2001 Conference Proceedings
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The Future of AAC: Bringing Research and Practice
Prentke Romich Company
Fifth Annual Anthony J. Vitale AAC Lecture
(For readers not attending the CSUN 2001 Conference, the author
is honored to have been invited to present the Fifth Annual
Anthony J. Vitale AAC Lecture. The dissemination of this paper
well beyond the CSUN environment is intended as a further tribute
to Mr. Vitale’s contributions to the field of AAC
(augmentative and alternative communication). It is hoped that
the Vitale lecture and this paper can be catalysts to widespread
People who rely on AAC depend on the services of professionals
for the selection and application of communication systems.
Researchers investigate issues that relate to the field of AAC.
However, a gulf exists between research and clinical practice.
This paper explores this gulf and suggests the need for a
paradigm shift in AAC research and dissemination of
The Goal of AAC Practice and the Method of Achieving It
The exploration of any topic relating to AAC should begin with
the goal of AAC. As stated in the USSAAC bylaws,
“Communication is the essence of human life”.
Personal achievement in life is a function of the ability to
communicate. The goal of AAC, then, must be the most effective
communication possible for the individual. Therefore, the goal of
AAC practice must be the achievement of the most effective
communication possible for the individual. AAC professionals are
ethically bound to the pursuit of such a goal. The ASHA (American
Speech-Language-Hearing Association) Code of Ethics, for example,
states in Principle I "Members shall honor their responsibility
to hold paramount the welfare of persons they serve
professionally.” (ASHA, 1994). The RESNA (Rehabilitation
Engineering and Assistive Technology Society of North America)
code of ethics maintains similar standards of conduct.
Having established the goal, what is the method by which the
goal is achieved? Spontaneous novel utterance generation (SNUG)
is the primary way of achieving effective communication. This is
not to suggest that pre-stored sentences have no utility.
However, with significant use of sentences the line between
communication and behavior can become very fuzzy. The predominant
use of SNUG is supported by at least the following six points
taken from Achieving Success in AAC: Assessment and Intervention
- Knowledge of normal language development confirms that young
children begin to speak using individual words and word
combinations, not full sentences. As language develops, children
apply the rules governing the sequencing of language's basic
units (i.e. words, morphemes) (McCormick & Schiefelbusch,
1990). An individual knows a language when he or she understands
and follows its basic units and rules (i.e. meaning, use).
Knowledge of language requires both linguistic competence
(understanding the rules), and linguistic performance (using
these rules). The basic rules of language apply to AAC.
- Knowledge of normal language use is a major point made by
Steven Pinker, MIT cognitive scientist and linguist, in The
Language Instinct (Pinker, 1994). He credits Chomsky with
making the point that the vast majority of the sentences we use
in our daily communication are sentences that we have never used
before in our lifetimes. Furthermore, those sentences have never
been spoken by anyone in the history of mankind. This being the
case, how could we possibly prepare in advance the sentences that
someone else may wish to speak in the future without violating
the rules of language or linguistic performance?
- Casual observations of the communication of people who rely
on AAC can be made at the many events at which they gather,
including conferences and meetings. Anecdotal evidence confirms
this point. Pre-stored messages are rarely used in conversations
occurring in the natural environment.
- Statements of people who rely on AAC clearly indicate that
they do not find pre-stored sentences useful for most of what
they want to say. Ray Peloquin is typical: "95% of the time, I
find myself having to create a sentence, and that's what takes
time." (Peloquin, 1999)
- Logged language samples of people who rely on AAC provide the
strongest evidence on this point. In various contexts, including
clinical settings as well as the natural environment, logged data
suggest that individuals communicating at the highest levels use
pre-stored utterances for less than 2% of communication.
- In an Australian research project, Sue Balandin and Teresa
Iacono asked speech therapists to predict the topics that would
be useful to employees in a sheltered workshop during breaks. The
success rate was dismal, less than 10%. If sentences were
pre-stored based on these predicted topics, the sentences would
have little relevance to the actual conversations occurring
(Balandin & Iacono, 1999).
The Goal of AAC Research and Research Topic Selection
Research can have many goals. For university students, research
can be pursued for the purpose of learning the research process.
Masters and doctoral dissertation research generally has as its
goal professional advancement. Every year enormous amounts of
thought, time, and energy are invested in research at this level.
Unfortunately, much of it is of little or no consequence to the
lives of people who rely on AAC and to AAC service providers.
Fortunately, all research does not share the same destiny. Other
research, largely funded by federal grants, does pursue topics of
relevance and creates knowledge that is useful.
The value of research to people who rely on AAC and to those who
support them must be a consideration in the selection of topics.
At the lowest levels of academic research, the acknowledgement of
this consideration should be ingrained in students for future
benefit. The field of AAC is so far from fully developed, and the
significance to consumers is so great, that precious research
resources should not be wasted.
So how does one identify a topic of significance? First, involve
people who rely on AAC in research (Krogh & Lindsay, 1999).
AAC researchers should always be personally familiar with
individuals representative of the subjects to be studied or those
who will benefit from the work. There are many ways to facilitate
a clearer appreciation. Something as simple as participation in a
consumer-oriented Internet listserve can be powerful (ACOLUG).
This can be supplemented with telephone conversations with people
who rely on AAC. However, far more effective is direct personal
interaction. This could take the form of periodic visits or even
the provision of personal care attendant (PCA) services. Major
research venues have staff who rely on AAC. Likewise with AAC
service providers, communication with them and observation of
their work can lead to an understanding of their needs. This
closeness to the customer can be very empowering and is an
element of the most significant research.
Another way of identifying topics of significance is to survey
consumers and/or service providers. Ask them what they need and
want. Surveys have been conducted that could be referenced for
this approach (O’Keefe et.al, 1998). Use caution and be
aware of the particular limitations of a survey. The invention of
the airplane was not inspired by input from future air
Dissemination and Use of Research Results
In Diffusion of Innovations, Everett Rogers (1995) offers
a model on how new information is disseminated and practices are
changed. He begins with identifying the elements of diffusion as
innovation, communication, time, and social structure. Change in
practice starts with an innovation. Information about the
innovation and the change in practice is communicated to others
over time through a social structure, influencing the practice of
The time needed for diffusion is influenced by many factors.
These include the perceived attributes of the innovation, the
nature of the process by which innovation is adopted, the nature
of the communication channels, the nature of the social system,
and the extent of the promotional efforts of the change agents.
The perceived attributes include relative advantage over
traditional practices, compatibility with values, experiences,
and needs of adopters, complexity of the new practice,
trialability, and observability.
Everett’s general model can be applied to the adoption of
hybrid seed corn by Iowa farmers in the 1930s as well as to the
adoption of modern methods by speech-language pathologists (SLPs)
working in the area of AAC in 2001. The model can help in an
understanding of what is required for innovation to be adopted.
Even when AAC research does have relevance to consumers and/or
service providers, seldom do they ever learn of the information
in a timely manner. Approximately 50,000 ASHA SLP members claim
to include AAC in their clinical practice (ASHA, 1999). The AAC
special interest division of ASHA has around 1000 members. Much
of the research in AAC is published in AAC Journal, of which
there are 710 U.S. subscribers, 1.4% of the ASHA number, and that
710 includes many of us who are not ASHA members. What does this
tell us? How, if ever, does this information filter down to the
people who can use it? How long does that take? Is the
information still valid by then?
An informal survey of AAC Journal authors suggests that the
average time from conception to completion of research published
in AAC is 24.2 months (N = 13). Further, they suggest that the
average time from completion to publication is 19.5 months. These
total over 3-1/2 years. Clearly, the impact of AAC research on
AAC clinical practice could be improved.
In a comprehensive coverage of many of these issues, McNaughton,
Beukelman, and Dowden offer suggestions of possible methods of
improvement (McNaughton, et.al., 1999). These include various
uses of the World Wide Web (WWW).
ASHA Special Interest Division 12 (AAC) is compiling a list of
AAC research projects. This will at least help in the general
awareness of topics being pursued. Maintaining such a list on an
Internet site should be practical. Further, an archive list of
completed research could be maintained in a like manner together
with links to additional information and perhaps full
Time compression is a concept that has touched many areas of
society. In industry, for example, it can refer to the use of
rapid prototyping technologies that can convert a drawing into a
physical item within hours. Easily over a decade ago, management
gurus such as Tom Peters (Thriving on Chaos; In Search of
Excellence) were advocating for total renewal of processes
with the goal of reducing time requirements. These notions were
and still are being applied across the organization, touching
product development, manufacturing, marketing, service delivery,
customer support, accounting and other areas of operation.
With the recent development of various AAC tools, the time
required for the collection of data to support research has been
significantly reduced (Romich & Hill, 1999). While additional
tools are on the way, those existing today support the
quantitative measurement of various AAC performance parameters,
including total number of utterances, percentage complete and
spontaneous, mean length of utterance (MLU) in words and
morphemes, total numbers of words and word roots, average and
peak communication rates (words per minute), selection rate (bits
per second), and word selection and spelling errors. Vocabulary
analysis is also possible.
As a demonstration of the potential for time compression in AAC
research, the author conducted a single subject study to explore
the feasibility of using Internet Instant Message as a method of
collecting language samples. If practical, such techniques could
have significant implications for both research and clinical
The stages of the study included 1) identification of the
research question, 2) development of the research plan, 3)
approval by the IRB (Institutional Review Board), 4) recruitment
of a subject, 5) collection of data, 6) analysis of data, 7)
generation of a report, and 8) posting of the report on an
Internet site (Romich, 2001). From conception to dissemination,
the time required for this study is measured in days, far less
than one week.
The AAC Institute is an example of a new model of organization
dedicated to improving the communication of people who rely on
AAC, largely through innovative approaches to addressing
traditional issues. Services include information dissemination,
language sample analysis, and a language sample library. Most
interaction is via Internet. Staff are worldwide.
Some Research Topics Needing Exploration
Many research questions can be asked and answered using time
compressed methods. Here is a representative set. Multitudes of
variations are obvious.
(When the number of symbols in the symbol set exceeds the number
of locations in the selection array, bad things start to happen
to the communication process.)
- What is the effect of AAC therapy on MLUw or MLUm?
- How does the natural environment communication rate compare
with the rate exhibited in the clinical setting?
- Does the frequency of use for language representation methods
change with different speaking situations?
- Normalized for selection rate, how does communication rate
change over time?
- How does selection rate change with time of day?
- How well does Fitts’ Law apply to consumer use of
common AAC systems?
- How much faster is a double hit on one key than hits on two
- How does Romich’s Hypothesis test for spelling?
When we do what we’ve always done, we will get what we
always got. People who rely on AAC benefit when three
stakeholders take action. 1) AAC researchers need to perform work
that is meaningful to consumers, do it quickly, and disseminate
the results promptly and widely; 2) AAC clinicians need to
provide guidance to researchers and provide AAC clinical services
in accordance with the principles of evidence-based practice,
including being aware of and applying field knowledge and
collecting data and analyzing the performance of the individual.
3) AAC consumers and their families need to tell researchers what
they need, stay aware of research results, actively practice
checks and balance, and measure their own performance. This all
requires, in part or in whole, a change in our behaviors.
References and Resources
AAC Institute: http://www.aacinstitute.org
ACOLUG: Augmentative Communication OnLine User Group, http://www.temple.edu/inst_disabilities/acolug
American Speech-Language-Hearing Association (1994). Code of
ethics. Asha, 36 (March, Suppl. 13), pp. 1-2.
ASHA (1999). 1999 ASHA Omnibus Survey.
Balandin S. & Iacono T., (1999). Crews, Wusses, and Whoppas:
Core and Fringe Vocabularies of Australian Meal-Break
Conversations in the Workplace, Augmentative and Alternative
Communication Vol. 15, pp. 95-109.
Hill, K. (2000). Achieving Success in AAC: Assessment and
Intervention. Center for Assistive Technology Education and
Research, Edinboro University of Pennsylvania.
Krogh, K. & Lindsay, P. (1999). Including People with
Disabilities in Research: Implications for the Field of
Augmentative and Alternative Communication. Augmentative and
Alternative Communication, Vol. 15, pp. 222-233.
McCormick, L. and Schiefelbusch, R. L. (1990). Early Language
Intervention: An Introduction, second edition. Merrill
Publishing Company, Columbus.
McNaughton, D., Beukelman, D., and Dowden, P. (1999). Tools to
Support International and Intercommunity Collaboration in AAC
Research. Augmentative and Alternative Communication, Vol.
15, pp. 280-288.
O’Keefe, B., Brown, L., and Schuller, R. (1998).
Identification and Rankings of Communication Aid Features by Five
Groups. Augmentative and Alternative Communication, Vol.
14, pp. 37-50.
Peloquin, Ray (1999). Presentation at the Pittsburgh Employment
Conference for Augmented Communicators.
Pinker, S. (1994). The Language Instinct.
Harper-Collins Publishers, New York.
Rogers, Everett M. (1995). Diffusion of Innovations, 4th
Ed. The Free Press, New York.
Romich, B.A. & Hill, K.J. (1999). A language activity
monitor for AAC and writing systems: Clinical intervention,
outcomes measurement, and research. Proceedings of the RESNA
'99 Annual Conference, Long Beach, CA. p.19-21.
Romich, B. (2001). AAC Language Sample Collection via Instant
Message for Clinical Service Delivery and Research. http://www.prentrom.com
under AAC Research and Resources / AAC Performance Measurement.
Barry Romich, P.E.
Prentke Romich Company
1022 Heyl Road
Wooster, OH 44691
Tel: 330-262-1984 ext 211
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