What We Write about When We Write About AAC: The Past 30 Years of Research and Future Directions

Mental health and mental health problems among users of AAC: a scoping review

Functional communication is crucial for mental health and for coping with mental health problems. People with disabilities are at increased risk of mental health problems, and people who use augmentative and alternative communication (AAC) are reported to be at greater risk of depression and anxiety than people without impairments. This scoping review summarizes existing knowledge about the mental health and mental health problems of people who use AAC. The review includes nine publications, published between 2001 and 2022. These mainly report on adults and elderly people who use AAC. Four of the nine publications included people who use AAC due to acquired impairments. None of the studies reported the prevalence of mental health problems and only a few addressed factors of positive mental health. The results indicate a shortage of theoretical accounts for most of the publications included, and the publications are not built on each other. The scarcity of knowledge is discussed in relation to the idea that the need for communicative support is a need based on communicative functioning rather than any diagnostic category and thus not visible in much of the health literature based on diagnostic categories. Several implications for practice and research are suggested.

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

Using Communication Assistants in Qualitative Health Research

Qualitative health research is hampered by narrow constructs of human communication that privilege participants with access to spoken and written (normative) language. With limited awareness of such things as augmentative and alternative communication (AAC) or the rights of people with complex communication access needs, qualitative research becomes a 'picker and chooser' of whose voices are included in studies and whose are not. In order for 'voices' to be heard, adaptations are required which include the acknowledgement and support of communication assistants (informal and formal) who can help provide a communication bridge between people with complex communication access needs and researcher(s). Yet little is known of who qualifies as a communication assistant nor the scope and limitations of this role in health research. Beginning with communication diversity arguments the article compares communication assistants with language interpreters before discussing practice and implications for health research.

A Multimodal Messaging App (MAAN) for Adults With Autism Spectrum Disorder: Mixed Methods Evaluation Study

BACKGROUND

Individuals with autism spectrum disorder (ASD) often exhibit difficulties in social and communication skills. For more than 30 years, specialists, parents, and caregivers have used techniques, such as applied behavioral analysis, augmentative and alternative communication, and the picture exchange communication system to support the social and communication skills of people with ASD. Even though there are many techniques devised to enhance communication, these techniques are not considered in existing social media apps for people with ASD.

OBJECTIVE

This study aimed to investigate the effect of adding accessibility features, such as text-to-speech (TTS), speech-to-text (STT), and communication symbols (CS), to a messaging app (MAAN). We hypothesized that these accessibility features can enhance the social and communication skills of adults with ASD. We also hypothesized that usage of this app can reduce social loneliness in adults with ASD.

METHODS

Semistructured interviews were conducted with 5 experts working in fields related to ASD to help design the app. Seven adults with ASD participated in the study for a period of 10 to 16 weeks. Data logs of participants' interactions with the app were collected. Additionally, 6 participants' parents and 1 caregiver were asked to complete a short version of the Social and Emotional Loneliness Scale for Adults (SELSA-S) questionnaire to compare pre-post study results. The Mobile Application Rating Scale: user version questionnaire was also used to evaluate the app's usability. Following the study, interviews were conducted with participants to discuss their experiences with the app.

RESULTS

The SELSA-S questionnaire results showed no change in the family subscale; however, the social loneliness subscale showed a difference between prestudy and poststudy. The Wilcoxon signed-rank test indicated that poststudy SELSA-S results were statistically significantly higher than prestudy results (z=-2.047; P=.04). Point-biserial correlation indicated that the SELSA-S rate of change was strongly related to usage of the TTS feature (r=0.708; P=.04) and CS feature (r=-0.917; P=.002), and moderately related to usage of the STT feature (r=0.428; P=.17). Lastly, we adopted grounded theory to analyze the interview data, and the following 5 categories emerged: app support, feature relevance, user interface design, overall feedback, and recommendations.

CONCLUSIONS

This study discusses the potential for improving the communication skills of adults with ASD through special features in mobile messaging apps. The developed app aims to support the inclusion and independent life of adults with ASD. The study results showed the importance of using TTS, STT, and CS features to enhance social and communication skills, as well as reduce social loneliness in adults with ASD.

Introduction of a new AAC symbol classification system: the multidimensional quaternary symbol continuum (MQSC)

Purpose

When the augmentative and alternative communication (ACC) model (Lloyd et al., 1990) was proposed, these components of symbols were not considered, nor were they contemplated when superordinate (Lloyd and Fuller, 1986) and subordinate levels (Fuller et al., 1992) of AAC symbol taxonomy were developed. The purpose of this paper is to revisit the ACC model and propose a new symbol classification system called multidimensional quaternary symbol continuum (MQSC)

Design/methodology/approach

The field of AAC is evolving at a rapid rate in terms of its clinical, social, research and theoretical underpinnings. Advances in assessment and intervention methods, technology and social issues are all responsible to some degree for the significant changes that have occurred in the field of AAC over the last 30 years. For example, the number of aided symbol collections has increased almost exponentially over the past couple of decades. The proliferation of such a large variety of symbol collections represents a wide range of design attributes, physical attributes and linguistic characteristics for aided symbols and design attributes and linguistic characteristics for unaided symbols.

Findings

Therefore, it may be time to revisit the AAC model and more specifically, one of its transmission processes referred to as the means to represent.

Originality/value

The focus of this theoretical paper then, is on the current classification of symbols, issues with respect to the current classification of symbols in terms of ambiguity of terminology and the evolution of symbols, and a proposal for a new means of classifying the means to represent.

Peer review

The peer review history for this article is available at: https://publons.com/publon10.1108/JET-04-2021-0024

Interaction symmetry: Assessing augmented speaker and oral speaker performances across four tasks

This investigation examined the impact of speech-generating devices (SGDs) on the interaction dynamics (i.e., symmetry) of augmented speakers and their conversation partners while performing several interaction tasks. This study involved 20 dyads: 10 in which one individual had ALS and primarily used an SGD for communication while the other participant primarily used speech (AS group); and 10 in a control group comprised of individuals who used speech as a primary means of communication (OS group). Interactions between participants in the AS group were compared across four tasks (i.e., map, retell, sequencing, and personal narrative). These results were also compared to performances of participants in the OS group performing the same tasks. Task completion times, talk times, contribution types (i.e., main/repair), and contribution functions (i.e., presentation/acceptance) were used to index symmetry performance patterns across tasks for the 20 dyads. Within- and between-group comparisons were significant in differentiating the two groups in terms of the ways in which they were able to adapt to different interaction task dynamics. Findings suggest symmetry is a useful metric for identifying the constraining influence of carrying out in-person interactions with an SGD.

Reseña del libro: Comunicación simbólica: Comunicación aumentativa y alternativa

Este manual presenta un marco teórico, así como pautas para la evaluación y la intervención basados en la literatura más reciente sobre comunicación aumentativa y alternativa (CAA). Está compuesto por siete capítulos en los que destaca el énfasis sobre cómo conseguir la comunicación por encima de herramientas concretas, y se ofrecen técnicas, instrumentos y programas relevantes que están basados en buenas prácticas y que se describen en detalle. El manual resulta de clara utilidad para estudiantes y profesionales que trabajan en este campo, constituyendo una referencia obligada y actualizada en la literatura en español sobre CAA.

An online community of practice to improve intervention for individuals with complex communication needs

Collaboration and information sharing are essential in the fast moving world of augmentative and alternative communication (AAC). This paper describes communities of practice, justifies their need in AAC, and introduces the Communication Matrix Community of Practice (CMCoP)-an online community of practice for professionals and family members supporting individuals at the earliest stages of communication development. Stakeholders share the goal of advancing language and communication intervention for individuals with complex communication needs. Features of the CMCoP include a community forum for discussing and sharing information; collections of posts by professionals and nonprofessionals on various topics; an events calendar of AAC-related activities relevant to stakeholders; and a shared science section offering portraits of the communication skills of various populations with severe communication disorders. The utility of these and other CMCoP features in supporting the implementation of AAC assessment and intervention strategies is discussed.

Communication with invasive mechanically ventilated patients and the use of alternative devices: integrative review

BACKGROUND

Communication with patients has always been a major concern in nursing care. Invasive mechanically ventilated (IMV) patients suffer from a communication barrier due to the presence of the endotracheal tube (ETT), which makes them unable to communicate through speech.

AIM

The purpose of this review is to examine available evidence regarding existing knowledge, skills, perceptions and barriers to IMV patient communication in order to guide the development of strategies that enhance effective communication with these patients.

METHODS

A review of the published literature was conducted between January 2010 and December 2016.

RESULTS

The literature support clear and concise communication in all areas of care, especially when patients suddenly become speechless. Invasive mechanically ventilated patients want to be heard, have control over their treatment and contribute to decisions concerning their health.

CONCLUSION

There is a need for the establishment of an effective nurse -patient communication strategy, which may include determining the mode of communication used by the patient, waiting and giving time to allow a patient to participate in the communication, confirming the message that was communicated with a patient himself/ herself, and the use of assistive and augmented communication to support comprehension when needed.

Augmentative and Alternative Communication – Scoping Review / Unterstützte Kommunikation – Scoping Review

Introduction

The effective use of Augmentative and Alternative Communication is challenging, not only for persons with complex communication needs, but also for their significant others. There is a need, therefore, for interprofessional collaboration in order to effectively assess, provide, and evaluate services.

Aim

The aim of this scoping review was to summarize current evidence in the field of Augmentative and Alternative Communication and reveal the demands for further research.

Method

We searched in the electronic databases Pubmed, AMED, and CINAHL using following keywords child*, disability, cerebral palsy, augmentative and alternative communication, intervention, and therapy to identify relevant literature. We summarised the content of the included studies.

Results

We included 16 literature reviews and 36 studies in this review. The 36 studies included 11 intervention studies, 20 descriptive studies, two experimental studies, and three studies evaluating assessments. Most of the studies were focussing on children with cerebral palsy and autism in the contexts of home, hospital, and primary school. There were no intervention studies, focusing on secondary and/or tertiary level of education or work. Moreover, we have not found any evidence from German speaking Europe.

Conclusion

In order to support the use of Augmentative and Alternative Communication and to enable participation of persons with complex communication needs, various endeavours are needed: in the practice of care settings interprofessional collaboration is required. Further research is needed in order to evaluate the effectiveness of interventions, focussing on youth and the contexts of secondary and/or tertiary education or work, or on assessments.