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Augmentative Communication (AAC)

Background

Augmentative and Alternative Communication (AAC) describes a variety of approaches used to support, enhance, or augment the communication of individuals who are not independent verbal communicators in all settings. AAC includes both low-tech systems, such as sign language, picture communication boards and communication notebooks, as well as high-tech systems, such as voice output computer-based communication devices, tablets and cell phones. Since the development of the iPad and the Android tablet, access to communication is much more available to children and adults with disabilities. Applications in both Mac and Android platforms are available for communication, learning, socialization and recreation. Many individuals may use both a low-tech communication approach and a high-tech device to communicate across various settings. Communication occurs when the needs or intent of one person is understood by another. The form of communication is less important than the success of communication.
Children with disabilities such as cerebral palsy, cognitive impairment, brain injury, autism, and neuromuscular disease may all benefit from the use of augmentative communication. Research has shown there are no prerequisite skills which must be demonstrated before augmentative communication is appropriate. Early intervention with AAC facilitates language development for children who are at risk for severe speech impairment. Intervention begins by introducing picture symbol systems and sign language to infants. As children grow they may transition to high-tech devices. Many studies have shown that use of augmentative communication does not interfere with acquisition of natural speech, and can actually assist in language development if the child has the ability of speech.

Assessment and Evaluation

While many children benefit from the use of augmentative communication, no one device or approach is appropriate for everyone. Appropriate fitting of a communication device requires an evaluation conducted by a speech pathologist working with a team of other professionals. The evaluation includes consideration of the child’s communication needs, motor skills, hearing, vision, cognitive abilities, and functional environment. The evaluation team determines the input method, vocabulary representation, and output method which meet the child’s specific needs. Care must be taken to consider the supports available to maintain and update the communication system. The needs of the child are then matched to the currently available technology. Some school districts may have an AAC team. Contact your school district special education department or ask your special education teacher for more information on an evaluation by the AAC team. Most states have Centers for Assistive Technology and Augmentative Communication, go to the Resources section below for Assistive Technology programs by state (RESNA).

iPad use

Use and Care of AAC Devices and Equipment

The primary care clinician may not be the person providing information about the use and care of the equipment; however, families may ask questions during visits to the medical home. Many AAC devices are computer technology-based, while a few are books or another low-tech type. More details about input, output, and other features can be found on the Basic Augmentative and Alternative Communication (AAC) Device Characteristics page.

The ACC equipment should increase the ease of communication, be comfortable to use, and not cause any other health concerns. New equipment may take some time to learn to use in terms of cognitive learning and physical functioning. The primary care clinician may ask about ease of use, stress for the patient and family, and physical difficulties. With new patterns of use and the weight of equipment, the primary care clinician may assess for pressure sores, increased or decreased use of limbs and muscles, and accidental injuries. Input devices may need to be adjusted for placement or sensitivity to promote optimal functioning. For children who use a wheelchair, a mounting device will need to be considered when purchasing the device. The medical home can coordinate care by referring any issues to the appropriate provider or product representative.



Proloquo2Go software on Apple's iPad
Tobii C12 augmentative communication device
Proloquo2Go communication software app on
the iPad.

Image courtesy of AssistiveWare and Apple
Tobii C12 augmentative communication device

Image courtesy of Tobii Technology

Costs and Funding

Costs for AAC technology vary widely, from signing and picture notebook systems which are very low cost, to high-tech eye gaze computers which cost up to $15,000. Simple digitized communication devices, and tablets or cell phones with applications can be purchased for under $1000. Full-featured "dedicated" communication devices are more costly. A dedicated device is one that is only used for the child's communication needs and generally are from high tech AAC companies like Dynavox or Tobii. Current costs are available on manufacturer websites.
At the time of this writing, insurance companies generally will pay only for a dedicated communication system, but some families are have found success by appealing and presenting the insurance company with a package that is much lower cost - a tablet (ipad, android or similar) and a communication application (app) that total less than $1000 (sometimes considered "non-dedicated") compared to up to $15,000. The funding process requires a prescription, letter of medical necessity, and evaluation documenting the need for and efficacy of the chosen device. Most medical insurance providers will consider replacing a communication device every five years. Other funding sources include government agencies such as Independent Living and Vocational Rehabilitation, and foundations that provide grants for ipads and tablets for children with speech impairments. School districts may not fund devices for a child’s personal use, though technology may be provided for the child’s use at school.

Resources

Information & Support

In addition to informational links, below we provide a few links to commercial sites offering AAC products that may help you understand the range of technology available.

For Professionals

International Society for Augmentative & Alternative Communication (ISAAC)
Membership organization working to improve the lives of children and adults with speech difficulties; sponsors education, meetings/conferences, research, a journal, and projects; website offers educational resources, notice of events, and many useful links.

For Parents and Patients

AAC-RERC
The Rehabilitation Engineering Research Center on Communication Enhancement provides information on the newest developments in augmentative and alternative communication.

Augmentative and Alternative Communication (ASHA)
Information and links from the American Speech-Language-Hearing Association.

Family Center on Technology and Disability
Supported by the US Department of Education, the FCTD aims to support organizations, families, and individuals with disabilities by providing information and resources on using technology to improve education.

Speech & Communication Disorders (MedLinePlus)
Basic information and links to high quality sites addressing many aspects of speech and communication disorders and their management; from the National Library of Medicine's MedLinePlus.

Utah Assistive Technology Program (UATP)
Nonprofit organization at Utah State University located at the Center for Persons with Disabilities (CPD). In coordination with community organizations and others who provide independence-related support to individuals with disabilities, they provide Assistive Technology devices and services, and train university students, parents, children with disabilities and professional service providers about AT.

AbleNet
A commercial site offering products and curricula for students with disabilities, including augmentative communication devices.

Adaptivation
A commercial assistive technology device company.

Assistive Technology, Inc. (ATI) and Tobii Technology
Developer of innovative hardware and software solutions for people with disabilities. Their mission to offer people with disabilities and those who support them the very best assistive technology solutions.

DynaVox
Commercial site offering augmentative and alternative communication devices.

Origin Instruments
Commercial site offering augmentative and alternative communication devices including accessories for popular technogy such as iPads and Kindles.

Prentke Romich Company
A commercial site offering augmentative and alternative communication devices; teaching materials, switches, and more.

AssistiveWare
Commercial site offering assistive communication software for popular devices such as iPods, iPhones, and iPads, including Proloquo2Go.

RJ Cooper & Associates
Software and hardware for people with disabilities and includes reviews, tips, and personal experience with equipment.

Saltillo
A commercial site dedicated to making personal communication possible to individuals who are unable to use their natural voice.

Assistive Technology programs by state (RESNA)
RESNA Catalyst Projects listed by state. Rehabilitation Engineering and Assistive Technology Society of North America (RESNA) receives funding to provide technical assistance to Assistive Technology (AT) Act Grantees for consumers with disabilities of all ages.

Tools

Autism Speaks - Autism Apps
This website has a comprehensive list of apps for children with Autism; the apps are listed by category, platform and age recommendation, and rated by research and effectiveness.

Bridging Apps – Easter Seals of Greater Houston
Bridging the gap between technology and people and disabilities. Focuses on apps that have been designed to address a particular need or have been creatively adapted by users to meet specific needs. Autism Speaks

Tap to Talk
Commercial site for application - AAC for autism, Down syndrome, apraxia, cerebral palsy, aphasia, any non-verbal condition - All languages, all ages, and across iPad, android, nook, kindle, nabi, windows, smartboard, Nintendo ds, pc and mac platforms.

iHelp for Special Needs
Commercial site with communication and learning apps for children with special needs.

Services

The service category below will include a variety of assistive technology providers, many of which will offer augmentative communication services and tools.

Assistive Technology

See all Assistive Technology services providers (104) in our database.

For other services related to this condition, browse our Services categories or search our database.

Authors

Authors: Tina Persels - 9/2013
Laura Barnett, MCSD/CCC - 6/2011
Content Last Updated: 2/2014