A Right to Speak Supporting Individuals who use Alternative and Augmentative Communication

Appendix 1 Definition and Description of AAC

AAC refers to methods that augment or replace usual methods where an individual has no reliable means of communication. AAC is used to optimise communicative competence for people with communication difficulties. AAC may be aided - for example, by using symbol book or voice output communication aids - or it may be unaided - for example, using gestures or listener scanning. Furthermore, aided AAC is usually catergorised as either low-tech - for example, a picture symbol book - or high-tech - for example, using adapted mainstream technology such as personal computers with specialist software or dedicated voice output communication aids. It is a collective term that refers to methods of communication that supplement or replace traditional methods. A widely accepted definition⁴⁸ of AAC's presented in the box below:

Definition of AAC

'An integrated group of components, including the symbols, aids, strategies and techniques used by an individual to enhance communication'

Beukleman & Miranda (1998) adapted from definition by American Speech-Language-Hearing Association

The definition above encompasses all types of AAC, aided and unaided, high-tech and low tech. Crucially it is concerned with optimising communicative competence regardless of mode of delivery, i.e. spoken or written.

An individual may use more than one type of AAC device for different purposes or may have a low-tech system in place to back up a high-tech system when there is a technical failure. So for any one individual AAC can be a global term that refers to a multi-modal system.

An illustrated example of a multi-modal AAC system is presented below. Here an individual describes their AAC system. Ward⁴⁹ describes a mixture of high-tech and low-tech AAC aids, each used for different situational and communicative functions. The high-tech system is used at work with a preference for low-tech systems at home. Ward also demonstrates that AAC systems evolve as needs change. He describes how he is no longer able to access his laptop due to decreasing functional use of his knee and that he is exploring alternative high-tech systems for use at home.

Description of an AAC system

'I really like the Eyegaze system…. I have my Dectalk voice on it and people come in my office and chat with me.

Away from work I communicate with a letter board. I still have my laptop computer but my leg is so weak now I cannot reliably use it. I have an eye blink system I could use but I find the letter board suffices. There are now portable Eyegaze systems available and I'm starting to look at them'

Mike Ward, person with MND
Source: Fried-Oken & Bersani (2000)

Here a person with no understandable speech and physical disabilities can continue to communicate. Ward's use of the letter board described is heavily dependent on the listener taking a very active role in facilitating the communication and on having a skilled listener. The high-tech system allows the speaker to generate messages independently.

Low-tech AAC systems are generally developed for an individual and tailored to suit their specific needs. For example, a low-tech communication book for an individual with a learning disability and unintelligible speech may be topic based and include several sets of pictures specific to different settings, interests and everyday experiences. These low-tech systems are usually produced in the classroom, hospital or clinic by teachers and speech and language therapists using specialist computer software, a colour printer and a laminator. Symbols have to be taught and the number of symbols presented varies depending on levels of understanding, visual acuity and other factors.

Low-tech AAC systems need not always be person specific or be used for daily communication. Some, more generic, AAC frameworks can be utilised to support people with communication difficulties to express their views about specific topics or situations. An example of such an approach is the Talking Mats®⁵⁰ framework. Talking Mats has been developed in Scotland by research speech and language therapists at Stirling University (www.talkingmats.com) and has been validated as an approach to support communication for people with dementia, aphasia and learning disability amongst others.^{51,52, 53,54} An example of Talking Mats in action is provided below where a person is expressing views about activities in his life that he enjoys and does not enjoy. His completed mat can be photographed and provides a record for the individual and the listener. It can be used as a discussion point around feelings, expectations and needs, as well as to support intervention planning and outcome measurement. In this example he has used blanks to add that he enjoys painting and bird watching. Further sub mats can be done on the areas he wishes to explore in more detail.

Talking Mat ® in action

High-tech AAC systems are sometimes quite simple devices and, for example, may take the form of a device that records real speech and uses interchangeable screens so that messages can be continually updated to reflect the needs of the individual using them. For example, they can be particularly useful with young children who are developing listening and language skills. It would be usual to see such devices used in pre-school nursery where they can be programmed to enable the child to participate in particular aspects of the curriculum.

Some high-tech AAC devices are computer based voice output communication devices that produce digitised speech. These devices are often multi-functional in that as well as providing speech output they can be used as a computer interface device (for environmental controls and to send text messages). Accessing these devices can be via direct access by pressing a keyboard or screen, by direct access using head pointing or eye-gaze technology or by using indirect methods such a scanning via a switch. Increasingly mainstream technology offers solutions to meet an individual's high-tech AAC needs.