Communication Vehicles

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Within almost every area of study, there is a network of individuals who are very active in the field. These individuals communicate frequently at conferences, by phone, and by letter. When a network is working properly, the very active constituents in the field are in frequent contact. In the alternative and augmentation communication field, an active network exists that crosses many disciplinary lines and involves program developers, clinicians, clinical researchers, system designers, manufacturers, equipment distributors, academicians, and nonspeaking persons. In my opinion, several groups appear to be somewhat under represented in the network—in particular, educators and parents and advocates of nonspeaking individuals.
 

Perhaps in no area is our communication link as active as through our rapid communication vehicles. Communication augmentation information is being disseminated through the rapid communication tools of nearly every group involved in this interdisciplinary field. Several newsletters including Communication Outlook, Closing the Gap, Current Expressions, The ManyFaces of Funding, and so forth are committed completely to the communication augmentation effort. In various fields the nonpeer reviewed, rapid communication tools fill a specific role. In some, new research and technical results are published. In others, meetings are announced, new products are introduced, "success stories" are presented and personal features introduce the "players" in the field to each other. The rapid communication tools in our field serve a variety of functions, but most of them are introductory and rather superficial. This is not a criticism; this vehicle is not suited for detailed presentations.
 

Until the public of Augmentative and Alternative Communication (AAC) the peer-reviewed journal was our second weakest communication link. Our peer-reviewed research was spread across many fields. This dispersion of information made literature search and review extremely difficult and time consuming for all of us. In addition, in my opinion, it permitted rather superficial treatment of research topics because the editorial boards of the various journals were usually not familiar with the content of this new field. Also, professionals within a discipline wrote primarily for others in their discipline. This pattern restricted the influence of the interdisciplinary contributions to the literature. To a large extent, the effectiveness of AAC in focusing the research in this field remains to be seen, because it is such a new publication. At least the peer-review tool designed to provide a careful archive of the activities of the field is now in place.
 

In my opinion, the book area has been a unique problem for us as a field. Those of us who write in this field have been asked to write numerous introductory chapters introducing this field in a variety of different books. It was necessary, perhaps, but it took a lot of time and effort that was not spent developing really strong written materials to support the education of new professionals and continuing professionals. Thus, a review of our book-based literature reveals many introductory chapters but relatively few excellent introductory and graduate level books needed to support preservice and in-service education.

Our field is motivated largely by the need of individuals who cannot write and/or speak to communicate to provide them access to interpersonal relationships, education, public transportation, health care, vocation, and recreation. Since nonspeaking individuals are not able to articulate their own need to communicate more effectively, that task has fallen to others—parents, advocates, professionals. For years this need was expressed on largely an individual basis through articles to the newspaper, personal interest stories, newsletter features, etc. Only recently have the needs of the field begun to be reported in the literature in terms of demographic studies which will provide the base on which public, educational, and insurance policy is developed. A review of our literature does not reveal solid demographic information about nonspeaking adults. In addition to the numbers of nonspeaking individuals in various etiology categories, we need information about their communication needs as well as their capabilities.
 

A review of our literature reveals that considerable attention has been focused on a discussion of the probable. Reviews of technological and educational approaches have been introduced and comments about how these approaches would probably be successful with nonspeaking individuals have been published. This has been particularly apparent in the computer technology area. While visionary writing about the probable is necessary as a guide, without empirical reports, these statements of the probable are of limited usefulness.
 

As a field, we have begun the effort of documenting the possible by reporting success stories through case study descriptions in film and written form. We have also described how it is possible to develop programs in schools, institutions, hospitals, and homes to serve nonspeaking individuals.

In my opinion more of this documentation needs to be done; however, I would urge that now we need to provide our readers with detailed descriptions of evaluation procedures, intervention rationales, training activities, and outcomes measures. As one reviews our literature, the near absence of communication augmentation interventions with certain populations is apparent. Of particular concern is the lack of documented interventions with severely aphasic, autistic, and head-injured individuals. I know some of these interventions are occurring; however, they are not reported in our literature.
 

I believe that our efforts to "document the possible" have been hindered by the lack of performance measurement tools in this field. We have begun; however, often our early efforts have resulted in cumbersome, time-consuming tools which are expensive to use for research efforts and out of the question for daily clinical activities. The research efforts describing the interaction patterns of augmentated communication are encouraging. Hopefully these efforts will provide the tools we need. Tool development is a pressing need, worthy of some sustained attention. Briefly, we need tools to identify communication needs and assess the effectiveness with which needs are met with selected communication approaches. Also, our assessment of client capability (visual, motor, and cognitive) remains informal with little documented relationship of capability testing results to communication approach success or failure. In addition, we need tools to predict a client’s ability to learn Morse code, visual scanning, and other processes and symbol systems used in our field. Finally, a refinement of tools to assess communication interaction pattern and effectiveness is needed.
 

The long-term development and well-being of our field from a research, commercial, and personal point of view eventually depends on the quality of our efficacy studies. These studies, of which there are essentially none in our field, attempt to determine the outcomes which can be attributed to a specific intervention whether it be training, environmental manipulation, or equipment based. We are all aware that the training and equipment used in our field are not inexpensive. Funding support rests at many levels, yet as our field matures, we will be called to greater and greater accountability. To a large extent this accountability will come from the documented efficacy of our work. These studies will also guide us to rethink our approaches, to continue, or to develop new approaches and training.

A review of our literature reveals an unbelievably high level of successful intervention, because at this time we tend only to report our successes. I encourage us to begin to report a series of intervention experiences with groups of similar clients, or similar intervention approaches with different clients and report the results—positive and negative. Only then will we be able to identify those factors associated with successful intervention. Subsequent research will then begin to support the predictions which are an integral component of clinical judgment.
 

As various approaches to meet a need are developed, the time comes when research is necessary to determine which of several options is most efficient to achieve a given outcome. This dirth of efficiency reports probably reflects of lack of activity in this area, as I am unaware of any research activity attempting to address efficiency issues.
 

There are many basic questions which our research efforts will need to focus on through the years. As I review our written record, I would assume that almost no communication augmentation system users also speak or use multiple modes of communication. Further, I would conclude that once a communication augmentation intervention is initiated, all attempts to develop natural speech are abandoned. I know this is not true. However, our literature should begin to reflect reality. As a respected colleague said to me, "You folks are putting nonspeaking individuals on the shelf, not providing them with the intervention necessary to develop natural speech." Unfortunately our literature largely supports his view. I would encourage us to carefully consider the question of whether or not communication augmentation approaches enhance or retard natural speech development. This is a fundamental question, that we only have dealt with antidotally and parenthetically. The question is so important that it demands a better effort.

In addition to the question of the import of communication augmentation on natural speech development, we also have questions about the influence of these interventions on other areas of human development, namely, vision, language, motor control as well as academic areas such as spelling, reading, grammar, mathematics, and so forth. These will not be easy areas to study. Yet, I personally desire this information. As I write justifications for communication augmentation intervention programs, I admit that I must conjecture about the impact of my client’s development. The literature of our field does not yet support or reject my conjecturing.

Although the needs of nonspeaking/nonwriting individuals are not new, the interdisciplinary communication augmentation focus is yet quite recent. I am pleased with our progress during the past ten years. However, there is so much to do. There are few active pens in this field. The information necessary to close the gap between the activity in our field and our literature is lurking in our file cabinets. In closing, I would remind us all of the slogan contained in the American Rehabilitation, a publication of the Rehabilitation Services Administration, "The weakest ink is better than the strongest memory."

Communication Outlook is a quarterly periodical published by the Artificial Language Laboratory, Michigan State University, Lansing, MI.

Closing the Gap is a bimonthly periodical published by Bud and Dolores Hagen. Henderson, MN 56044.

Current Expressions is a newsletter published by Prentke Romich Company, Wooster, OH 44691.

The Many Faces of Funding is a newsletter published by Phonic Ear, Inc., Mill Valley, CA 94941.

Augmentative and Alternative Communication is published quarterly by Williams & Wilkins, Baltimore, MD 21202.

Electronically printed with permission from ISAAC (http://www.isaac-online.org/isaac.html)