Children with disabilities often require multiple assistive technology (AT) devices to meet their needs across environments. Physical therapists, in collaboration with other team members, will assess for other technologies after addressing the child's positioning. As discussed in Chapter 17, proper positioning promotes improved function, movement, and participation in activities. When a child is well positioned and can move about his or her environment independently, the need for communication and other technologies increases. This chapter provides information pertinent to physical therapists working as members of AT teams when addressing the remaining categories of AT.
Augmentative and alternative communication (AAC) is the use of means other than speech to assist children in communication. The term “augmentative” includes the use of systems that support existing speech to assist children in communicating a message. In essence, all speakers use augmentative techniques from time to time. Speakers often augment their messages with facial expressions and gestures, or by pointing to visual supports in the environment in an effort to make sure the message is understood. “Alternative” communication describes systems that are intended to be the primary communication systems for children who are non-speaking. AAC systems consist of a wide variety of techniques, systems, and intervention strategies to assist children in becoming proficient communicators.
For any given AAC user, a core group of people, including the child, family, and professionals from two or three disciplines, typically assume the role of AAC team (Reed & Lahm, 2004). Each person provides essential information. For example, the child identifies his or her abilities, limitations, needs, and desires. Family members provide information about any pertinent medical and educational history; day-to-day communication needs; family dynamics, strengths, and needs; family resources; and environmental considerations. Educators discuss current and projected educational abilities, learning needs and potential, and use of materials in the classroom. Speech-language pathologists discuss current receptive and expressive communication abilities, current and future communication abilities, needs, opportunities, and barriers and provide communication intervention. When children who use AAC or may potentially use AAC also have physical disabilities that limit their motor control, a physical therapist can make a contribution by (1) assessing motor control, (2) identifying body part(s) and movement(s) that the child may use to control AAC devices, (3) assessing positioning and ensuring that positioning systems promote optimal motor control and use of devices, (4) designing a system that best matches the motor abilities of the child, and (5) designing intervention strategies to promote functional use of the AAC system (McEwen, 1997). AAC systems are broadly categorized as unaided or aided.
Unaided systems are naturally available to us and do not require the addition of something external. Examples of unaided systems are gestures, body language, vocalizations or speech, facial expressions, signals, and manual signs. For some children, behaviors, such as crying, smiling, or tensed or relaxed ...