The usability of an AAC pain description system for patients with acquired expressive communication disorders.

Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.

Preliminary Investigation of the Perspectives of Parents of Children With Cerebral Palsy on the Supports, Challenges, and Realities of Integrating Augmentative and Alternative Communication Into Everyday Life.

Purpose To ensure long-term adoption and use of augmentative and alternative communication (AAC) technologies, they must be designed to support children to participate within everyday activities and routines that are prioritized by families. The aim of this study was to gain parent perspectives on how AAC technologies were integrated into everyday life. Method Nine parents of children with cerebral palsy who used AAC technologies participated in semistructured interviews to provide their perspectives on how AAC technologies were integrated into the functional contexts of everyday life. Results Five major themes emerged from the discussions: (a) integrating AAC into life, (b) AAC technologies, (c) child needs and skills, (d) parent responsibilities and priorities, and (e) AAC process and decision making. Children were able to use AAC technologies within a variety of everyday contexts with various partners; however, challenges included access to technologies within care routines and outdoor activities as well as partners who lacked knowledge regarding operational competencies and effective interaction strategies. To integrate AAC technologies into life, parents prioritized technology features including ease of programming, improved physical design, features to enhance efficiency and ease of access, and availability of multiple functions and features (e.g., games and leisure activities, environmental controls). Conclusion AAC manufacturers and mainstream technology developers should work to ensure that technologies are responsive to the supports, limitations, and ideal features identified by parents. Future research should seek input from a larger group of stakeholders and use longitudinal methods to examine perceptions of AAC technologies over time. Supplemental Material https://doi.org/10.23641/asha.11625543.

Neuroprosthetic Speech: The Ethical Significance of Accuracy, Control and Pragmatics.

Neuroprosthetic speech devices are an emerging technology that can offer the possibility of communication to those who are unable to speak. Patients with 'locked in syndrome,' aphasia, or other such pathologies can use covert speech-vividly imagining saying something without actual vocalization-to trigger neural controlled systems capable of synthesizing the speech they would have spoken, but for their impairment.We provide an analysis of the mechanisms and outputs involved in speech mediated by neuroprosthetic devices. This analysis provides a framework for accounting for the ethical significance of accuracy, control, and pragmatic dimensions of prosthesis-mediated speech. We first examine what it means for the output of the device to be accurate, drawing a distinction between technical accuracy on the one hand and semantic accuracy on the other. These are conceptual notions of accuracy.Both technical and semantic accuracy of the device will be necessary (but not yet sufficient) for the user to have sufficient control over the device. Sufficient control is an ethical consideration: we place high value on being able to express ourselves when we want and how we want. Sufficient control of a neural speech prosthesis requires that a speaker can reliably use their speech apparatus as they want to, and can expect their speech to authentically represent them. We draw a distinction between two relevant features which bear on the question of whether the user has sufficient control: voluntariness of the speech and the authenticity of the speech. These can come apart: the user might involuntarily produce an authentic output (perhaps revealing private thoughts) or might voluntarily produce an inauthentic output (e.g., when the output is not semantically accurate). Finally, we consider the role of the interlocutor in interpreting the content and purpose of the communication.These three ethical dimensions raise philosophical questions about the nature of speech, the level of control required for communicative accuracy, and the nature of 'accuracy' with respect to both natural and prosthesis-mediated speech.

A novel dual and triple shifted RSVP paradigm for P300 speller.

BACKGROUND: A speller system enables disabled people, specifically those with spinal cord injuries, to visually select and spell characters. A problem of primary speller systems is that they are gaze shift dependent. To overcome this problem, a single Rapid Serial Visual Presentation (RSVP) paradigm was initially introduced in which characters are displayed one-by-one at the center of a screen. NEW METHOD: Two new protocols, Dual and Triple shifted RSVP paradigms, are introduced and compared against the single paradigm. In the Dual and Triple paradigms, two and three characters are displayed at the center of the screen simultaneously, holding the advantage of displaying the target character twice and three times respectively, compared to the one-time appearance in the single paradigm. To compare the named paradigms, three subjects participated in experiments using all three paradigms. RESULTS: Offline results demonstrate an average character detection accuracy of 97% for the single and double protocols, and 80% for the Triple paradigm. In addition, average ITR is calculated to be 5.45, 7.62 and 7.90 bit/min for the single, Dual and Triple paradigms respectively. Results identify the Dual RSVP paradigm as the most suitable approach that provides the best balance between ITR and character detection accuracy. COMPARISON WITH EXISTING METHODS: The novel speller system (the Dual paradigm) suggested in this paper demonstrates improved performance compared to existing methods, and overcomes the gaze dependency issue. CONCLUSIONS: Overall, our novel method is a reliable alternative that both removes limitations for users suffering from impaired oculomotor control and improves performance.

Eyes on communication: trialling eye-gaze control technology in young children with dyskinetic cerebral palsy.

PURPOSE: This study aims to identify eye-gaze control technology outcomes, parent perception of the technology and support received, and gauge the feasibility of available measures. METHODS: Five children with dyskinetic cerebral palsy, mean age 4 years, 4 months (1 year, 0 months); n = 4 males; trialled two eye-gaze control technology systems, each for six weeks. Parents completed pre- and post-questionnaires. RESULTS: Parents found the 6-week home-based trial period to be the right length. Written guidelines and instructions about set-up, calibration, and play and learning activities were perceived as important. Children demonstrated improvements in goal achievement and performance. Parents found questionnaires on quality of life, participation, behaviours involved in mastering a skill and communication outcomes challenging to complete resulting in substantial missing data. CONCLUSION: Eye-gaze control technology warrants further investigation for young children with dyskinetic cerebral palsy in a large international study.

Hearing Aid Compatibility Standards. Final rule; announcement of effective date.

In this document, the Commission announces that the Office of Management and Budget (OMB) has approved, for a period of three years, the information collection associated with rules adopted in the Commission's document Access to Telecommunication Equipment and Services by Persons with Disabilities; Amendment of the Commission's Rules Governing Hearing Aid-Compatible Mobile Handsets et. al., Report and Order and Order on Reconsideration (Order). This document is consistent with the Order, which stated that the Commission would publish a document in the Federal Register announcing the effective date of those rules.

[Information and communication technologies in the integrated care of people with dementia]. / Információs és kommunikációs technológiák alkalmazása dementiában szenvedok komplex ellátásában.

Modern information and communication tools have increasingly become an indispensable part of our everyday life. Research data demonstrate that it can be used effectively to preserve and restore health, not just among young people but also among the elderly, as for nowadays the use of the internet is widespread among the elderly, but healthcare applications are less well-known. This supports the significance of our project since it is important to develop and introduce disease-specific healthcare applications. Our preliminary results also indicated that men are less open to these new technologies, so in their case, specific methods are needed to facilitate the use of electronic devices. The high level of internet activity and the interest in information and communication technologies provide a reliable basis for applying these new technologies to the elderly. Thus, based on our research, we can develop a complex model of care based on the bio-psycho-social principles, which can be a significant advance in the prevention and early detection of age-related mental disorders and in alleviating the physical and psychological burdens of people with dementia and their families. Orv Hetil. 2018; 159(24): 965-973.

Use of speech generating devices can improve perception of qualifications for skilled, verbal, and interactive jobs.

BACKGROUND: We have previously demonstrated that when speech generating devices (SGD) are used as assistive technologies, they are preferred over the users' natural voices. OBJECTIVE: We sought to examine whether using SGDs would affect listener's perceptions of hirability of people with complex communication needs. METHODS: In a series of three experiments, participants rated videotaped actors, one using SGD and the other using their natural, mildly dysarthric voice, on (a) a measurement of perceptions of speaker credibility, strength, and informedness and (b) measurements of hirability for jobs coded in terms of skill, verbal ability, and interactivity. Experiment 1 examined hirability for jobs varying in terms of skill and verbal ability. Experiment 2 was a replication that examined hirability for jobs varying in terms of interactivity. Experiment 3 examined jobs in terms of skill and specific mode of interaction (face-to-face, telephone, computer-mediated). RESULTS AND CONCLUSIONS: Actors were rated more favorably when using SGD than their own voices. Actors using SGD were also rated more favorably for highly skilled and highly verbal jobs. This preference for SGDs over mildly dysarthric voice was also found for jobs entailing computer-mediated-communication, particularly skillful jobs.

Information and Communication Technology (ICT) Standards and Guidelines. Final rule.

We, the Architectural and Transportation Barriers Compliance Board (Access Board or Board), are revising and updating, in a single rulemaking, our standards for electronic and information technology developed, procured, maintained, or used by Federal agencies covered by section 508 of the Rehabilitation Act of 1973, as well as our guidelines for telecommunications equipment and customer premises equipment covered by Section 255 of the Communications Act of 1934. The revisions and updates to the section 508-based standards and section 255-based guidelines are intended to ensure that information and communication technology covered by the respective statutes is accessible to and usable by individuals with disabilities.

Brain-computer interface devices for patients with paralysis and amputation: a meeting report.

OBJECTIVE: The Food and Drug Administration's (FDA) Center for Devices and Radiological Health (CDRH) believes it is important to help stakeholders (e.g., manufacturers, health-care professionals, patients, patient advocates, academia, and other government agencies) navigate the regulatory landscape for medical devices. For innovative devices involving brain-computer interfaces, this is particularly important. APPROACH: Towards this goal, on 21 November, 2014, CDRH held an open public workshop on its White Oak, MD campus with the aim of fostering an open discussion on the scientific and clinical considerations associated with the development of brain-computer interface (BCI) devices, defined for the purposes of this workshop as neuroprostheses that interface with the central or peripheral nervous system to restore lost motor or sensory capabilities. MAIN RESULTS: This paper summarizes the presentations and discussions from that workshop. SIGNIFICANCE: CDRH plans to use this information to develop regulatory considerations that will promote innovation while maintaining appropriate patient protections. FDA plans to build on advances in regulatory science and input provided in this workshop to develop guidance that provides recommendations for premarket submissions for BCI devices. These proceedings will be a resource for the BCI community during the development of medical devices for consumers.

Hearing Aid-Compatible Mobile Handsets. Final rule.

In this document, the Federal Communications Commission (Commission) modernizes its wireless hearing aid compatibility rules. The Commission adopts these rules to ensure that people with hearing loss have full access to innovative handsets and technologies.

Integrating user centered design, universal design and goal, operation, method and selection rules to improve the usability of DAISY player for persons with visual impairments.

The Digital Accessible Information SYstem (DAISY) player is an assistive reading tool developed for use by persons with visual impairments. Certain problems have persisted in the operating procedure and interface of DAISY players, especially for their Chinese users. Therefore, the aim of this study was to redesign the DAISY player with increased usability features for use by native Chinese speakers. First, a User Centered Design (UCD) process was employed to analyze the development of the prototype. Next, operation procedures were reorganized according to GOMS (Goals, Operators, Methods, and Selection rules) methodology. Then the user interface was redesigned according to specific Universal Design (UD) principles. Following these revisions, an experiment involving four scenarios was conducted to compare the new prototype to other players, and it was tested by twelve visually impaired participants. Results indicate the prototype had the quickest operating times, the fewest number of operating errors, and the lowest mental workloads of all the compared players, significantly enhancing the prototype's usability. These findings have allowed us to generate suggestions for developing the next generation of DAISY players for people, especially for Chinese audience.

Development of Augmentative and Alternative Communication Assessment Tools for Patients with ALS.

ALS patients usually use augmentative and alternative communication tools to communicate with other people, but the assessment tools, including the selection of an input switch, are very difficult to operate. In this study, we developed a novel device to measure the physical ability of patients to operate the input switch with a push lever. The study focused on the amount of pushing and the power required to operate the input switch, and the effectiveness was verified.

Undergraduates' perceptions of three augmentative and alternative communication modes.

OBJECTIVE: To assess undergraduates' perceptions of three augmentative and alternative communication (AAC) modes. METHOD: We showed 104 undergraduates a video clip of a person using each of the three AAC modes and asked them to rate each option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) preference. The three AAC modes shown were (a) manual signing, (b) picture exchange, and (c) speech-generating device. RESULTS: Mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the speech-generating device. The speech-generating device and manual signing options were rated as being more preferred over picture exchange. Picture exchange was rated significantly higher on perceived ease of acquisition. CONCLUSION: Speech-generating devices were perceived to have greater social validity than manual signing and picture exchange.

Interaction of participant characteristics and type of AAC with individuals with ASD: a meta-analysis.

Individuals with autism spectrum disorders (ASD) and complex communication needs often rely on augmentative and alternative communication (AAC) as a means of functional communication. This meta-analysis investigated how individual characteristics moderate effectiveness of three types of aided AAC: the Picture Exchange Communication System (PECS), speech-generating devices (SGDs), and other picture-based AAC. Effectiveness was measured via the Improvement Rate Difference. Results indicated that AAC has small to moderate effects on speech outcomes, and that SGDs appear to be most effective when considering any outcome measure with individuals with ASD without comorbid intellectual/developmental disorders (IDD). PECS appears to be most effective when considering any outcome measure with individuals with ASD and IDD. SGDs and PECS were the most effective type of AAC for preschoolers, when aggregating across outcome measures. No difference was found between systems for elementary-aged and older individuals.

Self-calibration algorithm in an asynchronous P300-based brain-computer interface.

OBJECTIVE: Reliability is a desirable characteristic of brain-computer interface (BCI) systems when they are intended to be used under non-experimental operating conditions. In addition, their overall usability is influenced by the complex and frequent procedures that are required for configuration and calibration. Earlier studies examined the issue of asynchronous control in P300-based BCIs, introducing dynamic stopping and automatic control suspension features. This report proposes and evaluates an algorithm for the automatic recalibration of the classifier's parameters using unsupervised data. APPROACH: Ten healthy subjects participated in five P300-based BCI sessions throughout a single day. First, we examined whether continuous adaptation of control parameters improved the accuracy of the asynchronous system over time. Then, we assessed the performance of the self-calibration algorithm with respect to the no-recalibration and supervised calibration conditions with regard to system accuracy and communication efficiency. MAIN RESULTS: Offline tests demonstrated that continuous adaptation of the control parameters significantly increased the communication efficiency of asynchronous P300-based BCIs. The self-calibration algorithm correctly assigned labels to unsupervised data with 95% accuracy, effecting communication efficiency that was comparable with that of supervised repeated calibration. SIGNIFICANCE: Although additional online tests that involve end-users under non-experimental conditions are needed, these preliminary results are encouraging, from which we conclude that the self-calibration algorithm is a promising solution to improve P300-based BCI usability and reliability.

Quantitative and descriptive comparison of four acoustic analysis systems: vowel measurements.

PURPOSE: This study examines accuracy and comparability of 4 trademarked acoustic analysis software packages (AASPs): Praat, WaveSurfer, TF32, and CSL by using synthesized and natural vowels. Features of AASPs are also described. METHOD: Synthesized and natural vowels were analyzed using each of the AASP's default settings to secure 9 acoustic measures: fundamental frequency (F0), formant frequencies (F1-F4), and formant bandwidths (B1-B4). The discrepancy between the software measured values and the input values (synthesized, previously reported, and manual measurements) was used to assess comparability and accuracy. Basic AASP features are described. RESULTS: Results indicate that Praat, WaveSurfer, and TF32 generate accurate and comparable F0 and F1-F4 data for synthesized vowels and adult male natural vowels. Results varied by vowel for women and children, with some serious errors. Bandwidth measurements by AASPs were highly inaccurate as compared with manual measurements and published data on formant bandwidths. CONCLUSIONS: Values of F0 and F1-F4 are generally consistent and fairly accurate for adult vowels and for some child vowels using the default settings in Praat, WaveSurfer, and TF32. Manipulation of default settings yields improved output values in TF32 and CSL. Caution is recommended especially before accepting F1-F4 results for children and B1-B4 results for all speakers.

'Communicative competence' in the field of augmentative and alternative communication: a review and critique.

BACKGROUND: Understandings of 'communicative competency' (CC) have an important influence on the ways that researchers and practitioners in augmentative and alternative communication (AAC) work toward achieving positive outcomes with AAC users. Yet, very little literature has critically examined conceptualizations of CC in AAC. Following an overview of the emergence of the concept of CC and of the field of AAC, we review seven conceptualizations of CC identified in the literature. AIMS: To consider the contributions and potential shortcomings of conceptualizations of CC in AAC. METHODS & PROCEDURES: We use a critical theoretical approach to review, critique and synthesize conceptualizations of CC in AAC, with a particular focus on uncovering 'taken for granted' assumptions. By historically situating the reviewed literature, we examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC and their potential impacts on practice. MAIN CONTRIBUTIONS: We suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC might shift ways of thinking about CC in AAC which tend to focus on the individual who communicates differently, toward (re)location of CC as a shared, socially incorporated and performed communication construct. CONCLUSION & IMPLICATIONS: We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC.

The iconicity of picture communication symbols for children with English additional language and mild intellectual disability.

The purpose of this study was to examine the iconicity of 16 Picture Communication Symbols (PCS) presented on a themed bed-making communication overlay for South African children with English as an additional language and mild intellectual disability. The survey involved 30 participants. The results indicated that, overall, the 16 symbols were relatively iconic to the participants. The authors suggest that the iconicity of picture symbols could be manipulated, enhanced, and influenced by contextual effects (other PCS used simultaneously on the communication overlay). In addition, selection of non-target PCS for target PCS were discussed in terms of postulated differences in terms of distinctiveness. Potential clinical implications and limitations of the study, as well as recommendations for future research, are discussed.