Augmentative and alternative communication (AAC) in pediatric cochlear implant recipients with complex needs: A scoping review.

INTRODUCTION: Augmentative and alternative communication (AAC) encompasses all forms of unaided and aided modes of communication, but typically excludes codified language such as spoken words or American Sign Language (ASL). In pediatric patients with a documented additional disability (population of interest), deficits in communication may pose a barrier to language development. While forms of AAC are frequently mentioned in the literature, recent innovations have permitted the use of high-tech AAC in the rehabilitation process. Our objective was to review the implementation of AAC in pediatric cochlear implant recipients with a documented additional disability. METHODS: A scoping review of existing literature examining the use of AAC in pediatric CI recipients was conducted in the PubMed/MEDLINE and Embase databases. Studies with pediatric cochlear implant recipients with a concomitant diagnosis requiring additional therapeutic intervention outside the scope of standard post-CI follow-up care and rehabilitation from 1985 to 2021 met inclusion criteria (population of interest). Studies limited to spoken or formal sign language (e.g., American Sign Language, ASL) as communication modalities were excluded. RESULTS: Four hundred twenty studies were screened of which 29 were included. 13 were prospective, 10 were retrospective, 1 was cross-sectional, and 5 were case reports. Of these 29 studies, 378 patients met the inclusion criteria (age <18, CI user, additional disability, utilized AAC). Fewer studies (n = 7) utilized AAC as the primary intervention for investigation. Autism spectrum disorder, learning disorder, and cognitive delay were frequently mentioned as additional disabilities in conjunction with AAC. Unaided forms of AAC included gesture/behavior, informal sign, and signed exact English, while aided AAC included a Picture Exchange Communication System (PECS), Voice Output Communication Aids (VOCA), and touchscreen programs such as TouchChat® HD. Various audiometric and language development outcome measures were mentioned, most commonly the Peabody Picture Vocabulary Test (PPVT) (n = 4) and the Preschool Language Scale, Fourth Edition (PLS-4) (n = 4). CONCLUSION: There is a gap in the literature regarding the use of aided and high-tech AAC in pediatric CI users with a documented additional disability. Given the use of multiple different outcome measures, additional exploration of the intervention of AAC is warranted.

Adaptation to Technology Use in Families of Children With Complex Communication Needs: An Integrative Review and Family Theory Application.

Families with children who have developmental disabilities and complex communication needs (CCNs) face challenging demands affecting family adaptation. Many children with CCNs use augmentative and alternative communication (AAC) devices to support communication, yet little is known about family adaptation to such technology. To fill this gap, an integrative review, guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation was conducted to assess conceptual foundations and the state of the science of family adaptation among children utilizing AAC. Web-based searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Mixed Methods Appraisal Tool. Thirty-three studies met eligibility. Findings demonstrated that to enhance the science underpinning family adaptation to AAC use, future research should be grounded conceptually and address important components of the Resiliency Model. Work in this emerging area will identify and facilitate nursing efforts to assist families as they adapt to communication technology.

Brain-computer interfaces for communication.

Locked-in syndrome (LIS) is characterized by an inability to move or speak in the presence of intact cognition and can be caused by brainstem trauma or neuromuscular disease. Quality of life (QoL) in LIS is strongly impaired by the inability to communicate, which cannot always be remedied by traditional augmentative and alternative communication (AAC) solutions if residual muscle activity is insufficient to control the AAC device. Brain-computer interfaces (BCIs) may offer a solution by employing the person's neural signals instead of relying on muscle activity. Here, we review the latest communication BCI research using noninvasive signal acquisition approaches (electroencephalography, functional magnetic resonance imaging, functional near-infrared spectroscopy) and subdural and intracortical implanted electrodes, and we discuss current efforts to translate research knowledge into usable BCI-enabled communication solutions that aim to improve the QoL of individuals with LIS.

'We were just kind of handed it and then it was smoke bombed by everyone': How do external stakeholders contribute to parent rejection and the abandonment of AAC systems?

BACKGROUND: There are multiple stakeholders involved in the introduction of augmentative and alternative communication (AAC) systems to children with complex communication needs. Stakeholders such as speech-language pathologists (SLPs) and teachers who are external to the family unit play a key role in planning and implementing interventions. If this intervention is unsuccessful, it can result in parent rejection or abandonment of the AAC system. However, no studies explore the contribution of external stakeholders to AAC rejection and abandonment from the perspective of parents who have experienced such unsuccessful interventions. AIMS: To explore parents' perceptions of how external stakeholders may contribute to the rejection or abandonment of an AAC system. METHODS & PROCEDURES: Data were collected as a part of a larger study that explored parent experiences of AAC rejection and abandonment. Within this study, semi-structured interviews were completed with 12 parents who had rejected or abandoned an AAC system introduced to their child with complex communication needs. Data related to external stakeholder contributions were extracted from the interview transcripts, and a thematic analysis was conducted. OUTCOMES & RESULTS: Analysis revealed four themes that captured the role of external stakeholders in the rejection and abandonment of AAC systems: (1) parents were influenced by the attitudes and experience of professionals; (2) parents did not feel supported by SLPs; (3) communication between stakeholders was not effective; and (4) parents had difficulties using AAC without a supportive community. CONCLUSIONS & IMPLICATIONS: This study highlights the importance of family-centred service delivery when introducing an AAC system to the parent of a child with complex communication needs. SLPs may support parent acceptance of AAC systems by using family-centred practices such as listening to parents, acknowledging their expertise and finding compromises.

Visual P300 Mind-Speller Brain-Computer Interfaces: A Walk Through the Recent Developments With Special Focus on Classification Algorithms.

Brain-computer interfaces are sophisticated signal processing systems, which directly operate on neuronal signals to identify specific human intents. These systems can be applied to overcome certain disabilities or to enhance the natural capabilities of human beings. The visual P300 mind-speller is a prominent one among them, which has opened up tremendous possibilities in movement and communication applications. Today, there exist many state-of-the-art visual P300 mind-speller implementations in the literature as a result of numerous researches in this domain over the past 2 decades. Each of these systems can be evaluated in terms of performance metrics like classification accuracy, information transfer rate, and processing time. Various classification techniques associated with these systems, which include but are not limited to discriminant analysis, support vector machine, neural network, distance-based and ensemble of classifiers, have major roles in determining the overall system performances. The significance of a proper review on the recent developments in visual P300 mind-spellers with proper emphasis on their classification algorithms is the key insight for this work. This article is organized with a brief introduction to P300, concepts of visual P300 mind-spellers, the survey of literature with special focus on classification algorithms, followed by the discussion of various challenges and future directions.

Expanding Communication Modalities and Functions for Preschoolers With Autism Spectrum Disorder: Secondary Analysis of a Peer Partner Speech-Generating Device Intervention.

Purpose This study reports a secondary analysis of the nature of communicative functions and modalities used in initiations and responses of minimally verbal preschoolers with severe autism spectrum disorder (ASD) from a previously published study (Thiemann-Bourque, Feldmiller, Hoffman, & Johner, 2018). This analysis focused on the final cohort (n = 6) from a group design study (N = 45) that examined a peer mediation and speech-generating device (SGD) intervention compared to an SGD-only condition. Method After teaching peers to use an iPad as an SGD within a modified stay-play-talk approach, school staff implemented SGD instruction in child-peer dyads during typical preschool activities. To investigate individual differences among children who demonstrated increased communication acts in the peer + SGD condition, changes in reciprocity, modalities used, and communicative functions were examined using a multiple-baseline design across children. Fidelity of implementation and social validity data were also collected. Results Six children with ASD and their peers demonstrated more balanced reciprocity, with individual differences in how and why children communicated during exchanges. That is, all children with ASD increased in SGD use as their primary communication mode; 3 children used different modalities including more speech, and 3 children used primarily gestures and SGD. The most frequent function expressed was requests for objects. More modest increases were observed in comments and requests for actions, with negligible changes in gaining attention. Social validity reports by naïve judges reflected clear improvements in communication interactions. Conclusion Findings are promising for a preschool SGD intervention that can expand children's modalities and communicative functions to engage in balanced exchanges with peer partners. Supplemental Material https://doi.org/10.23641/asha.11374203.

A shared code for Braille and Arabic digits revealed by cross-modal priming in sighted Braille readers.

Quantities can be represented by different formats (e.g. symbolic or non-symbolic) and conveyed via different modalities (e.g. tactile or visual). Despite different priming curves: V-shape and step-shape for place and summation coded representation, respectively, the occurrence of priming effect supports the notion of different format overlap on the same mental number line. However, little is known about tactile-visual overlap of symbolic numerosities i.e. Braille numbers to Arabic digits on the magnitude number representation. Here, in a priming experiment, we tested a unique group of sighted Braille readers to investigate whether tactile Braille digits would activate a place-coding type of mental number representation (V-shape), analogous to other symbolic formats. The primes were either tactile Braille digits presented on a Braille display or number words presented on a computer screen. The targets were visually presented Arabic digits, and subjects performed a naming task. Our results reveal a V-shape priming function for both prime formats: tactile Braille and written words representing numbers, with strongest priming for primes of identical value (e.g. "four" and "4"), and a symmetrical decrease of priming strength for neighboring numbers, which indicates that the observed priming is due to identity priming. We thus argue that the magnitude information is processed according to a shared phonological code, independent of the input modality.

Brain-computer interfaces and personhood: interdisciplinary deliberations on neural technology.

OBJECTIVE: Scientists, engineers, and healthcare professionals are currently developing a variety of new devices under the category of brain-computer interfaces (BCIs). Current and future applications are both medical/assistive (e.g. for communication) and non-medical (e.g. for gaming). This array of possibilities has been met with both enthusiasm and ethical concern in various media, with no clear resolution of these conflicting sentiments. APPROACH: To better understand how BCIs may either harm or help the user, and to investigate whether ethical guidance is required, a meeting entitled 'BCIs and Personhood: A Deliberative Workshop' was held in May 2018. MAIN RESULTS: We argue that the hopes and fears associated with BCIs can be productively understood in terms of personhood, specifically the impact of BCIs on what it means to be a person and to be recognized as such by others. SIGNIFICANCE: Our findings suggest that the development of neural technologies raises important questions about the concept of personhood and its role in society. Accordingly, we propose recommendations for BCI development and governance.

Eye Tracking Measures Reveal How Changes in the Design of Displays for Augmentative and Alternative Communication Influence Visual Search in Individuals With Down Syndrome or Autism Spectrum Disorder.

Purpose This research note reports on how small changes to the organization of a simulated display for augmentative and alternative communication influence the visual search patterns of individuals with Down syndrome or autism, as measured through eye tracking technologies. Prior research had demonstrated that clustering symbols by their internal color facilitates search and reduces attention to distracters, in children with typical development. This research systematically replicated the procedures with individuals with Down syndrome or autism spectrum disorder. Method Participants engaged in a visual search task on a monitor with embedded automated eye tracking technology. Patterns of gaze during search were measured via this technology. Results Participants were significantly faster to fixate on the target and to select it with the mouse when the like-colored symbols were clustered together. In addition, participants were significantly less likely to fixate on distracters in the clustered condition. No group differences were found. Conclusions Small changes to the organization of the simulated augmentative and alternative communication display resulted in substantial differences in eye gaze and speed to find a target. Of greatest clinical import is the finding that clustering symbols reduced attention to distracters, given that individuals with disabilities may be prone to distraction.

Impact of Speller Size on a Visual P300 Brain-Computer Interface (BCI) System under Two Conditions of Constraint for Eye Movement.

The vast majority of P300-based brain-computer interface (BCI) systems are based on the well-known P300 speller presented by Farwell and Donchin for communication purposes and an alternative to people with neuromuscular disabilities, such as impaired eye movement. The purpose of the present work is to study the effect of speller size on P300-based BCI usability, measured in terms of effectiveness, efficiency, and satisfaction under overt and covert attention conditions. To this end, twelve participants used three speller sizes under both attentional conditions to spell 12 symbols. The results indicated that the speller size had, in both attentional conditions, a significant influence on performance. In both conditions (covert and overt), the best performances were obtained with the small and medium speller sizes, both being the most effective. The speller size did not significantly affect workload on the three speller sizes. In contrast, covert attention condition produced very high workload due to the increased resources expended to complete the task. Regarding users' preferences, significant differences were obtained between speller sizes. The small speller size was considered as the most complex, the most stressful, the less comfortable, and the most tiring. The medium speller size was always considered in the medium rank, which is the speller size that was evaluated less frequently and, for each dimension, the worst one. In this sense, the medium and the large speller sizes were considered as the most satisfactory. Finally, the medium speller size was the one to which the three standard dimensions were collected: high effectiveness, high efficiency, and high satisfaction. This work demonstrates that the speller size is an important parameter to consider in improving the usability of P300 BCI for communication purposes. The obtained results showed that using the proposed medium speller size, performance and satisfaction could be improved.

Augmentative and alternative communication improves quality of life in the early stages of amyotrophic lateral sclerosis.

This study aimed to evaluate the efficacy of low-tech augmentative and alternative communication (AAC) aids in improving quality of life (QoL) and mood disorders, as well as the psychosocial impact of assistive devices, in 10 patients affected by amyotrophic lateral sclerosis (ALS) in the early stage of the disease, when speech difficulties appear. The AACtraining (AAC-T) study lasted around six months and comprised two phases of three months each: AAC-intervention (AAC-I) followed by AAC-familiarization (AAC-F). All the patients were assessed at the beginning (T0) and at the end (T1) of AAC-I, as well as at the end of AAC-F (T2). During the AAC-I phase, we applied a three-phase AAC intervention model to evaluate intelligibility of language, participation patterns, communication needs and adaptation to the AAC tools. All the patients showed a gradual and significant improvement, especially in acceptance of the AAC aids, mood and QoL. Moreover, a reduction of caregiver burden was noted. Our study has demonstrated the utility of the AAC aids also in the early stages of the disease in patients with ALS presenting with dysarthria. In our opinion, AAC-T may act as a bridge between the initial and later phases of the disease, when patients need to use high-tech aids, including an eye-tracking communication device. In conclusion, in this study we highlighted how early AAC-T in patients with ALS may be a valuable tool to demonstrate how specific strategies and low-technology aids can improve QoL of these patients and their caregivers, also decreasing stress and depression.

Computer and internet use among people with long-standing spinal cord injury: a cross-sectional survey in the Netherlands.

STUDY DESIGN: Cross-sectional survey OBJECTIVES: To describe computer and Internet use (other than for work or study) among people with long-standing spinal cord injury (SCI), examine associations between demographic and lesion characteristics and Internet use, and examine associations between Internet use and mental health, participation, and life satisfaction. SETTING: Community, The Netherlands METHODS: Participants were 265 individuals living with SCI for at least 10 years, who were 18-35 at the onset of SCI, aged 28-65 at the time of the study and wheelchair-user. Scales for General and Health-related Internet use were developed. RESULTS: Nearly all (97.7%) participants had Internet access and 98.4% of those used it daily or weekly. Of those with tetraplegia, 47.4% had assistive devices for computer use. General Internet use, such as following news and online banking, was very frequent. Websites with information on general health or accessibility were typically visited a few times a year. Three-quarters never visited websites of other individuals with SCI or foreign websites with information on SCI. General Internet use was associated with male gender, younger age, and higher education. Participants with tetraplegia scored higher on Health-related Internet use compared to participants with paraplegia. Health-related Internet use was associated with worse participation, but not with the other psychosocial variables. CONCLUSION: Internet has become part of daily life of people with SCI in the Netherlands. However, only one association between Internet use and indicators of psychosocial functioning was found. Possible underuse of adaptive devices and of SCI-specific websites warrant further investigation.

Augmentative and Alternative Communication use: family and professionals' perceptions of facilitators and barriers. / A Comunicação Suplementar e Alternativa na percepção de familiares e fonoaudiólogos: facilitadores e barreiras.

PURPOSE: To investigate the facilitators and barriers involved in the use of Augmentative and Alternative Communication (AAC) by people with complex communication needs in social and therapeutic environments under family members/caregivers and speech-language pathologists (SLP) perceptions. METHODS: This is a transversal quantitative and qualitative study with 20 family members/caregivers (FCG) and 20 SLP (SLPG). The data was collected by semistructured interviews with specific questionnaires for each group; recorded and transcribed for further analysis. Data was categorized in thematic axes, categories and subcategories, using recurrent and salient criteria. The two most important topics were: barriers and facilitators. RESULTS: Both groups indicate as barriers: high material cost, using other ways to communicate, family member as interpreter, language and cognitive deficits, acceptance of AAC for users and family members, lack of comprehension of AAC and family perceptions of AAC as speech suppress. As facilitators, both groups indicate the use of high technology, versatility and availability of AAC systems, family adherence and engagement, contextualized use of AAC outside of therapeutic contexts and the importance of therapeutic setting and team support. CONCLUSION: In this way, the main interlocutors in AAC implementation, professionals or family members can be barriers when they make it difficult for users to exercise their autonomy in communication, or facilitators when they encourage and use AAC with users.

OBJETIVO: Conhecer facilitadores e barreiras no uso da Comunicação Suplementar e Alternativa (CSA) na percepção de familiares/cuidadores e fonoaudiólogos que atuam com pessoas usuárias de CSA nos contextos familiar, social e terapêutico. MÉTODO: Estudo transversal quantitativo e qualitativo com 20 fonoaudiólogos (GF) e 20 familiares e/ou cuidadores de usuários de CSA (GFC). Realizou-se a coleta de dados por meio de entrevistas semiestruturadas com questionários específicos para cada grupo, videogravadas e transcritas para análise. Os dados foram categorizados, conforme critérios de relevância e repetição, em dois eixos temáticos principais: barreiras e facilitadores, contendo categorias e subcategorias. RESULTADOS: Ambos os grupos apontaram como barreiras: custo dos materiais, utilização de outras formas de comunicação, familiar como intérprete, dificuldades linguístico-cognitivas e de aceitação de uso da CSA pelos usuários, falta de compreensão/conhecimento da CSA pelos familiares e inibição da fala na percepção dos familiares. Ambos indicaram como facilitadores: utilização de recursos de alta tecnologia, versatilidade/disponibilidade, envolvimento/adesão familiar, uso contextualizado, importância do ambiente terapêutico, equipe e estratégias utilizadas. CONCLUSÃO: Os principais interlocutores na implementação da CSA, profissionais ou familiares, podem se constituir como barreiras quando dificultam os usuários de exercer sua autonomia na comunicação ou facilitadores quando incentivam e utilizam a CSA com os usuários.

Incorporating a Peer-Mediated Approach Into Speech-Generating Device Intervention: Effects on Communication of Preschoolers With Autism Spectrum Disorder.

Purpose: This study examined the effects of incorporating a peer-mediated approach into a speech-generating device (SGD) intervention on communication of 45 nonverbal and minimally verbal preschoolers with autism spectrum disorder (ASD) and 95 peers without disabilities. The SGD was an iPad 2 (Apple) with voice output app. Method: Effects were evaluated using a multivariate randomized control trial design with repeated measures for 4 cohorts across baseline, intervention, generalization, and maintenance phases. Children were randomly assigned to an experimental treatment that trained peers on use of the SGD or a business-as-usual comparison condition with untrained peers. Communication outcomes were measured for both children with ASD and peers. Results: Children receiving the treatment demonstrated significant increases in rates of communication and more balanced responses and initiations (a measure of reciprocity) than children in the comparison group. They were able to generalize improvements and maintain communication gains. Treatment fidelity was high for school staff and peer implementation. Conclusions: Results support positive effects on communication of teaching young children with ASD and peers without disabilities to use the same SGD system in typical preschool activities. SGD interventions that utilize peer-mediated approaches may improve core deficits in communication and reciprocity and allow for greater classroom social participation and interactions with peers.

Effects of Interventions That Include Aided Augmentative and Alternative Communication Input on the Communication of Individuals With Complex Communication Needs: A Meta-Analysis.

Purpose: The purpose of this meta-analysis was to investigate the effects of augmentative and alternative communication (AAC) interventions that included aided AAC input (e.g., aided AAC modeling, aided language modeling, aided language stimulation, augmented input) on communicative outcomes (both comprehension and expression) for individuals with developmental disabilities who use AAC. Method: A systematic search resulted in the identification of 26 single-case experimental designs (88 participants) and 2 group experimental designs (103 participants). Studies were coded in terms of participants, intervention characteristics, dependent variables, outcomes, and quality of evidence. Results: AAC interventions that included aided AAC input in isolation, or as part of a multicomponent intervention, were found to be highly effective across participants of various ages, disabilities, and language skills. The interventions typically included aided AAC input in conjunction with expectant delay, direct prompting (e.g., spoken, gestural), contingent responding, and open-ended questions. The interventions were found to be highly effective in supporting both comprehension and expression across the domains of pragmatics, semantics, and morphosyntax. Outcomes related to expression were reported more often than outcomes related to comprehension. Conclusion: Aided AAC input may reduce input-output asymmetry and enhance expression and comprehension for individuals who use AAC; the evidence suggests that partners should utilize this strategy. Future research is needed to investigate the effects of AAC input (aided and unaided) on long-term language development for individuals who require AAC. Supplemental Material: https://doi.org/10.23641/asha.6394364.

The Role of Cognition on Navigational Skills of Children and Adolescents With Autism Spectrum Disorders.

Purpose: This study examined the role of cognition on the navigational process of a speech-generating device (SGD) among individuals with a diagnosis of autism spectrum disorder (ASD). The objective was to investigate the role of various cognitive factors (i.e., cognitive flexibility, sustained attention, categorization, fluid reasoning, and working memory) on the ability to navigate an SGD with dynamic paging and taxonomic grids in individuals with ASD. Method: Twenty individuals aged 5 to 20 years with ASD were assessed using the Leiter International Performance Scale-Revised (Roid & Miller, 1997) and the Automated Working Memory Assessment (Alloway, 2007). They also completed a navigational task using an iPad 4 (Apple, 2017; taxonomic organization). Results: Significant correlations between all of the cognitive factors and the ability to navigate an SGD were revealed. A stepwise linear regression suggested that cognitive flexibility was the best predictor of navigational ability with this population. Conclusion: The importance of cognition in the navigational process of an SGD with dynamic paging in children and adolescents with ASD has been highlighted by the results of this study.

Smartphone for smart living: Using new technologies to cope with everyday limitations in semantic dementia.

New technologies have considerable potential to support people with semantic dementia-a form of progressive aphasia-in their everyday lives, but evidence is still sparse. The first objective of the study was to document day-to-day compensation strategies, including the use of a smartphone, in ND, a 56-year-old man with semantic dementia. The second objective was to explore if, 5 years after receiving his diagnosis, ND could still learn new smartphone functions. Results for objective 1 showed that ND had adopted a large number of compensation mechanisms in his everyday life, and expanded the use of one application he had learned 4 years earlier. Results for objective 2 showed that, with an errorless learning approach, he learnt to effectively use 10 smartphone functions. He was also able to verbalise semantic knowledge about those functions and still used 40% of them in daily life 6 months post-intervention. He particularly appreciated note-taking, and spontaneously expanded his abilities in using this function's features in order to reduce his semantic difficulties. This study shows the potential of new mobile technologies for semantic dementia, how they can be adapted and modified as the disease progresses, and how some patients can creatively use external technological aids.

A Comunicação Suplementar e Alternativa na percepção de familiares e fonoaudiólogos: facilitadores e barreiras / Augmentative and Alternative Communication use: family and professionals' perceptions of facilitators and barriers

RESUMO Objetivo Conhecer facilitadores e barreiras no uso da Comunicação Suplementar e Alternativa (CSA) na percepção de familiares/cuidadores e fonoaudiólogos que atuam com pessoas usuárias de CSA nos contextos familiar, social e terapêutico. Método Estudo transversal quantitativo e qualitativo com 20 fonoaudiólogos (GF) e 20 familiares e/ou cuidadores de usuários de CSA (GFC). Realizou-se a coleta de dados por meio de entrevistas semiestruturadas com questionários específicos para cada grupo, videogravadas e transcritas para análise. Os dados foram categorizados, conforme critérios de relevância e repetição, em dois eixos temáticos principais: barreiras e facilitadores, contendo categorias e subcategorias. Resultados Ambos os grupos apontaram como barreiras: custo dos materiais, utilização de outras formas de comunicação, familiar como intérprete, dificuldades linguístico-cognitivas e de aceitação de uso da CSA pelos usuários, falta de compreensão/conhecimento da CSA pelos familiares e inibição da fala na percepção dos familiares. Ambos indicaram como facilitadores: utilização de recursos de alta tecnologia, versatilidade/disponibilidade, envolvimento/adesão familiar, uso contextualizado, importância do ambiente terapêutico, equipe e estratégias utilizadas. Conclusão Os principais interlocutores na implementação da CSA, profissionais ou familiares, podem se constituir como barreiras quando dificultam os usuários de exercer sua autonomia na comunicação ou facilitadores quando incentivam e utilizam a CSA com os usuários.

ABSTRACT Purpose To investigate the facilitators and barriers involved in the use of Augmentative and Alternative Communication (AAC) by people with complex communication needs in social and therapeutic environments under family members/caregivers and speech-language pathologists (SLP) perceptions. Methods This is a transversal quantitative and qualitative study with 20 family members/caregivers (FCG) and 20 SLP (SLPG). The data was collected by semistructured interviews with specific questionnaires for each group; recorded and transcribed for further analysis. Data was categorized in thematic axes, categories and subcategories, using recurrent and salient criteria. The two most important topics were: barriers and facilitators. Results Both groups indicate as barriers: high material cost, using other ways to communicate, family member as interpreter, language and cognitive deficits, acceptance of AAC for users and family members, lack of comprehension of AAC and family perceptions of AAC as speech suppress. As facilitators, both groups indicate the use of high technology, versatility and availability of AAC systems, family adherence and engagement, contextualized use of AAC outside of therapeutic contexts and the importance of therapeutic setting and team support. Conclusion In this way, the main interlocutors in AAC implementation, professionals or family members can be barriers when they make it difficult for users to exercise their autonomy in communication, or facilitators when they encourage and use AAC with users.

Ir al médico sin miedo: www. doctortea. org para la habituación al entorno médico de pacientes con autismo (AU) / Seeing the doctor without fear: www. doctortea. org for the desensitization for medical visits in Autism Spectrum Disorders

Introducción. Doctor Tea es una página web diseñada para facilitar las visitas médicas de las personas con trastornos del espectro del autismo y/o con otras discapacidades. Las personas con autismo en muchas ocasiones no solo tienen mayores necesidades médicas que la población general, sino que presentan, además, unas características particulares que hacen que acceder a los servicios médicos se convierta en una experiencia muy complicada e incluso a veces traumática. Estas personas tienen grandes dificultades para comprender situaciones y contextos con implicación social como una prueba o consulta médica; dificultad para tolerar situaciones nuevas; y umbrales sensoriales atípicos. Doctor Tea tiene como objetivo reducir la ansiedad ante consultas, procedimientos y profesionales médicos desde un ambiente seguro y conocido (colegio, casa, etc.). Material y método. La página www.doctortea.org proporciona información y materiales (videos, dibujos animados, animaciones 3D, secuencias de pictogramas, etc.) sobre las prácticas médicas más frecuentes a las que los pacientes con trastornos del espectro del autismo se tienen que enfrentar. También ofrece información a los médicos sobre las características de estos pacientes y a las familias sobre los problemas médicos más frecuentemente asociados. Resultados. Durante el año 2015, 17.199 usuarios diferentes visitaron la web. Desde su lanzamiento en noviembre de 2014 el número de visitantes fue de 23.348 personas procedentes de más de 70 países diferentes. Conclusiones. La familiarización con el entorno y los procedimientos médicos parece disminuir la ansiedad frente a los mismos y permite optimizar la eficacia de las visitas médicas y las pruebas complementarias que las personas con discapacidad necesitan (AU)

Introduction. Doctor Tea is an online website designed to facilitate medical visits for those with autism spectrum disorder and other disabilities. People diagnosed with autism not only have greater medical needs than the general population, but also have particular characteristics that are often not accommodated by medical services. This lack of medical accommodation often creates a very complicated, and sometimes traumatic experience, when visiting medical facilities. Individuals with autism have great difficulty understanding social situations and contexts, such as medical tests or consultations, as well as difficulty in tolerating new situations and atypical sensory thresholds. Doctor Tea aims to reduce anxiety before medical consultations and procedures from a safe and well-known environment (school, home, etc.). Material and Method. The website, www.doctortea.org, provides information and materials (videos, cartoon, 3D animations, pictogram sequences, etc.) about the most frequent medical procedures and practices for patients with autism. The website also offers information to the doctors and families of patients with autism about the most common medical problems associated with autism. Results. A total of 17,199 different users visited the website during 2015, with a total of 23,348 online visitors from more than 70 different countries since the website's release in November 2014. Conclusions. The familiarisation with the medical procedures and its environment appears to decrease the anxiety in patients with disabilities during medical visits, as well as optimising the effectiveness of their medical visits and tests (AU)