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Practitioners need validated strategies for teaching children with significant multiple disabilities (e.g., cognitive, motor, and sensory disability) to use tangible symbols for expressive communication. This single-case experimental design study replicated the positive effect of an adapted protocol for teaching Phase 1 of the Picture Exchange Communication System (PECS) using tangible symbols and extended it to a younger group (4-7 years old) of learners with multiple disabilities. It also tested the effect of an adapted protocol for Phase 2 of PECS to incorporate use of a single switch speech-generating device to gain the attention of an adult communication partner. Two of three students who reached mastery in Phase 1 also reached mastery in Phase 2 and may have generalized requesting behavior from the interventionist (i.e., researchers) to their classroom teacher. Results add to the growing evidence base that shows that the adapted PECS Phase 1 procedures are a promising practice for learners with multiple disabilities, including sensory impairment, and provide preliminary evidence for a more efficient and effective approach to adapting PECS Phase 2 than previously studied for this group of learners. Directions for future research and recommendations for practice are provided.

This was a two-phase study that aimed to (a) develop a tool for assessing visual attention in individuals with Rett syndrome using AAC with a communication partner during naturalistic interactions in clinical settings; and (b) explore aspects of the tool's reliability, validity, and utility. The Assessment of Visual Attention in Interaction (AVAI) tool was developed to assess visual attention operationalized as focused gazes (1 s or longer) at the communication partner, an object, and a symbol set. For the study, six video-recorded interactions with nine female participants diagnosed with Rett syndrome (range: 15-52-years-old) were used to calculate intra- and inter-rater agreement, and 18 recorded interactions were analyzed to examine sensitivity to change and acceptability. There was a significant difference in the AVAI results between two conditions (with and without aided-language modeling). Inter-rater agreement ranged from moderate and strong. There was a range in scores, indicating that the AVAI could differentiate between participants. The AVAI was found to be reliable, able to detect change, and acceptable to the participants. This tool could potentially be used for evaluating interventions that utilize aided AAC.

Many individuals with traumatic brain injury (TBI) rely on augmentative and alternative communication (AAC) supports to meet functional communication needs. The use of images to display message content may be advantageous for this population, given deficits in literacy, visual processing, and cognition. Grid and visual scene displays are two options for presenting images within AAC systems. Eye-tracking technology was utilized to evaluate the visual processing patterns of 13 adults with a history of TBI and 13 adults without TBI when interpreting themes depicted in grid and visual scene displays. Results indicated that differential processing and effort was required when interpreting the two display types. Both groups of participants required significantly more visual fixation time and exhibited patterns consistent with greater cognitive effort when identifying themes depicted in grids compared to visual scenes (i.e., greater numbers of short fixations). The participants with TBI were overall less efficient than those without TBI when identifying themes presented in both AAC display types. These results add to the growing body of evidence indicating that visual scenes may more effectively represent complex concepts than decontextualized, grid-based images for individuals with TBI. Additional clinical implications are discussed.

For individuals who rely on speech-generating devices (SGDs) to complement and substitute for spoken language, speed, and accuracy of access to the device are paramount for effective communication. There is some evidence that application of motor memory principles may improve effectiveness of SGD-based communication. This article reviews motor learning models and principles, including learning stages, types of practice, and environmental factors that affect learning, and highlights the potential applications of these principles in dynamic display SGD design, intervention, and research.

Children with severe motor impairments are restricted in their manipulation and exploration of objects, but little is known about how such limitations influence cognitive development. This study investigated visual-constructional abilities in 75 children and adolescents, aged 5;0-15;11 (years;months), with severe speech impairments and no intellectual disabilities (aided group) and in 56 children and adolescents with typical development (reference group). Verbal comprehension, non-verbal reasoning, and visual-spatial perception were assessed with standardized tests. The task of the participants was to verbally instruct communication partners to make physical constructions identical to models that the partner could not see. In the aided group, 55.7% of the constructions were identical to the models participants described, compared to 91.3% in the reference group. In the aided group, test results explained 51.4% of the variance in construction errors. The results indicate that the participants' language skills were decisive for construction success. Visual-perceptual challenges were common among the aided communicators, and their instructions included little information about size and spatial relations. This may reflect less experience with object manipulation and construction than children with typical development, and using aided communication to instruct others to make three-dimensional constructions. The results imply a need for interventions that compensate for the lack of relevant experience.

There is limited knowledge about aided language comprehension and use in children who use aided communication and who are considered to have a relatively good comprehension of spoken language. This study's purpose was to assess their aided language skills. The participants were 96 children and adolescents who used communication aids (aided group) and 73 children and adolescents with natural speech (reference group), aged 5 to 15 years. All of the participants who used aided communication were regarded by their teachers or professionals as having age-appropriate language comprehension. All of the participants completed (a) standardized tests of visual perception, non-verbal reasoning, and comprehension of spoken language, and (b) tasks designed for this study that measured comprehension and production of graphic utterances through communicative problem solving. Using their own communication systems, the participants achieved an average of 72% correct on the graphic symbol comprehension task items, and 63% on the expressive tasks. The participants with natural speech achieved an average of 88% correct on comprehension items, and 93-96% accuracy on production items. The differences between groups were significant on all the tasks and standardized tests. There was considerable variation within the group of participants who used aided communication, and the results reveal a need to develop instruments with norms for aided language competence that can inform the implementation of interventions to support aided language development.

Purpose: There is a need for speech-language pathology (SLP) research in the Philippines, in order to fill in knowledge gaps relevant to the local context. Information about the local SLP research status remains inadequate. This study describes local SLP research done over the almost past four decades., Method: Using a descriptive retrospective design, a search was made for all empirical research articles completed by Filipino SLPs from 1978 to 2015., Result: A total of 250 research articles were identified and described along several parameters. A predominant number were authored by the SLPs in the academe (97.20%). There was a focus on language (27.60%) and the nature of communication/swallowing disorders (20.80%). More than half utilised quantitative exploratory research designs (69.20%). Several used survey forms to generate data (38.41%). Nearly all were unpublished (93.60%) and were unfunded (94.80%)., Conclusion: The current study revealed a dearth of research studies, limited diversity of research articles, limited research dissemination and funding concerns. It is suggested that the results of the current study can serve as a reference point to restructure research systems in the Philippines and in other developing countries, and offer data that can be used to develop a research agenda for the profession.

This study in programmatic research on technology-supported instruction first identified, through pretesting using evidence-based criteria, students with persisting specific learning disabilities (SLDs) in written language during middle childhood (grades 4-6) and early adolescence (grades 7-9). Participants then completed computerized writing instruction and posttesting. The 12 computer lessons varied output modes (letter production by stylus alternating with hunt and peck keyboarding versus by pencil with grooves alternating with touch typing on keyboard), input (read or heard source material), and task (notes or summaries). Posttesting and coded notes and summaries showed the effectiveness of computerized writing instruction on both writing tasks for multiple modes of language input and letter production output for improving letter production and related writing skills.

Purpose Reading comprehension can change following acquired brain injury (ABI), impacting independence and participation. This review aims to identify and evaluate the interventions used for rehabilitation of discourse level reading in adults with ABI. Methods A systematic review was conducted of published journal articles. Methodological quality of studies was reviewed using formal and informal rating scales. Inclusion criteria involved adults with non-progressive ABI who experienced discourse level reading deficits related to aphasia or cognitive-communication disorders. Results A total of 23 studies were identified; these included randomized controlled trials, cohort and case studies. Six different types of reading interventions were found, overall results of these interventions were mixed. Reading deficits were reportedly related to language (aphasia) and/or cognitive deficits, with assessment processes varying. Questions arose regarding comparability of assessment methods and diagnostic issues across the studies. Conclusions Interventions for discourse level reading comprehension can make positive changes to reading function. However, no intervention was identified as a gold standard. A trend toward strategy-based reading was found, with these offering a potential for (comparatively) cost-effective lower-dosage reading treatments with positive-trend results. Cognitive and language features should be considered for assessment and intervention planning for discourse reading in ABI. Implications for Rehabilitation Six different types of discourse reading comprehension interventions for people with ABI were identified, with mixed evidence for each intervention. Clinicians need to consider both the linguistic and cognitive features of reading for assessment and intervention planning for discourse level reading. There is a research trend toward strategy-based reading interventions, which use a lower treatment dosage.

In a retrospective study of prelinguistic communication development, clinically referred preschool children (n = 9) aged 3-4 years, who as infants had failed a community-based screening program, were evaluated for features of childhood apraxia of speech (CAS). Four children showed no features and either delayed or normal language, five had from three-to-seven CAS features and all exhibited delayed language. These children were matched by age with 21 children with typically-developing (TD) speech and language skills. Case-control comparisons of retrospective data from 9 months of age for two participants with more severe features of CAS at preschool age showed a dissociated pattern with low expressive quotients on the Receptive-Expressive Emergent Language Assessment-Second Edition (REEL-2) and records of infrequent babbling, but normal receptive quotients. However, other profiles were observed. Two children with milder CAS features showed poor receptive and expressive development similar to other clinically referred children with no CAS features, and one child with severe CAS features showed poor receptive but normal expressive developmental milestones at 9 months and records of frequent babbling. Results suggest some but not all children with features of suspected CAS have a selective deficit originating within speech motor development.

Speech-language pathologists manage communication and swallowing disorders, both of which can occur in patients after tracheostomy insertion. An audit on the incidence and timing of speech-language pathology intervention for adults with tracheostomies has not previously been published. Data were retrospectively extracted from the medical records of all patients who were tracheostomized at Royal Prince Alfred Hospital, NSW, Australia, from October 2007 for 1 year. Extracted data included diagnosis, date and type of tracheostomy, time to speech-language pathologist involvement, time to phonation, and time to oral intake. Among the 140 patients (mean age 58 years, range 16-85), diagnoses were neurological (32%), head and neck (25%), cardiothoracic (24%), respiratory (6%), and other (13%). Speech-language pathology was involved with 78% of patients, with initial assessment on average 14 days after tracheostomy insertion (14 days to 166 days). Median time from tracheostomy insertion to phonation was 12 days (range 1-103). Median time from tracheostomy insertion to oral intake was 15 days (range 1-142). Only 20% of patients returned to verbal communication within 1 week after tracheostomy insertion. Further research into access to and timing of speech-language pathology intervention in the critical care setting is warranted.

The understanding of written or printed text or discourse - depicted either in orthographical, graphic-visual or tactile symbols - calls upon both bottom-up word recognition processes and top-down comprehension processes. Different architectures have been proposed to account for literacy processes. Research has shown that the first steps in perceiving, processing and deriving conceptual meaning from words, graphic symbols, manual signs, and co-speech gestures or tactile manual signing and tangible symbols can be seen as identical and collectively (sub)activated. Results from recent brain research and neurolinguistics have revealed new insights in the reading process of typical and atypical readers and may provide verifiable evidence for improved literacy assessment and the validation of early intervention programs for AAC users.

Apraxia of speech (AOS) is an acquired adult neurogenic communication disorder that often occurs following stroke. The purpose of this article is to review current research studies addressing the diagnostic and therapeutic management of AOS. Traditional definitions and characteristics are compared with current features that assist in the differential diagnosis of AOS. Prognostic indicators are reviewed in addition to how neuroplasticity may impact treatment in chronic AOS. Treatment techniques discussed include the articulatory kinematic approach (AKA), use of augmentative/alternative communication devices, intersystemic facilitation/reorganization, and constraint-induced therapy. Finally, the need to address functional communication through support groups, outside the therapeutic environment, is discussed.

Phonological memory is central to language and reading and writing skills. Many children with complex communication needs (CCN) experience problems with reading and writing acquisition. The reason could be because of the absence of articulatory ability, which might have a negative affect on phonological memory. Phonological and visuo-spatial short-term memory and working memory were tested in 15 children with CCN, aged 5 - 12 years, and compared to children with natural speech matched for gender, and mental and linguistic age. Results indicated weaker phonological STM and visuo-spatial STM and WM in children with CCN. The lack of articulatory ability could be assumed to affect subvocal rehearsal and, therefore, phonological memory which, in turn, may affect reading and writing acquisition. Weak visuo-spatial memory could also complicate the use of Bliss symbols and other types of augmentative and alternative communication.

The purpose of this study was to examine the relationships between patterns of spelling error and related linguistic abilities of four persons with complex communication needs and physical impairments, compared to younger individuals without disabilities matched by spelling age. All participants completed a variety of spelling and linguistic tasks to determine overall spelling age, patterns of spelling errors, and abilities across phonemic, orthographic, and morphological awareness. Performance of the spelling-age matched pairs was similar across most of the phonemic, orthographic, and morphological awareness tasks. Analysis of the participants' spelling errors, however, revealed different patterns of spelling errors for three of the spelling-age matched pairs. Within these three pairs, the participants with complex communication needs and physical impairments made most of their spelling errors due to phonemic awareness difficulties, while most of the errors on the part of the participants without disabilities were due to orthographic difficulties. The results of this study lend support to the findings of previous investigations that reported difficulties among individuals with complex communication needs and physical impairments evidence when applying phonemic knowledge to literacy tasks.