An Accurate and Rapidly Calibrating Speech Neuroprosthesis.

BACKGROUND: Brain-computer interfaces can enable communication for people with paralysis by transforming cortical activity associated with attempted speech into text on a computer screen. Communication with brain-computer interfaces has been restricted by extensive training requirements and limited accuracy. METHODS: A 45-year-old man with amyotrophic lateral sclerosis (ALS) with tetraparesis and severe dysarthria underwent surgical implantation of four microelectrode arrays into his left ventral precentral gyrus 5 years after the onset of the illness; these arrays recorded neural activity from 256 intracortical electrodes. We report the results of decoding his cortical neural activity as he attempted to speak in both prompted and unstructured conversational contexts. Decoded words were displayed on a screen and then vocalized with the use of text-to-speech software designed to sound like his pre-ALS voice. RESULTS: On the first day of use (25 days after surgery), the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. Calibration of the neuroprosthesis required 30 minutes of cortical recordings while the participant attempted to speak, followed by subsequent processing. On the second day, after 1.4 additional hours of system training, the neuroprosthesis achieved 90.2% accuracy using a 125,000-word vocabulary. With further training data, the neuroprosthesis sustained 97.5% accuracy over a period of 8.4 months after surgical implantation, and the participant used it to communicate in self-paced conversations at a rate of approximately 32 words per minute for more than 248 cumulative hours. CONCLUSIONS: In a person with ALS and severe dysarthria, an intracortical speech neuroprosthesis reached a level of performance suitable to restore conversational communication after brief training. (Funded by the Office of the Assistant Secretary of Defense for Health Affairs and others; BrainGate2 ClinicalTrials.gov number, NCT00912041.).

Designing Cultural Adaptations of Caregiver-Implemented Interventions for Latinx Caregivers of Children Who Use Augmentative and Alternative Communication: Key Considerations.

PURPOSE: Caregivers play a critical role in their children's development and serve as their primary communication partners. Family interactions provide the most naturally occurring opportunities for children with complex communication needs to learn language in the context of family routines. A growing body of research suggests that caregivers can effectively support their children's use of augmentative and alternative communication (AAC) systems when provided with appropriate training and coaching through caregiver-implemented interventions (CIIs). However, the efficacy of these interventions remains untested among culturally and linguistically diverse caregivers. Given the increasing diversity in the United States, there is a pressing need to develop CIIs that align with the cultural and linguistic preferences of diverse families. METHOD: Using the Ecological Validity Framework and the Checklist for Cultural Adaptations, this tutorial explores considerations for culturally adapting caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. The aim is to ensure that interventions are relevant, meaningful, and respectful of cultural and linguistic practices. Through carefully crafted cultural adaptations, interventions can achieve greater acceptance by caregivers. RESULTS AND DISCUSSION: This tutorial suggests a series of cultural adaptations to ensure accessibility, sustainability, and success of caregiver-implemented AAC interventions for Latinx caregivers of children with AAC needs. By incorporating cultural and linguistic considerations into the intervention design, we can enhance its acceptability among Latinx caregivers. This, in turn, can lead to improved outcomes in AAC implementation within the home environment.

Using PAALSS for the manual analysis of language samples of individuals who use aided AAC in Spanish: A pilot study.

This pilot study describes the application of the Protocol for the Analysis of Aided Language Samples in Spanish (PAALSS), specifically designed for the manual analysis of language samples from individuals in the early stages of Spanish aided language development. Data were collected from 22 language samples from 16 individuals who use aided AAC and are at the earlier stages of Spanish language development. The primary objective of this study was to explore the feasibility of using PAALSS as an analytical tool to describe various aspects of the language samples, including lexical productivity, lexical diversity, morphology, grammatical complexity, and syntax. Results are presented according to four different groupings, based on the language samples' grammatical complexity scores. The study provides preliminary evidence of the potential of PAALSS as a useful tool for the manual analysis of language samples from users of AAC in Spanish. However, future studies are needed to establish its formal psychometric and measurement properties.

Longevity of a Brain-Computer Interface for Amyotrophic Lateral Sclerosis.

The durability of communication with the use of brain-computer interfaces in persons with progressive neurodegenerative disease has not been extensively examined. We report on 7 years of independent at-home use of an implanted brain-computer interface for communication by a person with advanced amyotrophic lateral sclerosis (ALS), the inception of which was reported in 2016. The frequency of at-home use increased over time to compensate for gradual loss of control of an eye-gaze-tracking device, followed by a progressive decrease in use starting 6 years after implantation. At-home use ended when control of the brain-computer interface became unreliable. No signs of technical malfunction were found. Instead, the amplitude of neural signals declined, and computed tomographic imaging revealed progressive atrophy, which suggested that ALS-related neurodegeneration ultimately rendered the brain-computer interface ineffective after years of successful use, although alternative explanations are plausible. (Funded by the National Institute on Deafness and Other Communication Disorders and others; ClinicalTrials.gov number, NCT02224469.).

Exploring Communication Needs and Challenges in the Intensive Care Unit: A Survey Study From Providers' and Patients' Perspectives.

PURPOSE: Effective communication between nonspeaking patients and providers is critical for the quality of care in intensive care units (ICUs). This study aims to evaluate perspectives of health care providers and nonspeaking patients on effective communication and communication barriers in the ICU. METHOD: Qualitative and quantitative survey methodologies were employed to evaluate providers' and patients' perspectives on effective communication. Rating scales were utilized to measure patients' frustration levels and communication effectiveness. Open-ended questions were employed to reflect on barriers to communication in the ICU, instances of ineffective communication, and recommendations for enhancing effective communication. RESULTS: The results of the study suggest that nonspeaking patients experienced high levels of frustration due to ineffective communication. However, the data reveal that access to appropriate augmentative and alternative communication (AAC) strategies and materials could help mitigate patients' frustration. Providers mainly communicated via asking yes/no questions, which largely limited the information patients conveyed, leading to frequent communication breakdowns. Providers expressed a desire to participate in training programs to utilize appropriate AAC strategies and promote effective communication. CONCLUSIONS: This study provides preliminary survey results on perspectives of patients and providers on effective communication in the ICU. Both providers and patients reported experiencing challenges and frustration during their communication, due to barriers such as providers' insufficient training experience and lack of access to AAC materials. Skill training is warranted to promote effective patient-provider communication in intensive care settings. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.26339623.

A Hybrid BCI Integrating EEG and Eye-Tracking for Assisting Clinical Communication in Patients With Disorders of Consciousness.

Assessing communication abilities in patients with disorders of consciousness (DOCs) is challenging due to limitations in the behavioral scale. Electroencephalogram-based brain-computer interfaces (BCIs) and eye-tracking for detecting ocular changes can capture mental activities without requiring physical behaviors and thus may be a solution. This study proposes a hybrid BCI that integrates EEG and eye tracking to facilitate communication in patients with DOC. Specifically, the BCI presented a question and two randomly flashing answers (yes/no). The subjects were instructed to focus on an answer. A multimodal target recognition network (MTRN) is proposed to detect P300 potentials and eye-tracking responses (i.e., pupil constriction and gaze) and identify the target in real time. In the MTRN, the dual-stream feature extraction module with two independent multiscale convolutional neural networks extracts multiscale features from multimodal data. Then, the multimodal attention strategy adaptively extracts the most relevant information about the target from multimodal data. Finally, a prototype network is designed as a classifier to facilitate small-sample data classification. Ten healthy individuals, nine DOC patients and one LIS patient were included in this study. All healthy subjects achieved 100% accuracy. Five patients could communicate with our BCI, with 76.1±7.9% accuracy. Among them, two patients who were noncommunicative on the behavioral scale exhibited communication ability via our BCI. Additionally, we assessed the performance of unimodal BCIs and compared MTRNs with other methods. All the results suggested that our BCI can yield more sensitive outcomes than the CRS-R and can serve as a valuable communication tool.

An Applied Model of Interprofessional Collaboration-Assessment (AMIC-A): A Process-Based Approach to Augmentative and Alternative Communication.

Speech-language pathologists and board-certified behavior analysts both provide important support services to children who are candidates for augmentative and alternative communication. Current assessment practices neglect critical socioecological factors that are necessary to inform communication-based interventions. By leveraging the unique knowledge, research, and expertise of both disciplines, an interprofessional approach to assessment may help realize individualized or precision interventions and personalized supports that address the unique communication needs of each person. The purpose of this article is to introduce a process-based approach to assessment called the "Applied Model of Interprofessional Collaboration-Assessment (AMIC-A)." The AMIC-A will be defined and detailed including the rationale for development, a description of the approach, and recommendations for implementation. A case study example is provided to illustrate implementation of the AMIC-A.

How Health Care Organizations Are Implementing Disability Accommodations for Effective Communication: A Qualitative Study.

BACKGROUND: Prior studies have documented that, despite federal mandates, clinicians infrequently provide accommodations that enable equitable health care engagement for patients with communication disabilities. To date, there has been a paucity of empirical research describing the organizational approach to implementing these accommodations. The authors asked US health care organizations how they were delivering these accommodations in the context of clinical care, what communication accommodations they provided, and what disability populations they addressed. METHODS: In this study, 19 qualitative interviews were conducted with disability coordinators representing 15 US health care organizations actively implementing communication accommodations. A conventional qualitative content analysis approach was used to code the data and derive themes. RESULTS: The authors identified three major themes related to how US health care organizations are implementing the provision of this service: (1) Operationalizing the delivery of communication accommodations in health care required executive leadership support and preparatory work at clinic and organization levels; (2) The primary focus of communication accommodations was sign language interpreter services for Deaf patients and, secondarily, other hearing- and visual-related accommodations; and (3) Providing communication accommodations for patients with speech and language and cognitive disabilities was less frequent, but when done involved more than providing a single aid or service. CONCLUSION: These findings suggest that, in addition to individual clinician efforts, there are organization-level factors that affect consistent provision of communication accommodations across the full range of communication disabilities. Future research should investigate these factors and test targeted implementation strategies to promote equitable access to health care for all patients with communication disabilities.

Reading instruction for students with intellectual disabilities who require augmentative and alternative communication: A multiple single case study with baseline, posttest, follow-up, and maintenance.

The purpose of the current study was to examine whether seven children, aged 6-10 years, with intellectual disabilities who require augmentative and alternative communication, could acquire phonological awareness and reading skills by using a reading material that is based on research on the evidence-based reading program Accessible literacy learning. The effect of the measures has been examined using a multiple single-case design with baseline, posttest, follow-up, and maintenance. All the teachers were trained to deliver the reading intervention in the students' familiar place at school. The results indicated that students with intellectual disabilities who require augmentative and alternative communication could acquire phonological awareness and decoding by working systematically with reading material based on evidence-based strategies.

Identifying Components of a Person-Centered Augmentative and Alternative Communication Intervention for People With Dementia: Opinions of an International Expert Panel.

PURPOSE: Despite general agreement on the importance of person-centered care in speech-language pathology, guidelines for developing person-centered interventions for those with dementia are limited. This study aimed to obtain expert opinion on the components of a person-centered augmentative and alternative communication (AAC) intervention for persons with dementia. METHOD: A modified electronic Delphi technique was employed in a single round. A purposively sampled panel of experts was invited to provide their opinion on three open-ended questions related to (a) the elements of person-centered care, (b) communication supports, and (c) the interaction outcomes of a person-centered intervention. Thirty-one experts from nine countries participated on the panel. The majority were speech-language pathologists primarily involved in research. Qualitative written data were coded and analyzed using content analysis. RESULTS: Nine components were identified across the three open-ended questions: (a) the unique characteristics of the person with dementia, (b) working with a person with dementia, (c) preserving personhood, (d) a different view on person-centered care, (e) a range of communication supports, (f) supportive conversational partners, (g) designing communication supports, (h) interaction outcome measure, and (i) meaningful interaction outcomes. CONCLUSION: This study identified nine components that are useful in guiding speech-language pathologists in crafting future person-centered AAC interventions for people with dementia.

A Cascade xDAWN EEGNet Structure for Unified Visual-Evoked Related Potential Detection.

Visual-based brain-computer interface (BCI) enables people to communicate with others by spelling words from the brain and helps professionals recognize targets in large numbers of images. P300 signals evoked by different types of stimuli, such as words or images, may vary significantly in terms of both amplitude and latency. A unified approach is required to detect variable P300 signals, which facilitates BCI applications, as well as deepens the understanding of the P300 generation mechanism. In this study, our proposed approach involves a cascade network structure that combines xDAWN and classical EEGNet techniques. This network is designed to classify target and non-target stimuli in both P300 speller and rapid serial visual presentation (RSVP) paradigms. The proposed approach is capable of recognizing more symbols with fewer repetitions (up to 5 rounds) compared to other models while possessing a better information transfer rate (ITR) as demonstrated on Dataset II (17.22 bits/min in the second repetition round) of BCI Competition III. Additionally, our approach has the highest unweighted average recall (UAR) performance for both 5 Hz ( 0.8134±0.0259 ) and 20 Hz ( 0.6527±0.0321 ) RSVP. The results show that the cascade network structure has better performance between both the P300 Speller and RSVP paradigms, manifesting that such a cascade structure is robust enough for dealing with P300-related signals (source code is available at https://github.com/embneural/Cascade-xDAWN-EEGNet-for-ERP-Detection).

Funcionalidade de pessoas hospitalizados em vulnerabilidade comunicativa pela CIF / Functioning of hospitalized people in vulnerable communication by the ICF / Funcionalidad de las personas hospitalizadas con vulnerabilidad comunicativa por el CIF

Introdução: Pacientes hospitalizados, por causas diversas, podem apresentar comprometimentos de fala e linguagem que os coloquem em situação de vulnerabilidade comunicativa, influenciando sua funcionalidade. Adota-se a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF) para análise, sob esta perspectiva. Objetivo: Analisar a linguagem e funcionalidade de pessoas em vulnerabilidade comunicativa, em cuidados intensivo e semi-intensivo no hospital, pela CIF, como base conceitual. Método: Estudodescritivo e transversal, constituído por 18 participantes. Para a coleta de dados realizou-se: (i) levantamento dos prontuários, para caracterização do perfil sociodemográfico e das condições clínicas dos participantes; (ii) aplicação do protocolo ICUCS (Intensive Care Unit Communication Screening Protocol);(iii) introdução da Comunicação Suplementar e/ou Alternativa (CSA) e (iv) diário de campo (registro dos relatos). Os resultados foram analisados pela CIF e realizada análise estatística descritiva. Resultados: A maioria dos participantes estava alerta e compreendia comandos simples, sendo que 39% apresentaram problema grave de expressão de linguagem. Quanto à atividade e participação, 50% apresentaram dificuldade grave no falar, 33%, em iniciar e em manter conversas. Quanto aos fatores ambientais, familiares e profissionais de Saúde foram apontados tanto como facilitadores quanto como barreiras para a comunicação. A CSA foi vista como facilitadora da comunicação. Conclusão: Os participantes apresentaram alteração de expressão da linguagem oral, com compreensão preservada e dificuldades de atividade e participação, com impacto nos fatores ambientais, sendo a CSA uma facilitadora da comunicação. Reafirma-se a aplicabilidade da CIF no contexto hospitalar, para pessoas em vulnerabilidade comunicativa, para cuidado ampliado e humanizado.

Introduction: Hospitalized patients, due to various causes, may present impairment of speech and language which may lead them to a situation of communicative vulnerability, influencing its functioning. The ICF - International Classification of functioning, Disability and Health is adopted to perform this analysis, under this perspective. Purpose: To analyze the language and functioning of people in communicative vulnerability, under intensive or semi-intensive care at the hospital, according to ICF, as a concept basis. Methods: Descriptive and cross-sectional study, composed by 18 participants. Data collected through: (i) hospital chart survey analysis, in order to characterize sociodemographic profile and clinical conditions of the participants; (ii) application of ICUCS - Intensive Care Unit Communication Screening Protocol; (iii) introduction of AAC - Augmentative and Alternative Communication and (iv) field journal (entries of reports). The results were analyzed by ICF and then performed descriptive statistic analyses. Results: Most participants were alert and could comprehend simple commands, from which 39% presented severe problems regarding language expression. Regarding activity and participation, 50% presented severe difficulty of speaking and 33% of starting and keeping conversations. Regarding environmental, family and health professionals factors, they have all been appointed both as facilitators and barriers to communication. AAC was seen as a communication facilitator. Conclusion: Participants presented alteration of oral language expression, preserved comprehension and difficulties in activity and participation with impact in environmental factors, being AAC a communication facilitator. Reassurance of applicability of ICF in hospital context, directed to people in communicative vulnerability, regarding ample and humanized treatment.

Los pacientes hospitalizados, por las causas diversas, pueden presentar deterioro de la funcionalidad del habla y del lenguaje que se sitúa en el discurso comunicativo, lo que influye en su funcionalidad. Se utiliza la Clasificación Internacional del Funcionamiento de la Discapacidad y de la Salud (CIF) para análisis desde esta perspectiva. Objetivo: Analizar el lenguaje y la funcionalidad de personas en vulnerabilidad comunicativa, en cuidados intensivos y semiintensivos hospitalarios, utilizando la CIF, como fundamento conceptual. Método: Estudiodescriptivo y transversal, con 18 participantes. La recogida de datos incluyó: (i) estudios de las historias clínicas, para caracterizar el perfil sociodemográfico y las condiciones clínicas de los participantes; (ii) la aplicación del protocolo ICUCS (Intensive Care Unit Communication Screening Protocol);(iii) la introducción de la Comunicación Aumentativa y Alternativa (CAA) y (iv) un diario de campo (registro de informes). Los resultados se analizaron por la CIF y se realizó un análisis estadístico descriptivo. Resultados: La mayoría de los participantes estaban alerta y entendían órdenes sencillas, el 39% presentaron graves problemas para expresarse en el lenguaje. Em cuanto, a la actividad y la participación, el 50% tenía graves dificultades para hablar, y el 33%, para iniciar y mantener conversaciones. Los factores ambientales, los miembros de la familia y los profesionales sanitarios fueron identificados tanto como facilitadores como obstáculo para la comunicación. Se consideró que el CAA facilitaba la comunicación. Conclusión: Los participantes presentaban alteración en la expresión del lenguaje oral, con entendimiento resguardado y dificultades en la actividad y la participación, con impacto en los factores ambientales, siendo la CAA facilitadora de la comunicación. Se reafirma la aplicabilidad de la CIF en el contexto hospitalario, para personas en vulnerabilidad comunicativa, para la atención ampliada y humanizada.

Effects of an Augmentative and Alternative Communication Intervention Package on Socio-Communicative Behaviors Between Minimally Speaking Autistic Children and Their Peers.

PURPOSE: The purpose of this study is to investigate the effectiveness of an augmentative and alternative communication (AAC) intervention package consisting of systematic instruction and aided modeling with speech-output technologies on the acquisition, maintenance, and generalization of socio-communicative behaviors-initiating a request for a turn, answering questions, and commenting-in four, minimally speaking (MS) autistic children between the ages of 6 and 9 years. METHOD: A multiple-probe design across behaviors replicated across participants was implemented to evaluate the effects of systematic instruction and aided modeling on initiating requests for a turn, answering questions, and commenting behaviors. Additionally, a pre- and posttreatment multiple-generalization-probes design was used to assess generalization across peers. RESULTS: Visual analyses demonstrated experimental control for two participants (i.e., Derek, Ajay) showing a functional relationship between the intervention and outcomes across all social communicative behavior. For one participant (i.e., Matthew), experimental control could not be established because he did not reach the learning criterion for commenting. The fourth participant (i.e., John) transferred to a different school after making some progress on requesting. Effect size indicator analyses corroborated these findings, indicating medium-to-strong effects for initiating requests for a turn strong effects for answering questions, and medium-to-strong effects for commenting. Generalization of socio-communicative behaviors from researcher to a typically developing peer was variable across participants. Participants maintained socio-communicative behaviors 3 weeks after the last intervention session with varying degrees of success. CONCLUSION: The outcomes of this study suggest that aided modeling and systematic instruction using speech-output technologies may lead to gains in socio-communicative behaviors in some MS autistic children. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25799935.

Visual fixation patterns to AAC displays are significantly correlated with motor selection for individuals with Down syndrome or individuals on the autism spectrum.

Eye tracking research technologies are often used to study how individuals attend visually to different types of AAC displays (e.g. visual scene displays, grid displays). The assumption is that efficiency of visual search may relate to efficiency of motor selection necessary for communication via aided AAC; however, this assumption has not received direct empirical study. We examined the relation between speed of visual search and speed of motor selection of symbols. Ten individuals on the autism spectrum (AS; Study 1) and nine with Down syndrome (DS; Study 2) participated in a search task using simulated AAC displays with a main visual scene display (VSD) and a navigation bar of thumbnail VSDs. Participants were given an auditory prompt to find one of four thumbnail VSDs in the navigation bar. Eye tracking technologies measured how long it took participants to fixate visually on the thumbnail VSD, and recorded how long it took participants to select the thumbnail VSD with a finger. A statistically significant relationship emerged between visual fixation and selection latencies, confirming the positive relationship between visual processing and motor selection for both groups of participants. Eye tracking data may serve as a useful proxy measure for evaluating how display design influences selection of AAC symbols, especially when individuals are unwilling or unable to comply with traditional behaviorally-based assessment tasks.

Alternative Augmentative Communication in paediatric dentistry: a mighty tool to amplify mother tongue's power.

AIM: The role of a child's mother tongue in shaping his/her identity and emotional development is crucial. In the context of paediatric dentistry, this principle should always be reminded. The child's right to effective communication, even when a language barrier exists, is a fundamental principle, as recently stated in the 'Rights from the Start' rights fact sheet. Preserving a child's native language in the dental setting, especially in the context of an increasingly diverse society with a significant number of refugee children, is essential. Augmentative and Alternative Communication (AAC) strategies can assist in bridging language gaps and improving treatment outcomes, blending with the traditional approaches used in paediatric dentistry. The article promotes flexibility, innovation, and empathy in paediatric dentistry to provide optimal care and ensure that every child's rights are respected. CONCLUSION: • The relationship with one's mother language plays a central role in children's growth and in the relationship they can develop with the world, "motherised" by the words of the caregiver. • The interaction between immigrant children from different linguistic and cultural backgrounds and dentists providing their care requires the integration of traditional paediatric dental techniques with AAC strategies that can compensate for deficient oral communication. • Dentists treating immigrant children should follow the suggestions proposed in this article to establish the best and most tailored paediatric setting for the child's specific needs.

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications.

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

Average Time Consumption per Character: A Practical Performance Metric for Generic Synchronous BCI Spellers.

OBJECTIVE: The information transfer rate (ITR) is widely accepted as a performance metric for generic brain-computer interface (BCI) spellers, while it is noticeable that the communication speed given by ITR is actually an upper bound which however can never be reached in real systems. A new performance metric is therefore needed. METHODS: In this paper, a new metric named average time consumption per character (ATCPC) is proposed. It quantifies how long it takes on average to type one character using a typical synchronous BCI speller. To analytically derive ATCPC, the real typing process is modelled with a random walk on a graph. Misclassification and backspace are carefully characterized. A close-form formula of ATCPC is obtained through computing the hitting time of the random walk. The new metric is validated through simulated typing experiments and compared with ITR. RESULTS: Firstly, the formula and simulation show a good consistency. Secondly, ITR always tends to overestimate the communication speed, while ATCPC is more realistic. CONCLUSION: The proposed ATCPC metric is valid. SIGNIFICANCE: ATCPC is a qualified substitute for ITR. ATCPC also reveals the great potential of keyboard optimization to further enhance the performance of BCI spellers, which was hardly investigated before.

How Toddlers Use Core and Fringe Vocabulary: What's in an Utterance?

PURPOSE: Selecting vocabulary for preliterate individuals who use augmentative and alternative communication presents multiple challenges, as the number of symbols provided must be balanced with cognitive, motoric, and other needs. Prioritizing certain types of vocabulary thus becomes a necessity. For example, prioritizing core vocabulary-that is, words that are commonly used across a group of people and contexts-is a common practice that attempts to address some of these issues. However, most core vocabulary research to date has narrowly focused on individual word counts, ignoring other critical aspects of language development such as how vocabulary aligns with typical development and how children use core and fringe vocabulary within their utterances. METHOD: Descriptive and inferential statistics were used to analyze 112 transcripts to describe how typically developing toddlers (aged 2.5 years) use core and fringe vocabulary within their utterances, in reference to a range of commonly used core vocabulary lists. RESULTS: Results indicated that the proportion of the toddlers' utterances that consisted of only core, only fringe, or core + fringe vocabulary varied dramatically depending on the size of the core vocabulary list used, with smaller core lists yielding few "core-only" utterances. Furthermore, utterances containing both core and fringe vocabulary were both grammatically and semantically superior to utterances containing only core or only fringe vocabulary, as evidenced by measures such as mean length of utterance and total number of words. CONCLUSION: Thus, relying on word frequency counts is an insufficient basis for selecting vocabulary for aided preliterate communicators.

Increasing Reciprocal Social Interactions Between Children Who Use Augmentative and Alternative Communication and Peers Using a Collaborative Learning Framework.

PURPOSE: Children with complex communication needs who rely on augmentative and alternative communication (AAC) strategies to express themselves face significant difficulties interaction with peers. This study sought to design, implement, and evaluate a collaborative photography intervention designed to increase reciprocal social interaction between children who use AAC and their same-age peers. METHOD: A single-subject, withdrawal design (ABAB) was used to explore the functional relationship between engagement in a collaborative photography intervention and the frequency of reciprocal social interactions between children who use AAC and their same-age peers. Partial-interval time sampling was used to code the number of reciprocal social interactions across four dyads. RESULTS: Increased frequencies of reciprocal social interactions were observed in intervention phases across all four dyads. Very large levels of effect and 100% nonoverlapping data were noted for Dyads 1 and 4. Moderate levels of effect and 70% of nonoverlapping data were noted for Dyads 2 and 3. CONCLUSIONS: Collaborative learning frameworks may be used to increase reciprocal social interactions between children who use AAC and their peers. Speech-language pathologists should consider utilizing collaborative learning elements in activities with children who use AAC. Future research is needed to further explore collaborative learning frameworks for interventions for children who use AAC. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.25464064.

Still having his say: David Yoder's legacy in AAC.

On February 2 2023, one of the guiding lights in the field of augmentative and alternative communication (AAC) for more than four decades, David E. Yoder, passed away at the age of 90. A voracious reader and gifted storyteller, David was particularly fond of a quote from George Bernard Shaw's Back to Methuselah, "You see things; and you say 'Why?' but I dream things that never were; and I say 'Why not?'" That vision led him to take on multiple leadership roles and influence the field of AAC in multiple ways. He played a pivotal role in establishing both the International Society for Augmentative and Alternative Communication (ISAAC) and the United States Society for Augmentative and Alternative Communication (USSAAC). Additionally, he chaired the panel for the National Institute on Disability and Rehabilitation Research (NIDRR)'s inaugural Consensus Validation Conference on AAC, advocated for the American Speech-Language-Hearing Association to recognize AAC within the profession's scope of practice, and served as the first editor for the Augmentative and Alternative Communication journal. In this tribute, we describe David's diverse and unique contributions to improving the lives of people with communication challenges with a focus on some of his central insights and actions.