Children with developmental disabilities often have complex communication needs that require professional intervention. For children with limited or no functional speech, the first step in treatment programming is choosing an augmentative and alternative communication (AAC) modality that best represents the needs of the child. The availability and diversity of AAC systems are only increasing (Loncke, 2014). Parents and practitioners are faced with a difficult decision and existing literature has yet to come to a consensus on the potential benefits or disadvantages of incorporating specific AAC strategies. The field of applied behavior analysis has empirically demonstrated the utility of AAC modalities as viable manding topographies to reduce problem behavior (Harding et al., 2009; Ringdahl et al., 2009). Despite reliable reductions in problem behavior, there is paucity in research directly comparing mand modalities and the subsequent effects on communication repertoires. Existing studies contain methodological features that make it difficult to draw firm conclusions (Chambers & Rehfeldt, 2003; Gregory, DeLeon, & Richman, 2009; Tincani, 2004). Therefore, the purpose of the current investigation is to expand on existing literature evaluating aided and unaided AAC modalities and contribute to literature on mand training as it relates to topography-based versus selection-based system outcomes. This study compares three popular mand modalities frequently utilized in interventions implemented by speech-language pathologists and behavior analysts: (1) speech only (2) picture card + speech (3) sign + speech. Conditions were compared in an alternating treatments design for two participants to determine differential modality acquisition, problem behavior reduction, communicative gesturing, and speech emergence. Methodological considerations were given to control for the influence of transfer of stimulus control procedures by adopting a graduated time delay prompt fading procedure and, to the greatest degree possible, minimize the influence of response effort variability by employing the lowest response effort possible across all conditions. Results support the “multimodal” conceptual framework and the practice of “total communication” and provide evidence against the opposing “incompatibility hypothesis.” Keywords: augmentative alternative communication (AAC), mand, verbal behavior, multimodal, total communication, incompatibility hypothesis, aided, unaided, topography-based, selection-based

Patients who suffer from traumatic brain injury often face communication deficits during their hospital stay. This thesis intended to examine approaches the nurse can use to facilitate communication in collaboration with the speech-language pathologist. A review of literature was conducted to examine current research on the most effective devices used to facilitate communication in this patient population. Research revealed that low-technology devices were the most effective means of communicating in the hospital setting. Barriers to effective communication were identified as lack of time, education and access to the devices. Recommendations for future research include developing a documentation component that emphasizes nursing assessment and intervention through collaboration with the SLP. Additional recommendations for research include the examination of impact of AAC use on patient satisfaction and outcomes. Communication using AAC is necessary in order to improve patient outcomes for traumatic brain injured individuals. This can be achieved through increased collaboration with the SLP, and increased nursing knowledge of the available devices and their implementation.

Syfte: Syftet med studien var att undersöka tandhygienisters användning av alternativ kompletterande kommunikation i form av bildstöd i möte med barnpatienter. Metod och material: En digital enkät bestående av 15 frågor skickades ut till samtliga (102 stycken) verksamma tandhygienister i Region Jönköpings län. Antal deltagare var totalt 57 stycken, 54 kvinnor och 3 män. Resultatet redovisades i absoluta – och relativa frekvenser, samt medelvärde. p-värde ≤ 0,05 ansågs statistiskt signifikant. Chi2test användes för jämförelse mellan grupper. Resultat: Intresse för användning av bildstöd fanns bland tandhygienisterna. Totalt var det 32 % som använde bildstöd. Inom specialisttandvård använde samtliga tandhygienister bildstöd och bland tandhygienisterna inom allmäntandvård användes bildstöd av 23,5%.. Resultatet visade även att 55,6% av tandhygienisterna använde bildstöd på alla barn inte bara enstaka grupper. Det fanns inget statistisk signifikant samband mellan användning av bildstöd och längden på tandhygienistutbildningen, men tandhygienister med en treårig utbildning använde sig av bildstöd i större utsträckning än tandhygienister med kortare utbildning. Slutsats: Bildstöd har visat sig vara ett bra hjälpmedel vid möte med barnpatienter inom tandvården. Trots detta använder inte alla tandhygienister sig av bildstöd pga. bland annat tidsbrist. Därför behövs mer kunskap om bildstöd samt om deras användning och fördelar inom tandvården. / Aim: The aim of the study was to evaluate the use of pictorial support among dental hygienists when meeting children in a dental environment. Method and material: A digital questionnaire with 15 questions was send out to all (102) actively working dental hygienists in the county of Jönköping. There were a total of 57 participants, 54 women and 3 men who answered the questionnaire. Results were presented with absolute and relative frequencies, mean value and Chi-square test. Results: There was an interest in using pictorial support among dental hygienists. All dental hygienists in special dental care used pictorial support. Among dental hygienists in public dental care 23.5% used pictorial support. Results showed that the majority of dental hygienists preferred using pictorial support on all children. There was no statistically significant difference between using pictorial support and the length of dental hygienist education, but participants who finished a three-year education used pictorial support more often. Conclusion: Pictorial support has found to be a useful tool in dental care, still there are dental hygienists that don’t use it. More knowledge and research are needed about pictorial support so the effect of augmentative and alternative communication can be evaluated.

The purpose of this study was to determine what perceptual differences existed between a natural recorded human voice and a synthetic voice that was created to sound like the same voice. This process was meant to mimic the differences between a voice that would be used for Message Banking and a voice that would be created by the ModelTalker system. Forty speech pathology graduate students (mean age = 23 years) rated voices on clarity, naturalness, pleasantness, and overall similarity. Analysis of data showed that the natural human voice was consistently rated as more natural, clear, and pleasant. In addition, participants generally rated the two voices as very different. This demonstrates that, at least in terms of perception, using the method of Message Banking results in a voice that is overall perceived more positively than the voice created using ModelTalker.

This study surveyed speech-language pathologists (SLPs) working in medical settings in the state of Florida in order to: (a) assess the availability of AAC devices, related materials, and services in acute, sub-acute, long-term care, and outpatient medical facilities, (b) examine barriers and supports in providing AAC services to patients with complex communication needs (CCN) in the aforementioned settings, and (c) determine perceived levels of AAC knowledge of health care practitioners. One of the study's major findings was that 97.59% of SLPs served at least one patient they identified as having CCNs, and 94.1% of respondents indicated that their patients could benefit from increased access to AAC devices and service delivery. A notable finding relating to the need for increased AAC-related communication partner instruction (CPI) is as follows: 97% and 100% of respondents indicated that increased CPI for medical practitioners/staff and family members, respectively, were important elements in order to ensure functional communication for individuals with AAC needs in the medical setting. Major barriers to providing AAC services related to device access (i.e., lack of AAC supports / devices, lack of funding for equipment, length of time of device funding). Other barriers were related to the nature of medical settings (i.e., frequently changing caseloads, limited time with patients) and demands of the job (i.e., lack of time to prepare AAC materials / devices). Supports to providing AAC services included low-tech AAC options and mobile technologies. In terms of practitioner knowledge, 57.6% of respondents rated themselves not at all or somewhat knowledgeable regarding AAC. Physicians, nurses, and other rehabilitation professionals were rated as less than knowledgeable by 95%, 97%, and 84.3% of participants, respectively. Overall, the findings of this study suggests there is a high prevalence of patients in medical settings with AAC needs, and some face unmet communication needs resulting from barriers related to the setting itself, lack of access to AAC devices and materials, and limited time spent on AAC service delivery.

Prior studies have shown that individuals with disabilities, especially those with communication disabilities, are at higher risk for being exposed to domestic violence. The Swedish National Board of Health and Welfare recommend the municipal social services to use Augmentative Alternative Communication (AAC) as a means to facilitate communication with such individuals. Further, it is recommended that the social services use a standardized instrument called FREDA-risk assessment to ask clients about domestic violence. However, little is known about the use of those instruments among LSS administrators who handle service and support for individuals with disabilities, who may also have communication disabilities. The aim of this study was to investigate the use of FREDA- risk assessment and AAC among LSS administrators, and to explore whether the use of AAC affects the use of FREDA-risk assessment. In order to do so, a digital survey was conducted, in which 366 respondents spread over 144 municipalities participated. The results show that both instruments are not use at their full potential and that the use of AAC could facilitate the use of FREDA- risk assessment. Implications for social work practice and further research are discussed.