Augmentative and
Alternative Communication
Dissertation
2000
By
Karl Dean
(BSC Computing)
At
Humberside & Lincolnshire
University
Acknowledgments
Humberside
& Lincolnshire University
Frederick
Holmes School
Prentke
Romich Company
Barry
Taylor (Clinical Scientist)
Julie Adams
Contents
Introduction
6
Background
.
7
Chapter
one
9
Social and interactive
implications
Children
with AAC Systems 1.1
.. 9
Speech
improvement with an AAC 1.2
.. 11
Adult
users with an AAC system 1.3
14
Reducing
behaviour problems 1.4
.. 17
Using
the AAC system in the real world 1.5
. 18
Chapter
two
.. 20
Different ways of scanning icons
Introduction on scanning with different
displays 2.1
20
Operating
switches 2.2
22
Different
scanning methods 2.3
. 24
Scanning patterns 2.4
26
Making selection process more rapidly
2.5
. 28
Special
requirements for users 2.6
. 30
Children
and scanning 2.7
. 32
New scanning method 2.8
33
Summary
of Chapter 2 2.9
..
34
Chapter
three
. 35
Comparing previous speech
synthesizers with the updated models
Introduction 3.1
35
Investigating
the first AAC 3.2
35
Investigating
the latest AAC 3.3
40
First
AACs vs Pathfinder 3.4
... 43
Pathfinder
vs Pc 3.5
44
The
pros and cons for a AAC system 3.6
45
Pros
and cons on a laptop 3.7
. 45
Future
for AAC system 3.8
46
Conclusions
48
List of
figures
. 51
References
.52
Books
53
Websites
.55
Journals
55
Appendixes
Booklets
. A
Users questionaires
.
B
Designers questionaires
..
c
Letters
.. d
Introduction 0.1
Many people with disabilities can benefit from technology.
Microcomputers, in particular, have provided people with the opportunity
to lead more independent and normal lives.
Just as any able-bodied person in areas of vocation, education and
leisure can do. In some cases, there are distinct applications that augment
peoples abilities, such as allowing communication for those who have
difficulty with speaking. In the past
people with these difficulties could only communicate with people that were
close to them i.e. parents, brothers, sisters and friends they had known for a
while, as these would be the only people who could understand them. If they were to meet new people then it
would take a considerable amount of time for them to understand what was been
said, because it would take a while to get tuned in to there speech pattern.
This project is about Augmentative and alternative communication (AAC) devices; these electronic AAC devices are for people with severe communication impairment. The AAC devices are similar to a laptop computer in size and weight. (If you are not familiar with them, you should read the booklet in the appendixes before reading on!) Mainly the AAC equipment will be for people with physical disabilities. This will be mainly people who have Cerebral Palsy with little control over their body movements. For instance, physical disabilities are relevant to both the adaptive and prosthetic use of information technology. People with impaired manual function may not be able to use conventional input devices such as keyboards, and mice, while some people are unable to carry out such everyday operations as walking and may use a computer controlled wheelchair.
The main point of convergence is to investigate the social and interactive implications on the AAC equipment.
Secondly, I will be looking at the interactions that arise with a number
of strategies that apply switch-based scanning to text selection in a task
transparent fashion. The results should provide valuable insights regarding the
design of access systems that enable users of indirect scanning access methods
to achieve not just equal access, but to achieve equal productivity. Basically,
selecting text with an emphasis on reducing user strain, errors, and time. Also
to try to find out which is the best method on scanning.
Finally, I will also be
investigating whether or not the current equipment is keeping up to date with
the state of the art
technology. For instance, I will be investigating and asking questions like; is
the IT equipment available currently, adequate or inadequate to meet the needs
of disabled people? Are the needs of disabled people met in terms of IT
provision?
Background 0.2
In the mid 80s the Prentke Romich Company developed 2 AAC speech
synthesiser devices called the
Touch Talker and Light Talker. The synthesisers are like the boards but
are electronic with icons to press. The icons are laid out in rows. There are
eight lines, which contain 16 icons on each row. There is a storage device to
store words and sentences. For example, supposing the person wishes to say,
what time is it please? the sentence would be stored under the clock icon,
and the user would go to the clock icon and click on it, then the speech
synthesiser would say what time is it please? And also the talker will write this message in the speak display
LSD on the top of the machine.
This was the biggest improvement in people who had a speech problem because for many years disabled people with poor speech or even without any speech have been using paperboards with words/icons on it for communicating with people. The disabled person would point to an icon if he/she wanted to communicate with a person. This method was slow and limited to a few words. Supposing the disabled person was trying to tell another person a sentence, and then 90% of the listeners would have forgot the first part of the sentence when the speaker had finished, even more so, if the person didnt have a word on the board, then he/she would have to spell the word out by each letter. This is very confusing for them both, as you can imagine spelling a word by only pointing to each letters and remembering how to spell it, unless the opposite had a pen and paper to write the message down. The bliss board did not really work in the real world.
Chapter 1
Children with AAC Systems 1.1
The social and interactive implication is a very important topic, which
hasnt been fully explored as yet. Tens
of thousands of people worldwide have AAC systems and are enjoying the benefits
of these developments, but no one knows the social impact of the user. For
most AAC users, personal achievement is an essential role of the ability to
Communicate. The children in the first year at school have the potential
for high personal achievement that far exceeds what was possible even a few
years ago.
Therefore, the child with speech impairment should have an AAC from the
first day at school. There is some research done by Laura F. Meyers Ph.D. at
the university of California Los Angeles, Linguistics. From Closing the gap
Computer technology in special education and rehabilitation, February / March,
2000. Volume 18 Number 6.
She says, The AAC with Minispeak can be learned in the same natural way
as spoken and written language is normally learned. As in the normal processes
of spoken and written language learning, meanings comes first.
During active participation in conversations about personally meaningful
topics, the device user constructs an internal grammar for minspeak. These
methods make it natural to switch between minspeak and written language.
Minspeak strictly speaking is not a language but essentially an index system for retrieving words\sentences by means of mapping sequences of keystrokes to stored phrases. Each key can have any icon or character written on the keys.
There are accommodations that expand selections through a mapping
process as suggested by Vanderheiden and MacDougall et al. Three primary
methods of input
Mapping are commonly used:
One-to-one mapping: characters, words, phrases or
sentences are entered as displayed:
Macro or abbreviation-expansion
mapping: one or a
few letters or symbols are displayed and a complete message or command string
is entered when selected (Roa & Riley, 1981; Vanderheiden, 1984; Beukelman
& Yorkston, 1984; Stum & Demasco, 1992); and
Predictive mapping: a list of predictions of what the user intends to select is displayed following one or a few initial selections; a selection enters the predicted word (Swiffen, Alm and Newell, 1987; Darragh, Witten and James, 1990).
Therefore, Minspeak is essentially a translator from symbol sequences to phrase. For instance, pressing a key with drink icon in it, followed by a key with an icon of a pointing-finger on it, might result in the retrieval of the sentence Please will you go to the bar? Whereas drink icon plus a person icon might retrieve Do you want a drink? Here is the icons layout illustrated in the figure 1.1.
(Figure 1.1.)For more
information about minspeak refer to the booklet on AAC in the appendixes (A).
The children should come full of spontaneity with theirs feelings,
with their questions, with their creativity, with their risk to create, getting
their own words into their own hands in order to do beautiful things with
them. (Paulo Freire, 1985)
I feel that if children were provided with AAC from the beginning of
their education, even pre school, then they would benefit socially and
academically.
Speech improvement with an AAC 1.2
There have been many research studies on the natural speech increasingly
used by AAC, as parents are worried about their child giving up on attempting
to talk. The research shows that not only was natural speech not inhibited by
AAC systems but also that natural speech was likely to increase. Examined were
25 research studies published in 1998 that reported on individuals who used AAC
systems, but had some natural speech, they coded each study and looked for
reports about natural speech. Overall, they found that the majority of the
individuals in the studies showed that natural speech either stayed the same or
increased.
It increased because the AAC user has a backup device to communicate, unlike before when the user didnt have an AAC system, they would get tired of trying to say something and after a few attempts he/she would have given up or would revert to the bliss board. This was a very long-winded process so you couldnt really put a sentence together without thinking about having a conversation. However, in my research, I have found 60% of the AAC users prefer to have a sentence composed and speak it. This is because they dont like having someone looking over their shoulder reading what the user is trying to say. Because they said, most of the time, the person guesses, wrongly, what the user wants to say and this causes frustration.
You can see this in figure 1.2.
(figure 1.2.)
The other 40% of the AAC users I questioned proffered the person reading the screen as they typed. This is because they say it saves time when explaining something. The person listening can then pre-empt what the user is trying to say as it becomes pretty obvious.
As an AAC user myself, it really depends on the situation. For instance, I might want to compose the first sentence to start off the conversation, then let the person read the screen as the person will know what topic of conversation Im talking about.
I think at this point, the natural speech kicks in to gear. As we become deeper into the conversation, the user will only use the AAC for the main keyword if the other party cannot understand the users natural speech. An example could be that if the user is trying to say, please will you get me a bag of chips with the natural speech
The person might decode the sentence as,
Please will you get me a bag of ????? Without understanding the last word. So therefore, the AAC user will write chips on the display, this would save the user time and energy, without writing out all of the sentence. This means no embarrassment on both parts.
This is the natural speech increase. I have a theory - more time using the AAC equals more improvement in the users natural speech. I will use myself as an example, as I didnt have time to research this area, I had just thought of it a few weeks ago myself.
The longer the user uses the AAC system the shorter time it will take for their new friends to understand them with their natural speech. For example, when I received my AAC system at school, three months later I went to college and I was provided with a personal helper who I have not met before in my life. It took the helper 3 months to understand my natural speech. 11 years later, it takes my new helpers on average 3 weeks to get to understand me.
Im not saying the helpers fully understand what Im saying as there is always words they cannot decode, but there will be approximately 75% of words they will understand. Will my AAC be redundant? No, as it will limit myself to the people who I be able to talk to, (like the old days) and the probability of decreasing my natural speech as well.
Adult users with an AAC system 1.3
In my research I have found a lot
of the adults users do not know how to communicate with people using their AAC
systems. This means they cannot have a
conversation or even say a sentence.
This is because they only have been communicating with a few words in
their lifetime, like yes, no, toilet, drink, eat etc. Some of these people have
not had a conversation unless someone else was able to understand what they
were saying. However, when the adult
user received an AAC system, some of the users did not know how to communicate
with people, like putting a sentence together with their AAC. These people will have to re-learn how to
talk, basically, the learning process is a bit like teaching a baby to talk. Some
adults users will not touch their AAC system and, consequently there is a danger they will be reluctant to
get to know and use the AAC. The user
will not know how to communicate and will therefore be isolated from the real
world which could lead to frustration and misunderstandings.
I personally have known a few users who, still cannot communicate by having a conversation or even a saying a small sentence with somebody after eight years of using a machine. The learning process can differ from just one week to over 10 years, or maybe not at all in the users lifetime. However, the progress depends on an individual persons learning span.
Or it may be lack of support on teaching the adults how to use AAC
systems because there are only few adults with an AAC system.
From my questionnaires, Nick Lyth says I wish these talking machines were more simple and quicker for us
disabled people and not so expensive so we could purchase extra things to make
life that bit easier.
In my investigation, I wanted to find out why the old fashioned bliss boards are still been used and see what is the age range of these people.
I actually interviewed some people who still communicate with these boards in some of these so-called homes for the disabled. I asked them a few question like; have you tried a speech synthesiser? Would you swap your board to a speech synthesiser? How long have you used one of these boards?
All the disabled users, which communicate with these boards, were over 40 years old and didnt go out to work or college. They havent tried a speech synthesiser or some of them have not even heard one. Before I asked them questions with my speech synthesiser in the American accent they hadnt even heard one speak. Half of them said they would swap the board to a speech synthesiser straight away, before I told them the price of them. Well, £6,500 is a lot to pay for a few chips! The other half thought the machine would be too complicated for them to operate. I received the impression, that because they havent been in contact with computers in their lifetime they were totally apathetic to using one.
They have only ever known how to communicate with a bliss board, so they have not known any better, or are aware of up to date devices, but I feel these older generation are missing out on the technology and their quality of life is suffering because no-one has bothered introducing them to the new information technology or, as is usually the case they are too expensive.
From my research and experiences, the new technology is going to the age ranges of 4 to 16 years old, as the schools buy the new speech synthesisers from the school charities funds. Especially the special schools as they receive a lot of funds from such areas as firms to individual charity events. When the schools receive the donations the fundraisers like to come and watch them working through the classroom door window. It is really hard to carry out fund raising for adults, (unless they are dying) however, why should disabled people have to rely on charity?
Regrettably, the adults are
basically missing out on the AAC technology because it is a fact that all too often people are
being restricted rather than enlightened with the AAC systems. Further, they
may not even know of the availability and effectiveness of other options and
features. There can be many reasons why users are not comfortable with all the
potential AAC system options. These reasons can be funding, lack of
professionals and service resources, and lack of awareness of the options available
and their relative performance.
Another reason why disabled adults are still in the dark ages in the
communication area is they dont get regular speech therapists unlike when they
were at school. Nowadays speech therapists are trained to teach the AAC systems
to the users. Therefore, the adults dont obtain any support on their AAC.
Furthermore, if the adult hasnt had one he/she might not know about them. Here
is the answer from Barry Romich (The Boss) from Prentke Romich Company
who manufactures the AAC, from
my publicity questionnaire:
Customers pay for all publicity. Our primary marketing efforts are directed toward speech therapists since they are typically the gatekeepers to service provision. Further, they are a reasonably well-defined lot, allowing targeted promotion. This still is costly and we try to be judicious in spending our customers' money.
Reducing behaviour problems 1.4
Supposing an user has a behavior problems, for instance, throwing
objects, biting, head banging, attacking people, yelling etc
The AAC systems
might decrease the aberrant behavior, as it is about 85% this kind of behavior
is due to lack of understanding of the disabled person. For instance, if the
user wanted something but other people cannot understand what they are saying,
they will get angry, especially if that person already has a short fuse. The AAC could bridge the time between the
request and the providing the requested help.
However, those high achievers who rely on AAC systems have a clear vision of their aim in life. Providing they have the best systems and professionals, such as speech therapists, available, for full achievement.
For speech-language pathology professionals providing services in AAC, this consistent with the ASHA Code of Ethics (ASHA, 1994) as articulated in the introductory statement to Principe of Ethics 1:
Individuals shall honour their responsibility to hold paramount the welfare of persons they serve professionally.
This message is quite clear. Professionals are bound by their code of ethics to provide quality standards of care and service. Nothing is more important than acting in the highest interest of the person who relies on AAC, no matter what the presumed potential for achievement. If circumstances preclude behavior that is compliant with the Code, then a full disclosure to all involved is in order.
Using the AAC system in the real world 1.5
The AAC can make users much more independent. For example, they could go to purchase a take-away meal without any assistance. By storing a few orders in the memory, they will only need to press the right icon, to order the food. If that person was in a wheelchair, the AAC user could also tell the shop assistance to hang the take away on the back of the wheelchair before going home, thus enabling them to lead a normal every day life. In my own experiences, carrying out my research I found that after had I used a certain take away a few times the assistants became familiar with me, the AAC user, and they also got the money out of my pocket and hung the food on the back of the wheelchair without me, the AAC user, asking them. The process was that they asked me first, and got to know my special requirements and then, I, the AAC user would only have to say yes, thank you! Basically, the take-away shop assistance will treat the user as a normal customer. Basically the conversation would go something like this, good evening, what would you like to order tonight, Sir? The AAC user will press an icon to order the food by a programmed phrase.
The key point to this scenario is the AAC can be more actively involved in a variety of experiences like ordering independently in a fast-food take away or going to the pub with mates. The AAC makes it easier for people to associate with others and on equals terms. People are sure to respond when a user tells a joke or initiates an interaction like are you coming for a beer? or tell a person I love you (this is probably when the user had too much beer. The speech output allows individuals more opportunities for meaningful inclusion in activities with friends or with tutors and presentations.
Finally, through daily experiences, using an AAC will give users many
opportunities to practice important communication skills like turn taking,
cause and affect, and that language is reinforcing and has meaning.
It might take a user a long time to learn how to effectively communicate
using speech output. Therefore, if they never start, they will never learn.
Chapter 2
Introduction on scanning with
different displays 2.1
The chapter is about alternate
access and scanning solution that emulate the
input device(s) of an AAC, such as
keys.
When users have severe physical limitations, and cannot directly access
any alternate or modified keyboard, an indirect means of access is usually
indicated.
The scanning procedure encourages the user to consider different control
options, for instance, direct selection versus scanning, and control movement
(head, hand, foot, toe, etc) and to include in this decision process other
influential factors such as proper seating and appropriate stabilizers.
An example of indirect access is switch-based scanning with an on-screen
or virtual keyboard (Anson, 1991). An on-screen keyboard displays a
representation of a keyboard on the computer screen and contains keys that
inject keystrokes transparently into the target application when selected.
Here in figure 2.1. is an example of WIVIK software-:
(figure 2.1.)
Alternatives can be icons on the screen, as the AAC system
operates under a system called Minspeak. Minspeak uses icons to which the user
assigns meanings. Icons can have multiple meanings and can be combined in
sequences.
Scanning involves the successive lighting up of icons displayed in the
AAC. The user selects desired icons by activating a switch when that icon is
lit. It is considered indirect because a switch action does not directly
correspond to a keystroke. Similarly, when users are unable to use the standard
mouse or some alternative-pointing device, an indirect scanning solution is
often considered. This generally involves some form of scanning screen pointer.
To control the direction of movement, the screen pointer rotates in a scanning
fashion, or a specific direction is chosen by scanning the on-screen keyboard.
Then the screen pointer scans across the screen and along the chosen
heading.
Emulating a pointing device is considered necessary because pointing is
an integral component of current graphical user interfaces (GUIs).
It is also a fundamental concept of transparency that all keyboard keys
and mouse functions must be available within the access system. These new AAC
systems emulate the keyboard and type into the AAC and it will be displayed on
their pc by infra-red link. The advantage of an infra-red system is that any
selection method can be used and the access system is independent of any
computer manufacturer and operating system.
Operating switches 2.2
There are a variety of switches widely available for individuals to use
with these scanning methods (Closing The Gap Hardware and Software Resource
Guide, 1996). These switches vary in contact surface area, property sensed
(pressure, change in orientation, motion, relative positioning of components,
degree of change), shape, contour, texture, and feedback (auditory, tactile,
visual, kinesthetic) (Shein and Lee, 1983; Shein, Lee, Pearson, Milner and
Parnes, 1985;
Lee and Thomas (1990) describe
the following user actions to operate switches that vary with scanning method
A timed momentary activation (i.e., activate at a critical instant with
automatic scanning);
A non-timed momentary activation (i.e., activate at any time with step
and direct scanning);
A continuous activation with timed release (i.e., release time is
critical with inverse and directed scanning when selection is by release);
A continuous activation with a non-timed release (i.e., release time is
non-critical with inverse and directed scanning when there is a separate
selection switch).
These separate actions, differ in movement speed, direction, or
positioning and do not affect the outcome of activation with a separate switch.
Endurance becomes a critical concern with these actions because of the large
number of repetitive actions to accomplish most tasks. Excessive repetition of
movements may lead to fatigue and strain injury (Cantor, 1995).
One through five switches is not commonly used for scanning. Single
switches are most frequently used for timed activation in an automatic scanning
system, typically a row/column array. Occasionally they are used for inverse
scanning on the new AAC systems nowadays. In the latter case, the user selects
an icon by releasing the switch for a pre-set period of time. A second switch
is often used to augment single-switch scanning techniques. In automatic
scanning, the second switch often provides an escape or cancel function,
and in step or inverse scanning it acts as a selection switch while the first
switch is used to move the light.
Three switches are not very common, although they can provide some
additional control. For example, momentary activation or timed release of one
switch may advance the cursor from left-to-right, while similar movements of a
second switch may move the cursor from top-to-bottom. Releasing and reactivating one of these switches reverses the
scanning direction. Momentary activation of a third switch signals selection.
This approach has the advantage of enabling users to back up quickly if they
accidentally scan past a desired icon, instead of having to wait through
another scanning pass. Five switches provide a high degree of discrete
switch control for directed scanning. Momentary activation or timed release of
four switches, such as a micro switch joystick, directs the cursor within a
two-dimensional scanning array. A momentary activation of the fifth switch
selects the item under the cursor.
Different scanning methods 2.3
Indirect access through scanning can be intense and demanding on the
remaining abilities of the user. However, in my research from the AAC road show
at Frederick Holmes School, I have found much advancement has been done to
reduce scanning time and switch activations through icon arrangement and rate
enhancement techniques.
Nowadays there are 4 basic techniques.
The first one is automatic
scanning - it is a very basic
scanning method. The mechanism is that
the lights automatically move across an array of icons. The light pauses at
each icon for a pre-set time called a scan
interval, momentarily activating a switch, it usually stops the lights over
a row of icons and initiates scans across the row on an individual icon. If the
switch is activated when an individual icon is lit, that icon is selected.
Timing of the switch activation is a critical factor. Rather than track the
moving light, users are taught to focus on the target icon and activate the
switch whenever the target is lit. They continue with this until the target is
selected and scanning begins from the top. This is an old method, which was
used on the first AAC device in the mid 80s called the Light Talker. This
method is still widely used today especially for beginners as it is very simple
to use.
The second method is step
scanning, rather than the system control the speed of presentation, the
user is in control with step scanning, although more switch activations are
required. Here, repeated momentary activation of a switch advances the
highlight. The advantage of this method is that there is less time pressure on
the user. Icons are selected when lit, by activating an additional selection
switch, or by dwelling (i.e., pausing without selecting any switch).
Disadvantage is that there are more switches; consequently it will mean more
movements for the user.
Third method is the inverse
scanning technique, this is for
the advanced users. The mechanism is the cursor or light manually, maintaining switch
activation. While the switch is activated, the light pauses at each icon for a
scan interval. Timing the release of the switch within a scan interval is
important. Sometimes, step and inverse scanning are combined. This is a
virtually new method on the new AAC systems. It can be a bit complicated until
the user gets used to it
And the final method is directed
scanning associated with separate switches, with directions of cursor
movement. These switches are used in a step or inverse fashion. The switches
are often housed in a gated joystick, allowing users to direct the light, as
they would drive a powered wheelchair. However it is much harder to control the
lights on the screen with a joystick. For instance, in a chair it doesnt
matter if the user doesnt go exactly in a straight line as the footpath or
corridor will be larger then the width of the chair, however, it does matter on
an AAC system because if you cannot go in straight line on the row, you will
jump rows. Another direct switch is a laser or a light pen. Icons are selected by activating a selection
switch. Vanderheiden (1985, p. 23)
describes this scanning method as a hybrid between scanning and direct selection
because the selection is based on the type of movement made as well as the
point in time that the movement is made.
It really depends on individual users to see which is the best scanning
methods as some disabilities make one kind of input easier to use, while
another disability may function better with an alternative choice. Similarly,
differing output displays will benefit different users. Many variations of these methods exist that
depend upon the number of switches employed and scanning pattern.
Scanning patterns 2.4
The connection with automatic, step and inverse scanning are particular
patterns by which the scanning light moves across the format of keys/icons.
These patterns include element, row/column, and block scanning. In an element
scan, the cursor proceeds to light each icon of a medium in succession, usually
from left-to-right and top-to-bottom. After a selection, the cursor generally
returns to the first item and repeats scanning. Element scanning is typically
limited to less than 15 items (Vanderheiden and Lloyd, 1986). Illustration figure 2.2.
(figure 2.2)
Here is an example of element scanning. Above, the black square
indicates the current lit icon while the gray squares indicates the previous
lights.
In the second example below is on row/column technique. Row/column scanning
is a faster selection technique in which rows of icons are arranged in a
two-dimensional matrix and are scanned row-by-row from the top down. A
selection made
with the single switch stops the scanning at a particular row, which is
subsequently scanned, column-by-column until the desired icon is reached and
selected. As before, the cursor returns to the first row to repeat scanning
after a selection, shown here in figure 2.3.
(
figure 2.3.)
A third example is the block scanning approach, this is best used for
large matrices. One variation of block scanning is quadrant scanning (Basacchi,
1982) which is used with a square matrix of icons. The matrix is divided into
quadrants. Starting from the top left-hand quadrant, each quadrant in the board
is lit in succession. When a select switch is activated, the currently lit
quadrant is selected and scanning is repeated within that quadrant until
individual elements are scanned. This is a very efficient selection technique
where one of 4 icons can be selected with n
switch activations, shown in illustration figure 2.4.
