The Promise of Assistive Technology to Enhance Activity and Work Participation (2017) / Chapter Skim
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6 Augmentative and Alternative Communication and Voice Products and Technologies
6 Augmentative and Alternative Communication and Voice Products and Technologies
Pages 209-310
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Although the primary focus of this chapter is AAC systems, the discussion also briefly addresses voice restoration technologies that support communication associated with head and neck cancer treatments. AAC refers to all types of communication other than oral speech (e.g., pictures, symbols, writing, hand gestures)
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Next is a review of the clinical considerations entailed in comparing natural speech and technology-based voice output systems. Evaluation and monitoring, training and adaptation, and access and availability are then addressed in turn.
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There is no evidence to support the idea that persons with complex communication needs who undergo AAC evaluation receive no recommendation for AAC technology. The greater challenge is that there are few SLPs to provide AAC evaluation and treatment services, as is discussed later in this chapter.
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. For the purposes of this report, the term "AAC technology" refers generally to technology-based communication systems with voice output, and it includes both SGDs and mobile AAC technologies.
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Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (speech generating devices or [AAC technologies, mobile technologies]
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TABLE 6-1 Communication-Related Features of Aided AAC Systems 214 No-Technology Digitized Synthesized Mobile AAC Feature AAC SGD SGD Technology Minutes of recording time ≤8 9–20 21–40 >40 >40 >40 >40 Digitized voice output X X X X X Synthesized voice output X X X Message banking X X X X X X X Voice banking X X X X Visual output X X X X X X X Preprogrammed messages X X X X X X X X Message formulation X X X X X Battery operated X X X X X X X Rechargeable X X X X X X Fixed display X X X X X Dynamic display X X X Physical contact/direct selection X X X X X X X X Scanning X X X X X X X Multiple access options X X X X X Eye gaze access X X X Graphic/symbol representation X X X X X X X X Text representation X X X X X Photo/visual scene representation X X X X X X X X
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Rate acceleration: encoding X X X X X X X X Rate acceleration: prediction X X X Visual adjustments (spacing, font, brightness) X X X X X X Auditory adjustments (volume)
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to represent words and messages, sequencing icons to represent words and messages, selecting individual words from a display to generate word-byword messages, and selecting partial and full messages that have been programmed and stored for retrieval. Each variation is appropriate for some individuals, and given the complex cognitive demands of these systems, careful consideration is required across a wide range of technologies to match individuals with the most appropriate systems (Higginbotham et al., 2007; Light and McNaughton, 2013; Mizuko et al., 1994; Ratcliff, 1994; Rowland et al., 2003; Thistle and Wilkinson, 2013; Wagner and Jackson, 2006)
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. Morse code is another encoding system available in some AAC technologies; dot and dash combinations are used to access the alphabet, punctuation, numbers, and computer functions (King, 2000)
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. Hardware Components AAC technologies offer myriad hardware options for the message display, selection method, and output and input.
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. Visual scene displays may be used across a wide range of AAC technologies (e.g., photographic images placed on a digitized device, digital images placed on devices that support programming "hot spots")
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is used primarily to support messages when natural, digitized, or synthesized speech is not understood or available. Individuals with impaired natural speech may use synthesized or digitized speech to gain listeners' attention, produce utterances at a distance, communicate in group conversations, and talk on the telephone, among many other activities (Alamsaputra et al., 2006; Hanson et al., 2016; Hill, 2010)
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. Textto-speech synthesis, a common method for generating synthetic speech for AAC technologies, involves extracting speech sound components from words and then combining them to form natural-sounding synthetic voices (Beukelman and Mirenda, 2013; Drager et al., 2010)
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. Many AAC speakers retain some functional natural speech with limited degrees of intelligibility; as a result, they may use AAC technology in some speaking situations and natural speech in others.
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. Continued advances in the quality of synthesized speech are expected to result in output that is increasingly comparable to natural speech.
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. Efficiency of AAC output also is impacted by measures of rate, which are influenced by the same factors associated with spoken messages but also by the interaction with AAC technology and by physical (e.g., motor, sensory, perceptual)
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. The SLP typically is the lead professional in the AAC team evaluation process and is likely to provide the intervention with AAC technology.
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Access troubleshooting AAC manufacturer/vendor Identify AAC options Assist in evaluation process Provide equipment loans/trials Facilitate funding of selected AAC Provide AAC devices and accessories Provide AAC technical support AAC technology training Facilitate AAC evaluation and intervention agency Identify and recommend AAC options Establish and provide treatment Provide equipment loans/trials Provide AAC training Provide AAC technical support aAAC clinical specialists may perform testing associated with a collaborating professional (e.g., vision, h earing, physical skills, cognition) as related specifically to communication and access.
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. Although various models, frameworks, and guidelines are used in AAC assessments, feature matching (i.e., matching the user to AAC technology)
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Unintelligible speech or significantly reduced rate of speech influences functionality, thus supporting a person's need for AAC technology. Cognitive–Linguistic Considerations Beyond current language ability, conversational needs, and communication contexts, AAC techniques and symbols and/or strategies are evaluated to identify optimal communication performance (Hill and Corsi, 2012; Hill et al., 2010; Romich et al., 2005)
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, and effective interactions. When direct selection is ineffective as an access technique, the individual's ability to scan using one or multiple switches is assessed, which entails evaluating access to AAC technologies indirectly by means of switch activation.
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Selection of AAC Device Features Informing the individual and family of various AAC technology options is a critical step in feature matching, helping to remove bias from the selection process. The taxonomy of AAC devices presented earlier and in Annex Tables 6-1, 6-2, and 6-3 at the end of this chapter reveals the complexity of AAC features and their combinations.
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. AAC Technology Trials Practice with an assortment of AAC technologies that have been matched to the user's needs optimizes assessment outcomes for both the individual and the AAC team and illustrates the strengths and weaknesses of various options or combinations thereof.
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gleaned from AAC technology trials guides decision making and optimizes the selection of an AAC system. Clinical and personal evidence are based on comprehensive assessment of communication ability and the domains influencing communication, daily communication needs, functional communication goals, and personal preferences.
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High levels of acceptance of AAC technologies have been documented for a variety of individuals across disability groups. Among individuals with communication impairment resulting from traumatic brain injury using devices based on assessment recommendations, acceptance of synthesized high-tech devices was more than 94 percent, and acceptance of digitized low-tech devices was 100 percent (Fager et al., 2006)
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For individuals with degenerative conditions, AAC systems are managed so as to maintain effective communication through speech, language, cognitive, or motor control decline. Improving and stabilizing conditions include stroke/aphasia, traumatic brain injury, cerebral palsy, cognitive impairment, and locked-in syndrome, among others.
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that affect an individual's ability to communicate functionally using natural speech (ASHA, 2016a; Perry et al., 2004; Wodka et al., 2013)
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. Because AAC technologies are subject to breakdown, they require technical support and repair that results in loss of access to communication, and a loss of effective communication, however temporary, will impact an individual's ability to fulfill work responsibilities.
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. Even if an individual is matched with an appropriate device, receives extensive training, and becomes competent in using an AAC system, he or she may not engage adequately in a real-time discussion in a board room because of limitations imposed by the interrelationship among the method of communication; the AAC technology features; and the individual's physical disability, cognitive/linguistic skills, and skills in interacting with a communication partner (Higginbotham et al., 2007)
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. Emerging evidence indicates that perceived hireability may be limited when individuals communicate with even mild dysarthric natural speech instead of using AAC technologies for communication (Stern et al., 2017)
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devices that are designed specifically for AAC purposes and their respective features. • Knowledge of the performance differences of the broad array of [AAC technologies]
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This section highlights a few funding considerations that are specific to AAC technology. Funding policies and practices can affect the adequacy of AAC evaluation, as well as funding approval for prescribed AAC technologies.
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. Medigap policies do not cover items not approved by Medicare (e.g., mobile AAC technologies, hearing aids)
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Although many individuals in need of communication systems have funding available for the purchase of AAC technology, most clinical providers do not. Notably, many clinical facilities do not provide AAC evaluations because of the high cost of purchasing and maintaining AAC technologies, software, and access options.
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Surgical treatments may involve resection of head/neck structures and tissue that may result in partial or complete removal of the larynx, vocal cords, and articulatory structures, in turn resulting in loss of voice and/or speech. Voice Restoration Taxonomy Some individuals with head and neck cancer may benefit from various categories of AAC technology, including mobile technologies, SGDs (HCPCS: E2500-E2510)
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Although some individuals benefit from the specified AAC technologies, individuals typically are supported with voice restoration after undergoing head/neck cancer interventions (Tang and Sinclair, 2015)
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. These reports thus indicate a range of 34-45 percent of individuals undergoing head and neck cancer treatments who, although receiving benefit from voice restoration strategies, will likely require AAC technology to achieve fully functional communication.
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(L8510) A B C D E Total laryngectomy X X X X X Partial laryngectomy X Tracheostomy, intact larynx X Professional insertion X Patient insertion X Hands free use X X X X X Hand held use X X Shunt air into esophagus X X X Vibrate head/neck tissue X X X X Surgical placement X X Voice amplification X Battery, rechargeable X X
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C Blom-Singer® Duckbill– Patient Changeable Voice Prosthesis, InHealth Technologies.
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Copyright © 2017 Jill Gregory & Kellie Holoski, Head & Neck Cancer Guide. All rights reserved.
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Copyright © 2017 Jill Gregory & Kellie Holoski, Head & Neck Cancer Guide. All rights reserved.
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Studies have shown that voice restoration with tracheoesophageal puncture is superior to that with an electrolarynx and ESS (Clements et al.,
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. These factors play an obvious role in determining functional communication interventions using AAC technologies.
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To ensure that individuals with head and neck cancer can successfully meet all their communication needs, AAC assessment and intervention procedures are implemented in conjunction with voice restoration strategies (Ball et al., 2016b)
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. When long-term use of AAC technology is indicated, a comprehensive AAC evaluation may be required.
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. The goals of AAC for individuals with head and neck cancer are to augment intelligibility, decrease communication breakdowns or miscommunications, enable repair when communication breakdowns occur, and provide alternative means of communication when the voice restoration methods employed result in ongoing unmet communication needs (Ball et al., 2016b)
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. Access to voice restoration methods depends on the availability of appropriately trained professionals, which varies by region.
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6-4. Individuals receiving voice restoration head and neck cancer treatments may also require AAC to achieve fully functional communication.
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6-15. Medicaid funding varies by state, with some states having specific criteria for assessments; limiting access to treatment; and/or provid ing insufficient funding, especially for higher-cost AAC technologies.
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6-6. Differences in funding policies among various programs significantly limit access to AAC technology and clinical services.
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2006. Synthesized speech intelligibility among native speakers and non-native speakers of English.
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2010b. Eye-gaze access of AAC technology for persons with amyotrophic lateral sclerosis.
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2000. Current status of voice restoration following total laryngectomy.
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2009. The loneliness experiences of young adults with cerebral palsy who use alternative and augmentative communication.
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Assistive Technology 22(4)
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Assistive Technology 24(1)
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Assistive Technology 1-8. Glennen, S
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2012. The role speech language pathologists in assistive technology as sessments.
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Assistive Technology 8(2)
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2007. AAC technologies for children with complex communication needs: State of the science and future research directions.
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2014. Natural speech and AAC intervention in childhood motor speech disorders: Not an either/or situation.
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2002. Assistive technology: Matching device and consumer for successful reha bilitation.
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2005. Living in the state of stuck: How assistive technology impacts the lives of people with disabilities.
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2006. Increasing prevalence of cerebral palsy among very preterm infants: A population-based study.
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American Journal of Speech-Language Pathology 5(1)
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The images in Annex Table 6-1 serve as examples of device categories only and should not be considered an endorsement of specific products or manufacturers.
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 275 Relative Indications for Use Contraindications Benefits Limitations Basic messaging Visual impairment Lightweight No voice output Visual output Requires verbal Simple to create, use No telephone Establish topic output Replace when interaction Spell messages Complex or detailed damaged Limited Partner-supported messaging needs Create for multiple independence communication contexts Difficult with limited Digitized speech is literacy highly intelligible Fixed display Plexiglass board Printer required; may has increased require symbol durability software Limited clinical support available Limited funding available continued
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code Cost Range DIGITIZED VOICE OUTPUT
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 277 Relative Indications for Use Contraindications Benefits Limitations Eye gaze selection Low literacy Lightweight Partner-dependent Text output Portable communication Battery-operated Limited funding Dual LCD screen available for both communicators to see message Reduces effort of communication partner writing message by displaying on LCD screen Relative Indications for Use Contraindications Benefits Limitations Basic, brief Need to formulate Lightweight Require age/ messages novel messages Portable gender-matched Prerecorded Unimpaired adult Relatively communication messages cognitive function inexpensive partner to Literate Battery-operated record messages Supports greeting, Complex Durable design (partner name/labeling, communication Multilingual dependent) simple requesting, Simple message Limited protesting recording conversations Assessment and No spontaneous treatment codes messages established for speech-language pathologist (SLP)
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278 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range ≤8 minutes recording time $130–$3,000 HCPCS E2500 Examples: BIGmack LITTLE Step-by-Step Talking Brix Sequencer D LITTLE Step-by Step 9–20 minutes recording time $300–$500 HCPCS E2502 Examples: SuperTalker QuickTalker23 VoicePal Levels E
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 279 Relative Indications for Use Contraindications Benefits Limitations Single messages Initiate interactions Long messages Limited Social comments Multiple messages communication Call attention Message formulation needs Familiar Multiple communication environments partners Limited need Combine thoughts Multiple conversation for multiple into utterances partners messages Direct others Supports choice making from array continued
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280 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range 21–40 minutes recording time $600–$1,500 HCPCS E2504 Examples: GoTalk Express32 F Express32 >40 minutes recording time $400–$4,100 HCPCS E2506 Examples: Talara32 Logan ProxTalker Smart/128VSD G
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 281 Relative Indications for Use Contraindications Benefits Limitations Multiple basic Use messages to messages describe known Narrative storage places/activities and retell Multiple basic Lengthier message Unknown contexts, and detailed content activities messages Supports introductions continued
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282 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range SYNTHESIZED VOICE OUTPUT Physical Contact and Spelling $400–$7,000 HCPCS E2508 Examples: LightWriter SL40 Allora2 TextSpeak TS04 H LightWriter SL40 Connect
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spelling Text representation progressive every word, (b) Rate acceleration disease device speaking Assessment and Communication rate word by word, treatment codes limited by typing or (c)
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284 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range Multiple Formulation and Access $2,000–$16,000 HCPCS E2510 Examples: Wego NovaChat T7-15 Accent ComLink ProSlate Enable Eyes I Accent 1400 Multiple Formulation and Access $50–$1,300 HCPCS NA Examples: Apple iPad Android Tablet J
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Touchscreen, some Unlimited content Limited funding alternative access Symbol, photo, text options options representation Limited assessment Mainstream disability Rate acceleration and treatment, access options strategies professional Dynamic display support Relatively Synthesized inexpensive output can be supplemented with digitized messages Physical disability access options are limited Limited device– app integration support continued
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286 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range SOFTWARE
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 287 Relative Indications for Use Contraindications Benefits Limitations Provides language NA Provides Some compatibility supports for communication issues, communication platform for manufacturer or based on devices OS proprietary language skills Includes interface use and needs for alternative Voice synthesizers access, symbol offered as and message software management, and Requires device rate acceleration for voice output Some multilingual activation Professional knowledge of communication needs essential to selecting most appropriate software/app continued
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288 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range AAC TECNOLOGY software $100–$750 HCPCS E2511 Examples: Unity WordPower84 Communicator Speaking Dynamically Pro GoTalk Boardmaker Plus K Boardmaker Plus L
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 289 Relative Indications for Use Contraindications Benefits Limitations Require message Provide symbol sets, Varied levels of overlays for framework for training necessary digitized devices communication for use on device Communication Support digitized Some individuals will format on and synthesized require training to synthesized communication understand a new devices methods representational Often packaged with system (i.e., SGD using pictures to communicate) continued
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290 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range Apps $0–$500 HCPCS NA Examples: Proloquo2Go Proloquo4Text Verbally Compass Predictable M Proloquo2Go® N
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 291 Relative Indications for Use Contraindications Benefits Limitations Require message Because of frequent Readily available Some apps overlays for tablet changes to in online developed for systems apps, individuals marketplace single individual; with limited Relatively low cost varied quality acceptance of exists in market new formats or Limited access to updates may have support for use, difficulty training, and troubleshooting Large number of apps available; many professionals have difficulty remaining updated on options continued
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292 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range ACCESSORIES HCPCS E2599 Access Switches $20–$2,000 O Micro Light switch P
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et al., 2012) Indirect access May be cognitively Relatively Slow message through scanning taxing (scanning)
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Eyespeak 12HD AAC/AAC TECHNOLOGY Type CMS code Cost Range MOUNTING SYSTEMS HCPCS E2512
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may interfere with calibration and accuracy Relative Indications for Use Contraindications Benefits Limitations Provide access to Direct access to Transport Limited professional device in various touchscreen with communication support environments body device available (e.g., (e.g., wheelchair, Portable device Limit fatigue SLP with AAC desk, associated with specialization, workstation) device transport OT/PT with Secure AAC Provide optimal AAC technology technology and position for mounting accessories to access to device experience)
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296 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-1 Continued AAC/AAC TECHNOLOGY Type CMS code Cost Range Device Mounts $400–$1,500 Examples: Wheelchair mount Desk mount Rolling floor mount R DaeSSy Rigid Mount Tech/Talk, Speak & Scan Devices Switch/Accessory Mounts $50–$400 S
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 297 Relative Indications for Use Contraindications Benefits Limitations Secure SGD to Handheld portable Provide effective May require partner mobility devices, device in use transport of set-up for daily seating systems heavy AAC access and in home and devices repositioning community as body shifts location Secure switches/ Flexible switch Provide stable, Limited switch eye gaze to AAC placement consistent base placement technology, needed (e.g., of support for flexibility when mobility devices, on clothing, switch access in use seating systems bedding) May require partner in home and set-up for daily community access and with movement that removes person from switch proximity Company.
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298 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-2 Augmentative and Alternative Communication Software and Hardware AAC Language Representation Text, Alphabetic Symbols Letter- Whole by-Letter Word Word Letter Spelling Prediction Display Coding Morse Code Communication Proficiency YES YES YES YES YES Literacy Proficiency YES YES YES YES YES Prerecorded Utterances NO NO NO NO NO Novel Utterances YES YES YES YES YES Vocabulary Individual Individual Individual Individual Individual Selection Recall recall and recognition recall recall memory recognition memory memory memory memory supported Typically Often supported by display personalized supported by software- of high- for individual with visual embedded frequency display of dictionaries words the code Software and Hardware Features Symbol Set/ Language- Alphabetic Whole words Letters and Dot and System specific whole-word integrated numbers dash alphabet or options with are used to sequences characters, presented alphabet, create codes represent numbers, dynamically numbers, representing alphabet, and based on and messages numbers, punctuation the letter(s) punctuation (e.g., asap = punctuation, entered as soon as and possible)
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 299 Single-Meaning Picture Symbols Multiple-Meaning Icons Levels with Changeable Multiple Multiple Icon Multiple One Display Displays Displays Methods Sequencing Methods NO YES YES YES YES YES NO NO NO NO NO NO YES YES YES YES YES YES NO NO NO NO YES YES Professional/ Professional/ Professional/ Professional/ Individual Individual communi- communi- communi- communi- recall and recall and cation cation cation cation recognition recognition partner partner partner partner memory memory Selection Selection Selection Selection supported supported based based based based by high- by highon high- on high- on high- on high- frequency frequency frequency frequency frequency frequency words words vocabulary vocabulary vocabulary vocabulary Extended Extended and/or and/or and/or and/or vocabulary vocabulary customized customized customized customized selected selected based on based on based on based on based on based on personal personal personal personal personal personal choice, choice, choice, choice, choice, choice, context, context, context, context, context, context, activity activity activity activity activity activity Photos, line Photos, line Photos, line Photos, line Color Color drawings, or drawings, or drawings or drawings, or graphic graphic color graphic color graphic color graphic color graphic drawings drawings drawings drawings drawings drawings that that represent represent represent represent represent represent words, words, words, words, words and words and messages messages messages messages, messages messages paired with with more with more alphabet than one than one meaning meaning with alphabet configura tions continued
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300 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-2 Continued AAC Language Representation Text, Alphabetic Symbols Letter- Whole by-Letter Word Word Letter Spelling Prediction Display Coding Morse Code Number of Language- Not NA NA Based on Symbols specific applicable language letters or (NA) specific characters, symbol set numbers, punctuation, and other keyboard symbols Organization Language- Selection Typically Customized Language specific options organized letter codes, specific organization: may be based on most on a organization QWERTY, positioned frequency, separate ABCDEF, at different with the page or AEIOU, display alphabet on section of a DVORAK, locations the same or page etc.
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 301 Single-Meaning Picture Symbols Multiple-Meaning Icons Levels with Changeable Multiple Multiple Icon Multiple One Display Displays Displays Methods Sequencing Methods Based on Based on Based on Based on A limited A limited the number the number the number the number icon set is icon set is of display of display of display of display combined in combined in locations locations locations locations sequences sequences and and and and to represent to represent individual's individual's individual's individual's core core vocabulary vocabulary vocabulary vocabulary vocabulary vocabulary needs needs needs needs Several Several Typically, Typically, Typically, Typically, thousand thousand several several several several single- singlethousand thousand thousand thousand meaning meaning symbols are symbols are symbols are symbols are symbols symbols available in available in available in available in represent represent communi- communi- communi- communi- words words, cation cation cation cation including software, software, software, software, letters and and more and more and more and more numbers may be may be may be may be added added added added Based on Based on Based on Based on Does not Does not individual individual individual individual change with change with communi- communi- communi- communi- selections. selections cation needs: cation needs: cation needs: cation needs: Icon Icon frequency, frequency, frequency, frequency, sequences sequences grammar, grammar, grammar, grammar, represent represent activity, activity, activity, activity, core core topics of topics of topics of topics of vocabulary vocabulary conversation conversation conversation conversation and parts of and parts speech of speech paired with other functions Number of Number of Number of Number of Number of Number of locations locations locations locations locations locations ranges from ranges from ranges from ranges from ranges from ranges from 1 to 144 per 2 to 144 per 2 to 144 per 2 to 144 per 26 to 144 per 26 to 144 per display or display or display or display or display or display or page page page page page page continued
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302 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-2 Continued AAC Language Representation Text, Alphabetic Symbols Letter- Whole by-Letter Word Word Letter Spelling Prediction Display Coding Morse Code Visual Scene NA NA NA NA NA Color Coding Not typically; NA May custom NA NA individual- color code ized color (parts of coding is speech, possible importance, visual needs, etc.) Navigation; Limited; None; Range; None; NA None; NA Number typically predictions depending of Pages/ a small appear on on Displays number -- 1–6 the current organization pages/ page/ of words, displays display multiple pages may be required based on activities or topics Rate NA Likely; Likely; Yes Yes Enhance- reduced reduced ment keystrokes keystrokes
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 303 Single-Meaning Picture Symbols Multiple-Meaning Icons Levels with Changeable Multiple Multiple Icon Multiple One Display Displays Displays Methods Sequencing Methods Visual scenes Visual scenes Visual scenes Visual scenes NA Visual scenes may support may support may support may support may support single single or single or single or single or messages multiple multiple multiple multiple messages messages messages messages with with with with embedded embedded embedded embedded hotspots hotspots hotspots hotspots and may and may be paired be paired with text or with multi symbols meaning icons May custom May custom May custom May custom May custom May custom color code color code color code color code color code color code (importance, (parts of (parts of (parts of (parts of (parts of visual needs, speech, speech, speech, speech, speech, etc.) importance, importance, importance, importance, importance, visual needs, visual needs, visual needs, etc.)
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304 THE PROMISE OF ASSISTIVE TECHNOLOGY ANNEX TABLE 6-2 Continued AAC Language Representation Text, Alphabetic Symbols Letter- Whole by-Letter Word Word Letter Spelling Prediction Display Coding Morse Code The following features depend on additional needs of the individual. Computer, Yes Yes Yes Yes No Environmental Controls Training and Varies depending on manufacturer and/or distributor, clinical professional access Support Peripherals Touch guides, key guards, switches, mounting systems, external speakers, protective cases
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 305 Single-Meaning Picture Symbols Multiple-Meaning Icons Levels with Changeable Multiple Multiple Icon Multiple One Display Displays Displays Methods Sequencing Methods Yes Yes Yes Yes Yes Yes
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overlays • Partner-dependent • Comment message formulation • Protest/reject • Partner-dependent • Retell narratives message recording • hoices (from array) C • Multilingual Digitized Device • ultiple basic, detailed M • Greet, introduce >40 minutes recording messages • equest (attention, help, R Display modified manually • rief or lengthy message B food, break, objects, by changing communication content activities)
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AUGMENTATIVE AND ALTERNATIVE COMMUNICATION AND VOICE 307 Common Primary Communication Communication Communication Communication Barriers Contexts Purposes Control Limitations Home Express wants Initiate No long interactions or Workplace and needs communication conversational dialogue Car/public Engage in social Direct action of Prerecorded messages transport etiquette another Poor fit for spontaneous Community Information Social comments utterances transfer Call attention to Social closeness/ self-achievement relationships Home Express wants Initiate No long interactions or Workplace and needs communication conversational dialogue Car/public Engage in social Direct action of Prerecorded messages transport etiquette another Poor fit for spontaneous Community Information Social comments utterances transfer Call attention to Social closeness/ self-achievement relationships Combine thoughts into longer utterances Home Express wants Initiate Few long interactions, Workplace and needs communication limited conversational University Engage in social Direct action of dialogue Car/public etiquette another Prerecorded messages transport Gain and share Social comments Poor fit for spontaneous Community information Call attention to utterances Build and sustain self-achievement relationships Use words to Information describe location transfer Ask simple questions Home Express wants Initiate Limited long interactions Workplace and needs communication and conversational Car/public Engage in social Direct action of dialogue transport etiquette another Prerecorded messages Community Gain and share Social comments Poor fit for spontaneous information Call attention to utterances Build and sustain self-achievement relationships Use words to Information describe location transfer Ask simple questions continued
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programming for novel interactions • omment and describe C • Some multilingual • Protest/reject • ultiple display options M • ell narratives, past events T for visual needs • Hypothesize, speculate, self-talk • Manage dialogue Synthesized Device • Unlimited messages • Greet, introduce Multiple formulation and • Unlimited content • Formulate jokes access • Independent message • equest (attention, help, R Tablet (Android/Win/iOS) formulation food, break, objects, Display changes dynamically • Unlimited combinations activities, clarification)
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Community information for assistance, Some reduced intelligibility Build and sustain interactions of synthesized speech relationships Formulate and Many are large and heavy, Information interact with require mount for transfer complex language transport Home Express wants Initiate and maintain Slow message formulation, Workplace and needs communication particularly for timeUniversity Engage in social dialogue sensitive interactions Car/public etiquette Social comments (e.g., telephone, business transport Gain and share Call attention meetings) Community information for assistance, Some reduced intelligibility Build and sustain interactions of synthesized speech relationships Formulate and Requires selection of interact with access methods from complex language mainstream options Not considered DME Home Express wants Initiate and maintain Slow message formulation, Workplace and needs communication particularly for timeUniversity Engage in social dialogue sensitive interactions Car/public etiquette Social comments (e.g., telephone, business transport Gain and share Call attention meetings)
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Key Terms
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