The purpose of this study is to describe the profile of children with speech and motor impairments assessed to use robots in collaborative games. The method employed is a descriptive exploratory design conducted by a research group from the Federal University of Sergipe, in Brazil in a Specialized Rehabilitation Center. Participants' data were grouped and analyzed considering motor aspects, communication, cognitive skills, and schooling information. Eleven children were selected as suitable for using eye tracking devices to control the robotic arm. The study indicated that children with severe motor impairments tend to spend more time on health services than educational services. It highlighted the need for better coordination between these services considering other social barriers and the use of AAC to support peer interaction.
Using communication aids in everyday interaction is often challenging, despite evidence showing that their use can facilitate linguistic development and social participation. Previous research has identified that a key factor in promoting the use of communication aids is teaching communication partners skills that facilitate aided interaction. This paper outlines, step by step, the design process of a new evidence-based intervention model called Reco (relaxed communication), which was developed according to the Intervention Mapping Protocol. Reco was designed for children and young people for whom communication aids are recommended as well as for their communication partners. The aim of Reco is to facilitate the use of communication aids in everyday interaction. The development process began by identifying the problem and objectives for intervention and continued by selecting evidence-based methods. In the pilot phase, participants comprised two school-aged children who use AAC and their parents, school instructors, and speech and language therapists, and in the implementation phase six children and their communication partners. The implementation phase is currently under review. This protocol article is valuable for demonstrating how to use participatory research design and evaluate evidence-based interventions in the AAC field.
Literacy is crucial for participating in education and society. However, most persons with intellectual disability (ID) who use augmentative and alternative communication (AAC) enter adulthood without functional literacy skills. Teaching practices may contribute to explain this phenomenon. Reading instruction for these students has scarcely been investigated. It is crucial to learn more about this issue. A qualitative descriptive study was conducted with 29 teachers working with 35 students with ID who use AAC. Sixty reading lessons were observed, and 28 semi-structured interviews were conducted with the teachers. Approximately half of the students received phonics instruction and phonological awareness training during reading lessons. Listening comprehension and vocabulary instruction were rarely provided. Fewer than a quarter of the students were given nonspoken ways to actively participate in reading instruction. The study's findings underscore the urgent need for in-service training and the development of evidence-based teaching materials to support teachers optimize reading instruction for students with ID who use AAC.
Incorporating a co-design approach in the development of a training program, whereby intended recipients of the training are at the front end of the design process, is advantageous. Such an approach facilitates a deeper understanding of participants' experiences and identified needs. Since we identified a need for the training of professionals in augmentative and alternative communication (AAC) assessment, this study aimed to explore the assessment experiences and training needs of AAC professionals as the first phase in the co-design process of an online AAC training program. Two asynchronous online written focus groups were conducted with 15 participants from various professional backgrounds in South Africa. Thematic analysis was used to analyze the participants' contributions. Participants discussed the process of AAC assessment, highlighted various characteristics of AAC assessment and reported a variety of challenges faced when conducting an AAC assessment. They suggested aspects that should be included in a training program on AAC assessment and proposed strategies for the implementation of an online training program. The results confirmed that there is a need for a training program on AAC assessment for various professionals in AAC. Furthermore, the results highlight the experiences and training needs of such professionals.
Graphic symbol collections are often implemented in assessment and interventions with clients with autism spectrum disorder (ASD). The selection of the optimal collection is considered by speech-language pathologists (SLPs) a challenging task. Since limited literature exists on the factors that guide this selection specifically for clients with ASD, this study aimed to explore those in detail, for which a qualitative design was followed. Semi-structured interviews were conducted with SLPs who shared their views on the factors that affect this selection. A thematic analysis of the interview transcripts took place. The outcomes showed that SLPs focus on multiple factors, grouped as SLP-related factors (e.g., training on collection(s) of graphic symbols), client-related factors (e.g., age), family-related factors (e.g., opinions on graphic symbol collections), factors related to graphic symbol collections (e.g., iconicity), practical factors (e.g., cost), and assessment/intervention factors. Assessment methods such as trial-error and dynamic assessment to assist with this selection were also reported. The findings revealed the need to support SLPs in optimal symbol collection selection through evidence-based practices, helping to ensure that symbol selection is tailored to the communication needs of students with ASD.
This study examined the transparency and preference for two augmentative and alternative communication (AAC) symbol collections-Picture Communication Symbols (PCS) and VoiceSymbol (VS)-among typically developing, Mandarin-speaking Taiwanese children. Thirty children (15 boys, 15 girls) completed two tasks: a transparency measurement matching spoken Mandarin referents (verbs and adjectives) to symbols in a six-symbol array, and a preference measurement using pairwise selection between VS and PCS. The results indicate no statistically significant difference in transparency between the VS and PCS; however, PCS symbols showed slightly higher transparency scores. Conversely, children demonstrated a statistically significant and strong preference for VS over PCS. These findings suggest that symbol transparency alone may not fully determine symbol preference, as preference may be influenced by other factors. While limited by a modest sample size (N = 30) and specific referents, this study provides insights into symbol perception within Taiwanese communities. Future research should expand the sample size, age groups, and linguistic categories to further explore these trends.
Without appropriate support, communication disabilities can limit social participation in education, employment, and community engagement. Augmentative and alternative communication (AAC) services can help to mitigate barriers to participation. Research on AAC services is growing internationally, however, remains limited in Canada. The purpose of this study was to explore the perspective of service providers on AAC services in Ontario. A total of 21 participants, comprised of speech language pathologists, occupational therapists, and a communicative disorders assistant participated in focus groups. Authors used Appreciative Inquiry, a strengths-based approach to organizational change, guided by four phases: Discovery, Dream, Design, and Destiny. Using reflexive thematic analysis, the authors generated four themes that reflected areas of change in AAC services: expanding the reach of AAC services; aligning service delivery with client needs; leveraging the strengths of service providers; and focusing on the lived experience. Findings highlight key areas for improvement including enhancing professional autonomy, increasing service availability, and providing interventions in natural environments. Participants envisioned service delivery grounded in client-centeredness, efficiency, equity, accessibility, and support for service providers. This study provides a critical evidence base to guide future research and drive informed recommendations for transforming AAC service practices and policies across Ontario.
Augmentative and alternative communication (AAC) systems support individuals with significant communication challenges. In mainland China, AAC implementation remains limited, particularly within school settings due to a shortage of certified speech-language pathologists (SLPs). This study surveyed AAC-related knowledge, practices, and training needs among special education personnel in Tianjin, China, where educators often serve as de facto AAC providers. A 10-item questionnaire was administered to 383 teaching and non-teaching staff across ten special schools (response rate: 64.6%). The survey explored self-reported AAC competence, populations served, preferred training formats, and reading materials. Respondents reported limited knowledge of AAC, especially in low- and high-tech modalities. Most participants expressed a strong desire for training, favoring mentorship and workshops. Those with experience supporting students with autism, intellectual disabilities, and cerebral palsy showed stronger preferences for evidence-based materials and structured training. Principal component analysis (PCA) revealed a uniformly high interest across training topics, indicating broad foundational needs. Findings highlight the urgent need for accessible, entry-level AAC training tailored to the educational context in China. Results can inform national policy, curriculum development, and cross-sector collaboration to build sustainable AAC capacity.
Augmentative and Alternative Communication (AAC) is a critical aspect when ensuring learning and participation in children with complex communication needs. Several studies focused on the use of AAC in well-advanced classrooms; however, less is known about AAC implementation in a rural school setting. This study adopted a qualitative approach. Purposive sampling was used to recruit 21 teachers as participants from two special schools in Mpumalanga Province, South Africa. Data collection involved focus group interviews, and thematic analysis was conducted. The findings shed light on several factors negatively affecting the use of AAC in schools. A lack of support from stakeholders, diversity of learner population, overcrowded classrooms, and limited AAC resources emerged as some of the significant factors affecting the use of AAC in the schools. Upholding effective educational support for children with complex communication needs requires not only training for teachers, but prioritizing other factors, such as the availability of necessary educational resources, and promoting collaboration among stakeholders.
This retrospective case series examined the impact of personally relevant photographs and accompanying text on the spoken discourse of four people with chronic aphasia (PWA) using a high-tech AAC system with visual scene displays (VSDs). Analysis of the informativeness and syntactic complexity of the participants' narrative retells revealed individualized patterns of spoken language performance for each PWA, underscoring the complexity of these findings. Although personally relevant photographs and text supported communicative success in the original study, they did not consistently translate into superior spoken language performance in the current analysis. These findings highlight the importance of future research that more carefully control extraneous variables that were not feasible to address in this retrospective case series. Finally, the results suggest that direct instruction may be necessary to maximize spoken output while simultaneously supporting communication during moments of word retrieval difficulty.
This utilization-focused evaluation study aimed to describe augmentative and alternative communication (AAC) supports to enhance communication accessibility for children with significant communication support needs in a children's museum. Most of the participants had a diagnosis of autism spectrum disorder (ASD), which informed the design and interpretation of AAC strategies implemented in the museum setting. Utilizing feedback from museum staff and parents of children with communication disabilities, the study sought to identify practical strategies to improve the effectiveness of AAC supports in creating more inclusive community spaces. A utilization-focused evaluation framework guided the assessment of embedded-aided communication supports within the museum, ensuring that findings were relevant and actionable for stakeholders. The evaluation revealed three key insights: (a) the importance of communication access through multiple modalities, (b) the role of social awareness in supporting inclusive communication, and (c) the need for enhanced communication partner training and education. Additionally, while parent and museum staff participants recognized the benefits of the communication access program, they also identified limitations and areas for improvement. This study provides recommendations for future research and practice, emphasizing the value of stakeholder-driven evaluations in promoting communication accessibility in community settings.
Prior research has highlighted the positive impact of augmentative and alternative communication (AAC) on speech and language development for children who cannot use speech alone. However, little is known about AAC use specifically for children with childhood apraxia of speech (CAS). Therefore, the purpose of this scoping review was to identify and synthesize twenty years of research investigating AAC use in children with CAS and determine gaps. A systematic search strategy was employed to identify relevant literature in five databases. Abstract and full-text screening was conducted by all authors. Forward and backward citation chaining was completed resulting in a total of 11 eligible studies. Study results were synthesized within three categories: therapy focused, profile and perspective studies. All studies highlighted that early AAC intervention may optimize communication outcomes for children with CAS. Therapy focused studies demonstrated that AAC fulfills a complementary role in the management of CAS. Perspective studies demonstrated that there are a variety of factors which influenced a SLP's decision making surrounding AAC implementation for children with CAS. While prior systematic reviews have demonstrated the positive impact of AAC on speech production broadly, this review uniquely focuses on AAC use in children with CAS.
Individuals with significant communication and physical impairments often rely on augmentative and alternative communication (AAC) to facilitate independent communication across a range of communication partners and settings. Due to physical impairments, many individuals require alternate methods to access AAC systems, known as access technologies. While access technologies have advanced, they remain considerably slower than verbal communication. This scoping review explored recent advances in access technologies published between 2019 and 2024, focusing on technologies that facilitate communication speed and/or accuracy for individuals of any age with physical disabilities. Forty-six studies met inclusion criteria, covering a range of technologies such as brain-computer interfaces (BCIs), eye-tracking technology, and novel applications, such as a mixed reality AAC environment and multimodal access approaches (e.g., integrated eye-tracking with switch scanning, hybrid BCI eye-tracking). Despite technological progress, fewer than one-third of studies addressed the role of communication partners in setup and support, highlighting a gap in user-centred design. Findings are discussed in terms of practical applications and emerging directions for technology development. Implications for clinical practice and future research include the need for inclusive design, improved usability, and greater consideration of communication partner involvement in AAC access solutions.
Traditionally, alternative and augmentative communication (AAC) research has been led by researchers without lived experience using AAC. However, it is important to include AAC users as equitable partners to ensure that research addresses their priorities. This scoping review aimed to identify the extent and nature of AAC user involvement in research focused on adults with cerebral palsy (CP) who use AAC. A systematic search identified 57 data-based studies from the last 22 years that focused on adults with CP who used AAC. Seven (12%) of those studies involved at least one AAC user in at least one research process (conceptualization of the problem, design of study materials and procedures, implementation of the study, data analysis, or dissemination of results). The studies provided examples of advisory, collaborative group, and people-led approaches to involve AAC users in these research processes. Most of the studies utilized qualitative methods (n = 5), although there were also examples of survey (n = 1) and intervention (n = 1) research. Strategies from these studies, along with supporting literature, offer practical guidance for involving AAC users in all stages of future research. Building on these insights, this review outlines future directions for advancing inclusive research.
Families engaging with AAC bring diverse cultural and linguistic backgrounds that influence how services and systems are experienced. In the United States, Hispanic families constitute a rapidly growing population whose voices and experiences are still rarely reflected in AAC research. The present work explored the perspectives of six Hispanic mothers regarding their children's AAC services and system design. A phenomenological approach was used to capture mothers' lived experiences. Semi-structured interviews were conducted in English or Spanish, depending on the participant's preference, and then transcribed, translated, and thematically analyzed using the Braun & Clarke thematic analysis. Three overarching themes were identified. Navigating AAC services irrespective of cultural responsiveness described systemic challenges such as limited provider training, financial barriers, and families managing AAC independently. The role of culture in service delivery reflected how values such as familismo, personalismo, and respeto shaped mothers' perspectives. Cultural and linguistic considerations in AAC system design addressed visual representation, voice output, unique vocabulary, and dual-language navigation. The findings of the study contribute to conversations regarding AAC service delivery by documenting how cultural values and linguistic diversity shape family engagement with services and design features of communication systems.
Eye-gaze control technology (EGT) can facilitate communication and participation for people with physical disabilities or those who use augmentative and alternative communication (AAC). Clinical guidelines for EGT in cerebral palsy (CP) were published in 2021, but users' perspectives on service provision and outcomes remain underexplored. This study aimed to investigate these perspectives in the Australian context. Using a qualitative descriptive approach, semi-structured videoconference or email interviews were conducted with three adults with CP who use EGT and four communication partners. Data were analyzed using reflexive thematic analysis. Two themes were derived: 'EGT Has Opened the Doors for Us' and 'Navigating the EGT Journey', with subthemes 'The Integral Role of Support Systems' and 'Building Skills and Confidence'. Participants described how EGT enabled previously inaccessible forms of communication and participation, fostering autonomy and social connection. They also reported inconsistencies in assessments, trials, and support. Implementing EGT was characterized as a long and complex journey, involving challenges such as navigating funding systems, managing technical issues, and building skills and confidence. Findings revealed that access to EGT alone was insufficient; outcomes were shaped by the consistency of support, clinician expertise, and opportunities for users to build confidence over time. This study highlights the need for consistent application of EGT clinical guidelines to ensure equitable access, while allowing flexibility in how and when ongoing support is provided, reflecting user priorities and the complexity of EGT implementation in practice.
PURPOSE:The purpose of the current study was to explore how speech-language pathologists (SLPs) and occupational therapists (OTs) approach co-treatment sessions for children who use augmentative and alternative communication (AAC). Given a lack of research to date on co-treatment between SLPs and OTs, an initial investigation into the relationship between the professions in this setting was warranted. METHOD:Semi-structured interviews were conducted with 10 dyads of SLPs and OTs with experience treating children who use AAC together. Interviews were conducted either in-person or virtually and then were transcribed for thematic analysis. Reliability measures were completed. RESULTS:Four primary themes emerged from the interviews with 16 subthemes. Results indicated that SLPs and OTs consider their caseload and activities when preparing before sessions. During sessions, considerations include AAC use, communication strategies, and safety. After sessions, SLPs and OTs debrief and educate caregivers. Benefits and barriers to co-treatment were also noted. CONCLUSION:SLPs and OTs noted a number of factors that impact their co-treatment sessions with AAC users. Results of the study demonstrate that SLPs and OTs can collaborate with this population and feel that the model of care is beneficial.
The introduction of the National Disability Insurance Scheme (NDIS) in 2013, increased the need for disability support workers in Australia. However, there are no mandatory qualification or training requirements for support workers. Therefore, this study aimed to investigate the knowledge, training experiences and training needs of Australian support workers assisting NDIS participants who cannot rely on speech alone to be heard and understood. A total of 240 support workers responded to a convergent mixed methods survey disseminated online. While the majority of respondents had accessed some form of training, there was a strong desire for further training. Support workers reported a range of barriers to accessing further training including time and scheduling limitations, financial viability and the format and mode of training currently available. Support workers' self-perceived knowledge was variable between respondents. When asked to describe the strategies they used to assist individuals who cannot use speech alone to be heard and understood, support workers provided access to augmentative and alternative communication systems and supported comprehension and/or expression. The implications for policy makers, employers and research are reported and discussed.
The Family Impact of Assistive Technology Scale for Augmentative and Alternative Communication (FIATS-AAC) was developed to assess the impact of AAC systems on children and adolescents with complex communication needs based on family reports. A first study was conducted regarding the theoretical validation process of the scale, including initial translation, reconciled translation, content validity by experts, back-translation, and face validity. This article describes the steps taken for the preliminary validation of the psychometric properties of the cross-culturally adapted version of the scale into Brazilian Portuguese, the FIATS-AAC-Br. For the research development, FIATS-AAC-Br, the Participant Characterization Questionnaire developed for the research, and the Pediatric Quality of Life Inventory (PedsQL™) - Family Impact Module were used to assess the convergent validity of the scale as a comparative measure. Reliability analysis, including assessment of internal consistency and scale stability, was performed with 30 participants who completed both the Participant Characterization Questionnaire and the FIATS-AAC-Br. Cronbach's alpha calculation indicated excellent internal consistency from scale total (α = 0.94). The Intraclass Correlation Coefficient (ICC) demonstrated high stability for both the total FIATS-AAC-Br (ICC = 0.96; 95% CI = 0.92-0.98) and its 13 dimensions. Convergent validity was assessed with Pearson's Correlation Coefficient between the FIATS-AAC-Br and the PedsQL™, demonstrating a significant positive correlation (Pearson r = 0.719, p < 0.001). These results contribute to establishing a measuring tool for professionals and services working with AAC in monitoring proposed interventions.
Individuals with autism who are minimally speaking often use augmentative and alternative communication (AAC). Communication partner training is an integral element of AAC intervention, and caregivers are ideal communication partners for supporting their child's language development. Asynchronous, online trainings may offer caregivers an accessible and flexible medium to learn to support their child's AAC communication. The current study used a single-case randomized multiple-probe design to evaluate the effects of an asynchronous, online caregiver training on caregiver's AAC strategy use in the context of shared book reading. Visual and statistical analyses were used to determine the presence and magnitude of effects. Four out of five caregivers acquired the target strategy. A functional relation was observed between the online training and caregiver strategy use in addition to individual components of the strategy (e.g., modeling). Tau-U nonoverlap calculations suggested medium to large effects of the intervention on caregiver strategy use. Asynchronous, online trainings may offer a valuable resource to caregivers of children who use AAC for communication, and caregivers may prefer the flexibility and accessibility that is associated with asynchronous trainings. Future research should work toward identifying how online programs can most effectively support widespread parent training and improve outcomes for children who require AAC.
