The role of Augmentative and Alternative Communication in Speech and Language Therapy: A mini review.

Augmentative and Alternative Communication is an aided or unaided means of communication which supports existing communication abilities of an individual or replaces natural speech due to any speech and language disorder. The deficit could be developmental or acquired such as autism spectrum disorder, cerebral palsy, learning difficulties, dysarthria, dyspraxia or due to any acquired neurological condition such as aphasia and other degenerative disorders. Furthermore, it may be due to surgical procedures such as laryngectomy. Alternate means of communication have also been successfully used with COVID-19 patients. These tools may include pictures, symbols, signs or voice output devices. Parents of children with special needs and medical professionals have been reluctant in implementing the approach due to certain misconceptions. The aim of this review is to summarize the current evidence for the use of Augmentative and Alternative Communication with a range of disorders in relation to in relation to Pakistan.

Percepciones y prácticas acerca de la estimulación del lenguaje que refieren los cuidadores de niños y niñas con trastorno del lenguaje que asisten a tratamiento psicopedagógico en el Área Programática del Hospital General de Agudos Dr. J.M Ramos Mejía: Hacia una mejor intervención / Perceptions and practices about language stimulation referred to by caregivers of children and children with language disorders who attend psycho-pedagogical treatment in the Hospital General de Agudos Dr. J.M Ramos Mejía: Towards a better intervention

Esta investigación indaga sobre las percepciones y prácticas acerca de la estimulación del lenguaje que refieren los/las cuidadores de los niños/as con diagnóstico de trastorno del lenguaje que asisten a tratamiento psicopedagógico en el Área Programática del Hospital General de Agudos Dr. J.M. Ramos Mejía (HRM). La finalidad de esta investigación será mejorar las intervenciones y orientaciones realizadas por el equipo de psicopedagogía a las familias de dichos pacientes. Se utilizarán dos instrumentos: se trabajará con enumeración completa para la aplicación de un cuestionario autoadministrado a 11 cuidadores sobre prácticas que refieren los mismos en relación a la estimulación de las cuatro dimensiones del lenguaje (fonética-fonológica, morfosintáctica, semántica y pragmática) en actividades cotidianas. Este cuestionario fue validado conceptualmente y se realizaron pruebas piloto previamente a ser administrado a la muestra. El mismo cuenta con indicadores (actividades de estimulación) para cada dimensión del lenguaje, los cuales habrán sido identificados por los cuidadores según frecuencia de realización, mediante estas respuestas se realizará una síntesis (a partir de criterios pre-establecidos) que indicará la frecuencia de estimulación de cada dimensión (frecuencia de estimulación adecuada, frecuencia de estimulación medianamente adecuada y frecuencia de estimulación insuficiente). El segundo instrumento consiste en una entrevista semiestructurada a los/las cuidadores cuya muestra se definirá por saturación teórica. La misma pretende relevar información sobre cuatro dimensiones que se indagarán mediante una guía de pautas validada por expertos en la temática: el recorrido atravesado por los/las cuidadores para establecer el diagnóstico de Trastorno del Lenguaje de los/las pacientes; sus percepciones acerca de dicho diagnóstico; sus percepciones y las prácticas que refieren con respecto a la estimulación del lenguaje; las orientaciones brindadas por los profesionales de salud y sus respectivas valoraciones en relación a las estas últimas. (AU)

Technology-Enhanced Reading Therapy for People With Aphasia: Findings From a Quasirandomized Waitlist Controlled Study.

Purpose This study investigated the effects of technology-enhanced reading therapy for people with reading impairments, using mainstream assistive reading technologies alongside reading strategies. Method The study used a quasirandomized waitlist controlled design. Twenty-one people with reading impairments following stroke were randomly assigned to receive 14 hr of therapy immediately or after a 6-week delay. During therapy, participants were trained to use assistive reading technology that offered a range of features to support reading comprehension. They developed skills in using the technology independently and in applying the technology to their personal reading goals. The primary outcome measure assessed reading comprehension, using Gray Oral Reading Test-Fourth Edition (GORT-4). Secondary measures were as follows: Reading Comprehension Battery for Aphasia-Second Edition, Reading Confidence and Emotions Questionnaire, Communication Activities of Daily Living-Second Edition, Visual Analog Mood Scales, and Assessment of Living With Aphasia. Matched texts were used with the GORT-4 to compare technology-assisted and unassisted reading comprehension. Mixed analyses of variance explored change between T1 and T2, when the immediate group had received therapy but the delayed group had not, thus serving as untreated controls. Pretherapy, posttherapy, and follow-up scores on the measures were also examined for all participants. Results GORT-4 results indicated that the immediately treated group improved significantly in technology-assisted reading following therapy, but not in unassisted reading. However, the data were not normally distributed, and secondary nonparametric analysis was not significant. The control group was unstable over the baseline, improving significantly in unassisted reading. The whole-group analysis showed significant gains in assisted (but not unassisted) reading after therapy that were maintained at follow-up. The Reading Confidence and Emotions Questionnaire results improved significantly following therapy, with good maintenance of change. Results on all other secondary measures were not significant. Conclusions Technology-assisted reading comprehension improved following the intervention, with treatment compensating for, rather than remediating, the reading impairment. Participants' confidence and emotions associated with reading also improved. Gains were achieved after 14 therapy sessions, using assistive technologies that are widely available and relatively affordable, meaning that this approach could be implemented in clinical practice.

Perception of speech and language pathologists towards augmentative and alternative communication in Pakistan.

OBJECTIVE: To determine the level of understanding and use of augmentative and alternative communication devices in Pakistani speech pathologists.. METHODS: The cross-sectional survey was conducted from January to June 2015 in six major cities of Pakistan: Islamabad, Rawalpindi, Lahore, Karachi, Quetta and Peshawar. It comprised speech and language pathologists who were asked to fill a questionnaire that consisted of10 questions. Data was analysed using SPSS17. Result: Overall calculated mean and standard error of mean from the respondents who agreed and strongly agreed regarding understanding, opinion-assessment and treatment about augmentative and alternative communication was153±36.373 and 12.124 respectively. RESULTS: Of the 132 subjects, 68(51.5%) were in the education group and 64(48.5%) in the control group. Postintervention, 11(16.2%) women in the education group and 37(57.8%)in the control group developed severe preeclampsia. Subsequently, 44(64.7%) in the education group had no preeclampsia. The corresponding number in the control group was 15(23.4%). CONCLUSIONS: Speech pathologists had understanding of assessing and working with individuals using augmentative and alternative communication.

The Potential Effect of Forbrain as an Altered Auditory Feedback Device.

Purpose: The purpose of this study was to run a proof of concept on a new commercially available device, Forbrain® (Sound For Life Ltd/Soundev, Luxemburg, model UN38.3), to test whether it can modulate the speech of its users. Method: Participants were instructed to read aloud a text of their choice during 3 experimental phases: baseline, test, and posttest, while wearing a Forbrain® headset. Critically, for half of the participants (Forbrain group), the device was turned on during the test phase, whereas for the other half (control group), the device was kept off. Voice recordings were analyzed to derive 6 quantitative measures of voice quality over each of the phases of the experiment. Results: A significant Group × Phase interaction was obtained for the smoothed cepstral peak prominence, a measure of voice harmony, and for the trendline of the long-term average spectrum, a measure of voice robustness, this latter surviving Bonferroni correction for multiple comparisons. Conclusions: The results of this study indicate the effectiveness of Forbrain® in modifying the speech of its users. It is suggested that Forbrain® works as an altered auditory feedback device. It may hence be used as a clinical device in speech therapy clinics, yet further studies are warranted to test its usefulness in clinical groups.

Employing mobile technology to improve language skills of young students with language-based disabilities.

This exploratory study investigated the effects of a language building iPad application on the language skills (i.e., receptive vocabulary, expressive vocabulary, and sentence formation) of young students with language-based disabilities. The study utilized a pre-test-post-test control group design. Students in the treatment group used the iPad language building application, Language Builder, for 30 minutes a day. Participants were 31 first-grade to third-grade students with identified language-based disabilities. Students were assigned to two groups for the 8-week intervention. Data indicated that students in the treatment group made significantly greater gains in the area of sentence formation than the control group. Results revealed no significant difference between the two groups in the areas of expressive and receptive vocabulary. A short intervention of using Language Builder via the iPad may increase the sentence formation skills of young students with language delays. Additionally, discussion regarding the usefulness of iPad applications in education is presented.

El lenguaje y la maduración emocional, ¿Cómo lo trabajamos en grupo? / Language and emotional evolution: How to work on this area in groups?

En este artículo se expone el tratamiento de problemas de lenguaje y maduración emocional a través de grupos. En el CDIAP del Maresme, a menudo la demanda viene focalizada en el retraso de lenguaje, pero observamos que un grupo importante está relacionado con alteraciones en la vinculación. Estos casos se tratan en grupos de niños y padres. Se presentan dos experiencias: grupo de niños y padres con las mismas terapeutas y grupo paralelo de padres. Los beneficios terapéuticos se concretan en la mejor integración de las emociones y su reflejo en el avance en las relaciones con los iguales y en los aprendizajes Maltrato en la infancia y la adolescencia: Características y psicopatología asociada en un Centro de Salud Mental Infanto-Juvenil

In this article we deal with the treatment of language and emotional maturation problems through groups. In CDIAP Maresme, demand it is often focused on problems of language delay, but we have noted that a significant number of cases are related to alterations in entailment. These cases can be treated in groups of children and parents. Two experiences are presented: a group of children and parents with the same therapists, and a parallel group of parents. The therapeutic benefits take the form of improved integration of emotions and their reflection in the progress in relations with peers and learning

Aproximación al lenguaje en el trastorno del espectro autista / An approach to language in austim / Aproximació al llenguatge en el trastorn de l’espectre autista

Este artículo examina y reconsidera el papel del lenguaje en el trastorno de espectro autista (TEA). Aunque las anomalías lingüísticas no constituyen una categoría específica para el diagnóstico del TEA, no han pasado nunca desapercibidas. Es más, se observan en todo el espectro, son un indicador del grado de afectación y tienen un valor muy importante para el pronóstico. Un estudio detallado del lenguaje aportaría más información del perfil cognitivo y mejoras en el diagnóstico y tratamiento. Facilitaría además el diseño de terapias que actuaran sobre el lenguaje. El papel de la mentalización en la etiología de la conducta violenta

This article surveys and re-assesses the role of language in autism spectrum disorder (ASD). Although language abnormalities are not a specific category of ASD diagnosis, they have never gone unnoticed. Moreover, they are observable across the entirety of the spectrum and are an indicator of severity levels and highly relevant for prognosis. A detailed study of language can provide us with more information about the cognitive profile and improvements in diagnosis and treatment. In addition, it can promote therapy designs that would have an effect on language

Aquest article examina i reconsidera el paper del llenguatge en el trastorn de l’espectre autista (TEA). Tot i que les anomalies lingüístiques no constitueixen una categoria específica per al diagnòstic del TEA, mai no han passat desapercebudes. És més, s’observen en tot l’espectre, són un indi­cador del grau d’afectació i tenen un valor molt important per al pronòstic. Un estudi detallat del llenguatge aportaria més informació del perfil cognitiu i millores en el diagnòstic i tractament. Facilitaria, a més, el disseny de teràpies que actuaran sobre el llenguatge

Mandibular movement during speech of two related Latin languages.

OBJECTIVES/HYPOTHESIS: This study assessed the kinesiographic recordings of jaw movements during reading a text in Galician and Spanish language. STUDY DESIGN: Cross-sectional blind study. METHODS: A homogeneous healthy group of 25 normal stomatognathic system and native Galician participants was studied. Frontal and parasagittal plane recordings of the intraborder lateral jaw movements and during reading Galician and Spanish texts were recorded using a calibrated jaw-tracking device, kinesiograph. RESULTS: Although movements were similar in both languages, a greater retrusion of the jaw in the Spanish language was shown; moreover, a tendency exists for a left-side motion envelope in this right-handedness preference sample. CONCLUSIONS: This study supports the hypothesis that speech is controlled by the central nervous system rather than by peripheral factors and that the hemispheric dominance influences the asymmetry of the speech envelope.

Phonological recovery in Spanish developmental dyslexics through the tip-of-the-tongue paradigm / Recuperación fonológica en disléxicos evolutivos españoles mediante el paradigma de la punta de la lengua

Background: Developmental dyslexics have difficulties accessing and retrieving the phonological form of words, in the absence of a deficit at the semantic level. The aim of this work was to study, through the Tip-of-the-tongue (TOT) paradigm, the problems of lexical access in Spanish-speaking developmental dyslexics and the relationship with their phonological awareness. Method: A group of developmental dyslexics (14) and other children without reading difficulties (14), aged 7 to 12, performed a picture naming task of medium and low frequency and a task of phonological awareness. Results: The results indicated that dyslexic children generally show a greater number of TOT phenomena than the control group. Despite being able to provide semantic information of the drawing, they had difficulties retrieving partial phonological information. Conclusions: These results indicate that developmental dyslexic children have particular difficulty in accessing the phonological form of words, which may be interesting for the development of intervention programs for these children (AU)

Antecedentes: los disléxicos evolutivos tienen dificultades para acceder y recuperar la forma fonológica de las palabras, sin presentar un déficit a nivel semántico. El propósito de este trabajo era estudiar, a través del paradigma del fenómeno de la punta de la lengua, los problemas de acceso léxico en niños con dislexia evolutiva y su posible relación con la conciencia fonológica. Método: un grupo de niños disléxicos (14) y otro grupo sin dificultades lectoras (14), con edades comprendidas entre 7 y 12 años, realizaron una tarea de denominación de dibujos de frecuencia media - baja y una tarea de conciencia fonológica. Resultados: los resultados indicaron que los niños disléxicos generalmente presentan mayor número de fenómenos de punta de la lengua que el grupo control. A pesar de ser capaces de dar información semántica acerca del dibujo, los disléxicos presentan dificultades para recuperar la información parcial fonológica. Conclusiones: los resultados indican que los disléxicos evolutivos tienen particular dificultad para acceder a la forma fonológica de las palabras. Esto puede ser interesante para desarrollar programas de intervención para estos niños (AU)

Writing treatment for aphasia: a texting approach.

PURPOSE: Treatment studies have documented the therapeutic and functional value of lexical writing treatment for individuals with severe aphasia. The purpose of this study was to determine whether such retraining could be accomplished using the typing feature of a cellular telephone, with the ultimate goal of using text messaging for communication. METHOD: A 31-year-old man with persistent Broca's aphasia, severe apraxia of speech, global dysgraphia, and right hemiparesis participated in this study. Using a multiple baseline design, relearning and maintenance of single-word spellings (and oral naming) of targeted items were examined in response to traditional Copy and Recall Treatment (CART) for handwriting and a new paradigm using 1-handed typing on a cell phone keyboard (i.e., a texting version of CART referred to as T-CART). RESULTS: Marked improvements were documented in spelling and spoken naming trained in either modality, with stronger maintenance for handwriting than cell phone typing. Training resulted in functional use of texting that continued for 2 years after treatment. CONCLUSIONS: These results suggest that orthographic retraining using a cell phone keyboard has the potential to improve spelling knowledge and provide a means to improve functional communication skills. Combined training with both handwriting and cell phone typing should be considered in order to maximize the durability of treatment effects.

Default-mode network functional connectivity in aphasia: therapy-induced neuroplasticity.

Previous research on participants with aphasia has mainly been based on standard functional neuroimaging analysis. Recent studies have shown that functional connectivity analysis can detect compensatory activity, not revealed by standard analysis. Little is known, however, about the default-mode network in aphasia. In the current study, we studied changes in the default-mode network in subjects with aphasia who underwent semantic feature analysis therapy. We studied nine participants with chronic aphasia and compared them to 10 control participants. For the first time, we identified the default-mode network using spatial independent component analysis, in participants with aphasia. Intensive therapy improved integration in the posterior areas of the default-mode network concurrent with language improvement. Correlations between integration and improvement did not reach significance, but the trend suggests that pre-therapy integration of the default-mode network may predict therapy outcomes. Functional connectivity allows a better understanding of the impact of semantic feature analysis in aphasia.

A randomized control trial of interventions in school-aged children with auditory processing disorders.

OBJECTIVE: The primary purpose of the study was to compare intervention approaches for children with auditory processing disorder (APD): bottom-up training including activities focused on auditory perception, discrimination, and phonological awareness, and top-down training including a range of language activities. Another purpose was to determine the benefits of personal FM systems. DESIGN: The study is a randomized control trial where participants were allocated to groups receiving one of the two interventions, with and without personal FM, or to the no intervention group. The six-week intervention included weekly one-hour sessions with a therapist in the clinic, plus 1-2 hours per week of parent-directed homework. STUDY SAMPLE: 55 children (7 to 13 years) with APD participated in the study. Intervention outcomes included reading, language, and auditory processing. RESULTS: Positive outcomes were observed for both training approaches and personal FM systems on several measures. Pre-intervention nonverbal IQ, age, and severity of APD did not influence outcomes. Performance of control group participants did not change when retested after the intervention period. CONCLUSIONS: Both intervention approaches were beneficial and there were additional benefits with the use of personal FM. Positive results were not limited to the areas specifically targeted by the interventions.

Resultados de terapia de lenguaje con niños del espectro autista / Language therapy results with children of the autism spectrum

Los trastornos de comunicación en niños del espectro autista posiblemente persistirán a lo largo de sus vidas, especialmente si no reciben atención especializada en comunicación y lenguaje. El objetivo principal de esta investigación consiste en identificar modificaciones en el perfil funcional de comunicación (iniciativa, interacción, funciones y medios) y en el desempeño sociocognitivo (intención comunicativa vocal y gestual, imitación vocal y gestual, uso de instrumentos y de juego combinatorio y simbólico) después de 6meses de terapia de lenguaje. La muestra estuvo compuesta por 50niños y adolescentes (edad media 9,3años) con un diagnóstico dentro del espectro autista realizado por un psiquiatra infantil; todos los participantes estaban incluidos en un programa especializado de terapia de lenguaje de la Universidad de São Paulo (Brasil). Además, la totalidad de los sujetos fueron filmados en 2 ocasiones, con un intervalo de 6meses entre cada registro, y después de 6meses del comienzo de la terapia de lenguaje. Los datos fueron analizados estadísticamente con tests no paramétricos y nivel de significación del 0,5%. Los resultados mostraron que todos los participantes presentaron alguna mejoría, y que el 96% de ellos lo hicieron en el perfil funcional de comunicación. Ello sugiere que es posible identificar indicios objetivos de mejoría tras un periodo relativamente corto de terapia de lenguaje en personas con trastornos del espectro autista. La información objetiva sobre resultados terapéuticos puede favorecer una mejor integración de procedimientos terapéuticos y aumentar así las posibilidades de alcanzar mejorías más profundas (AU)

Communication disorders of children with autism spectrum disorders will probably follow them throughout life if they are not included in remediation and communication intervention programs. The aim of this research was to identify observed changes in the functional communicative profile (initiative, interaction, functions and means) and in the social cognitive performance (vocal and gestural communicative intent, vocal and gestural imitation, tool use, combinatory and symbolic play) after 6months of language therapy. Subjects were 50children and adolescents (mean age 9.3years), with diagnosis within the autistic spectrum attributed by a child psychiatrist, enrolled in a specialized language therapy program at the University of Sao Paulo (Brazil). All subjects were filmed twice, with a 6-month interval, after the first 6-months of the therapy onset. Statistical analysis of data used non-parametric tests with a significance level of 0.5%. Results showed that all subjects presented at least one progress index and that 96% of them presented progress in the functional communicative profile. These results suggest that it is possible to identify objective improvement indexes after a relatively short period of language therapy with individuals of the autism spectrum. Objective information about therapeutic results may favor better integration of intervention procedures and therefore enhance the possibilities of further improvements (AU)

[Detection of endpoint for segmentation between consonants and vowels in aphasia rehabilitation software based on artificial intelligence scheduling].

For the purpose of improving the efficiency of aphasia rehabilitation training, artificial intelligence-scheduling function is added in the aphasia rehabilitation software, and the software's performance is improved. With the characteristics of aphasia patient's voice as well as with the need of artificial intelligence-scheduling functions under consideration, the present authors have designed a set of endpoint detection algorithm. It determines the reference endpoints, then extracts every word and ensures the reasonable segmentation points between consonants and vowels, using the reference endpoints. The results of experiments show that the algorithm is able to attain the objects of detection at a higher accuracy rate. Therefore, it is applicable to the detection of endpoint on aphasia-patient's voice.

A multimedia PDA/PC speech and language therapy tool for patients with aphasia.

Aphasia is a speech disorder usually caused by stroke or head injury and may involve a variety of communication difficulties. As 30% of stroke sufferers have a persisting speech and language disorder and therapy resources are low, there is clear scope for the development of technology to support patients between therapy sessions. This paper reports on an empirical study which evaluated SoundHelper, a multimedia application to demonstrate how to pronounce target speech sounds. Two prototypes, involving either video or animation, were developed and evaluated with 20 Speech and Language Therapists. Participants responded positively to both, with the video being preferred because of the perceived extra information provided. The potential for the use on portable devices, since internet access is limited in hospitals, is explored in the light of opinions of Augmented and Alternative Communication (AAC) device users in the UK nd Europe who have expressed a strong desire for more use of internet services.

Treatment effects of Fast ForWord demonstrated by magnetoencephalography (MEG) in a child with developmental dyslexia.

Treatment effects of Fast ForWord, hypothesized to ameliorate temporal processing deficits, were demonstrated by magnetoencephalography in a child with dyslexia using four paradigms: Word/Non-word Reading (NW), Grapheme-to-Phoneme Matching (GP), Verbal, and Spatial Working Memory (VWM, SWM). Shifts in brain activation from right inferior frontal and temporal to left frontal, bilateral supramarginal, and transverse temporal regions occurred during GP. During NW, shifts progressed from (1) right or bilateral anterior and superior to (2) left, inferior frontal, to (3) left, superior posterior temporoparietal, to (4) left, inferior, posterior temporooccipital regions. Reading and written language improvements were noted in passage comprehension and spelling.

High scores on the Western Aphasia Battery correlate with good functional communication skills (as measured with the Communicative Effectiveness Index) in aphasic stroke patients.

OBJECTIVE: To examine the correlation between an impairment-level and a functional-level assessment scale of aphasia. DESIGN: Prospective, longitudinal study. SETTING: A stroke rehabilitation unit. SUBJECTS: Sixty-seven aphasic acute stroke patients who were undergoing a multi-disciplinary rehabilitation programme, including conventional speech and language therapy (SLT). INTERVENTION: Patients were assessed on study entry and 4, 8, 12 and 24 weeks after the start of SLT. The language impairment was assessed with the Western Aphasia Battery (WAB) and the communicative functional limitation associated with aphasia was measured with the Communicative Effectiveness Index (CETI).Results. There was a statistically significant correlation between the two scales for all assessment periods (Pearson's r=0.71; P<0.01). CONCLUSION: The study suggests that in the acute and subacute stages of stroke the scores of WAB and CETI can be surmised from one another.

Narrative and procedural discourse production by severely aphasic patients.

Five cbronically aphasic subjects were trained on a computerized iconographic communication system (C-VIC). Their performance in producing single sentences scripts. and narratives was assessed using both spoken English and C-VIC. The requisite vocabulary necessary and the narrative complexity of the target productions were controlled. Subject performance using C-VIC indicates that the ability to construct discourse at the macrostructural level is largely intact. Despite significant improvements in spoken production after C-VIC training, especially at the single sentence level, the subjects' spoken discourse remains severely impaired by their failures at the microlinguistic level. These results point to the limits of currently available approaches to the remediation of aphasia and suggest avenues for future research.