Augmentative and Alternative Communication

Relevant Clinical Populations

Since the time AAC emerged in the 1950s and 1960s, the field has undergone significant change with respect to relevant clinical populations within subscribed service delivery models. The shift from a narrow clinical focus on individuals with significant disabilities to the contemporary, broader focus on communicative participation has significantly extended the scope of practice, which now encompasses a focus on current and future functional communication for a wide range of individuals. Relevant clinical populations include individuals with congenital conditions (e.g., autism, cerebral palsy, Down syndrome), acquired conditions (e.g., traumatic brain injury, spinal cord injury), degenerative conditions (e.g., amyotrophic lateral sclerosis, multiple sclerosis, Parkinson's disease), and temporary conditions (e.g., as a result of shock, surgery, or medical interventions). The basis of impairment for some individuals with [Page 93]AAC needs may relate to cognitive and linguistic impairments, whereas for others, the root cause may relate to difficulties with the execution of speech movements. Irrespective of the underlying condition or diagnosis, the universal nature of contemporary AAC service delivery yields a highly heterogeneous clinical population with one basic commonality: complex communication needs such that natural speech is inadequate to meet all of their communication needs.

Nature of AAC

AAC fits within the broader category of assistive technology and involves an integrated group of components, including the symbols, aids, strategies, and techniques used by individuals to enhance communication. Therefore, it follows that AAC incorporates multiple modes of communication, including residual natural speech, gestural strategies such as sign language, low-tech strategies (e.g., paper communication boards and books), and high-tech strategies (e.g., computerized voice output communication aides or devices). This premise is in opposition to outdated schools of thought that relegated AAC to a last resort for only individuals with no functional speech. Current literature has shown that the use of AAC is not detrimental to natural speech development or rehabilitation and that it may in fact be facilitative. Through the strategic implementation of multiple modes of communication, AAC empowers individuals to efficiently and effectively communicate in a variety of interactions in activities of their choice.

This type of functional communication is critical to the overall health and well-being of individuals with complex communication needs. At the most basic level, it is important for all individuals to be able to communicate effectively with medical professionals about health status. Additionally, there are growing bodies of literature highlighting the relevance of effective practitioner-patient communication and health literacy to patient treatment compliance and overall outcomes. Finally, the psychological and social factors associated with stable and positive interactions and relationships with others should not be overlooked.

...