Augmentative and Alternative Communication - History

History

The history of AAC can be traced to the days of classical Rome and Greece, with the first recorded use of augmentative strategies with the deaf. The use of manual alphabets and signs was recorded in Europe from the 16th century, as was the gestural system of Hand Talk used by Native Americans to facilitate communication between different linguistic groups. The first known widely available communication aid was a letter and word-based communication board developed for, and with, F. Hall Roe, who had cerebral palsy. This communication board was distributed in the 1920s by a men's group in Minneapolis.

The modern era of AAC began in the 1950s in Europe and North America, spurred by several societal changes; these included an increased awareness of individuals with communication and other disabilities, and a growing commitment, often backed by government legislation and funding, to develop their education, independence and rights. In the early years, AAC was primarily used with laryngectomy and glossectomy cases, and later with individuals with cerebral palsy and aphasia. It was typically only employed after traditional speech therapy had failed, as many felt hesitant to provide non-speech intervention to those who might be able to learn to speak. Individuals with intellectual impairment were not provided with AAC support because it was believed that they did not possess the prerequisite skills for AAC. The main systems used were manual signs, communication boards and Morse code, though in the early 1960s, an electric communication device in the form of a sip-and-puff typewriter controller named the Patient Operated Selector Mechanism (POSM or POSSUM) was developed in the United Kingdom.

From the 1960s onward, sign language increased in acceptance and use in the Deaf community, and AAC also came to be viewed as acceptable for those with other diagnoses. Manual sign languages, such as Makaton, were advocated for those with both hearing and cognitive impairments, and later for those with intellectual impairment or autism with normal hearing. Research into whether primates could learn to sign or use graphic symbols spurred further interest the use of AAC with those with cognitive impairments. The use of Amer-Ind hand signals opened the field to AAC techniques specifically for adult users.

Blissymbols were first used in Canada in 1971 to provide communication to those not able to use traditional orthography; their use quickly spread to other countries. With improved technology, keyboard communication devices developed in Denmark, the Netherlands and the US increased in portability; the typed messages were displayed on a screen or strip of paper. By the end of the 1970s, communication devices were being commercially produced, and a few, such as the HandiVoice, had voice output. Countries such as Sweden, Canada and the United Kingdom initiated government-funded services for those with severe communication impairments, including developing centres of clinical and research expertise.

The late 1970s and 1980s saw a massive increase of AAC-related research, publications, and training as well the first national and international conferences. The International Society for Alternative and Augmentative Communication (ISAAC) was founded in 1983; its members included clinicians, teachers, rehabilitation engineers, researchers, and AAC users themselves. The organization has since played an important role in developing the field through its peer-reviewed journal, conferences, national chapters and its focus on AAC in developing countries. AAC became an area of professional specialization; a 1981 American Speech-Language-Hearing Association position paper, for example, recognized AAC as a field of practice for speech-language pathologists. At the same time, AAC users and family members played an increasing prominent role in the development of knowledge of AAC through their writing and presentations, by serving on committees and founding advocacy organizations.

"Knowing that most of y'all do not know the HandiVoice, I will describe it...It was operated with a numeric keyboard...Each word, or sentence, or phrase, or phoneme was stored and accessed by a three digit code, for example, "hello" was 010...It took three codes to say "Rick", that was nine numbers. Now if you think that's bad, let's go for the simple sentence, "Hello, this is Rick Creech speaking." This would have taken fifteen 3 digit codes, for a total of forty-five numbers. Looking back, I am not surprised that very few professionals thought a person could successfully use the HandiVoice 120. But I did. I did, because being able to communicate with people was so empowering to me."

Rick Creech describes the HandiVoice 120 speech generating device, which he received in 1977.

From the 1980s, improvements in technology led to a greatly increased number, variety, and performance of commercially available communication devices, and a reduction in their size and price. Alternative methods of access such eye pointing or scanning became available on communication devices. Speech output possibilities included digitized and synthesized speech, with text-to-speech options available in German, French, Italian, Spanish, Swedish and Ewe. AAC services became more holistic, seeking to develop a balance of aided and unaided strategies with the goal of improving functioning in the person's daily life, and greater involvement of the family. Increasingly, individuals with acquired conditions such as amyotrophic lateral sclerosis, Parkinson's disease, head injury, and locked-in syndrome, received AAC services. In addition, with the challenge to the notion of AAC prerequisites, those with severe to profound intellectual impairments began to be served. Courses on AAC were developed for professional training programs, and literature such as textbooks and guides were written to support students, clinicians and parents.

The 1990s brought a focus on greater independence for people with disabilities, and more inclusion in mainstream society . In schools, students with special needs were placed in regular classrooms rather than segregated settings, which led to an increased use of AAC as a means of improving student participation in class. Interventions became more collaborative and naturalistic, taking place in the classroom with the teacher, rather than in a therapy room. Facilitated communication – a method by which a facilitator physically and emotionally supports a person with severe communication needs as they type on a keyboard or letter board – received wide attention in the media and in the field. The question of the authorship made the approach controversial; most of the subsequent research indicated that the facilitators were unknowingly influencing the messages typed. As a result, professional organizations and AAC researchers and clinicians have not typically accepted facilitated communication.

Rapid progress in hardware and software development continued, including projects funded by the European Community. The first commercially available dynamic screen speech generating devices were developed in the 1990s. At the same time synthesized speech was becoming available in more languages. Software programs were developed that allowed the computer-based production of communication boards. High-tech devices have continued to reduce in size and weight, while increasing accessibility and capacities. Modern communication devices can also enable users to access the internet and some can be used as environmental control devices for independent access of TV, radio, telephone etc.

Future directions for AAC focus on improving device interfaces, reducing the cognitive and linguistic demands of AAC, and the barriers to effective social interaction. AAC researchers have challenged manufacturers to develop communication devices that are more appealing aesthetically, with greater options for leisure and play and that are easier to use. The rapid advances in smartphone and tablet computer technologies has the potential to radically change the availability of economical, accessible, flexible communication devices; however, the user interfaces are needed that meet the various physical and cognitive challenges of AAC users. Android and other open source operating systems, provide opportunities for small communities, such as AAC, to develop the accessibility features and software required. Other promising areas of development include the access of communication devices using signals from movement recognition technologies that interpret body motions, or electrodes measuring brain activity, and the automatic transcription of dysarthric speech using speech recognition systems. Utterance-based systems, in which frequent utterances are organized in sets to improve the speed of communication exchange, are also in development. Similarly, research has focussed on the provision of timely access to vocabulary and conversation appropriate for specific interactions. Natural language generation techniques have been investigated, including the use of logs of past conversations with conversational partners, data from a user's schedule and from real-time Internet vocabulary searches, as well as information about location from global positioning systems and other sensors. However, despite the frequent focus on technological advances in AAC, practitioners are urged to retain the focus on the communication needs of the AAC users: "The future for AAC will not be driven by advances in technology, but rather by how well we can take advantage of those advancements for the enhancement of communicative opportunities for individuals who have complex communication needs".