Raise your hand if AAC intimidates you

Augmentative and Alternative Communication (AAC) is one of the most underserved areas in the field of speech-language pathology. It’s dynamic, with so many different approaches, access methods, and considerations—plus external factors—that play a role in determining how to best facilitate language for complex communicators. Too often, AAC is viewed as a last resort, a "final option" when nothing else has worked. However, pursuing AAC—whether starting with low-tech tools or a high-tech device—doesn’t have to feel like a hail Mary. In fact, AAC can be purposeful, meaningful, and client-driven, aligning seamlessly with “traditional” speech therapy.

For much of my career, I’ve worked with adults in the neuro population. I’ll admit that, for many years, I didn’t consider AAC as an option for adults recovering from strokes or brain injuries. I thought AAC was just for kids—something used in schools, introduced one word at a time, focused on requests, maybe paired with ABA, and often involving a core board or a high-tech speech-generating device (SGD). Guess what? Adults can benefit from AAC just as much as children! The approach may differ, but the outcomes can be equally transformative. While we’ll explore considerations for pediatric AAC users in future posts, today, I want to outline the key factors to consider when introducing AAC for adults.

1. Prioritize a Robust Communication System

The most important factor when introducing AAC—whether for adults or children—is ensuring the system is robust. Communication is diverse, and AAC must accommodate that diversity. Robust systems include access to core vocabulary (high-frequency words), fringe vocabulary (specific or personal words), phrase-based communication, dynamic keyboards, and multimodal tools like whiteboards or scene displays.

2. Access Methods: How Will the Patient Use the Device?

Understanding how your patient will interact with the device is crucial. Will they use touch, eye gaze, or a scanning method? What is their physical status? Are they ambulatory? These are critical considerations when determining the best access method.

Most AAC users fall into one of three access categories:

• Touch Access:
  Patients interact with the device directly using a body part (e.g., hand, finger, or stylus). Accommodations can include touch-and-hold settings, swipe-to-select options, or precision tools like styluses. Touch access is common and highly effective for individuals with reliable fine motor skills.

• Scanning:
  Scanning involves a switch and specific on-screen scanning patterns. Patients use the switch—activated by a hand, temple, limb, or other body part—to make selections. This method works well for those with limited physical mobility or who need additional time for processing and decision-making.

• Eye Gaze:
  Eye gaze is a highly advanced method using specialized cameras or sensors to track where the user is looking on the screen, enabling them to select items. It’s ideal for individuals with minimal physical movement but good control over eye movement.

3. Pre-Stored Phrases for Efficient Communication

When working with AAC, efficiency and ease of communication are key. Pre-stored phrases allow users to communicate entire thoughts, sentences, or ideas with the press of a single button. This approach can be tailored to the individual, including phrases for self-advocacy, social interactions, or hobbies.

For example, I recently worked with a patient who wanted a folder dedicated to telling her family about the flowers in her garden. Pre-stored phrases gave her a way to express herself with ease, providing a sense of normalcy in her interactions. While emerging communicators may benefit from a core-word approach, pre-stored phrases can dramatically improve communication efficiency for adults.

4. Keyboard Access for Literate Individuals

For many literate adults with no cognitive impairments, a keyboard is a game-changer. Individuals living with conditions like ALS often don’t need symbol-based communication systems or pre-stored phrases but simply need a way to type and express their thoughts as they did before their diagnosis.

Many AAC systems include dynamic keyboards with predictive text features to improve speed and accuracy. These keyboards can also allow users to program their own devices, giving them autonomy and reducing reliance on caregivers for customization.

Closing Thoughts
AAC doesn’t have to be intimidating, and it’s not a last resort. By ensuring the system is robust, tailoring the access method to the patient, and incorporating features like pre-stored phrases or keyboards, we can provide meaningful communication solutions for adults with complex communication needs. Every individual deserves a system that works for them, empowering them to communicate effectively and reclaim their voice.