Page 205 - Handbook of Electronic Assistive Technology

Chapter 7 • Alternative and Augmentative Communication 193

High-tech devices may also include the facility to control other elements of a computer,
or to transmit commands to another device. This might include transmitting commands
to another computer system, a mobile phone or to an environmental control system as
described in Chapter 6.

Assessment

Clinicians may consider the introduction of AAC for individuals for whom written or spo-
ken communication is difficult. Such difficulties may be present for a variety of reasons,
occurring in the context of congenital disabilities such as cerebral palsy, progressive condi-
tions such as Parkinson’s disease or motor neuron disease or acquired disability following
a stroke or brain injury. It is often the case that individuals requiring AAC are described as
having a complex condition, where more than one impairment or difficulty is present – for
example, a person with a description of cerebral palsy may present with difficulties pro-
ducing clear speech, as well as difficulties with gross and fine motor function that would
preclude the use of a touchscreen or keyboard. As such, the introduction of an AAC system
may need to include the selection and provision of an access system as well as consider-
ation of an individual’s cognitive, sensory, social and linguistic abilities. An assessment for
a potential AAC system is therefore considered to be a multidisciplinary process requiring
input from a wide range of professionals. Equally, ongoing support and implementation
of an AAC system requires the careful consideration and balancing of the views, skills and
preferences of a range of stakeholders (Griffiths and Price, 2011), including the user them-
selves, family members and local and specialist clinical teams.
Successful selection and implementation of an AAC system is a complex process,
requiring consideration not only of the motor, sensory, learning, and communicative skills
of the individual user but also the environment, support networks and communication
partners with whom they will interact. The complex nature of many conditions producing
communication impairment means that such impairments are unlikely to occur in isola-
tion. As a result, it is reasonable to assume that assessment for an AAC system will require
input from a range of professionals. While there currently exist no published guidelines on
the professional roles required for an AAC assessment team, NHS England have recom-
mended in their Service Specification document for Specialised AAC Services that a core
assessment team may be made up of speech and language therapists, clinical scientists
and technologists, occupational therapists and specialist education professionals. In addi-
tion, access to services such as physiotherapy and psychology are recommended; motor
abilities, position for comfort and best function, and learning abilities and patterns should
all be considered in selecting AAC system components. Where communication impair-
ment is present as part of a complex condition, input from a medical doctor may also be
sought to clarify the impact of an individual’s health condition on their likely use of a sys-
tem, particularly if the condition is likely to change over time.
There is no defined, agreed assessment process for selecting AAC systems for adults
and children. In common with other electronic assistive technologies, dedicated National
Institute for Health and Care Excellence guidelines for AAC do not exist at the time of