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Interactive computing devices are increasingly being deployed to support individuals in improving and managing health, aging in place, and as assistive devices for those with functional limitations. Augmentative Alternative Communication (AAC) aids are devices that help individuals with speech impairments communicate. They are typically prescribed by clinicians (speech–language pathologists) based on a specific individual’s physical needs and disease classification. While personas have been used in the design of other consumer technologies, they have not been frequently deployed in the design of clinically oriented technologies, including AAC devices. Instead, a clinical/rehabilitation engineering approach to AAC design is typically used, focusing on the physical and symptomatic needs of a diverse group of individuals, and involving the consumer on the level of making feature recommendations and/or testing the technology near the end of the design and production process. To address this challenge,...

Communication gaps have been systematically linked to failures during surgery; however few studies have addressed challenges related to the remoteness of the surgeon during robot-assisted surgery (RAS). While studies on team communication in the Operating Room (OR) rarely report on nonverbal aspects, our initial work has shown that the vast majority of interaction events between the console surgeon and the right bed side assistant is nonverbal. This study focuses on improving our understanding of the nature of the multimodal interactions between surgeons and right bed side assistants. Six robot-assisted radical prostatectomies were recorded and the interaction events between the surgeon and the right bed side assistant were categorized by type (verbal/nonverbal), topic, and sender. The proportion of verbal and nonverbal events varied with the topic of the interaction. Strategies to improve team communication during surgery should take into account both the use of nonverbal communication means and the change in communication strategies based on purpose.

Communication breakdowns in the operating room (OR) have been linked to errors during surgery. Robot-assisted surgery (RAS), a new surgical technology, can lead to new challenges in communication owing to the remote location of the surgeon away from the patient and bedside assistants. Nevertheless, few studies have studied communication strategies during RAS. In this study, 11 robot-assisted radical prostatectomies were recorded and the interaction events between the surgeon and two bedside surgical team members were categorized by modality (verbal/nonverbal), topic, and pair (sender and receiver). Both verbal and nonverbal modalities were used by all pairs. The percentage of nonverbal interactions differed significantly by pair: 66% for the Surgeon-Physician Assistant, 50% for the Physician Assistant-Scrub Nurse, and 25% for the Surgeon-Scrub Nurse, indicating different communication strategies across pairs. In addition, there was a significant dependence between topic and the percentages of verbal and nonverbal events for all pairs. Strategies to improve team communication during RAS should take into account the use of verbal and nonverbal communication means and the variation in interaction strategies based on the topic of communication.

Augmentative Alternative Communication (AAC) aids are devices that help individuals with speech impairments communicate. Currently, the design and development of AAC devices does not follow a usercentered design philosophy. This affects the quality of life of individuals who are in need of AAC devices. Individuals with the progressive disease Amyotrophic Lateral Sclerosis (ALS) are a population for which AAC is of critical importance. Due to the ALS individuals’ physical capabilities and constraints, there are challenges in involving the user population in a user-centered design process. This paper recommends the application of the methodology of persona development derived from the field of interaction design/usercentered design to solve some of the existing problems in the design of AAC devices for this population. This research demonstrates how current user-centered design methodologies can be adapted to develop personas of individuals with ALS and more generally, how user-centered design should be integrated into the design of AAC devices to enhance the quality of life of individuals with communication impairments.

Significant progress has been made in the application of natural language processing (NLP) to augmentative and alternative communication (AAC), particularly in the areas of interface design and word prediction. This article will survey the current state-of-the-science of NLP in AAC and discuss its future applications for the development of next generation of AAC technology.

Evidence is accumulating for the language use model in psycholinguistics, the social sciences as well as work in human computer interaction. Recent research in augmentative and alternative communication (AAC) has demonstrated the insufficiency of the sender-receiver model for characterizing augmented interactions. In this paper we will begin to provide a framework for showing how the AAC field may benefit from examining how people perform using language during in-person interaction.

Augmentative and Alternative Communication (AAC) devices include special purpose electronic devices that generate speech output and are used by individuals to augment or replace vocal communication. Word prediction, including context specific prediction, has been proposed to help overcome barriers to the use of these devices (e.g., slow communication rates and limited access to situation-related vocabulary), but has not been tested in terms of effects during actual task performance. In this study, we compared AAC device use, task performance, and user perceptions across three tasks, in conditions where the AAC device used either was, or was not, primed with task specific vocabularies. The participants in this study were adults with normal physical, cognitive, and communication abilities. Context priming had a marginally significant effect on AAC device use as measured by keystroke savings; however, these advantages did not translate into higher level measures of rate, task performance, or user perceptions. In contrast, there were various statistically significant process and performance differences across task type. Additionally, results for two different emulations of human performance showed significant keystroke savings across context conditions. However, these effects were mitigated in actual performance and did not translate into keystroke savings. This indicates to AAC device designers and users that keystroke-based measures of device use may not be predictive of high level performance.

The purpose of this study was to evaluate the efficacy of a computer program, Converser, which uses the speech recognition of the speaking partner to predict contextually appropriate utterances and to store relevant noun phrases. The dyads (which consisted of a program user and a speaking partner) tested Converser in two communication tasks: a conversation and an interview. Two conditions were applied: A simple communication aid with an alphabet layout without Converser (alpha-only condition), and an identical aid with Converser (alpha-converser condition). Objective measurements were made concerning the program user's rate and Converser usage. The results showed that the alpha-converser condition generated a faster communication rate than the alpha-only condition. Also, the program users utilized the stored noun phrases in their productions more than the full utterances. Converser allowed for periodic instances of a fast rate of speech, which appeared to have a positive impact on communication.

The experiment compared the ability of a Comprehension Model versus an Interaction Model to account for the communication performance of augmented communicators. Five dyads consisting of adults without disabilities, with one participant in each dyad randomly assigned to use an augmentative communication device, engaged in ten direction-giving tasks in which the augmented communicator used either a Word Method (i.e., spoken words only) or a Mixed Method (i.e., mix of spoken words and letters) speech output. Results indicated an overall completion time and communication rate advantage for the Mixed Method output in most communication tasks, supporting the Interaction Model of augmented communication. The role of communication co-construction in augmented interaction and the implications of the Interaction Model for future communication device design are discussed.

A significant barrier to evidence-based practice in Augmentative and Alternative Communication (AAC) is the lack of validated performance measures that can be used by speech-language pathologists and rehabilitation engineers to evaluate the communication and device use of AAC consumers. Recently an effort has been made to develop automated data-logging techniques to facilitate the transcription and analysis of the AAC speaker's device use. A major source of error for the automated measurement of communication rate is the presence of excessive Inter-Selection Intervals (ISIs) (i.e., pause times), for which no communicative activity is occurring. The goal of this study was to develop an automated technique to filter out extreme ISIs, while preserving true communication rate performance. AAC data log files were obtained from seven individuals participating in a 1-month field trial of an AAC technology. Two temporal filtering techniques (arbitrary and individual) were compared for their ability to eliminate excessive ISIs. Results indicated that use of an individualized temporal filter was more sensitive to performance variability than use of an arbitrary temporal filter. Further, the individualized temporal filter elevated the participants' communication rate (measured by words per minute) by a factor of 1.8 to 34.5 greater than that of the unfiltered communication rate estimate. In addition, the first AAC communication rate performance estimates taken from the field are presented. Implications for further research and the valid use of automated data logging and analysis are discussed.

This study investigated the relative performance of two computer input devices appropriate for persons sharing similar motor challenges: a head operated device and expanded membrane cursor keys. Performance was evaluated in the context of a Fitts' law target acquisition task. For this initial phase of investigation, subjects without disabilities were selected to focus on performance differences inherent in the devices and their operation. Results indicated that the total time to acquire a target was significantly faster for the head device than for the expanded cursor keys. For typical young adults, the head-operated device required less time to reach asymptote performance by simplifying the cognitive demands for device operation. These results suggest that for persons unable to isolate their fingers, head-operated controls may offer advantages over input devices operated by the upper extremities.

The doctor of audiology (AuD) program at the University at Buffalo is summarized in this article. We begin with a description of the city of Buffalo and the University at Buffalo. This is followed by a brief history of the university and the Department of Communicative Disorders & Sciences. We then summarize the timeline and the process required to develop the AuD program. Admissions policies and prerequisites are then reviewed. We discuss the faculty active in our AuD program and present the requirements (clinical, academic, research) for the degree. The article ends with a delineation of the challenges we face, as well as a description of some of the factors that make the audiology program at the University at Buffalo unique.

Spoken language comprehension, including comprehension for inferential material in narrative discourse, is diminished in dementia of the Alzheimer type (DAT). There are, however, no empirical data concerning comprehension by adults with DAT of main ideas versus details in narratives. Evidence from other groups with and without brain damage has shown that comprehension for main ideas is relatively better than for details and that comprehension for stated material is relatively better than comprehension for inferential material. Participants in the present investigation were 24 older adults, 8 with early-stage DAT (EDAT), 8 with middle-stage DAT (MDAT), and 8 with no brain damage (NBD). Selected narratives and associated sets of yes-no questions from the Discourse Comprehension Test (DCT) (Brookshire and Nicholas, 1993) were presented on videotape. Participants with EDAT and MDAT had significantly poorer overall comprehension of DCT narratives than did those in the NBD group (p

The texts of 12 English and 12 Chinese children's books were analysed for how they referred to the main characters in the stories. Comparisons were made between referring expressions used in six texts for early-level readers and six texts for mid-level readers in both languages. There were no differences found between early- and mid-level texts in their use of full expressions, pronouns or ellipsis within the two languages. However, the Chinese books at both levels contained significantly more elliptical expressions than the English books, and there was a trend for the Chinese books to use fewer pronominal expressions than the English books. Finally, contexts of use for the full expressions indicated that these expressions tended to occur where something in the discourse was changing: moves in and out of the story frame, moves involving a shift in character or time and place of the story, and moves in and out of quoted speech. Full expressions were also used to resolve ambiguity. These differences...

Scanning communication systems provide a unique set of opportunities for the application of augmentative communication technologies. Possibilities include optimization of the row-column matrix, dynamic rearrangement of the matrix, addition of character or word lists, and combinations of these techniques. A series of descriptive experiments were performed to establish the switch savings performance of 14 different scanning configurations. A common software platform and a strictly regimented testing procedure were employed to ensure the reliability and consistency of the data, facilitating comparisons between the different paradigms. Within each configuration, a systematic analysis of the relevant parameters was performed. The best character prediction method provided an average switch savings of 40.5% over a baseline row-column configuration, while the best word prediction technique provided an average savings of only 38.8%. Both of these configurations used seven-element prediction lists, which did not pr...

This study investigates the different temporal orders that manifest in interactions involving a participant using an Augmentative Alternative Communications (AAC) device. Studies examining the use of AAC devices have regularly incorporated a particular understanding of temporality by using time as a measuring device to compare inter- and intra-individual action. In this paper we present an alternative perspective on time-in-interaction by showing how participants attend to time by examining their interactive behavior. Here, time is conceived in terms of how participants experience the duration and unfolding of a particular utterance. Through a close analysis of an interaction between a man with late-stage ALS and his wife, this paper shows how different orientations to time can underpin breakdowns of intersubjectivity. The analysis traces elements of this temporal disconnect to a variety of sources including the normative temporal expectations for the production of utterances through mouth-speech and the functioning of the device itself. The temporal misalignment leads to slippages in the participants' orientation to the sequential relevance of utterances and utterance parts that leads to misunderstanding.KEYWORDS: TEMPORALITY; TIME; SEQUENCE; AUGMENTATIVE ALTERNATIVE COMMUNICATION; TALK-IN-INTERACTION; CONVERSATION ANALYSIS; HUMAN-COMPUTER INTERACTION.1. IntroductionA focus on time has occupied a great deal of the attention that various academic fields have paid to the use of AAC devices, with special attention paid to the ways that turns and actions unfold in spontaneously occurring talkin- interaction, and, specifically, the rate at which augmented communicators produce their utterances (e.g. Beukelman and Mirenda 2005; Hill and Romich 2002; Smith et al. 2006; Todman and Rzepecka 2003; Todman et al. 2008; Trnka et al. 2007). To our knowledge, all of these studies have relied on objectified understandings of 'time' in order to document the interactional phenomena of investigation - e.g. words per minute, bits per second, delay at pre-utterance pause length, etc. In such studies, 'time' is understood in terms of the succession of uniform, discrete, measureable units that exist prior to and independent of any individual, situation, or event. Philosophers of the experience of time have argued that such a Newtonian model of duration is befitting of investigations of physical occurrences, but fails to account for the experience of duration necessary to make such measures appropriate to the study of humans. This owes to the fact that we do not typically experience time as an object, per se, but experience objects and events in time: both with respect to the duration of the sensations they engender and the relationships they conjure with remembered pasts and anticipated futures (Husserl 1964).More recently, scholars interested in conversation have applied tools developed in the field of conversation analysis (CA) to the field of AAC in order to focus on the sequentiality of action in an attempt to move beyond this sort of analytically imposed temporal objectivity. Examples of such work have been produced by members of the Sheffield/University College London group (e.g. Clarke and Wilkinson 2007; Clarke and Wilkinson 2008; Clarke and Wilkinson 2010; Clarke 2005; Wilkinson 1999; Wilkinson et al. 2003; Wilkinson et al. 2011) as well as others (e.g. Goodwin 2004; Goodwin 2006; Goodwin et al. 2002; Heeschen and Schegloff1999; Higginbotham and Engelke, in press; Higginbotham and Wilkins 1999). These analysts examine the ways that turns at talk (including those augmented by various graphic resources) are positioned and understood by the participants with respect to preceding and subsequent actions. This effort to reconceive the unfolding of an interaction in terms of sequential actions rather than elapsed time has produced a rich and valuable understanding of the ways in which interactions involving disabled and/or augmented speakers are organized. …

Conversational repair was examined in videotaped samples of spontaneous mealtime talk of 6 normal elderly adults, 5 subjects with early stage dementia of the Alzheimer's type (EDAT) and 5 subjects with middle stage DAT (MDAT) with a family member who acted as a conversational partner. The overall percentage of utterances involved in communication breakdown and repair and the specific proportions of utterances related to conversation problems, signals identifying problems, and repairs, were evaluated. Using the normal dyads as a control group, results showed the differential effects of DAT onset and progression on the conversational repair behavior of both subjects with DAT and their conversational partner. The percentage of conversation involved in repair was significantly higher for MDAT versus control and EDAT dyads. Despite the increase of conversational troubles with DAT onset and progression, the difficulties were repaired successfully the majority of the time. Subjects with EDAT produced more requests for repair than did their conversational partners. However, conversational partners of EDAT subjects used more elaboration repairs than did EDAT subjects. The opposite pattern was observed in the MDAT group where subjects with MDAT created and repaired more conversational problems than did their conversational partner. MDAT subjects produced more discourse trouble sources than did EDAT subjects. It was also observed that MDAT subjects and conversational partners frequently used nonspecific terms to signal misunderstandings. The findings have important implications for developing family caregiver communication enhancement strategies that are specific to the clinical stage of DAT.

The purpose of this investigation was to specify the kinds of miscomprehensions produced by individuals listening to synthetic speech. In the first study, 80 written summaries of synthesized speech passages were analyzed to determine the types of miscomprehensions or linguistic departures made by listeners when attempting to recall the spoken texts. These departures were classified according to their linguistic departure type (insertion, recast, reduction, substitution, paraphrase) and level (phonemic, lexical, phrase, clause, discourse). Linguistic departures were studied as to their role in miscomprehension and their ability to reveal listener comprehension strategies. In a second study, 159 written summaries were analyzed according to their primary departure type and then analyzed for their relation to speech synthesis voice quality, presentation rate, and scores from a global rating of discourse summarization accuracy. Three “clusters” emerged from these analyses, reflecting an association between spe...

The purpose of this investigation was to determine the effects of the quality and speech presentation rate (SPR) of synthetic speech and textual characteristics (length, complexity, genre) on a listener's ability to summarize paragraph-length texts. Forty able-bodied students and staff members were individually tested over a 3-day period, listening to eight texts produced by one of two synthesizers (DECtalk, Echo+) at a normal SPR or with 10-second intervals of silence interspersed between individual words. Using a discourse summarization taxonomy developed for this study, subjects listening to DECtalk speech produced more accurate summaries than did ECHO speech listeners, and synthetic speech presented at a slow rate was summarized more accurately than synthetic speech presented at a normal SPR. Additionally, a significant three-way interaction effect was noted for voice × SPR × text complexity. Echo listeners performed more poorly at normal versus slow SPRs regardless of text complexity level. However, ...

In this chapter, the authors will discuss the use of speech synthesis as a human communication tool in what is now referred to as Augmentative and Alternative Communication (AAC). The authors will describe the history and use of speech synthesis in AAC, relevant stakeholders, a framework for evaluating speech synthesis in AAC and relevant research and development with respect to intelligibility, comprehension, social interaction, emotional expressivity and personal identity potential of current implementations of speech synthesis into SGD technologies. Throughout the chapter recommendations will be made for making SGDs more effective and appropriate for social interaction and emotional expression. This chapter will also provide 1st person accounts of relating to SGD use in order to provide a stakeholder perspective.

This article discusses technology training in the communicative disorders discipline. In particular, we share our personal experiences and points of view about the preprofessional training of speech-language pathologists and augmentative communication specialists in the Department of Communicative Disorders and Sciences at the University at Buffalo (UB). Historically, clinical progress in the communicative disorders profession, and particularly in speech-language pathology, has been driven to a great extent by advances in linguistics, psychology, education, and medicine, but to a significantly lesser extent by technological developments, as is the case with rehabilitation engineering and certain areas of occupational therapy. Table 1 presents a variety of etiologies and communication problems presented by clients who are seen by speech-language pathologists. The diversity of these communication problems presents our graduate training programs with many significant "nontechnical" challenges in preparing students for professionallife. Within the last decade, however, advanced technologies (e.g., microcomputers, video recording and playback technologies, acoustic assessment systems, and augmentative communication devices) have become an intrinsic part of our clinical practice due to their availability, affordability, utility, and in particular, the relatively high level of software sophistication required to address the needs of clients and clinicians. One only has to tour the manufacturers' exhibit area at the American Speech-Language and Hearing Association national convention to witness the ever-increasing technology for speech-language pathology. In preparing this article, we talked with several colleagues about the technology training needs in their various specialty areas. Their responses consistently reflected the realization that our profession must come to grips with the rather extensive technology-related preparation skills required by students. These include the skills used with the modern technologies specific to the profession and with the more generic technologies, such as computers and video recording, required for general professional use.

This investigation assessed the written keystroke savings of five available assistive communication technologies (ACTs): E Z Keys, Predictive Linguistic Program, Words Strategy, Write 100, and a generic encoding technique. Each ACT was used to type 20 written expository texts composed by nondisabled individuals from four grade levels (4th, 8th, 12th, and college). Evaluation of keystroke savings revealed significant between-ACT differences in keystroke savings across devices for all typed text, typed text contained in an ACT's lexicon and spelled text, as well as differences in the vocabulary coverage of each ACT. Between-grade differences in keystroke savings were not generally noted. Results are discussed in regard to the utility of keystroke savings for clinical evaluation and communication device development.

This research explores the efficacy of an AAC application, Converser, that uses natural language processing to assist in communication. Converser uses speech recognition of the speaking partner to predict contextually appropriate utterances. This article reports on the subjective data gathered from an experimental evaluation of Converser's efficacy (see Wisenburn and Higginbotham, 2008 for a full description of Converser and the objective results). Converser was evaluated in two communication tasks (a Conversation and an Interview task) under two conditions: a simple alphabet board without Converser (alpha-only condition), and an identical board with Converser (alpha-Converser condition). Subjective data was gathered through rating questionnaires and written comments. Program users rated the speed of communication faster in the alpha-Converser condition. Program user ratings of quality, and speaking partner ratings of speed and quality, showed no difference between the two conditions; however, the participant comments about Converser were positive.

Transferring innovative technologies from the university to the manufacturing sector can often be an elusive and problematic process. The Rehabilitation and Engineering Research Center on Communication Enhancement (AAC-RERC) has worked with the manufacturing community for the last 10 years. The purpose of this article is to discuss barriers to technology transfer, to outline some technology transfer strategies, and to illustrate these strategies with AAC-RERC related activities.

In this concluding paper related to subject selection in augmentative and alternative communication (AAC) research, four issues previously discussed are brought together: the representativeness/homogeneity of subjects, methodological design, external validity, and research economics. In light of these particular issues, a set of heuristics for making appropriate subject choices is provided.

In this article, Clark's theory of language use is applied to the study of conversations of augmented speakers and their addressees. Discussion focuses on how shared meaning--called common ground--is achieved, the process of grounding utterances under real-time constraints, and how the media characteristics of devices affect the grounding process. A joint action analysis of grounding will be applied to examples of word-board and Voice Output Communication Aid (VOCA)-mediated conversations to show how participants organize their talk around specific media constraints to conduct their conversations and solve communication problems. The authors argue that this model of device-mediated communication performance, or some variety of it, has the potential to reconcile many of the individual research findings in this field within a single explanatory framework. If successful, this approach could be used to evaluate future research with an empirically-based model of communication performance.

The purpose of this investigation was to determine the relative effects of three different Augmentative and Alternative Communication (AAC) speech output methods (word, sentence, mixed words and letters) on a listener's ability to summarize paragraph-length texts. Based on previous work on the discourse processing of synthetic speech, a monotonic trend in a listener's ability to accurately summarize texts produced by different output methods was hypothesized (word > sentence > mixed). Thirty able-bodied adults were individually tested over a 2-day period, listening to four texts produced by a DECtalk speech synthesizer at a speech presentation rate of 7.5 wpm. Using a discourse summarization taxonomy developed by Higginbotham, Lundy, and Scally (1993), the experimental hypothesis was confirmed. Word-method listeners produced significantly more accurate renditions of the original texts than sentence-method listeners, who, in turn, did better than mixed-method listeners. Statistically significant differences also were found for the topic familiarity of the texts. The role of the above variables on AAC device comprehension and technology design is discussed.

A 6½ -year-old child’s oral and spelled utterances were compared over a 3-month period as he was trained to use Facilitated Communication (FC), a method of augmentative and alternative communication. The child’s language with FC was significantly better than his oral language in length of utterances, novelty of utterances, and syntactic complexity. His language with FC also contained more function words and over time was more intelligible and required less verbal scaffolding than his oral communication. Evidence that he was authoring his own messages during his facilitated spelling was found in his idiosyncratic use of language and his ability to convey verifiable information that was unknown to the facilitator. The strongest evidence came later with his ability to type messages without physical support. The results suggest the potential for using FC with children who have some functional oral skills but cannot express themselves fully in the oral modality. The method can serve as a means of investigating language potential and as a transition to literacy and independent typed communication.

This study sought to determine how augmentative communication device output modes differentially affected various aspects of interactions between nonspeaking persons (NSPs) and their speaking partners (SPs). It was hypothesized that when an electronic output display (EOD) was added to a communication board, the semipermanent display of information would lessen the dyad's need to adopt specialized turn and message formulation conventions, permitting the NSP to construct more complex messages with fewer communication breakdowns. A series of 10 interactional teaching tasks were recorded for two adult male nonhandicapped dyads performing under the two output conditions (±EOD). Interaction transcripts were analyzed with regard to quantitative differences within and between dyads with respect to turn taking, message formulation, propositional content, and several types of insertion sequences (guessing, confirmation queries, message reformulations). With the exception of message reformulation, changes due to output mode were nonexistent or inconsistent for the variables measured within and across dyads. The addition of the EOD significantly lowered the rate of message reformulation and the total number of reformulation-related turns. Results are discussed with regard to research and clinical implications for augmentative communication.