Assistive Technology
What are Augmentative and Alternative Communication Devices?
Imagine not being able to alert someone in an emergency, tell a doctor what part of your body hurts, or communicate what you want to eat or wear. Many people with cerebral palsy do not have to imagine these frustrations. Without Augmentative and Alternative Communication (AAC) devices, they would be unable to communicate.
The speech of some people with cerebral palsy is difficult to understand; others are unable to speak at all. The problem is not that these individuals can’t understand what other people say or that they can’t formulate language. The problem is in the delivery of speech, caused by damage to the part of the brain that transmits language thoughts to the mouth muscles. This brain damage may result in muscle spasticity and/or weakness in the lips, jaw and tongue just as it does in other parts of the body; this is called dysarthia. The brain damage might also cause problems in the brain’s ability to transmit instructions to the body parts used to speak; this is called apraxia.
For years people with cerebral palsy who had communication difficulties were not considered to be intelligent or capable of interacting with the world. Ruth Sienkiewicz-Mercer was placed in a state institution in 1962 at the age of 12. She stayed there for the next 16 years with minimal education. When a worker there carelessly transferred her and broke her leg, Ruth was unable to communicate that her hip was also injured. Her hip injury was not discovered for more than two years. In 1970, a Speech-Language Pathologist began working with Ruth. They developed word boards through which she could communicate simple thoughts. As technology developed, she began using electronic devices that allowed her to communicate more complex thoughts. Her story is detailed in the book, I Raise My Eyes to Say Yes, which she co-wrote with Steven Kaplan.
Just as Ruth Sienkiewicz-Mercer raised her eyes to say yes, many people who cannot communicate verbally have devised other ways to communicate. They make different sounds to indicate yes or no. They cry when they’re upset, hurt, or uncomfortable, or smile and laugh when they’re happy. They may be able to use signs or other gestures to indicate certain things that the people with whom they’re communicating understand. Such communication, while useful, is limited.
A variety of communication devices have been developed specifically for people with disabilities. Non-electronic devices include alphabet boards, picture and word boards, and picture books. When using one of these devices, an individual chooses a series of letters to spell a word, or a series of pictures to convey a thought or message. Spelling out every word can be incredibly time consuming. Even the use of pictures or symbols is limited by the number of pictures that fit on a page or board. In addition, some words and ideas can’t be conveyed by a picture or symbol. These devices also require the involvement of a communication partner to assist the user and discern what he or she is trying to communicate.
Non-electronic devices are unable to assemble the verbal communication that most people use. Research by the American Speech Language Hearing Association (ASHA) found that most sentences that people use have never been used before, and sentences pre-stored in AAC devices are used less than five percent of the time.
ASHA describes the most effective approach to augmentative communication as “SNUG” (Spontaneous Novel Utterance Generation). Electronic devices capable of “SNUG” allow the user to create sentences on-the-spot and communicate with others more interactively. The newest devices are portable.
Electronic devices are categorized by a variety of their features. They may have digitized speech output (meaning recorded human speech) or synthesized speech output (electronic speech).
They may have prerecorded messages that are stored in the device (such as Hello, Good Morning, and How Are You?) or the ability for the user to formulate messages spontaneously, or both. The recording duration of the devices also varies. The recording time is usually based on the memory size of the devices (as with computers).
Electronic devices have dynamic displays that can be changed and allow the user to select among sets of words or phrases. For example, there might be a selection set of family members and friends, another of foods, another of greetings. Devices that have dynamic displays often have a screen that can be activated by the touch of a hand or use of a tool.
A variety of tools and methods are available to access communication devices. Those who can’t touch a screen with their fingers can use pointing devices that can be handheld, placed in the mouth, or attached to a headband. A switch may be operated by a hand, foot, shoulder, face or head. Some people use eye gaze to control their device.
Anyone interested in obtaining an AAC device needs to have an assessment by a Speech-Language Pathologist. To find one, ask your doctor, visit the ASHA Web site www.asha.org, or call UCP Michigan at (800) 828-2714. Individuals who live in the Upper Peninsula can obtain an assessment at the UCP Michigan Assistive Technology Center by calling (906) 226-9903.
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