Communication is how we interact with the world around us. Without communication, we are disconnected from that world. As a pediatric speech-language pathologist, I help children communicate. When the children I work with have severe limitations in their oral communication, I help families find an alternative means for their children to communicate via AAC. AAC stands for Augmentative and Alternative Communication. The American Speech-Language-Hearing Association’s (ASHA) definition of AAC includes “all forms of communication (other than oral speech) that are used to express thoughts, needs, wants and ideas.” AAC includes, but is not limited to: pictures, facial expressions, gestures, sign language, communication boards, and electronic devices. My focus today is on high-tech electronic devices and access. Access refers to the way a person can physically access a device to use it. Sometimes concerns about accessibility cause families and therapists not to pursue use of electronic devices. A child’s deficits in motor, cognitive, visual, and/or hearing skills are seen as a barrier preventing use of an electronic device. Although limitations in multiple areas make accessing a device more challenging, there are multiple means of access that should be evaluated and trialed before determining that an electronic device is not a good option for your child.
When working with your therapist to find the best mode of communication for your child, be sure to consider your child’s ability to access an electronic device through the following different means:
1) Touch: Touch is a direct means to access pictures or letters on an electronic device by touching the screen. To use touch to access a device, the child must be able to use a finger to touch specific pictures or letters on the screen.
Factors to consider: size of symbols, number of symbols, positioning of child and device, use of keyguard or touchguides, device-specific settings for acceptance/release time.
Examples: PRC Accent and ECO series, Dynavox Vmax, Tobii I-Series, all communication apps on ipad (i.e., LAMP, Speak for Yourself, Sonoflex, Sounding Board, Dynavox Compass, Proloquo2go).
2) Alternative Mouse/Joystick: The child uses an external device to directly select pictures or letters on the device. To use an alternative mouse/joystick, the child must be able to manually control the external mouse/joystick to select specific keys.
Factors to consider: type of external mouse/joystick; positioning of child and device; highlighting keys when selected; changing cursor size, shape, color.
Examples: PRC Accent and ECO series; Dynavox Maestro and Vmax, Tobii I-Series
3) Headtracking: A small, reflective dot sticker is placed on the child’s forehead or glasses, and a wireless optical sensor interprets the movement of the dot. The child moves his/her head to directly select keys on the screen. To use headtracking, a child must be able to move his/her head to select specific keys.
Factors to consider: positioning of child/device; changing settings to accommodate for fine or gross head control; changing the cursor size, shape, color; hiding keys in the early stages.
Examples: PRC ECO series
Here is a short video of one of my patients working with Tracy Custer, from Prentke Romich Company, and learning how to use a headtracking communication system:
4) Eyegaze: The child directly selects a picture/letter on the screen by looking at the desired key. The device uses a camera to follow the child’s pupil. To use eyegaze, the child must be able to look at the desired key.
Factors to consider: positioning of child and device; screen size; tracking eye (one or both).
Examples: PRC Accent and ECO series, Dynavox Maestro and Vmax, Tobii I-Series.
You might recall seeing an eye gaze device during the Superbowl last year. Steve Gleason, a former NFL player now living with ALS (commonly known as Lou-Gehrig’s Disease), starred in a Microsoft commercial using his communication device and explaining how he uses eye gaze to communicate. AAC enriches the lives of both children and adults. Here is the ad if you have not seen it previously.*
* This Microsoft commercial is shown as an example of someone using eye gaze technology and not as an official endorsement or paid advertisement from Growing Places.
5) Scanning: The device presents choices visually and/or auditorily, and the child pushes an external switch when he/she hears or sees the choice he/she wants to select. A switch can be operated using a hand, head, or another body part with a reliable movement pattern. To use scanning, the child must be able to physically operate a switch and attend either visually or auditorily to choices offered and then select desired choice.
Factors to consider: positioning of child and device, settings for scan speed and acceptance and release times, settings for auditory and/or visual feedback.
Examples: PRC Accent and ECO series, Dynavox Maestro and Vmax, Tobii I-Series. Special switches can be purchased for the iPad, but not all communication apps work with these switches. Talk Tablet Neo and Sounding Board can be used for single or two switch scanning.
With the number of speech-generating devices on the market and the prevalence of AAC apps on the iPad, there is no shortage of options. Multiple devices should be trialed, and different means of access should be considered. Ideally, the process will involve family members, caregivers, teachers and therapists. Selecting an appropriate speech-generating device and determining the best means of access takes time, patience, and teamwork.
There are many AAC options, but here are just some of the companies manufacturing speech-generating devices:
- Prentke Romich Company: www.prentrom.com
- Dynavox: www.dynavoxtech.com
- Tobii: www.tobii.com
- Saltillo: saltillo.com
Most of my information came from a training I attended called: Strategies for Access & Language Integration by David Kay, M. Ed, OTR with Prentke Romich Company.
Communication Services and Supports for Individuals With Severe Disabilities from asha.org
Augmentative and Alternative Communication (AAC) from the ASHA website.
// Author: Katherine Garcia- MA, CCC-SLP
Katherine received her Bachelor of Arts in English from the University of Texas at Austin. She taught high school English before returning to school to become a speech-language pathologist. She received her Masters of Arts in Communication Sciences and Disorders from the University of Texas at Austin. Katherine holds the Certificate of Clinical Competence awarded by the American Speech-Language-Hearing Association and is licensed by the State of Texas to practice speech pathology. Since earning her Master’s degree, Katherine has been a pediatric speech-language pathologist in the home-health setting. She is interested in developmental delays and disorders, early language acquisition, social communication, and augmentative and alternative communication (AAC). Katherine is Hanen certified to teach It Takes Two to Talk and More Than Words. She has attended continuing education courses pertaining to feeding, apraxia, autism, and early intervention. When not at work, Katherine enjoys spending time with her husband and two little girls.