Facilitating Communication in a Pediatric Surgery Center: Implementation of an Interactive Communication Board.

BACKGROUND: Increasing linguistic diversity has important implications for providers serving limited English proficiency (LEP) populations. LEP patients have decreased understanding, increased risk for adverse events, and lower healthcare satisfaction. Limited interpreting methods affect nurses' ability to provide efficient, culturally competent care. OBJECTIVE: An interactive communication board was implemented to evaluate the perceived effectiveness of LEP patient communication and increase nurse satisfaction with communication in a pediatric ambulatory surgery center. METHODS: A pre-post survey design evaluated the implementation of an interactive communication board. After a 3-month implementation period, post-surveys assessed nurse satisfaction, perception of time required to interpret nursing tasks, and feasibility of the tool. RESULTS: Nurses reported a 64% increase (2.27 ± 0.88 pre; 3.57 ± 0.76 post; p = 0.0007) in satisfaction with the interpretation process and a 43% increase (2.07 ± 0.70 pre; 3.50 ± 0.76 post; p = 0.0001) in their self-perceived ability to communicate with LEP populations post-intervention. CONCLUSION: Communication boards and similar tools can improve nurse satisfaction and streamline the interpretation process in peri-operative periods. IMPLICATIONS FOR NURSING: Similar tools could be implemented in other healthcare settings to increase communication efficiency between nurses and LEP populations. Further projects must be conducted to evaluate the experience and efficacy of this tool from the patient/caregiver perspective.

Integrating familiar listeners and speech recognition technologies into augmentative and alternative communication intervention for adults with down syndrome: Descriptive exploration.

Many individuals with Down syndrome exhibit speech impairments that necessitate augmentative and alternative communication (AAC) intervention. AAC intervention allows for access to communication through means other than, or supplemental to, speech. This descriptive study provided initial insight into the feasibility of incorporating familiar listeners (e.g., family members) and speech recognition technology into AAC intervention to increase communication success for individuals with Down syndrome. Six adults with Down syndrome participated. The participants' intelligibility to a familiar listener, unfamiliar listeners, and speech recognition technologies (i.e., Google Speech-to-Text and Windows Speech Recognition) was evaluated. Additionally, consistency in word pronunciation was evaluated to examine the feasibility of future training of speech recognition technologies. The participating adults with Down syndrome experienced limited intelligibility to all listeners and technologies but were most intelligible to familiar listeners. The adults also demonstrated consistencies across their production of words, and across one another's productions. The findings suggest the promise in using familiar listeners as a current resource and speech recognition technology as a future resource in AAC intervention for adults with Down syndrome. However, intervention research and technological development are needed to thoroughly explore these approaches.

Instrumento de avaliação de linguagem na perspectiva da CSA: aplicação em crianças com TEA / Language assessment instrument from the perspective of AAC: application among children with ASD / Instrumento de Evaluación de Lenguaje en la perspectiva de la CSA: aplicación en niñas y niños con TEA

Há um aumento considerável do número de crianças diagnosticadas com Transtorno do Espectro do Autismo e tendo essa população grandes chances de apresentar necessidades complexas de comunicação, a intervenção fonoaudiológica com a Comunicação Suplementar e Alternativa deve ser considerada. Objetivo: Esta pesquisa se propõe a analisar a aplicação de um instrumento de avaliação de linguagem na perspectiva da comunicação suplementar e alternativa em crianças com transtornos do espectro do autismo. Método: Aplicação do instrumento CSA_Linguagem em crianças com diagnóstico de Transtorno do Espectro do Autismo, em situações de interação com a utilização de símbolos gráficos da Comunicação Suplementar e Alternativa. Resultados: Foi possível observar a forma de comunicação eleita pela criança e a possibilidade de efeitos positivos na comunicação com o uso da Comunicação Suplementar e Alternativa. Conclusão: O instrumento se mostrou operacional, de fácil aplicação e baixo custo; e possibilitou o delineamento do perfil dos sujeitos avaliados quanto à utilização de símbolos gráficos para efeitos de comunicação.

There has been a considerable increase in the number of children diagnosed with Autism Spectrum Disorder and, since this group of people has a high chance of showing complex communication needs, the speech-language pathology intervention with Augmentative and Alternative Communication is essential. Objective: This research aims to analyze the use of a language assessment instrument through the perspective of Augmentative and Alternative Communication among children with autism spectrum disorders. Method: Application of the CSA_Linguagem instrument among children diagnosed with Autism Spectrum Disorder in situations of interaction using Augmentative and Alternative Communication graphic symbols. Results: the instrument allowed the researcher to observe the way each child communicates and showed how Augmentative and Alternative Communication may have positive effects on communication. Conclusion: The CSA_Linguagem instrument is easy to apply and has a low operating cost. Additionally, it allowed the researcher to determine the subjects' profile regarding the use of graphic symbols as communicative effects.

Introducción: Hay un aumento considerable en el número de niñas y niños con diagnósticos de Trastorno del Espectro del Autismo y teniendo esta populación grandes posibilidades de presentar necesidades complejas de comunicación, la intervención fonoaudiológica en la Comunicación Suplementar y Alternativa debe ser considerada importante. O bjetivo: Esta investigación se propone a analizar la aplicación de un instrumento de evaluación de lenguaje en la perspectiva de la comunicación suplementar y alternativa en las niñas y niños con trastornos del espectro del autismo. Método: Aplicación del instrumento CSA Lenguaje en las niñas y niños con diagnósticos de Trastorno del Espectro del Autismo, en situaciones de interacción con la utilización de símbolos gráficos de la Comunicación Suplementar y Alternativa y análisis por medio de grabaciones de vídeo. Resultados: Ha sido observada la forma de comunicación elegida por la niña, o por el niño, y la posibilidad de efectos positivos en la comunicación con el uso de la Comunicación Suplementar y Alternativa. Conclusión: El instrumento se ha mostrado operacional, de fácil aplicación y bajo costo; y ha posibilitado el delineamento del perfil de los sujetos evaluados en relación con la utilización de símbolos gráficos para efectos de comunicación.

Mental health matters: a pilot study exploring the experiences and perspectives of individuals with complex communication needs.

Mental health and wellbeing are foundational in human interaction and life satisfaction. Persons with complex communication needs are at risk of reduced mental health and wellbeing. The aim of this project was to identify the facilitators and barriers that individuals with complex communication needs experience when attending to their mental health and wellbeing. A qualitative study design using a phenomenological approach was utilized. Data was collected through in-depth interviews with three participants with complex communication needs, observation, and reflexive journaling. An inductive process of cross-case thematic analysis identified common barriers and facilitators experienced by the participants when addressing mental health and wellbeing. The opportunity barriers described in Beukelman and Mirenda's  Participation Model were applied to classify the assistive and obstructive roles of communication partners. Barriers and facilitators to obtaining assistance for mental health and wellbeing related predominantly to communication partners' skills, attitudes, and support practices. The findings highlight a need to equip individuals with complex communication needs, carers, support workers, and mental health professionals with the knowledge, skills, and attitudes to promote mental health and wellbeing among this population.

School-Based Speech-Language Pathologists: Confidence in Augmentative and Alternative Communication Assessment.

Purpose The purpose of this study was to examine confidence levels and identify predictors of increased confidence of school-based speech-language pathologists (SLPs) relative to different aspects of the augmentative and alternative communication (AAC) assessment process. Method Surveys were completed by 272 school-based SLPs. Questions were designed to capture demographic information and confidence in areas of assessment such as student capabilities, participation, and feature matching. Results There were variable levels of confidence across aspects of assessment. Respondents were less confident in tasks related to assessing students with severe physical impairments and incorporating aspects related to cultural and linguistic diversity in their assessment. SLPs were more confident assessing student participation and unaided communication. Additionally, respondents had less confidence in matching the features of high-tech speech-generating devices to their students. Self-identification as an AAC specialist, years of experience, percentage of caseload of students with complex communication needs, and length of longest continuing education experiences all contributed to predicting confidence in most areas of assessment. However, years of experience did not contribute to predicting confidence in feature matching. Conclusions Results from this study acknowledge that SLPs are likely to have varied degrees of confidence in aspects of assessment related to preparation, clinical experience, and self-identification of specialty. Findings from this study support increasing training opportunities in AAC assessment. As specialization was the strongest predictor of confidence, further research should investigate the characteristics and preparation of self-identified AAC specialists. This is an important first step in pinpointing ways to increase confidence in school-based SLPs.

Dynamic assessment of augmentative and alternative communication application grid formats and communicative targets for children with autism spectrum disorder.

Six children with autism spectrum disorder (ASD) participated in dynamic assessment to determine whether the complexity of grid-based augmentative and alternative communication (AAC) application displays impacted the level of instructional supports needed for responding across different communicative functions/parts of speech. Dynamic assessment was integrated into a single-case multi-element design. The researchers examined the effects of three different display formats that varied in (a) array size, and (b) the number of steps needed to make a response, on the average levels of support needed to make item requests and action/social word responses. Three participants demonstrated high levels of independence when requesting items with displays that utilized small arrays and did not require navigation. These participants also showed rapid increases in their ability to make item requests with displays that required two-step navigation, and began to use action and social words across displays with decreasing levels of support. In comparison, the three remaining participants did not demonstrate consistent independence with any display or communicative function, but did show differences in levels of supports (e.g., overall less support needed for less complex displays and for item requests in comparison to action and social words). Implications for individualized AAC assessment and display selection for children with ASD are discussed.

A comprehensive assessment of Brain Computer Interfaces: Recent trends and challenges.

BACKGROUND: An uninterrupted channel of communication and control between the human brain and electronic processing units has led to an increased use of Brain Computer Interfaces (BCIs). This article attempts to present an all-encompassing review on BCI and the scientific advancements associated with it. The ultimate goal of this review is to provide a general overview of the BCI technology and to shed light on different aspects of BCIs. This review also underscores the applications, practical challenges and opportunities associated with BCI technology, which can be used to accelerate future developments in this field. METHODS: This review is based on a systematic literature search for tracking down the relevant research annals and proceedings. Using a methodical search strategy, the search was carried out across major technical databases. The retrieved records were screened for their relevance and a total of 369 research chronicles were engulfed in this review based on the inclusion criteria. RESULTS: This review describes the present scenario and recent advancements in BCI technology. It also identifies several application areas of BCI technology. This comprehensive review provides evidence that, while we are getting ever closer, significant challenges still exist for the development of BCIs that can seamlessly integrate with the user's biological system. CONCLUSION: The findings of this review confirm the importance of BCI technology in various applications. It is concluded that BCI technology, still in its sprouting phase, requires significant explorations for further development.

Validity of a nonspeech dynamic assessment of the alphabetic principle in preschool and school-aged children.

Learning to read and spell is an important but difficult achievement for children who have complex communication needs. Given that assessment is a vital part of any intervention program, one major barrier is the lack of reliable and valid assessments for this population. This study evaluated the reliability and validity of Dynamic Assessment of the Alphabetic Principle (DAAP), which does not require spoken responses. For this study, 27 preschool and school-aged children with typical development completed the DAAP and other standard measures of phonemic awareness and early literacy. Results indicated the DAAP had high internal consistency and strong correlations among its subtests, indicating high reliability. Moreover, performance on the DAAP had high correlations with standard measures of phonemic awareness and early literacy, providing evidence of its validity. Consequently, the DAAP represents one approach to fill the important need for assessments of early literacy that do not require speech responses.

Toward greater involvement of youth with complex communication needs in the selection of augmentative and alternative communication devices.

Purpose: The study aim was to examine the measurement properties of the Youth Evaluation of Products Scale for Augmentative and Alternative Communication (YEP-AAC) as a means to understand the product attitudes of youth toward their AAC devices.Methods: In study 1, four males and two females between the ages of 8 and 17 years (median age = 14 years) participated in face-to-face interviews. A researcher administered the YEP-AAC and then asked youths to explain the rationale for their item ratings. Two researchers analyzed masked transcripts of the interviews to predict the valence of item ratings assigned by youths. In study 2, 18 families participated in a mailed survey to examine the reliability and validity of the scale domains. Seventeen mothers/one father and their children (9 male/9 female) between the ages of 10 and 20 years participated (median age = 16 years).Results: The level of chance-corrected agreement between valences converted from youth ratings on the YEP-AAC and those assigned by researchers was fair (weighted kappa = 0.38). Internal consistencies of the scale domains were acceptable. Youths who rated their AAC devices more favourably had higher functional communication as hypothesized.Conclusion: The two studies provide support for the face validity, internal consistency and convergent validity of the YEP-AAC as a measure of the product attitudes of youth with complex communication needs.Implications for rehabilitationDeveloping reliable ways to understand the product needs, preferences and values of youth with complex communication needs will help to support the selection, acquisition and use of augmentative and alternative communication (AAC) devices.Consumer socialization helps to explain how youth may acquire the skills, knowledge and experience relevant to their role as AAC consumers.Reliable youth-report questionnaires that are grounded in consumer socialization provide an expedient way to understand the product attitudes of young consumers with complex communication needs.

Regulating hearing aid compatibility of cell phones: results from a national survey.

Accessibility of telecommunication technologies by people who are deaf or hard of hearing has been a critical issue since the invention of the telephone. As both telephone and hearing-aid technologies have evolved, finding compatible solutions has been an ongoing challenge. This paper uses the findings of a longitudinal study to examine the impact of Federal hearing-aid compatibility (HAC) regulations in resolving this problem. The study ran concurrently with the phase-in of Federal Communications Commission regulations requiring that mobile handset manufacturers and wireless service providers make available minimum numbers of cell phones with shielding to reduce electromagnetic interference when cell phones are positioned close to a hearing aid user's ear. These regulations also require package labeling and printed information to assist buyers in selecting a hearing-aid compatible phone. The survey presented here focused on changes in satisfaction with sound quality and ease of finding a hearing-aid compatible mobile handset. Data analysis suggests that the regulations have had limited success, and problems persist for consumers in locating a hearing aid compatible phone. The FCC has requested input on more stringent hearing-aid compatibility requirements; study findings suggest that these changes are not likely to remedy the problem.

Construção e avaliação de um protótipo de software aplicativo de telefonia móvel para acessibilidade nas solicitações de socorro pré-hospitalar / Construction and evaluation of a mobile phone application software prototype for accessibility in pre-hospital assistance requests

Pessoas que moram sozinhas, idosos, surdos ou cegos precisam de meios adequados para se comunicarem com serviços pré-hospitalares de urgência em situações de risco. Nesse contexto este estudo propõe-se a construir e avaliar um protótipo de média fidelidade de software aplicativo de telefonia móvel para promover acessibilidade comunicativa para a convocação de socorro pré-hospitalar por pessoas surdas, cegas, idosos e ou que estejam sozinhas. Trata-se de estudo metodológico realizado no período de maio a setembro de 2020, em três etapas: 1) Revisão sistemática da literatura utilizando-se as bases de dados PubMed, Web of Science, CINAHL, ISTA, LISA e SCOPUS para localizar estudos primários e sintetizar evidências sobre métodos de desenvolvimento de protótipos de aplicativos de saúde para telefonia móvel, que garantem melhor acessibilidade aos usuários; 2) Definição de requisitos funcionais, construção e disponibilização de protótipo de aplicativo para telefonia móvel para solicitação de atendimento pré-hospitalar e 3) Avaliação do protótipo de aplicativo por peritos por meio de checklist para avaliação heurística de aplicativos para celulares touchscreen, e pela população alvo utilizando a System Usability Scale. A análise e síntese de quatro artigos apontaram para o Design Centrado no Usuário, que foi utilizado na segunda etapa para disponibilizar o protótipo do aplicativo denominado "e-SU". Na terceira etapa participaram cinco peritos, empresários com experiência de desenvolvimento de aplicativos para telefonia móvel, com média de idade de 36,2 anos, que avaliaram o e-SU como de alta usabilidade (média de 58,75 pontos) e; 21 sujeitos da população alvo (cegos, surdos, idosos e pessoas com baixa visão, baixa audição; que vivem só; idoso, cego e surdo que mora sozinho) sendo 71,4% do sexo feminino, com idade média de 44,2 anos, e que indicaram um excelente índice de satisfação do usuário (média de 89,5 pontos).

Persons who live alone, elderly, deaf or blind persons need adequate ways to communicate with emergency pre-hospital services in situations of risk. In this context, this study proposes to build and evaluate a medium fidelity prototype of mobile phone application software to promote communicative accessibility for the call to pre-hospital assistance by deaf, blind, elderly and or those who are alone. This is a methodological study carried out from May to September 2020, in three stages: 1) Systematic literature review using the PubMed, Web of Science, CINAHL, ISTA, LISA and SCOPUS databases to locate primary studies and synthesize evidence on methods of developing prototypes of health applications for mobile telephony, which ensure better accessibility for users; 2) Definition of functional requirements, construction and provision of an application prototype for mobile telephony to request pre-hospital care and 3) Evaluation of the application prototype by experts through a checklist for heuristic evaluation of applications for touchscreen phones, and by the population target using the System Usability Scale. The analysis and synthesis of four articles pointed to User-Centered Design, which was used in the second stage to provide the prototype of the application called "e-SU". In the third stage, five experts participated, entrepreneurs with experience in developing mobile phone applications, with an average age of 36.2 years, who evaluated e-SU as highly usable (average of 58.75 points) and; 21 subjects of the target population (blind, deaf, elderly and people with low vision, low hearing; who live alone; elderly, blind and deaf who live alone) with 71.4% being female, with an average age of 44.2 years , and which indicated an excellent user satisfaction index (average of 89.5 points).

Complex intervention in augmentative and alternative communication (AAC) care in Germany: a study protocol of an evaluation study with a controlled mixed-methods design.

INTRODUCTION: The current practice of service delivery in Germany for people with complex communication needs (CCN) who are in need of augmentative and alternative communication (AAC) is characterised by diverse problems, including a lack of clarity in the responsibilities of the service providers involved. To address these issues a new service delivery model has been put in place, implemented in three AAC counselling centres for patients with a particular health insurance across Germany. The implementation of a new service delivery model aims to improve individualised service delivery. The model goes beyond standard care by adding case management, counselling, AAC training and, if needed, AAC therapy. This study aims to evaluate the effectiveness of this complex intervention. METHODS AND ANALYSIS: In consideration of the complexity of the new service delivery model, formative and summative evaluation will be conducted. The formative evaluation will provide data based on qualitative and quantitative assessments of the competences and perspectives of all involved stakeholders, including a proxy measurement of persons with CCN. The summative evaluation will include a controlled study design as the new service delivery model will be compared against the service delivery in an existing contract and against data gathered from caregivers of AAC users provided with standard care. With the exception of the individual interviews the data will be collected from proxies-that is, informal and formal caregivers. ETHICS AND DISSEMINATION: Data collection, storage and evaluation meet the currently valid data protection regulations. Consultation by the responsible data protection officer of the Oldenburg Medical School and a positive vote from its Ethics Committee were obtained prior to the start of the study. Dissemination strategies include the presentation of the obtained data and results in the form of publications and at conferences. TRIAL REGISTRATION NUMBER: DRKS00013628.

Designing Developmentally Sensitive AAC Technologies for Young Children with Complex Communication Needs: Considerations of Communication, Working Memory, Attention, Motor Skills, and Sensory-Perception.

Young children who require augmentative and alternative communication (AAC) must be provided with AAC technologies that are designed to meet their needs and accommodate their skills. One critical aspect of matching the system design features of aided AAC technologies to the needs and abilities of the child with complex communication needs is a consideration of the child's developmental skills. This article provides an overview of specific, early developmental milestones in communication, cognition (i.e., attention and working memory), motor skills, and sensory-perception (including visual attention) that influence decisions regarding AAC system design for young children. Developmental considerations are also reviewed for young children with Down's syndrome, a group that often benefits from early provision of AAC. Based on developmental theory and milestones, specific recommendations are provided for the design of developmentally sensitive AAC technologies for young children who are beginning communicators.

Speech and language therapy best practice for patients in prolonged disorders of consciousness: a modified Delphi study.

BACKGROUND: Research regarding speech and language therapy (SLT) for patients in prolonged disorders of consciousness (PDOC) is very limited. The Royal College of Physicians' (RCP) PDOC guideline provides recommendations regarding best practice, but does not give detail about many aspects of assessment and management. As a result, SLTs have little information regarding best practice for this complex patient group. AIMS: To ascertain the degree of consensus amongst expert SLTs regarding SLT best practice for patients in PDOC in order to inform the future development of SLT guidelines. METHODS & PROCEDURES: A two-round modified Delphi technique was used. Participants were recruited from major trauma centres and neurorehabilitation units in England and national SLT clinical excellence networks. To participate, SLTs had to be working on neurosciences, neurosurgery or neurorehabilitation wards that treat adult PDOC patients, or have ≥ 3 years' experience of working with PDOC. The Round 1 questionnaire was developed from the RCP's PDOC guideline and from existing research literature. It included ratings of statements regarding SLT best practice using Likert or temporal scales, with optional written justifications/comments and opportunities for participants to suggest additional statements. The percentage agreement amongst participants was calculated for each Round 1 statement. Written justifications for views were analysed using content analysis. The Round 2 questionnaire contained both quantitative and qualitative feedback from Round 1, allowing participants to reappraise their views. The final degree of consensus was then calculated after completion of both rounds. OUTCOMES & RESULTS: A total of 40 SLTs completed Round 1, with 36 completing Round 2 (90% response rate). Consensus was achieved for 87% (67/77) of statements regarding best practice on a variety of topics including communication, tracheostomy, dysphagia and oral hypersensitivity. The statements represented assessment, management and service delivery components of SLT practice. CONCLUSIONS & IMPLICATIONS: A total of 67 best practice statements were created. The statements provide a useful starting point for the creation of SLT guidelines to support best practice, and also have the potential to be used to advocate for the provision of SLT services for patients in PDOC. Future studies should focus on whether the expert opinion generated here can be borne out in experimental research.

Implementing Aided Augmentative Communication Systems With Persons Having Complex Communicative Needs.

Augmentative and alternative communication (AAC) systems can support communication skills for people with significant developmental disabilities who experience complex communication needs (CCNs). There is a need to tailor best practices in AAC assessment and intervention to create individualized communication systems with this population. In this article, we outline the important components of AAC systems that can be implemented in authentic settings. However, given the limited evidence on AAC interventions specific to people with CCNs, we also identify some priority areas for future inquiry. Among these involve strategies to enhance decision making regarding (a) matching communication mode(s) to learner skills and contextual demands, (b) identifying communicative opportunities and obligations, (c) individualizing aided communication display features, (d) selection of vocabulary specificity, and (e) considering dosage parameters needed to acquire and maintain a communicative repertoire. In addition, we briefly discuss the use of telehealth to enhance intervention capability.

Innovations for Supporting Communication: Opportunities and Challenges for People with Complex Communication Needs.

Individuals with complex communication needs have benefited greatly from technological innovations over the past two decades, as well as from social movements that have shifted focus from disability to functioning and participation in society. Three strands of technological innovation are reviewed in this paper: (1) innovations in the tools that have become available, specifically tablet technologies; (2) innovations in access methods (eye gaze technologies and brain-computer interfaces); and (3) innovations in output, specifically speech technologies. The opportunities these innovations offer are explored, as are some of the challenges that they imply, not only for individuals with complex communication needs, but also for families, professionals, and researchers.

What's important in AAC decision making for children? Evidence from a best-worst scaling survey.

The choice of which AAC device to provide for a child can have long lasting consequences, but little is known about the decision-making of AAC professionals who make recommendations in this context. A survey was conducted with AAC professionals using best-worst scaling methodology examining what characteristics of children and attributes of AAC devices are considered most important in decision-making. A total of 19 child characteristics and 18 device attributes were selected by the authors from lists generated from literature reviews and from focus groups with AAC professionals, people who use AAC, and other stakeholders. The characteristics and attributes were used to develop two best-worst scaling surveys that were administered to 93 AAC professionals based in the UK. The relative importance of characteristics/attributes was estimated using statistical modelling. Child characteristics related to language and communication, cognitive and learning abilities, and personality traits were generally found to be more important than physical features. Communication, language, and interface-related AAC device attributes were generally more important than hardware and physical attributes. Respondent demographics (e.g., experience, professional background) did not seem to influence the importance assigned to device characteristics or attributes. Findings may inform both future quantitative research into decision-making and efforts to improve decision-making in practice.

New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions.

This paper discusses recent research and development with a specific focus on selected new and emerging research-based augmentative and alternative communication (AAC) technologies that are developmentally appropriate and responsive to the individual interests, needs, and skills of children with developmental disabilities, their families, peers, and other communication partners. Specifically, this paper reviews the state of the science and future directions related to recent research and development of AAC technologies as supports to (a) enhance language learning, (b) facilitate social interaction, (c) improve literacy skills, (d) increase participation in society, and (e) teach interaction strategies to communication partners.

Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs.

The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments-education, employment, family, healthcare, and community living. Despite these advances, there remain critical challenges that must be addressed. This paper discusses key advances in the AAC field, delineates challenges, and discusses future directions to address these challenges, specifically as they relate to research and development to enhance AAC interventions and technologies for individuals with complex communication needs and their families.

New and emerging access technologies for adults with complex communication needs and severe motor impairments: State of the science.

Individuals with complex communication needs often use alternative access technologies to control their augmentative and alternative communication (AAC) devices, their computers, and mobile technologies. While a range of access devices is available, many challenges continue to exist, particularly for those with severe motor-control limitations. For some, access options may not be readily available or access itself may be inaccurate and frustrating. For others, access may be available but only under optimal conditions and support. There is an urgent need to develop new options for individuals with severe motor impairments and to leverage existing technology to improve efficiency, increase accuracy, and decrease fatigue of access. This paper describes person-centred research and development activities related to new and emerging access technologies, with a particular focus on adults with acquired neurological conditions.