"I don't think you can really understand it until you put it to action": school-based SLPs' reflections on graduate and continuing education in AAC.

Graduate programs have made strides to improve augmentative and alternative communication (AAC) learning opportunities for pre-service speech-language pathologists (SLPs). In addition, a number of continuing education opportunities are available to practicing SLPs; however, many still report feeling underprepared to serve clients with AAC needs. The purpose of this study was to describe school-based SLPs' perspectives regarding their graduate training, on-the-job experience, and ongoing professional development needs related to AAC. Semi-structured interviews were completed with 17 school-based SLPs. Interviews were recorded and transcribed verbatim. Using a phenomenological approach, key themes emerged related to AAC knowledge and skills including a need for SLPs to rely on a framework for decision making, the importance of interprofessional training, and difficulties with staying abreast of new technology. The researchers present recommendations of principles and concepts for instructors to include in graduate AAC courses, as well as professional development considerations.

Examining the Visual Attention Patterns and Identification Accuracy of Adults With Aphasia for Grids and Visual Scene Displays.

PURPOSE: We compared the degree of cognitive processing needed by people with aphasia to identify themes depicted in grids and visual scene displays (VSDs). We also compared the accuracy of theme identification for both display types. METHOD: Eye-tracking technology was employed to measure the visual processing patterns of 21 adults with aphasia when interpreting themes presented through grids and VSDs. Additionally, we assessed theme identification accuracy by having participants select themes from four choices after viewing each display. RESULTS: Participants more rapidly identified VSDs than grid displays, and VSDs required fewer visual fixations to process than grids. No significant differences were noted between grids and VSDs for theme identification accuracy; however, results indicate a ceiling effect for the variable, as participant accuracy levels were nearly 100% for both display conditions. CONCLUSIONS: Results from this study add to a growing body of evidence supporting the use of VSDs for adults with aphasia. Both display types were accurately identified; however, VSDs were processed more efficiently than grids indicating that both display types may prove effective for people with aphasia; however, VSDs may require less cognitive effort to effectively use than grid displays.

Lessons for the AAC field: a tribute to Dr. David Beukelman.

On February 5, 2022, the field of augmentative and alternative communication (AAC) lost a giant when Dr. David "Dave" Beukelman passed away. As the readership of this journal is aware, Dave was one of the principal founders of the AAC field and devoted his career to providing a voice to those without one. Before AAC became a field, people who could not talk were invisible or seldom noticed, unless they were in the way. For more than 40 years, he was a catalyst for change in AAC clinical practice, research, dissemination, teaching, and public policy development. This tribute aims to honor Dave's lifelong mission of serving others by sharing some of his most timeless and valued lessons. Each lesson begins with one of Dave's most enduring quotes that is then followed by a brief synopsis of the lesson Dave hoped to convey.

Personalization of Visual Scene Displays: Preliminary Investigations of Adults with Aphasia, Typical Females across the Age-Span, and Young Adult Males and Females.

Visual scene displays (VSDs) are becoming an increasingly popular method of message representation within augmentative and alternative communication (AAC) supports; however, design factors can influence the effectiveness of these images as communication supports. One issue that has come to light in recent years is the fact that selecting personalized VSDs, which depict the person with complex communication needs or an individual with whom they are familiar, are preferred over generic VSDs, which depict unfamiliar individuals. Although personalization is likely an important factor in the usability of VSDs, these images may be difficult for clinicians to obtain. As such, compromises must be identified. The purpose of this study was to explore the effects of controlling personal relevance factors (i.e., age and gender of the people depicted in generic VSDs) on the image preference patterns of adults with and without aphasia. Results from three very preliminary study summaries indicate that gender and age are both mitigating factors in image preference, as males tended to indicate preference for VSDs containing males over those containing females. In addition, females tended to indicate preference for females of a similar age depicted in VSDs.

Clinical and Research Perspectives on Visual Scene Displays.

Purpose The purposes of this study were to measure the perceptions of speech-language pathologists (SLPs) and researchers regarding the design of visual scene displays (VSDs) and to investigate the perceived difficulties of SLPs in regard to the acquisition and programming of VSDs. Method We recruited 270 SLPs and nine researchers who focus on VSDs to complete an online survey. The SLP survey addressed both perception of VSD design and difficulties associated with implementing these images as communication supports in the clinical realm. The researcher group was surveyed solely regarding their opinions associated with VSD design. Results SLPs and researchers both ranked high-context VSDs as more effective at supporting communication than low-context VSDs. In addition, both groups ranked VSDs with task-engaged people as more effective at supporting communication than VSDs with camera-engaged people or no people. SLPs reported difficulties with acquiring high-quality VSDs from online sources as well as difficulties with maintenance and upkeep of VSDs. In addition, a large portion of SLPs reported challenges with representing complex concepts through VSDs. Conclusions Results from this study provide evidence of general agreement between SLPs and researchers regarding perception of VSD design. SLPs continue to report challenges with the acquisition and programming of VSDs. Further research is needed to develop evidence-based guidelines to support clinical endeavors in these areas.

Effectiveness and Utility of Visual Scene Displays as Communication Supports for Adults and Children With Complex Communication Needs: Perspectives of Clinicians and Researchers.

Purpose The aims of this research study were to describe the perspectives of clinicians and researchers regarding the effectiveness of visual scene displays (VSDs) as communication supports in order to inform the translation of research to clinical practice. Method An online survey was completed by 298 clinicians and nine VSD researchers. Participants rated the effectiveness of VSDs in supporting a variety of communication functions and their strength of agreement regarding statements of VSD utility. Results Regardless of population served, clinicians and researchers rated VSDs as effective at supporting a range of communication functions. Participants also tended to agree with statements of VSD utility. Conclusions The current study highlights the perceptions of clinicians and researchers regarding the uses and benefits of VSDs for adults and children with complex communication needs and provides an initial measure of the current translation of research to clinical practice. Results indicate that VSDs can be used to support a variety of communication functions and utilities; however, further work is necessary to explore additional communication functions and delineate similarities and differences of VSD uses for differing populations. Supplemental Material https://doi.org/10.23641/asha.14551344.

Visual processing patterns of adults with traumatic brain injury when viewing image-based grids and visual scenes.

Many individuals with traumatic brain injury (TBI) rely on augmentative and alternative communication (AAC) supports to meet functional communication needs. The use of images to display message content may be advantageous for this population, given deficits in literacy, visual processing, and cognition. Grid and visual scene displays are two options for presenting images within AAC systems. Eye-tracking technology was utilized to evaluate the visual processing patterns of 13 adults with a history of TBI and 13 adults without TBI when interpreting themes depicted in grid and visual scene displays. Results indicated that differential processing and effort was required when interpreting the two display types. Both groups of participants required significantly more visual fixation time and exhibited patterns consistent with greater cognitive effort when identifying themes depicted in grids compared to visual scenes (i.e., greater numbers of short fixations). The participants with TBI were overall less efficient than those without TBI when identifying themes presented in both AAC display types. These results add to the growing body of evidence indicating that visual scenes may more effectively represent complex concepts than decontextualized, grid-based images for individuals with TBI. Additional clinical implications are discussed.

Identification and Expression of Themes Depicted in Visual Scene and Grid Displays by Adults With Traumatic Brain Injury.

Purpose The study purpose was to compare the speed and accuracy with which people with traumatic brain injury (TBI) identified themes depicted in visual scene and grid displays. Additionally, we compared the verbal responses associated with the 2 display types to determine whether adults with TBI tended to produce more action or naming messages. Method Thirteen adults with and 13 without TBI viewed grid and visual scene displays matched for content and theme. They then provided verbal responses stating the theme or central idea of each image. Results Although no significant differences were noted between groups for theme identification accuracy, adults with TBI required significantly more time than adults without TBI to process both display types. Both participant groups more rapidly and accurately identified visual scenes than grid displays. Additionally, participants with and without TBI produced more action messages in response to visual scenes and naming messages in response to grid displays. Conclusions This investigation provides preliminary evidence that themes that depicted visual scenes maybe more rapidly and accurately identified than those depicted in grid displays. Additionally, visual scenes may more effectively represent action messages, and grids may more effectively represent naming messages for people with TBI.

Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions.

This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to capture visual attention to VSDs (video VSDs) or to specific elements in VSDs. When using grid displays with children with developmental disabilities, research supports the use of spatial cues and clustering based on internal symbol colour to facilitate visual searching and selection. Background colour does not seem to facilitate searching for symbols on smaller displays, and may actually distract children from processing the meaningful components of symbols. Preliminary research suggests that the organization of onscreen keyboards and the number, types, and pairings of symbols in grids may impact performance of adults with acquired conditions. Directions for future research are discussed.

Using Images With Individuals With Aphasia: Current Research and Clinical Trends.

Purpose: Visuographic supports in the form of images are utilized during assessment and treatment for individuals with aphasia to supplement speech, language, and cognitive losses limiting communication. Clinicians rely on prior experience and intuition to make decisions regarding image-based support design and selection (e.g., augmentative and alternative communication strategies). Researchers have begun to focus on the relationship between the images and the benefits they provide for adults with aphasia. Method: The aim of this review-resulting from a roundtable discussion at the 2016 Clinical Aphasiology Conference-was to disseminate summaries of current and past researches regarding image use by individuals with aphasia and to highlight areas of need within research and practice. Results: Review of the literature illuminated 4 major themes: (a) image creation, capture, and sharing; (b) image characteristics; (c) image use across linguistic domains and contexts; and (d) implications for clinical and research practices. Conclusions: Reviewing current knowledge and practice regarding the use of visual supports for individuals with aphasia is essential to advancing therapeutic practices and providing evidence-based protocols for creating, selecting, and implementing images within augmentative and alternative communication strategies. Several gaps in knowledge were identified as future research needs (e.g., caregiver training and enhanced image feature investigation).

The effect of human engagement depicted in contextual photographs on the visual attention patterns of adults with traumatic brain injury.

Photographs are a frequently employed tool for the rehabilitation of adults with traumatic brain injury (TBI). Speech-language pathologists (SLPs) working with these individuals must select photos that are easily identifiable and meaningful to their clients. In this investigation, we examined the visual attention response to camera- (i.e., depicted human figure looking toward camera) and task-engaged (i.e., depicted human figure looking at and touching an object) contextual photographs for a group of adults with TBI and a group of adults without neurological conditions. Eye-tracking technology served to accurately and objectively measure visual fixations. Although differences were hypothesized given the cognitive deficits associated with TBI, study results revealed little difference in the visual fixation patterns of adults with and without TBI. Specifically, both groups of participants tended to fixate rapidly on the depicted human figure and fixate more on objects in which a human figure was task-engaged than when a human figure was camera-engaged. These results indicate that strategic placement of human figures in a contextual photograph may modify the way in which individuals with TBI visually attend to and interpret photographs. In addition, task-engagement appears to have a guiding effect on visual attention that may be of benefit to SLPs hoping to select more effective contextual photographs for their clients with TBI. Finally, the limited differences in visual attention patterns between individuals with TBI and their age and gender matched peers without neurological impairments indicates that these two groups find similar photograph regions to be worthy of visual fixation. LEARNING OUTCOMES: Readers will gain knowledge regarding the photograph selection process for individuals with TBI. In addition, readers will be able to identify camera- and task-engaged photographs and to explain why task-engagement may be a beneficial component of contextual photographs.

Effect of Message Type on the Visual Attention of Adults With Traumatic Brain Injury.

PURPOSE: The purpose of this investigation was to measure the effect of message type (i.e., action, naming) on the visual attention patterns of individuals with and without traumatic brain injury (TBI) when viewing grids composed of 3 types of images (i.e., icons, decontextualized photographs, and contextualized photographs). METHOD: Fourteen adults with TBI and 14 without TBI-assigned either to an action or naming message condition-viewed grids composed of 3 different image types. Participants' task was to select/sustain visual fixation on the image they felt best represented a stated message (i.e., action or naming). RESULTS: With final fixation location serving as a proxy for selection, participants in the naming message condition selected decontextualized photographs significantly more often than the other 2 image types. Participants in the action message condition selected contextualized photographs significantly more frequently than the other 2 image types. Minimal differences were noted between participant groups. CONCLUSIONS: This investigation provides preliminary evidence of the relationship between image and message type. Clinicians involved in the selection of images used for message representation should consider the message being represented when designing supports for people with TBI. Further research is necessary to fully understand the relationship between images and message type.

A Comparison of the Visual Attention Patterns of People With Aphasia and Adults Without Neurological Conditions for Camera-Engaged and Task-Engaged Visual Scenes.

PURPOSE: The purpose of the study was to compare the visual attention patterns of adults with aphasia and adults without neurological conditions when viewing visual scenes with 2 types of engagement. METHOD: Eye-tracking technology was used to measure the visual attention patterns of 10 adults with aphasia and 10 adults without neurological conditions. Participants viewed camera-engaged (i.e., human figure facing camera) and task-engaged (i.e., human figure looking at and touching an object) visual scenes. RESULTS: Participants with aphasia responded to engagement cues by focusing on objects of interest more for task-engaged scenes than camera-engaged scenes; however, the difference in their responses to these scenes were not as pronounced as those observed in adults without neurological conditions. In addition, people with aphasia spent more time looking at background areas of interest and less time looking at person areas of interest for camera-engaged scenes than did control participants. CONCLUSIONS: Results indicate people with aphasia visually attend to scenes differently than adults without neurological conditions. As a consequence, augmentative and alternative communication (AAC) facilitators may have different visual attention behaviors than the people with aphasia for whom they are constructing or selecting visual scenes. Further examination of the visual attention of people with aphasia may help optimize visual scene selection.

Noun representation in AAC grid displays: visual attention patterns of people with traumatic brain injury.

Clinicians supporting the communication of people with traumatic brain injury (TBI) must determine an efficient message representation method for augmentative and alternative communication (AAC) systems. Due to the frequency with which visual deficits occur following brain injury, some adults with TBI may have difficulty locating items on AAC displays. The purpose of this study was to identify aspects of graphic supports that increase efficiency of target-specific visual searches. Nine adults with severe TBI and nine individuals without neurological conditions located targets on static grids displaying one of three message representation methods. Data collected through eye tracking technology revealed significantly more efficient target location for icon-only grids than for text-only or icon-plus-text grids for both participant groups; no significant differences emerged between participant groups.

Measurement of the visual attention patterns of people with aphasia: a preliminary investigation of two types of human engagement in photographic images.

The focus of this investigation was to examine the visual attention patterns of adults with aphasia on task-engaged contextualized images in which a human figure was engaged with the context of the image and camera-engaged contextualized images in which a human figure was looking forward toward the camera. Analysis revealed that adults with aphasia tend to fixate rapidly and frequently on human figures in contextualized images regardless of the type of engagement in the image. In addition, they responded to engagement cues when viewing task-engaged contextualized images by fixating more frequently and more rapidly on the object area of interest for these images than for camera-engaged contextualized images.