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.

Using the OSU TBI-ID method for screening rural, older adults: a mixed methods feasibility study.

Objective: To examine the feasibility of: (1) a brain injury and screening tool (Ohio State University Traumatic Brain Injury Identification Method; OSU TBI-ID) training for rural Area Agency on Aging (AAA) health professionals, and (2) implementation of the screening process.  Research Design: A mixed methods design was utilized to assess several aspects of feasibility. Quantitatively, the researchers examined AAA health professionals' scores on a brain injury misconceptions survey, descriptive statistics about the clients screened, and health professionals' accuracy using the OSU TBI-ID. Qualitative data was collected via focus group interviews with the health professionals.  Methods and Procedures: The researchers conducted brain injury education and screening tool training for AAA health professionals. Subsequently, the health professionals used the OSU TBI-ID to screen their older adult clients for brain injury.  Main Outcomes and Results: AAA health professionals learned the OSU TBI-ID quickly and used the protocol correctly. The screening results established that 15% of the clients screened positive for brain injury; of those with positive screens, 87% did not have a previous brain injury diagnosis.  Conclusions: The current study presents evidence of feasibility for (1) training AAA health professionals, and (2) implementation of the OSU TBI-ID to screen older adult clients.

The diverse vocational experiences of five individuals returning to work after severe brain injury: A qualitative inquiry.

OBJECTIVE: The researchers explored the return-to-work experiences of five adults with severe traumatic brain injuries (TBIs) and those associated with them by performing a qualitative, multiple case study investigation involving in-depth, semi-structured interviews. Selection of this qualitative methodology allowed for personal, individualized accounts of adults with TBI returning to work. Specifically, this methodology promoted accurate representation of the idiosyncratic nature of each participant's experiences. METHODS: The researchers asked individuals to participate based on the diversity of their vocational experiences following TBI. RESULTS: Four of the five participants had returned to their pre-injury jobs. Two were subsequently fired and, at the time of research participation, were unemployed. One participant never returned to paid employment; however, he had held two volunteer positions for several years post-injury. Salient content from interview transcripts allowed for the identification of five to eight themes pertinent to each case. CONCLUSIONS: Interpretation of the themes led to three main conjectures about return-to-work experiences following TBI: (a) job satisfaction may relate more to involvement in productive activities than monetary compensation; (b) adults with TBI can be successful in holding and maintaining positions with high cognitive demands; and

Using Visual Scene Displays as Communication Support Options for People with Chronic, Severe Aphasia: A Summary of AAC Research and Future Research Directions.

Research about the effectiveness of communicative supports and advances in photographic technology has prompted changes in the way speech-language pathologists design and implement interventions for people with aphasia. The purpose of this paper is to describe the use of photographic images as a basis for developing communication supports for people with chronic aphasia secondary to sudden-onset events due to cerebrovascular accidents (strokes). Topics include the evolution of AAC-based supports as they relate to people with aphasia, the development and key features of visual scene displays (VSDs), and future directions concerning the incorporation of photographs into communication supports for people with chronic and severe aphasia.

The impact of interface design during an initial high-technology AAC experience: a collective case study of people with aphasia.

The purpose of this collective case study was to describe the communication behaviors of five people with chronic aphasia when they retold personal narratives to an unfamiliar communication partner using four variants of a visual scene display (VSD) interface. The results revealed that spoken language comprised roughly 70% of expressive modality units; variable patterns of use for other modalities emerged. Although inconsistent across participants, several people with aphasia experienced no trouble sources during the retells using VSDs with personally relevant photographs and text boxes. Overall, participants perceived the personally relevant photographs and the text as helpful during the retells. These patterns may serve as a springboard for future experimental investigations regarding how interface design influences the communicative and linguistic performance of people with aphasia.

Brain-computer interface for augmentative and alternative communication access: The initial training needs and learning preferences of speech-language pathologists.

PURPOSE: To enable the codesign of a training framework for brain-computer interfaces for augmentative and alternative communications access (BCI-AAC), the aim of this study is to evaluate the initial BCI-AAC training needs and preferred learning strategies of speech-language pathologists (SLPs) with AAC experience. METHOD: Eleven SLPs employed across a broad range of settings completed a semi-structured interview. A grounded theory approach alongside peer debriefing and review, member checking, and triangulation procedures were utilised for thematic analysis to help ensure data reliability and credibility. RESULT: Regarding critical training needs, SLPs identified the subthemes of (a) personalisation of intervention, (b) technical aspects, (c) BCI-AAC system types and access, and (d) how to support stakeholders in BCI-AAC implementation. Regarding learning strategy preferences, participants discussed (a) expert guidance and demonstrations, (b) hands-on experience, alongside (c) media and presentations. CONCLUSION: Findings present a continuum of critical training needs ranging from more foundational information to more personalised assessment and intervention consideration. These thematic results present a first step in developing a basic framework for SLP training in BCI-AAC to utilise and build from as technology development continues, and provides an important initial starting point for the codesign of clinically focused BCI-AAC trainings.

Revisiting the Rainbow: Culturally Responsive Updates to a Standard Clinical Resource.

PURPOSE: Cultural responsivity is essential for efficacious and affirming clinical relationships. This may be especially important with historically marginalized clients, such as transgender and gender-diverse (TGD) people seeking behaviorally based affirming communication services. We recommend modifications to standard tools for diagnostics and training that otherwise might undermine our efforts to create an inclusive and affirming environment. METHOD: Modifications to the Rainbow Passage, a standardized paragraph utilized for eliciting speech samples in clinical settings, focused on nongendered terminology and the elimination of content with religious connotations. RESULTS: The recommended edits to the Rainbow Passage maintain similar length, cadence, and phonetic balance while considering cultural and health care context for TGD people and other clients. CONCLUSION: Simple linguistic changes to a standardized paragraph maintain clinical benefits and facilitate SLP efforts toward cultural responsivity, client engagement, and good clinical outcomes.

Communication styles of persons with ALS as recounted by surviving partners.

The purpose of this study was to describe the communication patterns of individuals with Amyotrophic Lateral Sclerosis (ALS) as reported from the surviving spouses' perspectives. Six surviving spouses of people with ALS participated in semi-structured interviews after the deaths of their partners. The interviews were transcribed and coded. Data analysis revealed four primary themes: communication styles, augmentative and alternative communication (AAC) use, decision-making, and lifestyle changes. Spouses described unique changes in communication styles as their partners began to use augmentative communication strategies and devices. AAC devices were described as essential for individuals with ALS with respect to decision making and maintaining social roles. Spouses stated the importance of adapting social activities in order to maintain involvement in the community as well as with family and friends.

AAC assessment and clinical-decision making: the impact of experience.

People with complex communication needs often require a comprehensive augmentative and alternative communication (AAC) assessment to maximize participation in daily interactions. Assessment of AAC is a complex process and limited practice guidelines exist. The purpose of this qualitative study was to explore how 25 speech-language pathologists with varying levels of experience approach the AAC assessment process. Participants were classified as either (a) General Practice Speech-Language Pathologists (GPSLPs), (b) AAC Clinical Specialists (AAC-CS), or (c) AAC Research/Policy Specialists (AAC-RS). In-depth, semi-structured interviews were conducted to explore the participants' approach to AAC assessment. The results revealed that GPSLPs approach AAC assessment differently than the AAC-CS and AAC-RS; however, the Specialists reported a similar approach that may help guide the development of practice guidelines for AAC assessment.

Personnel roles in the AAC assessment process.

Completing an augmentative and alternative communication (AAC) assessment is a complex process that involves many stakeholders and professionals. To help clarify professional roles and provide assessment guidelines, an AAC Assessment Personnel Framework was developed. This framework was adapted from the work of Beukelman, Ball, and Fager in 2008, which focused on general AAC needs (not just assessment) and concentrated specifically on adults. In contrast, the present model examines the assessment process for all individuals who require AAC. The following AAC assessment personnel are discussed: AAC finders, general practice SLPs, AAC clinical specialists, facilitators and communication partners, collaborating professionals, AAC research and policy specialists, manufacturers and vendors, funding agencies and personnel, and AAC/assistive technology agencies and personnel. Current barriers for successful assessment outcomes are discussed, and suggestions for addressing personnel-related barriers are explored.

COVID-19 and the Vulnerabilities of Community-Dwelling Other Adults: Findings From a Statewide Survey of Home-Delivered Meals Recipients.

COVID-19's impact on community-dwelling older adults, especially those in rural and underserved areas, as well as those who are homebound, is of interest to policy makers and clinicians, now and in the future. This study aims to examine the consequences of the COVID-19 pandemic on community-dwelling older adults with the greatest social and economic needs residing in a mostly rural state. Using a self-administered survey, we collected data from 1852 home-delivered meal recipients, age 60 years and older, served by Nebraska's eight Area Agencies on Aging. Results highlight three areas of importance: social connections, healthcare access and utilization, and technology. We found that while most older adults maintained social interaction, despite the restrictions imposed by the pandemic, feelings of loneliness persisted or even increased, with 35% of respondents feeling lonelier because of the pandemic. Our findings further reveal that 42% of older adults skipped or postponed healthcare visits during the pandemic, although the majority expressed interest in using telehealth. Finally, the rural-urban divide was evident in our data, with less than one-half of respondents (45%) having access to reliable internet. Suggestions on how to prepare the most vulnerable people for similar crises are included.

Assessment With Children Who Need Augmentative and Alternative Communication (AAC): Clinical Decisions of AAC Specialists.

Purpose: The purpose of this study was to explore how speech-language pathologists (SLPs) who are augmentative and alternative communication (AAC) specialists approach the assessment process for 2 case studies, 1 child with cerebral palsy and 1 with autism spectrum disorder. The aim of the study was to answer the following questions: (a) How do clinicians with expertise approach the AAC assessment process for children with developmental disabilities? (b) Can any initial hypothesis be drawn about how SLPs approach the assessment of children with motor versus social interactive deficits? Method: This study used a phenomenological qualitative design. The researchers conducted 2 in-depth, semistructured interviews with 8 SLPs who specialized in AAC and self-identified as primarily working with children. Results: Four major themes emerged from the data: area of assessment, method of assessment, evaluation preparation, and parent education. Each major theme contained multiple subthemes and categories within those subthemes. Conclusions: Participants discussed similar areas of assessment for both cases, indicating that some aspects of AAC assessment are universal. However, the specific aspects of what they were assessing and how they went about assessing them differed between the 2 cases. The results of the current study provide an outline of an assessment protocol for children with complex communication needs.

Impact of personal relevance and contextualization on word-picture matching by people with aphasia.

PURPOSE: To determine the effect of personal relevance and contextualization of images on the preferences and word-picture matching accuracy of people with severe aphasia. METHOD: Eight adults with aphasia performed 2 experimental tasks to reveal their preferences and accuracy during word-picture matching. The researchers used 3 types of visual stimuli-personally relevant, contextualized photographs; non-personally relevant, contextualized photographs; and noncontextualized, iconic images-paired with 3 types of target words-labels of people or objects, actions, and socially relevant events-as the stimulus materials. RESULTS: Data analysis showed that participants (a) preferred using personally relevant, contextualized photographs rather than other types of photographs/images to represent target words and (b) performed more accurate word-picture matching when presented with target words associated with personally relevant, contextualized photographs than target words associated with noncontextualized or nonpersonalized photographs/images. CONCLUSIONS: Clinically, the findings highlight the importance of using personally relevant, contextualized photographs rather than generic contextualized photographs or noncontextualized, iconic images to support the communication attempts of people with aphasia who cannot communicate effectively using natural speech alone.