JCPSLP Vol 21 No 3 2019

Multimodal communication

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stakeholders’ roles, lack of confidence and experience with AAC, preference for speech • Facilitators – e.g., realistic goals and expectations, motivation, collaboration, increasing AAC awareness, community acceptance Support and relationships • Barriers – e.g., lack of experience, lack of training and coaching opportunities, incorrect and inconsistent implementation, time constraints, miscommunication between stakeholders • Facilitators – e.g., Rapport, supportive and collaborative relationships, extensive knowledge and experience in AAC, practice opportunities, positive feedback between stakeholders Services, systems and policies • Barriers – e.g., lack of time and resources, funding limitations, policy gaps, prioritisation of alternative goals, lack of support for all stakeholders, high staff turnover or shortages, limited training, lack of handover or collaboration • Facilitators – e.g, equipment and resources, intensive services, AAC availability, processes for prescription, follow up and implementation Products, technology and the natural environment • Barriers – e.g., prescriptive content, limited vocabulary and syntax, limited portability, lack of auditory feedback, inappropriate space, positioning and poor accessibility • Facilitators – e.g., personalised systems, readily accessible, affordable, freedom of use Personal factors Personal factors included attitudes and behaviours, older or younger age children, low socioeconomic status, consistent first language with the community, frequent illness, and poor social skills. Few personal factors, aside from having a motivated, persistent temperament and impaired communication, presented as facilitators of low-tech and unaided AAC use in this study. Body functions and structures Within the body functions and structures domain, barriers included poor attention, cognitive impairment, poor memory, limited motor functions and a reduced state of alertness. Conversely, frequent optimal states of alertness, greater cognitive abilities, impaired speech or voice, and functional vision supported the provision and use of AAC. It is possible for SLPs to address the larger proportion of environmental factors that hinder AAC intervention when they have access to accurate data that applies to their clinical populations. As stated by Moorcroft et al., the current body of research that addresses these factors

Moorcroft, A., Scarinci N., & Meyer, C. (2019). A systematic review of the barriers and facilitators to the provision and use of low-tech and unaided AAC systems for people with complex communication needs and their families . Disability and Rehabilitation: Assistive Technology , 14 (7), 710–731. doi:10.1080/17483107.2018.1499135 Ilona Sim Individuals and families who use AAC systems experience a range of barriers and facilitators throughout their AAC journey. Moorcroft, Scarinci and Meyer (2019) conducted a systematic review, following the lack of existing research that consolidated the factors impacting low-tech and unaided AAC use for individuals with complex communication needs. A total of 43 qualitative studies from 2000–2016 were included in the study. The total participants (n = 1080) included people with complex communication needs, family members, friends, SLPs, OTs, teachers, and other related professionals. The individuals with complex communication needs were a combination of children and adults with disabilities including Fragile X syndrome, Angelman syndrome, autism spectrum disorder, Down syndrome, cerebral palsy, intellectual disability, childhood apraxia of speech, epilepsy, Parkinson’s disease, acquired brain injury, motor neuron disease, hemimegalencephaly, aphasia, chronic respiratory failure, and amyotrophic lateral sclerosis. Unaided AAC systems considered in this study included signing, conventional gestures, enhanced naural gestures, eye pointing, head movements, mouth movements, vocalisations, facial expression, behaviour, and posture. Low-tech AAC systems included alphabet boards, picture communication boards and book, writing, drawing, PECS, tangible symbols, objects, photographs, visual schedules, community request cards, picture-based shopping lists, and About Me books. The team conducted a meta-synthesis of the studies by categorising their findings according to ICF domains and chapters. Moorcroft et al. identified an extensive number of barriers and facilitators to low-tech and unaided AAC use. The vast majority were attributed to the environmental factors, followed by personal factors, and a small proportion of factors related to body functions and structures. Barriers and facilitators Environmental factors Attitudes • Barriers – e.g., low client expectations, misconceptions of AAC and its purpose, prioritisation of verbal expression as a goal, burnout, incorrect assumptions of

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JCPSLP Volume 21, Number 3 2019

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