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

Photographs are a frequently employed tool for the rehabilitation of adults with traumatic brain injury (TBI). Speech-language pathologists (SLPs) working with these individuals must select photos that are easily identifiable and meaningful to their clients. In this investigation, we examined the visual attention response to camera- (i.e., depicted human figure looking toward camera) and task-engaged (i.e., depicted human figure looking at and touching an object) contextual photographs for a group of adults with TBI and a group of adults without neurological conditions. Eye-tracking technology served to accurately and objectively measure visual fixations. Although differences were hypothesized given the cognitive deficits associated with TBI, study results revealed little difference in the visual fixation patterns of adults with and without TBI. Specifically, both groups of participants tended to fixate rapidly on the depicted human figure and fixate more on objects in which a human figure was task-engaged than when a human figure was camera-engaged. These results indicate that strategic placement of human figures in a contextual photograph may modify the way in which individuals with TBI visually attend to and interpret photographs. In addition, task-engagement appears to have a guiding effect on visual attention that may be of benefit to SLPs hoping to select more effective contextual photographs for their clients with TBI. Finally, the limited differences in visual attention patterns between individuals with TBI and their age and gender matched peers without neurological impairments indicates that these two groups find similar photograph regions to be worthy of visual fixation. Learning outcomes : Readers will gain knowledge regarding the photograph selection process for individuals with TBI. In addition, readers will be able to identify camera- and task-engaged photographs and to explain why task-engagement may be a beneficial component of contextual photographs.

The purpose of this article is to discuss policy and systems change for patient-provider communication (PPC) for dysarthric speakers in medical situations. Six groups of communication-vulnerable patients are described. The types of medical orders that can be employed to facilitate PPC systems change in medical settings are discussed. Finally, accountability checklists to document the patient experience and the medical facility PPC program are provided.

Individuals with complex communication needs often use alternative access technologies to control their augmentative and alternative communication (AAC) devices, their computers, and mobile technologies. While a range of access devices is available, many challenges continue to exist, particularly for those with severe motor-control limitations. For some, access options may not be readily available or access itself may be inaccurate and frustrating. For others, access may be available but only under optimal conditions and support. There is an urgent need to develop new options for individuals with severe motor impairments and to leverage existing technology to improve efficiency, increase accuracy, and decrease fatigue of access. This paper describes person-centered research and development activities related to new and emerging access technologies, with a particular focus on adults with acquired neurological conditions.

This article reviews pertinent policies, information, and materials that assist speech-language pathologists (SLPs) to support effective communication between health care providers and communication vulnerable patients across health care settings. Five types of communication vulnerable patients and the roles of communication support personnel are discussed. Several types of medical referrals to initiate patient provider communication (PPC) support are introduced. Access to a variety of communication support materials and tools is provided. Instructional strategies to integrate PPC instruction into preprofessional programs and externship experiences are described.

People with such severe and complex communication needs that they require speech-generating devices (SGDs) to meet daily communication needs come from all age groups and socioeconomic backgrounds (Beukelman & Mirenda, 2013). Among this group are people eligible for Medicare, which will provide payment for a percentage (typically 80 percent) of covered health care costs, including SGDs. Medicare eligibility extends to people age 65 and older and younger people who became disabled from non-work related causes. In this article, the authors first review Medicare coverage for augmentative and alternative communication (AAC) devices beginning in the 1980s and subsequently document the SGD acquisition and access of 64 people with amyotrophic lateral sclerosis (ALS) whose speech became so severely limited that they required an SGD to support functional communication.

Long-term acute medical care hospital (LTACH) units serve a wide range of individuals, with serious medical problems requiring intense, special treatment for an extended period of time. Some of LTACH patients are unable to meet all of their communication needs using their natural speech, either temporarily or permanently. The purpose of this investigation was to survey personnel groups who routinely work in LTACH units regarding their preferences related to 3 communication options containing 27 representative communication boards, that were supported by mobile technology including an iPad only, an iPad with a flat screen that mirrored the iPad screen, and an iPad with a projected image that mirrored the iPad screen. Participants from 3 groups, (1) registered nurses and nursing assistants; (2) allied health professionals including respiratory, physical, and occupational therapists; and (3) speech-language pathologists, ranked the iPad-only AAC choice highest for patients in LTACH units followed by the iPad with screen, and iPad with projector. For the ease of use items by patients, families, and staff, all participant groups rated the iPad alone higher than the iPad with flat screen or the iPad with projector.

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

The purpose of this preliminary investigation was to explore the role photographs play in communication interactions involving neurotypical adults. Participants included 10 people from 2 age groups: younger adults between 23 and 25 years of age and older adults between 61 and 74 years of age. Referencing photographs to support one-on-one conversations between an examiner and either a younger or older neurotypical adult speaker occurred approximately 20% of the time. Younger participants relied solely on nonverbal communication in the form of a pointing gesture to convey their intent less than 2% of the time, whereas older participants never relied solely on pointing gestures to convey intent. This suggests that typical speakers treat the referencing of photographs as a supplemental rather than primary communication strategy during face-to-face interactions.

Dysarthria represents a group of motor speech disorders (MSDs) characterized by weakness, slowness, and/or lack of coordination of the speech musculature as a result of damage to the nervous system. This article reviews the history of our attempt to provide an evidence base for dysarthria intervention, to describe some recent efforts, and to propose some directions for the future. From 2001 to 2007, the Dysarthria Writing Committee published a series of 7 systematic reviews evaluating 333 articles focusing on specific components of speech production, such as velopharyngeal dysfunction, or intervention for specific conditions, such as spasmodic dysphonia. These reviews offer evidence for the benefits of dysarthria intervention for speakers with selected dysarthria characteristics. More recently, scoping reviews have been used to map areas of relevant literature on the topics of speech supplementation and intervention in amyotrophic lateral sclerosis. Two trends will influence the future: (a) the movement from evidence-based care to value-based care including evidence of intervention effectiveness, perceived value by the patients/clients and their families, and relative cost, and (b) the increasing availability of client report outcomes measures. These trends point to the need to incorporate client reports in our intervention studies by asking patient/client about the value of our interventions.

In this report, we describe the professional support preferred by the surviving family members of people with amyotrophic lateral sclerosis (ALS). The participants in this study were six surviving spouses and one daughter of people with ALS who had used high- and low-technology AAC strategies to communicate. These informants shared the lived experience with their partners and parent with ALS from diagnosis to death and provided nine suggestions for the professional support of people with ALS.

In this article, we summarize a presentation on the training of AAC communication partners at the SIG 12 Virtual Conference (2012). We describe the characteristics of effective communication partners. We also will discuss adult learning principles and learning mode preference as they relate to training of AAC communication partners.

Purpose The purpose of this investigation was to measure the effect of message type (i.e., action, naming) on the visual attention patterns of individuals with and without traumatic brain injury (TBI) when viewing grids composed of 3 types of images (i.e., icons, decontextualized photographs, and contextualized photographs). Method Fourteen adults with TBI and 14 without TBI—assigned either to an action or naming message condition—viewed grids composed of 3 different image types. Participants' task was to select/sustain visual fixation on the image they felt best represented a stated message (i.e., action or naming). Results With final fixation location serving as a proxy for selection, participants in the naming message condition selected decontextualized photographs significantly more often than the other 2 image types. Participants in the action message condition selected contextualized photographs significantly more frequently than the other 2 image types. Minimal differences were noted between participant groups. Conclusions This investigation provides preliminary evidence of the relationship between image and message type. Clinicians involved in the selection of images used for message representation should consider the message being represented when designing supports for people with TBI. Further research is necessary to fully understand the relationship between images and message type.

The purpose of this project was to identify unique vocabulary associated with specific medical procedures. Personnel from six medical facilities with acute care or long-term acute care hospital (LTACH) units participated by proposing vocabulary/messages associated with procedures in which they routinely participated. Speech-language pathologists, respiratory therapists, physicians, nurses, chaplains, and nursing aids participated in the project. The unique vocabulary associated with common medical procedures is available in this article and on our augmentative and alternative communication–related website, http://aac.unl.edu .

Text messaging is becoming an increasing popular social networking strategy. More than 80% of American adults have cell phones, three-quarters of them send and receive text messages. People who rely on AAC are also finding texting an efficient, asynchronous way to communicate. In this report, Michael Williams discusses his use of texting. We also introduce core vocabulary resources for AAC texting.

This article summarizes the design and evaluation of a new augmentative and alternative communication (AAC) interface strategy for people with complex communication needs and severe physical limitations. This strategy combines typing, gesture recognition, and word prediction to input text into AAC software using touchscreen or head movement tracking access methods. Eight individuals with movement limitations due to spinal cord injury, amyotrophic lateral sclerosis, polio, and Guillain Barre syndrome participated in the evaluation of the prototype technology using a head-tracking device. Fourteen typical individuals participated in the evaluation of the prototype using a touchscreen.

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

Augmentative and alternative communication (AAC) facilitators and general interventionists support individuals who rely on AAC to meet their communication needs. The purpose of this study was to evaluate the accuracy of an instructional strategy for potential AAC facilitators to operate and maintain high technology AAC device software using Remote Access Error-Free (RA-EF) instruction. During the RA-EF condition, the researcher and participant were in two different locations. The results of this investigation revealed that, following fewer than 30 minutes of instruction focusing on 11 operational skills, a group of 10 participants who were unfamiliar with the Visual Scenes Display for Aphasia application (Version 2) achieved post-instruction accuracy scores of 98.2%.

The purpose of this study was to investigate the self-perceived attention allocation of listeners as they transcribed the speech samples of speakers with mild to severe dysarthria as a result of amyotrophic lateral sclerosis. Listeners reported that their perceived attention allocation increased consistently as speech intelligibility for sentences decreased from 100% to 75%. In this study, self-perceptions of attention allocation peaked between 75% and 80% intelligibility. These results support the conclusion that listeners experience a considerable perceptual load as they attempt to comprehend the messages of persons whose speech has relatively high intelligibility but distorted due to dysarthria.

The augmentative and alternative communication (AAC) personnel framework identifies the various types of people involved in successful AAC interventions. The purposes of this article are to summarize information in the AAC intervention literature that documents the role and impact of various AAC personnel, describe key characteristics of adult learners, and review research that focuses on learning motivations and preferences of adults within the AAC framework.

This study compared the operation of a dynamic-display AAC device in two instructional conditions: corrective feedback (CF) and dual-screen guidance (DSG). In the CF condition prompts/feedback were provided for incorrect responses; the DSG condition used errorless guided instruction only. Twenty-one children with typical development - ten 6-year-olds and 11 7-year-olds - were randomly assigned to one instructional condition and completed five sessions: three learning/testing, one generalization, and one maintenance. The children were required to reproduce visual sentence stimuli on the AAC device. Differences were found in accuracy and efficiency of 6- and 7-year-olds. The 7-year-olds were more accurate and quicker than the 6-year-olds. Differences due to instructional condition were observed for 6-year-olds only. All children generalized and maintained learning.

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

Alphabet supplementation is a low-tech augmentative and alternative communication (AAC) strategy that involves pointing to the first letter of each word spoken. Sentence intelligibility scores increased an average of 25% (Hanson et al., 2004) when speakers with moderate and severe dysarthria (a neurologic speech impairment) used alphabet supplementation strategies. This project investigated the impact of both alphabet supplementation and an electronic word prediction strategy, commonly used in augmentative and alternative communication technology, on the sentence intelligibility of normal natural speech that was electronically distorted to reduce intelligibility to the profound range of

Background: People with aphasia often have concomitant reading comprehension deficits that interfere with their full participation in leisure and social activities involving written text comprehension. Aims: The purpose of this investigation was to explore the impact of three levels of visuographic support—(a) high‐context photographs, (b) low‐context photographs, and (c) no photographs—on the reading comprehension of narratives by people with chronic aphasia. Methods & Procedures: Participants were seven adults with chronic aphasia and concomitant reading comprehension deficits. Participants read three narratives, each presented with a different level of visuographic support. Using a repeated measures design, the researchers examined (a) reading comprehension response accuracy (measured in number of correct responses), (b) response time (measured in seconds), and (c) the participants' perceptions of image helpfulness. Outcomes & Results: Data analysis revealed that the participants demonstrated significa...

A personnel framework designed to support people who rely on augmentative and alternative communication (AAC) because of acquired medical conditions and those who assist them is described. The roles of AAC finders, general practice clinicians, AAC intervention specialists, AAC facilitators, and AAC experts are summarized. These roles are described in detail for people with amyotrophic lateral sclerosis, brainstem impairment, and severe chronic aphasia. The personnel preparation needs for each of these support personnel groups are identified.

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

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

The purpose of this study was to document augmentative and alternative communication (AAC) acceptance and use patterns of 25 adults with traumatic brain injuries (TBI) who used either high- or low-tech AAC devices or strategies at some point during their recovery. Specifically, the purposes were to (a) document acceptance of AAC system recommendations, (b) identify AAC use patterns by persons who accepted the recommendation and for whom AAC intervention was implemented, (c) identify AAC access patterns for message formulation and encoding, and (d) document the kind of communicative functions that different AAC strategies supported. Information was gathered via a questionnaire from speech-language pathologists who provided AAC assessments and interventions at six different sites. The speech-language pathologists provided information about individuals with TBI from their clinics for whom they had recommended AAC. Results revealed that these adults generally accepted both high- and low-tech AAC recommendations and used their AAC systems for extended periods of time. Most utilized letter-by-letter message formulation strategies. When AAC technology was abandoned, it was usually a reflection of a loss of facilitator support rather than a rejection of the technology.

The specific purposes of this article were (a) to study the computer technology interest levels, achievement goal orientation, self-efficacy, and learning mode preferences regarding AAC technology in AAC team members; and (b) to study the relationships among these variables to understand factors related to, and predictive of, learning mode preference. The companion articles focused on AAC intervention specialists and on pre-professional students. AAC team members reported relatively low interest in computer technology per se. They reported high mastery achievement goal orientation with a somewhat lower performance orientation and a relatively low social orientation. As a group the AAC specialists and regular AAC team members who participated in this investigation did not report strong learning mode patterns. However, the correlation analysis revealed some interesting trends. Self-efficacy was highly correlated with technology learning mode preference. Those with relatively high self-efficacy preferred to ...

A review of the use of augmentative and alternative communication (AAC) technology by 50 persons with amyotrophic lateral sclerosis was completed over the course of 4 years. Ninety-six percent of the participants in this study accepted AAC technology, either immediately (90%) or after some delay (6%), and only 4% (n = 2) rejected AAC technology. None of the participants discontinued use of their AAC technology. Reasons for acceptance decisions were discussed in interviews with study participants and the results are presented.

The purpose of this study was to examine the relationships among speech intelligibility and communication effectiveness as rated by speakers and their listeners. Participants completed procedures to measure (a) speech intelligibility, (b) self-perceptions of communication effectiveness, and (c) listener (spouse or family member) perceptions of communication effectiveness for speakers with amyotrophic lateral sclerosis (ALS). The results of this study revealed that perceptions of communication effectiveness for speakers with ALS were quite similar for the speakers and their frequent listeners across 10 different social situations. ALS speakers and their listeners reported a range of communication effectiveness depending upon the adversity of specific social situations. Learning outcomes (1) As a result of this activity, the participant will be able to identify social contexts that are identified by persons with ALS as difficult for effective communication. (2) As a result of this activity, the participant will be able to describe ALS symptomatology using the International Classification of Functioning, Disability, and Health. (3) As a result of this activity, the participant will be able to administer the CETI-M as a measure of communication effectiveness for persons with ALS. (4) As a result of this activity, the participant will gain information that will assist them in counseling persons with ALS and their families.

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

Two investigations were completed regarding attitudes toward components of AAC used to tell stories by people with amyotrophic lateral sclerosis (people with ALS). In Study 1, the attitudes of three groups of listeners (people with ALS, caregivers, and unfamiliar listeners) toward three communication modes (unintelligible natural speech, communication notebook, and synthesized speech) were examined. The listener groups viewed videotapes of people with ALS delivering three narratives, each with one of three different communication modes. In study 2, attitudes of three groups of listeners toward three message formulation techniques (word-by-word, sentence-by-sentence, and complete narrative) used for storytelling were examined. Listeners viewed videotapes of people with ALS using synthesized speech to tell three narratives, each with one of three different message formulation techniques. Results for both studies indicated agreement among the individuals who used AAC and listener groups, and a strong prefere...

In this study, the learning styles and preferences of preprofessional students enrolled in an introductory augmentative and alternative communication (AAC) course were investigated. The specific purposes of the present study were to examine preprofessional students' (1) achievement goal orientation, (2) computer technology interest, and (3) learning mode preferences regarding AAC. The results revealed that preprofessional students were statistically assigned to four distinctive clusters with regard to their achievement goal orientation. Their interest in computer technology was relatively low, and they preferred individual and small-group learning opportunities as compared with direct instruction in new technology.

This study focused on the learning styles and preferences of augmentative and alternative communication (AAC) intervention specialists. The specific purposes of this project were to examine AAC interventionists' (a) self-efficacy for AAC intervention, (b) goal achievement orientation, (c) computer technology interest levels, and (d) learning mode preferences regarding AAC. The results revealed that AAC intervention specialists viewed themselves as highly selfconfident (self-efficacious) with regard to their ability to learn new AAC technology and teach it to others. They demonstrated a highly consistent achievement orientation profile with emphasis on mastery of content and skill and on performance to achieve goals. Their interest in computer technology was relatively low, and they preferred individual and small-group learning opportunities compared with direct instruction in new technology.

The focus of this investigation was to examine the visual attention patterns of adults with aphasia on task-engaged contextualized images in which a human figure was engaged with the context of the image and camera-engaged contextualized images in which a human figure was looking forward toward the camera. Analysis revealed that adults with aphasia tend to fixate rapidly and frequently on human figures in contextualized images regardless of the type of engagement in the image. In addition, they responded to engagement cues when viewing task-engaged contextualized images by fixating more frequently and more rapidly on the object area of interest for these images than for camera-engaged contextualized images.