Still having his say: David Yoder's legacy in AAC.

On February 2 2023, one of the guiding lights in the field of augmentative and alternative communication (AAC) for more than four decades, David E. Yoder, passed away at the age of 90. A voracious reader and gifted storyteller, David was particularly fond of a quote from George Bernard Shaw's Back to Methuselah, "You see things; and you say 'Why?' but I dream things that never were; and I say 'Why not?'" That vision led him to take on multiple leadership roles and influence the field of AAC in multiple ways. He played a pivotal role in establishing both the International Society for Augmentative and Alternative Communication (ISAAC) and the United States Society for Augmentative and Alternative Communication (USSAAC). Additionally, he chaired the panel for the National Institute on Disability and Rehabilitation Research (NIDRR)'s inaugural Consensus Validation Conference on AAC, advocated for the American Speech-Language-Hearing Association to recognize AAC within the profession's scope of practice, and served as the first editor for the Augmentative and Alternative Communication journal. In this tribute, we describe David's diverse and unique contributions to improving the lives of people with communication challenges with a focus on some of his central insights and actions.

Are gestures worth a thousand words? Verbal and nonverbal communication during robot-assisted surgery.

Communication breakdowns in the operating room (OR) have been linked to errors during surgery. Robot-assisted surgery (RAS), a new surgical technology, can lead to new challenges in communication owing to the remote location of the surgeon away from the patient and bedside assistants. Nevertheless, few studies have studied communication strategies during RAS. In this study, 11 robot-assisted radical prostatectomies were recorded and the interaction events between the surgeon and two bedside surgical team members were categorized by modality (verbal/nonverbal), topic, and pair (sender and receiver). Both verbal and nonverbal modalities were used by all pairs. The percentage of nonverbal interactions differed significantly by pair: 66% for the Surgeon-Physician Assistant, 50% for the Physician Assistant-Scrub Nurse, and 25% for the Surgeon-Scrub Nurse, indicating different communication strategies across pairs. In addition, there was a significant dependence between topic and the percentages of verbal and nonverbal events for all pairs. Strategies to improve team communication during RAS should take into account the use of verbal and nonverbal communication means and the variation in interaction strategies based on the topic of communication.

The application of natural language processing to augmentative and alternative communication.

Significant progress has been made in the application of natural language processing (NLP) to augmentative and alternative communication (AAC), particularly in the areas of interface design and word prediction. This article will survey the current state-of-the-science of NLP in AAC and discuss its future applications for the development of next generation of AAC technology.

Participant evaluations of rate and communication efficacy of an AAC application using natural language processing.

This research explores the efficacy of an AAC application, Converser, that uses natural language processing to assist in communication. Converser uses speech recognition of the speaking partner to predict contextually appropriate utterances. This article reports on the subjective data gathered from an experimental evaluation of Converser's efficacy (see Wisenburn and Higginbotham, 2008 for a full description of Converser and the objective results). Converser was evaluated in two communication tasks (a Conversation and an Interview task) under two conditions: a simple alphabet board without Converser (alpha-only condition), and an identical board with Converser (alpha-Converser condition). Subjective data was gathered through rating questionnaires and written comments. Program users rated the speed of communication faster in the alpha-Converser condition. Program user ratings of quality, and speaking partner ratings of speed and quality, showed no difference between the two conditions; however, the participant comments about Converser were positive.

AAC technology transfer: an AAC-RERC report.

Transferring innovative technologies from the university to the manufacturing sector can often be an elusive and problematic process. The Rehabilitation and Engineering Research Center on Communication Enhancement (AAC-RERC) has worked with the manufacturing community for the last 10 years. The purpose of this article is to discuss barriers to technology transfer, to outline some technology transfer strategies, and to illustrate these strategies with AAC-RERC related activities.

The effect of context priming and task type on augmentative communication performance.

Augmentative and Alternative Communication (AAC) devices include special purpose electronic devices that generate speech output and are used by individuals to augment or replace vocal communication. Word prediction, including context specific prediction, has been proposed to help overcome barriers to the use of these devices (e.g., slow communication rates and limited access to situation-related vocabulary), but has not been tested in terms of effects during actual task performance. In this study, we compared AAC device use, task performance, and user perceptions across three tasks, in conditions where the AAC device used either was, or was not, primed with task specific vocabularies. The participants in this study were adults with normal physical, cognitive, and communication abilities. Context priming had a marginally significant effect on AAC device use as measured by keystroke savings; however, these advantages did not translate into higher level measures of rate, task performance, or user perceptions. In contrast, there were various statistically significant process and performance differences across task type. Additionally, results for two different emulations of human performance showed significant keystroke savings across context conditions. However, these effects were mitigated in actual performance and did not translate into keystroke savings. This indicates to AAC device designers and users that keystroke-based measures of device use may not be predictive of high level performance.

An AAC application using speaking partner speech recognition to automatically produce contextually relevant utterances: objective results.

The purpose of this study was to evaluate the efficacy of a computer program, Converser, which uses the speech recognition of the speaking partner to predict contextually appropriate utterances and to store relevant noun phrases. The dyads (which consisted of a program user and a speaking partner) tested Converser in two communication tasks: a conversation and an interview. Two conditions were applied: A simple communication aid with an alphabet layout without Converser (alpha-only condition), and an identical aid with Converser (alpha-converser condition). Objective measurements were made concerning the program user's rate and Converser usage. The results showed that the alpha-converser condition generated a faster communication rate than the alpha-only condition. Also, the program users utilized the stored noun phrases in their productions more than the full utterances. Converser allowed for periodic instances of a fast rate of speech, which appeared to have a positive impact on communication.

Access to AAC: present, past, and future.

Historically, access in augmentative and alternative communication (AAC) has been conceptualized as the physical operation of AAC technologies; more recently, research and development in the cognitive and social sciences has helped to broaden the concept to include a range of human factors involved in the successful use of AAC technologies in social interactions. The goal of this article is to expand the current understanding of communication access by providing a conceptual framework for examining AAC access, evaluating recent scientific and technical advances in the areas of AAC, and discussing the challenges to accessing AAC technologies for a range of communication activities.

The effect of the communication output method on augmented interaction.

The experiment compared the ability of a Comprehension Model versus an Interaction Model to account for the communication performance of augmented communicators. Five dyads consisting of adults without disabilities, with one participant in each dyad randomly assigned to use an augmentative communication device, engaged in ten direction-giving tasks in which the augmented communicator used either a Word Method (i.e., spoken words only) or a Mixed Method (i.e., mix of spoken words and letters) speech output. Results indicated an overall completion time and communication rate advantage for the Mixed Method output in most communication tasks, supporting the Interaction Model of augmented communication. The role of communication co-construction in augmented interaction and the implications of the Interaction Model for future communication device design are discussed.

The development of an automated method for analyzing communication rate in augmentative and alternative communication.

A significant barrier to evidence-based practice in Augmentative and Alternative Communication (AAC) is the lack of validated performance measures that can be used by speech-language pathologists and rehabilitation engineers to evaluate the communication and device use of AAC consumers. Recently an effort has been made to develop automated data-logging techniques to facilitate the transcription and analysis of the AAC speaker's device use. A major source of error for the automated measurement of communication rate is the presence of excessive Inter-Selection Intervals (ISIs) (i.e., pause times), for which no communicative activity is occurring. The goal of this study was to develop an automated technique to filter out extreme ISIs, while preserving true communication rate performance. AAC data log files were obtained from seven individuals participating in a 1-month field trial of an AAC technology. Two temporal filtering techniques (arbitrary and individual) were compared for their ability to eliminate excessive ISIs. Results indicated that use of an individualized temporal filter was more sensitive to performance variability than use of an arbitrary temporal filter. Further, the individualized temporal filter elevated the participants' communication rate (measured by words per minute) by a factor of 1.8 to 34.5 greater than that of the unfiltered communication rate estimate. In addition, the first AAC communication rate performance estimates taken from the field are presented. Implications for further research and the valid use of automated data logging and analysis are discussed.

The AuD program at the University at Buffalo.

The doctor of audiology (AuD) program at the University at Buffalo is summarized in this article. We begin with a description of the city of Buffalo and the University at Buffalo. This is followed by a brief history of the university and the Department of Communicative Disorders & Sciences. We then summarize the timeline and the process required to develop the AuD program. Admissions policies and prerequisites are then reviewed. We discuss the faculty active in our AuD program and present the requirements (clinical, academic, research) for the degree. The article ends with a delineation of the challenges we face, as well as a description of some of the factors that make the audiology program at the University at Buffalo unique.

AAC performance and usability issues: the effect of AAC technology on the communicative process.

In this article, Clark's theory of language use is applied to the study of conversations of augmented speakers and their addressees. Discussion focuses on how shared meaning--called common ground--is achieved, the process of grounding utterances under real-time constraints, and how the media characteristics of devices affect the grounding process. A joint action analysis of grounding will be applied to examples of word-board and Voice Output Communication Aid (VOCA)-mediated conversations to show how participants organize their talk around specific media constraints to conduct their conversations and solve communication problems. The authors argue that this model of device-mediated communication performance, or some variety of it, has the potential to reconcile many of the individual research findings in this field within a single explanatory framework. If successful, this approach could be used to evaluate future research with an empirically-based model of communication performance.

Discourse comprehension test performance of elders with dementia of the Alzheimer type.

Spoken language comprehension, including comprehension for inferential material in narrative discourse, is diminished in dementia of the Alzheimer type (DAT). There are, however, no empirical data concerning comprehension by adults with DAT of main ideas versus details in narratives. Evidence from other groups with and without brain damage has shown that comprehension for main ideas is relatively better than for details and that comprehension for stated material is relatively better than comprehension for inferential material. Participants in the present investigation were 24 older adults, 8 with early-stage DAT (EDAT), 8 with middle-stage DAT (MDAT), and 8 with no brain damage (NBD). Selected narratives and associated sets of yes-no questions from the Discourse Comprehension Test (DCT) (Brookshire and Nicholas, 1993) were presented on videotape. Participants with EDAT and MDAT had significantly poorer overall comprehension of DCT narratives than did those in the NBD group (p < .0001), but they did not differ significantly from each other. Responses to DCT narratives by participants in the NBD, EDAT, and MDAT groups followed the same pattern of relatively better comprehension for main ideas than for details and relatively better comprehension for stated than for implied information. Working memory and episodic memory were shown to be significantly associated with DCT overall scores. Together, these findings suggest that although overall narrative comprehension is diminished in those with DAT, individuals appear to retain a mental representation for narratives that facilitates better comprehension of main ideas than of details as well as better comprehension of stated information than of implied information. This interpretation is consistent with schema-based accounts of narrative comprehension.