For those with speech difficulties, a set of tools and strategies can help them communicate better, writes Deborah Yong Xinyi
ALTERNATIVE and Augmentative Communication (AAC) refers to any method that can enhance or supplement verbal speech and writing.
It can help people with autism, Down Syndrome, cerebral palsy or stroke patients who are non or minimally verbal.
Examples of AAC systems include sign language, key word signs, talking buttons, communication boards and books, alphabet boards, speech-generating devices and communication apps.
It also includes tools, strategies and approaches that are used when a person is unable to solely rely on their speech to communicate.
AAC enables users to express themselves and be understood.
Here are some of the commonly-asked questions about AAC.
Who can benefit from AAC?
People with speech-language delay or disorder, apraxia of speech (AOS), aphasia post-stroke, traumatic brain injury, Parkinson's disease and degenerative diseases.
Their communication difficulty may be for a short time or prolonged.
Examples include children with autism who can only say a few words, those with cerebral palsy and unclear speech or stroke patients who have trouble communicating with caregivers post-stroke.
How different is AAC from speech therapy?
The scope of speech therapy also covers AAC. However, Malaysia is considered an AAC-emerging nation where awareness and uptake are limited.
Similar to conventional speech therapy, the AAC includes an assessment and intervention sessions.
The assessment focuses on trialing various AAC systems to determine the one that best fits the person's needs.
This is followed by therapy sessions which focus on teaching the person how to use the AAC system and their family members on how to support them effectively.
How crucial is this service in Malaysia?
AAC assessment and intervention are a crucial specialised service in Malaysia as there are increasing numbers of people with complex communication needs.
Locally, caregivers have been found to be lacking in skills to select appropriate AAC systems and provide the much-needed support to loved ones who use AAC.
It is important for people to access AAC services from a trained speech therapist who is well versed in it as early as possible to ensure the best outcome.
Where can Malaysians access this service?
General AAC services can be found at speech-language therapy clinics under the Ministry of Health, whereas specialised AAC services are available at Cheras Rehabilitation Hospital, Kuala Lumpur.
AAC services are also provided by some private speech therapy providers.
In addition, teletherapy is an option to access AAC services. This enables Malaysians who live far from service providers to have better access to services, through reduction of travel time.
Malaysians who are registered with the Department of Social Welfare and have obtained a People with Disability Card (known as OKU card) can have their speech therapy services at government facilities fully subsidised.
How successful is AAC when used effectively?
The late Stephen Hawking, the British cosmologist and physicist, was perhaps the most prominent person in history who used it successfully.
Locally, a 12-year-old Malaysian girl who was diagnosed with quadriplegic cerebral palsy is now a successful AAC user after undergoing AAC intervention for more than five years.
Due to her physical limitations, she first started off by using a communication book where she communicated by pointing with her eyes.
Later, she progressed to high-tech AAC — a tablet paired with a head pointer to enable her to select icons on the device.
She uses the system gracefully with her supportive family, friends and school teacher.
AAC has opened the door to communication and enabled her to perform not just academically, but also in areas she never thought possible.
What are the misconceptions about AAC?
People assume AAC will stop children from using speech to talk. The truth is that research shows using AAC does not stop natural speech development and may even develop and improve verbal speech.
This is not surprising as language is very abstract and visual support in the form of AAC can help us understand it better.
Verbal speech is the most time efficient way to get a message across and children will generally still use speech if they are able to.
AAC can play many roles in early communication development and decrease challenging behaviours such as meltdowns. It augments speech, which means it can be used together with speech for people with speech and language difficulties.
It's also wrong to assume AAC is not for very young children. People of all ages can benefit from using AAC. There is no evidence to suggest children must be of a certain age to benefit from AAC interventions. When considering communication intervention, earlier is always better.
* The writer is a speech language therapist, assistive technology professional and AAC specialist.