What Is Augmentative and Alternative Communication (AAC)?

"I'm in a meeting, I'll call you later"

"On my way to you"

??

❤️

How many times a day do you use your smartphone icons to express your feelings? And how many times do you send short text messages because you are unable to speak in certain situations?

Congratulations! You are a daily user of high-tech Augmentative and Alternative Communication: that means you use high-tech non-verbal communication methods (mobile phone, computer, tablet) to express your thoughts, needs, and feelings.

Now imagine with me: what if this device were your only means of communication—what would you think of it? Would you use it as is? Does it need modifications? Is it easy for you to access? How much time would it take you to type a single sentence? Would your colleagues wait for you or interrupt you, or worse: ignore you as if you weren't there?

Welcome to the world of Augmentative and Alternative Communication :)

Communication is considered a right for the individual, not a privilege. Therefore, it is incumbent upon us as rehabilitation and therapy specialists to ensure communication quality for beneficiaries of all age groups: whether children, adolescents, young adults, middle-aged adults, or the elderly.

Augmentative and Alternative Communication is part of clinical practices in the field of communication and language disorders. It is concerned with empowering individuals with various communication disabilities—which limit the quality of their communication with others—and finding alternative ways that enhance their engagement in education, work, and society.

The Kingdom of Saudi Arabia has guaranteed in its regulations the rights of persons with disabilities who experience communication difficulties. The Law on the Care of Persons with Disabilities, issued by Royal Decree No. (M/37) dated 29/03/2000 CE, stipulates in its (Second) Article that the State guarantees the right of a person with a disability to prevention, care, and rehabilitation services, and encourages institutions and individuals to provide these services through competent authorities in all fields, including preparing public transportation to achieve the mobility of persons with disabilities safely and securely at reduced fares for persons with disabilities and their companions, in addition to providing assistive technology devices for access, their right to work, and others.

In recent years, educational institutions globally have paid special attention to Augmentative and Alternative Communication under the umbrella of universal access for students with severe disabilities who face daily difficulties and challenges in classrooms and in keeping up with peers socially.

Who benefits from / uses Augmentative and Alternative Communication services?

- Congenital disorders, problems, and diseases: intellectual disabilities, cerebral palsy, autism spectrum disorder, developmental disorders, metabolic disorders, childhood apraxia of speech.

- Acquired health conditions (requiring rehabilitation):

- Temporary health conditions: such as a patient being in intensive care or having a breathing tube that prevents them from speaking.

- Neurodegenerative diseases: multiple sclerosis, Lou Gehrig's disease, apraxia.

- Traumatic brain injuries: resulting from car accidents and military explosions.

- Aphasia: resulting from stroke.

- Speech disabilities resulting from surgical operations: removal of part of the tongue, the tongue, or the larynx due to cancer.

Let us address the second group of beneficiaries: can we truly use Augmentative and Alternative Communication with patients in the critical phase of injuries and diseases? Yes, and for several fundamental reasons:

The patient is frightened/anxious because they are in an unfamiliar environment, and many decisions are being made regarding their health that they cannot deal with as required; therefore, alternative communication enhances the patient's ability to take control of their fate. Also, in many cases, there is a breathing tube and/or a voice problem that requires a speaking valve to help the patient speak and recover from swallowing difficulties. Likewise, the inability to speak may be the result of the type of injury that does not allow the patient to express pain, ask for help, or understand their condition. Add to that the fact that most discussions around the patient are fast-paced and may be in a different language they do not understand, and prescribed medications, along with lack of sleep or sleep problems, may affect the patient's cognitive level. The patient must be empowered to request medication or see the doctor. And let us not forget that language/cognitive stimulation has been proven to reduce delirium in critical care.

As for the first group of beneficiaries (congenital disorders, problems, and diseases), the individual with a disability and the specialist face many challenges when they wish to implement Augmentative and Alternative Communication, such as: the community's lack of acceptance of Augmentative and Alternative Communication, parents wanting speech therapy only, teachers not integrating Augmentative and Alternative Communication tools into the student's educational plan, higher education in the Kingdom not supporting the use of these devices in class, and the difficulty of diagnosing and treating some severe cases. It is also unfortunate that what has contributed to slowing the spread of these good technologies is the existence of much confusion and myths surrounding Augmentative and Alternative Communication (AAC), which have been debunked by evidence-based clinical practices, and I will address the most prominent of them in this article:

Myth:

- Children who use Augmentative and Alternative Communication lose the ability to learn speech

Fact:

- On the contrary, studies have shown that AAC users, in addition to speech and language therapy, acquire language faster and better, and it has reduced aggressive behaviors because they have become better able to express themselves; children with autism spectrum disorder who were characterized by limited speech increased their expressive content and learned new words compared to children who did not use AAC.

Myth:

- Preschool children cannot use AAC.

Fact:

- Early intervention using AAC contributed to developing children's language and speech, improved their grammar development, enhanced their use of multiple symbols in a single sentence, and their receptive language improved.

Myth:

- Children with intellectual disabilities who do not comprehend the cause-effect relationship do not benefit from AAC.

Fact:

- Using language AAC enhanced their cognitive skills, improved their communication skills, and laid the foundations for learning reading and writing, and social communication skills.

The speech-language pathologist, occupational therapist, assistive medical technology specialist,

and special education teacher evaluate the individual with special needs and develop an appropriate treatment plan for them.

What are the important factors that determine the specialist's choice of the required AAC system?

- Cognitive skills: attention, focus, working memory, higher cognitive skills, and the like.

- The individual's language skills: literate, illiterate, has not yet learned language, has difficulties with certain levels of language.

- Motor skills: determining the type of controller the team selects.

Expressing needs and wants, information transfer, social closeness, following social etiquette, and communicating with oneself and the ability to think out loud are the most important components of effective communication that must be ensured when selecting the system the individual will use to communicate.

What is the impact of Augmentative and Alternative Communication on quality of life and universal accessibility for persons with disabilities?

- Helps enhance the individual's quality of life

- Enhances their engagement in society and helps them make friendships

- Contributes to including the individual in general education and increases their chances of pursuing higher education

- Helps them achieve universal access goals

- Enhances future employment opportunities

References:

• Happ MB. (2004) Communicating with mechanically ventilated patients: state of the science. Wes J Nurs Res,Feb 26 (1); 85-103.
• Patak L, Gawlinski A, Fung NI, Doering L, Berg J. (2006). Communication boards in critical care: A patient's view.
• Applied Nursing Research, 19(4), 182-90.
• Patak L, Gawlinski A, Fung NI, Doering L, Berg J. (2004). Patient's reports of health care practitioner interventions related to communication during mechanical ventilation. Heart & Lung - The of Acute and Critical Care, 33(5), 308-320.
• ASHA.org
• Beukelman & Mirenda, 2004

Noura Alghusoon - Senior Speech-Language Pathologist

American Competence in Speech-Language Pathology

Norah Alghusun, MA. CCC-SLP

@nalghusun.

Originally published in Arabic. This English version was produced with AI-assisted translation; the Arabic original remains the reference.