Communication support through multimodal supplementation: a scoping review

The confidence and competence of speech language pathologists in augmentative and alternative communication: a scoping review

Augmentative and alternative communication (AAC) is a core component of speech pathology practice. However, international literature has highlighted that speech language pathologists (SLPs) may not feel confident or competent in this area. Confidence and competence are critical factors in therapy as they can impact the quality-of-service provision. The purpose of this scoping review was to investigate the confidence/competence of SLPs in AAC. A systematic scoping search was conducted using four databases to identify relevant literature. The first two authors reviewed 30% of abstracts and the remaining 70% were reviewed by the first author. Full-text screening applied the same review approach. Data was then extracted and organized according to the research questions. Thirteen studies were included in the review. All thirteen used self-assessment to measure confidence or competence with one study also using an objective evaluation. Overall, confidence and competence levels varied based on the specific clinical task and etiology of the client in addition to being influenced by prior training, clinician age, workplace and AAC caseload. While current research provides a snapshot of the SLP workforce, it is limited in that the research predominantly uses self-assessment measures, is cross-sectional and is quantitative in nature. Further research into the confidence and competence of SLPs in AAC is required, specifically how confidence and competence can be defined and developed.

A scoping review of Augmentative and Alternative Communication (AAC) interventions in Low-and Middle-Income Countries (LMICs)

Currently, a small number of studies discuss augmentative and alternative (AAC) interventions in low- and middle-income countries (LMICs). The primary purpose of this scoping review was to summarize the current evidence base on communication-based interventions and partner training in LMICs, to explore and identify gaps in the AAC evidence base and guide future research. A total of 18 studies were identified. The results revealed many positive outcomes arising from AAC interventions, including increased communication, improved participation, increased knowledge about communication, and increased use of partner communication strategies, thus adding to the evidence base that AAC can be successfully implemented in LMICs. However, these studies did not broadly represent most LMICs and there were only a handful of indirect intervention studies training communication partners. To this end, there is an urgent need to expand the level of AAC intervention research conducted in LMICs in order to better serve individuals with complex communication needs living in these countries.

A systematic review of group intervention for acquired dysarthria in adults

PURPOSE

This review aimed to evaluate the evidence for group therapy in improving speech production in adults with acquired dysarthria. Secondary outcomes included communication effectiveness and/or wellbeing.

MATERIALS AND METHODS

A review protocol was prospectively published on PROSPERO. Fourteen electronic databases were searched to identify experimental studies investigating adults with acquired dysarthria participating in group intervention with outcomes related to communication and/or wellbeing. The quality of included studies was assessed using the Mixed Methods Appraisal Tool (MMAT) or the McMaster University's Critical Review Form, and the TIDieR template for intervention description and replication.

RESULTS

21 studies were identified involving 330 individuals with dysarthria, from mostly Parkinson's disease (PD) (97%; n = 321). Treatment approaches included singing therapy (n = 10), loudness therapy (n = 5) and multi-components therapy (including a combination of impairment and/or compensatory approaches) (n = 4). Studies varied in intensity and outcome measures used. Statistically significant improvements to speech production and/or wellbeing were reported following most approaches.

CONCLUSION

There is some preliminary moderate-quality evidence to suggest that group therapy may improve speech production and in some cases communication effectiveness or wellbeing in people with dysarthria following PD, with more consistent improvements being found for loudness approaches. Singing approaches were frequently studied in PD with some improvements to intelligibility evident. Further well-designed controlled studies including individuals with non-progressive aetiologies is warranted to establish the effectiveness of group treatment.IMPLICATIONS FOR REHABILITATIONGroup therapy may be an effective means of improving speech production and/or wellbeing in individuals with dysarthria following Parkinson's disease.Studies' employing loudness-based group therapy for PD demonstrated more consistent improvements to intensity measures.Some controlled studies utilising singing group therapy resulted in improved intelligibility in PD.PROSPERO registration number: CRD42015029374.

Effect of online instruction on volunteers who support people with complex communication needs in active recreation

This study was conducted to teach and evaluate the effectiveness of an online training called The CAPTURE & Share program. The program was taught using online instruction in an asynchronous manner with six volunteers who facilitate recreational participation for individuals with complex communication needs. The online training focused on teaching volunteers how to support opportunities for individuals to capture photos and videos from recreation and then share them across their social networks. The first aim of the study was to teach the volunteers about implementation and use of the 8-step CAPTURE & Share program while the second aim was to evaluate the programs' overall effectiveness. Two multiple baselines designs across three participants each were used to evaluate the volunteers' written responses to probes delivered during baseline, intervention, maintenance, and generalization phases. Additionally, social validation data were collected. Results indicated that volunteers were not only successful in learning the program, but were also highly satisfied with the online training methods. Implications for using online instruction are discussed for speech-language pathologists, caregivers, individuals with complex communication needs, and recreational professionals.

ALS: Management Problems

Amyotrophic lateral sclerosis (ALS) is a fatal disease with no cure; however, symptomatic management has an impact on quality of life and survival. Symptom management is best performed in a multidisciplinary care setting, where patients are evaluated by multiple health care professionals. Respiratory failure is a significant cause of morbidity and mortality in patients with ALS. Early initiation of noninvasive ventilation can prolong survival, and adequate use of airway clearance techniques can prevent respiratory infections. Preventing and treating weight loss caused by dysphagia may slow down disease progression, and expert management of spasticity from upper motor neuron dysfunction enhances patient well-being.

Telling tales: unlocking the potential of AAC technologies

Augmentative and alternative communication (AAC) has been transformed by the social media revolution made possible by the emergence of mobile technology. The cumbersome dedicated devices of the 1970s have evolved into a burgeoning AAC app industry. However, the limited use and abandonment of AAC technologies remains high. Unlocking the untapped potential of technology requires a paradigm shift in the design of AAC technologies by building systems that minimize the cognitive load placed on users, adapting to their individual physical and language needs. Telling Tales shares insights and stories of how the combination of user-centred design, interdisciplinary research and the application of intelligent computing is providing a vision of future generations of AAC technologies.

New and emerging access technologies for adults with complex communication needs and severe motor impairments: State of the science

Individuals with complex communication needs often use alternative access technologies to control their augmentative and alternative communication (AAC) devices, their computers, and mobile technologies. While a range of access devices is available, many challenges continue to exist, particularly for those with severe motor-control limitations. For some, access options may not be readily available or access itself may be inaccurate and frustrating. For others, access may be available but only under optimal conditions and support. There is an urgent need to develop new options for individuals with severe motor impairments and to leverage existing technology to improve efficiency, increase accuracy, and decrease fatigue of access. This paper describes person-centred research and development activities related to new and emerging access technologies, with a particular focus on adults with acquired neurological conditions.

Using Images With Individuals With Aphasia: Current Research and Clinical Trends

PURPOSE

Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia.

METHOD

The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice.

RESULTS

Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices.

CONCLUSIONS

Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

The effect of human engagement depicted in contextual photographs on the visual attention patterns of adults with traumatic brain injury

Photographs are a frequently employed tool for the rehabilitation of adults with traumatic brain injury (TBI). Speech-language pathologists (SLPs) working with these individuals must select photos that are easily identifiable and meaningful to their clients. In this investigation, we examined the visual attention response to camera- (i.e., depicted human figure looking toward camera) and task-engaged (i.e., depicted human figure looking at and touching an object) contextual photographs for a group of adults with TBI and a group of adults without neurological conditions. Eye-tracking technology served to accurately and objectively measure visual fixations. Although differences were hypothesized given the cognitive deficits associated with TBI, study results revealed little difference in the visual fixation patterns of adults with and without TBI. Specifically, both groups of participants tended to fixate rapidly on the depicted human figure and fixate more on objects in which a human figure was task-engaged than when a human figure was camera-engaged. These results indicate that strategic placement of human figures in a contextual photograph may modify the way in which individuals with TBI visually attend to and interpret photographs. In addition, task-engagement appears to have a guiding effect on visual attention that may be of benefit to SLPs hoping to select more effective contextual photographs for their clients with TBI. Finally, the limited differences in visual attention patterns between individuals with TBI and their age and gender matched peers without neurological impairments indicates that these two groups find similar photograph regions to be worthy of visual fixation.

LEARNING OUTCOMES

Readers will gain knowledge regarding the photograph selection process for individuals with TBI. In addition, readers will be able to identify camera- and task-engaged photographs and to explain why task-engagement may be a beneficial component of contextual photographs.

Supporting communication for patients with neurodegenerative disease

BACKGROUND

Communication supports, referred to as augmentative and alternative communication (AAC), are an integral part of medical speech-language pathology practice, yet many providers remain unfamiliar with assessment and intervention principles. For patients with complex communication impairments secondary to neurodegenerative disease, AAC services differ depending on whether their condition primarily affects speech and motor skills (ALS), language (primary progressive aphasia) or cognition (Alzheimer's disease). This review discusses symptom management for these three conditions, identifying behavioral strategies, low- and high-tech solutions for implementation during the natural course of disease. These AAC principles apply to all neurodegenerative diseases in which common symptoms appear.

OBJECTIVES

To present AAC interventions for patients with neurodegenerative diseases affecting speech, motor, language and cognitive domains. Three themes emerge: (1) timing of intervention: early referral, regular re-evaluations and continual treatment are essential; (2) communication partners must be included from the onset to establish AAC acceptance and use; and (3) strategies will change over time and use multiple modalities to capitalize on patients' strengths.

CONCLUSIONS

AAC should be standard practice for adults with neurodegenerative disease. Patients can maintain effective, functional communication with AAC supports. Individualized communication systems can be implemented ensuring patients remain active participants in daily activities.

O uso da comunicação suplementar e alternativa como recurso para a interpretação de livros de literatura infantil

RESUMO: Objetivo: analisar o uso da Comunicação Suplementar e Alternativa como recurso de interpretação de livros de literatura infantil por uma criança com paralisia cerebral e necessidades complexas de comunicação. Métodos: para isso, realizou-se um estudo por meio do delineamento de sujeito único com um participante de sete anos com diagnóstico de paralisia cerebral e com necessidades complexas de comunicação. A variável dependente constituiu-se nas habilidades de comunicação e interpretação e a variável independente constituiu-se nas atividades de interpretação de histórias infantis, utilizando livros e figuras adaptadas por meio da Comunicação Suplementar e Alternativa. As atividades realizadas foram conduzidas em três etapas, sendo: Linha de Base, Intervenção e Manutenção. As sessões foram filmadas e anotadas em folhas de registro, e, posteriormente, os dados obtidos foram analisados quantitativamente. Resultados: os resultados obtidos permitiram identificar notável avanço no número de êxitos alcançados pelo participante durante as sessões realizadas, respondendo de forma autônoma, independente e assertiva às indagações, por meio das figuras e algumas verbalizações. Conclusão: foi possível constatar a eficácia da Comunicação Suplementar e Alternativa como recurso pedagógico e de apoio nas atividades de compreensão e interpretação de histórias na sala de aula por alunos com necessidades complexas de comunicação.

"My World Has Expanded Even Though I'm Stuck at Home": Experiences of Individuals With Amyotrophic Lateral Sclerosis Who Use Augmentative and Alternative Communication and Social Media

PURPOSE

This study aimed to expand the current understanding of how persons with amyotrophic lateral sclerosis (pALS) use augmentative and alternative communication and social media to address their communication needs.

METHOD

An online focus group was used to investigate the experiences of 9 pALS who use augmentative and alternative communication and social media. Questions posed to the group related to (a) current use of social media, (b) advantages of social media, (c) barriers to independent use, (d) supports to independent use, and (e) recommendations for developers, policy makers, and other pALS.

RESULTS

Participants primarily reported that use of social media was a beneficial tool that provided increased communication opportunities, connections to communication partners, and networks of support. Specific results are discussed with reference to the research as well as implications for practice and recommendations for future research.

CONCLUSIONS

As individuals with ALS experience loss of function, some communication modes may no longer be viable. Providing access to different modes of communication, including social media, can allow independence, participation and better quality of life.

Effects of Alphabet-Supplemented Speech on Brain Activity of Listeners: An fMRI Study

PURPOSE

The purpose of this article was to examine the neural mechanisms associated with increases in speech intelligibility brought about through alphabet supplementation.

METHOD

Neurotypical participants listened to dysarthric speech while watching an accompanying video of a hand pointing to the 1st letter spoken of each word on an alphabet display (treatment condition) or a scrambled display (control condition). Their hemodynamic response was measured with functional magnetic resonance imaging, using a sparse sampling event-related paradigm. Speech intelligibility was assessed via a forced-choice auditory identification task throughout the scanning session.

RESULTS

Alphabet supplementation was associated with significant increases in speech intelligibility. Further, alphabet supplementation increased activation in brain regions known to be involved in both auditory speech and visual letter perception above that seen with the scrambled display. Significant increases in functional activity were observed within the posterior to mid superior temporal sulcus/superior temporal gyrus during alphabet supplementation, regions known to be involved in speech processing and audiovisual integration.

CONCLUSION

Alphabet supplementation is an effective tool for increasing the intelligibility of degraded speech and is associated with changes in activity within audiovisual integration sites. Changes in activity within the superior temporal sulcus/superior temporal gyrus may be related to the behavioral increases in intelligibility brought about by this augmented communication method.

Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

In 1989, Light defined communicative competence for individuals with complex communication needs who require augmentative and alternative communication (AAC) as a dynamic interpersonal construct based on functionality of communication; adequacy of communication; and sufficiency of knowledge, judgment, and skills. Specifically, Light argued that, in order to demonstrate communicative competence, individuals who required AAC had to develop and integrate knowledge, judgment, and skills in four interrelated domains: linguistic, operational, social, and strategic. In 2003, Light expanded this definition and argued that the attainment of communicative competence is influenced by not just linguistic, operational, social, and strategic competencies but also a variety of psychosocial factors (e.g., motivation, attitude, confidence, resilience) as well as barriers and supports in the environment. In the 25 years since this definition of communicative competence for individuals who use AAC was originally proposed, there have been significant changes in the AAC field. In this paper, we review the preliminary definition of communicative competence, consider the changes in the field, and then revisit the proposed definition to determine if it is still relevant and valid for this new era of communication.

The Role of Photographs in Face-to-Face Interactions involving Younger and Older Neurotypical Adults

The purpose of this preliminary investigation was to explore the role photographs play in communication interactions involving neurotypical adults. Participants included 10 people from 2 age groups: younger adults between 23 and 25 years of age and older adults between 61 and 74 years of age. Referencing photographs to support one-on-one conversations between an examiner and either a younger or older neurotypical adult speaker occurred approximately 20% of the time. Younger participants relied solely on nonverbal communication in the form of a pointing gesture to convey their intent less than 2% of the time, whereas older participants never relied solely on pointing gestures to convey intent. This suggests that typical speakers treat the referencing of photographs as a supplemental rather than primary communication strategy during face-to-face interactions.