The Benefits of Alternative and Augmentative Communication: A Quality of Life Issue

This article summarizes the need for alternate forms of communication for those who are unable to use verbal speech. The importance of allied health professionals in understanding alternative communication is critical in patient care. The authors describe the various forms of augmentative and alternate communication devices that can be used to help non verbal individuals communicate their wants, needs, and thoughts. Financial and social consequences for using these devices is discussed.  As humans, our reality is intricately based on our ability to perceive the world around us. What we hear, see, smell, taste, and touch creates our reality, which in turn becomes our thoughts; then our thoughts are formulated by the language that surrounds us. This rather complex, systematic process of translating thought into speech is something on which the majority of people never concentrate. We are born into a certain region of the world and raised to speak a specific language with seemingly no difficulties. However, for individuals who are born without the capacity to develop language normally or for individuals who lose the ability to communication at some point in life, there must be an alternative means to express language. This population still deserves the chance to communicate and the opportunity to communicate with others. Augmentative and Alternative Communication (ACC) aims to enhance communication for individuals with complex communication needs. Light and McNaughton describe life for individuals with disabilities in the past; "Thirty to 40 years ago, people with complex communication needs typically lived in large institutions, isolated from the community." 1 Thirty one years ago, a small group of professionals concerned with this topic came together to form a society known as the International Society for Augmentative and Alternative Communication (ISAAC) and since then, it "has grown into a vibrant community with a membership greater than 3,700 from more than 60 countries around the world." 2 This organization aims at increasing awareness and acceptance of AAC, increasing cultural and linguistic diversity, recognizing changes in the scope of communication needs, and revolutionizing and advancing the current AAC systems.3 Alternative and augmentative communication is a rising field founded in basic human rights that needs to be studied and implemented into our society with greater success. AAC helps encourage verbal communication for children or adults who may be functioning at a pre symbolic level. Those are individuals who communicate with gestures, eye gaze, or using strategies other than word production. If language can be developed using an AAC system, their quality of life can be vastly enhanced. The purpose of this article is to help allied health professionals understand AAC and how using alternate modes of communication with patients who have limited or no verbal communication can enhance the quality of care. In turn, the patients' quality of life is no doubt improved by being able to adequately communicate with all providers. The Benefits of Alternative and Augmentative Communication: A Quality of Life Issue 2 (c) The Internet Journal of Allied Health Sciences and Practice, 2016 POPULATION,  One of the fundamental concepts of AAC is that it is extremely versatile. It applies to a wide population and there are countless modes of augmentative and alternative communication. AAC can be utilized in the lives of an individual of any age who has difficulty producing verbal speech. Traumatic brain injury, cerebral palsy, Down Syndrome, Autism, Amyotrophic Lateral Sclerosis (ALS) or any developmental disability are just a few of the many populations that can benefit from the use of AAC. An additional benefit that AAC offers is the variety and types of communication systems available for individuals, including both aided and unaided systems. Unaided systems, like signing and gestures, do not require an external device or special materials, while aided systems use picture charts, books, and specialized technology. An assessment to determine the need for and appropriate type of AAC system is done by a team of professionals. The team may include physicians, occupational therapists, and physical therapists. They can contribute to the assessment from their professional perspective to assist the speech language pathologist and family in decision making. When embracing any new type of change there are always fears associated with the risks. Clinicians ask themselves countless "what if" questions and can become bogged down with the fear of uncertainty. AAC is a new and rising field that has been researched but not yet fully integrated into society. Sophisticated technologies have been developed to maximize the efforts of augmentative communication but can cause users to feel apprehension if they are unfamiliar with high technology equipment. There is an increasing need for AAC stakeholders such as engineers, teachers, therapists, policy makers, funding agencies, and researchers to broaden the use and acceptance of AAC to those who need it. 4 Parents of children with complex communication needs (CCN) often times become concerned that if their child is given a speech generating device then they will be less motivated to learn to speak. Topia and Hawking shared research by Beukelman and Mirenda: "AAC systems [are] capable of enhancing communication development and social participation for anyone with communication needs. They further claimed that AAC interventions underpin the essential foundations for language development and can facilitate the development of natural speech." 5 The underlying reason why implementing an AAC device into the life of a child with CCN actually stimulates natural speech is that the child begins to understand that they are capable of affecting their environment. Think of a three year old, non verbal child with autism who for the first time has the power to determine even just a small part of his life. Instead of being told what he will eat for dinner or which toys he can play with because he cannot verbalize his desires, he can now push a button or sequence a small phrase on his device saying "I want applesauce" and feel empowered while making his own decisions. Once a child understands that language creates cause and effect, which in turn gives the child personal freedom and independence, he or she will begin to value it more and become a better communicator. Furthermore, parents and professionals no longer resort to AAC after exhausting every other option when searching for methods of communication development. According to Light and McNaughton, "the population of children referred for AAC services has changed substantially in recent years to include much younger children, children with a greater range of disabilities, and children from more diverse cultural/linguistic backgrounds."2 Due to advancements in medical technology resulting in decreased infant mortality rates of infants with disabilities, an increased focus on early intervention, and the rising number of students receiving special education services in the United States' public school system that come from culturally and linguistically diverse backgrounds, there is a surge of young children who could benefit from AAC.1 Children in the United States who do not have the ability to produce natural speech deserve every opportunity to communicate and interact with their world. Moreover, though AAC can be of great benefit to children with CCN, "AAC is an effective tool to support communication, language, and literacy development from an early age with children with limited or no speech, those at risk for speech development, and those that have speech that is difficult to understand."3 Oral communication remains the leading form of communication being that it is the most efficient and widely used, but research has proven that ACC is an effective method to spark speech development and the fundamental skills that go along with it for children who may be struggling with oral communication. TYPES OF AAC DEVICES AND FUNDING AAC is a versatile field that can be adapted to many individuals with a wide range of needs. There is a large population world wide who can benefit from the use of ACC: from the young child with mild autism who has not yet begun verbalizing words to the 52year old woman with Parkinson's disease who lost much of her vocal quality making communication very challenging. Augmentative communication means anything that supports one's ability to speak and alternative communication means anything The Benefits of Alternative and Augmentative Communication: A Quality of Life Issue 3 (c) The Internet Journal of Allied Health Sciences and Practice, 2016 that substitute's speech. Examples of augmentative communication can include gestures, sign language, body language, letter boards, and eye pointing. Examples of alternative communication include picture exchange communication systems, chat books, and static communication boards. In some cases, systems that augment one person's communication can serve as alternative communication for another person. All of the aforementioned systems are typically considered to be low tech, meaning that they do not require equipment or devices to use. A device is considered to be high tech if it is a speech generating device (SGD) That type of system uses synthesized speech that can be heard once the client activates it. Unfortunately, because high tech devices use sophisticated technology, they are also the most expensive form of ACC. Tobii Dynavox and PRC (Prentke Romich Company) are two of the high tech device companies. Purchasing one of their devices can cost between $5,000$15,000. For most families, especially those who may also have additional medical expenses for a medically fragile family member, purchasing an AAC device may not seem like a priority. But as evi