Design of aided augmentative and alternative communication systems for children with vision impairment: psychoacoustic perspectives.

Children with complex communication needs often have multiple disabilities including visual impairments that impact their ability to interact with aided augmentative and alternative communication (AAC) systems. Just as the field benefited from a consideration of visual cognitive neuroscience in construction of visual displays, an exploration of psychoacoustics can potentially assist in maximizing the possibilities within AAC systems when the visual channel is either (a) not the primary sensory mode, or (b) is one that can be augmented to ultimately benefit AAC outcomes. The purpose of this paper is to highlight background information about psychoacoustics and present possible future directions for the design of aided AAC system technologies for children with visual impairments who rely on auditory information to learn and utilize AAC.

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.

Individuals Who Use Augmentative and Alternative Communication and Participate in Active Recreation: Perspectives From Adults With Developmental Disabilities and Acquired Conditions.

PURPOSE: The aim of the study was to gather the perspectives and lived experiences of 10 adults who use augmentative and alternative communication (AAC) and participate in active recreation. Active recreational participation includes individual sports such as adaptive skiing, surfing, and cycling, as well as unified team sports such as soccer, bocce, and basketball. METHOD: This research involved a qualitative study with two separate asynchronous online focus groups each conducted over a 6-week span. The focus groups included literate individuals who use AAC and engage in active recreational pursuits across the United States. One focus group included five individuals with acquired conditions, and the other group included five individuals with developmental disabilities. RESULTS: Thematic analysis of the data from both focus groups revealed five primary themes with corresponding subthemes: barriers (intrinsic and extrinsic), supports (intrinsic and extrinsic), benefits (intrinsic and extrinsic), communication (methods), and recommendations for communication partners and people who use AAC. CONCLUSIONS: This study provides important information to individuals who use AAC and their communication partners about the benefits of active recreation and the supports needed to make these experiences successful. As a result of this study, speech-language pathologists, related professionals, and caregivers will gain a better understanding of how they can support recreational participation for people who use AAC with a specific focus on enhancing communication and expanding social networks. Supplemental Material https://doi.org/10.23641/asha.17701043.

Increasing reciprocal social interactions using collaborative art activities: An intervention for children with complex communication needs and their peers.

Purpose: Children with complex communication needs who require augmentative and alternative communication (AAC) strategies to communicate have difficulty participating in interactions with their peers. Integrating a collaborative learning framework with art activities may facilitate social interactions between children with complex communication needs and their peers.Method: A single-subject withdrawal design was utilised to examine the impact of collaborative art activities on reciprocal social interactions between 2 dyads of participants with complex communication needs and their same-age peers. Additional dependent variables included the roles of participants with complex communication needs in interactions (initiator or responder), AAC modalities (unaided, aided, natural speech), and engagement.Result:Tau-U calculations for Dyad 1 demonstrated 64% improvement from baseline, indicating moderate effects with the collaborative art activity (Intervention One) and 100% improvement, indicating strong effects following the activity enhanced with photography (Intervention Two). Dyad 2 demonstrated 100% improvement from baseline following Intervention One and 96% improvement following Intervention Two, indicating strong effects.Conclusion: Both collaborative art activities demonstrated potential for facilitating social interactions for children with complex communication needs and their peers.

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.

Creating a Path for Systematic Investigation of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication.

Purpose There is limited information about how to support children with cortical visual impairment (CVI) who require augmentative and alternative communication (AAC). An initial review designed to explore the available evidence was used to outline critical needs in moving research and intervention forward for children who use AAC and have CVI. Method Previous systematic reviews, six databases, and theses and dissertations were systematically searched, along with reviews of the resulting works cited. An initial yield of 575 articles was narrowed to 10, which discussed AAC interventions that included children with CVI. Results Three interventions were technology based, and seven were instructional based. The use of textured microswitches was the most frequent form of technology intervention, with the frequency of switch activations being the most frequently coded outcome. Overall, the studies represent explorations in the area rather than systematic lines of inquiry. Conclusions While evidence shows at least some children with CVI have been included in AAC research to date, the inclusion is more incidental than deliberate. Issues such as clear descriptions of the vision capabilities and needs of participants may have impacted study results.

Music Improves Social and Participation Outcomes for Individuals With Communication Disorders: A Systematic Review.

There is increasing interest in exploring the benefits of music in rehabilitation settings. In the field of speech-language pathology, an ultimate goal for individuals with communication disorders is to foster participation across multiple contexts. The goal of this systematic review was to explore social and participation outcomes for individuals with communication disorders who received arts-based interventions. A systematic search of the literature yielded 86 studies, which were coded and summarized in terms of participants, arts-based intervention, social and participation variables, outcome, and quality of evidence. The majority of identified studies (N = 71) utilized music. Results indicated that music-based interventions can improve social and participation outcomes, such as frequency of responses, initiation of communication, turn-taking, joint attention, and group participation for children and adults with autism spectrum disorder and developmental and acquired communication disorders; however, future research is needed to expand the use of varied arts-based interventions targeting a larger breadth of social and participation outcomes.

Exploration of Head Related Transfer Function and Environmental Sounds as a Means to Improve Auditory Scanning for Children Requiring Augmentative and Alternative Communication.

Many individuals who require augmentative and alternative communication (AAC) cannot directly select items on computer-based displays. Individuals who also have visual impairments may need to rely on sequential announcement of array choices in auditory scanning. The method is challenging and there is a lack of research to improve this access method. Two potential solutions were tested: using environmental sounds to represent items (e.g., the sound of a clock ticking for a clock) and providing spatial cues regarding the organization of items (e.g., presenting auditory information and altering temporal and spectral features so that sounds are heard as left, right, up, or down relative to each other). The individual and combined effects of these cues were tested with typically developing 3-year-old children. After collecting and validating a set of stimulus sounds, 24 children participated in a within-subjects design with four conditions (spoken word label only, associated environmental sound only, spoken word label with spatial information, associated environmental sound plus spatial information). Dependent measures included reaction time (RT) and accuracy. Results indicated that the use of sounds without any spatial cues revealed slower RTs than any other conditions. Also, sounds regardless of spatial cues led to less accurate scores than words.

Weaving participation, interaction, and technology across recreational experiences: perspectives from volunteers, caregivers, and people with complex communication needs.

Recreational and leisure activities offer many meaningful and motivating opportunities for communication and improving quality-of-life. Volunteers in recreation activities have important roles as participation and communication facilitators, while also creating opportunities for learning and social interaction. The aim of this study was to implement a novel photo and video intervention called the CAPTURE & Share Program, and to evaluate its impact on communication opportunities and participation. For the study, five volunteers were assigned to five individuals with complex communication needs. Each dyad took photos and videos during a series of three kayaking lessons. After each lesson, volunteers participated in feedback sessions, while caregivers, support staff, and participants with complex communication needs shared their perspectives during pre- and post-lesson interviews. A thematic analysis, based on the data from the volunteer feedback sessions, revealed five primary themes: Program Components, Modifications, Barriers, Supports, and Benefits. Findings revealed that volunteers supported the individuals with complex communication needs who participated in the study to collect photos and videos as they learned how to use cameras and communicate their preferences for capture. Furthermore, the photos and videos that were collected were shared with family and friends, which encouraged more frequent social interactions and opportunities for communication. Findings suggest that recreational activities were perceived to provide an appropriate infrastructure for photo and video capture and to support opportunities for communication.

Identification and drawing of early concepts in children with autism spectrum disorder and children without disability.

This comparative study is a replication and extension of previous work related to children's drawings of early concepts. In all, 15 children with autism spectrum disorder (ASD) and 19 children without disability took part in the study, and were video recorded as they drew 10 early emerging concepts such as "eat" and "more." In a second task, the participants were asked to label Picture Communication Symbols conventionally used in augmentative and alternative communication (AAC) systems. Descriptive, correlational, and inferential statistics were used to analyze the data. The results were consistent with previous research for both groups. Across the 10 features coded, participants in both groups drew entire scenes and were more likely to draw complete representations of people. Identification of PCS was less than 25% for both groups. After a brief time delay, the participants were able to remember the names of their drawings; however, performance on this recall task was positively related to their age. The language scores of the participants without disability were associated with their use of isolated parts in drawings. Trends in the data suggest potential avenues for follow up with larger studies examining use of self, others, and entire scenes in children with ASD. Implications for therapy and future directions pertaining to symbolic understanding in children with ASD are discussed.

Designing augmentative and alternative communication applications: the results of focus groups with speech-language pathologists and parents of children with autism spectrum disorder.

PURPOSE: The purpose of this study was to gain insight from speech-language pathologists (SLPs) and parents of children with autism spectrum disorder (ASD) regarding appealing features of augmentative and alternative communication (AAC) applications. METHOD: Two separate 1-hour focus groups were conducted with 8 SLPs and 5 parents of children with ASD to identify appealing design features of AAC Apps, their benefits and potential concerns. Participants were shown novel interface designs for communication mode, play mode and incentive systems. Participants responded to poll questions and provided benefits and drawbacks of the features as part of structured discussion. RESULTS: SLPs and parents identified a range of appealing features in communication mode (customization, animation and colour-coding) as well as in play mode (games and videos). SLPs preferred interfaces that supported motor planning and instruction while parents preferred those features such as character assistants that would appeal to their child. Overall SLPs and parents agreed on features for future AAC Apps. CONCLUSION: SLPs and parents have valuable input in regards to future AAC app design informed by their experiences with children with ASD. Both groups are key stakeholders in the design process and should be included in future design and research endeavors. Implications for Rehabilitation AAC applications for the iPad are often designed based on previous devices without consideration of new features. Ensuring the design of new interfaces are appealing and beneficial for children with ASD can potentially further support their communication. This study demonstrates how key stakeholders in AAC including speech language pathologists and parents can provide information to support the development of future AAC interface designs. Key stakeholders may be an untapped resource in the development of future AAC interfaces for children with ASD.

A comparison of the performance of 2.5 to 3.5-year-old children without disabilities using animated and cursor-based scanning in a contextual scene.

Although recent evidence suggests learning demands for children can be reduced by organizing augmentative and alternative communication (AAC) displays in contextual scenes, there is little evidence on how such scenes could be made accessible for children who cannot use direct selection. Using a line drawn scene of a living room, a traditional traveling cursor (a green outline of objects within the scene) was compared with sequential animation-logically matching the function of items in the scene (e.g., hands of a clock moving, a lamp turning on and off, etc.). After three learning sessions, only the matched function animation condition revealed a significant increase in accuracy scores from session 1 to session 3. Age-related trends suggested the mean scores in the cursor-based condition were associated with older children consistently performing at high levels and younger children remaining at low levels, while trends in the animated group were associated with children learning the interface in a way not associated with age. Findings support that enhanced presentations of scanning can increase the transparency of the scanning interface for some children and suggest that contextual scene displays could benefit from animations and sound for children not using direct selection.

"You Get More Than You Give": Experiences of Community Partners in Facilitating Active Recreation with Individuals who have Complex Communication Needs.

Recreation is an essential part of life that provides enriching experiences that may define one's life course similar to careers or other interests. An understanding of the role of volunteers in active community-based recreational programs can help to generate ways to enhance participation and contribute to additional communication opportunities with people who have complex communication needs. Nine volunteers from two adaptive ski programs and one therapeutic horseback-riding program in the Northeast region of the United States participated in semi-structured interviews. Audio-recordings were transcribed and analyzed and resulted in five thematic areas: (a) benefits, (b) why individuals volunteer, (c) barriers, (d) successful program supports, and (e) who are the riders and skiers using AAC. The findings provided insight to support the notion that active community-based recreational activities foster an environment for communication, meaningful engagement, and social relationships between volunteers and people with complex communication needs.

Simultaneous natural speech and AAC interventions for children with childhood apraxia of speech: lessons from a speech-language pathologist focus group.

In childhood apraxia of speech (CAS), children exhibit varying levels of speech intelligibility depending on the nature of errors in articulation and prosody. Augmentative and alternative communication (AAC) strategies are beneficial, and commonly adopted with children with CAS. This study focused on the decision-making process and strategies adopted by speech-language pathologists (SLPs) when simultaneously implementing interventions that focused on natural speech and AAC. Eight SLPs, with significant clinical experience in CAS and AAC interventions, participated in an online focus group. Thematic analysis revealed eight themes: key decision-making factors; treatment history and rationale; benefits; challenges; therapy strategies and activities; collaboration with team members; recommendations; and other comments. Results are discussed along with clinical implications and directions for future research.

Situational and psychosocial factors mediating coordinated joint attention with augmentative and alternative communication systems with beginning communicators without disabilities.

This study examined how infants' age, joint attention (JA) skills, caregiver ratings of language and temperament, and caregiver JA style related to JA in a structured literacy task with an augmentative and alternative communication (AAC) system. Sixteen infants (mean = 10.6 months) without disabilities participated in two storybook reading interactions with an experimenter in two conditions where the AAC system was either aligned or divided from the experimenter's eye gaze. Individual differences in JA skills, caregiver JA style, and temperament were associated with coordinated JA across both conditions. The findings suggest it is important to examine both extrinsic and intrinsic factors, which may not only reduce attention demands but also mediate the success of JA interactions with AAC systems.

The effects of reading personal narratives written by an individual who uses AAC on the attitudes of pre-professionals in business.

A Solomon Four-Group Design was used to study the effects of reading personal narratives written by an individual with complex communication needs on the attitudes, potential future behaviors, and general experiences of 109 undergraduate business majors. The Attitudes Toward Nonspeaking Persons Scale (ATNP) and a scale of behavioral intentions modeled according to Ajzen's ( 1991 ) Theory of Planned Behavior were used as dependent variables. A sub-group of individuals in the experimental group participated in individual follow-up interviews. Results revealed individuals who read the narratives had more positive attitudes than those who did not; however, there were potentially reactive effects for pre-testing evident on one subscale of the ATNP scale. Interviews revealed a need for more explicit information about the workings of AAC and a need to change expectations about working with individuals with disabilities.

The effect of high-tech AAC system position on the joint attention of infants without disabilities.

Joint attention is critical for language development in children. Children with complex communication needs have additional challenges in managing their joint attention, and there is minimal information on how to reduce these demands. Sixteen infants without disabilities and their caregivers participated in a within-subjects design with two storybook reading interactions. In reading, the researcher either held a high-tech AAC system directly in front of herself (aligned with eye-gaze) or to the side (divided from eye-gaze). The frequency and duration of coordinated and passive joint attention episodes were analyzed. The aligned condition resulted in significantly greater frequency and duration of coordinated joint attention than passive joint attention in episodes involving the AAC system. Age was significantly related to frequency and duration of joint attention only in the aligned condition. Future directions and clinical implications are discussed.