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Augmentative and alternative communication (AAC) has been used by patients with acquired expressive communication disorders as an alternative to natural speech. The use of symbols to express pain, which is intangible, is challenging because designing a series of comprehensible symbols to represent personal experiences such as pain is not straightforward. This study describes (a) the development of symbols to express pain that were derived from Chinese pain-related similes and metaphors for an AAC mobile application developed specifically for this study known as PainDiary and (b) an assessment of the appropriateness of the app compared to conventional methods of collecting pain information. The symbols depicted headache pain and discomfort, which is prevalent among neurosurgical patients. The participants were 31 patients diagnosed with acquired expressive communication disorders who were receiving treatment in a neurosurgery general ward of Chang Gung Memorial Hospital in Taiwan and 14 nurses who worked on the ward. Pain information was collected by nurses using conventional methods and the PainDiary app. Assessment data, including the accuracy and efficiency of and user satisfaction with PainDiary, are compared. The results show that use of the app was effective in reporting pain and that patients required less time to report a pain event. The results further indicate that the PainDiary app was better received by younger individuals than by their older counterparts.

Purpose To ensure long-term adoption and use of augmentative and alternative communication (AAC) technologies, they must be designed to support children to participate within everyday activities and routines that are prioritized by families. The aim of this study was to gain parent perspectives on how AAC technologies were integrated into everyday life. Method Nine parents of children with cerebral palsy who used AAC technologies participated in semistructured interviews to provide their perspectives on how AAC technologies were integrated into the functional contexts of everyday life. Results Five major themes emerged from the discussions: (a) integrating AAC into life, (b) AAC technologies, (c) child needs and skills, (d) parent responsibilities and priorities, and (e) AAC process and decision making. Children were able to use AAC technologies within a variety of everyday contexts with various partners; however, challenges included access to technologies within care routines and outdoor activities as well as partners who lacked knowledge regarding operational competencies and effective interaction strategies. To integrate AAC technologies into life, parents prioritized technology features including ease of programming, improved physical design, features to enhance efficiency and ease of access, and availability of multiple functions and features (e.g., games and leisure activities, environmental controls). Conclusion AAC manufacturers and mainstream technology developers should work to ensure that technologies are responsive to the supports, limitations, and ideal features identified by parents. Future research should seek input from a larger group of stakeholders and use longitudinal methods to examine perceptions of AAC technologies over time. Supplemental Material https://doi.org/10.23641/asha.11625543.

Background: A speller system enables disabled people, specifically those with spinal cord injuries, to visually select and spell characters. A problem of primary speller systems is that they are gaze shift dependent. To overcome this problem, a single Rapid Serial Visual Presentation (RSVP) paradigm was initially introduced in which characters are displayed one-by-one at the center of a screen., New Method: Two new protocols, Dual and Triple shifted RSVP paradigms, are introduced and compared against the single paradigm. In the Dual and Triple paradigms, two and three characters are displayed at the center of the screen simultaneously, holding the advantage of displaying the target character twice and three times respectively, compared to the one-time appearance in the single paradigm. To compare the named paradigms, three subjects participated in experiments using all three paradigms., Results: Offline results demonstrate an average character detection accuracy of 97% for the single and double protocols, and 80% for the Triple paradigm. In addition, average ITR is calculated to be 5.45, 7.62 and 7.90 bit/min for the single, Dual and Triple paradigms respectively. Results identify the Dual RSVP paradigm as the most suitable approach that provides the best balance between ITR and character detection accuracy., Comparison With Existing Methods: The novel speller system (the Dual paradigm) suggested in this paper demonstrates improved performance compared to existing methods, and overcomes the gaze dependency issue., Conclusions: Overall, our novel method is a reliable alternative that both removes limitations for users suffering from impaired oculomotor control and improves performance., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Neuroprosthetic speech devices are an emerging technology that can offer the possibility of communication to those who are unable to speak. Patients with 'locked in syndrome,' aphasia, or other such pathologies can use covert speech-vividly imagining saying something without actual vocalization-to trigger neural controlled systems capable of synthesizing the speech they would have spoken, but for their impairment.We provide an analysis of the mechanisms and outputs involved in speech mediated by neuroprosthetic devices. This analysis provides a framework for accounting for the ethical significance of accuracy, control, and pragmatic dimensions of prosthesis-mediated speech. We first examine what it means for the output of the device to be accurate, drawing a distinction between technical accuracy on the one hand and semantic accuracy on the other. These are conceptual notions of accuracy.Both technical and semantic accuracy of the device will be necessary (but not yet sufficient) for the user to have sufficient control over the device. Sufficient control is an ethical consideration: we place high value on being able to express ourselves when we want and how we want. Sufficient control of a neural speech prosthesis requires that a speaker can reliably use their speech apparatus as they want to, and can expect their speech to authentically represent them. We draw a distinction between two relevant features which bear on the question of whether the user has sufficient control: voluntariness of the speech and the authenticity of the speech. These can come apart: the user might involuntarily produce an authentic output (perhaps revealing private thoughts) or might voluntarily produce an inauthentic output (e.g., when the output is not semantically accurate). Finally, we consider the role of the interlocutor in interpreting the content and purpose of the communication.These three ethical dimensions raise philosophical questions about the nature of speech, the level of control required for communicative accuracy, and the nature of 'accuracy' with respect to both natural and prosthesis-mediated speech.

Purpose: This study aims to identify eye-gaze control technology outcomes, parent perception of the technology and support received, and gauge the feasibility of available measures., Methods: Five children with dyskinetic cerebral palsy, mean age 4 years, 4 months (1 year, 0 months); n = 4 males; trialled two eye-gaze control technology systems, each for six weeks. Parents completed pre- and post-questionnaires., Results: Parents found the 6-week home-based trial period to be the right length. Written guidelines and instructions about set-up, calibration, and play and learning activities were perceived as important. Children demonstrated improvements in goal achievement and performance. Parents found questionnaires on quality of life, participation, behaviours involved in mastering a skill and communication outcomes challenging to complete resulting in substantial missing data., Conclusion: Eye-gaze control technology warrants further investigation for young children with dyskinetic cerebral palsy in a large international study.

Modern information and communication tools have increasingly become an indispensable part of our everyday life. Research data demonstrate that it can be used effectively to preserve and restore health, not just among young people but also among the elderly, as for nowadays the use of the internet is widespread among the elderly, but healthcare applications are less well-known. This supports the significance of our project since it is important to develop and introduce disease-specific healthcare applications. Our preliminary results also indicated that men are less open to these new technologies, so in their case, specific methods are needed to facilitate the use of electronic devices. The high level of internet activity and the interest in information and communication technologies provide a reliable basis for applying these new technologies to the elderly. Thus, based on our research, we can develop a complex model of care based on the bio-psycho-social principles, which can be a significant advance in the prevention and early detection of age-related mental disorders and in alleviating the physical and psychological burdens of people with dementia and their families. Orv Hetil. 2018; 159(24): 965-973.

In this document, the Commission announces that the Office of Management and Budget (OMB) has approved, for a period of three years, the information collection associated with rules adopted in the Commission’s document Access to Telecommunication Equipment and Services by Persons with Disabilities; Amendment of the Commission’s Rules Governing Hearing Aid-Compatible Mobile Handsets et. al., Report and Order and Order on Reconsideration (Order). This document is consistent with the Order, which stated that the Commission would publish a document in the Federal Register announcing the effective date of those rules.

We, the Architectural and Transportation Barriers Compliance Board (Access Board or Board), are revising and updating, in a single rulemaking, our standards for electronic and information technology developed, procured, maintained, or used by Federal agencies covered by section 508 of the Rehabilitation Act of 1973, as well as our guidelines for telecommunications equipment and customer premises equipment covered by Section 255 of the Communications Act of 1934. The revisions and updates to the section 508-based standards and section 255-based guidelines are intended to ensure that information and communication technology covered by the respective statutes is accessible to and usable by individuals with disabilities.

Background: We have previously demonstrated that when speech generating devices (SGD) are used as assistive technologies, they are preferred over the users' natural voices., Objective: We sought to examine whether using SGDs would affect listener's perceptions of hirability of people with complex communication needs., Methods: In a series of three experiments, participants rated videotaped actors, one using SGD and the other using their natural, mildly dysarthric voice, on (a) a measurement of perceptions of speaker credibility, strength, and informedness and (b) measurements of hirability for jobs coded in terms of skill, verbal ability, and interactivity. Experiment 1 examined hirability for jobs varying in terms of skill and verbal ability. Experiment 2 was a replication that examined hirability for jobs varying in terms of interactivity. Experiment 3 examined jobs in terms of skill and specific mode of interaction (face-to-face, telephone, computer-mediated)., Results and Conclusions: Actors were rated more favorably when using SGD than their own voices. Actors using SGD were also rated more favorably for highly skilled and highly verbal jobs. This preference for SGDs over mildly dysarthric voice was also found for jobs entailing computer-mediated-communication, particularly skillful jobs.

In this document, the Federal Communications Commission (Commission) modernizes its wireless hearing aid compatibility rules. The Commission adopts these rules to ensure that people with hearing loss have full access to innovative handsets and technologies.

The Digital Accessible Information SYstem (DAISY) player is an assistive reading tool developed for use by persons with visual impairments. Certain problems have persisted in the operating procedure and interface of DAISY players, especially for their Chinese users. Therefore, the aim of this study was to redesign the DAISY player with increased usability features for use by native Chinese speakers. First, a User Centered Design (UCD) process was employed to analyze the development of the prototype. Next, operation procedures were reorganized according to GOMS (Goals, Operators, Methods, and Selection rules) methodology. Then the user interface was redesigned according to specific Universal Design (UD) principles. Following these revisions, an experiment involving four scenarios was conducted to compare the new prototype to other players, and it was tested by twelve visually impaired participants. Results indicate the prototype had the quickest operating times, the fewest number of operating errors, and the lowest mental workloads of all the compared players, significantly enhancing the prototype's usability. These findings have allowed us to generate suggestions for developing the next generation of DAISY players for people, especially for Chinese audience., (Copyright © 2015 Elsevier Ltd and The Ergonomics Society. All rights reserved.)

Objective: To assess undergraduates' perceptions of three augmentative and alternative communication (AAC) modes., Method: We showed 104 undergraduates a video clip of a person using each of the three AAC modes and asked them to rate each option in terms of perceived (a) intelligibility, (b) ease of acquisition, (c) effectiveness/acceptability, and (d) preference. The three AAC modes shown were (a) manual signing, (b) picture exchange, and (c) speech-generating device., Results: Mean ratings for perceived intelligibility and effectiveness/acceptability were significantly higher for the speech-generating device. The speech-generating device and manual signing options were rated as being more preferred over picture exchange. Picture exchange was rated significantly higher on perceived ease of acquisition., Conclusion: Speech-generating devices were perceived to have greater social validity than manual signing and picture exchange.

ALS patients usually use augmentative and alternative communication tools to communicate with other people, but the assessment tools, including the selection of an input switch, are very difficult to operate. In this study, we developed a novel device to measure the physical ability of patients to operate the input switch with a push lever. The study focused on the amount of pushing and the power required to operate the input switch, and the effectiveness was verified.

Individuals with autism spectrum disorders (ASD) and complex communication needs often rely on augmentative and alternative communication (AAC) as a means of functional communication. This meta-analysis investigated how individual characteristics moderate effectiveness of three types of aided AAC: the Picture Exchange Communication System (PECS), speech-generating devices (SGDs), and other picture-based AAC. Effectiveness was measured via the Improvement Rate Difference. Results indicated that AAC has small to moderate effects on speech outcomes, and that SGDs appear to be most effective when considering any outcome measure with individuals with ASD without comorbid intellectual/developmental disorders (IDD). PECS appears to be most effective when considering any outcome measure with individuals with ASD and IDD. SGDs and PECS were the most effective type of AAC for preschoolers, when aggregating across outcome measures. No difference was found between systems for elementary-aged and older individuals.

Objective: Reliability is a desirable characteristic of brain-computer interface (BCI) systems when they are intended to be used under non-experimental operating conditions. In addition, their overall usability is influenced by the complex and frequent procedures that are required for configuration and calibration. Earlier studies examined the issue of asynchronous control in P300-based BCIs, introducing dynamic stopping and automatic control suspension features. This report proposes and evaluates an algorithm for the automatic recalibration of the classifier's parameters using unsupervised data., Approach: Ten healthy subjects participated in five P300-based BCI sessions throughout a single day. First, we examined whether continuous adaptation of control parameters improved the accuracy of the asynchronous system over time. Then, we assessed the performance of the self-calibration algorithm with respect to the no-recalibration and supervised calibration conditions with regard to system accuracy and communication efficiency., Main Results: Offline tests demonstrated that continuous adaptation of the control parameters significantly increased the communication efficiency of asynchronous P300-based BCIs. The self-calibration algorithm correctly assigned labels to unsupervised data with 95% accuracy, effecting communication efficiency that was comparable with that of supervised repeated calibration., Significance: Although additional online tests that involve end-users under non-experimental conditions are needed, these preliminary results are encouraging, from which we conclude that the self-calibration algorithm is a promising solution to improve P300-based BCI usability and reliability.

Purpose: This study examines accuracy and comparability of 4 trademarked acoustic analysis software packages (AASPs): Praat, WaveSurfer, TF32, and CSL by using synthesized and natural vowels. Features of AASPs are also described., Method: Synthesized and natural vowels were analyzed using each of the AASP's default settings to secure 9 acoustic measures: fundamental frequency (F0), formant frequencies (F1-F4), and formant bandwidths (B1-B4). The discrepancy between the software measured values and the input values (synthesized, previously reported, and manual measurements) was used to assess comparability and accuracy. Basic AASP features are described., Results: Results indicate that Praat, WaveSurfer, and TF32 generate accurate and comparable F0 and F1-F4 data for synthesized vowels and adult male natural vowels. Results varied by vowel for women and children, with some serious errors. Bandwidth measurements by AASPs were highly inaccurate as compared with manual measurements and published data on formant bandwidths., Conclusions: Values of F0 and F1-F4 are generally consistent and fairly accurate for adult vowels and for some child vowels using the default settings in Praat, WaveSurfer, and TF32. Manipulation of default settings yields improved output values in TF32 and CSL. Caution is recommended especially before accepting F1-F4 results for children and B1-B4 results for all speakers.

Background: Understandings of 'communicative competency' (CC) have an important influence on the ways that researchers and practitioners in augmentative and alternative communication (AAC) work toward achieving positive outcomes with AAC users. Yet, very little literature has critically examined conceptualizations of CC in AAC. Following an overview of the emergence of the concept of CC and of the field of AAC, we review seven conceptualizations of CC identified in the literature., Aims: To consider the contributions and potential shortcomings of conceptualizations of CC in AAC., Methods & Procedures: We use a critical theoretical approach to review, critique and synthesize conceptualizations of CC in AAC, with a particular focus on uncovering 'taken for granted' assumptions. By historically situating the reviewed literature, we examine the shifting boundaries and tensions among theoretical conceptualizations of CC in AAC and their potential impacts on practice., Main Contributions: We suggest ways that revisiting past scholarly work, alongside emergent, innovative conceptualizations of CC might shift ways of thinking about CC in AAC which tend to focus on the individual who communicates differently, toward (re)location of CC as a shared, socially incorporated and performed communication construct., Conclusion & Implications: We propose that emerging critical perspectives drawn from AAC and other interdisciplinary literatures offer innovative ways of theorizing communication difference, which might inform evolving conceptualizations of CC in AAC., (© 2013 Royal College of Speech and Language Therapists.)

The purpose of this study was to examine the iconicity of 16 Picture Communication Symbols (PCS) presented on a themed bed-making communication overlay for South African children with English as an additional language and mild intellectual disability. The survey involved 30 participants. The results indicated that, overall, the 16 symbols were relatively iconic to the participants. The authors suggest that the iconicity of picture symbols could be manipulated, enhanced, and influenced by contextual effects (other PCS used simultaneously on the communication overlay). In addition, selection of non-target PCS for target PCS were discussed in terms of postulated differences in terms of distinctiveness. Potential clinical implications and limitations of the study, as well as recommendations for future research, are discussed.

The purpose of the study was to determine whether significantly different preference exists in typical adults between Picture Communication Symbols (PCSs) and Gus Communication Symbols (GCSs) frequently displayed on their AAC. A total of 56 participants participated in the study, including 15 participants in ages 20-35; 14 participants in ages 36-50; 13 participants in ages 51-60; and 14 participants in ages 66-80. Two tasks, an identification task and a preference task, were administered sequentially and individually. The results of this study suggest: (1) typical adults' preference between PCSs and GCSs did not show any significant difference; (2) the effect of age groups of typical adults did not have any significant effect on their preference between PCSs and GCSs. However, except the group of ages 51-65, the other three groups did consciously show their preferences for PCSs. Limitations and clinical implications of the current study have been concluded., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background: Involving people with dementia in research is not self-evident. Inclusion of people with dementia in the development process of user-friendly, supportive IT applications may be especially useful to improve the quality of these applications and may be beneficial to the person with dementia. The aim of this study was to gain insight into the involvement of people with dementia in developing supportive IT applications. The focus of involvement was on phase, methods, role and impact on the quality of the IT application and on the person with dementia., Method: A systematic search was undertaken using Cochrane Library, PubMED, PsycInfo, EMBASE, and CINAHL. Publications were selected using the following inclusion criteria: publications had to address a development process of an IT application involving people with dementia. The BMJ checklist was used to assess the quality of the included publications., Results: Twenty-six publications relating to 15 IT programs met the inclusion criteria. People with dementia were mainly involved in the exploratory and technical development phases. The methods most frequently used to involve the participants were interviews, observations and usability try-outs. In most studies, participants were objects of study and informants. People with dementia provided useful feedback and gave valuable recommendations for researchers and designers regarding the development of user-friendly, supportive, IT applications. Involvement in all phases may have empowering effects on people with dementia., Conclusion: To develop valuable, user-friendly, supportive IT applications that increase the quality of life of people with dementia involvement in all phases of the development process is of great importance., (Copyright © 2013 Elsevier B.V. All rights reserved.)

Purpose: This investigation examined the effect of repeated exposure to novel and repeated spoken words in typical environments on the intelligibility of 2 synthesized voices and human recorded speech in preschools., Method: Eighteen preschoolers listened to and repeated single words presented in human-recorded speech, DECtalk Paul, and AT&T Voice Michael during 5 experimental sessions. Stimuli consisted of repeated and novel words presented in each speech output condition during each session. Sessions took place in the presence of typically occurring noise in classroom or home settings., Results: There was a significant main effect for voice as participants accurately identified significantly more words in the human-recorded speech and AT&T Voice than in the DECtalk speech output condition. When averaged across speech output conditions, children increased their accuracy as they participated in additional sessions. There was a statistically significant interaction between session and voice. DECtalk had a slightly larger effect of session than did AT&T Voice and human-recorded speech.

Purpose: An Audience Response System (ARS) commonly used in schools and universities was studied for its benefit in rehabilitation. Audience response systems or "clickers" are technological tools for promoting interactive learning. Clickers were studied for their applicability to clinical settings as well., Method: Current literature shows evidence-based research and best practices for clicker use within schools. This study expanded ARS into the rehabilitation milieu and then analyzed learner opinions and outcomes. Qualitative data was obtained from both professional and patient groups., Results: Clickers were used while presenting research findings at conferences, when conducting staff seminars, and during client support groups and subsequent educational sessions. Response graphs and decision trees illustrate the flexibility of ARS for helping educators match presentation content to audience feedback., Discussion: Clickers narrowed the gap between those with expertise and those with minimal experience, since immediate clarification was given according to clicker results. ARS helped to engage listeners, which is consistent with clicker research conducted in academic environments., Conclusion: With clickers, the knowledge and viewpoints of participants can be instantly graphed and displayed, and pertinent information can be provided in real-time. Examples from rehabilitation scenarios depict benefits of Audience Response Systems beyond academia., (© 2012 Association of Rehabilitation Nurses.)

We describe the ICF-CY for AAC Profile, a tool to integrate information about the multiple factors affecting communication skill development and use in school-aged children with complex communication needs. The Profile uses the World Health Organization's International Classification of Functioning, Disability and Health - Children & Youth Version ( WHO, 2007 ) as its framework. We propose that the ICF-CY for AAC Profile constitutes a code set for AAC users and discuss the iterative process of code-set development. The Profile is one component of a proposed process to guide the development of educational goals for children in Grades kindergarten-12 who currently or potentially rely on AAC.

The purpose of this article is to discuss the implementation of the International Classification of Functioning, Disability and Health (ICF), and the ICF version for Children and Youth (ICF-CY), within the context of augmentative and alternative communication (AAC). First, the use of the ICF and the ICF-CY in AAC research is analyzed. Second, examples of training and implementation of ICF from other contexts besides AAC are provided. Finally, we synthesize data to provide directions for future implementation of the ICF and ICF-CY in the field of AAC. We conclude that, within AAC, organizational routines and intervention documents need to be adapted to the universal language and classification framework of the ICF and ICF-CY. Furthermore, examples are needed to demonstrate how factors affect implementation at organizational and individual levels.

Objectives: A stroke that affects the medulla oblongata and/or pons can result in tetra pareses and paralysis of the lower cranial nerves while other parts of the brain remain intact, thus locking the person in. The incidence and prevalence is not known. The aim of this article is to communicate the need for and benefits of a comprehensive rehabilitation and a standardized way of approaching the locked-in person., Material and Methods: To illustrate the rehabilitation process, we present four cases to highlight the needs of the person and what is required of the team., Results:   Communication at arrival: three persons communicated through eye movement, one by weak voice. At follow-up (1-6 years later): computer assisted communication was used by two persons, a letter board by one and 'ordinary communication' by one., Conclusions: There is a need for follow-up not only to re-assess skills and needs partly owing to new technologies but also to see whether the person needs more assistance to adapt to the alternative means of communication or whether the carers of the person need extra information about communication. We conclude that the low incidence of the syndrome necessitates a skilled team in which different professionals can together assess the person. This probably requires some centralization., (© 2011 John Wiley & Sons A/S.)

This study described preliminary work with the Supplemented Speech Recognition (SSR) system for speakers with dysarthria. SSR incorporated automatic speech recognition optimized for dysarthric speech, alphabet supplementation, and word prediction. Participants included seven individuals with a range of dysarthria severity. Keystroke savings using SSR averaged 68.2% for typical sentences and 67.5% for atypical phrases. This was significantly different to using word prediction alone. The SSR correctly identified an average of 80.7% of target stimulus words for typical sentences and 82.8% for atypical phrases. Statistical significance could not be claimed for the relations between sentence intelligibility and keystroke savings or sentence intelligibility and system performance. The results suggest that individuals with dysarthria using SSR could achieve comparable keystroke savings regardless of speech severity.

This cross-sectional research design compares the efficiency of videoconferencing in distance communication for signing deaf persons with that of teletypewriter (TTY)-based telecommunication for the deaf. The efficiency of message transmission was evaluated among 30 signing deaf persons (18 to 65 years) under the six following experimental conditions: (a) Omnitor Allan eC software, (b) Polycom ViaVideo II software, (c) Microsoft Windows Live Messenger software, (d) the D-Link videophone, (e) TTY (written French), and (f) face to face (reference standard). Three timed intelligibility tests and a satisfaction assessment were carried out for each of the experimental conditions. Results showed that videoconferencing technologies offer a better efficacy/time ratio for communication than does TTY. Communication using videoconferencing technologies was very similar to face-to-face communication; this was also true for technologies that are not designed specifically for the deaf population. Equivalent satisfaction levels were observed between TTY and videoconferencing technologies. Microsoft Windows Live Messenger was less preferred due to image fluidity issues.

This investigation examined the extent to which a set of 98 best practices in AAC, previously agreed upon by a panel of experts in AAC and inclusive education, reflected the actual preferences of 32 parents of children diagnosed with Angelman Syndrome. Parents' responses were examined in relation to whether their children were currently in mostly integrated (MI) settings with children without disabilities, or mostly segregated settings with other children with disabilities. With two exceptions, both groups, regardless of their children's current placements, viewed the practices favorably. When asked to prioritize the most important communication skills they wished their children to attain, all of the most frequently cited priorities were reflected in items contained in the questionnaire, supporting the social validity of the questionnaire as truly reflecting parents' priorities for AAC instruction. Implications of this investigation are discussed, along with next steps.

This study evaluated whether two people with multiple disabilities and minimal motor behavior would be able to improve their pointing performance using finger poke ability with a mouse wheel through a Dynamic Pointing Assistive Program (DPAP) and a newly developed mouse driver (i.e., a new mouse driver replaces standard mouse driver, changes a mouse wheel into a thumb/finger poke detector, and intercepts mouse action). Initially, both participants had their baseline sessions. Then intervention started with the first participant. When his performance was consolidated, new baseline and intervention occurred with the second participant. Finally, both participants were exposed to maintenance phase, in which their pointing performance improved significantly. Both participants improved their pointing efficiency with the use of DPAP and remained highly successful through maintenance phase. Implications of the findings are discussed.

These two studies involved a boy and a man with multiple disabilities, who were taught to use a mouth-drying response to reduce the effects of their drooling. Both studies relied on microswitch technology to monitor the drying response and follow it with positive stimulation (i.e., during intervention). In Study I, the boy performed the drying response via a special napkin. The microswitch technology consisted of touch/pressure sensors and a radio transmitter hidden inside the napkin. Drying responses led the boy to 8s of preferred stimulation. In Study II, the man performed the drying response via a handkerchief. The microswitch technology consisted of an optic sensor and a radio transmitter at the man's chest. Drying responses led the man to 8-10s of preferred stimulation. The stimulation time/conditions were subsequently modified to promote a reduction in the man's response frequency. The experimental design involved an ABAB sequence (Study I) or an ABABB(1)B(2) sequence (Study II), with the second B or the B(1)B(2) combination spreading over periods of about 3 months. The results indicated vast increases in drying responses and decreases in chin wetness during the intervention phases. The frequencies of the drying response remained consistent for the boy and stabilized at a lower level (i.e., in line with the manipulation of the stimulation conditions) for the man. Implications of the findings and limitations of the studies are discussed.

Intervention programs, based on learning principles and assistive technology, were assessed in two studies with two post-coma men with minimally conscious state and pervasive motor disabilities. Study I assessed a program that included (a) an optic microswitch, activated via double blinking, which allowed a man direct access to brief music intervals, and (b) a voice output communication aid (VOCA) with two channels, activated via different hand-closure movements, which allowed the man to call his mother and a research assistant who provided stimulation events. Study II assessed a program that included (a) a pressure microswitch, activated via head movements, which allowed a man direct access to video-clips and music, and (b) a VOCA device, activated via prolonged eyelid closure, which allowed the man to call the caregiver (i.e., a research assistant) who provided attention and sung to him. Each of the two participants had significant increases in both microswitch- and VOCA-related responses during the intervention phases of the studies. Moreover, purposeful choice seemed to occur between the two VOCA responses in Study I. Implications of the findings for improving the situation of post-coma persons with minimally conscious state and pervasive motor disabilities are discussed.

This study assessed whether two people with profound multiple disabilities and minimal motor behavior would be able to control environmental stimulation using thumb poke ability with a mouse wheel and a newly developed mouse driver (i.e., a new mouse driver replacing standard mouse driver, and turning a mouse into a precise thumb poke detector). The study was carried out according to an ABAB design and included a 2-month post-intervention check. The two people increased significantly in the target response (thumb poke) to activate the control system to produce environmental stimulation during the B (intervention) phases. This performance was maintained at the post-intervention check. Practical and developmental implications of the findings were discussed.

This study undertakes a simulation and validation experiment to provide guidelines regarding pointing device usage for quadriplegic individuals assisted by a newly developed integrated pointing device apparatus (IPDA). The simulation experiment involving 30 normal subjects whose upper limb movement was restricted by splints. Another 15 subjects with high level cervical spinal cord injury (SCI) were recruited for the validation study. All normal subjects employed six control modes for target-acquisition and drag-and-drop tasks using an IPDA to integrate common pointing devices. A previously designed software was used to evaluate the operational efficiency (OE), expressed as "able performance" (%AP), of the subjects. The experimental results indicated that the OE of normal subjects for controlling the pointing devices were dominated first by using the unilateral hand (69-100 %AP), then by using the wrist/hand (65-73 %AP), and finally by using either bilateral body parts or the combination of limb and chin (45-53 %AP). The OE for operating an orientation-rotated mouse using the dominant wrist/hand via IPDA in both tasks was equivalent to that for operating a trackball using the dominant hand. The experimental results obtained by subjects with SCI also demonstrated similar findings, although the OEs in each control mode were lower than in normal subjects. Results of this study provide valuable guidelines for selecting and integrating common pointing devices using IPDA for quadriplegic individuals. The priority for selecting which body part should control the pointing devices was as follows: unilateral hands, unilateral wrist/hands, and either bilateral body parts or a limb and chin/head/neck in combination.

Purpose: To explore users' experiences and perceptions of speech-driven environmental control systems (SPECS) as part of a larger project aiming to develop a new SPECS. The motivation for this part of the project was to add to the evidence base for the use of SPECS and to determine the key design specifications for a new speech-driven system from a user's perspective., Method: Semi-structured interviews were conducted with 12 users of SPECS from around the United Kingdom. These interviews were transcribed and analysed using a qualitative method based on framework analysis., Results: Reliability is the main influence on the use of SPECS. All the participants gave examples of occasions when their speech-driven system was unreliable; in some instances, this unreliability was reported as not being a problem (e.g., for changing television channels); however, it was perceived as a problem for more safety critical functions (e.g., opening a door). Reliability was cited by participants as the reason for using a switch-operated system as back up. Benefits of speech-driven systems focused on speech operation enabling access when other methods were not possible; quicker operation and better aesthetic considerations. Overall, there was a perception of increased independence from the use of speech-driven environmental control., Conclusions: In general, speech was considered a useful method of operating environmental controls by the participants interviewed; however, their perceptions regarding reliability often influenced their decision to have backup or alternative systems for certain functions.

Objectives: The objectives of this study were to develop a pointing device controlled by head movement that had the same functions as a conventional mouse and to evaluate the performance of the proposed device when operated by quadriplegic users., Methods: Ten individuals with cervical spinal cord injury participated in functional evaluations of the developed pointing device. The device consisted of a video camera, computer software, and a target attached to the front part of a cap, which was placed on the user's head. The software captured images of the target coming from the video camera and processed them with the aim of determining the displacement from the center of the target and correlating this with the movement of the computer cursor. Evaluation of the interaction between each user and the proposed device was carried out using 24 multidirectional tests with two degrees of difficulty., Results: According to the parameters of mean throughput and movement time, no statistically significant differences were observed between the repetitions of the tests for either of the studied levels of difficulty., Conclusions: The developed pointing device adequately emulates the movement functions of the computer cursor. It is easy to use and can be learned quickly when operated by quadriplegic individuals.

Six principles of AAC research and practice are offered for consideration and discussion within the AAC community. Principle 1 requires the active participation of individuals with complex communication needs (CCN) in all AAC activities. Principle 2 seeks to ensure that theoretical constructs underlying research and development in AAC are grounded, widely accepted, and clearly defined. Principle 3 underscores the need to use ergonomics in the design and development of AAC technologies and instructional strategies. Principle 4 highlights communication partners and the unique roles they play in AAC. Principle 5 accentuates the need to focus on societal roles, relationships, and opportunities made possible by AAC technologies and services. Finally, principle 6 draws attention to the importance of measuring a broad range of AAC outcomes, especially those most significant to primary AAC stakeholders.

Background: Some patients receiving mechanical ventilation experience an intensified need to communicate while their ability to do so is compromised as the endotracheal tube prevents speech. Although the use of a communication board to enhance communication with such patients has been suggested, few descriptive or empirical studies have addressed the content and format of these devices or of patients' perspectives on decreasing frustration with communication., Objectives: The objectives of this study were: (1) to identify the perceived level of frustration of patients receiving mechanical ventilation while they attempt to communicate; (2) to determine patients' perceived level of frustration if a communication board had been used; and (3) to describe patients' perceptions of the appropriate content and format of a communication board., Methods: Twenty-nine critically ill patients who were extubated within the past 72 hours were included in this descriptive study. Subjects participated in a 20- to 60-minute audiotaped interview consisting of questions about their perceived level of frustration when communicating with and without a communication board and their thoughts about the appropriate content and format of a board. Transcripts were analyzed by questions for meaning and overall themes., Results: Sixty-two percent (n = 18) of patients reported a high level of frustration in communicating their needs while receiving mechanical ventilation. Patients judged that their perceived level of frustration in communicating their needs would have been significantly lower (P < .001) if a communication board had been offered (29.8%) than if not (75.8%). Most patients (69%; n = 20) perceived that a communication board would have been helpful, and they also identified specific characteristics and content for a communication board. A communication board may be an effective intervention for decreasing patients' frustration and facilitating communication., Conclusions: Most patients receiving mechanical ventilation experienced a moderate to a high level of frustration when communicating their needs. In this study, a communication board, if used patiently during mechanical ventilation, has been shown to alleviate frustration with communication. Patients have specific ideas about what terms and ideograms are useful for a communication board. Further research is needed to test the effects of a communication board and other methods of facilitating communication on outcomes such as satisfaction and anxiety of patients, adequate and appropriate management of pain, and length of mechanical ventilation time and hospital stay.

Four experiments examined the utility of real-time text in supporting deaf students' learning from lectures in postsecondary (Experiments 1 and 2) and secondary classrooms (Experiments 3 and 4). Experiment 1 compared the effects on learning of sign language interpreting, real-time text (C-Print), and both. Real-time text alone led to significantly higher performance by deaf students than the other two conditions, but performance by deaf students in all conditions was significantly below that of hearing peers who saw lectures without any support services. Experiment 2 compared interpreting and two forms of real-time text, C-Print and Communication Access Real-Time Translation, at immediate testing and after a 1-week delay (with study notes). No significant differences among support services were obtained at either testing. Experiment 3 also failed to reveal significant effects at immediate or delayed testing in a comparison of real-time text, direct (signed) instruction, and both. Experiment 4 found no significant differences between interpreting and interpreting plus real-time text on the learning of either new words or the content of television programs. Alternative accounts of the observed pattern of results are considered, but it is concluded that neither sign language interpreting nor real-time text have any inherent, generalized advantage over the other in supporting deaf students in secondary or postsecondary settings. Providing deaf students with both services simultaneously does not appear to provide any generalized benefit, at least for the kinds of materials utilized here.

Background: Alternative communication., Aim: To evaluate the efficacy of the adapted Pecs and Picture Communication Symbols (PCS) in the communication of a child with cerebral palsy., Method: The participant of this study was a 9 year and 10 months old girl, with athetoid quadriplegia. All stages of the adapted Pecs were applied (Walter, 2000), using the PCS pictures (Johnson, 1998), associated with the functional curriculum proposed by LeBlanc (1991). An experimental AB Design was used in order to test the procedures., Results: The subject was able to pass through all of the adapted Pecs phases and to use her communication board in school activities., Conclusion: The adapted Pecs proved to be effective in improving the subject's communication abilities.

Typical audible pedestrian signals indicate when the pedestrian walk interval is in effect but provide little, or even misleading information for directional alignment. In three experiments, blind and blindfolded sighted adults crossed a simulated crossing with recorded traffic noise to approximate street sounds. This was done to investigate how characteristics of signal presentation affected usefulness of the auditory signal for guiding crossing behaviour. Crossing was more accurate when signals came only from the far end of the crossing rather than the typical practice of presenting signals simultaneously from both ends. Alternating the signal between ends of the crossing was not helpful. Also, the customary practice of signalling two parallel crossings at the same time drew participants somewhat toward the opposite crossing. Providing a locator tone at the end of the crossing during the pedestrian clearance interval improved crossing accuracy. These findings provide a basis for designing audible pedestrian signals to enhance directional guidance. The principal findings were the same for blind and sighted participants and applied across a range of specific signals (e.g. chirps, clicks, voices).

Background: Language development in individuals who use Augmentative and Alternative Communication analyzed in a vygotskian perspective., Aim: To investigate the use of Picture Communication Symbols (PCS) as a mediation instrument for a non-speaking child., Methods: A qualitative research based on the re-telling of stories using PCS, mediated by an adult., Results: Changes in the narratives were observed. The child presented a better discursive structure at the end of the study., Conclusions: The findings demonstrate the importance of PCS as a mediation instrument for non-speaking individuals, improving their language and life quality.

This article examines the extent to which Short Message Service (SMS) messages are breaking down communication barriers among deaf people and between deaf and hearing people. It is predicted that deaf texters will use SMS to increase the bonds between themselves in deaf communities, creating new opportunities to develop relationships, understanding, and intimacy with those not physically present. The most exciting question raised by this article is whether those kinds of relationships, understanding, and intimacy will develop to the same extent with hearing colleagues, friends, and intimates.

Use of cell phones has grown dramatically; however, there remains a gap between people with disabilities and the general public in regard to access to cellular telephony. This article describes the importance of cell phone use among people who use augmentative communication devices. An "off-the-shelf" solution is described and illustrated with the goal of improving access to mobile communication among individuals with significant communication disabilities. Finally, a discussion of the need for universal design of cell phones that includes such features as infrared ports, volume range, speakerphones, matrix displays, EZ buttons, voice dialing, and messaging is presented.

Some physicians may be insufficiently prepared to work with the many patients who have hearing loss. People with hearing loss constitute approximately 9% of the U.S. population, and the prevalence is increasing. Patients with hearing loss and their physicians report communication difficulties; physicians also report feeling less comfortable with these patients. Although communication with patients plays a major role in determining diagnoses and management, little attention is given to teaching medical students and residents the skills necessary to facilitate communication when hearing loss is involved. The need for these skills will increase with the expected rise in the number of such patients. The author presents the rationale for including information about hearing loss in curricula on patient-doctor communication, and suggests curricular content, including background regarding hearing loss and techniques that can enhance the physician's ability to listen to (that is, "hear") and learn about the stories of these patients.