The language and communication attributes of graphic symbol communication aids – a systematic review and narrative synthesis

Abstract Background: Symbol communication aids are used by children with little or no intelligible speech as an Augmentative and Alternative Communication strategy. Graphic symbols are used to help support understanding of language and used in symbol communication aids to support expressive communication. The decision making related to the selection of a symbol communication aid for a child is poorly understood and little is known about what language and communication attributes are considered in this selection. Aim: To identify from the literature the language or communication attributes of graphic symbol communication aids that currently influence AAC practice. Method and Procedure: A search strategy was developed and searches were performed on a range of electronic databases for papers published since 1970. Quality appraisal was carried out using the CCAT tool and papers rated as weak were not included in the review. Results: Eleven studies were included in the review reporting data from 66 participants. Weaknesses were identified in most studies that would limit the validity of the results for application to practice. Included studies investigated aspects of vocabulary organization and design, the process of vocabulary selection, and the choice of the symbol system and encoding method. Two studies also evaluated innovative communication aid attributes. Conclusions: Information from studies reported in the research literature provides a sparse source of information about symbol communication aids from which clinicians, children or family members may make informed decisions. Implications for Rehabilitation This review is the first to systematically appraise the literature to answer the question what evidence exists to inform clinical decision making in relation to the language or communication attributes of graphic symbol based communication aids? The review establishes that there is a paucity of evidence from studies and that these decisions must thus be based on other information and factors. The review does establish a small number of language or communication attributes of symbol communication aids, but no synthesis of the results of these studies was possible. This review thus suggests that vocabulary design and organization, symbol system and encoding method, and the choice of vocabulary selection method are attributes that clinicians may carefully review in order to inform decisions. Clinicians encountering symbol vocabulary packages claiming to be ‘evidence based’ should query the nature of this evidence. The rehabilitation research community should debate and develop appropriate research designs that will facilitate future robust studies investigating the effect of specific language or communication attributes of communication aids.

[1]  Laura J. Ball,et al.  Personnel Roles in the AAC Assessment Process , 2012, Augmentative and alternative communication.

[2]  J. Bornman,et al.  Social Validation of Vocabulary Selection: Ensuring Stakeholder Relevance , 2013, Augmentative and alternative communication.

[3]  Catherine Law,et al.  Worked examples of alternative methods for the synthesis of qualitative and quantitative research in systematic reviews , 2007, BMC medical research methodology.

[4]  Janice Light,et al.  The effects of message encoding techniques on recall by literate adults using AAC systems , 1990 .

[5]  J. Goldbart,et al.  Decision-making in communication aid recommendations in the UK: cultural and contextual influencers , 2019, Augmentative and alternative communication.

[6]  Kathryn D R Drager,et al.  The performance of typically developing 2 1/2-year-olds on dynamic display AAC technologies with different system layouts and language organizations. , 2003, Journal of speech, language, and hearing research : JSLHR.

[7]  Janice Light,et al.  Communicative Competence for Individuals who require Augmentative and Alternative Communication: A New Definition for a New Era of Communication? , 2014, Augmentative and alternative communication.

[8]  Janice C Light,et al.  Message-encoding techniques for augmentative communication systems: the recall performances of adults with severe speech impairments. , 1992, Journal of speech and hearing research.

[9]  Jennifer J. Thistle,et al.  Building Evidence-based Practice in AAC Display Design for Young Children: Current Practices and Future Directions , 2015, Augmentative and alternative communication.

[10]  P. Shekelle,et al.  Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: elaboration and explanation , 2015, BMJ : British Medical Journal.

[11]  Hugh Stewart,et al.  Improving the communication rate for symbol based, scanning voice output device users , 2002 .

[12]  A. Vanbiervliet,et al.  Predictors of assistive technology use: The importance of personal and psychosocial factors , 2005, Disability and rehabilitation.

[13]  B. Iwata,et al.  Nonvocal language acquisition in adolescents with severe physical disabilities: Bliss symbol versus iconic stimulus formats. , 1982, Journal of applied behavior analysis.

[14]  Ehud Reiter,et al.  Supporting Personal Narrative for Children with Complex Communication Needs , 2012, TCHI.

[15]  Jonathan J. Evans,et al.  Neuropsychological Rehabilitation: An International , 2013 .

[16]  Kathryn D. R. Drager,et al.  Comparison of correct responses and response latency for fixed and dynamic displays: performance of a learner with severe developmental disabilities , 2000 .

[17]  Janice Light,et al.  Putting People First: Re-Thinking the Role of Technology in Augmentative and Alternative Communication Intervention , 2013, Augmentative and alternative communication.

[18]  Mary Dixon-Woods,et al.  Synthesising qualitative and quantitative evidence: a review of possible methods. , 2005, Journal of health services research & policy.

[19]  S. Hess,et al.  What’s important in AAC decision making for children? Evidence from a best–worst scaling survey , 2019, Augmentative and alternative communication.

[20]  Ella Inglebret,et al.  Perspectives of speech language pathologists regarding success versus abandonment of AAC , 2006, Augmentative and alternative communication.

[21]  Bernard M O'Keefe,et al.  Identification and Rankings of Communication Aid Features by Five Groups , 1998 .

[22]  Kathryn M. Yorkston,et al.  A Comparison of Standard and User Vocabulary Lists , 1988 .

[23]  Mark A. McDaniel,et al.  Recognition of Vocabulary in Children and Adolescents with Cerebral Palsy: A Comparison of Two Speech Coding Schemes , 2004 .

[24]  Kathryn M. Yorkston,et al.  Vocabulary selection: a case report , 1989 .

[25]  M. Crowe.  The design and evaluation of a critical appraisal tool for qualitative and quantitative health research , 2011 .

[26]  Mark A McDaniel,et al.  The fruitfulness of a nomothetic approach to investigating AAC: comparing two speech encoding schemes across cerebral palsied and nondisabled children. , 2003, American journal of speech-language pathology.

[27]  E. Alant,et al.  The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech. , 2009, American journal of speech-language pathology.

[28]  J. Goldbart,et al.  Professionals’ decision-making in recommending communication aids in the UK: competing considerations , 2019, Augmentative and alternative communication.