Digital, co-created implementation of communication partner training programs for stroke, brain injury, and dementia: Past, present, and future.

PURPOSE: Communication partner training is a recommended intervention for partners of people with acquired brain injury. In this paper we explore the past, present, and future of communication partner training (CPT) based on our 2023 Speech Pathology Australia national conference address. METHOD: We focus on our research team's contributions, and highlight research knowledge across stroke, traumatic brain injury (TBI), and dementia. This work is anchored in the voice of people with communication disability. One partner in the CPT journey, Rosey Morrow, co-authors this paper. RESULT: The CPT evidence base for acquired neurological conditions is growing, including in the areas of technology, co-design, and translation. However, knowledge and implementation gaps remain. CONCLUSION: The future of CPT will require us to harness co-design and technology, whilst meeting the implementation challenges of complex systems to enable communication for all.

Identifying Components of a Person-Centered Augmentative and Alternative Communication Intervention for People With Dementia: Opinions of an International Expert Panel.

PURPOSE: Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia. METHOD: A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis. RESULTS: Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes. CONCLUSION: This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia.

Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers.

PURPOSE: The purpose of this study is to investigate the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided modeling with speech-output technologies on the acquisition, maintenance, and generalization of socio-communicative behaviors-initiating a request for a turn, answering questions, and commenting-in four, minimally speaking (MS) autistic children between the ages of 6 and 9 years. METHOD: A multiple-probe design across behaviors replicated across participants was implemented to evaluate the effects of systematic instruction and aided modeling on initiating requests for a turn, answering questions, and commenting behaviors. Additionally, a pre- and posttreatment multiple-generalization-probes design was used to assess generalization across peers. RESULTS: Visual analyses demonstrated experimental control for two participants (i.e., Derek, Ajay) showing a functional relationship between the intervention and outcomes across all social communicative behavior. For one participant (i.e., Matthew), experimental control could not be established because he did not reach the learning criterion for commenting. The fourth participant (i.e., John) transferred to a different school after making some progress on requesting. Effect size indicator analyses corroborated these findings, indicating medium-to-strong effects for initiating requests for a turn strong effects for answering questions, and medium-to-strong effects for commenting. Generalization of socio-communicative behaviors from researcher to a typically developing peer was variable across participants. Participants maintained socio-communicative behaviors 3 weeks after the last intervention session with varying degrees of success. CONCLUSION: The outcomes of this study suggest that aided modeling and systematic instruction using speech-output technologies may lead to gains in socio-communicative behaviors in some MS autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25799935.

Pedagogical Approaches to Cultural and Linguistic Diversity in Communication Sciences and Disorders Programs: A Nationwide Survey.

PURPOSE: This study investigates how instructors in communication sciences and disorders (CSD) programs teach about cultural and linguistic diversity (CLD) in general-content courses as well as those dedicated to CLD content with the goal of identifying ways of improving training of preservice clinicians to provide culturally responsive service delivery. METHOD: A survey was sent to 4,192 instructors in CSD programs at 295 institutions in the United States and Puerto Rico, of which 565 responded. The survey contained choice response questions and open-ended questions. RESULTS: Curricular infusion as the sole strategy of CLD training has decreased since a similar survey was published by Stockman et al. (2008), while the number of programs that offer courses dedicated to CLD or use both strategies has increased. Dedicated CLD courses offer broader training in CLD issues and are considered more effective at preparing students to work with CLD populations. A number of challenges were identified, such as a lack of available resources or time to cover CLD issues. CONCLUSIONS: A combination of curricular infusion and dedicated CLD coursework is recommended to ensure sufficient training in CLD issues. The development of additional resources is needed to better support instructors in both general-content and CLD-dedicated courses. Finally, CLD training should engage students in challenging unjust systems and harmful ideologies and not just celebrate multiculturalism in order to provide culturally responsive service to all clients. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25587651.

Increasing Reciprocal Social Interactions Between Children Who Use Augmentative and Alternative Communication and Peers Using a Collaborative Learning Framework.

PURPOSE: Children with complex communication needs who rely on augmentative and alternative communication (AAC) strategies to express themselves face significant difficulties interaction with peers. This study sought to design, implement, and evaluate a collaborative photography intervention designed to increase reciprocal social interaction between children who use AAC and their same-age peers. METHOD: A single-subject, withdrawal design (ABAB) was used to explore the functional relationship between engagement in a collaborative photography intervention and the frequency of reciprocal social interactions between children who use AAC and their same-age peers. Partial-interval time sampling was used to code the number of reciprocal social interactions across four dyads. RESULTS: Increased frequencies of reciprocal social interactions were observed in intervention phases across all four dyads. Very large levels of effect and 100% nonoverlapping data were noted for Dyads 1 and 4. Moderate levels of effect and 70% of nonoverlapping data were noted for Dyads 2 and 3. CONCLUSIONS: Collaborative learning frameworks may be used to increase reciprocal social interactions between children who use AAC and their peers. Speech-language pathologists should consider utilizing collaborative learning elements in activities with children who use AAC. Future research is needed to further explore collaborative learning frameworks for interventions for children who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25464064.

Still having his say: David Yoder's legacy in AAC.

On February 2 2023, one of the guiding lights in the field of augmentative and alternative communication (AAC) for more than four decades, David E. Yoder, passed away at the age of 90. A voracious reader and gifted storyteller, David was particularly fond of a quote from George Bernard Shaw's Back to Methuselah, "You see things; and you say 'Why?' but I dream things that never were; and I say 'Why not?'" That vision led him to take on multiple leadership roles and influence the field of AAC in multiple ways. He played a pivotal role in establishing both the International Society for Augmentative and Alternative Communication (ISAAC) and the United States Society for Augmentative and Alternative Communication (USSAAC). Additionally, he chaired the panel for the National Institute on Disability and Rehabilitation Research (NIDRR)'s inaugural Consensus Validation Conference on AAC, advocated for the American Speech-Language-Hearing Association to recognize AAC within the profession's scope of practice, and served as the first editor for the Augmentative and Alternative Communication journal. In this tribute, we describe David's diverse and unique contributions to improving the lives of people with communication challenges with a focus on some of his central insights and actions.

Project Building Bridges: A Framework for Preparing Highly Qualified Speech-Language Pathologists to Serve Culturally and Linguistically Diverse Students With Augmentative and Alternative Communication Needs.

PURPOSE: Project Building Bridges was funded by the U.S. Department of Education Office of Special Education Programs to address the shortage of speech-language pathologists qualified to serve students with complex communication needs who benefit from augmentative and alternative communication (AAC) and are culturally and linguistically diverse. The purpose was to train future speech-language pathologists in culturally responsive AAC practices through coursework and fieldwork in AAC integrated into the Master of Science degree in Speech, Language and Hearing Sciences. METHOD: Fifty-seven graduate students completed the project. The scholars' curriculum consisted of two AAC courses, both on-campus and externship AAC clinical practicum experiences to provide services to multicultural and linguistically diverse students, a U.S. or international service-learning opportunity, and cumulative portfolio presentations. RESULTS: Mixed-methods outcome measures consisted of four sets of pre- and postsurveys and qualitative feedback from exit interviews to assess changes in graduate student competencies. Significant differences were demonstrated between scholars' pre- and post-assessments of confidence ratings. Significant differences were also demonstrated in both scholars' and school mentors' pre- and post-assessments of competency ratings. No significant differences were found between evaluations of AAC preparation by Clinical Fellowship (CF) candidates and their CF mentors at 1 year postgraduation. CONCLUSIONS: Project Building Bridges provides a framework for preparing highly qualified speech-language pathologists to serve culturally and linguistically diverse students who benefit from AAC as evidenced by pre- and postsurvey results. The project can serve as a model for other university programs in the development of preservice preparation programs focusing on culturally and linguistically diverse students with AAC needs.

Parents' Perceptions of Eye-Gaze Technology Use by Children With Complex Communication Needs.

PURPOSE: Some preschool students with complex communication needs explore eye-gaze computer technology (EGCT) and adopt computer-based augmentative and alternative communication (AAC). The objective of this study was to follow preschool explorers of EGCT who are now school aged to describe the children's use of technology and parents' perceptions of its utility for communication, participation, or leisure. METHOD: Ten parents completed survey questions by Internet and phone and reported their perceptions of nine children's effectiveness in the use and acceptance of AAC and the support they received in implementing technology. The results are reported as a descriptive study. RESULTS: All children in this research continue to use AAC technology in school and most at home. Many children who tried and obtained EGCT while in preschool continue to use that technology. Most parents agreed that the children understood how to use the devices, which enhanced the children's communication, and that the parents received sufficient support. Most children were limited in their use of the devices for leisure and control of their environments. CONCLUSIONS: Computer-based AAC for school-aged children who trialed it when they were in preschool appears to be a powerful means for them to communicate and participate. However, the technology appears not to be used to its full capabilities to support the children's agency to control environments and to pursue leisure. Teams may want to consider how to support children in using their AAC devices to meet multiple needs. The study was limited by its small sample size and its descriptive nature. Additional research on this subject is needed.

A systematic review of acquisition and mastery of skills taught using the Picture Exchange Communication System.

The Picture Exchange Communication System (PECS) is a popular augmentative and alternative communication intervention for individuals with developmental disabilities that includes six, sequential phases of instruction. We systematically reviewed published and unpublished single-case PECS studies for details about the percentage of participants mastering PECS phases, how long it took participants to master PECS phases (in trials to mastery), and what constituted mastery of PECS phases. We found most participants mastered only the first two phases of PECS, and Phases I, II, and IV showed the slowest and widest variability in trials to mastery. Moreover, participants who were taught the third PECS phase learned to select from an average array of three symbols, which may limit the range of messages they can communicate. We discuss our findings in light of a few important limitations and provide directions for future researchers along with recommendations for professionals who might consider PECS.

Communication support in care homes for older adults: Views and reported practices of speech and language therapists and care home activities staff in the UK.

BACKGROUND: Speech and language therapists (SLTs) and care home activities staff play key roles in managing and supporting the communication needs of older residents in care homes. However, the current practice and perspectives of these two professions in the United Kingdom has not been examined. AIMS: To investigate the practice patterns and views of SLTs and activities staff working in UK care homes for older adults in relation to residents' communication needs. METHODS AND PROCEDURES: Two online surveys, with 63 questions (SLT survey) and 46 questions (activities staff survey) in total, were created using the online platform Qualtrics. Participants were asked to consider their routine practice before COVID-19. Results were analysed using descriptive statistics and qualitative content analysis. OUTCOMES AND RESULTS: A total of 116 valid responses were received from SLTs and 29 valid responses from activities staff. A high level of communication needs in care homes was reported by both participant groups, as was insufficient time and resources and lack of managerial encouragement in this area. SLTs reported that the majority of referrals to their service from care homes was for swallowing needs (70%). Cognitive communication difficulty was the most commonly reported communication need by SLTs (65%). Most SLTs (73%-87%) provided some level of communication intervention and considered management of residents' communication needs to be both part of the SLT role and a good investment of their time. Lack of confidence setting goals and providing direct intervention for communication needs was reported, with 25% feeling stressed at the thought of this. The main themes from free text responses about SLT service improvement were increased staff training, funding (of resources and specialist posts) and changes to service provision (referral criteria and accessibility/awareness of SLT service). Hearing impairment was the communication need most commonly reported by activities staff (43%). Participants demonstrated relatively high awareness of communication difficulty in residents and reported high levels of knowledge and confidence identifying and supporting residents' communication. Most (79%-89%) considered identifying and supporting the communication needs of residents to be part of their role and expressed interest in receiving further training in communication support. The reported activities staff data set may be positively biased. CONCLUSIONS AND IMPLICATIONS: SLTs and activities staff were highly motivated to support the communication needs of care home residents. Increased training, time and resources dedicated to managing the communication needs of residents emerged as opportunities for service improvement across both data sets. WHAT THIS PAPER ADDS: What is already known on the subject There is a high level of communication need amongst older care home residents. Social interaction and relationships are important factors contributing to quality of life in this population and rely on successful communication. Speech and language therapists (SLTs) and activities staff play key roles in managing and supporting the communication needs of this client group, but the current practice and perspectives of these professions in the United Kingdom has not been examined. What this study adds A high level of communication need in care home residents was identified by both SLT and activities staff and both participant groups were motivated to address, identify and manage this need. However, insufficient time and resources, as well as a perceived lack of encouragement from managers to provide communication support/intervention, were reported by both groups. SLT practice was constrained by referral criteria and care pathways, which differed between services. Suggestions for SLT service improvement are reported. Clinical implications of this study Targeted, ongoing staff training is required in care homes to improve the communication environment and develop care home staff capacity to support residents' communication needs. There is also a call for service level improvements to increase the range of SLT practice in care homes, including a greater focus on communication needs and more specialist (e.g., dementia) SLT roles.

Understanding adults with communication disorders in Ghana: Accessing rehabilitation and support systems.

Communication is pivotal to our societal experiences; therefore, the onset of a communication disorder will negatively affect an individual's social capabilities. However, in sub-Saharan African countries, there is limited public discourse on the development of individuals with communication disorders. From the perspective of critical disability theory, there have been few opportunities for adults with communication disorders to share stories about their experiences and their developmental progress. A semi-structured interview guide was designed to collect data from 23 adults with communication disorders recruited from 10 communities in three districts in a region in Ghana. The findings are thematized under the following criteria: diagnosis and rehabilitation, familial support and impact on development. The study concludes with an invitation to policymakers to prioritize the rehabilitation needs of individuals with communication disorders and a discussion on additional study implications.

The pervasive and unyielding impacts of cognitive-communication changes following traumatic brain injury.

BACKGROUND: Cognitive-communication disorders (CCDs) are common in the traumatic brain injury (TBI) population. Despite this, there has been limited research that explores the long-term impacts of reduced cognitive-communication functioning on daily life for this population. AIMS: To identify the long-term impacts of cognitive-communication impairment as reported by adults with TBI and their significant others. METHODS & PROCEDURES: A qualitative descriptive approach grounded in phenomenology was used. Semi-structured, one-on-one interviews were conducted with adults with CCDs following TBI (n = 16) and their significant others (n = 12) to explore their lived experiences. OUTCOMES & RESULTS: Reflexive thematic analysis revealed an overarching theme of 'The pervasive and unyielding impacts of cognitive-communication changes on daily life following TBI'. Within this overarching theme, three subthemes were identified: (1) self-awareness of communication changes; (2) fatigue; and (3) self-identity and life roles. CONCLUSION & IMPLICATIONS: The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on daily life. Health professionals supporting this population should consider ways to reduce the significant impact CCDs have on the lives of adults following TBI and their significant others. In addition, the findings highlight the importance of long-term rehabilitation services following TBI, with further research needed that explores how these services can be optimised. WHAT THIS PAPER ADDS: What is already known on this subject Cognitive-communication disorders (CCDs) affect the majority of adults who experience moderate to severe traumatic brain injury (TBI) and encompass any component of communication that is affected by cognition. The hallmark characteristic of CCDs are breakdowns that affect social communication skills as well as cognitive-linguistic deficits. Combined, these can have dramatic implications for a person's quality of life, their level of independence, employment opportunities and social participation. There has been limited research to date that explores the long-term impacts of CCDs on the lives of adults following TBI. Further research that explores these impacts is needed to improve the support services and rehabilitation models of care available for this population. What this study adds The overarching theme was 'The pervasive and unyielding impacts of communication changes on daily life following TBI' with subthemes including changed communication, self-awareness of communication changes, fatigue and self-identity and life roles. The findings from this study highlight the long-term negative impacts of reduced cognitive-communication functioning on everyday functioning and quality of life as well as the importance of long-term rehabilitation services following TBI. What are the clinical implications of this work? Speech-language therapists and other health professionals working with this clinical population should consider how to address the significant and long-lasting impacts of CCDs. Due to the complex nature of the barriers experienced by this clinical population, an interdisciplinary targeted approach is advised wherever possible when providing rehabilitation services.

Focusing Our Attention on Socially Responsive Professional Education to Serve Ethnogeriatric Populations With Neurogenic Communication Disorders in the United States.

PURPOSE: This viewpoint discusses a plausible framework to educate future speech-language pathologists (SLPs) as socially responsive practitioners who serve and advocate for the burgeoning vulnerable ethnogeriatric populations with neurogenic communication disorders. METHOD: We provide an overview of the demographic, epidemiological, and biopsychosocial context that supports the implementation of equity-based, population-grounded educational approaches for speech-language pathology services in ethnogeriatric neurorehabilitation caseloads and discuss a plausible perspective based on the educational social determinants of health (SDOH) framework by the National Academies of Sciences, Engineering, and Medicine. RESULTS: The NASEM's three-domain SDOH educational perspective integrates education, community, and organization to create a self-reinforcing pedagogical coproduction that, grounded in the synergized partnerships of educational institutions, engaged communities, and organizational leadership, aims to address systemic drivers of health perpetuating ethnoracial disparities in health, care, and outcomes. CONCLUSION: Exponentially growing vulnerable ethnogeriatric populations with age-related neurogenic communication disorders warrant the implementation of health equity education strategies to train technically prepared, socially conscious SLPs as service providers and advocates.

Apragmatism: The renewal of a label for communication disorders associated with right hemisphere brain damage.

BACKGROUND: Right hemisphere communication disorders are neither consistently labelled nor adequately defined. Labels associated with right hemisphere brain damage (RHD) are broad and fail to capture the essence of communication challenges needed for stroke-related service provisions. Determination of rehabilitation needs and best-practice guidelines for the education, management and functional improvement of communication disorders after RHD are all predicated on an apt diagnostic label and disorder characteristics. AIMS: In this paper apragmatism is proposed as a potential communication-specific diagnostic label for the impairments in communication that occur after RHD. In particular, the researchers aimed: (1) to establish an operational definition of apragmatism; and (2) to describe the linguistic, paralinguistic and extralinguistic communication deficits under the umbrella term apragmatism. METHODS & PROCEDURES: An international collaborative of researchers with expertise in RHD followed a multilevel approach to consider the utility of apragmatism as a diagnostic label. Adopting the relational approach to concept mapping, the researchers engaged in a series of group meetings to complete four levels of mapping: (1) identify and review, (2) define, (3) expert discussion and (4) label determination. MAIN CONTRIBUTION: Apragmatism was established as a suitable diagnostic label for the impairments in communication associated with RHD. The paper offers an operational definition and description of the linguistic, paralinguistic and extralinguistic features of apragmatism through evidence summaries and examples from people with RHD retrieved from the RHDBank. CONCLUSIONS & IMPLICATIONS: The adoption of the term apragmatism offers an opportunity to capture the hallmark of RHD communication deficits. The use of the term is recommended when referencing the pragmatic language impairments in this population. Apragmatism, which may co-occur with or be exacerbated by cognitive impairments, can interfere with the ability to interpret and convey intended meaning and impact the lives of right hemisphere stroke survivors and their families. WHAT THIS PAPER ADDS: What is already known on the subject RHD results in a heterogeneous group of deficits that range in cognitive-communicative complexity. Many of the deficits are subsumed under pragmatics. For example, adults with RHD may demonstrate tangential or verbose communication, insensitivity to others' needs and feelings, prosodic changes, minimal gesture use and facial expression, and more. While descriptions of pragmatic impairments pervade the literature, there is no consistently used diagnostic label. The clinical consequences of this absence include difficulty with inter- and intra-disciplinary communication about these patients, difficulty consolidating findings across research studies, and challenges in communicating about these pragmatic changes with patients, families and other stakeholders. What this paper adds to existing knowledge The term apragmatism is proposed as a diagnostic label to consistently describe pragmatic communication changes after RHD. Apragmatism is characterized using three components of pragmatics: linguistic, paralinguistic and extralinguistic. Descriptions and examples of these three components are provided with supplemental transcripts retrieved from the RHDBank. What are the potential or actual clinical implications of this work? Adoption of the term apragmatism by speech and language therapists and other medical and rehabilitation professionals has the potential to provide consistency in describing the abilities and challenges experienced by people following a right hemisphere stroke. Such improvements may help drive the development of evidence-based assessments and treatments for this population.

"Communication Is Not Exactly My Field, but It Is Still My Area of Work": Staff and Managers' Experiences of Communication With People With Traumatic Brain Injury.

PURPOSE: Communication between people with traumatic brain injury (TBI) and rehabilitation staff can be impacted by cognitive-communication disorders. Communication partner training (CPT) programs hold potential to improve communication between people with TBI and their communication partners. To tailor CPT programs to the rehabilitation environment, it is critical to understand the nature of communicative interactions for staff members. This study explores staff and managers' experiences of communication with people with TBI in the rehabilitation setting. METHOD: Individual semistructured videoconference interviews were carried out with staff members (n = 22) and managers (n = 4) varying in terms of professions and length of work experience. Interviews were guided by a phenomenological approach to gain comprehensive knowledge of staff and managers' lived experiences of communication with people with TBI. RESULTS: Four themes with nine subthemes were generated: (a) cognitive-communication disorders challenge interaction (communication is socially inappropriate, the diversity of presenting symptoms associated with TBI is demanding), (b) staff struggle in communication (there is a breakdown of communicative collaboration, communication increases staff's workload, emotional well-being of staff is at risk), (c) communication context is crucial (tasks affect communication, extending the professional roles), and (d) staff want communication knowledge and skills (needs vary according to work experience, access to tailored strategies, and feedback). CONCLUSIONS: Staff and managers experienced communication with people with TBI as highly demanding. The socially inappropriate communication in people with TBI was perceived to disturb the collaborative aspects of communication and create negative emotional impacts for staff. Staff experiences varied according to discipline, work experience, rehabilitation tasks, and facility. Consequently, staff and managers expressed a need for specific communication strategies to help them overcome the communicative challenges. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.21579159.

Community-based rehabilitation for adults with cognitive-communication disorders following traumatic brain injury: A mixed methods investigation.

OBJECTIVE: To investigate the experiences and perspectives of speech pathologists when delivering cognitive-communication therapy to adults following traumatic brain injury (TBI). METHODS: An explanatory sequential mixed methods design was used to explore the practices of speech pathologists working in community-based rehabilitation (CBR) settings. The first participant group completed an in-depth online survey, whilst the second group participated in an interview to discuss their processes and recommendations when managing adults following TBI. RESULTS: Participants highlighted the need for services to be client-centered and inclusive in their approaches to meet the rehabilitation needs of people following TBI in community-based settings. The key features identified to achieve this included utilizing a flexible service delivery approach, implementation of meaningful therapy, as well as inclusion of significant others. CONCLUSIONS: These findings provide a snapshot of the current practices employed by a range of speech pathology services across Australia and New Zealand. Health professionals and rehabilitation service providers should consider the key factors highlighted by the participants when designing future CBR models of care for this client group.

The role of Augmentative and Alternative Communication in Speech and Language Therapy: A mini review.

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan.

Telerehabilitation for Communication and Swallowing Disorders in Parkinson's Disease.

Communication and swallowing disorders are highly prevalent in people with Parkinson's disease (PD). The negative impact of these disorders on the quality of life of the person with PD and their families cannot be underestimated. Despite a demand for speech-language pathology services to support people with PD, many barriers to services exist. Telerehabilitation provides an alternate and complementary approach to in-person therapy that is patient-centered, enables timely assessment and intervention, and facilitates continuity of care throughout the course of the disease. This review explores the telerehabilitation applications designed for the management of the communication and swallowing disorders in PD, addresses the benefits and challenges of telerehabilitation, identifies future research directions, and highlights the potential of new technologies to enhance the management of communication and swallowing disorders and quality of life for people with PD.

Children With Cortical Visual Impairment and Complex Communication Needs: Identifying Gaps Between Needs and Current Practice.

Purpose This scoping study sought to establish a baseline for how well the needs of children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC) are currently aligned with the services available to them. CVI is the most common cause of visual impairment in children today, and AAC methods rely heavily on vision. Yet, the prevalence of CVI in children who use AAC methods is not yet known, and there is virtually no research concerning use of AAC with children with CVI. Our overarching goals were to identify barriers and suggest priorities for improving outcomes for these children. Method Surveys were distributed anonymously online to professionals from multiple disciplines in different school-based settings and to parents of children with CVI who use AAC. Results School-based professionals identified many barriers, including a lack of knowledge and skills about CVI and about AAC, limited access to training and experts, and concerns about services being delivered in isolated silos with limited time allotted for interprofessional collaboration and planning. Parent reported that their children (M age = 11 years) continued to rely predominantly on body-based forms of communication and lacked access to symbolic language, which, in AAC, is primarily visually based. Conclusions The barriers to services identified by school-based professionals indicate a need to develop and disseminate reliable information about CVI and AAC, both at a preservice and in-service level and, while doing so, to respect the diversity of stakeholders who need this information, including parents. Future research on what types of AAC approaches support the development of language and communication skills for children with CVI is essential.

Perceived importance of AAC messages to support communication in rehabilitation settings.

PURPOSE: Permanent or temporary speech loss can occur due to a variety of medical conditions and often requires individuals to use augmentative and alternative communication (AAC) strategies and technologies to support communication. The use of AAC in medical and rehabilitation settings is critical to ensure the health, safety and psychological well-being of communicatively vulnerable individuals. METHOD: This study surveyed the perceived importance of communication messages within five categories (Basic Needs, Patient-Provider Specific Communication, Social, Feelings, and Messages for Young Children) by individuals with disability who have undergone recent medical care as well as by rehabilitation care providers. RESULTS: Results indicated that, with only a few exceptions, participants with disability more frequently selected all of the messages listed under the Patient-Provider Specific, Social, and Feelings categories compared to rehabilitation care providers' responses. Additionally, the individuals with disabilities selected messages that were more personalised to their specific care needs under Basic Needs. Both participant groups were asked to also suggest other messages that they perceived as important under each category. The other suggested messages demonstrated the potential need to provide personalisation to AAC displays to best meet the communication needs of individuals with disability.Implications for RehabilitationThere is a critical need for individuals who find themselves in medical settings (ICU, acute care hospital, rehabilitation hospital, etc.) to be able to communicate. This study provides preliminary information on the breadth of communication content that is perceived as relevant by individuals with disability and rehabilitation care providers. The need to provide personalized as well as a wide range of communication content options was of particular importance to individuals with disability. This information may provide specific guidance on how to best develop augmentative and alternative communication options for individuals in medical settings.