Personalization of Visual Scene Displays: Preliminary Investigations of Adults with Aphasia, Typical Females across the Age-Span, and Young Adult Males and Females.

Visual scene displays (VSDs) are becoming an increasingly popular method of message representation within augmentative and alternative communication (AAC) supports; however, design factors can influence the effectiveness of these images as communication supports. One issue that has come to light in recent years is the fact that selecting personalized VSDs, which depict the person with complex communication needs or an individual with whom they are familiar, are preferred over generic VSDs, which depict unfamiliar individuals. Although personalization is likely an important factor in the usability of VSDs, these images may be difficult for clinicians to obtain. As such, compromises must be identified. The purpose of this study was to explore the effects of controlling personal relevance factors (i.e., age and gender of the people depicted in generic VSDs) on the image preference patterns of adults with and without aphasia. Results from three very preliminary study summaries indicate that gender and age are both mitigating factors in image preference, as males tended to indicate preference for VSDs containing males over those containing females. In addition, females tended to indicate preference for females of a similar age depicted in VSDs.

Building capacity in AAC: A person-centred approach to supporting participation by people with complex communication needs.

Effective communication is based both on the capacity of the person with complex communication needs, and of other key stakeholders (including communication and education professionals, family members, community partners, and healthcare professionals), to ensure that appropriate AAC supports are provided. In this paper, we describe strategies to build awareness of AAC and to assist people with complex communication needs in obtaining needed services; to build the knowledge, skills, and attitudes of AAC service providers; to provide instruction for people with complex communication needs, as well as communication partners and advocates; and to develop communication supports in society more broadly. We also provide an agenda for building capacity in research and development activities to support full participation by people with complex communication needs throughout society.

Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions.

This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to capture visual attention to VSDs (video VSDs) or to specific elements in VSDs. When using grid displays with children with developmental disabilities, research supports the use of spatial cues and clustering based on internal symbol colour to facilitate visual searching and selection. Background colour does not seem to facilitate searching for symbols on smaller displays, and may actually distract children from processing the meaningful components of symbols. Preliminary research suggests that the organization of onscreen keyboards and the number, types, and pairings of symbols in grids may impact performance of adults with acquired conditions. Directions for future research are discussed.

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 Visual Scene Displays as Communication Support Options for People with Chronic, Severe Aphasia: A Summary of AAC Research and Future Research Directions.

Research about the effectiveness of communicative supports and advances in photographic technology has prompted changes in the way speech-language pathologists design and implement interventions for people with aphasia. The purpose of this paper is to describe the use of photographic images as a basis for developing communication supports for people with chronic aphasia secondary to sudden-onset events due to cerebrovascular accidents (strokes). Topics include the evolution of AAC-based supports as they relate to people with aphasia, the development and key features of visual scene displays (VSDs), and future directions concerning the incorporation of photographs into communication supports for people with chronic and severe aphasia.

Influence of computerized sounding out on spelling performance for children who do and do not rely on AAC.

PURPOSE: Spelling is an important skill for individuals who rely on augmentative and alternative communication (AAC). The purpose of this study was to investigate how computerized sounding out influenced spelling accuracy of pseudo-words. Computerized sounding out was defined as a word elongated, thus providing an opportunity for a child to hear all the sounds in the word at a slower rate. METHODS: Seven children with cerebral palsy, four who use AAC and three who do not, participated in a single subject AB design. RESULTS: The results of the study indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words produced by participants. CONCLUSION: The study provides preliminary evidence for the use of computerized sounding out during spelling tasks for children with cerebral palsy who do and do not use AAC. Future directions and clinical implications are discussed. IMPLICATIONS FOR REHABILITATION: We investigated how computerized sounding out influenced spelling accuracy of pseudowords for children with complex communication needs who did and did not use augmentative and alternative communication (AAC). Results indicated that the use of computerized sounding out increased the phonologic accuracy of the pseudo-words by participants, suggesting that computerized sounding out might assist in more accurate spelling for children who use AAC. Future research is needed to determine how language and reading abilities influence the use of computerized sounding out with children who have a range of speech intelligibility abilities and do and do not use AAC.

Communication support through multimodal supplementation: a scoping review.

Speech supplementation strategies improve spoken communication for people with motor speech disorders who experience reduced speech intelligibility. The purpose of this review was to summarize the literature on traditional supplementation strategies (e.g., alphabet supplementation, topic supplementation, and gestural supplementation) and to expand the definition of speech supplementation to include additional modalities, such as augmenting speech with pictures via mobile technology, and conversation management strategies. Results showed that studies of traditional supplementation consistently reported positive outcomes, including increased intelligibility, decreased speech rate, and positive attitudes toward speakers. New modalities, such as supplementing speech through digital photos, may come to be integrated with traditional approaches, given the proliferation of digital photography and mobile tablet technologies. In addition, new research is exploring the role of communication partners in dyads where one speaker has dysarthria, as well as strategies that communication partners employ to understand dysarthric speech.

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.

Impact of Computerized "Sounding out" on Spelling Performance of a Child Who Uses AAC: A Preliminary Report.

Spelling is a vital skill for people who rely on augmentative and alternative communication (AAC). The ability to spell words provides an opportunity to create novel and spontaneous communication and increases educational, social, and employment opportunities for children and adults. However, many children and youth who rely on AAC struggle to gain functional spelling skills and written language. The purpose of this preliminary investigation was to develop a strategy to provide auditory letter-sounds using commercially available computer equipment and to evaluate how such a computerized "sounding out" strategy influences spelling accuracy for one child who required AAC support. The spelling accuracy of both consonants and vowels increased during intervention sessions when individual sounds associated with target words were provided compared to the baseline session when individual sounds were not provided. Future directions are discussed.

Access interface strategies.

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.

Current and future AAC research considerations for adults with acquired cognitive and communication impairments.

Adults with acquired language impairments secondary to stroke, traumatic brain injury, and neurodegenerative diseases are candidates for communication supports outside of the traditional restoration-based approaches to intervention. Recent research proves repeatedly that augmentative and alternative communication (AAC) provides a means for participation, engagement, conversation, and message transfer when individuals can no longer expect full return of pre-morbid communication skills and that inclusion of communication supports should begin early. We discuss current research and future directions for integrated systems of technical supports that include low-technology, high tech, and partner-dependent strategies for adults with severe and chronic aphasia, cognitive-communication problems resulting from traumatic brain injuries, and primary progressive aphasia.

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.

Navigation of a dynamic screen AAC interface by survivors of severe traumatic brain injury.

The researchers examined the effect of cognitive flexibility, image contextualization, and prompt type on accuracy and speed when adults with severe traumatic brain injury (TBI) navigated dynamic screen augmentative and alternative communication (AAC) interfaces. Eighteen participants formed two groups based on cognitive flexibility status. Given matching informative versus uninformative prompts and three image contextualization conditions, participants located words on 3-level AAC systems. ANOVA computations revealed differences between groups and between prompt types for navigation accuracy; differences occurred among image conditions and between prompt types for navigation speed. Analyses using responses from participants with cognitive flexibility challenges revealed inter-subject variability regarding error types. Overall, findings suggest cognitive flexibility may predict who may and may not need explicit training to master AAC device navigation.

Impact of personal relevance and contextualization on word-picture matching by people with aphasia.

PURPOSE: To determine the effect of personal relevance and contextualization of images on the preferences and word-picture matching accuracy of people with severe aphasia. METHOD: Eight adults with aphasia performed 2 experimental tasks to reveal their preferences and accuracy during word-picture matching. The researchers used 3 types of visual stimuli-personally relevant, contextualized photographs; non-personally relevant, contextualized photographs; and noncontextualized, iconic images-paired with 3 types of target words-labels of people or objects, actions, and socially relevant events-as the stimulus materials. RESULTS: Data analysis showed that participants (a) preferred using personally relevant, contextualized photographs rather than other types of photographs/images to represent target words and (b) performed more accurate word-picture matching when presented with target words associated with personally relevant, contextualized photographs than target words associated with noncontextualized or nonpersonalized photographs/images. CONCLUSIONS: Clinically, the findings highlight the importance of using personally relevant, contextualized photographs rather than generic contextualized photographs or noncontextualized, iconic images to support the communication attempts of people with aphasia who cannot communicate effectively using natural speech alone.

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.

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.

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.

AAC menu interface: effectiveness of active versus passive learning to master abbreviation-expansion codes.

This study investigated the accuracy with which 30 young adults without disabilities learned abbreviation expansion codes associated with specific vocabulary items that were stored in an AAC device with two accessing methods: mouse access and keyboard access. Both accessing methods utilized a specialized computer application, called AAC Menu, which allowed for errorless practice. Mouse access prompted passive learning, whereas keyboard access prompted active learning. Results revealed that participants who accessed words via a keyboard demonstrated significantly higher mastery of abbreviation-expansion codes than those who accessed words via a computer mouse.

Accuracy, efficiency and preferences of survivors of traumatic brain injury when using three organization strategies to retrieve words.

The primary objective was to compare the accuracy and preferences of adult survivors of traumatic brain injury (TBI) when using three organization strategies--semantic topic, geographic place and a word's first letter (alphabet)--to retrieve words using augmentative and alternative communication (AAC) technology. A repeated measures research design was employed. Twelve adult survivors of TBI ranging in age from 18-50 years participated in the study. These participants retrieved words using an AAC system organized using the three experimental conditions. In addition, they rank-ordered their preferences for each of the three strategies. Results showed that adults with TBI retrieve words more accurately and more efficiently when using the alphabet organization strategy than when using the topic or place strategies. Despite this, participants expressed a preference for using the topic strategy. Explanations for the findings and implications for AAC use are provided.