Imagine what it would be like if you couldn't speak...how would you get a cup of coffee? Phone a friend? Share your ideas at school or work? Tell your parents you love them? Sometimes you canāt communicate everything you want by gestures and pointing. And often communication needs to happen across distance and time. At times like this, people need more powerful ways to communicate.

There are more than 2 million Americans who have significant communication disabilities and are not able to use their speech to communicate with others. Augmentative and alternative communication systems were developed to provide ways for these individuals to communicate at home, school, work and in the community.

What exactly is AAC?

Augmentative and Alternative Communication, or AAC, is just what it sounds like:

• Augment...to enhance or improve
• Alternative...another way or means
• Communication...the sending and receiving of messages

So, AAC means anything that can improve someoneās ability to communicate. This can include things like using a voice output communication aid to talk to a friend, pointing to pictures in a communication book to order at a restaurant, or using a computer to type and send E-mail. But imagine how important these Īalternativesā would be if you couldnāt talk·

Learn more from Sara, a woman who uses AAC...

Learn more from Jon, a man who uses AAC...

Who uses AAC?

Some people, who have communication disabilities, need augmentative communication in their daily lives. For example, people with Cerebral Palsy (CP) are born with problems controlling their speech muscles (e.g. those in the tongue, lips, and vocal cords). Others have difficulties learning speech because of Autism or Down Syndrome, and use AAC to give them more ways to say what they want. Some people may not be able to talk, but that doesnāt mean they donāt have anything to say!

Other people might need to use AAC after a stroke or Traumatic Brain Injury. People who have had strokes and head injuries might find that they canāt speak as well as they could before the accident. In some cases they might have slurred speech (Dysarthria), or they might not be able to coordinate their speech muscles (Apraxia). In other cases, they may have problems with language (Aphasia). People with aphasia might have problems forming sentences, naming things, understanding othersā speech, reading, writing, and even gestures. AAC can help make up for some of these problems.

Some people use AAC because of progressive degenerative disorders such as MS (Multiple Sclerosis), MD (Muscular Dystrophy), Lou Gehrigās Disease or ALS (Amyotrophic Lateral Sclerosis), Parkinsonās Disease, MG (Myasthenia Gravis), Locked-In Syndrome and others. They may lose their ability to walk and talk.

What are AAC systems?

AAC systems can include anything and everything that helps someone to get their message across. Think of all the alternatives you could use to send a message - writing and reading, gesturing, pointing to pictures, making facial expressions, vocalizations, e-mail messaging, telephone conversations, typing on a computer, pager messaging, and the list goes on.

Here are some examples:

• Ashley is a young girl who had a stroke. Now she uses a combination of single words, signs, and a computer with picutres and voice output to help her communicate. Read more about Ashley...
• Howard is a man who has ALS, or Lou Gehrig's disease. He uses a computer that tracks his eye movement to communicate. It lets him do everything from paying his bills to telling jokes. Read more about Howard...
• Denise is woman who has a physical disability. When she started college, she could only type 8 words a minute. Then one day, she tried typing with her feet! Read more about Denise...
• George is a man who has Multiple Sclerosis. Over the years, he recorded his own speech into a communication device. Now he presses a button to activate the device and have it speak his stored messages. Read more about George...
• Paul is a "sit-down" comedian who lives with Cerebral Palsy. Throughout the day, he communicates differently depending on who his partner is. Sometimes he uses his own speech, and sometimes he uses a computer with synthesized speech. Read more about Paul...

The specific means of communicating the message can change depending on the situation (e.g. using a telephone to talk to someone at the same point in time when you are in a different place, or writing a letter to someone who will read it at a different point in time, at a different place). This is why people need to have a whole range of means to communicate within their communication system.

But what about speech?

People sometimes worry that augmentative communication will "replace" any natural speech ability. Some worry that the person will "lose" what words and sounds they can produce. Others worry that a child may never learn to speak if we start using other forms of communication before the child starts talking on his or her own.

So is natural speech totally out of the picture? No! Absolutely not! Remember that the first "A" in "AAC" stands for "augmentative" ö it helps enhance or improve. An important principle in AAC is to build upon what natural abilities already exist. Natural speech is always an important part of the whole communication system, but it is not always effective on its own. This is when other forms of communication (like gestures, symbols, or writing) can help to get the message across.

More research needs to be done to determine just what effect AAC has on the development of natural speech. The research so far suggests that natural speech abilities will NOT decline (or get worse) when AAC is used. In fact, the research suggests that many individuals may show improvements in their speech once they start using AAC. If you want to find out more about this issue, you can read a research review by Millar, D., Light, J., and Schlosser, R., 1999.

What types of AAC systems are there?

AAC systems are typically divided into two main types: "unaided" and "aided."

Unaided AAC Systems

Unaided AAC systems refer to any type of communication that occurs naturally, without the use of an aid. Unaided communication can include:

• vocalizations
• natural speech
• gestures
• manually coded language (e.g., American Sign Language)
• fingerspelling or a manual alphabet

Aided AAC Systems

Aided AAC systems refer to any type of communication that is aided by the use of some sort of tool. Aided communication can include:

• actual objects (e.g., holding up the shirt you want to wear)
• photographs (e.g., using a photo of the family vacation to start a conversation on that topic)
• line drawings and color pictures (e.g., showing a drawing of a person eating to indicate that you are hungry)
• traditional orthography (e.g., writing a note on a piece of paper, or typing a sentence on a computer)
• morse code
• recorded speech (or digitized speech) (e.g., using a form of tape recording to capture a message to be spoken later)
• synthesized speech (e.g., using a computer algorythm to produce written words as spoken output)

Aided AAC systems are typically divided into two more types: "light tech" and "high tech."

Light Tech AAC Systems

Light tech AAC systems use aids for communication, but they do not require computers or other "high tech" equipment. Light tech AAC systems display words or concepts in a static, unchanging form. Some examples of light tech AAC systems include:

• a communication book (such as a binder or album) containing photos of familiar people, places, and objects
• a communication wallet (to hold several small items) containing labelled picture cards to help someone remember a sequence of tasks to perform at work
• an alphabet display on the lap tray of a wheelchair for pointing to letters to spell words
• a communication vest worn by a child's parent, covered with pictures of toys, so that the child can "point" at the one she wants by looking at it

High Tech AAC Systems

High tech AAC systems use computers or other "high tech" equipment. High tech systems exist in many forms, and have many features that allow the user to be more independent. However, the more complex the system, the more time and effort it takes to learn how to use the system efficiently. Most high tech AAC systems can produce both "visual output," such as pictures or text messages, as well as "voice output," using recorded or synthesized speech. Here are some examples:

• a laptop computer can be used to type messages, write E-mail, and do homework assignments
• a small box has several buttons with pictures on them. A push of a button with a picture of a person with a spoon in his mouth "speaks" the tape-recorded message "I'm hungry."
• a specialized computer can run a picture-based program that "speaks" when you touch a picture on the screen
• another specialized electronic device stores combinations of icons in its memory. When you push the buttons for 3 different icons, a stored message is retrieved and spoken out loud.

There are many different types of high tech communication systems. To learn more about some specific types, visit the links at the website for the Communication Aid Manufacturer's Association (CAMA) at www.aacproducts.org.

 Click here to go back to the AAC Mentor Project web site.