This thesis investigates best practices for teaching and supporting bilingual augmentative and alternative communication (AAC) users as they develop their communication skills. Although there are guidelines that inform best practices for teaching and supporting bilingual AAC users, there is very little information on what these practices look like. This thesis investigates the techniques and strategies that bilingual speech-language pathologists (SLPs) who practice in Catalunya, a bilingual community in northeastern Spain, use to evaluate, teach, and support people who use pictogram-based AAC modalities to communicate. To do this, six SLPs who practice in Catalunya participated in interviews regarding their practices when teaching bilingual AAC users. These interviews were analyzed thematically, based on an iterative, inductive coding process. Analysis revealed that most bilingual AAC users have access to an AAC system in only one language of the community. This may reflect a monolingual mindset (Tonsing & Soto, 2020), and limits the opportunities for engagement with both the larger community, and the individuals’ home communities. This is particularly true for those who speak a language other than those of the community with their families. Despite this, AAC users seem to understand both languages, develop bilingual identities, and “feel bilingual.” Additionally, despite the lack of access to multilingual AAC systems, professionals employ practices that show respect for the home language, whether it is Castilian Spanish, Catalan, or another language. The results suggest that the monolingual mindset is a deeply-ingrained part of educational and therapeutic systems in both monolingual and bilingual communities, even when individual practitioners respect and value their clients’ home language(s) and bilingual identities.

Multiprofessionella team i rehabiliteringsverksamheter kräver att patienter kontinuerligt uttrycker sina önskningar och behov för att teammedlemmar ska kunna arbeta personcentrerat. För patienter med kommunikativa svårigheter kan det uppstå hinder i vårdsammanhang i form av minskad delaktighet gällande sin vård. För att effektivisera kommunikationen och motverka låg delaktighet behöver anpassningar göras. Anpassningar kan komma i form av alternativ och kompletterande kommunikation (AKK) eller andra strategier som underlättar ett samtal för båda samtalsparter. Föreliggande studie undersöker interaktionen mellan logopeder och patienter med kommunikativa svårigheter med respektive utan AKK under vårdbesök. Studien innefattar dessutom vårdpersonals samt patienters upplevelser avseende AKK och kommunikation.  Materialet bestod av videoinspelningar av två behandlingsbesök med två logopeder och två patienter som använder AKK. I samband med videoinspelningarna intervjuades även patienterna. Därtill inkluderades intervjuer med tio deltagare som representerade fem olika professioner. Det inhämtade videomaterialet analyserades med hjälp av multimodal interaktionsanalys och intervjuerna analyserades tematiskt. Resultatet som framkom i studien indikerade att interaktionen mellan vårdpersonal och patienter generellt förbättras vid AKK-användning. Däremot finns faktorer som påverkar effektiviteten av AKK-användningen, till exempel vad det är för omgivning, patientens motivation, frustration respektive insikt om kommunikationssvårigheterna samt vårdens bemötande och vilka anpassningar som tillämpas. Intervjuerna med vårdpersonalen visade att logopeden har en betydande roll inom teamet i relation till att öka kunskapen och medvetenheten avseende hur man samtalar med patienter med kommunikativa svårigheter. Videoinspelningarna och tillhörande patientintervjuer stöttade flera aspekter som framkom i vårdpersonalintervjuerna samtidigt som de bidrog med ytterligare perspektiv. Slutsatsen som dras i föreliggande studie är behovet av ökad kunskap avseende kommunikation och AKK, vilket kan leda vidare till ett tätare samarbete mellan teammedlemmar som arbetar med patienter med kommunikativa svårigheter. Slutligen är det av vikt att betona att kommunikativa svårigheter inte endast beror på en patients insjuknande, utan de blir mer påtagliga när goda förutsättningar i olika sammanhang inte finns. / Multiprofessional teams within rehabilitation clinics are dependent on patients verbalizing their needs and wishes in order for the team members to work with a person-centered approach. Patients with communication difficulties may experience reduced participation regarding their own healthcare. Therefore, it is important that adjustments are implemented to increase communication efficiency and the patient’s participation. The adjustments can be Augmentative and Alternative Communication (AAC) or other strategies that facilitate a conversation between the participants. The present study investigated interaction between speech and language pathologists (SLPs) and patients with communication difficulties with or without AAC during a medical appointment. The study also investigates experiences of healthcare professionals and patients regarding communication and AAC.  The data consisted of video recordings of two treatment visits between two SLPs and two patients that use AAC. The patients were interviewed after the visit. The data also consisted of interviews with ten participants that represented five different professions that regularly work with patients who use AAC. The video data was analyzed using multimodal interaction analysis and for analysis of the interviews with professionals, thematic analysis was employed. The findings indicated that the interaction between healthcare professionals and patients was improved when AAC was used. There were, however, factors that may affect the effectiveness of AAC, such as the type of environment, the patient’s motivation, frustration and an awareness of the communication difficulties, as well as healthcare providers’ attitudes and adjustments that are implemented. Analysis of the interview conducted with healthcare providers demonstrated the vital role of the SLP in a team in regard to improving knowledge and awareness of how to communicate with patients with communication difficulties. The video recordings with complementary patient interviews supported many aspects that emerged in the interviews with healthcare providers. Video analysis also contributed to additional perspectives.  Results of the present study imply that there is a need to improve the knowledge of communication and AAC in interprofessional teams, which could also lead to enhanced collaboration between team members. Lastly, it is of importance to highlight that communication difficulties are not solely due to a patient’s illness.  Communication difficulties become more pronounced when various contextual conditions are not favorable.

La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

<p>Huvudsyftet med denna studie är att beskriva hur ett barn, som använder ett datorbase­rat grafiskt kommunikationshjälpmedel (Tellus), med hjälp av reparationer löser lokala kommunikativa problem i samarbete med människor i sin omgivning. Barnet har video­filmats i vardagliga naturligt förekommande aktiviteter – skola och hem. Som analys­metod har Conversation Analysis (CA) använts. Resultaten visar att reparationer är en typ av resurser för deltagarna att, bland annat, skapa samförstånd genom att förtydliga oklarheter och missförstånd i samtalet. Reparationssekvenserna är ofta långa, och leder till inskottssekvenser i samtalet, men har en viktig interaktionell betydelse för att uppnå samförstånd. Analysen visar även att kommunikation med datorbaserad AKK är mul­timodal, trots att datorn är barnets primära kommunikationshjälpmedel. Exempelvis används tecken, gester och ljud för att markera fel och för att visa upp känslor. Aktivi­teten och datorns placering påverkar också interaktionen. I skolan används datorn oftare som en traditionell kommunikationskarta. Detta beror till stor del på att samtalspartnern sitter på ett sådant sätt att det barnet gör med datorn blir synligt för båda. Forskning som belyser reparationer i denna typ av AKK-samtal saknas. Denna studie kommer förhopp­ningsvis att skapa intresse för fortsatt forskning som, med ett interaktionellt synsätt, identifierar och beskriver fungerande kommunikativa praktiker i AKK-samtal.</p> / <p>The main purpose of this study is to describe how a child, who uses a computer based graphical communication aid (Tellus), with the help of repairs resolves local communi­cative problems in cooperation with people in the immediate surroundings. The child has been videotaped in natural occurring activities – school and home. Conversation Analysis (CA) has been used as a method. The results show that repairs are a set of re­sources for the participants to, among other things, create mutual understanding by clarifying ambiguities and misunderstandings in the talk. The sequences of repair are often long, and lead to inserted sequences in the talk, but have an important interac­tional meaning in achieving mutual understanding. The analysis also shows that the computer based AAC is multimodal, despite the fact that the computer is the user’s pri­mary technical communication aid. For example, signs, gestures and sounds are used to indicate errors and to display emotion. The activity and the placement of the computer also affect the interaction. In school the computer is more often used as a traditional communication map. This is largely due to the fact that the communication partner is positioned in such a way that what the child is doing with the computer becomes visible to both of them. Presently, research that illustrates repair in these kinds or AAC conver­sations is sparse. This study will hopefully create interest for continuing research that, with an interactional approach, identifies and describes functional communicative prac­tices in AAC conversations.</p>

Huvudsyftet med denna studie är att beskriva hur ett barn, som använder ett datorbase­rat grafiskt kommunikationshjälpmedel (Tellus), med hjälp av reparationer löser lokala kommunikativa problem i samarbete med människor i sin omgivning. Barnet har video­filmats i vardagliga naturligt förekommande aktiviteter – skola och hem. Som analys­metod har Conversation Analysis (CA) använts. Resultaten visar att reparationer är en typ av resurser för deltagarna att, bland annat, skapa samförstånd genom att förtydliga oklarheter och missförstånd i samtalet. Reparationssekvenserna är ofta långa, och leder till inskottssekvenser i samtalet, men har en viktig interaktionell betydelse för att uppnå samförstånd. Analysen visar även att kommunikation med datorbaserad AKK är mul­timodal, trots att datorn är barnets primära kommunikationshjälpmedel. Exempelvis används tecken, gester och ljud för att markera fel och för att visa upp känslor. Aktivi­teten och datorns placering påverkar också interaktionen. I skolan används datorn oftare som en traditionell kommunikationskarta. Detta beror till stor del på att samtalspartnern sitter på ett sådant sätt att det barnet gör med datorn blir synligt för båda. Forskning som belyser reparationer i denna typ av AKK-samtal saknas. Denna studie kommer förhopp­ningsvis att skapa intresse för fortsatt forskning som, med ett interaktionellt synsätt, identifierar och beskriver fungerande kommunikativa praktiker i AKK-samtal. / The main purpose of this study is to describe how a child, who uses a computer based graphical communication aid (Tellus), with the help of repairs resolves local communi­cative problems in cooperation with people in the immediate surroundings. The child has been videotaped in natural occurring activities – school and home. Conversation Analysis (CA) has been used as a method. The results show that repairs are a set of re­sources for the participants to, among other things, create mutual understanding by clarifying ambiguities and misunderstandings in the talk. The sequences of repair are often long, and lead to inserted sequences in the talk, but have an important interac­tional meaning in achieving mutual understanding. The analysis also shows that the computer based AAC is multimodal, despite the fact that the computer is the user’s pri­mary technical communication aid. For example, signs, gestures and sounds are used to indicate errors and to display emotion. The activity and the placement of the computer also affect the interaction. In school the computer is more often used as a traditional communication map. This is largely due to the fact that the communication partner is positioned in such a way that what the child is doing with the computer becomes visible to both of them. Presently, research that illustrates repair in these kinds or AAC conver­sations is sparse. This study will hopefully create interest for continuing research that, with an interactional approach, identifies and describes functional communicative prac­tices in AAC conversations.

In speech and language intervention, the ability to interact is seldom evaluated; rather intervention is evaluated in terms of improved testresults.  If goal-setting in intervention also is based on everyday communicative needs, the relevance of the treatment may be increased and intervention outcome may be implemented in the patient’s natural environment. The present study, as part of a research-project, is based on analyses of interaction and interviews to examine everyday conversations and speech and language intervention. The aim was to explore if there is a relation between everyday communication needs and goal-setting in speech and language intervention for people with aphasia. A further aim was to investigate if there are everyday communicative needs that may form goals for speech and language intervention. Two individuals with aphasia and one individual with both dysarhtria and aphasia participated in the study. Three speech and language pathologists and two relatives also participated in the study. Everyday interaction and intervention sessions were recorded and transcribed according to Conversation Analysis principles and analysed from an interactional perspective. Interviews regarding intervention and everyday communication were carried out with all participants. Recordings were presented and discussed with all participants, in so called retrospections. Four phenomena that illustrate communication needs of the participating patients were identified: repair, alternative and augmentative communication, co-construction and feedback. Analysis, interviews and retrospections have revealed that communication needs can form the basis of goal-setting in speech and language intervention. It is also demonstrated that intervention mainly is based on the everyday communication needs of the patient. Retrospections were also shown to be useful in order to observe communication needs in everyday life and in order to evaluate speech and language intervention. The retrospections were found to be beneficial to an open dialogue between speech and language pathologist, patient and relatives regarding the content and aim of the intervention.

Kommunikation och interaktion är viktigt för att utveckla både språklig och social kompetens. Barn som använder alternativ och kompletterande kommunikation (AKK) får dock inte alltid samma möjligheter som talande barn att kommunicera. Speciellt svårt kan det vara att interagera och därigenom skapa relationer med jämnåriga. Det övergripande syftet med denna studie var att studera samtal mellan jämnåriga, speciellt hur de bygger upp och upprätthåller gemensam förståelse i samtal. Studien innefattade två unga pojkar som på grund av cerebral pares (CP) saknade talförmåga och därför använde bliss som AKK. De filmades under ett samtal med varsin klasskamrat. En samtalsanalytisk metod (conversation analysis, CA) användes för att identifiera mönster i interaktionen och analysera deltagarnas strategier för att etablera gemensam förståelse. De strategier som användes visade sig vara tolkningsförslag, följdfrågor, formuleringar och reparationer. Strategierna användes främst vid responspunkter efter blissyttranden, men reparationer förekom även under konstruktionen av yttranden. Analysen visade också att förståelsestrategier ibland saknades i det ena samtalet vilket då ledde till att samtalet stannade av. De talande tog större delen av ansvaret för förståelsearbetet i båda samtalen, men även de blissande pojkarna var delaktiga. Sammantaget visade analysen att samtal med AKK kan se mycket olika ut. Vilka strategier deltagarna använde sig av för att etablera gemensam förståelse var av stor betydelse i båda samtalen. Det krävdes att alla samtalsdeltagare var engagerade i förståelsearbetet för att samtalet inte skulle avstanna. / Communication and interaction are important parts in developing both linguistic and social skills. Children who uses augmentative and alternative communication (AAC) may not always have the same opportunities as talking children to communicate. It can be especially difficult to interact and thereby create relationships with peers. The aim of this study was to explore conversations between peers, more specifically in which ways they establish and maintain common understanding in the conversation. Participants in the study were two young boys with cerebral palsy (CP) causing non-intelligible speech, and therefore using blissymbolics as their AAC. The boys were videotaped during a conversation with a classmate. A Conversation Analysis method (CA) were used to identify patterns in the interaction, and to analyze the participants' strategies to establish common understanding. Strategies used were suggestions of interpretation, following up-questions, formulations and reparations. The strategies were most used in transition-relevance places, but reparations could also be found during the creation of blissymbolic utterances. The analysis also found that understanding-oriented strategies sometimes were missing in one of the conversations, which led to breakdown in the conversation. The talking individuals were responsible for establishing common understanding in the major part of both conversations, but the boys using blissymbolics did not leave the responsibility entirely to them. In total the analysis showed that conversations with AAC can differ in many ways. Which strategies the participants used to establish common understanding were of great importance in both conversations. Every participant in the conversation were obliged to engage in creating common understanding in order to not lead the conversation to a breakdown.

La présente recherche a pour objet la pratique orthophonique en suppléance à la communication (SC) auprès de personnes qui ont une déficience intellectuelle (DI). Des recherches ont montré que les aides à la communication à sortie vocale (ACSV) pouvaient améliorer la communication des personnes ayant une DI. Cependant, la plupart de ces recherches ont été menées dans des conditions idéales qui ne reflètent pas nécessairement celles que l’on retrouve dans les milieux cliniques typiques. On connaît peu de choses sur les pratiques professionnelles en SC auprès des personnes ayant une DI. Le but de cette recherche est de décrire la pratique orthophonique, de documenter les perspectives des utilisateurs sur les résultats des interventions et de décrire l’implication des parents et leurs habiletés à soutenir leur enfant dans l’utilisation d’une ACSV afin de proposer un modèle d’intervention en SC auprès de cette clientèle qui tienne compte de ces différentes perspectives. Une méthode qualitative a été choisie pour réaliser la recherche. Des entrevues individuelles semi-structurées ont été réalisées avec onze orthophonistes francophones et avec des parents ou familles d’accueil de dix utilisateurs d’ACSV et des entrevues structurées ont été menées avec huit utilisateurs d’ACSV. Un outil d’entrevue a été conçu à l’aide de pictogrammes pour permettre aux utilisateurs d’ACSV de répondre à des questions portant sur leur appréciation et utilisation de leur ACSV, leur satisfaction et priorités de communication. Un cadre conceptuel a été conçu à partir des guides de pratique clinique et un codage semi-ouvert a été utilisé pour réaliser les analyses thématiques des données provenant des orthophonistes. Un codage ouvert a servi à analyser les données provenant des parents. Des analyses descriptives ont servi à examiner les réponses des utilisateurs. Diverses procédures ont assuré la crédibilité des analyses. Entre autres, les analyses des entrevues des orthophonistes ont été validées lors d’un groupe de discussion avec sept participantes orthophonistes. Les résultats montrent que les ACSV sont utilisées surtout dans le milieu scolaire. Elles sont parfois utilisées lors des loisirs et dans la communauté, mais ces contextes sont ceux où les utilisateurs ont exprimé le plus d’insatisfaction et où se situe la majeure partie des priorités qu’ils ont identifiées. Les analyses ont permis d’identifier les facteurs qui rendent compte de ces résultats. Les orthophonistes manquent d’outils pour réaliser des évaluations exhaustives des capacités des clients et elles manquent de procédures pour impliquer les parents et obtenir d’eux une description complète des besoins de communication de leur enfant. Conséquemment, l’ACSV attribuée et le vocabulaire programmé ne répondent pas à l’ensemble des besoins de communication. Certaines orthophonistes manquent de connaissances sur les ACSV ou n’ont pas le matériel pour faire des essais avec les clients. Il en résulte un appariement entre la personne et l’ACSV qui n’est pas toujours parfait. À cause d’un manque de ressources en orthophonie, les parents sont parfois laissés sans soutien pour apporter les changements à la programmation lors des transitions dans la vie de leur enfant et certains ne reçoivent pas d’entraînement visant à soutenir l’utilisation de l’ACSV. Un modèle d’intervention en SC est proposé afin d’améliorer la pratique orthophonique auprès de cette population. / This research targets the practices in Augmentative and Alternative Communication (AAC) of speech-language pathologists (SLPs) who work with individuals who have an intellectual disability (ID). Prior research has shown that speech generating devices (SGDs) can help individuals with ID to improve their communication. However, these studies were conducted under ideal conditions, which do not necessarily reflect those that prevail in typical clinical settings. We have little information about AAC practices with individuals with ID or about the efficacy of SGD attribution and AAC intervention under typical conditions. The goals of this research are therefore to describe AAC practices of SLPs with individuals who have an ID, to document the users’ perspectives on the outcome of AAC interventions and to describe the parents’ implication and their abilities to support their child’s use of an SGD in order to propose an intervention model that takes into account these different perspectives. Qualitative methods were chosen to address these questions. Individual semi-structured interviews were conducted with eleven French-speaking SLPs and with the parents or foster families of ten SGD users, and structured interviews with eight SGD users. These interviews were analyzed in order to gather information about research questions. An evaluation tool, made of graphic symbols, was developed to gather information from SGD users about their use of their SGD, their satisfaction, and communication priorities, and about their appreciation of their SGDs. A conceptual framework was developed based on clinical practice guidelines to analyze SLP’s interviews, and a thematic analysis was conducted with semi-open coding. Open coding was used for the data from parents’ interviews, and descriptive analysis of the SGD users’ responses was performed. Steps were taken to ensure credibility of the findings; in particular a focus group was conducted with seven of the participating SLPs to validate the interview results. The results showed that the SGDs are used most frequently in school settings. They are used only occasionally in leisure activities and in the community, but these are the contexts in which the users were most dissatisfied with their communication and in which they most frequently indicated priorities for communication. Factors that explain these results were identified through thematic analysis. SLPs lack the tools they need to perform a comprehensive evaluation of the users’ capacities. They lack procedures for involving parents in the evaluation and for obtaining a thorough description of their child’s communication needs. This might result in attribution of SGSs and identification of vocabulary that do not meet the user’s needs. Some of the SLPs lack sufficient knowledge and do not have SGDs available for trials with their clients, resulting in a less-than-perfect matches between the users and the SGDs. Lack of professional resources leaves parents without support to make changes needed in times of transition in their child’s life. Parents may be unable to support their child’s use of SGD in a variety of contexts. An attribution and AAC intervention model is proposed in order to improve AAC intervention and SLP’s practices.

The aim of this thesis is to attempt to summarize what communication possibilities children suffering from a serious form of infantile cerebral palsy have, to describe them and possibly to clarify what exactly restricts these possibilities. The thesis also tries to answer the question in what way the communication of these individuals differs from the communication of intact persons. The core of the thesis resides in a theoretical exposition which deals - among others - with the communication process and its verbal and non-verbal parts, the diagnostic characterization of the infantile cerebral palsy and the impaired communication ability in symptomatic speech disorders which are associated with this disability. It describes how especially mobility impairment and mental retardation are reflected in the way and possibilities of communication. Special attention is paid to methods of alternative and augmentative communication which can be used as a therapy in the stimulation of the development of communication and speech skills, and which very often represent one of few possible ways of communicating for persons with this disability. The theoretical part is accompanied by video recordings showing communication of four girls suffering from infantile cerebral palsy. As manifestations of this diagnosis...

Made available in DSpace on 2016-06-02T19:46:31Z (GMT). No. of bitstreams: 1 6625.pdf: 4166870 bytes, checksum: be3e580d0e4836b2730b6d56fc4026ff (MD5) Previous issue date: 2015-02-24 / Financiadora de Estudos e Projetos / The Augmentative and Aumentative Communication (AAC) is an area of assistive technology that seeks to facilitate the participation of people in different communicative contexts. There is a variety of techniques and methods one of them Picture Exchange Communication (PECS) that proposes to develop communication skills within the social context. Associated with the implementation of PECS, some research has shown benefits of using Video Modeling (VM) that consists a teaching technique that search the development of academic, social, communication and daily leaving skills for individuals of various disabilities. The objective of this study was to apply and analyze the effects of PECS associated with the VM on the development of communication skills of children with Down syndrome. To this end, we selected three participants in a special school in one city in the state of São Paulo, aged between nine and 12 who were diagnosed as Down syndrome and complex communication needs. The following instruments were used in this study: Assessment of Communication Skills was used to evaluate functional communication skills the child; Protocol for Communication Skills Assessment in a school environment with the objective to identify the communication skills of the student in the school environment from the perception of teachers; Vocabulary selection spread sheet with the objective to identify reinforcing objects; Record Sheet that informed participants' performance during the intervention process; Vocabulary sheet monitored the vocabulary of the participants during the intervention; Chart Qualitative Performance was used as a field diary in order to record observations during the intervention process and the Social Validity of questionnaire with the objective to evaluate the perceptions of parents and teachers of the participants about the intervention. In order to verify the effects of the intervention it used Multiple Baseline Design cross subjects including three phases: baseline, intervention, and maintenance, in which the PECS associated with the VM was the independent variable and communication skills constituted the dependent variable. Data were analyzed considering some aspects such as the participant's performance, monitoring vocabulary, level of independence in the baseline, intervention and maintenance steps. The results showed that participants' performance was satisfactory both in respect of each phase and with respect to all the learning process intervention. The level of independence remained above average throughout the training for the three participants, in other words, they understood what they must do in each session of each phase without the aid of the communication partner or physical stimulator. There was an increase in the vocabulary of the three participants, although each of them with his own specificities and development of language, it is noted that the use of the pictures served as a support for the increase in this vocabulary words and phrases formulations through both figures as through speech. Thus, the present study showed a possibility of intervention that favored the participants with Down syndrome, demonstrating that the PECS associated with the VM promoted the development of communication skills, both in speech production as in the use of the figure as a form of communication. / A Comunicação Suplementar e Alternativa (CSA) é uma área da tecnologia assistiva que busca facilitar a participação das pessoas nos vários contextos comunicativos. Há uma variedade de técnicas e métodos em CSA uma delas é o Sistema de Comunicação por Troca de Figuras (PECS), que tem como propósito aumentar as habilidades de comunicação dentro do contexto social. Associado à aplicação do PECS, algumas pesquisas têm demonstrado benefícios do uso do Video Modeling (VM) que consiste em uma técnica de ensino voltada às habilidades de comunicação social, vida diária e desempenho acadêmico para indivíduos das mais variadas deficiências. A presente pesquisa teve por objetivo aplicar e analisar os efeitos do PECS associado ao VM em relação ao desenvolvimento das habilidades de comunicação em crianças com síndrome de Down. Para tanto, foram selecionados três participantes de uma escola especial de um município do interior paulista, com idades variando entre nove e 12 anos que apresentavam diagnóstico de síndrome de Down, além de necessidades complexas de comunicação. Para a coleta de dados foram utilizados os seguintes instrumentos: Avaliação das Habilidades de Comunicação que teve por finalidade avaliar as competências de comunicação funcional da criança; Protocolo para a Avaliação de Habilidades Comunicativas em ambiente escolar que objetivou identificar as habilidades comunicativas do aluno em ambiente escolar a partir da percepção dos professores; Planilha de seleção de vocabulário que objetivou identificar os itens reforçadores; Folha de Registro que informou o desempenho dos participantes durante o processo de intervenção; Folha de Vocabulário monitorou o vocabulário dos participantes durante a intervenção; Quadro Qualitativo do Desempenho foi utilizado como um diário de campo com a finalidade de registrar observações durante o processo de intervenção e o Questionário de Validade Social que teve por finalidade avaliar a percepção dos pais e professores dos participantes quanto à intervenção. Para tanto, empregou-se o delineamento experimental de linha de base múltipla cruzando com sujeitos (linha de base, intervenção e manutenção), sendo o PECS associado ao VM a variável independente e as habilidades de comunicação se constituíram na variável dependente. Os dados foram analisados considerando alguns aspectos como o desempenho dos participantes, monitoramento do vocabulário e nível de independência nas etapas de linha de base, intervenção e manutenção. Os resultados indicaram que o desempenho dos participantes foi satisfatório, tanto em relação a cada fase, como em relação à aprendizagem de todo o processo de intervenção. O nível de independência se manteve acima da média durante todo o treinamento para os três participantes, ou seja, conseguiram compreender o que precisavam fazer em cada sessão de cada fase sem o auxílio do parceiro de comunicação ou do estimulador físico. Observou-se um aumento no vocabulário dos três participantes, embora cada qual com suas especificidades e desenvolvimento de linguagem própria, foi possível perceber que o uso da figura serviu de apoio para o aumento de vocabulário presente nas formulações de palavras e frases tanto por meio das figuras como por meio da fala. Dessa forma, o presente estudo apresentou uma possibilidade de intervenção que favoreceu os participantes com síndrome de Down, demonstrando que o PECS associado ao VM promoveu o desenvolvimento das habilidades de comunicação, tanto na produção da fala como no uso da figura como forma de comunicação.