Key Aspects in AAC state of the sceince...

Key Aspects in AAC: State of the Science

Albert M. CookFaculty of Rehabilitation Medicine

and Faculty of ExtensionUniversity of Alberta

Colloque 2.0 RéadaptATion - Aides techniques13 May 2011

Researchin AAC -Themes

• AAC design features for children• Direct and indirect access methods• Visual Scene Displays (VSDs)• VSDs and Aphasia• Dementia• ALS and TBI• Changes in Technology


• AAC design features for children• Access methods for Children• Visual Scene Displays (VSDs)• VSDs and Aphasia• Dementia• ALS and TBI• Changes in Technology

Design features to enhance the appeal of AAC technologies for young children• Multiple functions• Dynamic contexts• Motivating and

interactive activities• Innovative functions• Accommodate

development• Light weight • Soft plush materials• Personalized

Light and Drager, Augmentative and Alternative Communication, 23: 204 – 216, 2007

Multiple Functions• Social interaction• Communication• Play• Artistic expression• Humor• Companionship• Environmental

controls• Use a variety of

shapes including character shapes

• Incorporate transformable configurations and moveable parts

AAC at School

Bells, whistles, bright lights• Multiple bright colors

– Symbols– Hardware– Removable covers for personalization

• Designate operations or functions with color • Use lights for feedback & visual effects• Sound Library

– sound effects (e.g., animal sounds, car sounds, burping)– emotions (e.g., laughter, anger, crying)

• Music– songs– MP3 files– musical instruments

• Range of voices• Phoneme level speech sounds to support sound play

and phonological awareness

Using Robot to Interact with classmates

•12 y.o. F with CP (severe limitations) •AAC Device

– Vanguard, with Unity 45 Full vocabulary set

•Access Method– two switch step

row-column scanning

– one switch on each side of head

Sample vocabularypage

Robot controlpage

Commercial AAC DeviceIntegrated with Robot to Develop

Educational Activities



Access methods for Children-what the research tells us

• Direct selection vs. indirect selection• Typically developing young children

– Indirect vs. direct selection– Scanning– Design of scanning arrays

• Children with cerebral palsy• Strategies to increase efficiency of

scanning

Direct selection vs. Indirect Selection• Direct Selection vs. Scanning & coded access

– Direct selection is faster than indirect selection– Direct selection is less demanding cognitively than

indirect selection,– Direct selection to multiple targets requires more

motor control than indirect selection – Direct selection has less negative impact on short-

term visual memory (Treviranus and Roberts, 2006),

• Coded access:– Coded access (e.g., Morse Code) is potentially fast

and efficient once mastered, but mastery can require a substantial amount of practice and training

– Some users may have difficulty with the motor demands (particularly timing) of Coded access (Treviranus and Roberts, 2003)

Typically developing young children: Indirect vs. direct selection

• Impact of short-term memory on selection techniques– 22 typically developing 4 year olds – Shown pairs of line drawings and instructed, after demonstration,

to find the same symbols in the correct order on randomly arranged arrays of 10, 20, 30 and 40 items

– Used scanning and direct selection– No significant difference in the accuracy of the selection

techniques– Mean level of accuracy was significantly greater with direct

selection than with scanning for the 40 item array. (Mizuko, Reichle, Ratcliff & Esser, 1994)

• Direct selection and visual linear scanning in a memory recall task using line drawings.– 130 Kindergarten, first and third grade typically developing

students– students retrieved more symbols correctly using direct selection

than scanning– third graders also retrieved more symbols than first graders or

kindergartners. (Wagner and Jackson, 2000)

Typically developing young children Scanning

• Selection from a circular array with scanning and pointing– twelve typical 4-year olds – two- or three-symbol sequences on a circular array, – no significant differences in the number of correct

sequences selected by the children using the two selection techniques (Mizuko & Esser, 1991)

• Linear and row column scanning. – typically developing 2-4 year old children – no significant differences in errors made between these two

techniques,– errors increased with the number of cursor movements to

get the desired symbol and the number of cursor passes (Petersen, Reichle & Johnston,2000)

Typically developing young children Scanning

• Directed and group-item scanning – typically developing 4-year olds– more accurate with directed scanning – no advantage for directed scanning over

group-item scanning in terms of efficiency of response (Dropik & Reichle,2008)

Typically developing young children Design of scanning arrays

• Redesigned scanning arrays to reduce the learning demands– Animation– Speech output with appropriate intonation.

• Two-year-olds– more rapid learning and greater accuracy with the

redesigned scanning than with traditional scanning– results suggest that by redesigning scanning we

can reduce the instructional time required for children to attain mastery. (Light and Drager, 2007)

Children with cerebral palsy: automatic, inverse and step scanning

Single item selection in an array with otherwise empty boxes

• 6 participants with cerebral palsy, half spasticity and half athetoid

• primarily sensory-motor in nature as there was no symbol selection

• group data showed no significant differences among the scanning methods

• subjects with spastic cerebral palsy were least accurate with automatic scanning and subjects with athetoid cerebral palsy were least accurate with step scanning (Angelo, 1992)

Strategies to increase efficiency of scanning

• Arrange the matrix to minimize the number of cursor movements or “pulses” required to select the most frequent items.

• Placing most frequently used characters at the beginning of a row-column array increases rate of communication by 35% or more.

• Space is one of the most frequently occurring items => place early in the matrix

Foulds, Baletsa, and Crochetiere (1975) and Lesher, Moulton, and Higginbotham (1998) and Reichleet al (1991)

Strategies to increase efficiency of scanning

• Place backspace early in the matrix for rapid error correction

• Use prediction with word lists based on previous scanning input

• Scan predicted words before resuming scanning of the character matrix or permitting user to choose whether to scan the word list or the character matrix first

• Using a dynamic matrix rearrangement in which prediction is based on the previous four entries rather than fewer previous entries

Foulds, Baletsa, and Crochetiere (1975) and Lesher, Moulton, and Higginbotham (1998) and Reichleet al (1991)



Screen Display Options for AAC • Present symbols out of

context; language is presented in a box, isolated from the context in which it occurs.

• Do not preserve conceptual nor visual relationships between concepts – in a traditional grid display,

the line drawing of the apple used to represent apple may be as big as the head of the boy used to represent the concept boy,

– which in turn may be as big as the entire person used to represent the concept eat

Typical Grid displays

Screen Display Options for AAC • Maximize meaningfulness

by representing familiar events & activities

• Present language concepts in context

• Organize language by event experiences

• Preserve the conceptual and visual relationships between symbols that occur in lifeVisual Scene Display (VSD)

VSDs For Beginning Communicators

• Present language concepts in context, providing support for children's understanding in the early stages of language learning

• Organize language according to event experiences like young children organize language concepts

• Preserve the conceptual and visual relationships between symbols that occur in life (e.g., location, proportionality of concepts).

VSD Layout

VSDs For Beginning Communicators

• Maximize meaningfulness by representing familiar events & activities in the children's lives

• Present language concepts in context, providing support for children's understanding in the early stages of language learning

• Organize language according to event experiences like young children organize language concepts

• Preserve the conceptual and visual relationships between symbols that occur in life (e.g., location, proportionality of concepts).

Critical Aspects Of Layout And Organization For Young Children

• Learning demands of typically developing children (ages 2 - 5)

• Impact of layout and organization– a taxonomic grid layout (i.e., symbols organized

according to hierarchical categories and displayed in a row-column layout),

– a schematic grid layout (i.e., symbols organized according to events or experiences and displayed in a row-column layout),

– a schematic visual scene layout (i.e., a contextual scene of an event with concepts embedded under hot spots in the scene),

– iconic encoding - 4 and 5-year-olds onlyLight and Drager, Augmentative and Alternative Communication, 23: 204 – 216, 2007

Critical Aspects Of Layout And Organization For Young Children

• Youngest children (age 2.5 years)– most accurate locating vocabulary using the visual

scene displays compared to the grid layouts– displays were not personalized to the experiences

of the children • Children ages 4 and 5

– able to locate vocabulary with the visual scene displays and the grid layouts with similar levels of accuracy,

– had significant difficulty learning to use iconic encoding

Visual Scene Displays With Young Children

• Intervention with children who have developmental disabilities (ages 1 - 3) – upon initial introduction all were able to use the

visual scene displays in social interactions once use had been modeled

– demonstrated significant increases in turn taking immediately upon introduction of visual scenes

– gains in turn taking sustained over the long term– learned to use other types of displays over time,

including traditional grid displays and hybrid displays

• Similar results in a study of preschoolers with autism (ages 3 - 5)

Visual Scene Displays With Young Children

• Intervention with children who have developmental disabilities (ages 1 - 3) – upon initial introduction all were able to use the

visual scene displays in social interactions once use had been modeled

– demonstrated significant increases in turn taking immediately upon introduction of visual scenes;

– gains in turn taking sustained over the long term– learned to use other types of displays over time,

including traditional grid displays and hybrid displays

• similar results in a study of preschoolers with autism (ages 3 - 5)

Navigation: a challenge for children using multiple pages or screens

• Learning demands of different approaches to menu pages and page layouts for typically developing 3-year-olds,– visual scene displays that used screen shots of the four

scenes on the menu page for navigation,– traditional grid displays that used screen shots of the four

vocabulary grid pages on the menu page,– traditional grid displays with a traditional menu page (i.e.,

four single symbols on the menu page used to represent navigation to the four pages of vocabulary).

• most accurate locating vocabulary using VSDs with screenshots of the scenes on the menu page

• least accurate using the traditional grid display with the traditional menu design

Navigation: a challenge for children using multiple pages or screens

• Demands of navigating dynamic display systems for young children– typically developing children (ages 2 - 5) had more difficulty

locating the correct page (from a main menu with a choice of four symbols/page) than locating the target symbol when on the correct page (out of a choice of 12 - 30 symbols)

• Navigation difficulties for young children– they must hold in mind a conceptual model of the hidden

pages in the system – they must understand the relationship between the

representations used on the menu page and the hidden pages of vocabulary

• Can reduce navigational demands– screenshots on the menu page– provide a mnemonic cue– relationship to the hidden vocabulary pages is explicit

VSDs and ASD• Visual scenes used as a pictorial portrayal of a

concept or command that is being presented simultaneously through spoken language

• Visual scene cues with children with ASD– as compensatory strategies where the goal is to

bypass the child's comprehension deficits or auditory processing difficulties

– as therapeutic tools where the goal is to build comprehension of the oral language input by gradually reducing dependence on scene cues

• Use of scene cues, along with speech input, resulted in significant improvements in performance compared to spoken input alone



Severe, chronic aphasia and apraxia of speech

• 40% of individuals with aphasia have chronic, severe language impairment;

• Traditional aphasia intervention– focused on restoration of functional

communication by reducing the language impairment

– individuals with severe aphasia often do not recover sufficient language capability to become functional communicators without compensatory AAC strategies

Beukelman; Fager; Ball; Dietz and Alternative Communication, 23: 230 – 242, 2007

Severe, chronic aphasia and apraxia of speech

Compensatory communication strategies • drawing,, remnant materials, gestures,

writing, low- and high-tech AAC• Co-construction of messages by individuals

with aphasia and their communication partners

• Language limitations in symbolizing meaning restrict use of AAC strategies – printed messages or icons (representation),– spelling, combining words, or sequencing icons into

messages (formulation)– locating information in a book or electronic device

(navigation)

Computer-assisted Language Intervention for Severe, Chronic Aphasia

• Lingraphica– Icons (small pictures,

sometimes animated), – Windows in which these

icons are can be accessed, manipulated, and displayed,

– Cursor manipulation of icons and windows in

• Talking Screen– Similar to Lingraphica– comparable treatment Small Talk-iPhone app

Computer-assisted Language Intervention for Severe, Chronic Aphasia

• Critical Lingraphica implementation issues – measured improvement by means of pre- and post-test

methods utilizing standardized tests– no pre- and post-treatment measures of changes in quantity

or quality of conversational exchanges or community-based communication performance

– question as to whether this performance can be translated into a functional AAC system

• Other technological interventions focused on supporting specific communication tasks– answering the phone – calling for help– ordering in restaurants or stores, – giving speeches – saying prayers– engaging in scripted conversations

AAC and Aphasia • Portraits ( static pictures or other

symbols)– limited, usually decontextualized

information– additional information about the

person(s) or object in a portrait must be generated by the individual with aphasia or speculated on by the communication partner.

– This spontaneous generation of specific and detailed information is difficult for individuals with severe, chronic aphasia

RERC on Communication Enhancement, AAC for Persons with Degenerative Language DisordersMelanie Fried-Oken (Oregon Health & Science University)

Grid layout

• Grids with symbols/pictures/icons occupy individual spaces at regular intervals – individual square demarcation isolates each

symbol, requiring users to process individual symbols and combine them to formulate messages

– individuals with aphasia and their communication partners are required to formulate messages using icons that have little implied relationship to one another

Beukelman, Fager, Ball, Dietz , Augmentative and Alternative Communication, 23: 230 – 242, 2007

VSD• Each element pictured in natural

relationship and position to all other elements in the scene

• Individual with aphasia and the communication partner co-construct “the gist” of the visual scene

• The meaning of all elements and semantic associations are integrally tied together, creating a holistic context.

• Pictures paired with text and voice output to communicate specific messages, ask questions, and/or provide support for the communication partner

VSDs for Adults with severe, chronic aphasia (and apraxia)

• Designed for common interactions– relatively wide range of

topics – narratives & experiences

• Provides visual-contextual support– facilitates navigation of

dynamic display– supports successful

communication of messages

VSD for Adults with severe, chronic aphasia (and apraxia)

Visual scene is contextualized– elements shown in

relationship to the environment

– establishes context for conversational interaction

– provides information to support multiple communication exchanges

– allows for mutual understanding

– may decrease the need for extensive generative language use

Impact of VSDs for people with chronic aphasia

• Personal relevance • Contextualization• Lead to comprehension

McKelvey, M., Hux, K., Dietz, A., Beukelman, D. (2010). Impact of personal relevance and contextualization on comprehension by people with chronic aphasia. American Journal of Speech Language Pathology, 19, 22-33.



Dementia• Incidence expected to grow• Currently4 million people in the US

– 10% of people over 65 years – 47% of people over 85

• Expected to increase to 14 million by the year 2050

Dementia

• Aim of current interventions– maximize communicative and memory

functioning to maintain (or increase) activities

– Increase participation/engagement, and quality of life for people with dementia across the disease progression

• May also increase the quality of life and decrease the stress of family and professional caregivers of individuals with dementia

Goals for Dementia AT Interventions

• Maintain function• Compensate for lost function• Counsel the individual or family

regarding conditions and options for managing the symptoms of dementia

Forms of compensatory support for Dementia

• Low-tech communication cards and books, pictures, drawings, and printed reminders

• Designed to support those with dementia to remind them of temporal or semantic information

• High-tech support such as computerized memory aids for visual or auditory information

• Designed to support the individual, rather than to support his or her communication interactions, per se

AAC Interventions for Dementia• Low-tech memory and communication books

and high-tech displays that are positioned within the living space

• Relatively new with mounting evidence of effectiveness

• Modification of communication partner's behavior during communicative interactions– reduction of distractions,– using short simple sentences, – reducing questions to yes/no format, – allowing time for the individual with dementia to

respond, – word finding strategies, such as word description

if it cannot be retrievedBeukelman, Fager, Ball, Dietz , Augmentative and Alternative Communication, 23: 230 – 242, 2007



Recent advances in AAC for people with degenerative and chronic acquired

neurological conditions

• Recent AAC technological advances• Acceptance, use, limitations, and

future needs of individuals• ALS,TBI, brainstem impairment

Beukelman, Fager, Ball, Dietz , Augmentative and Alternative Communication, 23: 230 – 242, 2007

ALS• Approximately 95% of people with ALS

become unable to speak at some point prior to death

• AAC acceptance– increased considerably during the past decade– Prior to 1996, accepted by approximately 72% of

men and 74% – A 2004 study found that 96% of people with ALS

for whom AAC was recommended, accepted and used AAC; with 6% delaying but eventually accepting the technology, no differences were reported for males and females

ALS: Referral for AAC• Refer for AAC assessment when speaking

rate reaches 100 to 125 words per minute on the Sentence Intelligibility Test*

• Individuals with ALS use their technology until within a few weeks of their deaths– those with primary bulbar ALS used their AAC

technology an average of 24.9 months– those with spinal ALS used their AAC technology

for an average of 31.1 months.

*mean speaking rate on this test for adults without disability is 190 words per minute

Traumatic Brain Injury (TBI)

• Problems with cognition (thinking, memory, and reasoning),

• Sensory processing (sight, hearing, touch, taste, and smell),

• Communication (expression and understanding),

• Behavior or mental health (depression, anxiety, personality changes, aggression, acting out, and social inappropriateness)

TBI and AAC• Individuals with TBI generally accepted

AAC recommendations.• AAC technology abandonment usually

reflected the loss of facilitator, not rejection of the technology

• Communication disorders resulting from TBI include cognitive/linguistic as well as motor speech disorders

AAC for TBI: Linguistic aspects• Predominantly letter-by-letter

spelling strategies• Cognitive limitations interfered with

ability to encode messages and utilize other message formulation strategies

• None of the participants rejected AAC after receiving a low technology or high technology AAC option

Facilitator Training (ALS and TBI)

• Lots of staff changes occur over the lifetime for TBI

• Families provide facilitation for ALS • Technical comfort level varies widely in

facilitators • Requires “just in time training” including

programming of device vocabulary and that is at a useful technical level

TBI: Reducing The Cognitive Load For Word/Message Prediction And Retrieval

• Use of encoding strategies during routine communication is rare

• Few reports describe use of word prediction• Beukelman et al. attempted to teach the use

of encoding and/or word retrieval to several individuals with TBI who spell their messages using AAC technology– some were able to learn the encoding or prediction

strategy in the intervention setting– none used the strategy in their everyday

communication, reporting that it was “too much work” and that they did not “think that way.”

TBI• 68% of this sample was advised to utilize high-

technology AAC devices– 94% of these individuals and their decision-makers, accepted

the recommendations– After 3 years, 81% continued to use their AAC technology,

6% had not receive the technology because of funding problems, and 12% had discontinued AAC device use because they did not have appropriate AAC facilitator support

– 87% used letter-by-letter spelling, while the remaining 13% relied on symbols and drawings.

• Low technology AAC options were recommended for 32% of the total group– 100% accepted the recommendation– After 3 years, 63% continued to use their low-technology

AAC strategies at least part time– 37% discontinued use because they regained sufficient

natural speech to meet their communication needs



Alternative and Augmentative Communication

• The availability of mainstream technologies with apps for people with disabilities is increasing rapidly

What will be the AAC impact of mainstream technologies?

Cell Phones and AAC• Four cell phone features have increased

opportunities for use as AAC devices:– Increased processing power, – Ease of downloading into the phone, – Wireless connection to a worldwide network,– Affordable by persons with disabilities since

features are built into standard cell phones . • Since the operating system is open source,

many applications for people with CCN can be downloaded from the Internet

Cell Phone features Useful for AAC

• Speech synthesis • Word completion/prediction, • Abbreviation expansion • Digital photography built into cell

phones can aid vocabulary building

A few Examples of Android Apps• AAC-android project “Our goal is to develop an

open source "Augmentative and Alternative Communication" program that allows uses with speaking disability to construct sentences via a decision tree by choosing pictures in sequence. “http://code.google.com/p/aac-android/

• Voice4u picture AAC application, 154 icons and 12 categories. Users can customize them or create new ones with their own graphics and voice $29.99 http://www.androidzoom.com/android_applications/communication/voice4u_meza.html

• iAugComm - Android AAC app using a simple, icon-based interface. $4.99 http://www.androidzoom.com/android_applications/communication/iaugcomm_tey.html

Voice 4U –screen shots

http://www.androidzoom.com/android_applications/communication/voice4u_meza_screenshots.html

Example iPhone Apps for people with disabilities

• Proloquo2Go an AAC device with speech output, symbol vocabulary, $200.

• Sounding Board a communication device that uses photos or symbols and generates speech output $50

• iCommunicate is an app that develops a storyboard, consisting of pictures or photos and can be used as a prompting device iPhone $19, iPad$29

• A Special Phone allows the user to shake the iPhone a specific number of times, and it will dial the phone number selected $0.99

• Zentap Pro abbreviations and word prediction $2.99• Only available for purchase at iTunes stores

Source: Matthew Stoloff. http://stoloff-law.com/blog/iphone-apps-that-help-people-with-disabilities-be-more-independent/

SoundingBoard• Transforms iPhone Into

a Communicator• Create custom boards• Record messages for

each symbol • Use photo library or

built-in symbols• Increase the physical

size of the boards by using iPad

$49.99

Source:http://thejournal.com/articles/2010/10/01/ablenet-brings-communication-board-to-ios.aspx

Proloquo2go

• Full-featured AAC device for people who have difficulty speaking

• Text-to-speech• Default vocabulary of

over 7000 items• Vocabulary organization

by category• $200• BUT

…there are Medicare funding issues in the US

iPhone

iPad

http://www.proloquo2go.com/About/article/what-is-proloquo2go

iPhone Universal Remote

• Requires hardware accessory $70

• 40,000+ IR codes• Trainable IR

controller• Works with iPhone,

iPod touch and iPad• App download is free• Could control

appliances or toys like Lego Mindstormsrobot

http://www.i-got-it.com/index.html/

Robot control via AAC – using mobile technologies

• Lego NXT Blue tooth Version

• Same features and flexibility as Mindstorms

• $350• Controllable by any

Blue tooth device

Brain Computer Interface

Brain Computer Interface

Mobile BCI -ThinkContacts

• Operates like “Brain computer Interface lite”

• NeuroSky Mindset transfers brain signals to Nokia N900.

• Accompanying headset detects the user's EEG as a measure of attention

• If the attention level is higher than 70%, the software scrolls to the next contact in the list

• If the attention level is higher than 80%, the software makes a phone call to the selected contact

https://projects.forum.nokia.com/ThinkContacts

Nokia N900

Screen shot

NeuroSky MindSet• Developed for consumer games

and education, brainwave interface measures electrical impulses generated by mental activity

• Calculates varying levels of brain activity interpreted as mental states

• Digital input for computers, phones, software, and devices.

• Raw unfiltered brainwave measurements are available through use of SDK.

• Data fed via Bluetooth• Audio and voice support for MP3

and VoIP. http://meegoarena.com/2010/08/control-your-nokia-n900-by-your-mind/

The Potential Downside• Accessibility of phones, or iPad• Will apps really meet needs?• How robust are the apps?

– Hobbyist kluge vs. professional development– Do you get what you pay for?

• Lack of support (Soft technologies)• Cultural relevance• Language• How to pick from many possible apps

Feature Matching Chart of AppsWhat the Chart is….

• A list of features that are important to many people with CCN, although not all are currently featured in existing apps

• Constantly changing and updating (both features and apps)

What the chart IS NOT….

•List of all the Apps•List of features of Apps

Jessica Gosnell, MS, CCC-SLPChildren's Hospital Boston

Full chart coming soon towww.childrenshospital.org/acp

AAC-RERC White Paper on Mobile Devices and Communication Apps

• Based on interviews with 25 AAC “thought leaders”between January and March, 2011

• The idea that ANY one device can (or should) “do the job” for individuals with CCN no longer makes sense

• Many people with CCN, across the age span, require multiple technology options.

• Some needs may be met by mainstream technologies, while others may require accessories and techniques designed specifically for them

•www.aac_rerc.com

Questions to be Explored• Limited evidence demonstrating the

efficacy of mobile technologies and AAC Apps on functional communication and quality of life of people with CCN– Who uses mobile devices?– Which ones? – For what purposes? – Where? Why? How often?

Questions to be Explored• How does the availability of low-cost, highly portable,

multi-use devices change the traditional AAC intervention process?– What clinical and technical supports need to be in

place? – Who needs to be involved?– What, if any, standards are needed; and how does

all this impact clinicians, end users and AAC manufacturers?

• What design specifications should be incorporated into Apps for people with CCN whose communication needs are poorly met by current AAC technology and applications?

The Appeal of Mainstream Devices + Apps

• “Normalization” of tablets or other mobile devices takes the mystique out of AAC

• Expands reach to those who may not traditionally think about AAC – Families of very young children– Individuals with autism

• Ongoing access to information, social interactions, entertainment, music and games

The Pros

• General public is becoming more aware of AAC

• More people consider what AAC can do for them or a family member

• Feelings about traditional AAC technology– too large, too heavy, too costly, and – too difficult to learn,

• New Apps on familiar platforms are a welcome innovation

The Cons• Lower costs and Internet-delivered

information are driving many AAC purchases – communication goals may not be realized – may include loss of technical support– lack of quality control– less customization– costs in monthly service agreements

• Abandonment may occur if devices do not live up to expectations

• Widened digital divide for those who cannot afford to purchase mobile technologies and communication Apps

The “democratization of AAC technology”

• People with CCN are becoming more active consumers

• Mobile devices are relatively inexpensive and widely available through retail outlets or on-line;

• Apps are low cost and easily acquired

Issues to be Resolved• Access for individuals with motor

limitations• Access for individuals with language and

cognitive limitations• Those who make their own purchases

lack clarity about– the complexity of the communication

process– how to support the development of

language and communication skills

Varied scenarios for use of Apps

• Meet most of an individual’s communication needs, serving as the person’s primary communication system

• Meet some of an individual’s communication needs, serving as one of several communication tools– as a backup system when the person’s SGD is

unavailable– when going out with friends to a movie;

• Be used primarily for training -for example language or literacy Apps

• Not an option due to lack of access by the individual

Mobile technology is driving service delivery

• Device and Apps selected before the clinician is seen • AAC professionals want to:

– retain the desirable characteristics of a thoughtful decision making process that matches the personal characteristics and goals of the person to features of existing technologies

– see evidence-based information integrated into the design of communication Apps and user interfaces

• When technologies are deemed part of an education or treatment plan– SLP writes a report to request funding for

recommended equipment (SGD and accessories), – training, technical support and follow up are

included

Service Delivery Issues• Device purchased for capabilities and

Apps (e.g., game applications) not directly related to communication leads to a mismatch between communication goals and technology

• Current service delivery system is ill-prepared for the pace of this transition

• Clinician-based model is costly– developed over many years– may no longer be the only model– may not prove to be the best model

Development Issues -“There’s an App for that”

• Manufacturers and developers create products that users never knew they needed

• Current Apps are unimaginative• More customization is needed • Challenges with mobile devices

– glare – ruggedness– sound– system back-up

• Some people with CCN will always need unique features that mainstream companies will not address

Research Issues• Areas of further exploration for mobile

devices and communication Apps– identifying human factors related to design and

access for people with CCN– social issues such as usability, integration and

discontinuance– technology compatibility– identify sensory and cognitive demands– clinical issues including feature matching, language

use, literacy, etc.• Single case longitudinal across populations to

address ethnographic questions, quality of life issues, preferences and usage over time

White Paper Summary/Conclusions

• The field needs to respond; in some cases provide guidance, and in others determine a new role

• We need to maintain professionalism during this change; partnering will serve the AAC professional better than resistance

• Keeping the holistic perspective of AAC is crucial

Technology Addressing Need

Displays can get in the way of interaction

A virtual display

Direct retinal display –creates image that overlays view of real object or appears in space in front of eye (IEEE Spectrum, May 2004)

Tactile input using Arm surface• Mobile devices keyboards –

difficult for people with motor impairments

• Sensing from large parts of the body increases the number of sites

• Finger impacts create acoustic waves detected by acoustical arm band sensors

• Can project an image over the sensor locations-e.g. a keypad

• Disambiguates the taps and maps onto keypad for output

Harrison, Tan, Morris, Skinput: CHI 2010, April 10–15, 2010, Atlanta, Georgia, USA.

What Does all this have to do with AAC?• The primary goal for people with

complex communication needs is to have effective communicative interactions

• Technology can be more of a barrier than aid

• Natural, easily used augmentative approaches are still elusive

Not all tech is good tech…

• Sorting the wheat from the chaff … and possibly making bread

• Quality is like buying oats: If you want good clean oats you must pay a fair price, if you are willing to settle for oats that have been through the horse…then they are a little cheaper.


• AAC design features for children• Direct and indirect access methods• Visual Scene Displays (VSDs)• VSDs and Aphasia• Dementia• ALS and TBI• Changes in Technology

The future for persons with disabilities

• Will not be driven by advances in technology, but rather

• By how well we can take advantage of those advances for the accomplishment of the many tasks of living that require technological assistance

Questions or comments?

References• Angelo, J. (1992). Comparison of three computer scanning modes as an interface method for persons with cerebral palsy.

American Journal of Occupational Therapy, 46, 217-222 • Dropik, P.L. & Reichle, R. (2008). Comparison of accuracy and efficiency of directed scanning and group-item scanning for

augmentative communication selection techniques with typically developing preschoolers. American Journal of Speech-Language Pathology, 17, 35-47.

• Foulds, R., Baletsa, G., Crochetiere, W. (1975). The effectiveness of language redundancy in non-verbal communication Proceedings of the Conference on Systems and Devices for the Disabled, 82-86.and Horn, E.M. & Jones, H.A. (1996). Comparison of two selection techniques used in augmentative and alternative communication. Augmentative and Alternative Communication, 12, p. 23-31

• Lescher, G.W., Moulton, B.J., Higginbotham, D.J. (1998). Techniques for augmenting scanning. Augmentative and Alternative Communication, 14(2), 81-101 Mizuko, M. & Esser, J. (1991). The effect of direct selection and circular scanning on visual sequential recall. Journal of Speech & Hearing Research, 34, 43-48.

• McCarthy, J., Light, J., Drager, K., McNaughton, D., Grodzicki, L., Jones, J., Panek, E., & Parkin, E. (2006). Re-designing scanning to reduce learning demands: The performance of typically developing 2-year-olds. Augmentative and Alternative Communication, 22, 269-283.

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• Venkatagiri, H.S. (1999). Efficient keyboard layouts for sequential access in augmentative and alternative communication. Augmentative and Alternative Communication, 15, 126-134.

• Wagner, B.T. and Jackson, H.M. (2000). Developmental memory capacity resources of children retrieving picture communication symbols using direct selection and visual linear scanning with fixed communication displays. Journal of Speech, Language and Hearing Research, 49, 113-126.

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