Access to hands-on mathematics measurement activities using robots controlled via speech generating devices: three case studies

Abstract

Purpose: To examine how using a robot controlled via a speech generating device (SGD) influences the ways students with physical and communication limitations can demonstrate their knowledge in math measurement activities. Method: Three children with severe physical disabilities and complex communication needs used the robot and SGD system to perform four math measurement lessons in comparing, sorting and ordering objects. The performance of the participants was measured and the process of using the system was described in terms of manipulation and communication events. Stakeholder opinions were solicited regarding robot use. Results: Robot use revealed some gaps in the procedural knowledge of the participants. Access to both the robot and SGD was shown to provide several benefits. Stakeholders thought the intervention was important and feasible for a classroom environment. Conclusions: The participants were able to participate actively in the hands-on and communicative measurement activities and thus meet the demands of current math instruction methods.

• Implications for Rehabilitation

• Current mathematics pedagogy encourages doing hands-on activities while communicating about concepts.

• Adapted Lego robots enabled children with severe physical disabilities to perform hands-on length measurement activities.

• Controlling the robots from speech generating devices (SGD) enabled the children, who also had complex communication needs, to reflect and report on results during the activities.

• By using the robots combined with SGDs, children both exhibited their knowledge of and experienced the concepts of mathematical measurements.

     

Initial constructs for patient-centered outcome measures to evaluate brain–computer interfaces

Purpose: The authors describe preliminary work toward the creation of patient-centered outcome (PCO) measures to evaluate brain–computer interface (BCI) as an assistive technology (AT) for individuals with severe speech and physical impairments (SSPI). Method: In Phase 1, 591 items from 15 existing measures were mapped to the International Classification of Functioning, Disability and Health (ICF). In Phase 2, qualitative interviews were conducted with eight people with SSPI and seven caregivers. Resulting text data were coded in an iterative analysis. Results: Most items (79%) were mapped to the ICF environmental domain; over half (53%) were mapped to more than one domain. The ICF framework was well suited for mapping items related to body functions and structures, but less so for items in other areas, including personal factors. Two constructs emerged from qualitative data: quality of life (QOL) and AT. Component domains and themes were identified for each. Conclusions: Preliminary constructs, domains and themes were generated for future PCO measures relevant to BCI. Existing instruments are sufficient for initial items but do not adequately match the values of people with SSPI and their caregivers. Field methods for interviewing people with SSPI were successful, and support the inclusion of these individuals in PCO research.

• Implications for Rehabilitation

• Adapted interview methods allow people with severe speech and physical impairments to participate in patient-centered outcomes research.

• Patient-centered outcome measures are needed to evaluate the clinical implementation of brain–computer interface as an assistive technology.

     

A comparison of two approaches for representing AAC vocabulary for young children

Abstract

Purpose: Young children with complex communication needs often experience difficulty in using currently available graphic symbol systems as a method of augmentative and alternative communication (AAC). Information on young children's performance with graphic representations based on this population's conceptualizations of these vocabulary items may assist in the development of more effective AAC systems.

Method: This study developed Developmentally Appropriate Symbols (DAS) for 10 early emerging vocabulary concepts using procedures designed to address both conceptual and appeal issues for graphic representations for young children. Using a post-test only, between-subjects comparison group design, 40 typically-developing 2.5–3.5-year-old children were randomly assigned to receive a brief training in either of two different types of graphic symbol sets: (a) DAS or (b) Picture Communication Symbols (PCS), a, commercially available graphic symbol system.

Result: Results of a two sample independent t-test provide evidence that children in the DAS condition correctly identified more symbols than children trained with the PCS symbols. There was no evidence of a preference between the symbol sets.

Conclusion: The results provide support for careful consideration of children's use and understanding of language in developing AAC systems for young children.     

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

Abstract

Purpose: Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

Method: Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants’ suggestions for the optimal implementation of these approaches.

Result: Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

Conclusion: Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.     

“Now I am a techie too” – parental perceptions of using mobile technology for communication by children with complex communication needs in the Global South

Abstract

Purpose: Parental perceptions are key to the uptake of augmentative and alternative communication (AAC) devices for their children with complex communication needs. This study aimed to explore the perceptions of parents in a resource poor Global South country on the use of mobile technology as AAC devices.

Materials and methods: Sixteen participants (11 female; 5 male) were included in the study. Focus group discussions, face-to-face interviews and telephone interviews were conducted with the aid of an interview guide. The interview data were analysed using the key principles of Framework analysis and through the lens of critical disability studies.

Results: Six broad themes emerged. Most participants indicated a penchant for mobile technology, though its current use with their children was mainly as a teaching tool rather than a communication device. Concerns were raised about the cost of mobile technology, which if used within communication, was only as a temporary stop-gap measure with limited knowledge. The power of mainstream technology to challenge prevalent notions of disability was also highlighted by the participants.

Conclusions: There is an openness to using mainstream mobile technology by parents with their children with complex communication needs. This use is currently reserved mainly for educational purposes while its power to challenge disability-related stereotypes is acknowledged. More parent training is required to encourage the use of mobile technology as AAC devices for communication.

• Implications for rehabilitation

• Current parent perspectives on mobile technology as AAC devices must be explored, given its potential impact on the uptake of these devices to support communication in their children with complex communication needs.

• Mainstream mobile technology could challenge perceptions of disability and therefore, be more acceptable to parents for their children with complex communication needs.

• Parental training is required to increase knowledge on the use of mobile technology as AAC devices for communication to enable informed choice-making.

     

Associations between self-perceived voice disorders in teachers,perceptual assessment by speech-language pathologists,and instrumental analysis

Purpose: The three aims of this study were to assess agreement between self-perceived voice disorders, perceptual and instrumental assessment; to determine factors associated with perceptual voice assessment; and to determine which associated factors would serve as an initial screening tool for ascertainment of the presence or absence of voice disorders among teachers.

Method: A cross-sectional study was conducted among 574 Colombian teachers. Participants filled in a questionnaire and recorded a voice sample. The voice samples were perceptually evaluated by a speech-language pathologist with the Grade, Roughness, Breathiness, Asthenia, and Strain (GRBAS) scale and objectively with an automated voice analysis for fundamental frequency, jitter, shimmer and maximum phonation time. Agreements between GRBAS scale, self-reported voice disorders and instrumental analysis were determined by unweighted Coheńs Kappa coefficients and receiver operating characteristic curves. Multivariate logistic regression analysis was used to identify variables associated with the perceptual assessment. Diagnostic performance of these variables was assessed by the area under the curve.

Result: There was no agreement between self-reported voice disorders and GRBAS assessments. Maximum phonation time showed a slight agreement with perceptual assessment of voice disorders.

Conclusion: Since these three methods offer different information, it is advisable to include all methods in ascertainment of voice disorders among teachers at work.     

Effect of mobile technology featuring visual scene displays and just-in-time programming on communication turns by preadolescent and adolescent beginning communicators

Purpose: Visual scene displays (VSDs) and just-in-time programming supports are augmentative and alternative communication (AAC) technology features with theoretical benefits for beginning communicators of all ages. The goal of the current study was to evaluate the effects of a communication application (app) on mobile technology that supported the just-in-time programming of VSDs on the communication of preadolescents and adolescents who were beginning communicators.

Method: A single-subject multiple-baseline across participant design was employed to evaluate the effect of the AAC app with VSDs programmed just-in-time by the researcher on the communication turns expressed by five preadolescents and adolescents (9–18 years old) who were beginning communicators.

Result: All five participants demonstrated marked increases in the frequency of their communication turns after the onset intervention.

Conclusion: Just-in-time programming support and VSDs are two features that may positively impact communication for beginning communicators in preadolescence and adolescence. Apps with these features allow partners to quickly and easily capture photos of meaningful and motivating events and provide them immediately as VSDs with relevant vocabulary to support communication in response to beginning communicators’ interests.     

The role of psychogenic and psychosocial factors in the development of functional voice disorders

The primary objective of this discussion paper is to review the available evidence for the role of psychogenic and psychosocial factors in the development of functional voice disorders (FVD). Current theoretical models linking these factors to the aetiology of FVD and to vocal hyperfunction are then considered. Since there is a paucity of solid empirical evidence to date, general patterns of evidence derived from single case reports and case series are examined first, followed by those empirical studies using more sophisticated methodologies. The discussion is structured around a framework that includes the following psychosocial areas of enquiry: demographic profiles of individuals with FVD; stressful incidents preceding onset; personality traits; coping styles and psychiatric disorder. Current evidence and associated theoretical models suggest that cognitive, affective, neurophysiological and behavioural aspects culminate in the development of these complex voice disorders. The implications of these findings are discussed with respect to clinical practice and clinical training, with suggestions for future scientific research.     

Human Factors Considerations in the Design of Language Interfaces in AAC

The design and development of new augmentative and alternative communication (AAC) systems and techniques must often include a focus on the presentation, selection, and processing of language items. We define this as the language interface and argue that researchers must take into account the broad base of knowledge available from the fields of human factors and human–computer interaction in the design process. This article will present an overview of these fields and discuss design principles that are relevant to AAC language interfaces. These principles will be discussed with respect to a number of currently available techniques. In addition, design case studies will be presented on some techniques currently under investigation. Finally, issues related to evaluation will be discussed.     

Review supports use of aided augmentative and alternative communication (AAC) systems for improving communication skills for individuals with autism spectrum disorders: The role of moderators is not yet clearly established

This review provides a summary and appraisal commentary on the treatment review by Ganz, J. B., Earles-Vollrath, T. L., Heath, A. K., Parker, R. I., Rispoli, M. J., & Duran, J. B. (2011). A meta-analysis of single case research studies on aided augmentative and alternative communication systems with individuals with autism spectrum disorders. Journal of Autism and Developmental Disorders. Advance online publication. doi: 10.1007/s10803–011–1212–2.

Source of funding and disclosure of interest: No source of funding reported, and no conflicts of interest reported by the original authors of this research report.     

Perception and multimeaning analysis of graphic symbols for Thai picture-based communication system

Graphic symbols are a vital part of most augmentative and alternative communication systems. Communication fluency of graphic symbol user depends on how well the relationship between symbols and its referents are learnt. The first aim of this study is to survey the perception of the selected graphic symbols across seven age groups of participants with different educational background. Sixty-five individuals identified themselves as Thai and ranged in age from 10 to 50 years participated in the investigation used 64 graphic symbols. The last aim of this study is to demonstrate the analysis of multimeaning graphic symbols, which will be used in Thai Picture-based communication system. The twenty graphic symbols with 9–14 meanings are analyzed in both syntactic and semantic aspects. The meanings are divided into five categories: noun, verb/adjective, size, color and shape. Respect to the first aim, the results suggest that the participants under investigation with different sexes, age groups, as well as various educational levels perceive the features or inherent characteristics of such graphic symbols similarly. The results of the analysis of multimeaning of graphic symbols indicate that the foundation of Minspeak, polysemy and redundancy of the words illustrates the inherit meanings of the real-life objects, and it also conveys that the Thai graphic symbols are influenced by numerous factors in Thai circumstance such as ability, motivation, experience, worldview and culture.

Implications for Rehabilitation

• Graphic symbols have been used in sequences for coding language in Minspeak, which is known commercially as an acronym for minimum effort speech.

• Graphic symbols are also a means of augmenting or providing alternative communication for individuals with little or no functional speech.

• Perception of graphic symbols can be influenced by many factors: features or inherent characteristics of symbol set/system, individual’s own abilities and motivation, selected vocabulary and individual’s previous experience and world knowledge.

• This paper shows the perception of the selected graphic symbols across seven age groups of Thai participants with different educational background, and the analysis of multimeaning graphic symbols also.

     

Communicative participation changes in pre-school children receiving augmentative and alternative communication intervention

Purpose: This paper reports changes in communicative participation skills—systematically measured and described—in an empirical observational case series of eight children receiving augmentative and alternative communication (AAC) interventions.

Method: The eight children (seven boys, one girl), ranging from 1 year 4 months to 4 years 11 months (mean = 2.8 years; SD = 1.32 years) received varied AAC interventions (i.e. sign language, assistive technology, PECS), averaging 15 hours of treatment over a 12-month period. Parents completed an outcome measure (FOCUS) three times: at the start, mid-point (6 months) and end of the intervention period (after 12 months). They also completed the ASQ-SE at the start and end of intervention.

Result: FOCUS scores increased over the treatment interval, indicating improvement in real-world communication skills as observed by their parents. The ASQ-SE items that pertained to communication also improved, while the items that did not correspond to communication did not. This divergence suggests that the communicative participation improvements resulted from treatment rather than general developmental gains. The largest improvements were noted in receptive language/listening, pragmatics and social/play skills. Improvements in intelligibility were also measured for several children.

Conclusion: These results suggest that AAC intervention facilitated improvements in communicative participation skills in pre-school children.     

A Language Activity Monitor for Supporting AAC Evidence-Based Clinical Practice

Augmentative and alternative communication (AAC) evidence-based practice requires the collection and analysis of performance data. This article presents the development, evaluation, and application of automated performance monitoring tools for use in clinical practice. Language activity monitoring (LAM) is the systematic data collection of the actual language activity of an individual who relies on AAC. Work completed to date includes the development and evaluation of the language activity monitor function, which now is commercially available in three forms: (1) a standard feature built into modern high performance AAC systems, (2) an external add-on package for use with older AAC devices based on synthetic speech, and (3) software that allows the personal computer to serve as an LAM in the clinical environment. The LAM records the time and content of language events (the generation of one or more letters or words). A logging protocol suitable for clinical application has been in use since late 1998. The logged data is uploaded periodically to a computer for editing, analysis, and the generation of a summary measure report. The applications of this work in the areas of clinical service delivery are presented.     

Providing instructional support for AAC service delivery in low- and middle-income (LAMI) countries

Purpose: The majority of individuals with disabilities live in low- and middle-income (LAMI) countries; typically these individuals receive limited, if any, communication rehabilitation services. The present study investigated the experiences of eight augmentative and alternative communication (AAC) professionals who had provided instructional support for AAC service delivery in LAMI countries.

Method: An online focus group was used to explore the training experiences of eight AAC professionals.

Result: A thematic analysis of the focus group discussion resulted in four major recommendations when providing training for AAC service delivery in LAMI countries: (a) investigate learner needs, (b) provide contextually relevant instructional content, (c) use engaging instructional activities and (d) assess the impacts of instructional activities.

Conclusion: The instructional recommendations of the focus group participants are discussed within a theoretical framework of recommended best practices in supporting adult learning. The information shared by the focus group participants will benefit others providing instructional support for AAC service delivery in LAMI countries.     

The Communication Supports Inventory-Children & Youth (CSI-CY), a new instrument based on the ICF-CY

Purpose: Two studies are presented that evaluated the Communication Supports Inventory-Children & Youth (CSI-CY), an instrument designed to facilitate the development of communication-related educational goals for students with complex communication needs (CCN). The CSI-CY incorporates a code set based on the ICF-CY. The studies were designed to determine the effect of using the CSI-CY on IEP goals for students with CCN and to evaluate consumer satisfaction.

Method: In Study 1, sixty-one educators and speech–language pathologists were randomly assigned to either (a) provide a student’s current IEP (control group) or (b) complete the CSI-CY prior to preparing a student’s next IEP and to submit the new IEP (experimental group). Study 2 was a field test to generate consumer satisfaction data.

Results: Study 1 showed that IEP goals submitted by participants in the experimental group referenced CSI-CY-related content significantly more frequently than did those submitted by control participants. Study 2 revealed high satisfaction with the instrument.

Conclusions: The code set basis of the CSI-CY extends the common language of the ICF-CY to practical educational use for children with CCN across diagnostic groups. The CSI-CY is well regarded as an instrument to inform the content of communication goals related to CCN.

• Implications for Rehabilitation

• The CSI-CY will guide rehabilitation professionals to develop goals for children with complex communication impairments.

• The CSI-CY is a new instrument that is based on the ICF-CY for documentation of communication goals.