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

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In an effort to quantify communication efficiency, speaking rates and intelligibility scores were obtained from a normal speaking adult and 13 dysarthric speakers representing a wide range of severity. Speakers were audio recorded as they read words and sentences. A panel of judges transcribed all recordings and subjectively ranked a randomly selected sample from each speaker according to "communication efficiency." The following measures were obtained for each speaker: word and sentence intelligibility, speaking rate, rates of intelligible and unintelligible speech and a numerical ranking of communication efficiency. Results indicated that speaking rate and speech intelligibility are not closely correlated. By plotting measures that incorporate intelligibility and rate, one can rank speakers similarly to subjective rankings of communication efficiency, and distinguish mildly dysarthric from normal speakers. The addition of intelligibility and rate measures to supplement other assessment procedures in the evaluation of dysarthric speakers is discussed.

The purpose of this study was to develop a technique for quantifying connected speech samples of aphasic individuals as they recover from the moderate to the mild range of severity. Verbal picture descriptions elicited from mild and moderate aphasic speakers were audio-recorded and compared to those elicited from normal adult and geriatric speakers. These samples were compared on the basis of a measure of amount of information conveyed (content units) and two measures of efficiency including speaking rate (syllables per minute) and rate at which information was conveyed (content units per minute). Results indicated an inverse relationship between severity of aphasia and amount of information conveyed. However, mild and high-moderate aphasic speakers tended to communicate as much information as normal speakers. Both measures of efficiency differentiated groups of mild and high-moderate aphasics from normal speakers as well as differentiating low-moderate from mild aphasic speakers. Use of this quantification system which takes into account both amount of information and efficency of communication is illustrated with data obtained from a recovering aphasic speaker.

The purpose of this review is to describe the state of the science of augmentative and alternative communication (AAC) for adults with acquired neurogenic communication disorders. Recent advances in AAC for six groups of people with degenerative and chronic acquired neurological conditions are detailed. Specifically, the topics of recent AAC technological advances, acceptance, use, limitations, and future needs of individuals with amyotrophic lateral sclerosis (ALS), traumatic brain injury (TBI), brainstem impairment, severe, chronic aphasia and apraxia of speech, primary progressive aphasia (PPA), and dementia are discussed.

Almost all people with amyotrophic lateral sclerosis (ALS) experience a motor speech disorder, such as dysarthria, as the disease progresses. At some point, 80 to 95% of people with ALS are unable to meet their daily communication needs using natural speech. Unfortunately, once intelligibility begins to decrease, speech performance often deteriorates so rapidly that there is little time to implement an appropriate augmentative and alternative communication (AAC) intervention; therefore, appropriate timing of referral for AAC assessment and intervention continues to be a most important clinical decision-making issue. AAC acceptance and use have increased considerably during the past decade. Many people use AAC until within a few weeks of their deaths.