Augmentative and alternative communication (AAC) encompasses the communication methods used to supplement or replace speech or writing for those with impairments in the production or comprehension of spoken or written language. AAC is used by those with a wide range of speech and language impairments, including congenital impairments such as cerebral palsy, intellectual impairment and autism, and acquired conditions such as amyotrophic lateral sclerosis and Parkinson's disease. AAC can be a permanent addition to a person's communication or a temporary aid. Stephen Hawking used AAC to communicate through a speech-generating device.
Writing Dexter 039;s Book - Cerebral Palsy
Augmentative and alternative communication is used by individuals to compensate for severe speech-language impairments in the expression or comprehension of spoken or written language.[6][7] People making use of AAC include individuals with a variety of congenital conditions such as cerebral palsy, autism, intellectual disability, and acquired conditions such as amyotrophic lateral sclerosis, traumatic brain injury and aphasia.[8] Prevalence data vary depending on the country and age/disabilities surveyed, but typically between 0.1 and 1.5% of the population are considered to have such severe speech-language impairments that they have difficulty making themselves understood, and thus could benefit from AAC.[8][9] An estimated 0.05% of children and young people require high technology AAC.[10] Well-known AAC users include physicist Stephen Hawking, broadcaster Roger Ebert and poet Christopher Nolan.[11][12] Award-winning films such as My Left Foot and The Diving Bell and the Butterfly, based on books by AAC users Christy Brown and Jean-Dominique Bauby respectively, have brought the lives of those who use AAC to a wider audience.[13][14][15]
Cerebral palsy is a term referring to a non-progressive developmental neuromotor disorder with an upper motor neuron lesion origin.[111] Depending on the location of the brain lesion, individuals with cerebral palsy can have a wide variety of gross and fine motor challenges, including different forms and areas of the body affected. Fine motor planning, control and coordination are often affected.[112] Dysarthria, a speech disorder resulting from neurological damage to the motor-speech system, occurs in an estimated 31% to 88% of those with cerebral palsy. Such individuals may require AAC support for communication. Approximately one half to one third have some degree of intellectual impairment, and visual and hearing problems are also common.[113][114] Gross and fine motor challenges are often of particular concern in accessing an AAC device.[112] Appropriate seating and positioning are important to facilitate optimum stability and movement.[115] Extensive motor training and practice may be required to develop efficient AAC access and use.[116] The trend towards custom-placed sensors and personalized signal processing may assist in facilitating communication for those who are incapable of using other AAC technologies.[117]
Depending on their language and cognitive skills, those with aphasia may use AAC interventions such as communication and memory books, drawing, photography, written words, speech generating devices and keyboards.[139] Visual scene displays have been used on communication devices with adults who have chronic, severe aphasia; these feature photos of people, places or events that are meaningful to the individual and facilitative of communicative interaction.[139] Approaches such as "Supported Conversation for Adults with Aphasia" train the communication partners to use resources such as writing key words, providing written choices, drawing, and using items such as photographs and maps to help the individual with aphasia produce and comprehend conversation.[141][142] Communication boards can be very helpful for patients with aphasia, especially with patients who are very severe. They can be produced at a very low tech level, and can be utilized by patients to point to pictures/words they are trying to say. Communication boards are extremely functional and help patients with aphasia communicate their needs.
The history of AAC can be traced to the days of classical Rome and Greece, with the first recorded use of augmentative strategies with the deaf.[13][165] The use of manual alphabets and signs was recorded in Europe from the 16th century, as was the gestural system of Hand Talk used by Native Americans to facilitate communication between different linguistic groups.[13][165] The first known widely available communication aid was a letter and word-based communication board developed for, and with, F. Hall Roe, who had cerebral palsy. This communication board was distributed in the 1920s by a men's group in Minneapolis.[3]
The modern era of AAC began in the 1950s in Europe and North America, spurred by several societal changes; these included an increased awareness of individuals with communication and other disabilities, and a growing commitment, often backed by government legislation and funding, to develop their education, independence and rights.[165][166] In the early years, AAC was primarily used with laryngectomy and glossectomy cases, and later with individuals with cerebral palsy and aphasia.[167] It was typically only employed after traditional speech therapy had failed, as many felt hesitant to provide non-speech intervention to those who might be able to learn to speak.[165][166] Individuals with intellectual impairment were not provided with AAC support because it was believed that they did not possess the prerequisite skills for AAC.[121][166] The main systems used were manual signs, communication boards and Morse code, though in the early 1960s, an electric communication device in the form of a sip-and-puff typewriter controller named the Patient Operated Selector Mechanism (POSM or POSSUM) was developed in the United Kingdom.[3][165]
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