Questions and Answers on ACC

Rosemary Crossley, Ph.D

Individuals are described as having a severe communication impairment (SCI) when their speech and handwriting are insufficient to meet their communication needs. The term is usually used in relation to people with no speech or very little intelligible speech, but it may also be applied appropriately to people whose speech, while clear and fluent, is still not meaningful or representative of their real thoughts.

Impaired speech may be replaced or augmented by gesture and body language, hand signs, spelling, and specially developed communication aids. These strategies may all be described as augmentative communication, or AAC (which stands for Augmentative and Alternative Communication—‘augmentative’ communication is added on to speech, ‘alternative’ is used instead of speech).

Strategies for augmenting speech

Gesture and body language are used to some extent by almost everyone. Some formalized gestures, such as nodding the head for ‘yes’ and shaking for ‘no’, are powerful, but there are intrinsic limits on the sophistication of communication obtainable by gesture and body language alone. While a person may respond to questions or make basic needs understood with gestures, carrying on a conversation is virtually impossible.

Sign Language—hand signs are often taught to children with delayed speech. They are useful, but require good hand skills. Unfortunately many people with SCI have difficulty reproducing the sequences of fine movements necessary for signing (and handwriting). As a result, they often end up able to recognize many more signs than they can produce. And, of course, hand signs are only useful if everyone the child interacts with recognizes the signs.

The Picture Elicited Communication System (PECS) is a strategy aimed at encouraging children who find speech difficult, particularly children with autism, to initiate communication by taking a card with a picture or symbol of a wanted item to an adult. PECS is a useful strategy for getting basic needs met and avoiding frustration, but by itself it allows only limited communication, due to the obvious vocabulary limitations.

Communication aids are devices specifically developed or adapted for use by people with severe communication impairments. Because these people have very varied skills, needs and problems, there are many communication aids, ranging from simple communication boards to lap-top computers which speak. Some require literacy, but many do not.

Communication boards or books represent language in words, pictures or specially drawn symbols. There are many symbol systems (Blissymbols, Picyms, Compic, etc) but they all share the same limitation—a communication board user can only say what the person who assembled the board thought was necessary or suitable. It is impossible to provide enough symbols or phrases to cover all situations, and the larger the number of items the harder the system is to use.

VOCAS—voice output communication aids, are electronic communication aids which talk, either in synthetic speech or in digitized human speech. There are many of these, ranging from single-utterance devices to aids which contain thousands of utterances and text-to-speech devices which say anything which is typed.

Spelling gives people without fluent speech access to an unlimited vocabulary understood by most of the people with whom they come in contact. Spelt communication loses the inflection of speech and sign, but it is nonetheless the most empowering non-speech communication strategy. People who can spell but cannot write can use keyboards or alphabet cards.

Visual strategies include calendars, schedules, choiceboards and menus, transition/travel helpers, task organizers and so on. Providing information in a clear visual form may help some people with SCI to be sure about what is happening and what they are expected to do. Visual strategies foster the development of both literacy and independence skills, but they serve primarily an input role, providing information rather than being a means of expression, and should be used in conjunction with individualized expressive communication programs.

Where does Facilitated Communication come in?

Facilitated communication training is a strategy for teaching people who need to use AAC to use communication aids with their hands. In facilitated communication training (FCT) a communication partner (facilitator) helps a communication aid user overcome difficulties in hand use and develop functional movement patterns. The immediate aim is to allow the aid user to make choices and to communicate in a way that has been impossible previously. Practice using a communication aid such as a picture board, speech synthesizer, or keyboard in a functional manner is encouraged, to increase the user’s physical skills and self-confidence. As the student’s skills and confidence increase the amount of facilitation is reduced. The ultimate goal is for students to be able to use the augmentative communication strategies of their choice independently.

Facilitation is an access strategy which has to be used in conjunction with an appropriate communication aid. Like other access strategies, such as eye-pointing, expanded keyboards and single-switch scanning, it is an accommodation to physical problems designed to allow more individuals with SCI to make use of AAC.

Some Communication Aids

There are many different communication aids, all of which fit someone’s needs in some situations and none of which fit everyone’s needs or even one person’s needs all the time.

Here’s a list of some I find useful. This is a small selection from a very large field.

Low tech:

• YES/NO cards

• Opinion and multiple choice boards

• White boards

• Communication folders of words and sentences

• Spelling boards

• Diary containing personal information and conversation starters

Limited utterance high tech:

• Talk Trak wrist band—4 digitized utterances

• Message Mates with keyguards—limited vocabulary, digitized speech

• Dynamo—small aid with dynamic displays

• Cheaptalks—many versions—limited vocab., digitized speech

• Macaw—sophisticated aid with digitized speech

• Laptop with Speaking Dynamically Pro software, etc. etc.

Unlimited utterance high tech:

• Lightwriter with deep keyguard

• Dynamite—sophisticated aid with dynamic displays

• Polyana—pocket computer with voice

• Babar—hand held bar code reader

• Laptop with Words + software

• Vanguard, etc. etc.

Writing replacement

• Alphasmart keyboard—a mini-laptop with keyguard

• Laptop computer with Co-Writer word prediction and/or Intellitalk text to speech software

• Desktop computer with Co-Writer and/or Intellitalk software

• Intellikeys enlarged programmable keyboard—has to be used with a computer

• Polyana etc. etc.

Which aids when?

Worn during waking hours

Talk Trak wrist band: This talking wrist band holds 4 voice-recorded messages. It is an excellent way of attracting attention and quickly answering YES/NO questions. Its great advantage is that it is attached to the user. Its small keys are difficult for many people.

Multiples readily available in all settings

YES/NO cards: These are laminated cards with YES and NO printed on them. These should be on refrigerator, table, TV, in bathroom, on dash board etc. etc.—anywhere a quick yes/no answer would be helpful.

Whiteboards—accompanied by water-soluble or dry-erase makers, whiteboards are a great way of offering quick choices, both at home and at school. Laminated sheets of white paper make good whiteboards.

Opinion boards/Multiple choice boards: Opinion boards are boards which have a set of opinions written on them, e.g.

ROTTEN      SO-SO      OK      FINE      GREAT

Babar: The Babar is a small, hand held bar code reader. When it recognizes a code it speaks the message that a speaking person has previously recorded for that code. For example—you might stick a bar code strip on the door, and record “Could you open the door please?” The user, who is carrying the Babar, puts it on the code on the door when they want to go out.

Communication folder: A communication folder contains grids of words and phrases the user might want to say. Pictures can be used for young children or people with limited literacy. The folder is set up to enable quick communication of basic feelings and needs, and choicemaking. The front page of the folder leads to other grids e.g. if the user chooses I’m hungry their partner is directed to turn to Grid 2. If they then choose Why don’t we get takeout? The partner turns to Grid 7, which contains the names of favorite restaurants.

Diary: This serves the same function as an ordinary diary, in that it records both future and past events, however the idea is that past events have enough information written, as the user might write it, to act as a conversation starter e.g. I’ve been up in Syracuse, at a great conference on Facilitated Communication. The front of the diary can include named photos of the user’s family, friends and associates and important places, and more can be added as the year goes on.

Aids for writing set up in appropriate locations

Alphasmart: An Alphasmart is a stripped down laptop which is very portable. It can be used by itself or as a keyboard for a laptop or desktop computer. It can be raised on a stand and an excellent metal keyguard is available. The Link is an Alphasmart which speaks.

Laptop or desktop computers: These can be set up with Intellitalk II, a talking word processor, and/or Co-Writer 4000, a powerful word prediction program. Some people use enlarged keyboards such as the Intellikeys, especially with desktop computers, because they find these easier to use independently. Laptops can also be set up with specialist software such as EzyKeys by Words + or Speaking Dynamically Pro.

Polyana: The Polyana, marketed by Zygo, is a pocket computer to which a selection of voices has been added, along with word prediction software. This means you can do word processing and access email as well as talk.
 

Note of appreciation: Rosemary graciously gave us permission to re-print this handout from her preconference workshop presented April 28, 2002 at the Narrating dis/ABILITY Conference held at Syracuse University

Dr. Crossley's contact information:

 

Rosemary Crossley, Ph.D

DEAL Communication Centre

538 Dandenong Rd., Caulfield 3162 Australia

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A member of the University of Maine System

Updated: 01/11/2007