Augmentative and Alternative Communication (AAC)

  • Augmentative and alternative communication (AAC) includes all forms of communication (other than oral speech) that are used to express thoughts, needs, wants, and ideas. We all use AAC when we make facial expressions or gestures, use symbols or pictures, or write.
  • People with severe speech or language problems rely on AAC to supplement existing speech or replace speech that is not functional. Special augmentative aids, such as picture and symbol communication boards and electronic devices, are available to help people express themselves. This may increase social interaction, school performance, and feelings of self-worth.
  • AAC users should not stop using speech if they are able to do so. The AAC aids and devices are used to enhance their communication.

Glossary of Communication Terms

Who uses AAC:

  • Individuals who are born with the types of congenital disability that cause an inability to speak (i.e., autism, cerebral palsy, various syndromes, hearing loss)
  • Individuals  with certain types of traumatic brain injury (any age)
  • In adulthood: stroke, ALS, cancer, MS
sign language symbol

International symbol for sign language interpretation

Primary Types of AAC:

  • Facial Expressions
  • Gestures
  • Sign Language
  • Pictures, Symbols
  • Writing
  • Speech Generating Devices (SGDs)

Types of AAC Systems:

  • Unaided communication systems rely on the user's body to convey messages. Examples include gestures, body language, and/or sign language.
  • Aided communication systems require the use of tools or equipment in addition to the user's body. Aided communication methods can range from paper and pencil to communication books or boards to devices that produce voice output (speech generating devices or SGDs)/and/or written output.
  • Electronic communication aids allow the user to use picture symbols, letters, and/or words and phrases to create messages. Some devices can be programmed to produce different spoken languages.

Glossary of Terms

Alphabet-Based Methods - These include spelling, word prediction, letter codes, and whole words. Literacy is required.

Core Vocabulary - The small number of words that are used for the majority of communication. For most people, about 85% of communication is accomplished using just a few hundred words.

Extended Vocabulary - The words that are used for the 15% of communication not covered by core vocabulary.

Fingerspelling - Letters are formed by different shapes of the hand and fingers. Each word is then spelled out. Fingerspelling often is used with sign language for spelling of proper names, technical terms, and the like.

Gestures Some gestures, such as shaking or nodding the head or shrugging the shoulders, are so common that they are generally understood by everyone. Other less obvious, but still easily recognizable, gestures can also be used for communication. For example, the American Indians made up a group of hand signals that they could use for basic communication at their intertribal meetings. These gesture systems are easy to use, but detailed conversation is not possible.

Language Activity Monitoring - This is the automatic recording of the content and time of language events. The information is then analyzed to produce a report of various quantitative summary measures of communication performance.

Language Representation Methods - Speech output AAC systems use one or a combination of three basic language representation methods: single meaning pictures, alphabet-based methods, and semantic compaction. An understanding of the performance differences and appropriate choices of method(s) are very important to the effectiveness of the communication system.

Sign Languages - These are languages composed of different hand shapes originally developed for people with severe hearing loss or deafness. They require a certain amount of manual dexterity and are not understood well by people who do not know the system. Different sign languages have developed in different countries.

Single Meaning Pictures - Each word in the vocabulary is represented by a different picture. Thousands of pictures are needed for a modest vocabulary size. Meanings must be taught since most words are not naturally represented by pictures.

Speech - Oral symbols/speech can be spoken by a person or generated by computer.

Semantic Compaction - This method uses sequences of multi-meaning icons to represent vocabulary items.

Transmission Techniques

There are a variety of different ways to send messages. With good motor control, an individual can produce communication symbols by using speech, gestures, sign language, fingerspelling, writing, head shaking, eye blinks, and other facial and body movements. When an electronic AAC device is used, the device transmits the communication in response to input from the user.

Selection Techniques

Without adequate motor control, an individual must be taught how to indicate those symbols he or she wants to use. Selection techniques include direct selection, scanning, and encoding. The selection rate has direct impact on the rate of communication. Selection rate can be measured, and the fastest technique should be used.

Direct Selection

The individual directly indicates the desired symbol, usually by pointing with a body part, such as the finger, thumb, fist, elbow, eyes, foot, or knee. Often, a pointing aid is needed. It can be a pointer held in a closed fist, a stick held in the mouth, or a light beam mounted in a headband. If motor control is not good enough for pointing, a number of electronic devices are available to help with selection. One such device uses a very good camera and a high-speed microprocessor to find even very small eye movements. For people who can speak but not write, desired words can be spoken, decoded by computer, and then printed out. Direct selection generally is faster than other approaches.

Scanning

In scanning, symbol choices are presented to the user one at a time. The user chooses the symbol, or group of symbols, wanted by signaling at the appropriate time. Scanning can be done with or without electronic equipment. In one of the simplest forms, the user has a chart of pictures representing various personal needs and interests. The communication partner points to each picture one at a time and asks a yes/no question (e.g., "Is this what you want?"). The user answers the question with a head nod or eye blink, and the process is repeated until the correct choice is found. By using an electronic device, an individual can produce messages independently. A special switch is used to stop a moving light when it comes to the desired symbol. Many different kinds of switches are available that can be used by people who have very limited motor control. Basic scanning is slow, and is useful only when no more than 15 choices are available. When more choices are needed, other types of scanning have to be used. Choices may be arranged in rows and columns. The user locates the desired symbol, and allows the light to move from column to column until it reaches the right one and then from row to row until the desired symbol is lit. For even more choices, the user may have a number of different charts with different rows and columns. Through self-selection or answering yes-no questions, the user chooses the chart with the desired symbol on it, and the communication then proceeds just as it did for row and column scanning.

Encoding - With encoding, the user learns to use specific codes for each message. Numerical codes (1 = "Can I talk with you a minute," 2 = "I'd like to have pizza for lunch," 3 = "Let's pick a movie to see," etc.) are the most common, but sequences of letters and shapes also have been used. Encoding can be a very rapid way of expressing lengthy messages. If mental abilities are better than motor abilities, encoding can provide a greater range of vocabulary options. For example, a vocabulary display may only have room for ten choices. However, by combining numbers, many more messages can be expressed. For example, I + 3 = "Please leave me alone!" Usually, both users and communication partners must know the code or have a chart of the codes available. However, some communication devices work by pressing a number code that generates computer speech.