Chapter 2: No-Tech AAC

Publication and Citation Context

  • Chapter Title: Chapter 2: No-Tech AAC

  • Contributing Author: Amal Maghazil

  • Book Title: Fundamentals of AAC: A Case-Based Approach to Enhancing AAC

  • Book Authors: Nerissa Hall, Jenifer Juengling-Sudkamp, Michelle L. Gutmann, and Ellen R. Cohn

  • Publisher & Copyright: Copyright © 2023 by Plural Publishing, Inc. All rights reserved.

Learning Objectives

  • Describe types of unaided and aided no-tech Augmentative and Alternative Communication (AAC) systems.

  • Compare various grid display designs used with communication boards.

  • Explain key factors necessary to design a lite-tech AAC system.

  • Summarize the critical importance of communication partner and family involvement and training starting from the initial assessment stages.

  • Identify advantages and disadvantages associated with no-tech and lite-tech AAC systems.

Core Terminology and Concept Definitions

  • No-Tech AAC: AAC systems that are typically paper-based, do not have a battery, and provide no voice output. Also known as low-tech and/or lite/light-tech systems.

  • Low-Tech Communication Devices: Devices that possess a simple electronic component and can be purchased off the shelf at novelty stores (e.g., adapted photo frames, greeting cards). These devices usually require minimal programming and are sometimes limited to single messages.

  • Iconicity: An icon's meaning and how directly it relates to its referent. Iconicity exists on a continuum:

    • Transparent: The symbol's meaning is clear and directly apparent.

    • Translucent: The symbol's meaning can be understood with a small amount of explanation.

    • Opaque: The symbol's meaning is abstract and requires specific information or instruction to understand the connection between the symbol and its referent.

  • Display Representation: The structural arrangement and organization of vocabulary on an AAC system.n

  • Schematic Organization: Display layout organized by a specific activity or routine.

  • Semantic-Syntactic Organization: Display layout organized according to parts of speech and spoken word order.

  • Taxonomic Organization: Display layout organized by categories.

  • Alphabetical Organization: Display layout organized alphabetically.

  • Chronological Organization: Display layout organized by the sequence of events or activities.

  • Pragmatic Organization Dynamic Display (PODD): Formulated by Porter (2014), PODD represents a combination of display options where the first page of the book usually displays phrase starters paired with a number representing the number of the next page to turn to in order to complete the phrase with more specific choices.

  • Picture Exchange Communication System (PECS): A specific and clearly defined behavioral approach developed by Bondy & Frost (2001) to train individuals with Autism to communicate by exchanging cards (line drawings) representing objects or items to communicate messages. PECS is a program consisting of six distinct phases, where training starts with single pictures and advances to multiple pictures to formulate complete sentences.

  • Visual Scene Displays (VSDs): Picture-based displays that present a scene or context with salient elements that can be pointed to or manipulated (exchanged with a communication partner).

Unaided versus Aided AAC Systems

  • Unaided AAC:

    • Refers to intrinsic, natural forms of communication that require no physical tools external to the user's body.

    • Accounts for roughly two-thirds (23\frac{2}{3}) of human communication.

    • Forms of Unaided AAC:

      • Gestures

      • Facial expressions

      • Body language

      • Signs and formal sign language

      • Eye blinks

      • Vocalizations

  • Aided AAC:

    • Involves tools and systems external to the individual.

    • Categories of Aided AAC:

      • No-tech systems

      • Mid-tech systems

      • High-tech systems

Design Characteristics and Symbol Types in No-Tech AAC

  • System Characteristics:

    • Aided form of communication.

    • No technology involved (contains no batteries and provides no synthetic/recorded voice output).

    • Varies in design based on symbols, organization, and display format.

    • Alternative nomenclature: paper-based, low-tech, lite-tech, light-tech.

  • Visual Referents and Physical Formats:

    • Communication boards, Picture Exchange Communication System (PECS) cards/books, and alphabet boards.

    • Can contain words, pictures, visual symbols, or full phrases.

    • Can be rendered as a single board, a multi-page book, or placed directly in the physical environment.

  • Types of Symbols:

    • Real objects: Physical objects representing themselves.

    • Partial objects: A part of an object used to represent the whole.

    • Associated objects: An item associated with the activity or object.

    • Photographs: Real-life photographic representations.

    • Line drawings: Simplified visual icon representations.

    • Traditional orthography: Written words and text.

  • Symbol Selection Factors:

    • Symbol selection depends on individual feature-matching, evaluating cognitive skills, language comprehension, physical abilities, and sensory skills.

    • Icons vary in concreteness (e.g., real object or photograph vs. opaque symbol or line drawing) and must be meaningful to both the individual using AAC (PWUAAC) and their communication partners.

Designing No-Tech Systems and Grid Displays

  • Feature-Matching Parameters for PWUAAC:

    • Number of icons included.

    • Size of individual icons.

    • Number of icons displayed at a given time.

    • Overall physical size of the display.

  • Display Layout Determinants:

    • Cognitive skills of the individual.

    • Communication environments.

    • Communication partners.

    • Age of the user.

    • Target vocabulary and frequency of word usage.

  • Color-Coding Systems for Parts of Speech:

    • Color-coding is utilized across different systems (Proloquo2Go, Goossens', Crain, & Elders, PRC, Fitzgerald Color Code) to organize parts of speech visually:

      • Pronouns (e.g., I, he, she, it): Orange / Yellow

      • Verbs (e.g., like, want, have): Pink/Magenta / Green

      • Descriptors / Adjectives: Blue / Blue

      • Prepositions (e.g., in, out, under, over): Green / Purple

      • Nouns: Yellow / Orange

      • Question Words (e.g., who, what, why, when, where): Grey / Purple

      • Core Words (e.g., eat, drink): White

Physical Formats and Access Methods

  • Physical Formats:

    • Paper or Physical Material Board/Book: Language board or book. Direct access via physical manipulation/pointing; indirect access via Partner-Assisted Scanning (PAS).

    • Specific Board: Eye-gaze board / E-Tran (Eye Transfer) board. Direct access via eye looking/fixation; indirect access via PAS.

    • Manipulatives: PECS cards, interactive boards, visual scene displays, and PODD books. Direct access via physical manipulation or pointing.

  • Access Modes:

    • Direct Access: Pointing directly to letters, words, pictures, or phrases using:

      • Fingers

      • Eye gaze

      • Lights or lasers

      • Direct Access Modifications:

        • Touchguide (raising the physical borders around individual icons/cells).

        • Increased padding or spacing between cells.

    • Indirect Access:

      • Partner-Assisted Scanning (PAS), where a communication partner presents options systematically.

Comprehensive Evaluation: Advantages and Disadvantages

  • Advantages of No-Tech AAC:

    • Functions as a stand-alone tool, complements alternative communication tools, or acts as a back-up system for high-tech devices.

    • Ensures communication across all physical environments (e.g., swimming pool, gym, outdoor settings).

    • Highly accessible, affordable, and easily replicable.

    • Supports immersion into the environment (can be printed on various surfaces, including waterproof substrates).

    • Can be created in any language.

    • Provides a shared visual referent that facilitates shared understanding and active engagement.

    • Requires no battery power or electrical access.

  • Disadvantages of No-Tech AAC:

    • Lacks auditory speech/voice output.

    • Increased vocabulary size makes physical boards/books heavy and bulky.

    • Static nature (lacks dynamic screen shifts).

    • Access rate is inherently slow.

    • Time-consuming to construct and maintain.

    • More difficult to edit or correct errors on the fly.

    • Visual symbols are not always universally understood by unfamiliar partners.

Case Study: PG

  • Triad of AAC Assessment:

    • The Individual: Cognitive, physical, sensory, and linguistic profile.

    • Their Communication Partners: Family, caregivers, professionals, and peers.

    • Their Environment: Home, clinical, educational, or community settings.

  • Sample Display Elements and Navigation (Case Study PG):

    • English Phrase Starters & Navigation:

      • "STOP"

      • "need"

      • "What's your name?"

      • Page numbers / links: 3, 10, 13, 20

    • Bilingual Arabic-English Grid Layout (Medical & Daily Needs):

      • "I have pain"

      • Arabic Body Parts linked to "Move my…" (حرك…):

        • رأسي (my head)

        • رجلي (my leg/foot)

        • يدي (my hand/arm)

        • حلقي (my throat)

        • صدري (my chest)

      • Arabic Environment & Request Commands:

        • أرفع السرير (Raise the bed)

        • نزل السرير (Lower the bed)

        • التلفزيون (The TV)

        • النور (The light)

        • أبي أصلي (I want to pray)

        • أبي أنام (I want to sleep)

        • "YouTube"

      • Arabic Social Phrases & Pragmatic Repairs:

        • السلام عليكم (As-salamu alaykum / Peace be upon you)

        • وعليكم السلام (Wa alaykumu s-salam / And upon you be peace)

        • كيف الحال؟ (How are you?)

        • ما فهمت (I didn't understand)

        • ممكن تعيد (Can you repeat?)

        • ممكن توقف (Can you stop?)

    • Arabic Alphabet Board Integration:

      • Includes a complete Arabic alphabet layout for manual spelling:

        • أ ب ت ث ج ح خ د ذ ر ز س ش ص ض ط ظ ع غ ف ق ك ل م ن ه و ي