Past, Present, and Future of Augmentative and Alternative Communication

Published August 4, 2020

Augmentative and alternative communication, or AAC, is any form of communication that supplements or replaces oral speech. The use of AAC might include clinical intervention, high-tech devices, or simple facial expressions.

AAC can be unaided or aided. Unaided systems don’t require additional gadgets or technology. "You do not need anything but your own body to use unaided systems," explains the American Speech-Language-Hearing Association (ASHA). "These include gestures, body language, facial expressions, and some sign vocabulary."

Aided systems, on the other hand, use "some sort of tool or device." ASHA says:

There are two types of aided systems—basic and high-tech. A pen and paper is a basic aided system. Pointing to letters, words, or pictures on a board is a basic aided system. Touching letters or pictures on a computer screen that speaks for you is a high-tech aided system. Some of these speech-generating devices, or SGDs, can speak in different languages.

Sometimes, AAC intervention may be required when a person has either not developed or has lost speech or language skills. AAC includes many different techniques, strategies, and technologies to support people with complex communication needs (CCN).

History of AAC

According to a great timeline by NDi Media, one of the earliest communication devices developed was the Patient Operated Selector Mechanism (POSM), which was a sip-and-puff typewriter controller designed by Reg Maling in 1960. Following this invention, Orest Z. Roy of the National Research Council of Canada created a communication device known as the Comhandi. This was an electronic letter board that allowed people to select letters and build words.

In 1967, the Patient Initiated Light Operated Telecontrol (PILOT) allowed people to operate typewriters by directing a beam of light. In the 1970s, transistorized devices began to replace early mechanical systems. These systems often used the electrical activity generated by skeletal muscles to control devices, which is known as electromyography.

At this time, Richard Foulds piloted the design of the Tufts Interactive Communicator (TIC), a scanning communication aid. He ultimately developed the ANTIC, which was the first aid that predicted the next most likely letter to be typed. A few years later in 1973, the Talking Broach and the Lightwriter became the first portable communication devices.

Following the Rehabilitation Act of 1973 and the Education for All Handicapped Children Act of 1975 — which helped to advance the research and development of AAC devices — AAC became an area of professional specialization, and the American Speech-Language-Hearing Association recognized it as an area of practice. Through the 1980s and 90s, technology evolved from the EyeTyper, which allowed people to type via eye movements, to the Dynavox, the first AAC product that utilized touch screens with dynamic displays, and with integrated word and grammar prediction.

The Improving Access to Assistive Technology for Individuals with Disabilities Act, signed into law by President Bush in 2004, built upon the existing laws on the books, and according to the American Foundation for the Blind:

The goal of the act is to provide assistive technology to persons with disabilities, so they can more fully participate in education, employment, and daily activities on a level playing field with other members of their communities. Under the law, each U.S. state and territory receives a grant to fund an Assistive Technology Act Project (ATAP). These projects provide services to persons with disabilities for their entire life span, as well as to their families or guardians, service providers, and agencies and other entities that are involved in providing services such as education and employment to persons with disabilities.

Explore AAC describes AAC as “a voice for people who can’t speak.” AAC is utilized by individuals with severe speech, language, reading, or writing difficulties. Difficulty developing speech could be the result of many different factors ranging from structural issues in the mouth or throat to developmental disabilities such as cerebral palsy, autism, or Down syndrome. Individuals with acquired or degenerative disabilities like ALS and dementia or a traumatic brain injury may lose their ability to speak. AAC provides many of these individuals the ability to express themselves and communicate with others.    

Current state of AAC

Since the unveiling of the iPad in 2010, AAC has become more-widely accessible. While individuals can use the notes or messages app to communicate, they can also choose from a plethora of AAC apps from the App Store. These apps, which are available for people of all ages, can be separated into three categories: basic apps, moderate apps, and robust apps, with basic apps being offered at low cost or even free, and robust apps priced at $150 or more.

Additionally, there are numerous speech generating devices on the market, including TobiiDynavox, Prentke Romich (PRC), and Saltillo. While these devices are more expensive, they offer flexible access options including eye-gaze, head tracking, joystick and alternative mouse control, as well as single and multiple switch control.

Future of AAC

There have been significant advancements in AAC over the years with the advent of apps and speech generating aids dovetailing with disability advocacy efforts. What is even more encouraging is that technology continues to progress. Researchers at the Media Lab at MIT are currently working on a groundbreaking project called Official Commalla, which will assist people who are non-verbal or minimally verbal and “communicate certain emotions and desires through vocalizations that do not have typical verbal content.” The mission of the project is to develop a device that will interpret the vocalizations of non- or minimally verbal people, allowing them to communicate with people who are not familiar with their atypical “verbal content”. With such intelligent technology being developed, it seems the future of AAC is limited only by our collective imaginations.

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