Augmentative & Alternative Communication (AAC) refers to any technique or aid that supplements, replaces, or enhances conventional communication methods, such as speech or writing. When a person is unable to communicate effectively with traditional methods of expression, these techniques are used to enhance (augment) or completely replace the individual's mode of communication. Most of us incorporate conventional AAC methods into our own communication, including hand gestures, facial expressions and head nodding. Telephones, TTYs, fax machines, computers, and typewriters are also used to communicate ideas and needs. These AAC methods are used by most of the general public. Many forms of AAC have been developed specifically for people with severe communication difficulties. These forms typically fall into two categories: aided techniques, such as communication boards & electronic devices, and unaided techniques, such as sign language and gestures.

The most effective & functional AAC intervention for an individual is determined through an assessment, and should always use the team approach. The inter-disciplinary team traditionally includes a speech language pathologist, occupational therapist, the individual and his or her family members, an educator and rehab engineer. The age, disability and goals of each individual will determine the makeup of the assessment team. Physical therapy, vocational rehabilitation, psychology, social services, recreational therapy, vision therapy, audiology, and medicine are other disciplines which may be involved in the assessment. The individual and their family members are the most important part of the process, and should be included in all components of the intervention. This includes the needs assessment, defining goals, identifying characteristics or features that will best meet the individual's communication needs, and then matching these features to the most suitable or appropriate system. In addition, the assessment may provide information on funding sources, and make recommendations for training and follow-up services. All AAC assessments should be guided by the needs of the individual.

The purpose of the team assessment is to determine the communication needs of an individual based on their physical, cognitive and language abilities, while also taking into account the environmental factors that will affect modes of expression. It is therefore very useful to perform the assessment in the environment or environments where the individual will be using the communication system. To enable the individual to communicate effectively, an AAC evaluation includes the following steps:

• Assess the individual's abilities: cognitive, sensory and perceptual, motor, speech, and language. If needed, the assessment should also include seating and positioning , literacy, and emotional status.
  
  
• Determine communication needs in the individual's environments. For example: identify communication partners; does the individual need to speak face to face, in front of a group, use the telephone, or write messages?
  
  
• Set functional communication goals and prioritize them.
  
  
• Identify technology features that would provide the support necessary to reach goals.
  
  
• Select, purchase and set-up a customized system. This involves integrating the system and related technologies into the individual's environment or environments.
  
  
• Train and develop skills for the individual, family members, and other communication partners.
  
  

  Communication Modes

  Low-Tech Communication Devices

  This form of AAC typically refers to communication boards, displays, or wallets ("manual" indicating the use of the hands). Language is displayed using pictures, photographs, objects (e.g. soda can, cup, toy, candy bar), textures, letters of the alphabet, words, symbols, or a any combination of these. This type of system is accessed by pointing; using a finger, headwand or lightpointer, or eye-gaze to indicate needs and ideas. Typically, manual communication boards are used as an introduction to AAC and electronic devices, although they are not always a precursor to the use of high-tech devices. However, they have proven beneficial as a communication aid for individuals who are just beginning to recognize abstract concepts through pictorial representations; as a tool for emergent literacy; and for individuals who are functioning at a lower level, and/or are sensitive to, or do not respond well to auditory feedback. They are also a very important component for high-tech users, both as a complement to an electronic device and as a back-up system. These systems are fairly inexpensive and relatively easy to create.

  High-Tech Communication Devices

  These systems typically fall into two broad categories: dedicated communication systems and computer based communication systems. Dedicated devices are stand-alone systems designed for communication. However, they incorporate voice and can include printers and other features. Computer-based systems are typically laptop computers that incorporate communication software and usually a speech synthesizer; and can be used for other applications as well as for communication.

  For the majority of high-tech AAC devices, language is generated through pictures, symbols, traditional writing, or a combination of these. Pictures or symbols may be used to represent a word, phrase, sentence or concept. These may be sequenced together, meaning two or more pictures are selected to create a phrase or sentence. Language is then "spoken" using either synthesized speech, digitized speech, or a combination. Synthesized speech uses a computer chip to generate spoken words from written text, based on phonetics. Digitized speech is an actual recording of an individual's voice, and requires more memory than synthesized speech. If digitized speech is the sole output method, however, it eliminates the ability to communicate spontaneously, since every word, phrase & sentence must be thought out beforehand and recorded into the device. Many devices allow language to be created on different levels. For example, the first level may be used to represent communication concerning activities at home; the second level for school activities, and the third level for church related activities. The amount of language created utilizing different levels, in conjunction with sequencing, is limited only by the amount of memory in the device.

  Other systems have a single level or overlay, and allow generation of unique messages by combining or sequencing pictures in different ways. When traditional orthography is used messages can be spelled, or rate enhancement techniques such as abbreviation expansion or word prediction can be used . These types of features increase the cognitive and sensory/perceptual demands of the user.

  Selection Technique

  Selection techniques for accessing communication systems are varied and often unique. With an appropriate access evaluation, a selection technique can be identified for anyone. Direct selection means the individual can access the device using their hands, a headstick, mouthstick or other typing aid, or an infrared or light-pointing device. Scanning is typically used by individuals who cannot direct select because of physical limitations. In visual scanning, the vocabulary on the communication device is "highlighted" in a predetermined manner (one cell at a time, by row then column). When the selection the individual wants to access is "lit up," speech is generated by activating a switch. Or, the switch may be held down until the appropriate selection is highlighted. When the switch is released speech will be generated. Auditory scanning is an option for individuals who are blind or visually impaired. With auditory scanning, selections are verbalized to the user through a small, external speaker. When the message they wish to express is heard, it may be verbalized to the communication partner by activating a switch. Communication systems may also be accessed through other indirect means, such as a joystick or trackball.

  Considerations

  The type of communication system selected for an individual will depend on their sensory, motor, language, and cognitive levels. Other considerations include the portability of the system, how it will be mounted and/or carried, and expected battery life. How well does it stand up to typical daily wear and tear (being dropped, exposed to fluids)? Does the manufacturer have a toll free number for service & technical assistance? Is the system easy to program and use? How easily can changes be made? What is the "growth potential?" That is; does the device have the capacity to grow as the user's needs change? It is important to look at the way the person is communicating now, and to try and modify or blend some of those methods into the AAC system.

  AAC Resources

  Information Resources:

  American Speech, Language, Hearing Association
  10801 Rockville Pike
  Rockville, MD 20852
  (301) 897-5700
  
  Augmentative & Alternative Communication
  Journal Decker Periodicals
  4 Hughson Street South, 4th Floor
  P.O. 620, LCD 1 Hamilton, Ontario L8N 3K7
  
  Augmentative Communication News
  One Surf Way, Suite 237
  Monterey, CA 93940
  (408) 649-3050
  
  Communication Outlook
  Artificial Language Laboratory
  Michigan State University,
  East Lansing, MI 48824
  (517) 353-0870
  
  Communication Aid Manufacturers' Association
  P.O. Box 1039
  Evanston, IL 60204-1039
  E-mail: cama@northshore.net
  (800) 441-2262
  
  U.S. Society for Augmentative and Alternative Communication
  P.O. Box 5271
  Evanston, IL 60204-5271
  (847) 869-2122
  
  

  Manufacturers of Communication Products:

  Ability Research,
  Inc. P.O. Box 1721
  Minnetonka, MN 55345
  E-mail: ability@skypoint.com
  (612) 939-0121
  
  AbleNet, Inc.
  1081 Tenth Avenue SE
  Minneapolis, MN 55414-1312
  (800) 322-0956
  (612) 379-0956
  
  ADAMLAB
  Wayne County Regional Educational Service Agency
  33500 Van Born Road
  Wayne, MI 48184-2497
  (313) 467-1415
  
  Adaptive Communication Systems
  1400 Lee Drive
  Coraopolis, PA 15108
  (800) 227-2922
  
  Adaptivation, Inc.
  224 SE 16th Street, Suite 2
  Ames, IA 50010-8004
  E-Mail: adaptaac@aol.com (800) 723-2783
  (515) 233-9086
  
  Applied Human Factors, Inc.
  PO Box 781076
  San Antonio, TX 78278
  E-Mail: info@ahf-net.com
  WWW: http://www.ahf-net.com
  (888) 243-0098
  (210) 408-0098
  
  Assistive Technology, In
  850 Boylston Street
  Chestnut Hill, MA 02167
  E-Mail: customercare@assistivetech.com
  WWW: http://www.assistivetech.com
  (800) 793-9227
  (617) 731-4900
  FAX: (617) 731-5201
  
  Attainment Company, Inc.
  P.O. Box 930160
  Verona, WI 53593-0160
  (800) 327-4269
  
  Aurora Systems, Inc.
  2647 Kingsway
  Vancouver, BC V5R 5H4 Canada
  E-mail: aurora@cyberstore.ca
  (800) 361-8255
  
  Canon USA, Inc.
  One Canon Plaza
  Lake Success, NY 11042
  (800) 828-4040
  (516) 488-6700
  Common Cents Systems
  P.O. Box 110514
  Nashville, TN 37222
  (615) 834-7666
  
  Communication Devices, Inc.
  Holly-Com 2433 Government Way, Suite A
  Coeur dÕAlene, ID 83814-3630
  E-mail: hollycom@rand.nidlink.com
  (800) 604-6559
  (208) 765-1259
  
  Companion Products International
  P.O. Box G
  Milford, PA 18337-0208
  (800) 258-6423
  
  Compeer, Inc.
  1409 Graywood Drive
  San Jose, CA 95129
  (408) 255-3950
  
  Consultants for Communication Technology
  508 Bellevue Terrace
  Pittsburgh, PA 15202-1146
  (412) 761-6062
  E-mail: 70272.1034@compuserve.com
  
  Crestwood Company
  6625 N. Sidney Place
  Milwaukee, WI 53209-3259
  (414) 352-5678
  E-mail: crestcom@aol.com
  
  D. C. & D., Inc.
  42 Skinner Road
  East Windsor, CT 06016
  (860) 623-7364
  
  Don Johnston, Inc.
  P.O. Box 639
  Wauconda, IL 60084-0639
  (800) 999-4660
  (847)526-2682
  E-Mail: DJDE@aol.com
  
  Franklin Electronic Publishers, Inc.
  One Franklin Plaza
  Burlington, NJ 08016
  (609) 386-2500
  
  GMR Labs, Inc.
  1030 East El Camino Real #308
  Sunnyvale, CA 94087-3759
  (800) 234-8288
  E-mail: roark@gmrlabs.com
  
  Great Talking Box Company
  2211 B Fortune Drive
  San Jose, CA 95131
  (408) 456-0133
  E-mail: 102375.3351@compuserve.com
  
  GUS Communications, Inc.
  1006 Loantree Court
  Bellingham, WA 98226
  (360) 715-8580
  
  Imaginart International, Inc.
  307 Arizona Street
  Bisbee, AZ 85603
  (800) 828-1376
  (520) 432-5741
  E-mail: imaginart@aol.com
  
  Innocomp
  26210 Emery Road, Suite 302
  Warrensville Heights, OH 44128-5771
  (800) 382-8622
  (216) 464-3636
  E-Mail: Innocomp@aol.com
  
  IntelliTools, Inc.
  55 Leveroni Court, Suite 9
  Novato, CA 94949-5751
  (800) 899-6687
  (415) 382-5959
  E-Mail: info@intellitools.com
  
  InvoTek Company Engineering Research Center
  700 W. 20th Street
  Fayetteville, AK 72701
  (501) 575-7659
  
  LC Technologies
  9455 Silver King Court
  Fairfax, VA 22031
  E-mail: info@lctinc.com (800) 733-5284
  (703) 385-7133
  
  LingraphiCARE America
  3600 West Bayshore Road, Suite 202
  Palo Alto, CA 94303
  E-mail: steele@cdr.stanford.edu
  
  Luminaud, Inc.
  8688 Tyler Blvd.
  Mentor, OH 44060-4348
  (800) 255-3408
  (216) 255-9082
  
  Magic Laboratories, Inc
  . 1733 Woodside Road, Suite 315
  Redwood City, CA 94061
  E-mail: gordonhc@aol.com
  (415) 368-9498
  
  Mayer-Johnson Company
  P.O. Box 1579
  Solana Beach, CA 92075-7579
  E-Mail: MayerJ@aol.com
  (619) 550-0084
  
  Med Labs, Inc.
  28 Vereda Cordillera
  Goleta, CA 93117
  (800) 968-2486
  
  Microsystems Software, Inc.
  600 Worcester Road
  Framingham, MA 01701-5342
  (800) 828-2600
  (508) 879-9000
  
  Pointer Systems, Inc.
  One Mill Street
  Burlington, VT 05401
  (800) 537-1562
  (802) 872-8378
  
  Prentke Romich Company
  1022 Heyl Road
  Wooster, OH 44691-9744
  E-Mail: bromich@aol.com
  (800) 262-1984
  (330) 262-1984
  
  Sentient Systems Technology
  2100 Wharton Street, Suite 630
  Pittsburgh, PA 1520-1942
  E-mail: sstsales@sentient.sys.com
  (800) 344-1778
  (412) 381-4883
  
  TASH, International
  91 Station Street, Unit 1 Ajax,
  Ontario L1S 3H2 Canada
  E-Mail: tashcan@aol.com
  (800) 463-5685
  (905) 686-4129
  
  Toys for Special Children
  385 Warburton Ave.
  Hastings-on-Hudson, NY 10706
  (800) 832-8697
  
  Words+, Inc.
  40015 Sierra Highway Building B-145
  Palmdale, CA 93550-2101
  (800) 869-8521
  (502) 266-8500
  E-Mail: wwwordspls@aol.com
  
  Zygo Industries, Inc.
  P.O. Box 1008
  Portland, OR 97207-1008
  (503) 684-6006
  (800) 234-6006
  (also distribute Toby Churchill)
  
  

  For more information on assistive technology, please contact:

  Jill Oberstein, Project Director Arizona Technology Access Program
  Institute for Human Development
  Northern Arizona University
  4105 N. 20th Street, Suite 260
  Phoenix, AZ 85016
  (602) 728-9534 Voice
  (602) 728-9536 TTY
  (602) 728-9535 Fax
  (800) 477-9921 Toll-Free
  E-Mail: Jill.Oberstein@nau.edu
  website: http://www.nau.edu/ihd/aztap
  
  

  AzTAP provides support to five Regional Resource Centers (RRCs) in Arizona. These RRCs provide direct assistive technology services to persons with disabilities, and are available to help consumers select the most appropriate devices, and advocate for themselves in order to acquire funding for devices and services.

  ASSIST! To Independence
  Contact Person: Ann O'Connor
  PO Box 4133
  Tuba City, AZ 86045
  (928) 283-6261 Voice/TTY
  (888) 848-1449 Toll-Free
  E-Mail: assist@cybertrails.com
  
  IHD Assistive Technology Center
  Institute for Human Development
  Northern Arizona University
  Contact Person: Larry Gallagher
  Building 27, Room 171
  PO Box 5630
  Flagstaff, AZ 86011
  (928) 523-5083 Voice
  (928) 523-1695 TTY
  (928) 523-9127 Fax
  (800) 553-0714 Toll-Free
  E-Mail: Lawrence.Gallagher@nau.edu
  
  Southwest Human Development
  Contact Person: Cheryl Belitsky
  202 E. Earll Drive, Suite 140
  (602) 266-5976 ext. 324 Voice/TTY
  (602) 274-8952 Fax
  E-Mail: cherylb@swhd.org
  Website: http://www.swhd.org
  
  Technology Access Center of Tucson (TACT)
  Contact Person: Paula Feeney
  4710 E. 29th Street,
  PO Box 13178
  Tucson, AZ 85732-3178
  (520) 519-1776 Voice
  (520) 790-7637 Fax
  E-Mail: tactaz@aol.com
  Website: http://www.ataccess.org
  
  UCP of Central Arizona
  Contact Person: Cindy Blair
  321 W. Hatcher Road, Suite 102
  Phoenix, AZ 85021
  (602) 943-5472 Voice
  (602) 943-4936 Fax
  E-Mail: atprogram@aol.com
  Website: www.ucpa.org
  
  

  This document was developed by the Arizona Technology Access Program. Funding is provided by the U.S. Department of Education, National Institute on Disability and Rehabilitation Research (NIDRR) Grant #H224A40002. The contents of this publication do not necessarily reflect the views of NIDRR or the U.S. Department of Education, and do not imply endorsement by the U.S. Government.

  Please contact the AzTAP office for a copy of this material in an alternate format. Rev. 07/01