Use of an intelligent tutoring system for a curriculum on augmentative and alternative communication: Feasibility for implementation.

BACKGROUND: Over 8 million children with disabilities live in Africa and are candidates for augmentative and alternative communication (AAC), yet formal training for team members, such as speech-language therapists and special education teachers, is extremely limited. Only one university on the continent provides postgraduate degrees in AAC, and other institutions provide only short modules at an undergraduate level. The need for an introductory training course on AAC that is accessible by university students continent-wide was identified. An online programme, namely an intelligent tutoring system (ITS), was identified as a possible option to facilitate interactive learning without the need for synchronous teaching. The use of an ITS is shown to be effective in developing knowledge and clinical reasoning in the health and rehabilitation fields. However, it has not yet been applied to student teaching in the field of AAC. AIM: To determine both the feasibility of an ITS to implement an AAC curriculum for students in four African countries, and the usability and effectiveness of such a system as a mechanism for learning about AAC. METHOD & PROCEDURES: The study included two components: the development of a valid AAC curriculum; and using the ITS to test the effectiveness of implementation in a pre- and post-test design with 98 speech-language therapy and special education students from five universities. OUTCOMES & RESULTS: Statistically significant differences were obtained between pre- and post-test assessments. Students perceived the learning experience as practical, with rich content. CONCLUSIONS & IMPLICATIONS: The findings suggest that the ITS-based AAC curriculum was positively perceived by the students and potentially offers an effective means of providing supplementary AAC training to students, although modifications to the system are still required. WHAT THIS PAPER ADDS: What is already known on the subject Professionals typically lack formal training in AAC. In Africa, this presents a serious challenge as there are over 8 million children who are candidates for AAC. A need for an introductory training course on AAC, which can be accessed by university students continent-wide, was identified. What this paper adds to existing knowledge An AAC curriculum was developed and integrated into an ITS, an online programme allowing interactive learning through asynchronous teaching. Students from four African countries completed the AAC ITS curriculum. The curriculum was positively received by the students and statistically significant changes in knowledge were identified. What are the practical and clinical implications of this work? This feasibility study shows that the use of an ITS is an effective means of providing AAC training to university students in these African countries. The results provide a valuable contribution toward ensuring the equitable distribution of AAC training opportunities in the African context. This will have a significant positive impact on those who are candidates for AAC.

Stakeholder validation of a Sepedi core vocabulary list as a resource for augmentative and alternative communication.

PURPOSE: The development of culturally and linguistically appropriate resources to support communication interventions for underserved communities is an urgent necessity. The purpose of the study was to obtain stakeholder feedback on vocabulary items from a Sepedi core vocabulary list developed as a resource for vocabulary selection for augmentative and alternative communication (AAC) systems, and to expand the list based on stakeholders' vocabulary recommendations. METHOD: A questionnaire was used to obtain the ratings of 57 stakeholders regarding the importance of including 155 Sepedi words from the Sepedi core vocabulary list on an AAC system for a child with receptive language skills at the level of a 4-year-old or higher. Stakeholders also suggested additional words to include on the system. RESULT: All words were rated as important or very important. However, there was a statistically significant inverse relationship between the average frequency of occurrence of words belonging to a specific category and the average importance rating that stakeholders assigned to words in that category. A total of 48 words were additionally suggested by three or more stakeholders. CONCLUSION: Stakeholder ratings validated the list as relevant to consult in vocabulary selection for Sepedi AAC systems for children. Stakeholder-suggested words may be a useful supplement to this list.

The Sustainable Development Goals: A framework for addressing participation of persons with complex communication needs in South Africa.

BACKGROUND: Participation in society is the cornerstone to living a meaningful, connected, and healthy life. Persons with complex communication needs, however, often have restricted opportunities to participate in everyday contexts and situations. Reasons for this include societal attitudinal barriers, as well as limited knowledge and skills about augmentative and alternative communication (AAC) to enhance participation. Enhancing participation of persons with complex communication needs requires a holistic and multi-faceted approach. The 17 Sustainable Development Goals (SDGs) with their disability-inclusive agenda provide an impetus for shaping the approach of the Centre for Augmentative and Alternative Communication (CAAC) in enhancing participation of persons with complex communication needs in South Africa. PURPOSE: This paper aims to provide a reflective description and application of the work conducted by the CAAC in addressing the SDGs in South Africa. RESULT: Research and training conducted by the CAAC is shown to be aligned to five SDGs, namely zero hunger (SDG 2), good health and well-being (SDG 3), quality education (SDG 4), decent work and economic growth (SDG 8) and peace, justice, and strong institutions (SDG 16), with a focus on reaching these goals in order to benefit persons with complex communication needs. CONCLUSION: The paper demonstrates that, despite some gains in addressing the SDGs, research and clinical practice still needs to be on these and the remaining SDGs. Furthermore, there is a need to also find ways to integrate the SDGs to ensure participation of persons with complex communication needs in major life activities and society.

Designing electronic graphic symbol-based AAC systems: a scoping review. Part 1: system description.

PURPOSE: This is the first of two papers summarizing studies reporting on the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems, to determine the state of the field. The aim of this paper was to provide an overview of the general characteristics of the studies and to describe the features of the systems designed. METHODS: A scoping review was conducted. A multifaceted search resulted in the identification of 28 studies meeting the selection criteria. Data were extracted relating to four areas of interest, namely (1) the general characteristics of the studies, (2) features of the systems designed, (3) availability of the systems to the public, and (4) the design processes followed. In this paper, findings relating to the first three areas are presented. RESULTS: Most study authors were affiliated to fields of engineering and/or computer science and came from high-income countries. Most studies reported the design of AAC applications loaded onto mobile technology devices. Common system features included customizable vocabulary items, the inclusion of graphic symbols from both established AAC libraries and other sources, a dynamic grid display, and the inclusion of digital and/or synthetic speech output. Few systems were available to the public. CONCLUSIONS: Limited justifications for many of the complex design decisions were provided in the studies, possibly due to limited involvement of rehabilitation professionals during the design process. Furthermore, few studies reported on the design of graphic symbol-based AAC systems specifically for middle- and low-income contexts and also for multilingual populations.Implications for rehabilitationComplex design decisions about electronic graphic symbol-based augmentative and alternative communication (AAC) systems should be made purposefully and with sufficient justification.Increased collaboration between designers and rehabilitation professionals during the design of electronic graphic symbol-based systems could improve the products.Design of AAC systems for populations residing in low and middle-income contexts and also for multilingual populations are urgently needed.

Designing electronic graphic symbol-based AAC systems: a scoping review. Part 2: application of human-centred design.

PURPOSE: This is the second of two papers summarizing studies reporting on the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems. The aim of this paper was to describe the design approaches used and to determine to what extent the principles of human-centred design (HCD) were reflected in the design approaches and processes used. METHODS: A scoping review was conducted. A multifaceted search resulted in the identification of 28 studies meeting the selection criteria. Data were extracted relating to four areas of interest, namely, (1) the general characteristics of the studies, (2) features of the systems designed, (3) availability of the systems to the public and (4) the design processes followed. In this paper, findings related to the last area are presented. RESULTS: Design approaches were often inconsistently described. User-centred design was mentioned more often than HCD. Even so, various HCD principles were considered in most studies. Notably, stakeholders were involved in the design process in all studies. However, users were not involved in all studies and stakeholder roles were predominantly informative rather than collaborative. Prototype and product evaluations focussed mostly on usability rather than user experience. Although many design teams were multidisciplinary, engineers and computer scientists predominated. CONCLUSIONS: There is a need for designers to be more transparent about the type of design approach used to guide the system design and also to clearly report on design approaches and processes used. The application of HCD to the design of graphic symbol-based AAC systems is still limited.Implications for rehabilitationHuman-centred design approaches can productively guide the design of electronic graphic symbol-based augmentative and alternative communication (AAC) systems.Creative methods are needed to involve stakeholders with complex communication needs in all phases of the design process.Evaluation of electronic graphic symbol-based AAC systems should consider both usability and user experience.

Voices of children with intellectual disabilities on participation in daily activities.

BACKGROUND: Participation in daily activities is expressed as a human right. Full participation of children with disabilities in daily activities creates optimal opportunities for learning and development. Previous studies have focused primarily on proxy ratings of participation of children with intellectual disabilities in daily activities. However, little is known about how the children rate barriers and facilitators to their participation in everyday activities. OBJECTIVES: To identify barriers to and facilitators for everyday activities as experienced by children with intellectual disabilities from low- and middle-income countries and high-income countries. The research questions were as follows: 'what barriers to participation do children with disabilities experience in everyday activities?' and 'what facilitators to participation do children with disabilities experience in everyday activities?' METHOD: A qualitative content analyses was used in this study, and individual interviews were conducted with 49 children with intellectual disabilities. The interviews were performed using pictures. The children also selected the most important activities and described in their own words the facilitators and barriers relevant to being able to perform the activities. RESULTS: The most important activities were organised leisure activities, formal learning at school, taking care of other family members and family mealtimes. Self-reported barriers identified were personal functioning, social exclusion and lack of resources. The identified facilitators included satisfaction, personal capability, being included and having access to resources. CONCLUSION: These findings provide important knowledge about the factors to consider in the development of interventions, aimed at improving the participation of children with intellectual disabilities.

Barriers to and facilitators of employment of persons with disabilities in low- and middle-income countries: A scoping review.

BACKGROUND: Unemployment rates for persons with disabilities in low- and middle-income countries (LMICs) are high. This is despite the call to action by the United Nations Convention on the Rights of Persons with Disabilities and Sustainable Development Goals aimed at improving the economic well-being of the marginalised. To improve the employment outcomes of persons with disabilities in these countries, factors that facilitate and hinder employment should be explored. OBJECTIVES: This study explored barriers to and facilitators of employment for persons with disabilities in LMICs through a scoping review. METHODS: A search strategy included a systematic search of nine databases using specific keywords. The International Classification of Functioning, Disability and Health (ICF) framework was used as a conceptual framework and barriers and facilitators were reported according to the domains of the ICF. Articles published between 2008 and 2020 were reviewed using a predefined criteria. RESULTS: Thirty-two studies were identified in the review. Factors were identified in all domains of the ICF: (1) body function and body structure (12; 39%); (2) activities and participation (13; 42%); (3) personal factors (23; 74%); (4) environmental factors (27; 84%). CONCLUSION: Factors that hinder and facilitate the participation of persons with disabilities in LMICs were mainly found in the environment, with personal factors also influencing participation. The presence of negative attitudes and lack of services mainly in health and transport were major factors within the environment whilst personals factors included the lack of educational qualifications and skills. These results indicate the importance of consideration of contextual factors when developing intervention strategies aimed at facilitating the employment of persons with disabilities in LMICs.

Determining the core vocabulary used by Sepedi-speaking children during regular preschool activities.

PURPOSE: In order to provide equitable communication intervention and support services to clients from diverse cultural and linguistic backgrounds, the development of language-specific resources for assessment and intervention is needed. The purpose of the study was to develop a core vocabulary list based on language samples from Sepedi-speaking children, in order to make it available as a resource to inform vocabulary selection for augmentative and alternative communication (AAC) systems for children in need of AAC from a Sepedi language background. METHOD: The speech of six typically developing Sepedi-speaking children aged 5-6 years was recorded using small body-worn audio recording devices. Children were recorded during their regular pre-school day. The recordings were transcribed, coded and analysed. RESULT: The composite transcript consisted of 17 579 words, of which 1023 were different words. The core vocabulary was determined by identifying all words that were used with a minimal frequency of 0.05%, and were used by at least half of the participants. The Sepedi core vocabulary consisted of 226 words that accounted for 88.1% of the composite sample. CONCLUSION: The core vocabulary determined in this study represents a small pool of reusable linguistic elements that form the grammatical framework of the Sepedi language. As such, is a valuable resource that can be used to assist with vocabulary selection for children who require AAC and who come from a Sepedi language background.

Adapting and translating the Mullen Scales of Early Learning for the South African context.

BACKGROUND:  South African speech-language therapists have identified the need for culturally valid and sensitive assessment tools that can accommodate multiple languages and cover a reasonable age range. The Mullen Scales of Early Learning (MSEL) extend from birth to 68 months, contain five separate subscales including receptive language, expressive language, gross motor, fine motor and visual reception scale, are straightforward to administer and have been successfully used in other African countries, such as Uganda. It also identifies a child's strengths and weaknesses and provides a solid foundation for intervention planning. OBJECTIVES:  This research aimed to demonstrate the appropriateness and usefulness of the translated and culturally and linguistically adapted MSEL across four South African languages (Afrikaans, isiZulu, Setswana and South African English) through two sub-aims: (1) to describe differences, if any, in MSEL performance across language groups and (2) to describe differences, if any, in MSEL performance between age groups. METHOD:  A total of 198 typically developing children between the ages of 21 and 68 months spread across the four language groups were individually assessed with the culturally and linguistically adapted and translated MSEL. RESULTS:  A one-way analysis of variance (ANOVA) showed no statistically significant differences between the four language groups for total MSEL scores. A Welch's one-way ANOVA showed that the total MSEL scores were significantly different between age groups. CONCLUSION:  The translation and adaptation of the MSEL was successful and did not advantage or disadvantage children based on their home language, implying that linguistic equivalence was achieved. The MSEL results differed between age groups, suggesting that the measure was also successful in differentiating the performance of children at different developmental levels.

Language Assessment for Children With a Range of Neurodevelopmental Disorders Across Four Languages in South Africa.

Purpose: The purpose of this study is (a) to examine the applicability of a culturally and linguistically adapted measure to assess the receptive and expressive language skills of children with neurodevelopmental disorders (NDDs) in South Africa and then (b) to explore the contributions of 2 additional language measures. Method: In Part 1, 100 children with NDD who spoke Afrikaans, isiZulu, Setswana, or South African English were assessed on the culturally and linguistically adapted Mullen Scales of Early Learning (MSEL). Clinicians independently rated the children's language skills on a 3-point scale. In Part 2, the final 20 children to be recruited participated in a caregiver-led interaction, after which the caregiver completed a rating scale about their perceptions of their children's language. Results: Performance on the MSEL was consistent with clinician-rated child language skills. The 2 additional measures confirmed and enriched the description of the child's performance on the MSEL. Conclusions: The translated MSEL and the supplemental measures successfully characterize the language profiles and related skills in children with NDD in multilingual South Africa. Together, these assessment tools can serve a valuable function in guiding the choice of intervention and also may serve as a way to monitor progress.