Designing augmentative and alternative communication applications: the results of focus groups with speech-language pathologists and parents of children with autism spectrum disorder

Purpose: The purpose of this study was to gain insight from speech-language pathologists (SLPs) and parents of children with autism spectrum disorder (ASD) regarding appealing features of augmentative and alternative communication (AAC) applications.

Method: Two separate 1-hour focus groups were conducted with 8 SLPs and 5 parents of children with ASD to identify appealing design features of AAC Apps, their benefits and potential concerns. Participants were shown novel interface designs for communication mode, play mode and incentive systems. Participants responded to poll questions and provided benefits and drawbacks of the features as part of structured discussion.

Results: SLPs and parents identified a range of appealing features in communication mode (customization, animation and colour-coding) as well as in play mode (games and videos). SLPs preferred interfaces that supported motor planning and instruction while parents preferred those features such as character assistants that would appeal to their child. Overall SLPs and parents agreed on features for future AAC Apps.

Conclusion: SLPs and parents have valuable input in regards to future AAC app design informed by their experiences with children with ASD. Both groups are key stakeholders in the design process and should be included in future design and research endeavors.

• Implications for Rehabilitation

• AAC applications for the iPad are often designed based on previous devices without consideration of new features.

• Ensuring the design of new interfaces are appealing and beneficial for children with ASD can potentially further support their communication.

• This study demonstrates how key stakeholders in AAC including speech language pathologists and parents can provide information to support the development of future AAC interface designs.

• Key stakeholders may be an untapped resource in the development of future AAC interfaces for children with ASD.

     

Research directions in augmentative and alternative communication for preschool children

PURPOSE: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). METHOD: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. RESULTS: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. CONCLUSION: SAL is a viable communication intervention approach for young children.     

Research directions in augmentative and alternative communication for preschool children

Purpose: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). Method: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. Results: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. Conclusion: SAL is a viable communication intervention approach for young children.     

Research directions in augmentative and alternative communication for preschool children

Purpose: To review issues related to the use of augmentative systems with young children and present a case study of one child and family's experience with the System for Augmenting Language (SAL). Method: The case involved a preschool child with severe developmental delays who had little functional speech. Acquisition and use of graphic symbols on a speech-output communication device was studied in home and clinical settings. Language and communication behaviours of the child and his communication partners were observed and language assessment measures were collected. Results: Child engagement state varied across the two settings with a stable profile seen in the therapy setting and a clear increase at home. Child communicative attempts increased following the introduction of the augmented system. Parents reported successful use of the SAL. Conclusion: SAL is a viable communication intervention approach for young children.     

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.     

Evaluating pictogram prediction in a location-aware augmentative and alternative communication system

This study compared the performance of two statistical location-aware pictogram prediction mechanisms, with an all-purpose (All) pictogram prediction mechanism, having no location knowledge. The All approach had a unique language model under all locations. One of the location-aware alternatives, the location-specific (Spec) approach, made use of specific language models for pictogram prediction in each location of interest. The other location-aware approach resulted from combining the Spec and the All approaches, and was designated the mixed approach (Mix). In this approach, the language models acquired knowledge from all locations, but a higher relevance was assigned to the vocabulary from the associated location. Results from simulations showed that the Mix and Spec approaches could only outperform the baseline in a statistically significant way if pictogram users reuse more than 50% and 75% of their sentences, respectively. Under low sentence reuse conditions there were no statistically significant differences between the location-aware approaches and the All approach. Under these conditions, the Mix approach performed better than the Spec approach in a statistically significant way.     

Using confidence assessment to explore physiotherapists,dieticians, speech pathologists and occupational therapists knowledge of medicines

ABSTRACT

Medicines are the largest single intervention provided to patients on admission to hospital. Adverse effects of medicines may decrease the ability of patients to participate in clinical interventions from physiotherapists, dietitians, speech pathologists and occupational therapists (PDSOs), which in turn impacts on quality of care and length of hospital stay. PDSOs receive medicines education as part of their undergraduate degree but little education once commencing practice. Pharmacists’ possess significant knowledge about medicines and are well placed to educate PDSOs about medicines which may benefit their interventions. This study used certainty- based scoring to evaluate an interprofessional workshop addressing medicines safety information for PDSOs. Scoping interviews established baseline knowledge. Interview data was then used to formulate the workshop and case study. Knowledge was assessed using a pre and post quiz including a certainty- based score. A two-hour pilot workshop attracted thirty-three attendees from the PDSO professions. A trend towards more correct answers and increased certainty they were correct was observed from pre to post quiz. This style of workshop measures PDSOs knowledge of, and competence with, medicines. The assessment for competence is an important consideration with increasing numbers of medicines and complexity of patients potentially increasing risk of adverse events.     

The application of natural language processing to augmentative and alternative communication

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

Interprofessional education on a training ward for older people: students' conceptions of nurses, occupational therapists and social workers

Collaboration between professionals in health and social care is essential to meet the needs of the patient. The collaboration is dependent on knowledge and understanding of each other's roles. One means of improving communication and collaboration among professionals is interprofessional education. The aim of this study was to describe the variation in how students in nursing, occupational therapy and social work perceived their own and the other professions. Over a three-week period two interviews were conducted with each of 16 students who were on an interprofessional training ward for older people in a municipal setting in Sweden. A phenomenographical approach was used in the analysis of the interviews. The findings showed great variation in how the students perceived the professions, from simplistic in terms of tasks to a more complex conception in terms of knowledge, responsibility and values. Differences in the ways professions were described concerning their professional stance towards the patients were especially accentuated. The findings indicate that the students need opportunities for reflection on and scrutiny of each other's beliefs and knowledge. The influence of interprofessional education involving reflection on the different health-care professions needs to be explored in future research.     

A systematic review of the effectiveness of nurse communication with patients with complex communication needs with a focus on the use of augmentative and alternative communication

Aims and objectives. To systematically review the research regarding communication between nurses and patients with complex communication needs (CCN). The research was reviewed with respect to the following themes: (a) the importance of communication; (b) the barriers to effective communication; (c) the supports needed for effective communication; and (d) recommendations for improving the effectiveness of communication between nurses and patients with CCN. Augmentative and alternative communication (AAC) strategies that can be used by nurses to facilitate more effective communication with patients with CCN are discussed. Background. Effective nurse‐patient communication is critical to efficient care provision. Difficulties in communication between nurses and patients arise when patients are unable to speak. This problem is further complicated because nurses typically receive little or no training in how to use AAC to communicate with patients with CCN. Design. Systematic review. Method. This paper reviewed the published research focusing on the perspectives of nurses, patients with CCN and their caregivers regarding the challenges to effective communication between nurses and patients with CCN. Further, specific strategies (i.e., using AAC) that nurses can use to improve and facilitate communication with patients with CCN are provided. Conclusions. Communication between nurses and patients is critical to providing and receiving quality care. Nurses and patients have reported concern and frustration when communication is not adequate. Using AAC strategies will help nurses and patients better communicate with each other when speech is not an option. Relevance to clinical practice. Communication with all patients is very important to the provision of quality nursing care. Communication cannot always be achieved using the speech modality. Nurses need to have tools and skills that will allow them to communicate with all of their patients whether or not they can speak.     

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.     

Factors influencing the education of occupational therapists in Ontario

This paper examines some of the factors which were involved in the December 1974, decision, of the Ontario's Minister of Colleges and Universities to Mohawk College of Applied Arts and Technology to establish an experimental program in occupational therapy. This program is being launched without the endorsement of the provincial and national association of occupational therapy which wish to maintain a baccalaureate level of education for occupational therapists in a university settings. Some questions which are explored in the examination of this case are: What is a College of Applied Arts and Technology? How is it different from a University? What is a profession? What is a paraprofession? Is occupational therapy a profession or a paraprofession? Why did Mohawk College propose an occupational therapy program? What factors contributed to the occupational therapists' inability to stop the proposal? What was the process of approval of the proposal? How important are status and prestige as factors in these issues? The following discussion will attempt to deal with these questions as they relate to the educational arrangements for occupational therapists in Ontario.     

Scoping review of interventions for children who require augmentative and alternative communication is limited by focus on randomized controlled trials

This review provides a summary and appraisal commentary on the treatment review by Costantino, M., & Bonati, M. (2014). A scoping review of interventions to supplement spoken communication for children with limited speech or language skills. PLoS ONE, 9, 1–15.

Source of funding and declaration of interests: Christine Holyfield was supported by funding from the Penn State AAC Leadership Project, a doctoral training grant funded by U.S. Department of Education [grant #H325D110008]. The original authors report no conflicts of interest.     

Problem-based learning,critical thinking and concept mapping in speech-language pathology education: A review

Despite speech-language pathology (SLP) education undergoing many innovative changes over the years, there has been little research about learning or outcomes in SLP programs. Critical thinking in clinical decision-making, however, has been identified as a critical skill in SLP. Several recent studies have shown that concept mapping can be used to assess, and perhaps enhance, critical thinking. Problem-based learning (PBL) is reported to be one way to encourage critical thinking and life-long learning. Here we review the literature in PBL, concept mapping, and critical thinking, focusing on the education of SLP students. The review illustrates the close and complex interactions amongst problem-based learning, critical thinking and concept mapping. The aim of the review is to provide a better understanding of the mechanism of PBL, and to increase understanding regarding why the employment of PBL in SLP programs may facilitate critically-thinking graduate clinicians. The evidence indicates that PBL allows more meaningful learning that promotes better integration between theory and clinical practice.     

Discharge experiences of speech-language pathologists working in Cyprus and Greece

Post-termination relationships are complex because the client may need additional services and it may be difficult to determine when the speech-language pathologist-client relationship is truly terminated. In my contribution to this scientific forum, discharge experiences from speech-language pathologists working in Cyprus and Greece will be explored in search of commonalities and differences in the way in which pathologists end therapy from different cultural perspectives. Within this context the personal impact on speech-language pathologists of the discharge process will be highlighted. Inherent in this process is how speech-language pathologists learn to hold their feelings, anxieties and reactions when communicating discharge to clients. Overall speech-language pathologists working in Cyprus and Greece experience similar emotional responses to positive and negative therapy endings as speech-language pathologists working in Australia. The major difference is that Cypriot and Greek therapists face serious limitations in moving their clients on after therapy has ended.     

Sociocultural development and validation of lexicon for Asian-Indian individuals who use augmentative and alternative communication

Purpose. Individuals who temporarily or permanently are not able to communicate through use of gestures/signs, speech, and/or written communication mode benefit from the use of augmentative and alternative communication (AAC) systems. Effective communication skills for individuals who use an AAC system depend on appropriate lexicon. This study was designed to develop and validate a socially and culturally appropriate lexicon for Asian-Indians who use AAC.

Method. To this end, 120 individuals from India participated in this study. A composite list of lexical items was identified, using a structured social validation technique involving non-categorical and categorical nominations, and a rating of lexical items from a Picture Communication Symbols (PCS) lexicon.

Results. Data analysis indicated that 88 lexical items from the nomination task were not represented in the PCS lexicon and 247 items were rated as having no value for the Asian-Indian culture.

Conclusions. Findings suggest that while a lexicon from symbol sets developed for one culture might have considerable overlap across cultures, these lexicons may not be appropriate as a source of selecting a lexicon for an AAC user from a culturally and linguistically diverse background. Implications of these findings are discussed for speech-language pathologists and other rehabilitation professionals.     

A review of standardized patients in clinical education: Implications for speech-language pathology programs

The use of standardized patients has been reported as a viable addition to traditional models of professional practice education in medicine, nursing and allied health programs. Educational programs rely on the inclusion of work-integrated learning components in order to graduate competent practitioners. Allied health programs world-wide have reported increasing difficulty in attaining sufficient traditional placements for students within the workplace. In response to this, allied health professionals are challenged to be innovative and problem-solving in the development and maintenance of clinical education placements and to consider potential alternative learning opportunities for students. Whilst there is a bank of literature describing the use of standardized patients in medicine and nursing, reports of its use in speech-language pathology clinical education are limited. Therefore, this paper aims to (1) provide a review of literature reporting on the use of standardized patients within medical and allied health professions with particular reference to use in speech-language pathology, (2) discuss methodological and practical issues involved in establishing and maintaining a standardized patient program and (3) identify future directions for research and clinical programs using standardized patients to build foundation clinical skills such as communication, interpersonal interaction and interviewing.