By Katarina Fiorentino Klatzkow
For speech-language pathologists — health care professionals who evaluate and treat individuals with communication, cognitive and swallowing disorders across the lifespan — assistive technology can make a big impact on the lives of the patients they serve.
“Assistive technology is any equipment that an individual uses in day-to-day life to enhance access to their environment,” said Kristen “Kristy” Lewandowski, M.A., CCC-SLP, a speech-language pathologist and instructional assistant professor in the University of Florida College of Public Health and Health Professions department of speech, language, and hearing sciences.
This could be a walker for an older adult with mobility challenges, a pencil grip for a school-aged child with fine motor impairments, or an augmentative and alternative communication, or AAC, device for people with communication needs.
“AAC gives the user a way to independently and autonomously share their own thoughts, ideas and needs,” she said. “An individual can express various communicative functions through AAC. If they are unable or limited in their use of oral speech or language, it gives them an alternative way to communicate.”
Augmentative and alternative communication comes in many forms, including speech-generating devices, core boards and communication apps such as Proloquo2go and TouchChat. According to the American Speech-Language-Hearing Association, an estimated 5 million Americans may benefit from using AAC.
“At the beginning of my career, I worked with a patient living in a skilled nursing facility who was diagnosed with a terminal illness that impacted the area of her brain that controls language. As a result, she had this really debilitating expressive language impairment,” Lewandowski said. “My team advocated for a speech generating device for her, so she had a way to communicate. She just wanted to be able to tell her kids and her husband that she loved them. Her AAC gave her a way to do that, and essentially, she got her voice back.”
Lewandowski, who has more than 10 years of clinical experience in various settings throughout the Gainesville community, is educating the next generation of speech-language pathologists to work with patients who benefit from assistive technology and AAC.
“I teach a graduate course every fall semester on assistive technology and AAC to our master’s students in speech-language pathology. I always tell my students that they are going to work with AAC across the lifespan. It’s become much more utilized and widely implemented,” she said. “It’s a valid communication modality for so many individuals and can be the difference between fully engaging in one’s environment and communication isolation.”
AAC can be used in a number of settings, Lewandowski said.
“Take for example a school-aged student who has a communication disorder or is non-speaking. If that student has access to a communication board or speech-generating device, they can now interact with peers on the playground, order their own food, ask for help from their teachers, and have autonomy. And in a hospital setting, AAC can be critical in empowering patient autonomy, including to make medical decisions, directly communicate with health care providers, and express emotions when loved ones come to visit. All of these things help contribute to positive overall health outcomes.”
AAC can also benefit individuals who have experienced a sudden injury, such as a patient who has trouble expressing or understanding language after a stroke. Some people may benefit from the use of AAC all the time and others on a temporary or as-needed basis. Lewandowski has witnessed firsthand the benefits of AAC for patients with cerebral palsy, apraxia of speech, dementia, aphasia, progressive neurological diseases such as ALS or Parkinson’s, mild language impairments, autism and motor speech disorders.
“Someone who has aphasia may speak in single words, and for some purposes, that’s really effective,” she said. “But if they need to say more, they might want to use their communication device. For someone with a neurological condition that impacts voice, AAC could help with any vocal fatigue that might occur later in the day. AAC can be for anyone. It’s not all or nothing.”
One common misconception, she notes, is that AAC hinders oral speech or language development in children or rehabilitation in adults. But in fact, it’s the opposite.
“There is a large body of evidence, as well as ongoing research, that shows AAC as an intervention or communication modality can actually have a positive impact on oral speech and language. As clinicians, we try to counsel our patients and their families on the positive benefits of using AAC.”
Additionally, there are no prerequisites to using AAC.
“This is a common myth, that someone has to do A, B and C before we can recommend any type of AAC system,” she said. “That’s not the case. If there is a barrier to communication that AAC can help solve, then we’ll just jump right in.”
Part of a speech-language pathologist’s role is working with an interprofessional team of health care providers, including AAC vendors, to customize devices and empower families to navigate vocabulary.
It’s important that AAC reflects all communicative functions, including negative or uncomfortable topics, Lewandowski said. For an adult patient, this can include programming for the expression of negative emotions, intimacy vocabulary and curse words.
“As clinicians, we shouldn’t be barring our patients from having access to all types of expression,” she said.
Ultimately, Lewandowski hopes that the world continues to become more inclusive of AAC.
“It’s important to normalize AAC as another valid and effective communication modality. To engage with AAC users and give them a space to communicate,” she said. “Communication is a human right. People who use AAC are just as intelligent, creative, engaging and interactive as oral communicators are. Impairments do not mean lesser than. I hope that people accept AAC users as equals and let them know they hold just as much value, and their voice is just as significant, as the person who communicates in a different way.”