Designing effective AAC displays for individuals with developmental or acquired disabilities: State of the science and future research directions.

This paper reviews research on the impact of AAC display variables on visual attention and performance of children with developmental disabilities and adults with acquired conditions, and considers implications for designing effective visual scene displays (VSDs) or grids. When using VSDs with children with developmental disabilities or adults with acquired conditions, research supports the use of personalized photo VSDs that include familiar people engaged in meaningful activities, with navigation bars with thumbnail VSDs, located adjacent to the main VSD. Adults with acquired conditions seem to benefit from the inclusion of text boxes adjacent to the scene. Emerging evidence supports the use of motion to capture visual attention to VSDs (video VSDs) or to specific elements in VSDs. When using grid displays with children with developmental disabilities, research supports the use of spatial cues and clustering based on internal symbol colour to facilitate visual searching and selection. Background colour does not seem to facilitate searching for symbols on smaller displays, and may actually distract children from processing the meaningful components of symbols. Preliminary research suggests that the organization of onscreen keyboards and the number, types, and pairings of symbols in grids may impact performance of adults with acquired conditions. Directions for future research are discussed.

Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs.

The field of augmentative and alternative communication (AAC) has witnessed significant changes since its inception. AAC services are now considered for a much greater number of individuals with complex communication needs and there are many more AAC options available as communication supports, including a proliferation of technologies. The scope and options for communication within society have increased substantially to include a wide array of digital and social media. Individuals with complex communication needs have increased expectations for participation and engagement across a full range of environments-education, employment, family, healthcare, and community living. Despite these advances, there remain critical challenges that must be addressed. This paper discusses key advances in the AAC field, delineates challenges, and discusses future directions to address these challenges, specifically as they relate to research and development to enhance AAC interventions and technologies for individuals with complex communication needs and their families.

Speech Recognition for Environmental Control: Effect of Microphone Type, Dysarthria, and Severity on Recognition Results.

This study examines the use of commercially available automatic speech recognition (ASR) across microphone options as access to environmental control for individuals with and without dysarthria. A study of two groups of speakers (typical speech and dysarthria), was conducted to understand their performance using ASR and various microphones for environmental control. Specifically, dependent variables examined included attempts per command, recognition accuracy, frequency of error type, and perceived workload. A further sub-analysis of the group of participants with dysarthria examined the impact of severity. Results indicated a significantly larger number of attempts were required (P = 0.007), and significantly lower recognition accuracies were achieved by the dysarthric participants (P = 0.010). A sub-analysis examining severity demonstrated no significant differences between the typical speakers and participants with mild dysarthria. However, significant differences were evident (P = 0.007, P = 0.008) between mild and moderate-severe dysarthric participants. No significant differences existed across microphones. A higher frequency of threshold errors occurred for typical participants and no response errors for moderate-severe dysarthrics. There were no significant differences on the NASA Task Load Index.

Preference and visual cognitive processing demands of alphabetic and QWERTY keyboards of individuals with and without brain injury.

Following a severe brain injury (BI), some literate individuals who require augmentative and alternative communication (AAC) strategies to support communication may benefit from the use of onscreen keyboards to generate text. A range of layouts are available to these individuals within specialized communication software. However, a paucity of information is available to describe user preferences, user perceptions, as well as the visual-cognitive processing demands of such layouts. Such information is critical to guide clinical decision-making for keyboard selection and to provide patient-centered services. This study: (a) described the preferences and perceptions of two onscreen keyboard layouts (QWERTY and alphabetic) and (b) used eye-tracking analysis to investigate the visual-cognitive processing demands between these onscreen keyboards for individuals with and without BI. Results indicated participants in both groups held a strong preference for QWERTY keyboard interfaces and had extensive prior experience using the QWERTY keyboard layout on mobile devices. Eye-tracking analysis revealed less visual-cognitive processing demands using a QWERTY keyboard layout for both groups but were only statistically significant for those without BI. Results suggest that use of a keyboard layout that aligns with client preferences and prior experiences (i.e., the QWERTY keyboard for these participants) may lead to increased satisfaction with the communication experience and increased communication efficiency.

Personalization of Patient-Provider Communication Across the Lifespan.

People with disabilities are more likely to be hospitalized and use healthcare services relative to people without disabilities. They also report experiencing negative experiences interacting with health care providers during these encounters placing them at risk for preventable adverse medical events, poor quality of life, and dependence on others. Fortunately, providers and people with communication disabilities can take steps to improve these interactions by personalizing and implementing communication supports to empower people with communication disabilities to actively participate in these interactions and improve outcomes. The purpose of this article is to describe strategies that health care providers can use to develop and implement personalized communication supports for children and adults with communication disorders during health care interactions. Additional strategies are provided to guide people with disabilities as well as their community/school providers and families to prepare for health care interactions. Case examples are provided to illustrate use of these strategies in acute care, inpatient rehabilitation, and outpatient settings. The use of emerging training tools (e.g., video visual scene displays) and AAC partner training formats (e.g., just-in-time training) are also presented as future directions to expedite learning and implementation of communication supports in fast-paced and time-limited health care interactions.

Personalization of Visual Scene Displays: Preliminary Investigations of Adults with Aphasia, Typical Females across the Age-Span, and Young Adult Males and Females.

Visual scene displays (VSDs) are becoming an increasingly popular method of message representation within augmentative and alternative communication (AAC) supports; however, design factors can influence the effectiveness of these images as communication supports. One issue that has come to light in recent years is the fact that selecting personalized VSDs, which depict the person with complex communication needs or an individual with whom they are familiar, are preferred over generic VSDs, which depict unfamiliar individuals. Although personalization is likely an important factor in the usability of VSDs, these images may be difficult for clinicians to obtain. As such, compromises must be identified. The purpose of this study was to explore the effects of controlling personal relevance factors (i.e., age and gender of the people depicted in generic VSDs) on the image preference patterns of adults with and without aphasia. Results from three very preliminary study summaries indicate that gender and age are both mitigating factors in image preference, as males tended to indicate preference for VSDs containing males over those containing females. In addition, females tended to indicate preference for females of a similar age depicted in VSDs.

Perceived importance of AAC messages to support communication in rehabilitation settings.

PURPOSE: Permanent or temporary speech loss can occur due to a variety of medical conditions and often requires individuals to use augmentative and alternative communication (AAC) strategies and technologies to support communication. The use of AAC in medical and rehabilitation settings is critical to ensure the health, safety and psychological well-being of communicatively vulnerable individuals. METHOD: This study surveyed the perceived importance of communication messages within five categories (Basic Needs, Patient-Provider Specific Communication, Social, Feelings, and Messages for Young Children) by individuals with disability who have undergone recent medical care as well as by rehabilitation care providers. RESULTS: Results indicated that, with only a few exceptions, participants with disability more frequently selected all of the messages listed under the Patient-Provider Specific, Social, and Feelings categories compared to rehabilitation care providers' responses. Additionally, the individuals with disabilities selected messages that were more personalised to their specific care needs under Basic Needs. Both participant groups were asked to also suggest other messages that they perceived as important under each category. The other suggested messages demonstrated the potential need to provide personalisation to AAC displays to best meet the communication needs of individuals with disability.Implications for RehabilitationThere is a critical need for individuals who find themselves in medical settings (ICU, acute care hospital, rehabilitation hospital, etc.) to be able to communicate. This study provides preliminary information on the breadth of communication content that is perceived as relevant by individuals with disability and rehabilitation care providers. The need to provide personalized as well as a wide range of communication content options was of particular importance to individuals with disability. This information may provide specific guidance on how to best develop augmentative and alternative communication options for individuals in medical settings.

Integrating end-user feedback in the concept stage of development of a novel sensor access system for environmental control.

PURPOSE: This article illustrates user-centred design of a novel sensor access system for environmental control in the concept stage of development. METHODS: Focus groups of individuals with disabilities and rehabilitation healthcare professionals were provided with video illustration of the technology and asked to provide quantitative and qualitative feedback through a semistructured interview process. Qualitative methods were employed to analyse transcribed comments to develop themes supporting ongoing development of the technology. RESULTS: Both end-user streams rated the original design features of the sensor access system (alternative interface to assistive technologies, having wireless capabilities and not requiring batteries) as having high potential value. Both groups identified a need for the future design of the sensor technology to be able to capture minimal/reduced movements for those with severe physical impairments. Themes included (1) the sensor technology could be individualized/customized to accommodate the user, (2) minimal positioning and set-up requirement and (3) technology that alleviated problems encountered with touch-based solutions. CONCLUSIONS: Inclusion of end-user feedback provided the research team with valuable information that supported the initial conceptualization of the design features of the technology and provided valuable data to support development of a new prototype that can capture more reduced/minimal movements. Implication for Rehabilitation User-centered design of assistive technology is essential to the development of technology that can meet the unique needs of those with the most severe physical impairments. New sensor technology may alleviate some of the access challenges faced by individuals with severe physical impairments. Collaboration between all key stakeholders (individuals with disabilities, rehabilitation professionals, researchers, and developers) is an essential component in the iterative assistive technology design process.

Patients' experiences with technology during inpatient rehabilitation: opportunities to support independence and therapeutic engagement.

PURPOSE: To understand individuals' perceptions of technology use during inpatient rehabilitation. METHOD: A qualitative phenomenological study using semi-structured interviews of 10 individuals with diverse underlying diagnoses and/or a close family member who participated in inpatient rehabilitation. RESULTS: Core themes focused on assistive technology usage (equipment set-up, reliability and fragility of equipment, expertise required to use assistive technology and use of mainstream technologies) and opportunities for using technology to increase therapeutic engagement (opportunities for practice outside of therapy, goals for therapeutic exercises and technology for therapeutic exercises: motivation and social interaction). CONCLUSION: Interviews revealed the need for durable, reliable and intuitive technology without requiring a high level of expertise to install and implement. A strong desire for the continued use of mainstream devices (e.g. cell phones, tablet computers) reinforces the need for a wider range of access options for those with limited physical function. Finally, opportunities to engage in therapeutically meaningful activities beyond the traditional treatment hours were identified as valuable for patients to not only improve function but to also promote social interaction. IMPLICATIONS FOR REHABILITATION: Assistive technology increases functional independence of severely disabled individuals. End-users (patients and families) identified a need for designs that are durable, reliable, intuitive, easy to consistently install and use. Technology use (adaptive or commercially available) provides a mechanism to extend therapeutic practice beyond the traditional therapy day. Adapting skeletal tracking technology used in gaming software could automate exercise tracking, documentation and feedback for patient motivation and clinical treatment planning and interventions.