Environmental factors contributing to using spelling in communication: Perceptions of literate aided communicators.

The aim of this interpretive qualitative study was to explore how environmental factors influence the transition from relying solely on graphic symbols to using spelling in face-to-face communicative interactions, from the perspective of literate adults with speech and motor impairments who use augmentative and alternative communication (AAC). Fourteen adults either chose to submit a written story with weekly email follow-up, took part in interviews conducted via Zoom1, or chose to communicate solely by email. Researchers analyzed data using Charmaz's (2014) constructivist grounded theory approach. The analysis yielded three themes explaining environmental factors relevant to the transition from using graphic symbols to spelling in communication: (a) access to AAC systems and services; (b) knowledgeable and supportive communication partners who have high expectations; and (c) opportunities to learn reading, writing, and spelling. Supportive factors included providing sufficient time for spelling in communicative interactions, structured learning opportunities for practice and independence, opportunities to learn through socially meaningful interactions and having print-rich and language-rich activity settings. Slow speed in navigating graphic symbols and lack of ability to express an exact message were motivational reasons for participants to use spelling in communicative interactions. The interaction among environmental factors and person-related characteristics warrants further investigation.

Adopting new habits and routines in response to COVID-19 lockdown disruptions: A qualitative study.

Introduction: COVID-19-related restrictions resulted in changes to time use and occupational participation, impacting individual and collective well-being. This study addressed a knowledge gap concerning the adaptive process during periods of occupational disruption. We explored the experience of occupational disruption and how people managed disruption during the COVID-19 pandemic. Methods: We used a qualitative descriptive approach and interviewed 18 participants of a larger survey study of time use during the COVID-19 pandemic undertaken around a medium-sized city in Canada. Transcript analysis was conducted inductively using conventional content analysis. Findings: Two overarching themes were constructed during data analysis: The Disruption Experience and Adopting New Habits and Routines. In the face of disruption, participants described a sense of loss and disconnection, and challenges with time management. Establishing new habits and routines required new learning associated with increased time and flexibility, connecting with others and health and wellness. Conclusion: During changing pandemic restrictions, participants expressed a sense of loss, disconnection and time management challenges associated with occupational disruptions, but also described ways they adapted, improving their health and well-being. Strategies identified through this work may be used to enhance adaptation during disruptions. Future research should explore differences in adaptation, among more diverse populations.

Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada.

Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.

Canadian manufacturer and technician perspectives on the design and use of augmentative and alternative communication technology.

PURPOSE: Device manufacturers and technicians (MaTs) of augmentative and alternative communication (AAC) systems play key roles in the design and successful uptake of communication devices. This study aims to investigate MaT perspectives on AAC device design and effective use. MATERIALS AND METHODS: To investigate their perspectives, a focus group of MaTs within Canada was conducted. Reflexive thematic analysis was used to analyze data. FINDINGS: Three major themes resulted from analysis, which reflect MaT's views: AAC hardware and software flexibility, AAC knowledge and implementation, and social good versus financial resources. CONCLUSIONS: This study provides insights into the complexities faced by MaTs in balancing technical support of system end-users and the financial resources necessary for that support. These insights indicate a need for increased financial resources and the expansion of individuals who qualify for AAC system candidacy. MaTs suggest that an increase in resources and candidacy could lead to more successful AAC implementation and a greater understanding of AAC for all stakeholders.

Augmentative and Alternative Communication (AAC):• AAC technology provides individuals with communication disabilities a form of alternative communication.• The success of AAC systems is dependent on multiple factors including AAC stakeholders, system design, and system implementation.• This study explores AAC manufacturers and technicians perspectives on how to make AAC systems as effective and widely accessible as possible.

Models and frameworks for guiding assessment for aided Augmentative and Alternative communication (AAC): a scoping review.

BACKGROUND: Augmentative and Alternative Communication (AAC) supports individuals with complex communication needs. Conceptual models and frameworks exist to evaluate, implement, and assess the needs of persons with communication disabilities, however, it is unknown which models were grounded in previous evidence-based research. OBJECTIVE: What are the models and frameworks grounded in empirical or conceptual research that enable communication outcomes for persons who require aided AAC systems? ELIGIBILITY CRITERIA: The study had to be the original publication of a defined model or framework that included aided AAC and the model had to be developed through research, either conceptual or empirical. SOURCES OF EVIDENCE: Eleven databases were searched using terms associated with AAC devices, conceptual models, and assessment processes. Fifteen articles presenting 14 independent assessment models were included. CHARTING METHODS: A custom data extraction form included model development using existing models and research evidence, the model's input parameters, and explicit outcome measures. RESULTS: Four models were specific to AAC while ten models were general evaluations for assistive technology systems. Models used a variety of descriptive traits during assessment including: person, technology, environment and context, and the activity or task. Only nine models sought to iteratively assess the client. Eleven of the models identified the inclusion of members from different disciplines in the assessment process. CONCLUSIONS: There is a need to standardize descriptive traits: personal abilities, environmental characteristics, potential assistive technology, and contextual factors. Models should include teams of different disciplines to provide holistic assessments. Models should include outcomes and include iterative solutions.Implications for RehabilitationStandardizing the definitions of descriptive traits used in the assessment of the personal abilities, environmental characteristics, potential assistive technology, and contextual factors would enable better evaluation of outcomes across disciplines and abilities.By identifying what factors are instrumental in the successful recommendation of assistive technology, professionals may achieve a well-organized and efficient assessment tool.An assessment model tailored specifically to individuals who may benefit from Augmentative and Alternative Communication (AAC) should be considered that are rooted in existing theories, research evidence, and the experiences of those in the AAC community.An AAC specific model would allow for consistent outcome tracking across individuals or assessment teams and the comparison of the effectiveness of various models for research purposes.

Family quality of life and children with disability in Ethiopia: The role of support providers.

Background: Family quality of life (FQOL) is an important outcome for families of children with disabilities globally and provision of support is associated with enhanced FQOL. However, FQOL research primarily focuses on conceptualisation and measurement, and originates from high-income contexts despite the fact that most children with disabilities live in low-income countries. Objectives: The authors examined how Ethiopian disability support providers practically contribute to meeting the needs of families of children with disabilities to enhance FQOL. Method: Building on a previous study exploring Ethiopian families' perspectives on FQOL, the authors used an exploratory descriptive qualitative approach to interview various support providers. Interviews were conducted virtually (because of the coronavirus disease 2019 [COVID-19] pandemic) in English or with interpreting assistance. Audio-recorded interviews were transcribed verbatim and analysed thematically. Results: Support providers affirmed what families had described as important for FQOL - spirituality, relationships, self-sufficiency - and recognised their enormous support needs. They described various ways to support families - emotionally, physically, materially and informationally. They also expressed challenges and their need for support to meet families' needs. Conclusion: Ethiopian families of children with disabilities need holistic support that incorporates spirituality, the whole family's needs and disability awareness-raising. Collaborative and committed engagement from all stakeholders is necessary to support Ethiopian families to flourish. Contribution: This study contributes to global understandings of FQOL and describes practical approaches to support families of children with disabilities in an African context. The findings of this study highlight the influence of spirituality, relationships, self-sufficiency, poverty and stigma and the need for holistic support and disability awareness-raising to enhance FQOL.

Barriers and facilitators to accommodations in the workplace for adults who use augmentative and alternative communication (AAC): a systematic review.

Workplace accommodations can reduce barriers to employment for people who use augmentative and alternative communication (AAC), however, the lack of accommodations continues to challenge participation in employment. This systematic review identified and analyzed barriers and facilitators to implementing workplace accommodations for adults (19 years and over) who use AAC. A systematic search of nine databases was conducted to identify relevant studies using the search terms "AAC" and "workplace accommodations" and variations of each term. Results were imported into Covidence. Seventeen studies met the inclusion criteria. Results were presented using the International Classification of Functioning, Disability, and Health (ICF) framework. The Oxford levels of evidence and Confidence in Evidence from Review of Qualitative Research (GRADE-CERQual) were used to assess the quality of the studies and confidence in findings, respectively. Environmental barriers related mainly to attitudes and technology, and personal barriers related to job qualifications, education, and work-related skills. A combination of facilitators such as personal strengths, access to technology, and supportive relationships contributed to successful implementation of accommodations. The findings of this review suggest that implementing workplace accommodations for adults who use AAC strategies is complex and further research is needed to advance practices and policies that support the implementation of workplace accommodations.

Therapy services for children and youth living in rural areas of high-income countries: a scoping review.

PURPOSE: To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services. METHODS: This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers. RESULTS: Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described. CONCLUSIONS: Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.

Activity and participation experiences of people with disabilities in Ethiopia.

Background: Ethiopia, as a State Party to the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD), has committed to upholding the rights of people with disabilities in Ethiopia. There is little evidence, however, reflecting the impact of this commitment on the lived experiences of people with disabilities in Ethiopia. Objectives: This study sought to uncover how the experiences of participation and activity shape the enactment of rights for Ethiopians with disabilities as enshrined in the UNCRPD. Method: Analysis of 25 qualitative interviews with people with disabilities and family members living in Ethiopia used a reflexive thematic analysis approach to arrive at central themes. Results: People with disabilities in Ethiopia experience marginalisation, distress and practical challenges in both routine daily activities and participation in broader social roles and opportunities. These experiences affect their ability to claim many of the rights afforded by the UNCRPD. Conclusion: Despite legislative efforts to bring about change in Ethiopia, people with disabilities continue to live on the social margins. A meaningful change will require substantial allocation of needed resources by the Ethiopian government to support national-level programmes and policy change. It is critical that people with disabilities and their families are engaged in receiving relevant support, and serve as change leaders. Contribution: This study illustrates how marginalisation, distress and practical challenges in daily activities and social participation arise and are sustained for people with disabilities in Ethiopia. The findings can help to inform the country's efforts to enact the rights of Ethiopians with disabilities as enshrined in the United Nations Convention on the Rights of Persons with Disabilities.

Aided communication, mind understanding and co-construction of meaning.

Mind understanding allows for the adaptation of expressive language to a listener and is a core element when communicating new information to a communication partner. There is limited knowledge about the relationship between aided language and mind understanding. This study investigates this relationship using a communication task. The participants were 71 aided communicators using graphic symbols or spelling for expression (38/33 girls/boys) and a reference group of 40 speaking children (21/19 girls/boys), aged 5;0-15;11 years. The task was to describe, but not name, drawings to a communication partner. The partner could not see the drawing and had to infer what was depicted from the child's explanation. Dyads with aided communicators solved fewer items than reference dyads (64% vs 93%). The aided spellers presented more precise details than the symbol users (46% vs 38%). In the aided group, number of correct items correlated with verbal comprehension and age.

Emotional Well-Being of Children and Youth with Severe Motor and Communication Impairment: A Conceptual Understanding.

BACKGROUND: Children and youth with severe motor and communication impairment (SMCI) have difficulty providing self-expression through typical speech, writing with a paper and pencil, or using a standard keyboard. Their emotional expressions can be missed by peers and novel caregivers. PURPOSE: To describe the indicators and components of emotional experiences for children/youth with SMCI. METHODS: Primary guardians of nine children/youth with SMCI were involved in photo/video data collection and follow-up qualitative interviews. Twenty-one familiar people (e.g., friends, family members, and/or care team) participated in semi-structured qualitative interviews. RESULTS: A conceptual understanding of emotional well-being specific to the population has been developed consisting of nine themes, encompassed by four domains i) Core Attributes, ii) Personal Experiences, iii) Surroundings, iv) Expression and Reception. CONCLUSIONS: Emotional experiences of children/youth with SMCI are diversely expressed. Primary guardian and familiar person insight can be amplified to positively impact care and participation.

Coping with COVID: pandemic narratives for Australian children.

The experience of the COVID-19 pandemic can be recognised as traumatic for the way in which its sudden and unexpected onset disrupted a sense of ordinary life for so many around the world. Adults, and far less so children, were unable to prepare for the danger of the rapidly spreading disease. As such, both were left vulnerable to the experience of trauma and anxiety that surrounds the threat of COVID. Whereas adults, however, have access to a range of resources and strategies for mental health protection, children of various ages need targeted resources to enable them to understand, prepare for, and come to terms with a trauma situation. A great deal of research exists around the value of children developing their own narratives as a means of coming to terms with trauma, such that storytelling is identified as a primary coping device. Similarly, literature exists that compares parental narratives of trauma with those of their children. Moreover, the use of the fairy tale as a cautionary tale has long been examined. What has not been established is the way in which contemporary multimedia narratives - such as television programmes, animations, and digital stories - can be used to develop coping strategies in children and to mitigate anxiety in young people experiencing global or collective trauma. This article examines a selection of such narratives produced for Australian children during the COVID-19 pandemic. Through a cross-disciplinary framework, this work considers how these resources can help (or hinder) mental health recovery in young children under the age of five, as well as strategies for best practice in the future development of trauma-informed resources for this age group.

Direct assessment of emotional well-being from children with severe motor and communication impairment: a systematic review.

PURPOSE: Explore methods used in peer-reviewed literature for obtaining self-expression of well-being information from children with severe motor and communication impairment (SMCI). MATERIALS AND METHODS: A comprehensive search was conducted on 22 August 2019 through academic databases: CINAHL; Embase; MEDLINE; PsycINFO; InSpec; Compendex. Search strategies were informed by keywords under the following areas: (1) population: children with SMCI, (2) assessment methods: alternative to natural speech, paper and pencil report or standardized keyboard use (e.g., eye gaze) and (3) target information: well-being (e.g., quality of life). Studies were excluded if they focused on individuals over 25-years old, exclusively autism or typically developing children. RESULTS: Non-duplicate studies of 10,986 were screened; 49 studies met inclusion criteria. Most studies used high-tech methods of self-expression in a single context (n = 17). Familiar partners play a significant role in self-expression; 18 studies required a familiar partner for children with SMCI to self-express. Thirty-five studies involved children self-expressing to solely adults, in comparison to 14 studies which involved peers. CONCLUSION: Findings highlight the advancement of high-tech communication devices restricted to application in single contexts. Familiar partner knowledge of children with SMCI has the potential to be shared with others (e.g., respite care providers), enhancing both caregiver and child well-being. Future research that would enhance the literature could explore the assessment of emotional well-being for application in various contexts using multimodal methods. Opportunities for children with SMCI to express their emotional well-being can further influence the understanding and enhancement of participation, social connections, and experiences.IMPLICATIONS FOR REHABILITATIONUse of lower tech methods of self-expression to obtain information directly from children with severe motor and communication impairment (SMCI) remain more feasible in home and school contexts.By utilizing familiar partners' experiences and knowledge of the child, respite care providers, novel support workers, and others involved in the lives of children with SMCI can become further informed.Current high-tech methods for obtaining the emotional expressions of children with SMCI may benefit from incorporating multimodal approaches including lower tech methods, to be feasibly applied in real world contexts where well-being takes place.Further research on this topic is imperative to enable children with SMCI to self-express their emotional well-being which can enhance participation, activities, social connections, and experiences.

Family quality of life for families of children with disabilities in African contexts: a scoping review.

BACKGROUND: Family Quality of Life (FQOL) is an important outcome for families of children with disabilities and is influenced by context and culture. Minimal research explores FQOL in African contexts. PURPOSE: This scoping review identifies factors contributing to FQOL for families of children with disabilities in African contexts. METHOD: We were guided by Arksey and O'Malley's scoping review framework, searching for research papers from the following electronic databases: CINAHL, Embase, Medline, Global Health, and PsycINFO. Using pre-determined eligibility criteria, two authors independently reviewed articles for inclusion via Covidence, a reference manager that facilitates blind reviewing. Two other authors independently extracted data from studies using a data-charting form based on Zuna and colleagues' FQOL framework. Reviewers met regularly for discussion to reach consensus. RESULTS: Fifty-three articles met the inclusion criteria, and findings demonstrated a broad variety of factors contributing to FQOL within the FQOL framework related to family unit factors, individual member factors, and external support factors. We found that poverty, stigma, and spirituality were particularly prominent factors affecting FQOL negatively and positively in African contexts. CONCLUSION: Whilst there are universal factors that contribute to FQOL, recognising the influence of context-specific factors (i.e. poverty, stigma, spirituality) is important in order to provide effective, culturally relevant support that enhances FQOL for families of children with disabilities in African contexts.

Artistic Freedom or Animal Cruelty? Contemporary Visual Art Practice That Involves Live and Deceased Animals.

This paper examines a selection of 21st-century international examples of exhibited visual artworks involving live or deceased animals. It seeks to reveal the risks and benefits of unique encounters with animals through art and to consider the ethical implications of artwork deploying animals. Australian and international animal protection laws are not explicit when it comes to the sourcing of animals for art nor for the direct inclusion of animals in artworks. This lack leads to a variety of artistic practices, some considered ethical while others are viewed as controversial, bordering on animal cruelty. Artwork selection is determined by a focus on high-profile artists who intentionally use animals in their practice and whose reputation has been fostered by this intention. The study provides insight into how the intentional use of ethically sourced animals within art practice can be a method of addressing hierarchal human-animal imbalances. Further, this study identifies unethical practices that may be best avoided regardless of the pro-animal political statements the artists put forward. Recommendations of how to better determine what is an acceptable use of animals in art with a view to informing legal guidelines and artistic best practice are presented.

Family support and family and child-related outcomes among families impacted by disability in low- and middle-income countries: A scoping review.

There is a growing interest in understanding the relationship between family support and family or child-related outcomes in high-income countries. However, this has received little attention in low- and middle-income countries. The purpose of this review was to explore the relationship between family support and family and child-related outcomes among families affected by disability in low- and middle-income countries. We conducted a scoping review of five databases using search terms related to 'family', 'support', 'child', and 'disability'. A total of 13 articles met the inclusion criteria. Families of children with disabilities received most of their support from informal sources (e.g. immediate family members, friends, and parents support groups). Parental stress was most often evaluated as the family outcome and was negatively linked to emotional support and childcare assistance from immediate family members. Movement and mobility therapy offered by rehabilitation professionals was found to improve children's walking patterns. Positive attitudes from community members were key facilitators to participation of children with disabilities in social activities. The review calls for urgent attention to research in low- and middle-income countries, particularly the extent of support families are receiving from government-led support systems.

Decision-making in communication aid recommendations in the UK: cultural and contextual influencers.

High-tech communication aids are one form of augmentative and alternative communication (AAC) intervention offered to children following an assessment process to identify the most appropriate system based on their needs. Professional recommendations are likely to include consideration of child characteristics and communication aid attributes. Recommendations may be influenced by contextual factors related to the cultural work practices and service context of professionals involved, as well as by contextual factors from the child's life including their family environment and wider settings. The aim of this study was to explore the influence of cultural and contextual factors on the real-time decision-making processes of specialized AAC professionals in the UK. A total of six teams were recruited to the study. Each team carried out an assessment appointment related to a communication aid recommendation for a child and family. Following the appointment, each team participated in a focus group examining their decision-making processes during the preceding assessment. Inductive coding was used to analyse the transcribed data, and three organizing themes emerged relating to the global theme of Cultural and Contextual Influencers on communication aid decision-making. An explanatory model was developed to illustrate the funnelling effect that contextual factors may have on decision-making, which can substantially alter the nature and timing of a communication aid recommendation. Implications for clinical practice and future research are discussed.

Constructing narratives to describe video events using aided communication.

Narratives are a pervasive form of discourse and a rich source for exploring a range of language and cognitive skills. The limited research base to date suggests that narratives generated using aided communication may be structurally simple, and that features of cohesion and reference may be lacking. This study reports on the analysis of narratives generated in interactions involving aided communication in response to short, silent, video vignettes depicting events with unintended or unexpected consequences. Two measures were applied to the data: the Narrative Scoring Scheme and the Narrative Analysis Profile. A total of 15 participants who used aided communication interacted with three different communication partners (peers, parents, professionals) relaying narratives about three video events. Their narratives were evaluated with reference to narratives of 15 peers with typical development in response to the same short videos and to the narratives that were interpreted by their communication partners. Overall, the narratives generated using aided communication were shorter and less complete than those of the speaking peers, but they incorporated many similar elements. Topic maintenance and inclusion of scene-setting elements were consistent strengths. Communication partners offered rich interpretations of aided narratives. Relative to the aided narratives, these interpreted narratives were typically structurally more complete and cohesive and many incorporated more elaborated semantic content. The data reinforce the robust value of narratives in interaction and their potential for showcasing language and communication achievements in aided communication.

Visual-spatial cognition in children using aided communication.

Children with severe motor impairments are restricted in their manipulation and exploration of objects, but little is known about how such limitations influence cognitive development. This study investigated visual-constructional abilities in 75 children and adolescents, aged 5;0-15;11 (years;months), with severe speech impairments and no intellectual disabilities (aided group) and in 56 children and adolescents with typical development (reference group). Verbal comprehension, non-verbal reasoning, and visual-spatial perception were assessed with standardized tests. The task of the participants was to verbally instruct communication partners to make physical constructions identical to models that the partner could not see. In the aided group, 55.7% of the constructions were identical to the models participants described, compared to 91.3% in the reference group. In the aided group, test results explained 51.4% of the variance in construction errors. The results indicate that the participants' language skills were decisive for construction success. Visual-perceptual challenges were common among the aided communicators, and their instructions included little information about size and spatial relations. This may reflect less experience with object manipulation and construction than children with typical development, and using aided communication to instruct others to make three-dimensional constructions. The results imply a need for interventions that compensate for the lack of relevant experience.

Communication aid provision and use among children and adolescents developing aided communication: an international survey.

A fundamental requirement of a supportive language development for young children who need aided communication is that an aided communication system is made available and its use is supported. There is limited information about the age at which children are typically provided with a communication aid or about how aided communication is used in everyday situations. Using questionnaire-based interview data, this study investigated (a) the pattern of provision of communication aids to 84 children and adolescents, (b) parents' and professionals' evaluation of the quality of communication across contexts, and (c) availability and use of aided communication in these contexts. The age at which the participants received their first aided system varied considerably across the group; however, most were considerably older than the age at which children with typical development usually begin to speak. Parents and professionals rated most everyday situations as good communication situations but reported that the participants did not have their main form of expressive language available in many of these situations, or did not use it much. Parents rated their child's education in relation to aided language positively, but many professionals indicated that they had limited knowledge about the participant's use of aided communication outside of the school environment, or about the parents' attitudes. The study gives insights into the language learning situation of children and adolescents who develop aided communication.