AAC for adults with acquired neurological conditions: A review

Abstract

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.

Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication?

“…This research has established empirical evidence of the positive impact of AAC (Beukelman et al, 2007;Bopp, Brown, & Mirenda, 2004;Branson & Demchak, 2009;Fried-Oken et al, 2012;Ganz et al, 2011;Machalicek et al, 2010;Roche et al, 2014;Schlosser, Sigafoos, & Koul, 2009;Walker & Snell, 2013;Wendt, 2009) and has demonstrated that these gains come at no risk to speech development or recovery (e.g., Millar, Light, & Schlosser, 2006;Romski et al, 2010). As a fi eld, we should take pride in this increased research base that has resulted in advances in evidence-based AAC services.…”

“…Operational skills involve skills in the technical operation of AAC strategies and techniques, including: (a) skills to produce the hand or body positions, shapes, orientations, and movements for gestures, signs, or other forms of unaided communication (e.g., eye blink codes, head nod/shake); (b) skills to utilize selection technique(s) for aided AAC systems (e.g., direct selection with a fi nger or fi st, eye gaze, scanning with a single switch); and, (c) skills to navigate and operate aided AAC systems accurately and effi ciently (e.g., navigate between pages, enter codes to retrieve pre-stored vocabulary items). These operational skills must extend across the full range of modes used by the individual with complex communication needs, including both unaided and aided means of communication, and both low tech and high tech systems (Beukelman, Fager, Ball, & Dietz, 2007;Hodge, 2007). Randy Horton described the signifi cant demands of learning the operational skills for a single AAC system (approximately 96 hours in Randy ' s case) and the lack of instruction typically provided to support the development of these skills:…”

“…Twenty-fi ve years ago, the fi eld was focused on demonstrating what was possible with access to appropriate AAC interventions (Mirenda, 2014). Now that the possible has been established, the challenge will be to ensure that it becomes the probable and that every individual with complex communication needs has access to effective evidence-based AAC intervention to maximize participation and communication (Beukelman et al, 2007;Rispoli, Franco, van der Meer, Lang, & Camargo, 2010). There remain far too many individuals with complex communication needs who do not receive the effective, culturally competent, evidence-based AAC services that they require to realize communicative competence and achieve their full potential (Baxter, Enderby, Evans, & Judge, 2012;Hodge, 2007).…”

The Changing Face of Augmentative and Alternative Communication: Past, Present, and Future Challenges

“…Over the past 30-40 years, there have been substantial changes to these practices. There is now a growing body of empirical evidence documenting the positive outcomes of AAC intervention (e.g., Beukelman, Fager, Ball, & Dietz, 2007;Bopp, Brown, & Mirenda, 2004;Branson & Demchak, 2009;Fried-Oken, Beukelman, & Hux, 2012;ganz, et al, 2011;Machalicek et al, 2010;Schlosser, Sigafoos, & Koul, 2009;Wendt, 2009). Moreover, there is evidence that AAC interventions pose no risk to speech development or recovery (e.g., Beukelman & Mirenda, 2013;Millar, Light, & Schlosser, 2006;Schlosser & Wendt, 2008).…”

“…In addition, increasing numbers of speech language pathologists are working to reconcile the traditional restorative approaches to language intervention (utilized historically with individuals with aphasia) with AAC interventions that focus on functional communication for these individuals (SimmonsMackie, King, & Beukelman, in press). Increased awareness and acceptance of AAC have also resulted in its successful application to new populations of adults with acquired disabilities, including individuals with primary progressive aphasia, Alzheimer's disease and dementia, and those in intensive care units (ICU) who may have temporary conditions (e.g., Beukelman et al, 2007;Bourgeois, Dijkstra, Burgio, & Allen-Burge, 2001;Cress & King, 1999;Fried-Oken, Rau, & Oken, 2000;Fried-Oken, Rowland et al, 2012;Downey & Hurtig, 2006).…”