About augmentative and alternative communication

Augmentative and Alternative Communication (AAC) refers to a field of research, clinical, and educational practice (Beukelman & Mirenda, 2013) aimed at assisting individuals with severe communication disabilities who struggle to express themselves adequately using speech and/or struggle to comprehend spoken language. AAC describes communication methods that either supplement the speech of such individuals or provide a complete alternative way of communication – for those who cannot speak at all, e.g. after a brain stem stroke. AAC may also be implemented as an alternative or supplementary method of supporting comprehension. AAC therefore does not focus on improving speech as does traditional speech therapy, although it may sometimes be implemented alongside traditional speech therapy. Research has shown that AAC typically does not hinder the use or development of speech (Millar et al., 2006; Schlosser & Wendt, 2008).

AAC strategies and techniques include using natural gestures and signs from sign language in a keyword strategy (key word signing), using communication boards with a range of different symbols and using speech generating devices. As the ultimate goal is functional communication to enable full participation in all valued life activities, AAC intervention also focuses on overcoming barriers in the physical and social environment that may hinder communication and full participation – and this typically includes partner training and physical adjustments to the environment. Additionally, awareness creation and removal of practice and policy barriers are often necessary. This approach is congruent with the International Classification of Functioning, Disability and Health (ICF) (World Health Organization, 2001), where participation outcomes of a person result from the interaction between the person and his/her environment. This approach also articulates with a functional approach to intervention, that focuses on facilitating participation through environmental adjustments rather than focusing on ‘fixing’ the person (King et al., 2017; Law & Darrah, 2014).

Since many factors need to be addressed to ensure the successful implementation of AAC, various professionals are involved in AAC assessment and intervention, and the constellation of the team may change as clients transition between environments (e.g., health, education, home and the community) and/or as their skills change. Depending on the needs of the client and family, the following professionals, amongst others, may be involved:

• Speech-language therapist
• Occupational therapist
• Physiotherapist
• Rehabilitation engineer
• Teacher/special education teacher
• Computer technologist

In addition, the family and client him-/herself are integral team members, as may be personal carers/assistants.

Although professionals all have primary expertise in specific areas, this expertise should be integrated within a team approach in order to be able to address participatory goals that lead to improved well-being, rather than focusing on isolated skills in decontextualized situations. Professionals’ willingness to collaborate is key in ensuring successful AAC intervention (Binger & Kent-Walsh, 2010). Central to AAC implementation should be the client and the family.

The AAC expertise of different team members can vary considerably and is not predicted by profession. According to Burke et al. (2002), AAC specialists (i.e., those with a high level of AAC expertise) can include persons from various disciplinary backgrounds, such as special education, speech-language pathology, rehabilitation engineering and occupational therapy (p. 242).

The role of each professional on the AAC team is delineated by his/her professional scope of practice, as regulated by the professional board to whom that professional belongs.

References

Beukelman, D. R., & Mirenda, P. (2013). Augmentative and Alternative Communication: supporting children and adults with complex communication needs (4th ed.). Paul H. Brookes.

Binger, C., & Kent-Walsh, J. (2010). AAC assessment basics. In What every Speech-language pathologist / Audiologist should know about Augmentative and Alternative communication (pp. 36–43).

Burke, R., Beukelman, D. R., Ball, L., & Horn, C. A. (2002). Augmentative and alternative communication technology learning part 1: Augmentative and alternative communication intervention specialists. AAC: Augmentative and Alternative Communication, 18(4), 242–249. https://doi.org/10.1080/07434610212331281321

King, G., Imms, C., Stewart, D., Freeman, M., & Nguyen, T. (2017). A transactional framework for pediatric rehabilitation: shifting the focus to situated contexts, transactional processes, and adaptive developmental outcomes. Disability and Rehabilitation, 40(15), 1829–1841. https://doi.org/10.1080/09638288.2017.1309583

Law, M., & Darrah, J. (2014). Emerging therapy approaches: an emphasis on function. Journal of Child Neurology, 29(8), 1101–1107. https://doi.org/10.1177/0883073814533151

Millar, D. C., Light, J. C., & Schlosser, R. W. (2006). The impact of augmentative and alternative communication intervention on the speech production of inidviduals with developmental disabilities: a research review. Journal of Speech, Language and Hearing Research, 49, 248–264.

Schlosser, R. W., & Wendt, O. (2008). Effects of augmentative and alternative communication intervention on speech production in children with autism: a systematic review. American Journal of Speech-Language Pathology, 17(August), 212–230. https://doi.org/10.1044/1058-0360(2008/021)

World Health Organization. (2001). International classification of functioning, disability and health. Author.