Facilitated Communication

The practice of facilitated communication was designed to help people with a disorder that hampers speech (e.g., autism or cerebral palsy) express themselves.

From: Encyclopedia of Consciousness, 2009

Chapters and Articles

Treatment and Management

ROSE ANN (ROZ) PARRISH, ... EUGENIA CHAN, in Developmental-Behavioral Pediatrics, 2008

FACILITATED COMMUNICATION

Facilitated communication, not to be confused with augmentative communication, is intended to assist a nonverbal person's use of a communication device, such as a computer keyboard, by supporting the individual's hand as he or she selects letters to spell out words. Proponents suggest that through facilitated communication, individuals with severe expressive language difficulties such as autism or mental retardation can demonstrate higher-than-expected literacy and communication skills.89 The technique has been especially controversial because of some cases of alleged sexual abuse reported through the use of facilitated communication.90 Controlled studies in individuals with ASD, mental retardation, and other developmental disabilities have been unable to demonstrate replicability or validity,91 and the American Academy of Pediatrics does not recommend its use for children with disabilities.88

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Assistive technology: Supports for aging adults

Kimberly A. Furphy DHSc, OTR, ATP, ... David C. Burdick PhD, in Occupational Therapy with Aging Adults, 2016

Communication

Older adults can have difficulties with communicating clearly due to various age-related changes or diseases that affect their ability to produce speech, to hear speech or to see someone communicating with them, or to read written words.

When people have difficulty producing words due to aphasia or a motor apraxia, or difficulty producing clear speech due to dysarthria or hearing difficulties, this can significantly affect their quality of life. There are no-tech, low-tech, and high-tech assistive devices that can help individuals communicate by supplementing their current speech ability, replacing their difficulty in communicating verbally, or compensating for their sensory loss (vision or hearing). Devices that compensate for speech are called augmentative and alternative communication devices (Case Example 21-2).

CASE EXAMPLE 21-2

Augmentative Communication

Harold is a 70-year-old man who was diagnosed with a cerebrovascular accident (CVA) 1 year ago that resulted in significant declines in independence in self-care and mobility, and severe expressive aphasia. In the past year, he has improved in his functional ability in self-care activities and mobility but has not seen many improvements in his ability to speak so that others can understand him.

Harold is getting increasingly frustrated when trying to communicate his needs to others. His wife has asked for assistance in providing her husband with a means to communicate. After evaluation, it was determined that Harold had the ability to type and spell and was cognitively intact. Because of these characteristics, he was deemed a good candidate for a speech-generating augmentative and alternative communication (ACS) device. With a device that he can use to either spell out his needs or point to words to create sentences to indicate his needs, Harold will be able to communicate effectively with his family and friends.

Unaided speech options include the use of gestures, body language, and sign language, which enable the individual to get his or her meaning across without the use of devices. Low-tech options include writing on a tablet; pointing to items on a picture, phrase, letter, or word board; or choosing a word or phrase from a booklet that contains words and phrases most commonly used by the individual. It is important if the older adult has difficulty communicating that the occupational therapist consult with a speech and language pathologist to include the most appropriate communication words and symbols for that person’s current capabilities. The speech and language pathologist would determine the words/pictures that are used for a low-tech communication board, and the occupational therapist would determine the access means to the device. There are a variety of ways that a person can access a communication device. The person conveying the message can use his or her finger or an alternative pointing device (e.g., a head pointer or laser pointer) to point to choices on the board. The individual could also use eye gaze to indicate his or her choice as the partner in the conversation watches where the individual’s eyes are looking to determine the individual’s choice.

Functional communication can also become difficult for older adults if they experience a loss of hearing or vision that is not corrected through traditional compensation devices such as glasses/contacts and hearing aids. Referrals to appropriate professionals (optometrists, ophthalmologists, or audiologists) are needed to find the best device or adaptation possible to maximize a person’s functional communication in light of any sensory impairment. Hearing aids are expensive and unaffordable for many older adults because they are not currently a covered benefit for Medicare recipients. Not being able to hear what is going on around you is always frustrating, but older adults and their families can become extremely frustrated when hearing aids are purchased out of pocket and they do not totally compensate for a hearing loss and the older adult ends up not using them.

Other devices to compensate for a hearing impairment are adaptive alerting mechanisms such as alarm clocks that shake a bed, light-activated doorbells and warning systems, and telephone systems with extra-loud volume control. Most television sets that have been purchased in the last 10 years have settings to activate closed captions on television programs to allow someone with a hearing limitation to understand the content of programs by reading the closed captioning on the screen.

When you are communicating with people who have sensory impairments (visual or auditory), it is important to communicate in quiet environments with sufficient ambient lighting, while also reducing glare on the eyes of the older adult. Seating the client where the glare is to his or her back, rather than in the client’s eyes, can dramatically improve the client’s ability to pick up nonverbal cues and to use limited lip reading. (See chapter 10 for additional suggestions on dealing with low vision.)

Problems with communication due to vision loss may be compensated through enlarged print, colored overlays, brighter light, magnification (handheld magnifying glasses or increased magnification on a computer screen), and text-to-speech programs (simple programs are built into most computer operating systems, but much more sophisticated programs are also available commercially). These compensations are discussed in the following high-technology section of this chapter. Please refer to the websites in Box 21-1 for examples of available programs.

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Control Interfaces for Assistive Technologies

Albert M. Cook PhD, PE (ret), ... Pedro Encarnação PhD, in Assistive Technologies (Fifth Edition), 2020

Touch Screens

Touch screens are available on augmentative communication devices (see Chapter 18), EADLs (see Chapter 14), notebook computers, mobile phones and tablets (see Chapter 9). The user makes selections by movements such as swiping, tapping, pinching, dragging, flicking, or a multi-touch that can be difficult for individuals with fine motor impairments. A handheld pointer can help increase accuracy but not all gestures are possible with it.

Touch screens on mobile devices use icons for selecting apps, functions, and actions. The advantage of the icons is that the children or others who cannot read text can directly touch a picture or symbol and have the device carry out a task. They may also facilitate access for persons with cognitive limitations. Furthermore, touch screens are useful for older adults who have limited experience with a computer and who find it difficult to use a mouse.

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Contexts: Assistive Technology at Home, School, Work, and in the Community

Diane Nelson Bryen, Amy S. Goldman, in Clinician's Guide to Assistive Technology, 2002

Access Devices

Access devices are used to interface a user to an augmentative communication device, a computer, a wheelchair, or battery-operated toys and appliances to enhance speed, accuracy, endurance, and independence when hand use is limited. Access technologies include input devices (e.g., switch, expanded keyboard, mouse, trackball touch window, joystick, speech recognition), head pointers, keyguards, and keyboard emulators. When access systems are integrated appropriately, maximum independence and effective functioning are ensured when an individual uses several types of assistive technologies (e.g., powered mobility, augmentative communication, computers, environmental controls).

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Augmentative and Alternative Communication Systems

Albert M. Cook PhD, PE (ret), ... Pedro Encarnação PhD, in Assistive Technologies (Fifth Edition), 2020

1.

What are the two major communicative needs normally addressed by augmentative communication systems?

2.

Distinguish between aided and unaided communication.

3.

Distinguish between speech and language.

4.

What are the major goals for augmentative communication systems designed for conversational use?

5.

According to research, what AAC goals do parents have for their nonspeaking children? Do mothers and fathers have the same goals for their children?

6.

Describe differences in the conversational conventions that apply between two speaking persons and those between one speaking person and one augmentative communication user.

7.

Describe the relationship between the Social Networks model and the Participation model. How does each of these relate to the HAAT model described in this text?

8.

How do attitudes of the communication partners toward AAC users differ for the five circles of the Social Networks model?

9.

What factors influence the attitudes of children toward their peers who use AAC?

10.

What features distinguish competent augmentative communicators from those who are not competent?

11.

Distinguish between formal writing and note taking in terms of the characteristics AAC devices must have to meet each need. What is the most important feature in each case?

12.

Describe auditory scanning. Give an example of both a low-tech or no-tech approach and an electronic AAC approach. What are the essential features for the AAC auditory scanning device?

13.

What are the seven steps to build communication competence through training?

14.

What are dynamic displays, and what advantages do they provide?

15.

What are visual scene displays and what unique features do they have?

16.

What populations might benefit most from visual scene displays? Why?

17.

Describe the major challenges and approaches for AAC intervention of individuals whose primary disorder is language- or cognitively based. How does this compare with individuals whose primary disorder is motor or physical?

18.

Why do some AAC users prefer communicating over the Internet rather than in person?

19.

What are the four types of competencies acquired in AAC training? Pick an AAC system for an individual and design the training. You must make assumptions regarding the person’s skills and needs, and other people available to help facilitate the training.

20.

For each of the categories of devices described in Table 18.5, define a user profile (skills and needs) that would lead you to focus on that category in selecting a device for that person.

21.

What are the primary advantages and limitations associated with the use of mainstream technologies (mobile phones and tablets) as SGDs?

22.

How has the availability of mainstream AAC apps affected the AAC field clinically and from a manufacturer’s perspective?

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Sensory Aids for Persons With Visual Impairments

Albert M. Cook PhD, PE (ret), ... Pedro Encarnação PhD, in Assistive Technologies (Fifth Edition), 2020

Impact of Vision Loss on the Use of Assistive Technology

Visual function is important (but not essential) for the effective use of AT systems, especially regarding access systems. For example, in using augmentative communication systems (Chapter 18), individual items must be found in arrays of vocabulary elements, scanning cursors must be tracked, and visual feedback is often used to signify successful message generation. Likewise, to use a power wheelchair (Chapter 11), visual scanning of the environment must be present, and there must be adequate acuity and visual field to guide the chair around obstacles effectively, safely, and efficiently. For individuals who have visual impairments, reading print material or computer displays can be difficult or impossible, and ATs can be of help. We discuss AT for visual impairment in this chapter.

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Pediatric Communication Disorders

JUDITH S. GRAVEL PhD, ... AMY WHITE AuD, in Pediatric Otolaryngology, 2007

Augmentative and Alternative Communication

For children who have insufficient speech skills to be functional communicators, augmentative or alternative forms of communication need to be investigated. There is a wide variety of types of augmentative communication options available, including manual signs, picture communication boards (in which the child points to a picture to convey a message), basic electronic communication devices with a limited number of recorded messages, and sophisticated computerized devices with language-based software that allow the child to compose novel, grammatically intact messages. Assessment focuses on identifying the appropriate techniques and equipment that the child can use to communicate at a level consistent with his or her cognitive and linguistic skills.

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Section IV Tools and techniques to modernize prevention, detection, and response to epidemics

Joseph N. Fair, ... Marjorie P. Pollack, in Modernizing Global Health Security to Prevent, Detect, and Respond, 2023

To break this cycle and ensure the safety of all individuals, we must find ways to protect intellectual rights and incentivize data sharing. The upcoming chapters will address the need for laboratory enhancements, facilitated communications, and improved public health surveillance. The COVID-19 pandemic has brought to the forefront the importance of enhancing public health surveillance, as exemplified by the revision of the International Health Regulations (IHR) and the recognition of “Public Health Emergency of International Concern” (PHEIC). Additionally, innovative disease surveillance initiatives utilizing AI, web-crawling, social media, and participatory surveillance have emerged, leveraging nontraditional information sources.

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Brain Machine Interfaces: Implications for Science, Clinical Practice and Society

Sonja C. Kleih, ... Andrea Kübler, in Progress in Brain Research, 2011

The BCI system

Up to now, the communication speed of a visual P300 BCI is, compared to natural communication speed, relatively slow. Various attempts were undertaken to improve BCI performance addressing speed and accuracy for facilitated communication. For example, various electrode montages were applied (Hoffmann, 2007; Kaper et al., 2004; Krusienski et al., 2008). Overall, the use of between six and ten central and occipitoparietal electrodes is recommended (Hoffmann, 2007, Krusienski et al., 2008) and proven to achieve equal performance compared to an electrode setup with more electrodes. Also, other factors were varied such as the interstimulus interval (Sellers et al., 2006), matrix size (Pineda et al., 2003; Sellers et al., 2006), and various signal processing methods (see the section “Classification” under “P300”) to improve BCI performances. Sellers et al. (2006) reported a 3 × 3 matrix to be more suitable to achieve higher accuracies while a 6 × 6 matrix yields a higher information transfer rate. Other research did not find the size of the matrix to be a significant factor in terms of accuracy (Pineda et al., 2003). Concerning the ISI, higher P300 amplitudes were reported with longer ISIs of 1200 ms or more (Gonsalvez and Polich, 2002). In line with this result (Gonsalvez and Polich, 2002), higher accuracy was found with a decrease of stimulus rate (McFarland et al., 2010), while on the contrary, Sellers et al. (2006) found a shorter ISI of 175 ms to lead to a more accurate result. Additionally to matrix size and ISI, the P300-based stimulus presentation was experimentally investigated. Takano et al. (2009) found a blue/green chromatic flashing of the speller matrix to be advantageous concerning accuracy compared to the usually used gray/white matrix. Townsend et al. (2010) investigated a novel presentation way, the checkerboard paradigm (CBP) with an 8 × 9 matrix containing 72 items. In the CBP, the items flash in random groups of six items and the adjacent items cannot be included in the same flash group. This paradigm was tested on 18 able-bodied adults and 3 ALS patients and revealed higher accuracy in the CBP (92%) compared to the classical row/column paradigm (77%). As performance with a visual speller deteriorates when users switch from directly fixating a target (overt attention) to paying attention to targets in the visual periphery (covert attention, Brunner et al., 2010), a new matrix for P300 BCI use was suggested by Treder and Blankertz (2010) which should still allow for high performances in case of covert attention (e.g., for people whose eye movement is impaired; Treder and Blankertz, 2010). Bearing in mind that in ALS patients the oculomotor control can deteriorate, the dichotomous Hex-o-Spell (Blankertz et al., 2007; Williamson et al., 2009) was adapted as an ERP device (Treder and Blankertz, 2010). Around one circle in the middle of the screen, six hexagons were arranged. Each of the hexagons contained five letters of the alphabet and was randomly highlighted. When chosen, this hexagon expanded the letters contained in it into the other six hexagons including the backspace option in one empty hexagon. It was found that, in both, the usual matrix and the Hex-o-Spell, performances of up to 100% were achieved, even though the Hex-o-Spell version allowed for this performance level faster (lower number of sequences). In covert, attention performances of up to 60% were found using the Hex-o-Spell compared to 40% for the matrix version of the speller. As all reported results were obtained offline, online trials with disabled users are awaited to judge the potential advantage of the Hex-o-Spell for P300 BCI use.

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