Augmentative Communication Technologies: A Beginner’s Guide to AAC Devices, Apps, and Setups

Augmentative and Alternative Communication (AAC) includes various tools, strategies, and technologies that help individuals with speech impairments communicate effectively. This comprehensive guide is tailored for families, caregivers, clinicians, and anyone interested in understanding AAC. We will cover the core concepts of AAC, the different types of devices and apps available, and practical tips to choose and set up solutions. Whether you are supporting a child with autism or an adult recovering from a stroke, this guide will provide valuable insights into enhancing communication.

What Is AAC? Core Concepts

AAC encompasses any method or tool that assists communication when natural speech is limited. Here are key terms:

• AAC (Augmentative and Alternative Communication): The umbrella term for all communication-enhancing methods.
• SGD (Speech-Generating Device): Devices that produce synthetic or recorded speech.
• Low-tech vs. High-tech: Low-tech solutions, like picture boards, do not require electronics, while high-tech solutions include dedicated devices, tablets, and apps with text-to-speech (TTS) capabilities.

Primary Goals of AAC:

• Enable functional communication (requests, refusals, comments).
• Promote social participation and relationships.
• Support language learning and literacy.

Who Benefits from AAC?

• Children with autism or developmental language disorders.
• Individuals with motor impairments, such as cerebral palsy.
• Adults facing conditions like ALS or recovering from strokes.
• People experiencing temporary speech loss due to medical procedures.

AAC is personalized based on individual needs. A clinical assessment is vital to match the right technology and strategies with a user’s motor, cognitive, sensory, and language skills. For more information, refer to the American Speech-Language-Hearing Association (ASHA) and the National Institute on Deafness and Other Communication Disorders (NIDCD).

Types of Augmentative Communication Technologies

AAC technologies can be categorized by their complexity and features:

1. Low-Tech Solutions

• Examples: Communication boards, picture books, the Picture Exchange Communication System (PECS).
• Pros: Cost-effective, durable, easily customizable, no power needed.
• Cons: Limited vocabulary; often requires partner assistance.

Use Case: In a preschool, a child uses a laminated picture board to select “eat,” “drink,” or “play” during activities.

2. Mid-Tech Devices

• Examples: Devices that can play back single or multiple recorded messages.
• Pros: Portable, battery-powered, and straightforward to use.
• Cons: Limited flexibility compared to full-featured apps.

Use Case: An adult with temporary speech loss uses a mid-tech device in a hospital to convey essential messages.

3. High-Tech Solutions

• Examples: Dedicated SGDs, tablet/smartphone apps (e.g., Proloquo2Go, TouchChat).
• Features: Extensive vocabularies, word prediction, multiple voice options, and multilingual support.
• Pros: Rapid communication and customization capabilities.
• Cons: Cost, need for charging, and potential learning curve.

4. Advanced Input Methods and Emerging Tech

• Methods: Includes touch, switch scanning, head-tracking, eye-tracking, and speech-to-text.
• Emerging technologies: Brain-computer interfaces (BCI) and machine learning for predictive language are still in experimental stages.

For insights on sensor technology, refer to our article on camera sensor technology explained.

Key Components: Hardware, Software, and Symbols

Hardware Choices:

• Tablets (like iPad, Android): Popular due to app availability and portability.
• Dedicated SGDs: Built to be robust and often include medical-grade warranties.
• Mounts and cases: Essential for device positioning and protection.
• Alternative input devices, such as switches and eye trackers (e.g., Tobii).

Software and Apps:

• Communication apps: Include Proloquo2Go, TouchChat, and CoughDrop for dynamic displays.
• TTS Engines: Varying quality across built-in and third-party options like Amazon Polly.
• Symbol Libraries: Systems like Picture Communication Symbols (PCS) provide consistent visuals.

Vocabulary and Symbols:

• Core vs. Fringe Vocabulary: Core words are high-frequency (e.g., “I,” “want”); fringe words are specific (e.g., “guitar”).
• Using a standard symbol set enhances learning consistency.

TTS quality impacts social communication—natural-sounding voices foster acceptance and engagement.

How AAC Works: Basic User Flow

Simple AAC Workflow:

1. Input: The user selects an icon or utilizes alternative inputs (switch, eye gaze).
2. Selection: The system interprets the input to choose a word, phrase, or sentence.
3. Output: The device processes the input, producing synthesized speech or a message on-screen.

Scenarios:

• Child with Picture Board: A child points to the “drink” icon; the partner vocalizes the request while providing the drink, reinforcing communication.
• Adult Using Eye Gaze: An adult seeks help by gazing at the “I need help” icon on a tablet, which then vocalizes the phrase.

Choosing the Right AAC: Assessment and Practical Tips

Team Collaboration:

• Involve a multidisciplinary team, including speech-language pathologists (SLPs), occupational therapists (OTs), families, and tech specialists.
• SLPs assess language needs; OTs focus on motor and positioning requirements.

Selection Criteria Checklist:

• Motor Abilities: Can the user operate the touchscreen? Do they have reliable head or eye control?
• Cognitive and Language Skills: Is symbol-based language usable by the user, or do they need recorded messages?
• Sensory Considerations: Are vision or hearing impaired?
• Environmental Factors: Will the device function effectively outdoors or in loud areas?
• Budget and Support Options: Explore funding through insurance or grants.

Trials and Funding:

• Device trials are crucial—many vendors and clinics offer short-term loans.
• Funding sources could include insurance, educational assistance, or nonprofit grants.

practical tip:

Engage the end user early in the process. Start with a trial device and adjust vocabulary and layout progressively. Those building or testing hardware can refer to our guide on building a home lab: hardware requirements (Beginners) or the PC building guide (Beginners) for further information.

Getting Started: Recommended Devices, Apps, and Tools for Beginners

Common Tablet Apps:

• Proloquo2Go (iOS): Feature-rich, emphasizing core vocabulary and customization.
• TouchChat (iOS): Offers flexible layouts and diverse voice options.
• CoughDrop (iOS/Android/web): Cloud-enabled for multi-device usability.
• Google Look to Speak (Android): Free eye-tracking app utilizing a front-facing camera—great for experimentation.
• OptiKey (Windows, open-source): An eye-controlled on-screen keyboard.

Accessories and Setup Tips:

• Choose mounts and rugged cases to ensure stability and durability.
• Use external microphones for improved audio input.
• Select switches based on pressure sensitivity.

Quick Setup Tips for Beginners:

• Start with core vocabulary and common phrases.
• Utilize large buttons at the beginning.
• Pre-configure greetings and emergency phrases.
• Incorporate word prediction gradually as literacy develops.

Starter Options Table

Technical Considerations for Developers and IT Pros

APIs and SDKs

• TTS: Utilize services like Amazon Polly and Google Cloud Text-to-Speech for diverse voice options.
• Eye-tracker SDKs: Tobii provides SDKs for developers focusing on gaze-controlled interfaces.
• Accessibility APIs: Leverage iOS VoiceOver and Android TalkBack for app integration.

Privacy and Data Security

• Store sensitive data as PII/PHI and follow regulations like HIPAA and GDPR.
• Use encryption to ensure data safety; minimize logs while allowing user data control.

Interoperability and Standards

• Enable users to export/import vocabularies in formats like CSV/JSON.
• Support established symbol libraries to facilitate transitions.

Performance and Offline Needs

• Ensure TTS and local prediction functionalities for offline reliability.
• Remember memory constraints and latency when developing for tablets.

Authentication and Identity

• Design simple user authentication for cloud sync, prioritizing privacy. Consider decentralized identity solutions—check our guide on decentralized identity solutions.

Developer Snippet: Simple JSON Vocabulary Export

{
  "user": "Jane Doe",
  "vocabulary": [
    { "id": 1, "text": "I", "symbol": "pcs_i.png" },
    { "id": 2, "text": "want", "symbol": "pcs_want.png" },
    { "id": 3, "text": "help", "symbol": "pcs_help.png" }
  ]
}

Simple Web Speech API TTS Example (Browser)

const msg = new SpeechSynthesisUtterance('Hello, how can I help you today?');
msg.lang = 'en-US';
window.speechSynthesis.speak(msg);

Implementation Tips: Training, Customization, and Community

Training Users and Communication Partners

• Ensure both AAC users and their support network (family, educators, caregivers) receive training for effective communication reinforcement.
• Clinician-led coaching is beneficial for modeling language opportunities.

Vocabulary Organization and Pacing

• Start with a small set of core words and common phrases.
• Gradually integrate vocabulary specific to the user’s interests.
• Regularly reassess vocabulary as skills evolve.

Maintenance and Support

• Keep software updated and regularly back up vocabulary files.
• Inspect hardware regularly for wear.
• Schedule periodic assessments with clinicians to validate continued communication effectiveness.

Community Resources

• Engage with manufacturer forums, AAC user groups, and relevant clinical communities.
• Online forums and social media provide valuable troubleshooting support.
• For training sessions about AAC, refer to our guide on creating engaging technical presentations.

Future Trends in AAC

• AI and Predictive Language: Advances in AI support personalized language recommendations and improved phrase prediction.
• Better Sensors: Lower-cost eye-tracking technology is widening access to gaze-based AAC solutions.
• Brain-Computer Interfaces (BCI): Non-invasive BCIs hold potential though still mainly experimental.
• Telepractice and Cloud Management: Remote support can enhance accessibility, especially in underserved areas.

Resources, Further Reading, and Next Steps

Authoritative Organizations and Resources:

• American Speech-Language-Hearing Association (ASHA) — AAC Information.
• National Institute on Deafness and Other Communication Disorders (NIDCD) — Background on AAC.
• World Health Organization (WHO) — Assistive Technology factsheet.

Helpful Apps and Tools Mentioned:

• Proloquo2Go (iOS), TouchChat (iOS), CoughDrop (iOS/Android/web), Google Look to Speak (Android), OptiKey (Windows, open-source).

Where to Trial Devices:

• Check with local assistive technology teams, rehabilitation centers, or manufacturer programs for device trials.

Next Steps for Beginners:

• Consult an SLP for a formal assessment—ASHA provides resources for finding professionals.
• Experiment with a low-cost app or a laminated picture board to identify communication preferences.

Conclusion

AAC represents a spectrum of options, from simple picture boards to sophisticated speech-generating devices with advanced eye-tracking capabilities. The focus should always be on personalization, functional goals such as facilitating requests and social participation, and a collaborative assessment approach that involves clinicians and the user’s family. Start with modest tools: test a low- or mid-tech device, seek guidance from an SLP, and adapt as necessary. Embracing technological advancements can significantly improve communication effectiveness and quality of life.