Augmentative and Alternative Communication

The History and Definition of Augmentative and Alternative Communication

What is Augmentative and Alternative Communication?

Augmentative and alternative communication is an umbrella term for a mode of communication for people who have impairment or restriction on their communication, whether it be speech, writing or comprehension. If a person is unable to adequately communicate without help, augmentative and alternative communication does exactly as the name suggests; it augments a person's innate communication abilities or offers an alternative method of communication. Augmentative and alternative communication is simply an aid to help people who have difficulty communicating on their own to function as normally as possible.

What types of Augmentative and Alternative Communication are there?

Augmentative and alternative communication can be divided into aided and unaided methods.
Unaided augmentative and alternative communication is, for example, body language, facial expressions and sign language.

Aided augmentative and alternative communication is when a device is used to aid in communication. This can be technological, but does not have to be. For the purposes of this paper we will be focusing specifically on high tech aided augmentative and alternative communication.

An Overview of the People That This Method of Assistance Helps

Anyone who finds it very difficult to communicate by just speech may be helped by using AAC. Lots of different AAC methods are used by people of all ages, with physical or learning difficulties. Some people use AAC just to communicate. Other people use AAC to help them understand what is being said to them.

Some people need to use AAC because of something that happened when they were born – people with cerebral palsy or learning disabilities. Other people start to use AAC when they are older. This can be because they have had a stoke or a brain injury or a disease.
Any disability that makes it difficult for the person to communicate may find AAC methods helpful. For some people, AAC is just used for a short time such as after an operation. Other people use AAC all their lives. (Communication, 2004)

The International Society of Augmentative and Alternative Communication promote the use of alternative and augmentative communication for a wide variety of people, whether it is temporary or long term use. As is mentioned above, people with physical or learning difficulties are the ones who make use of augmentative and alternative communication. Some illnesses that cause these difficulties are cerebral palsy, autism, aphasia and amyotrophic lateral sclerosis to name a few.

“Cerebral palsy is a disorder that affects muscle tone, movement, and motor skills (the ability to move in a coordinated and purposeful way). Cerebral palsy can also lead to other health issues, including vision, hearing, and speech problems, and learning disabilities.” (Steven J. Bachrach, 2009)

Autism is a neural development disorder causing impairment in social interaction and communication. (American Psychiatric Association, 2000)
Aphasia is a language disorder that is aquired when the brain is damaged. It can result in difficulty utilizing or comprehending language, be it spoken or written. (Howard S Kirchner MD, 2009)

Amyotrophic lateral sclerosis (ALS) is a disease that makes the newve cells in muscles stop working and die. The nerves lose the ability to trigger specific muscles, causing weakining and eventual paralysis in the body, and eventually leading to death. (American Psychiatric Association, 2000)

These and other diseases all have the commonality of causing a difficulty in speech. Different methods of augmentative and alternative communication can be used depending on the level of complications with speech the individual has.

The Technologies Currently Available

Keyboard and Symbol Based Text to Speech Devices

LightWRITERs, by ZYGO Industries, are a text-to-speech device with a dual screen, one on either side to display the text being spoken. This allows for a more natural conversation, with both individuals facing one another and being able to see what is typed. The keys are large enough for those with limitations requiring this and arranged alphabetically so they can be used more easily by children who are just beginning to learn their alphabet and those who find the standard QWERTY arrangement difficult. LightWRITERs, though, are an older technology. ZYGO Industries is constantly creating new products.

Optimist-MMX-2 is ZYGO Industries newest product. The product is a specialized computer system that can come with a selection of augmentative and alternative communication software of blank so that the users choice of software may be loaded onto the unit. Software is specialized based on the needs of the user. Non-communication software is locked out of the dedicated speech generation device versions. The device can function in three modes. The laptop mode is the same as a regular laptop, with a keyboard and the screen facing the user. The second mode is as a swivel screen, allowing the user to turn the monitor to the person or people they are communicating with. The third and final available mode is the tablet mode. This allows the device to be used as a touch screen. The keyboard folds away and the user has the ability to tap the screen to select the symbols necessary to communicate their meaning to others. The product has a 10.1” touch screen, runs Microsoft Windows 7 Home Edition, has 1GB of memory, and Intel Atom processor and an 160GB hard drive. It is simply a specialized laptop, and this seems to be the way that this technology is heading.

Switch Based or Eye Gaze Based Text to Speech Devices

The DynaVox EyeMax system combines the DynaVox Vmax with the EyeMax accessory, which allows the user to navigate by looking at a specific spot on the screen or by blinking.

Homegrown Solutions

Proloquo2Go is an AssistiveWare product providing an augmentative and alternative communication for anyone who cannot afford to spend thousands of dollars on an augmentative and alternative communication device. It is software that runs on the iPhone and iPod touch, as well as the iPad. The cost of the software is $189.00, and provides a solution that can allow their users to use a device that everyone else has. All the user needs is an iPod touch, iPhone or iPad and speakers.

A Comparison of the Pros and Cons of the two Options

The Dialect-MMX-2, which is the locked down version of the Optimist-MMX-2, costs $1,000.00. The Optimist-MMX-2 ranges from a basic package containing only the device without any software at $2,700.00 and going all the way to $5,300.00 for the widest range of software included along with the device.

In comparison, the most expensive Macbook Pro has a 17” screen, has 4GB of memory, an Intel Core i5 processor and a 500GB hard drive. It is better in every comparable way to the Optimist-MMX-2 and costs $2,299.00. The 13” screen Macbook Pro, which is still better but closer in size to the Optimist-MMX-2 costs $1,199.00. The Optimist-MMX-2 costs approximately $1,500 more than the 13” Macbook Pro, and the Pro line of Mac products is the most expensive, not to mention the fact that Apple products as a whole tend to be some of the most expensive on the market.

The one advantage that the ZYGO Industries Optimist-MMX-2 has over the Macbook Pro is that it is a touch screen computer. But the cost of an Apple iPad is at most $829.00, and this includes 3G support.

This is an absolutely huge price difference, and has the potential to completely change the landscape of augmentative and alternative communication devices.

The overwhelming cost difference is due to the fact that technology specially designed for a small percentage of the population cannot be mass produced like the Macbook Pro or the iPad can. In order to make a profit the company that produces a product like the Dialect-MMX-2 must charge much more. Not only this, but ZYGO must have to hire a large selection of specialists along with purchase the separate technologies and pay for the production of their product and the design of their software.

“The price of the devices covers the materials required to make them durable; extensive service that is often needed for disabled patients; as well as complicated software, said Ed Donnelly, the chief executive of DynaVox.” (Valentino-DeVries, 2010)

The article that is cited and has addressed the idea of software for non specialized hardware, unfortunately reveals a bias and inaccuracies when implies that devices of similar technological value cost as much as $15,000, but they are actually speaking of eye gaze technology, which is drastically more complex and subsequently more expensive than a symbol based text to speech software program. You can see this bias here:

“Specialized speech devices from companies like DynaVox Inc. and Prentke Romich Co. range from about $2,500 on the low end to $15,000 for a device that uses the eye movements of people who are paralyzed to allow them to select words on a screen. Most are about $7,000, near the amount that Medicare covers for such hardware.” (Valentino-DeVries, 2010)
Nevertheless, there is still a significant price difference between the specialized hardware and software and the Apple product method.

In the United States of America, Medicare covers approximately $7,000 for augmentative and alternative communication hardware, which is enough to purchase a specialized device. But a mainstream tablet would not be covered by Medicare, since it could be used for nonmedical purposes. (Valentino-DeVries, 2010)



Works Cited

American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association.

Communication, I. S. (2004). International Society for Augmentative & Althernative Communication. Retrieved Novemeber 6, 2010, from http://www.isaac-online.org/en/aac/

Howard S Kirchner MD, D. H. (2009, July 17). emedicine. Retrieved November 7, 2010, from http://emedicine.medscape.com/article/1135944-overview

Steven J. Bachrach, M. (2009, April). Retrieved November 7, 2010, from KidsHealth: http://kidshealth.org/parent/medical/brain/cerebral_palsy.html

Valentino-DeVries, J. (2010, October 13). Using the iPad to Connect. Retrieved November 7, 2010, from Wall Street Journal: http://online.wsj.com/article/SB10001424052748703440004575547971877769154.html