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.

Community service providers' roles in supporting communication disability rehabilitation in Majority World contexts: An example from Ghana.

Purpose: In Majority World countries, where speech-language pathology services are extremely limited, people with communication disabilities (PWCD) may seek help from a range of service providers. This qualitative research aimed to explore the nature of community services offered to people with communication disabilities who seek help in Accra, Ghana.Method: Semi-structured interviews were conducted with nine individuals from three professions: pastors (3), doctors (3), and herbalists (3) exploring services that they may offer to PWCD seeking help. Interviews were analysed using Thematic Network Analysis.Result: Six global themes described beliefs about communication disability, types of intervention, explanations provided to people with communication disabilities, promoting communication, processes for selecting treatments, and links between service providers. Interventions encompassed physical, spiritual, psychosocial and environmental approaches, with the notion of plural beliefs interwoven through a number of themes.Conclusion: In Ghana, and other Majority World contexts, service providers in sectors not commonly associated with communication disability rehabilitation may have important roles to play in supporting people with communication disabilities. Understanding the contributions of other service providers may assist the growing profession of speech-language pathology to collaborate across sectors, to develop specific, culturally responsive approaches to service development.

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.

"Augmentative and Alternative Communication (AAC) Will Give You a Voice": Key Practices in AAC Assessment and Intervention as Described by Persons with Amyotrophic Lateral Sclerosis.

The purpose of this study was to describe the perceptions of persons with amyotrophic lateral sclerosis (pALS) who use augmentative and alternative communication (AAC) with the AAC assessment and intervention process. Twenty-one pALS with complex communication needs participated in a multipart survey (and follow-up e-mails) to provide information on their experiences with AAC assessment and intervention. A majority of the participants agreed with the importance of three key AAC intervention principles: appropriate staging of the timing of assessment and intervention activities, inclusion of communication partners, and the use of multiple modalities and strategies as communication supports. Most participants reported that their assessment and intervention experiences included at least some aspect of these three key practices. The results of this study suggest that the identified best practices in AAC should be reviewed and implemented on an individualized basis for pALS with complex communication needs.

Guidelines for Feature Matching Assessment of Brain-Computer Interfaces for Augmentative and Alternative Communication.

Purpose: Brain-computer interfaces (BCIs) can provide access to augmentative and alternative communication (AAC) devices using neurological activity alone without voluntary movements. As with traditional AAC access methods, BCI performance may be influenced by the cognitive-sensory-motor and motor imagery profiles of those who use these devices. Therefore, we propose a person-centered, feature matching framework consistent with clinical AAC best practices to ensure selection of the most appropriate BCI technology to meet individuals' communication needs. Method: The proposed feature matching procedure is based on the current state of the art in BCI technology and published reports on cognitive, sensory, motor, and motor imagery factors important for successful operation of BCI devices. Results: Considerations for successful selection of BCI for accessing AAC are summarized based on interpretation from a multidisciplinary team with experience in AAC, BCI, neuromotor disorders, and cognitive assessment. The set of features that support each BCI option are discussed in a hypothetical case format to model possible transition of BCI research from the laboratory into clinical AAC applications. Conclusions: This procedure is an initial step toward consideration of feature matching assessment for the full range of BCI devices. Future investigations are needed to fully examine how person-centered factors influence BCI performance across devices.

Assessment of aided language comprehension and use in children and adolescents with severe speech and motor impairments.

There is limited knowledge about aided language comprehension and use in children who use aided communication and who are considered to have a relatively good comprehension of spoken language. This study's purpose was to assess their aided language skills. The participants were 96 children and adolescents who used communication aids (aided group) and 73 children and adolescents with natural speech (reference group), aged 5 to 15 years. All of the participants who used aided communication were regarded by their teachers or professionals as having age-appropriate language comprehension. All of the participants completed (a) standardized tests of visual perception, non-verbal reasoning, and comprehension of spoken language, and (b) tasks designed for this study that measured comprehension and production of graphic utterances through communicative problem solving. Using their own communication systems, the participants achieved an average of 72% correct on the graphic symbol comprehension task items, and 63% on the expressive tasks. The participants with natural speech achieved an average of 88% correct on comprehension items, and 93-96% accuracy on production items. The differences between groups were significant on all the tasks and standardized tests. There was considerable variation within the group of participants who used aided communication, and the results reveal a need to develop instruments with norms for aided language competence that can inform the implementation of interventions to support aided language development.

Addressing the Communication and Other Needs of Persons With Severe Disabilities Through Engaged Interprofessional Teams: Introduction to a Clinical Forum.

PURPOSE: Interprofessional collaborative practice (IPCP) is introduced as a viable and preferred clinical methodology for speech-language pathologists and others serving persons with severe disabilities. Contributions to this clinical forum dedicated to IPCP and severe disabilities are described. METHOD: This clinical focus article introduces IPCP and reviews literature specific to its origins and effectiveness, defines severe disabilities, and proposes IPCP as a vital tenet in effective communication-related and other service delivery for this population. CONCLUSION: IPCP is supported as a recommended practice methodology for speech-language pathologists and other team members providing services to persons with severe disabilities.

The Trifocus Framework and Interprofessional Collaborative Practice in Severe Disabilities.

PURPOSE: Individuals with severe disabilities are a diverse group of learners with complex communication needs. This article presents a synthesis of the literature addressing the five strategies of the trifocus framework, with its triadic structure of learner with disability, communication partner, and environment. The application of interprofessional collaborative practice (IPCP) to the implementation of trifocus framework communication strategies is emphasized. METHOD: A literature search was conducted using Google Scholar and EBSCO to identify literature and research studies on IPCP and communication intervention for learners with severe disabilities, published 1994-2015, and then organized within the trifocus framework. The trifocus strategies are enhancing sensitivity, utilizing routines, increasing communication opportunities, modifying the communication environment, and augmenting input. Studies that included at least one participant with severe disabilities and their communication partners were considered. A secondary search was then conducted by reviewing the articles referenced in the original articles. CONCLUSION: Effective IPCP in communication intervention considers the learner's characteristics, the knowledge and skills required of communication partners, and effective environmental arrangements to support communication. Future research should include clear participant descriptions, documentation of fidelity measures, and evidence of generalization to support professionals to know when findings are relevant to the individuals they serve.

Cotreatment as a Vehicle for Interprofessional Collaborative Practice: Physical Therapists and Speech-Language Pathologists Collaborating in the Care of Children With Severe Disabilities.

PURPOSE: This article defines interprofessional collaborative practice and links its key features with accepted practice conceptualizations of physical therapy. Cotreatment with speech-language pathology is described as a vehicle for interprofessional collaborative practice for children with severe disabilities. METHOD: The article reviews the International Classification of Functioning, Disability, and Health (WHO, 2015) and the Hypothesis-Oriented Algorithm for Clinicians II (Rothstein, Echternach, & Riddle, 2003) as existing service-delivery frameworks in physical therapy and discusses how interprofessional collaborative practice between speech-language pathologists and physical therapists can be useful within these practice guidelines. RESULTS: A case illustration featuring interprofessional collaborative practice during cotreatment for a child with severe disabilities through physical therapy and speech-language pathology showed more seamless care and better progress in the pursuit of three main goals: physical movement, communication of needs, and participation in classroom activities. CONCLUSIONS: Interprofessional collaborative practice is supported as a recommended practice methodology for physical therapists and speech-language pathologists serving persons with severe disabilities.

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.

Practices and views of audiologists regarding aural rehabilitation services for adults with acquired hearing loss.

BACKGROUND: Hearing loss in adults is one of the leading disabilities globally. It is managed through aural rehabilitation for which there is a paucity of literature in South Africa. This raises the question of interest, the integrity of holistic service provision amongst audiologists and whether interest and challenges affect current practices. OBJECTIVES: To describe audiologists' practices and views on aural rehabilitation services for adults, including interest and challenges experienced. METHOD: A descriptive online survey was completed by 45 of 1440 invited practicing audiologists who were members of the two national professional associations in South Africa. Each association emailed the questionnaire link to all its members. Data were analysed using the Statistical Package for the Social Sciences version 21, and included the paired samples t-test and chi-squared tests. RESULTS: The most provided services were hearing aids (81.4%), communication strategies training (69.8%) and informational counselling (79.8%). A strong interest was reported by most for each service. Challenges included limited client compliance, unaffordability of services, limited undergraduate training, language barriers, unrealistic expectations and individual differences. Statistically significant differences between service provision, interest and challenges indicated that these are influential but not individually significant to service provision. CONCLUSION: Imbalanced service provision, high interest and many more challenges are experienced. These factors contribute but are not solely markedly influential in service provision.

EXTENDING THE ASSESSMENT OF TECHNOLOGY-AIDED PROGRAMS TO SUPPORT LEISURE AND COMMUNICATION IN PEOPLE WITH ACQUIRED BRAIN INJURY AND EXTENSIVE MULTIPLE DISABILITIES.

Intervention programs for people with acquired brain injury and extensive motor and communication impairment need to be diversified according to their characteristics and environment. These two studies assessed two technology-aided programs for supporting leisure (i.e., access to songs and videos) and communication (i.e., expressing needs and feelings and making requests) in six of those people. The three people participating in Study 1 did not possess speech but were able to understand spoken and written sentences. Their program presented leisure and communication options through written phrases appearing on the computer screen. The three people participating in Study 2 did not possess any speech and were unable to understand spoken or written language. Their program presented leisure and communication options through pictorial images. All participants relied on a simple microswitch response to enter the options and activate songs, videos, and communication messages. The data showed that the participants of both studies learned to use the program available to them and to engage in leisure and communication independently. The importance of using programs adapted to the participants and their environment was discussed.

iPads, mobile technologies, and communication applications: a survey of family wants, needs, and preferences.

Families of children with communication disabilities were surveyed to explore wants and preferences relative to mobile media technology, including iPads, as a form of augmentative and alternative communication (AAC). The families surveyed reported wanting information and support from professionals, including speech language pathologists (SLPs), who are knowledgeable about AAC. These families wanted devices to meet their children's individual needs and reported that ease of use and affordability were the most influential characteristics in the purchase of mobile media devices and communication applications. SLPs who understand family decision making can utilize collaborative clinical decision making that respects families' wants and needs, while also focusing on device feature matching and family education.

Eye tracking research to answer questions about augmentative and alternative communication assessment and intervention.

Recently, eye tracking technologies (i.e., technologies that automatically track the point of an individual's gaze while that person views or interacts with a visual image) have become available for research purposes. Based on the sampling of the orientation of the individual's eyes, researchers can quantify which locations within the visual image were fixated (viewed), for how long, and how many times. These automated eye tracking research technologies open up a wealth of avenues for investigating how individuals with developmental or acquired communication disabilities may respond to aided augmentative and alternative communication (AAC) systems. In this paper, we introduce basic terminology and explore some of the special challenges of conducting eye tracking research with populations with disabilities who might use AAC, including challenges of inferring attention from the presence of fixation and challenges related to calibration that may result from participant characteristics, behavioral idiosyncracies, and/or the number of calibration points. We also examine how the technology can be applied to ask well-structured experimental questions that have direct clinical relevance, with a focus on the unique contributions that eye tracking research can provide by (a) allowing evaluation of skills in individuals who are difficult to assess via traditional methods, and (b) facilitating access to information on underlying visual cognitive processes that is not accessible via traditional behavioral measures.

Supporting communication for children with cerebral palsy in hospital: views of community and hospital staff.

OBJECTIVE: We aimed to investigate the views of allied health and nursing staff on supporting the communication of children with cerebral palsy (CP) and complex communication needs (CCN) in hospital. METHOD: We conducted 12 focus groups with 49 community- and hospital-based allied health professionals and hospital nurses. RESULTS: Participants reported having active roles in supporting children's seating, mobility, equipment, mealtime management and psychosocial needs, but not in supporting the children's communication in hospital. Participants described several environmental barriers to supporting children's augmentative and alternative communication (AAC) in hospital, and suggested a range of strategies to ease communication difficulties at the bedside. CONCLUSION: Results indicate a potential new role for community- and hospital-based health professionals in supporting nurses to implement AAC strategies at the bedside. Supporting nursing staff to remove environmental barriers and use communication technologies might create a more communicatively accessible hospital ward for children with CP and CCN.

Struggling to be seen and heard: the underserved and unserved populations.

OBJECTIVE: The purpose of this paper is to provide some current information on the topic of the underserved and unserved populations including modern-day slaves, stateless/displaced persons, refugees/migrants and indigenous populations. METHOD: Speech-language pathology education and services for the underserved as well as unserved populations are discussed. Three case studies which demonstrate knowledge transfer and exchange as potential models for future development are presented. CONCLUSION: These case studies lead to more inquiries, studies, innovations and involvement from individuals and groups who are concerned about the underserved and unserved populations.

Living with locked-in syndrome: an explorative study on health care situation, communication and quality of life.

PURPOSE: to explore and describe the health care situation, the use of aids, the way of communicating and the quality of life of Locked-in syndrome patients in Flanders (Belgium) and to collect information on their fulfilled and unfulfilled needs. METHOD: in depth interviews with eight LIS-patients by means of an extensive questionnaire consisting of five parts: (i) general information and medical history, (ii) health care, rehabilitation and follow-up, (iii) speech and communication, (iv) quality of life, (v) needs and problems experienced. RESULTS: the patients' condition, mostly caused by ischemic stroke, persisted for a mean period of 6 years 8 months. Their mean age was 41;10 years. At the moment of our study all the patients were living at home. Care was provided by an extensive care team. Some recovery of head and neck movements was mentioned, recovery of upper and lower limb mobility however was very limited. Most patients use an alphabet system to communicate, all of them had access to and made use of a PC with internet connection. Except for the domain of physical functioning, the quality of life scores of our patient group are rather high. As for unfulfilled needs, half of the patients experience a lack of information on their condition and a lack of appropriate information on (communication) aids. CONCLUSION: most results seem to be in line with those of other studies, though larger scale and follow-up studies are needed to confirm these findings.