Speech Communication

Speech Communication

Key Takeaways

What is Assistive Technology (AT) for Speech Communication?

  • AT for speech communication is often referred to as Augmentative and Alternative Communication or AAC.
  • AAC includes speech-generating and voice amplification devices, supports for expressive language like writing/typing/word prediction, graphic organizers and software to support sentence development, supports for receptive language like accessing text with text-to-speech options, and devices with delayed auditory feedback. 
  • AAC can be low-, mid-, or high-tech
  • AAC encompasses any and all means of communication other than oral speech.

Common No-Tech and Low-Tech Speech AT Solutions:

  • Sign language
  • Pencil/paper or dry erase marker/board
  • Standalone photos, pictures, or symbols (ex. hand drawings, clip art, Google images, or Boardmaker)
  • Communication board, book, ring, or wallet

When Do I Need to Use AAC?

  • People with speech communicate all the time across all environments, so a person using AAC will need access to the system/device all the time! 
  • Behavior is communication, so when a person with a speech impairment or disability is acting out, throwing fits, or stonewalling, this - in and of itself - is communication and can be a “red flag” indicating a communication tool may be needed.
  • AAC may only be used during communication breakdowns.

Who Needs AAC?

  • Anyone who is not able to speak intelligibly whether face-to-face or long distances (Ex. on the telephone or via social media/email/etc.)
  • Those who are born with disabilities affecting their speech (Ex. Autism, Cerebral Palsy, Down syndrome)
  • Those with acquired disabilities (Ex. Traumatic Brain Injury, Amyotrophic Lateral Sclerosis, Stroke)
  • Those with temporary needs (Ex. Intubation during medical procedure prohibiting a person from speaking)

Why Do People Without Speech Not Use AAC?

  • Sometimes people are not aware of the tools available to assist people who have trouble communicating verbally. 
  • Speech pathologists get very little training on AAC, so they may not always know how to help match a person with a communication tool. 
  • Parents are sometimes scared that if their child uses an AAC device then they will not develop speech, and there are also misconceptions on how to pay for these communication tools.

Situations for Using Speech Communication AT: 

School Environment 

  • Whole class lessons/activities/assignments
  • Small group activities
  • Classmate comments/engagement during lunch or play
  • Therapy sessions – Occupational Therapy, Physical Therapy, Speech Therapy
  • Assemblies

Socialization

  • Meeting with friends
  • Sports
  • Music, games, TV
  • Groups and club activities

Work Environment

  • Interview process
  • Meetings
  • Training
  • Daily tasks

Family/Home Environment

  • Conversations at home
  • Mealtime
  • Bath time
  • Homework
  • Morning and nighttime routines
  • Family outings and errands
  • Traveling in the car
  • Using the phone/computer
  • During emergencies

Community

  • Field trips
  • Sporting events
  • Church or Sunday school
  • Movie theater
  • Grocery store
  • Doctor's office
  • Plays or musicals
  • Dining out
  • Other family settings

Commonly Asked Questions about AAC:

  • Q – Will a child’s speech be hindered by the use of a speech-generating device?
    • A - Research and experience show that children benefit from having a tool (like a speech-generating device) to help them communicate because it takes the pressure off of them to be completely verbal. They also, then, get multiple, correct models of speech from the device, and many times, they become more verbal themselves.
  • Q – How do people afford expensive speech-generating devices?
    • A - There are many funding options for these devices. One option is for a parent to use private insurance, including SoonerCare or Medicaid, to cover the cost of the device. As long as the child is using that device, it is essentially the child’s. Schools are another great funding option as the Individuals with Disabilities Education Act (IDEA) requires Local Education Agencies (LEAs) to ensure AT, like AAC devices, are available to the child or family at no cost. It is also an option for families to purchase the devices outright. This means the device will belong to the family to do with what they want and to transition with the child wherever the child goes. If families need help, low-interest financing options are available through ABLE Tech.

Blue Able Tech logo

AT Solutions at ABLE Tech:

View ABLE Tech’s Speech Communication AT Inventory   

Helpful Links & PDF Resources:

  • American Speech-Language-Hearing Association (ASHA)
    ASHA definition and description of Augmentative and Alternative Communication. 
  • The Prentke Romich Company (PRC)
     Success stories profile individuals who communicate using AAC, parents of children who use AAC, speech pathologists, teachers, and other professionals who are in the field of AAC.
  • Saltillo
    Offers support through a chat corner, shared resources, and curriculum partners.
  • Tobii Dynavox
    Success stories from people who communicate using Tobii DynaVox products.

Guides and Articles:

Video/Webinar/Podcast Resources:

Check out these videos highlighting speech communication devices available to borrow from ABLE Tech. 

EDUCATION

Case Studies of Individuals with Speech/Communication Needs and Recommendations 

Case Study #1

A 3-year-old student enrolled in pre-k, functionally nonverbal, demonstrates negative behaviors at school and home 

This student just transitioned from SoonerStart services into the public school. He has a diagnosis of Down syndrome. He can make vocalizations but is functionally nonverbal. He currently grabs what he wants and has tantrums when not understood. He can follow basic instructions. He does not initiate communication interactions with peers or adults. He enjoys watching videos and wears glasses. His fine motor skills are developing.

Possible Recommendations:

Start by helping this student establish basic communication skills using play to shape requests, rejections, comments, or protests. Model and support speech attempts, gestures, and sign language while using external tools. This is called the whole language approach. Features of a good communication tool are that it may be low-, mid-, or high-tech with or without speech output. It includes real photos, and messages are displayed in the context of a scene. This is known as a visual scene display. Speech output may be digital (prerecorded by another student) or synthetic (computerized) speech Additional features include Just-in-Time programming of “hot spots” using a visual scene display. This facilitates communication “on the fly” creating motivating topics for students to communicate about and eliminating the time it takes to pre-program devices and guesses what vocabulary a student may want to “say”. (Learn more about speech communication tools)

Goals and Outcomes:

The student will participate and communicate in the classroom with peers and adults using speech, gestures, and AAC tools as necessary. Some suggested goals to track outcomes include counting the number of times the student initiates communication or responds during class activities.

See the attached SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework
Sample solutions:

Case Study #2

5th grade student with good receptive language skills, knows what he wants to say but has trouble “getting the words out”

This student is diagnosed with Childhood Apraxia of Speech and has limited verbal output. He knows what he wants to say but when he tries to say it, he struggles, and the words do not always come out. He is smart and performs on grade level. He enjoys reading and playing basketball.

Possible Recommendations:

Start by recognizing this student may still greatly benefit from speech-language therapy to improve his speech output. Balance traditional apraxia therapy techniques with using augmentative communication tools when he gets stuck and is unable to say his message. Features of a communication tool that may be useful include a high-tech device that has alphabet letters and word prediction allowing the student to type messages quickly. The device may also have pictures/symbols/written words to choose from on a dynamic (or changing) screen. Core words are recommended because they work best across all environments and facilitate the creation of novel utterances.  Appropriate systems may range in screen size from 5 to 8 or 10 inches making them usually lightweight and portable. As this student develops speech, the high-tech device may be used less and less, with the possibility of not at all as speech becomes the primary mode of communication. 

Goals and Outcomes:

The student will participate and communicate in the classroom with peers and adults using speech and AAC tools as necessary. Some suggested goals to track outcomes include counting the number of times the student uses complete sentences to initiate communication or respond during class activities.

SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework

Sample Solutions:

 

Case Study #3

High school student has unintelligible speech and multiple physical disabilities

This student is diagnosed with Cerebral Palsy and has unintelligible speech. She knows what she wants to say but lacks sufficient breath support to produce clear speech. She enjoys science classes, and her work is modified. She enjoys hanging out with peers.

Possible Recommendations:

Start by addressing her current curricular goals then determine her post-high school goals.  She wants to work at a place with animals like a veterinarian clinic or animal shelter.  Connect with her Vocational Rehabilitation (VR) counselor through the Department of Rehabilitation Services (DRS) to choose a device that could meet her needs both now and during employment. Features of a communication tool that may be useful include a high-tech device that has multiple access methods allowing her to touch the screen when she is relaxed and rested as well as use a head switch when her increased muscle tone prevents her from directly selecting choices on a communication device.  Because it may take her a while to make selections on a screen, due to her physical challenges, she may prefer a device with phrases and sentences on buttons instead of single words or spelling.  This also allows for quicker, more specific messages to be relayed.  Appropriate systems may have larger screen sizes from 12 to 16 inches making them easy to mount to her wheelchair but also see and touch with larger buttons optional. 

Goals and Outcomes:

The student will participate and communicate in the classroom with peers and adults using speech and AAC tools as necessary. Some suggested goals to track outcomes include counting the number of times the student uses her communication tool to initiate communication, respond during class activities, or complete classroom assignments.

See the attached SETT Framework for feature-matching forms based on the Student, Environment, Tasks, and Tools model.

Case Study Forms – SETT Framework
Sample Solutions:

EMPLOYMENT

Case Studies of Individuals with Speech/Communication Needs and Recommendations 

Case Study #1

A young man with autism, ambulatory, no functional speech, great vision, and fine motor skills.

This student just graduated from high school. He does not use external tools to help him communicate. Those who know him best understand his gestures and body language. He otherwise meets most of his needs by helping himself. He is seeking employment at a restaurant that serves pizza buffet-style. He will need to communicate during an interview and following that will need a tool(s) to help him remember sequences for restocking ingredients at the buffet as well as greet customers.

Possible Recommendations:

Because this young man does not already have an external tool he uses, we will want to provide for him a way to ask and answer questions during an interview. The tool, ideally, would provide verbal prompts that he can follow while completing work tasks and provide a way for him to greet customers. Features of a tool(s) that may meet his needs include systems/devices that are durable, portable, can be accessed through touching, and – ideally – have speech output. Consider that with a little modification, one tool may meet all this employee’s needs or that he may prefer different tools for different outcomes. No-low-tech reminders at each station or a device with speech output, so he can listen to prompts while completing a task. Consider also that if one tool does one thing very well, the employee might need more than one at each station he works.

Goals and Outcomes:

Employee will ask and answer questions during a job interview. He will also complete steps to work tasks and greet customers. Some suggested goals to track outcomes include counting the number of times the employee correctly completes the steps of a task and counting the number of times he greets customers.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample solutions:

Case Study #2

Adult with quadriplegia, uses a wheelchair, is literate, has unintelligible speech, is happy, motivated, funny, and social

This woman is diagnosed with Cerebral Palsy and uses her eyes to indicate what she wants/needs. She is an ambassador for a speech-generating device company which requires her to create and do presentations both in-person and virtually.

Possible Recommendations:

Features of a communication tool that may be useful include a high-tech device that has multiple computer features and functions including presentation software, internet capabilities, social media outlets with email and telecommunications platforms like Skype. It also must be accessible using eye gaze. Because it would take her too long to present while directly gazing at a system that has individual letters, single words, or even pre-programmed phrases, the device would need the ability to store one or more novel sentences on individual buttons. This will make for a more fluid presentation with fewer delays. Appropriate systems may have larger screen sizes from 12 to 15 inches making them easy to see from its mounted position on her wheelchair.

Goals and Outcomes:

Employee will present both in-person and virtually using her speech-generating device. Some suggested goals to track outcomes include counting the number of times she presents in-person and virtually.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample solutions:

Case Study #3

Adult with decreased speech volume, ambulatory, active

This adult acquired an injury to his vocal cords during a surgery and is not able to maintain a typical speech volume throughout the course of the day. He teaches elementary school students and needs to speak for prolonged periods of time and often get students’ attention in noisy environments. In addition to class lessons, he rotates between bus, cafeteria, recess, and car line duties.

Possible Recommendations:

We would start by addressing his need for voice amplification in the classroom. As the day goes on or as he finds himself needing to say the same thing over and over, he may consider using multiple devices depending on the situation and environment. Features of a communication tool(s) that may be useful include a device that amplifies his own speech. He could opt for a classroom system but would also need a portable system to use in his other environments. If he finds he is saying the same thing multiple times a day, he may choose to use a mid-tech device with pre-recorded, digital messages. When his voice is really spent but he needs to communicate more novel utterances, he may consider a device with synthetic voice output, word prediction, and keyboard access.

Goals and Outcomes:

Employee will teach curricular lessons to elementary students and perform all additionally assigned duties requiring him to get and maintain the attention of children and direct them during daily events. Some suggested goals to track outcomes include counting the number of minutes/hours the employee uses his voice amplification tool to conduct classroom and extra-curricular activities as well as the number of minutes/hours he needs additional support using an alternative communication tool.

See the attached HAAT Model form to see how to match the employee to needed AT.

Case Study Forms – HAAT Model
Sample solutions:

Funding Sources for Individuals with Speech/Communication Needs

Public Sources

Private Sources

COMMUNITY

Case Studies of Individuals with Speech/Communications Needs and Recommendations 

Case Study #1

2-year-old, functionally nonverbal, demonstrates negative behaviors at school and at home

This child is diagnosed with Down syndrome.  She makes vocalizations but is functionally nonverbal.  She currently grabs what she wants and has tantrums when not understood. She does not initiate communication interactions.  Her hearing is within normal limits, and she wears glasses.  Her fine motor skills are developing.

Possible Recommendations:

Start by helping this child establish basic communication skills using play to shape requests, rejections, comments, or protests. Model and support speech attempts, gestures, and sign language while using external tools. This is called the whole language approach. Features of a good communication tool are that it may be low-, mid-, or high-tech with or without speech output. It includes real photos, and messages are displayed in the context of a scene. This is known as a visual scene display. Speech output may be digital (prerecorded by another child) or synthetic (computerized) speech. Additional features include Just-in-Time programming of “hot spots” using a visual scene display. This facilitates communication “on the fly” creating motivating topics for children to communicate about and eliminating the time it takes to pre-program devices and guess what vocabulary a child may want to “say”. (Read more information about speech communication tools)

Goals and Outcomes:

The child will communicate to parents and siblings using speech, gestures, and AAC tools as necessary. Some suggested goals to track outcomes include counting the number of times the child initiates communication or responds during play activities.

See the attached HAAT Model form to see how to match the child to needed AT.

Case Study Form – HAAT Model
Sample Solutions:

Case Study #2

Adult with severe physical limitations just joined a support group

This gentleman is diagnosed with Amyotrophic Lateral Sclerosis (ALS) and is unable to communicate verbally. He currently uses a motorized wheelchair to get around and would like to start attending support group meetings. 

Possible Recommendations:

Due to difficulties moving his upper and lower extremities, it is suggested he try a device that can be mounted to his wheelchair with the option to operate the device using eye gaze. It would be efficient for him, and less fatiguing. It is also recommended that the device screen be large enough (13 to 16 inches) to include multiple messages at a time (without them being too small to select via eye gaze) and that vocabulary options range from: single letters, single words, short phrases, sentences, and even pre-stored paragraphs. This gives him the option of creating novel messages while also communicating specific needs thoroughly and quickly (Ex. A single button that says: I’d like to rest now).

Goals and Outcomes:

He will communicate daily needs and converse with his family and caregivers. He will participate in support group by sharing his story and answering questions of others.

See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Form – HAAT Model
Sample Solutions:

Case Study #3

Person with a stroke just discharged from hospital to home.

This person has just had a stroke and has Aphasia. He no longer has clear, fluent speech and then sometimes says single words that do not make sense in the conversation. He no longer has good use of the right side of his body and needs a wheelchair. He is spending the majority of his time at home unless he is heading to doctor or therapy appointments.

Possible Recommendations:

This gentleman may need a device that is lightweight, so it can easily be carried in one hand. Another option would be to have the device mounted to his wheelchair, so that he does not have to carry it in his one good hand. Research shows that people who have had strokes benefit from communication tools organized using visual scene displays. This is when messages are displayed in the context of a scene - typically using real photos and programming “hot spots” with the messages. Another consideration is that when a communication option is selected, this person may want a complete sentence (or sentences) to be said out loud (versus single alphabet letters, single words, or short phrases).

Goals and Outcomes:

An important goal will be for this person to be able to independently communicate what he needs and wants accurately and in a timely way. He may need to call for help when he is alone in a room. He will also need to communicate with his doctors and therapists about aches, pains, and other needs.

See the attached HAAT Model form to see how to match the individual to needed AT.

Case Study Form – HAAT Model
Sample solutions:

Funding Sources for Individuals with Speech/Communication Needs

Public Sources 

Private Sources