by Meggin Nunamaker

I use AAC; I have a virtual keyboard on my laptop screen that I mouse-click letters to “type” a message. I also use a text to speech app on my laptop. To a person who has trouble speaking, or can’t speak at all, AAC devices can feel like their salvation. The voice output devices enable them to make their wants & needs known. However, the more I use AAC, the more aware I’ve become of its faults. Several of these include lack of volume, timing, lack of emphasis & intonation and word pronunciation. Other shortcomings are cost & availability, and people’s ignorance & prejudices

Volume

From my own experience, voice output devices are very limited when it comes to volume. If there is any noise it is very difficult to be heard & get people’s attention. According to research, “A quiet and familiar environment benefits Communication…”, (Stans et al., 2018b). Often, a noisy environment cannot be prevented. At times, I wish my AAC had an airhorn button to get people’s attention.

Timing

“Giving the client enough time”, (Stans et al., 2018b). Easier said than done. It takes a lot of time to input messages into AAC devices. This can interrupt the timing of a conversation. For example, I was sitting in a group conversation. I thought of the perfect joke to make, but by the time I input my joke into my device, the group was talking about a different topic. So, no one got my joke. It made me want to cry.

Lack of Intonation, & Emphases

Do you remember the monotone teacher in the movie, “Ferris Bueller’s Day Off”? That is what synthesized computer voices remind me of. A research article stated, “For people who cannot speak themselves this can have particularly profound repercussions. Augmentative communication often involves text-to-speech, a technology that only supports a basic choice of prosody…” (Pullin & Cook, 2013). Without a variety of intonation and emphases on choice words, it is very difficult to convey aspects of your personality like sarcasm, or emotions you are having such as anger or excitement, or the urgency of your message, such as telling someone, “Look out!”

Word Pronunciations

In my experiences, AAC devices do not pronounce all English language words correctly. For example, I was preparing a presentation about my tracheostomy or trache (traike). Instead of saying the word trache correctly, it said a word that sounded French; it said “trizsh”. I solved the problem by changing the spelling of the word. Apparently, this is a common problem because you can do a simple Google search and find a slew of websites showing how to change pronunciations of words on different devices.

Cost & Availability

Two important factors that influence the use of AAC devices are availability and cost. Whether a device is available to people who need them, often depends on where they live. Many people live in a rural area and don’t have access to resources there are in large cities.

A very important “barrier” is money, stated, “…the highlight is the cost of devices,

regarded as high and little affordable, especially those of high technology…” (Nátali Romano1 Regina Yu Shon Chun, 2018). I have a good friend who is a teacher. Two-thirds of her basic school supplies come from generous strangers on Amazon. Also, don’t forget, as children grow and learn, they’ll need different devices adding to the cost. Lastly, adults who are on SSI, or disability cannot afford such devices out of pocket; they are often trapped in poverty by the legal limitations of net worth for SSI recipients.

Ignorance & Prejudices

Most if not all people who use AAC devices have at one time or another, run into people that harbor prejudices against those who have difficulty communicating or they are just ignorant, “There is a lack of knowledge about AAC…”, (Stans et al., 2018b).

It’s amazing how many people make assumptions such as your mental ability, based on the way you communicate. I’ve had a teacher who upon meeting me, asked why I wasn’t in special education. I’ve surprised many teachers and professors with my academic ability. Some communication partners try, but, “Some participants found it disheartening when partners lacked the patience to give them time to construct messages or became bored when listening to the speech output” (Broomfield et al., 2022). The best way to confront these two issues is education and advocacy. In my opinion, communication with not just with people who use AAC, but how to interact with all people should be incorporated into part of the core curriculum.

If this were to happen, communication with people that use AAC will be more common & mainstream, and that would make it easier to improve other shortcomings.

In an ideal world, people would have devices that can replicate their natural speech or allow them to project an image of what they mean. However, such technologies are decades away, and such technologies that are affordable as well as widely available are even further away.

References

Broomfield, K., Harrop, D., Jones, G. L., Sage, K., & Judge, S. (2022). A qualitative evidence synthesis of the experiences and perspectives of communicating using augmentative and alternative communication (AAC). Disability and Rehabilitation: Assistive Technology, 1–15. https://doi.org/10.1080/17483107.2022.2105961

Nátali Romano1 Regina Yu Shon Chun. (2018). ISSN 2317-1782 (Online version) This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which  permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Augmentative and Alternative  Communication use: family and  professionals’ perceptions of facilitators and  barrier. Codas, 4(30), 9.

Pullin, G., & Cook, A. (2013a). The value of visualizing tone of voice. Logopedics Phoniatrics Vocology, 38(3), 105–114. https://doi.org/10.3109/14015439.2013.809144

Pullin, G., & Cook, A. (2013b). The value of visualizing tone of voice. Logopedics Phoniatrics Vocology, 38(3), 105–114. https://doi.org/10.3109/14015439.2013.809144

Stans, S. E. A., Dalemans, R. J. P., Roentgen, U. R., Smeets, H. W. H., & Beurskens, A. J. H. M. (2018). Who said dialogue conversations are easy? The communication between communication vulnerable people and health-care professionals: A qualitative study. Health Expectations, 21(5), 848–857. https://doi.org/10.1111/hex.12679

About the Author

Meggin Nunamaker has a bachelor’s degree and master’s degree in Communication Disorders from Murray State & Western Kentucky Universities. She has a congenital muscle myopathy that is progressive (described as similar to muscular dystrophy). She now has a tracheostomy (since 2012) and lives in a hospital on a ventilator (since 2013). She has been using AAC for about two or three years. After much trial & error, she finds that using a built-in function of an on-screen keyboard to “type” messages by clicking letters works best for her. She also uses a free text to speech app that she downloaded on her laptop from the Microsoft store. She was inducted into the vast world of AAC when she joined Patient Provider Communication network, and became a registered speaker for the United States Society of AAC. She’s written and published two books. This first book, A New Beginning, chronicles what it is like to live with a tracheostomy. The second book, Real Life is too Funny to Make Up (publication in process), contains funny and heartfelt stories from her life.