclusions Findings provide an initial framework for understanding photographic image complexity and how it differs from drawn AAC symbols. Furthermore, findings outline a toolbox of composition principles that may help limit VSD complexity, along with providing recommendations for AAC development to support the quick application of compositional principles to limit burdens associated with capturing photographic images. Supplemental Material https://doi.org/10.23641/asha.15032700.

Effectiveness and Utility of Visual Scene Displays as Communication Supports for Adults and Children With Complex Communication Needs: Perspectives of Clinicians and Researchers

Purpose The aims of this research study were to describe the perspectives of clinicians and researchers regarding the effectiveness of visual scene displays (VSDs) as communication supports in order to inform the translation of research to clinical practice. Method An online survey was completed by 298 clinicians and nine VSD researchers. Participants rated the effectiveness of VSDs in supporting a variety of communication functions and their strength of agreement regarding statements of VSD utility. Results Regardless of population served, clinicians and researchers rated VSDs as effective at supporting a range of communication functions. Participants also tended to agree with statements of VSD utility. Conclusions The current study highlights the perceptions of clinicians and researchers regarding the uses and benefits of VSDs for adults and children with complex communication needs and provides an initial measure of the current translation of research to clinical practice. Results indicate that VSDs can be used to support a variety of communication functions and utilities; however, further work is necessary to explore additional communication functions and delineate similarities and differences of VSD uses for differing populations. Supplemental Material https://doi.org/10.23641/asha.14551344.

Personalized AAC Intervention to Increase Participation and Communication for a Young Adult with Down Syndrome

Many adults with Down syndrome (DS) experience difficulty with speech production, and intelligibility challenges and communication breakdowns are common. Augmentative and alternative communication (AAC) intervention can provide important supports for persons with these complex communication needs, but must be customized to address the goals, strengths, and needs of the individual. This article provides a description of a personalized AAC intervention for a young adult with DS whose speech was frequently unintelligible. The AAC intervention made use of a video visual scene display (VSD) approach, and was investigated in two separate studies in two key community settings: An inclusive post-secondary education program (a single-case reversal ABAB design), and a community shopping activity (a non-experimental AB case study design). The participant demonstrated sharp increases in successful communication and participation in both settings following the introduction of the video VSD, and both the participant and key stakeholders viewed the intervention positively. The results provide preliminary evidence that personalized AAC intervention, including the use of a video VSD approach, can provide important supports for communication and participation in community settings for adults with DS and complex communication needs.