alternative communication alternative communication umbrella term encompasses communication methods supplement replace speech writing production spoken written language wide range speech language including cerebral intellectual acquired conditions lateral disease permanent addition person communication temporary aid modern use began 1950s systems lost ability speak following surgical procedures 1960s 1970s spurred increasing commitment west inclusion disabled individuals mainstream society developing skills required independence use manual sign language graphic symbol communication grew greatly 1980s began emerge field right rapid progress technology including speech synthesis paved way communication devices speech output multiple options access communication physical disabilities systems diverse communication uses equipment includes signing body language aided approaches use external tools aided communication methods range paper pencil communication books boards devices produce voice output speech generating devices written output symbols include gestures photographs pictures line drawings letters words combination body parts adapted mice eye tracking select target symbols directly switch access scanning indirect selection message generation generally slower spoken communication result rate techniques reduce number selections required techniques include prediction user offered word phrase composed longer messages retrieved code evaluation user abilities requirements include individual motor visual language communication strengths weaknesses evaluation requires input family members particularly early intervention ethnicity family beliefs key family centered competent approach studies use development speech result modest increase speech production users grown report satisfying relationships life activities poor literacy unlikely employment convention rights persons disabilities defines alternative communication communications display text large print communication plain language accessible accessible information communications technology scope alternative communication individuals compensate severe speech language expression spoken written language people making use include individuals variety conditions cerebral intellectual disability acquired conditions lateral traumatic brain injury prevalence data vary depending country age disabilities surveyed typically population considered severe speech language difficulty making understood benefit estimated children young people require high technology known users include physicist broadcaster roger_ebert poet award winning films left foot butterfly based books users respectively brought lives use wider audience field originally called communication term served indicate communication systems supplement natural speech replace addition alternative followed later clear individuals non speech systems means communication users typically utilize variety aided communication strategies depending communication partners context forms systems require external tool include facial expression gestures sign languages systems informal gestures body language facial expressions natural communication signals profound disabilities codes exist lack base naturally occurring language example code based plains indian sign language children severe profound disabilities adults variety including benefits gestures available user usually understood educated listener efficient means communicating contrast sign languages linguistic base permit expression unlimited number messages approaches signing divided major categories existing language languages right considered widely example common example signing conjunction speech support communication individuals variety disorders specific hand shapes movements sign gesture require individual adequate fine motor motor planning skills sign languages require fine motor coordination transparent meaning codes limits number people able understand person communication training aided aid device electronic non electronic transmit receive messages aids range communication books speech generating devices skills areas difficulty communication needs users vary greatly equally diverse range communication aids devices required low tech low tech communication aids defined need batteries electricity electronics simple communication boards books user letters words phrases pictures symbols communicate message depending physical abilities limitations users indicate appropriate message body light eye gaze direction head mouth stick alternatively indicate yes listener possible options high tech high tech aids permit storage electronic messages allowing user communicate speech output devices known speech generating devices voice output communication aids device speech output synthesized systems play recorded words phrases generally synthesized speech uses text speech software harder understand permits user spell words speak novel messages high tech systems dedicated devices developed solely non dedicated devices computers run additional software allow function devices static dynamic form static communication devices symbols fixed positions paper changed manually increase vocabulary available static devices multiple levels different words appearing different levels dynamic devices user change symbols available page links navigate appropriate pages vocabulary messages high tech devices vary information store size weight access methods depend abilities user include use direct selection symbols screen keyboard body adapted mice indirect selection switches scanning devices voice output offer user advantage power including ability initiate conversation communication partners distance typically require programming tend unreliable low tech systems recommended backup case device failure symbols symbols high low tech systems include graphic symbols represent objects actions concepts users literacy skills low high tech devices use alphabet based symbols including individual letters words parts thereof low tech devices communication partner interpret symbols chosen high tech device speak created message aloud large graphic symbol sets developed include possess linguistic characteristics iconic symbols objects real objects parts real objects communication symbols particularly individuals visual significant intellectual symbols choices spoken words code integrated technology visually impaired choice symbols aspects presentation size background depend individual preferences linguistic visual skills access selection methods technological advances dramatically increased types selection methods available individuals communication direct selection selection pointing desired symbol finger alternative eye gaze head stick eye controlled mouse accommodate motor control difficulties users use alternative activation strategies example timed activation user maintains selection symbol period time recognized system release activation selection item person releases contact display direct activation system generally choice access method faster easier unable use indirect selection scanning method items displayed selection scanning visual lights highlighting contrasting borders spoken prompts communication partner device desired message reached user indicates choice alternative selection technique switch gesture different patterns switch access scanning available circular scanning items displayed circle time introduced children beginning users easiest understand linear scanning items organized rows time choice demanding circular scanning easy learn finally group item scanning items grouped groups particular group selected items group common group item strategies row column scanning row forms group rows items row selected items row time message selected main selection control techniques scanning automatic scanning scan proceeds pre determined speed pattern user item scanning switch held advance scan released choose desired step scanning user switch indicator items switch select item vocabulary organization vocabulary organization refers way pictures words phrases sentences displayed communication system general goal facilitate efficient effective communication especially individual system contains large number symbols communication books devices presented grid format vocabulary items displayed organized spoken word order frequency usage category key organization symbols different classes organized groups left right facilitate sentence construction research shown children adults use small number words frequently core fringe vocabulary organization words messages communicated frequently appear main page fringe vocabulary words messages rarely specific individual appear pages symbols organized category grouping people places feelings foods drinks action words form grid organization groups vocabulary according specific activities display contains symbols people places objects feelings actions relevant vocabulary items specific activity routine visual scene displays different method organizing presenting symbols depictions events people objects related actions picture photograph virtual environment representing situation place specific experience similar activity displays contain vocabulary associated specific activities routines example photo child room included child system objects events photograph symbols communication research suggests visual scene displays easier grid displays young children learn use rate strategies alternative communication typically slower speech users generally producing words minute rate strategies increase user rate output words minute result enhance efficiency communication main options increasing rate communication prediction technique permitting user produce entire word sentence phrase system alpha letter known expansion words sentences coded sequences letters numbers example retrieve hello iconic strategies icons picture symbols combined sequence produce words phrases prediction rate strategy device attempts predict letter word phrase written user user select correct prediction needing write word word prediction software determine words predicted based frequency language association words past choices user assessment system implementation evaluation individual abilities limitations communication needs necessary select appropriate techniques purpose assessment identify potential approaches bridge potential user current communication present future communication needs conducted specialized teams include speech language rehabilitation engineer social worker physician users family members teachers key members decision making team sensitivity respect cultural diversity contributes ongoing family involvement selection appropriate system members cultural groups presence device increases visibility disability viewed user motor abilities communication skills needs vision assessed order determine appropriate match communication system depending individual physical status recommendations alternative access method change seating positioning mounting system communication aid adaptations needed example arm movements require key guard keyboard reduce selection non target items person needs abilities determine symbols chosen organization goal communication system efficiently possible different contexts different communication partners different social purposes researcher light identified social purposes interaction expression needs wants listener transfer information general conversation development social things jokes cheering finally social practices thank purposes vary terms relative importance content rate duration focus interaction important systems selected reflect priorities individual family western cultures professionals communication device helping promote individual self determination ability decisions choices cultural religious factors affect degree individual autonomy valued construct influence family attitudes training help user use system communicate effectively control environment communication choices decisions mistakes skilled users areas linguistic operational social strategic linguistic refers language skills person native language linguistic code symbol system selected operational involves skills use maintenance tool communication social strategic reflect knowledge judgment interactions including required slow speaking rate communication unfamiliar user require specific device programming training achieve areas communication partners require training notice consistently interpret communication signals severely disabled individual particularly danger learned result repeated failure communicate successfully parties need assistance avoid directive communication style lead child user develop range communication skills initiating taking lead conversation complex asking questions making commands adding new information young users benefit rich language literacy experiences foster vocabulary development discourse skills awareness supports successful literacy learning communication partners encouraged provide augmented input child signing pointing symbols codes communicate including individual communication system benefit explicit reading instruction outcomes speech reviews found use development speech individuals developmental disabilities fact result modest gains observed research review intervention studies found gains speech production cases studied remainder showing change descriptive review looking specifically intervention studies found studies reported increase speech later phases noted little effect researchers device pressure having speak allowing individual focus communication reduction psychological stress makes speech production easier speculate case speech generating devices model spoken output leads increase speech production language literacy language literacy far reaching effects facilitate self expression social interaction variety settings furthermore literacy independence providing access educational opportunities children disabilities require experience developmental delays language skills vocabulary knowledge length sentences impaired pragmatic skills delays fact expressive language limited children language knowledge unlike speaking children children use access system don select content available device external characteristics impact language learning opportunities children category achieve literacy skills typically developing year old language learning delays contribute difficulty literacy development environmental factors play role users report having access abundant reading writing material home school childhood studies shown children use literacy experiences reduced quality quantity opportunity home school compared children disabilities research suggests explicit reading instruction users develop good literacy skills employment according report severely disabled individuals employed despite barriers employment users achieve success educational employment lower paying jobs factors found related employment strong work ethic access technology support family friends education work skills individuals use continue working factors supporting continued employment include access support employers governmental programs employers users report skills time management problem solving communication technology good education important employers quality life studies young adults childhood report generally good quality life lived independently paid employment young adults multiple modes communication including aided approaches positive quality life outcomes better quality communication interaction personal characteristics family community support excellent services poorer outcomes related lack access appropriate supports resources problems technology negative attitudes specific groups users cerebral cerebral term referring non progressive developmental disorder upper motor origin depending location brain individuals cerebral wide variety gross fine motor challenges including different forms areas body affected fine motor planning control coordination affected speech disorder resulting damage motor speech system occurs estimated cerebral individuals require support communication approximately half degree intellectual visual hearing problems common gross fine motor challenges particular concern device appropriate seating positioning important facilitate stability movement extensive motor training practice required develop efficient access use intellectual individuals intellectual face challenges developing communication skills including problems transfer learned skills daily activities lack communication opportunities daily lives responsive understand communication methods intervention population emphasizes partner training opportunities integrated natural communication studies shown appropriate use techniques children adults intellectual enhance communication skills increase participation activities choice making influence perceptions stereotypes communication partners individuals intellectual disabilities issues problems area typically prevalent population approaches teaching functional communication skills non speaking individuals alternative acting purpose independence taking control informing preferences disorder development characterized impaired social interaction communication restricted repetitive behaviour typically particular difficulty acquiring expressive communication skills children found strong visual processing skills making good candidates approach intervention population directed linguistic social abilities child including providing child concrete means communication development skills systems population generally begin communication boards object picture exchanges descriptive review provided preliminary evidence easily learned individuals provides communication little functional speech limited positive impact social interaction challenging study compared use speech generating device picture exchange system found reasonable options children ease speed acquisition system similar developmental verbal developmental verbal known childhood speech developmental motor speech disorder involving motor control speech production speech child developmental verbal point daily communication needs met child developmental verbal experiences great amounts frustration strategy support communication alongside traditional speech therapy improve speech production wide variety systems children developmental verbal manual signs gestures frequent introduced children include use alongside speech manual signs shown decrease errors aided systems typically include communication boards speech generating devices approach approaches introduced child advantage effective method particular situation traumatic brain injury traumatic brain injury result severe motor speech disorders common disorder accounting roughly cases depending stage recovery intervention involve identifying consistent communication signals reliable yes responses questions ability express basic needs answer questions individuals recover natural speech degree sufficient meet communication needs typically suffer severe related difficulties memory learning new skills influence choices established spelling effective systems require navigation multiple pages access information result damage brain language centres affecting production cause severe chronic language individuals communicate combination speech gestures aided communication proportion change person recovers depends context individual skills depending language skills use communication memory books drawing photography written words speech generating devices keyboards visual scene displays communication devices adults chronic severe feature photos people places events meaningful individual interaction approaches supported conversation adults train communication partners use resources writing key words providing written choices drawing items photographs maps help individual produce conversation communication boards helpful patients especially patients severe produced low tech level utilized patients point pictures words trying communication boards extremely functional help patients communicate needs locked syndrome strokes occur cause profound including locked syndrome emotional linguistic abilities remain intact voluntary motor abilities lost people affected type stroke rely strategies communicate recover speech functional voice strategies vary individual preferences motor capabilities change time eye movements likely preserved eye frequently communication low tech alphabet boards introduced immediately provide individual basic communication partner assisted scanning user signals desired letter named communication partner vertical horizontal eye movements functional transparent alphabet board user looks desired letter acknowledged communication partner individuals locked syndrome difficulty high tech devices issues motor control vision memory linguistic ability particular voluntary reliable easily controlled muscle movement necessary access device head jaw hand finger movements individuals intensive practice long initial stroke shown increase accuracy consistency head movements access communication device lateral lateral progressive condition leads weakness eventual approximately people unable speak time death procedure known voice banking people digitally record words phrases able later inclusion communication device systems typically change time depending severity speech physical status individual communication needs use communication strategies generally begins speaking rate drops words minute early stages consist alphabet board cue listener letter word spoken familiar individual later stages main method familiar conversation partners understand spoken words vision typically unaffected writing based systems preferred graphic symbols allow unlimited expression words language method access communication device depends type severity disease spinal form limbs affected onset disease cases head mouse eye tracking access initially form speech affected limbs keyboard style devices frequently forms users change access methods disease progresses low tech systems eye partner assisted scanning situations electronic devices unavailable example bathing final stages disease disease disease progressive condition develop later progression disease individuals eventually lose functional speech approaches generally supplement support natural speech portable example increase volume speech individual taught point letter word alphabet board leading reduced speech rate visual cues listener compensate impaired entire words spelled necessary users reduced range speed movement smaller usual selection display preferred high tech keyboard speech generating devices required prevent accidental caused typical disease factors affecting use disease include motor changes result problems spoken communication multiple common communication problem individuals multiple significant difficulties speech uncommon individuals vary widely motor control capacity presence intention methods access technology adapted accordingly visual common approaches scanning systems large print text synthetic speech feedback plays words letters acquired chronic characterized memory domains communication partly attributed memory intervention compensate capitalize person strengths ability recognize material recall low tech devices generally preferred memory books include autobiographical information daily schedules photographs labels studies shown positive outcomes topic conversation length interaction approaches gains maintained months training use memory aids ceased high tech devices voice output found effective study devices resulted limited topic initiation reduced output heightened distraction enhance use augmented listening strategies identifying topics conversation pictures improves skills individuals history history traced days classical rome greece recorded use strategies deaf use manual signs recorded europe 16th century system native americans facilitate communication different linguistic groups known widely available communication aid letter word based communication board developed cerebral communication board distributed 1920s men group minneapolis modern era began 1950s europe north_america spurred societal changes included increased awareness individuals communication disabilities growing commitment backed government legislation funding develop education independence rights early years primarily cases later individuals cerebral typically employed traditional speech therapy failed felt hesitant provide non speech intervention able learn speak individuals intellectual provided support believed possess skills main systems manual signs communication boards code early 1960s electric communication device form controller named patient operated mechanism developed united_kingdom 1960s onward sign language increased acceptance use deaf community came viewed acceptable manual sign languages advocated hearing later intellectual normal hearing research learn sign use graphic symbols spurred interest use use hand signals opened field techniques specifically adult users canada provide communication able use traditional use quickly spread countries improved technology keyboard communication devices developed denmark netherlands increased messages displayed screen strip paper end 1970s communication devices commercially produced voice output countries sweden canada united_kingdom initiated government funded services severe communication including developing centres clinical research expertise late 1970s 1980s saw massive increase related research publications training national international conferences founded members included teachers rehabilitation engineers researchers users organization played important role developing field peer reviewed journal conferences national chapters focus developing countries area professional american speech language hearing association position paper example recognized field practice speech language time users family members played increasing prominent role development knowledge writing presentations serving committees founding advocacy organizations 1980s improvements technology led greatly increased number variety performance commercially available communication devices reduction size price alternative methods access eye pointing scanning available communication devices speech output possibilities included synthesized speech text speech options available german french italian spanish swedish services seeking develop balance aided strategies goal improving functioning person daily life greater involvement family increasingly individuals acquired conditions lateral disease head injury locked syndrome received services addition challenge notion severe profound intellectual began served courses developed professional training programs literature textbooks guides written support students parents 1990s brought focus greater independence people disabilities inclusion mainstream society schools students special needs placed regular classrooms segregated settings led increased use means improving student participation class collaborative taking place classroom teacher therapy room facilitated communication method physically emotionally supports person severe communication needs type keyboard letter board received wide attention media field question authorship approach controversial subsequent research indicated influencing messages result professional organizations researchers typically accepted facilitated communication rapid progress hardware software development continued including projects funded commercially available dynamic screen speech generating devices developed 1990s time synthesized speech available languages software programs developed allowed computer based production communication boards high tech devices continued reduce size weight increasing accessibility capacities modern communication devices enable users access internet environmental control devices independent access radio telephone etc future directions focus improving device reducing linguistic demands barriers effective social interaction researchers challenged manufacturers develop communication devices appealing aesthetically greater options leisure play easier use rapid advances tablet computer technologies potential radically change availability economical accessible flexible communication devices user needed meet physical challenges users android open source operating systems provide opportunities small communities develop accessibility features software required promising areas development include access communication devices signals movement recognition technologies interpret body motions measuring brain activity automatic speech speech recognition systems based systems frequent organized sets improve speed communication exchange development similarly research provision timely access vocabulary conversation appropriate specific interactions natural language generation techniques investigated including use logs past conversations partners data user schedule real time internet vocabulary searches information location global positioning systems sensors despite frequent focus technological advances practitioners urged retain focus communication needs users future driven advances technology advantage opportunities individuals complex communication needs
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