Augmentative and Alternative Communication - Assessment and System Implementation

Assessment and System Implementation

I stiffened my body and put my left foot out again, for the third time. I drew one side of the letter. I drew half the other side... I set my teeth so hard that I nearly pierced my lower lip. But – I drew it – the letter 'A'... Shaky, with awkward, wobbly sides and a very uneven centre line... I had done it! I had started – the thing that was to give my mind its chance of expressing itself. True, I couldn't speak with my lips, but now I would speak through something more lasting than spoken words – written words. That one letter, scrawled on the floor with a broken bit of yellow chalk gripped between my toes, was my road to a new world, my key to mental freedom.

The poet and author Christy Brown describes his communication breakthrough at 5 years in the book My Left Foot.

An evaluation of an individual's abilities, limitations and communication needs is necessary to select appropriate AAC techniques. The purpose of the assessment is to identify potential AAC approaches that can bridge discrepancies between a potential user's current communication and their present and future communication needs. AAC evaluations are often conducted by specialized teams which may include a speech-language pathologist, occupational therapist, rehabilitation engineer, physiotherapist, social worker and a physician. Users, family members and teachers are also key members of the decision making team. Sensitivity to and respect of cultural diversity contributes to ongoing family involvement and to the selection of the most appropriate AAC system. For members of some cultural groups the presence of an AAC device increases the visibility of disability and is thus viewed as stigmatizing.

A user's motor abilities, communication skills and needs, cognition and vision are assessed in order to determine the most appropriate match to a communication system. Depending on the individual's physical status, recommendations of an alternative access method, a change in seating/positioning, a mounting system and/or communication aid adaptations may be needed. For example, someone with spastic arm movements may require a key guard on top of the keyboard or touchscreen to reduce the selection of non-target items. The person's needs and abilities determine the symbols chosen and their organization, with the goal being that the communication system can be used as efficiently as possible in different contexts, with different communication partners, and for different social purposes. Researcher Janice Light identified four social purposes of communicative interaction in AAC: the expression of needs and wants to a listener, the transfer of information as in more general conversation, the development of social closeness through such things as jokes and cheering, and finally social etiquette practices such as "please" and "thank you". These four purposes vary in terms of the relative importance of the content, rate, duration and the focus of the interaction. It is important that the AAC systems selected also reflect the priorities of the individual and their family. In Western cultures, professionals may see a communication device as helping to promote an individual's self-determination, i.e., the ability to make one's own decisions and choices. However, cultural and religious factors may affect the degree to which individual autonomy is a valued construct, and influence family attitudes towards AAC.

Training can help the user make use of their AAC system to communicate effectively with others, to control their environment through communication, and to make choices, decisions and mistakes. Skilled users of AAC show communicative competence in four interrelated areas: linguistic, operational, social and strategic. Linguistic competence refers to language skills in the person's native language as well as the linguistic code of the symbol system selected. Operational competence involves the skills in the use and maintenance of the tool of communication, while social competence and strategic competence reflect knowledge and judgment in communicative interactions, including the compensations required for a slow speaking rate, communication breakdowns and those unfamiliar with AAC. An AAC user may require specific device programming and/or training to achieve competency in these areas.

Communication partners may also require training to notice and consistently interpret the communication signals of a severely disabled individual, particularly because there is a danger that learned helplessness can be the result of repeated failure to communicate successfully. Parties may need assistance to avoid the directive communication style that can lead a child user of AAC not to develop a full range of communication skills such as initiating or taking the lead in conversation, using complex syntax, asking questions, making commands or adding new information. Young AAC users benefit from rich language and literacy experiences to foster vocabulary development, discourse skills, and phonological awareness, all of which supports successful literacy learning. Communication partners are encouraged to provide augmented input with the child, such as signing or pointing to symbols and codes as they communicate, including using the individual's communication system themselves. They also benefit from focussed and explicit reading instruction.