2001 Conference Proceedings

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The Future of AAC: Bringing Research and Practice Together

Barry Romich,
P.E.
Prentke Romich Company
Wooster, Ohio

Fifth Annual Anthony J. Vitale AAC Lecture
CSUN 2001

(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 positive change.)

Abstract

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 results.

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 (Hill, 2000).
  1. 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.
  2. 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?
  3. 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.
  4. 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)
  5. 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.
  6. 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 travelers.

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 others.

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 reports.

Time Compression

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 practice.

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.
  1. What is the effect of AAC therapy on MLUw or MLUm?
  2. How does the natural environment communication rate compare with the rate exhibited in the clinical setting?
  3. Does the frequency of use for language representation methods change with different speaking situations?
  4. Normalized for selection rate, how does communication rate change over time?
  5. How does selection rate change with time of day?
  6. How well does Fitts’ Law apply to consumer use of common AAC systems?
  7. How much faster is a double hit on one key than hits on two separate keys?
  8. How does Romich’s Hypothesis test for spelling?
(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.)

Summary

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.

Contact:
Barry Romich, P.E.
Prentke Romich Company
1022 Heyl Road
Wooster, OH 44691
Tel: 330-262-1984 ext 211
Fax: 330-263-4829
Email: bromich@aol.com 


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