Communication in critical care tracheostomy patients dependent upon cuff inflation: A scoping review.

OBJECTIVES: The aim of this study was to synthesise the evidence concerning communication in critically ill tracheostomy patients dependent on cuff inflation. The aim was to identify the psychological impact on patients awake and alert with tracheostomies but unable to speak; strategies utilised to enable communication and facilitators and barriers for the success of these strategies. REVIEW METHOD USED: This scoping review was conducted using the Joanna Briggs Institute framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. DATA SOURCES: CINAHL, Embase, Medline, and Web of Science were searched from 1st January 2000 to 30th September 2023 and supplemented with hand searching of references from included studies. REVIEW METHODS: Studies were eligible if they addressed the psychological impact of voicelessness and/or the structure, process, and outcomes of augmentative and alternative communication (AAC) systems, in addition to facilitators and barriers to effectiveness. The population of interest included critically ill tracheostomy patients dependent on cuff inflation, their families, and healthcare workers. Screening and data extraction were undertaken by two reviewers independently. Data analysis involved descriptive statistics and content analysis. RESULTS: A total of 23 studies met the inclusion criteria: 11 were qualitative, nine were quantitative, and three were mixed-methods studies. Voicelessness elicited negative emotions, predominantly frustration. AAC systems, encompassing unaided and aided (low-tech and high-tech) methods, presented both advantages and drawbacks. High-tech strategies held promise for patients with physical limitations. Patients equally appreciated the support offered through unaided strategies, including eye contact and touch. Facilitating factors included speech therapy involvement and assessment. Patient-related challenges were the most frequent barriers. CONCLUSION: Facilitating meaningful communication for critically ill tracheostomy patients dependent on cuff inflation is of paramount psychological significance. Whilst AAC systems are practicable, they are not without limitations, implying the absence of a universally applicable solution. This underscores the importance of continuous evaluation, reinforced by a multidisciplinary team. REVIEW PROTOCOL REGISTERED: 27 July 2022. REVIEW REGISTRATION: Open Science Framework Registries: https://osf.io/kbrjn/.

A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications.

Individuals with multiple disabilities are among the most challenging to serve and AAC teams often lack direction in determining effective interventions. The purpose of this scoping review was to summarize the research evidence on AAC interventions for individuals with complex communication needs and simultaneous motor, and visual impairments as part of their multiple disabilities; to consider implications for practice; and to determine gaps and directions for future research. A total of 27 studies were identified and reviewed, involving 55 unique participants with multiple disabilities. Most studies focused on direct intervention to increase requesting or choice-making, with little focus on social communication. Only two studies focused on training communication partners. Results indicated that AAC interventions can be highly effective to increase communication for individuals with multiple disabilities. However, there is an urgent need for increased rigor and more detailed participant information in future AAC intervention research with this population. Future research should investigate AAC intervention to improve social communication and increase language development, not just expression of needs and wants. Future research should focus on the needs of individuals with multiple disabilities from culturally and linguistically diverse backgrounds and on implementation of AAC within natural environments.

The prevalence of relational basic concepts on core vocabulary lists for AAC: is frequency enough?

The selection of appropriate vocabulary is a crucial and challenging aspect of augmentative and alternative communication (AAC) intervention. Core vocabulary lists are frequently used to support vocabulary selection for children who require AAC. A vocabulary domain that has garnered limited attention within the AAC literature is relational basic concepts (RBCs). RBCs describe relationships between objects, persons, or situations, and play a pivotal role in language development, communication, and academic success. For the present study, we created a list of 156 RBCs, drawing primarily from assessments that measure basic concept knowledge in preschool and early elementary school students. We examined the overlap of these words on nine core vocabulary lists. We found that most concepts were not represented on any core lists. Additionally, there was relatively little overlap of RBCs between the core lists. These findings suggest that vocabulary selection resources created using exclusively a core vocabulary approach may have limited utility for identifying many concepts that preschool and early elementary students are expected to know and use. Implications for AAC research and practice are discussed with emphasis on the need for further consideration of RBCs within vocabulary selection practice and the field of AAC at large.

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.

Behavioral pain scale may not be reliable in awake non-verbal intensive care patients: a case control study.

BACKGROUND: The evaluation of pain in patients, unable of oral communication, often relies on behavioral assessment. However, some critically ill patients, while non-verbal, are awake and have some potential for self-reporting. The objective was to compare the results of a behavioral pain assessment with self-reporting in awake, non-verbal, critically ill patients unable to use low-tech augmentative and alternative communication tools. METHODS: Prospective cohort study of intubated or tracheotomized adult, ventilated patients with a RASS (Richmond Agitation Sedation Scale) of -1 to + 1 and inadequate non-verbal communication skills in a surgical intensive care unit of a tertiary care university hospital. For pain assessment, the Behavioral Pain Scale (BPS) was used. Self-reporting of pain was achieved by using an eye tracking device to evaluate the Numeric Rating Scale (NRS) and the pain/discomfort item of the EuroQol EQ-5D-5 L (EQ-Pain). All measurements were taken at rest. RESULTS: Data was collected from 75 patients. Neither the NRS nor the EQ-Pain (r < .15) correlated with the BPS. However, NRS and EQ-Pain were significantly correlated (r = .78, p = < 0.001), indicating the reliability of the self-reporting by these patients. Neither the duration of intubation/tracheostomy, nor cause for ICU treatment, nor BPS subcategories had an influence on these results. CONCLUSIONS: Behavioral pain assessment tools in non-verbal patients who are awake and not in delirium appear unreliable in estimating pain during rest. Before a behavioral assessment tool such as the BPS is used, the application of high-tech AACs should be strongly considered. TRIAL REGISTRATION: German Clinical Trials Register, Registration number: DRKS00021233. Registered 23 April 2020 - Retrospectively registered, https://drks.de/search/en/trial/DRKS00021233 .

Mand Modality Preference Assessments among High- and Low-Tech Options for Individuals with Intellectual and Developmental Disabilities: A Systematic Review.

The extant literature demonstrates that individuals with intellectual and developmental disabilities (IDD) exhibit preferences among communication modalities when multiple modalities are available and produce reinforcement on identical reinforcement schedules. High- and low-tech communication options, such as voice output devices and picture cards, are commonly recommended for individuals with limited vocal communication skills. In this study, we conducted a systematic literature review of research studies that implemented mand modality preference assessments (MMPAs) that included both a high- and low-tech communication option with individuals with IDD. We identified 27 studies meeting our inclusion criteria and summarized the participant demographics, MMPA design and procedural variations, and MMPA outcomes. The results suggested that high-tech communication options were generally more preferred over low-tech options. However, there was a high degree of variability in how the studies were conducted and conclusions were reached. We discuss some of the current research gaps and the implications for clinical practice.

Factors influencing communication partners of persons with severe/profound intellectual disability use of augmentative and alternative communication: an integrative review.

PURPOSE: To present a synthesis of evidence related to the factors influencing communication partners' use of augmentative and alternative communication with persons with severe/profound intellectual disability. MATERIALS AND METHODS: An integrative review guided by five steps; problem identification, literature search, data evaluation, data analysis and presentation was undertaken. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, nine databases were searched, 1,342 studies were screened against the eligibility criteria, and 15 studies underwent thematic analysis. RESULTS: Two themes emerged; (1) Achieving Meaningful Communication and (2) Communication Partners' Preparedness to Use Augmentative and Alternative Communication. Achieving meaningful communication was central to communication partners' use of augmentative and alternative communication and was two-fold. It involved identifying the persons' communication methods and encouraging them to communicate. Communication partners' preparedness also influenced their use of augmentative and alternative communication. This preparedness was impacted by communication partners' preconceived thoughts about and knowledge of augmentative and alternative communication, nurturing their belief in augmentative and alternative communication, and the interpersonal dynamic between network members. CONCLUSION: Communication partners' use of augmentative and alternative communication is influenced by multiple and complex factors. The findings contribute to the knowledge of the potential factors to be considered to prepare communication partners to use augmentative and alternative communication.

Multiple, complex factors influence communication partners of persons with severe/profound intellectual disability use of augmentative and alternative communication (AAC), which include communication partners' beliefs, attitudes, expectations, knowledge and resources such as training, support and time.To offer individuals with severe/profound intellectual disability opportunities to communicate, communication partners need to recognise their attempts and thus, their ability. Continuously being sensitive to the individuals' communication methods, whilst being cognisant that these methods can change may enhance communication partners' awareness and understanding of the individuals' communication attempts.Communication partners' need to feel prepared to use AAC. To feel prepared, they need to be aware of the potential benefits that AAC can offer the interaction and the long-term outcomes, develop their knowledge, and be surrounded by a supportive team dynamic.

A systematic review of acquisition and mastery of skills taught using the Picture Exchange Communication System.

The Picture Exchange Communication System (PECS) is a popular augmentative and alternative communication intervention for individuals with developmental disabilities that includes six, sequential phases of instruction. We systematically reviewed published and unpublished single-case PECS studies for details about the percentage of participants mastering PECS phases, how long it took participants to master PECS phases (in trials to mastery), and what constituted mastery of PECS phases. We found most participants mastered only the first two phases of PECS, and Phases I, II, and IV showed the slowest and widest variability in trials to mastery. Moreover, participants who were taught the third PECS phase learned to select from an average array of three symbols, which may limit the range of messages they can communicate. We discuss our findings in light of a few important limitations and provide directions for future researchers along with recommendations for professionals who might consider PECS.

A retrospective chart review of the patient population accessing augmentative & alternative communication at an urban assistive technology center.

The purpose of this study was to 1) identify and describe the population seeking alternative and augmentative communication (AAC) evaluations at an assistive technology (AT) center in the Midwestern United States and 2) describe the AAC device features or services participants identify as most important at their initial AAC evaluations. Charts of 53 participants seeking AAC interventions at an AT center in the Midwestern United States were retrospectively reviewed. Information from the QUEST 2.0 was used to determine what AT features were identified as most important. The majority of participants seen at the AT center had progressive diseases. Across all of the participants, ease of use and effectiveness were identified as the "most important" aspects of an AAC device satisfaction. These findings highlight the importance of determining who is accessing AAC services across AT centers to determine whether barriers to AAC services exist. Moreover, patients report regarding what variables they deem as most important reflect the fact that excellent service-delivery may not overcome the importance of other variables, such as ease of use that impact AAC use.

Examining core vocabulary with language development for early symbolic communicators.

PURPOSE: Core vocabulary lists are frequently used to select vocabulary for early symbolic communicators who require augmentative and alternative communication (AAC). The current study extended existing work by investigating how core vocabulary lists overlap and diverge from typical language development. METHOD: We investigated when the words on seven core vocabulary lists emerge in typical language development, the composition of the lists based on their parts of speech, and how the composition of the words on the lists compare to the MacArthur Bates Communication Development Inventories (CDI). RESULT: On average, the words on the seven core vocabulary lists appear after the second year of life in children with typical spoken language development (25, 27, 37, 45, 47, 50, and 66 months). Verbs were the most prevalent part of speech in all but one of the core vocabulary lists. Core vocabulary words made up only a small percentage of words on the CDI. CONCLUSION: The words on the core vocabulary lists do not emerge until later points in typical lexical development. Focussing on core words when working with early symbolic communicators who require AAC may lead to limited and variable lexicons with wide gaps.

Turn-taking and communication modes of students and staff in group activities at non-inclusive schools for students with intellectual disability.

Most students with intellectual and communicative disability who rely on augmentative and alternative communication (AAC) attend non-inclusive school settings. Little is known about turn-taking and the use of various communication modes in groups of students and staff in this context. Previous studies on single students with intellectual disability in various school settings have found that staff tend to dominate interactions and augmented communication modes are used more during structured than unstructured activities. The present study explored turn-taking contributions and communication modes in whole groups of students and staff in non-inclusive school settings in Sweden. Video observations of 33 students and 30 school staff were conducted in seven classrooms during one structured activity (circle time) and one unstructured activity (leisure time). Turn-taking contributions and communication modes were examined when comparing students and staff and when comparing the two activities. Findings revealed that staff dominated the interactions and augmented communication modes were used less during leisure time than circle time. Notably, aided augmented communication modes, particularly speech-output technologies, were used sparsely. Findings of this study highlight the importance of supporting staff members in applying partner strategies and incorporating augmented input, especially aided augmented input, across various group activities at school.

Parental perceptions of social life before and after attending a parent training program for children with complex communication needs: the ComAlong example.

Parent training programs aimed at improving language outcomes for children with complex communication needs have predominantly been evaluated on child-centered outcomes and less often on the impact on social life or parental well-being. This study examined parent perceptions of social life before and after ComAlong, a group intervention providing parents with knowledge and training in responsive communication, environmental-milieu teaching strategies and augmentative and alternative communication (AAC). Parents (N = 467) completed questionnaires during the first and last sessions of ComAlong groups held in Sweden 2012 to 2018. Main outcome measure was change in the Social Life Scale from the Family Impact Questionnaire. Associations between this measure and demographic factors of parents and children were analyzed, along with reported change in parents' use of AAC. Pre-post comparisons revealed small significant positive changes in perceived impact of social life following intervention. The magnitude of the positive change was larger among parents of children with non-syndromic diagnoses and parents of children with autism spectrum disorder or attention deficit hyper activity disorder (ADHD). Differences in social life impact was not associated with parents' gender, language proficiency, age, or educational background. In conclusion, communication-focused parent training programs can have a positive impact on social family life and may thereby influence children's participation.

Using occupational therapy principles and practice to support independent message generation by individuals using AAC instead of facilitated communication.

Facilitated communication (FC) has been a heavily debated and documented topic across multiple disciplines, including sociology, education, psychology, pediatrics, speech-language pathology, and disability studies. Although many professionals from various disciplines and advocates have offered opinions, suggestions, and research on the topic, there has been minimal input from the occupational therapy (OT) profession. The lack of OT input is noteworthy as OTs are experts in enabling upper extremity performance and independence through a variety of training, adaptation and modification strategies, and use of external supports. Because of their professional code of ethics and a specific knowledge base, OTs are uniquely positioned to provide a host of ethical and evidence-based strategies that enable independent access to communication technology. The consideration of multiple access options is contrary to the typical facilitated encounter where facilitators exclusively choose to manipulate an upper extremity in order for letters to be selected on a display or keyboard. The purpose of this paper is threefold: (a) To offer insight into the standard of care by OTs including their ethical standards; (b) to identify varied accommodations that enable access using a feature-matching standard of care that eliminates the need for a facilitator; and (c) to highlight how to increase independent assistive technology/augmentative and alternative communication access, thus dissuading the need or use of facilitated access to letters.

Design of aided augmentative and alternative communication systems for children with vision impairment: psychoacoustic perspectives.

Children with complex communication needs often have multiple disabilities including visual impairments that impact their ability to interact with aided augmentative and alternative communication (AAC) systems. Just as the field benefited from a consideration of visual cognitive neuroscience in construction of visual displays, an exploration of psychoacoustics can potentially assist in maximizing the possibilities within AAC systems when the visual channel is either (a) not the primary sensory mode, or (b) is one that can be augmented to ultimately benefit AAC outcomes. The purpose of this paper is to highlight background information about psychoacoustics and present possible future directions for the design of aided AAC system technologies for children with visual impairments who rely on auditory information to learn and utilize AAC.

Revisiting Topography-Based and Selection-Based Verbal Behavior.

In topography-based verbal behavior, different antecedent stimuli control different topographies of responding, whereas in selection-based verbal behavior, different antecedent stimuli control the selection of visually distinct stimuli from an array of options. In this article, we point out three variable characteristics of selection-based behavior, highlighted by recent technological developments, that affect its similarity to topography-based behavior: The extent to which stimuli can be constructed from minimal units, the size and composition of the selection array, and the similarity of response-produced stimuli to verbal stimuli that are prevalent in the speaker's verbal community. Although a distinction between topography-based and selection-based behavior has merit, particular characteristics of a selection-based verbal behavior modality may often be more relevant for researchers and clinicians to consider than its status as selection-based.

Teaching South African center-based caregivers to implement augmentative and alternative communication strategies.

In South Africa, many children with extensive support needs-including children who require AAC-are accommodated in care centers rather than the public schooling system. Caregivers employed at these centers need training in order to support children's communication using augmentative and alternative methods. A total of 29 center-based caregivers took part in this study. A single group pretest-posttest design was used to evaluate the effect of a 5-day training workshop on caregivers' ability to demonstrate and implement five AAC strategies. The effect of the workshop on caregivers' perceptions of their own skills as well as the social validity of the training were also evaluated. Results suggest that the workshop effectively taught caregivers to demonstrate the skills in a simulated roleplay situation. A proportion of caregivers also supplied video footage after the workshop that suggests the ability to implement the strategies in the care center contexts. Caregivers also perceived their own skills to have improved post workshop, and evaluated the training positively.

Predictors of Picture Exchange Communication System (PECS) outcomes.

Background & aims: Although the Picture Exchange Communication System (PECS) has been demonstrated to be an effective intervention to teach people diagnosed with autism spectrum disorder a functional communication system, the research indicates variability in PECS outcomes across people and studies. Therefore, the purpose of the current study was to explore child characteristics and treatment variables that may explain the variation in, and potentially predict, PECS outcomes. Method: A total of 22 children and youth diagnosed with autism or a related developmental disorder, all of whom scored substantially below average on standardized measures of cognitive and adaptive abilities, participated in a PECS intervention. Results: Participants who achieved high phases of PECS (≥PECS phase IIIb) differed significantly from those who mastered lower PECS phases (≤PECS phase IIIa) in terms of overall, verbal, and nonverbal mental age, matching abilities, and adaptive behavior level. Stimulus generalization was also associated with significant variation in PECS outcome. PECS outcomes could be predicted with good accuracy using a combination of these child characteristics and treatment variables. Conclusions: The findings from the current study suggest that children with relatively higher cognitive and adaptive skill levels are more likely to achieve higher phases of PECS; further, approaches to generalization training also play a role. Factors such as autism symptom severity and parental ratings of maladaptive behavior were not associated with significant differences in PECS outcomes. However, more research is needed. Implications: Gaining a better understanding of predictors of PECS outcomes is important to inform intervention, provide more accurate outcome expectations for families, and guide PECS teaching procedures. Although participants were more likely to achieve higher phases of PECS if they had a higher mental age, adaptive skill level, and matching skills, the average scores for these measures were well below those expected for same age peers. These results indicate that PECS is appropriate for use with children with clinically significant deficits in cognitive and/or adaptive abilities. Further, results suggest that even children who demonstrate more severe symptoms of autism and exhibit more challenging behavior can achieve higher phases of PECS.

Characteristics of drawing deficits in people with aphasia: Differences between symbolic and realistic drawn objects.

BACKGROUND: Pictures drawn by people with aphasia (PWA) are often more challenging to understand than those drawn by healthy people. There are two types of objects: those that tend to be drawn symbolically (symbolically drawn objects-SOs) and those that are likely to be drawn realistically (realistically drawn objects-ROs). AIMS: To compare the identification rate and number of misunderstanding types between SOs and ROs drawn by PWA and healthy controls (HCs). To reveal trends in the misunderstandings of drawings by PWA, and to identify the language or cognitive abilities related to the identification rate of pictures drawn by PWA. METHODS & PROCEDURES: We designed a drawing task involving SOs and ROs. A total of 18 PWA and 30 HCs completed the task, and respondents identified the drawings. The identification rate and number of misunderstandings were analysed with two-way analysis of variance (ANOVA) including group (PWA and HCs) and object type (SOs and ROs). The misunderstandings were divided into four categories varying in semantic and morphological similarity; these ratios were examined with a chi-square test. The relationships of language and cognitive abilities with the identification rate were investigated with multiple regression analyses. OUTCOMES & RESULTS: There was a significant effect of the interaction between group and object type on the identification rate (F(1.1387) = 3.90, Mean Squared Error (MSE) = 4139.67, p = 0.04): the identification rates for ROs were lower in the PWA than in the HCs. For the number of misunderstanding types, an interaction was observed between group and object type (F(1.56) = 8.26, MSE = 26.93, p < 0.01): the number of misunderstanding types for ROs in the PWA was greater than that in the HCs. The misunderstanding patterns differed between ROs and SOs (χ2 (3) = 694.30, p < 0.001, V = 0.37). ROs were semantically related, whereas SOs were morphologically related. The identification rates of ROs and SOs were correlated only with Kanji writing scores (ROs: ß = 3.66, p = 0.01; SOs: ß = 6.57, p < 0.01). CONCLUSIONS & IMPLICATIONS: In drawings by the PWA, SOs had a higher identification rate, while ROs had a lower identification rate and a greater variety of misunderstandings. SOs may increase drawing motivation. Interventions to improve the identifiability of SOs and ROs should reflect each character. Identification rates were correlated only with Kanji writing scores. The PWA, whose native language was Japanese and had preserved Kanji writing abilities, and their communication abilities may be increased through drawing. WHAT THIS PAPER ADDS: What is already known on the subject PWA often have impaired drawing abilities and draw pictures that third parties misinterpret. Some objects tend to be drawn symbolically, and some are drawn realistically. However, it is not clear whether there is a difference between these types of drawings depicted by PWA in identifiability and the tendency to be misunderstood by ordinary people. In addition, the relationships between language or cognitive abilities and the identification rate of drawn pictures are not clear. What this paper adds to the existing knowledge The identification rate differed between SOs and ROs. In drawings by PWA, SOs had a higher identification rate, while ROs had a lower identification rate and the greatest variety of misunderstandings. Approximately half of the misunderstandings were related to the target object. SOs tended to be confused with morphologically related objects, while ROs tended to be confused with semantically related objects. Identification rates were correlated only with Kanji writing scores. What are the potential or actual clinical implications of this work? To motivate PWA's drawing, it is suitable to begin with SOs. Examining drawing ability from the perspective of SOs and ROs increases the chance of identifying drawing ability. PWA whose native language is Japanese and have preserved Kanji writing abilities may be able to increase their communication abilities through drawing.

Simulation of other-initiated repair using AAC.

This simulation study assessed the ability of Speech-Output Technologies (SOTs) to keep in-time during conversational repair. Fifty-eight Other Initiated Repair (OIR) initiators were collected from transcripts of repair interaction sequences collected from past research. A range of selection latencies were then used to calculate simulated utterance composition delays for the OIR initiators using two popular SOT software apps, with and without the use of word prediction. To determine whether OIR utterances could be produced within a socially sensitive temporal gap, composition delay was compared to a conservative temporal limit obtained for oral communicators (Kendrick, 2015). Even at the fastest 0.5 s selection latency level, utterance-level composition delays for both SOTs were substantially greater than the OIR limit set for this study. Next, AAC production rate data spanning a variety of technologies, access methods, tasks and user profiles was obtained from the literature. Communication performance for these groups was then evaluated against the identified temporal OIR limit. None of the user groups were found to be capable of producing full OIR utterances within the temporal limits of oral-speech conversation, with most unable to type even a single selection within these bounds. Because of the frequency and importance of repair in conversation, these results have important implications for designing devices to enable their users to successfully engage in such important conversational activities.

Using longitudinal qualitative research to explore the experience of receiving and using augmentative and alternative communication.

BACKGROUND: People who have communication difficulties may benefit from using augmentative and alternative communication (AAC). Understanding and measuring outcomes from the use of AAC is an important part of evaluating the impact of devices and services. Outcome measurement needs to reflect the changing nature of the impact of using AAC on an individual's ability to participate in activities of daily life. There is a limited understanding of the concepts that should inform the evaluation of outcomes from AAC device provision, nor how people's expectations from AAC may change over time. AIMS: To inform the development of a patient-reported outcome measure for AAC by understanding more about people's expectations from AAC and how these change over time. METHODS & PROCEDURES: A longitudinal qualitative research study was designed and carried out with seven participants over a period of 2 years. Participants were recruited from a regional specialist assessment service for AAC in the south-west of the UK. Four semi-structured interviews were carried out: (1) before assessment for AAC, (2) after assessment, (3) directly after provision of an AAC device and (4) between 6 and 12 months after provision. An original analytic method was used in this study that built on the principles of longitudinal interpretative phenomenology analysis, applied with a dialogic theoretical lens. This approach enabled the inclusion of a range of multimodal and embodied data collected to this study and allowed the research team to draw out salient themes across the cohort group while attending to the influence of time and context on experience. OUTCOMES & RESULTS: The results confirm and extend the three core concepts that were used to guide analysis: changes; contexts; future possibilities. The contextual and temporal influences on outcomes attainable from AAC for this cohort were also identified and illustrated through cross-case comparison. Deeper, analytic, and conceptual engagement with theory, which was then applied to analysis of the data, provided methodological rigour in the study. The results enhance our understanding of people's hopes and expectations from AAC and how these change over time. CONCLUSIONS & IMPLICATIONS: This qualitative longitudinal research study provides new insights into the journeys of people who experience communication disability, and the shifting nature of their sense of identity as they engage with, and learn from using, AAC. The study is significant as it attends to the dynamic nature of experience and how contextual and experiential factors influence people's hopes and expectations from AAC. The paper presents an original application of longitudinal qualitative research methodology with people who use AAC which can be further applied and tested in the field of communication disability research. WHAT THIS PAPER ADDS: What is already known on this subject We did not know the impact that time has on the concepts that have been identified to represent important outcomes from AAC. The existing concepts used to define outcomes from AAC were not adequately conceptualized to develop a patient-reported outcome measure. This study sought to extend our knowledge about outcomes from AAC. What this paper adds to the existing knowledge This study adds to the methodological toolkit available for qualitative inquiry in the field of communication disability research by presenting a longitudinal qualitative research methodology. It adds depth to our understanding of the concepts that underpin outcomes from AAC and highlights the dynamic nature of contexts and how this influences desired outcomes. What are the potential or actual clinical implications of this work? This longitudinal qualitative research study provides a broader perspective on the experience of getting AAC. It will enable clinicians to better navigate the contextual and transitionary factors that influence people's experience of acquiring AAC devices. The enhanced concepts described will also support clinical conversations that consider the wider facets of communication and what AAC can add to existing communicative tool kits beyond getting a message across.