AAC for Acquired Communication Impairments

by Camille Stewart MA, CCC-SLP; NWACS volunteer

reading time: 4 minutes

The views expressed in this post are that of the author and do not necessarily reflect the views and policies of NWACS. No endorsement by NWACS is implied regarding any device, manufacturer, resource, or strategy mentioned.

Augmentative and Alternative Communication (AAC) can be a helpful tool for some people with acquired communication impairments (ACI). These are changes in how one communicates due to a:

• brain injury

• stroke

• neurological disorder

This article is an introduction to ACI and how AAC can be a helpful tool for people with ACI.

What is an acquired communication impairment?

ACIs can look different for each person depending on:

• diagnosis

• part of the brain affected

• other medical conditions that may impact a person

Below are some different types of ACIs.

Aphasia is not a single disorder. It is a family of disorders that involve varying degrees of impairment in four primary areas.

1. spoken language

2. written language

3. language comprehension

4. reading comprehension.

This means it can impact a person’s ability to:

• speak

• understand what is said

• read and/or write

Apraxia of speech (AOS) is a motor speech disorder. A person knows what they want to say but cannot move their mouth to say the sounds of the word. It is due to a disruption of the message sent from the brain to the mouth.

Dysarthria is a motor speech disorder caused by muscle weakness. A person’s speech may:

• be harder to understand

• sound “slurred

• be slower or faster in rate

• sound less clear overall

Sometimes, acquired communication impairments do not appear in isolation, but together. For example, a person could have aphasia and apraxia, both impacting their communication.

Keep in mind there may be other things to consider that could impact a person's communication and their ability to use AAC, beyond the communication impairment. These could include:

• Cognition/Thinking Skills: changes to the brain can impact someone’s ability to

  • pay attention

  • remember new information

  • process information

  • problem-solve

  • recognize their own difficulties communication

• Motor Skills: a person’s ability to walk or move parts of their body may be changed, in addition to their communication.

• Vision: a person’s vision may be changed in addition to their communication. This can result in different changes, such as:

  • difficulty understanding/processing what they are seeing (cortical visual impairment)

  • difficulty seeing certain parts of what is in front of them (visual field cut)

  • difficulty paying attention to everything they are seeing (visual neglect).

What types of AAC tools are helpful for this population?

High-Tech Tools:

Picture/Symbol Communication: People with ACIs have varying degrees of literacy skills. For those who have difficulty reading and/or writing, picture communication systems with voice output can be helpful.

How it works:

Language Expression: A person may have trouble saying a word but can understand the meaning of pictures or single words. They can use these skills to use picture communication devices for independent communication.

Language Comprehension: If a person’s ability to understand has been affected, their communication partner can make picture selections on the device to help the person with aphasia understand what they are trying to communicate.

Some High-Tech Picture Communication Systems available as dedicated devices or iOS apps, for people with ACIs:

• Lingraphica

• Tobii Dynavox Snap Scene

• Tobii Dynavox TD Snap Aphasia

• Saltillo Communication Journey: Aphasia

(available as of 10/2022)

Text-to-Speech: For people with the ability to spell, text to speech communication systems can be helpful. A person can type out what they are trying to communicate. They can use it to quickly spell out a word in their spoken sentence that their communication partner is having trouble understanding. Often these devices come with quick phrases and predictive typing to support quick communication.

Some High-Tech Text-to-Speech Communication Tools available on dedicated devices or as iOS apps for people with ACIs:

• Smartbox Grid Text Talker

• Tobii Dynavox TD Talk

• Proloquo4Text

• Google translate (free)

(available as of 10/2022)

These tools are great examples of why AAC is called Augmentative and Alternative Communication. They are not meant as replacements for a person’s spoken language. Rather, they are a way to help a person communicate more independently. They also help people with ACIs continue to improve their spoken language skills.

Verbal Communication Support: Some people with ACI have difficulty communicating spontaneously. They may be able to repeat or benefit from hearing how a word sounds to try to say the word themselves. High-tech systems can be helpful for this population because they speak out loud. So, a word or sentence can be repeated and paired with meaning to improve a person’s spoken language, while helping them communicate more independently.

Light-Tech and Mid-Tech Tools:

Light-Tech and Mid-Tech AAC tools are AAC tools that are not a part of a tablet/computer system. They can be helpful and quick-to-access tools. They support in-the-moment communication when high-tech is not available, for example:

• waiting for your high-tech device to arrive

• or in a place where high-tech might not be an option (like at the pool)

They can also be used as a way to learn how to use AAC when someone is having difficulty learning high-tech AAC options.

Light/mid-tech AAC tools include:

• Wants/Needs boards

• Letter boards

• Talking buttons programmed with quick phrases like:

  • “I need help”

  • “hey come here”

  • “I need a break”, etc

• Whiteboards

Do you know of more resources? Please share them with us in the comments below!