Technology for Children Who Can’t Speak
Alternative Augmentative Communication has been around for 20 years, but with the help of Cal State East Bay’s Elena Dukhovny, it’s now getting easier to use
Emily* came to Cal State East Bay’s Speech, Language and Hearing Clinic several years ago with an overwhelming interest in strings and buttons — tying and untying them, stretching them out and rolling them up, organizing them by color — but almost no ability to talk about her interest, or anything else, because of serious physical disabilities.
With help from Cal State East Bay speech-language pathology student-clinicians, including Giti Froz and Lyssa Rome, Emily began using an Augmentative and Alternative Communication app on an iPad. To say a word, the school-aged client would touch an image on the screen and the device produced the sound for her.
For the first time in her life, she was able to actively put her own thoughts out into the world.
Froz and Rome’s faculty supervisor, AAC researcher and Assistant Professor Elena Dukhovny, followed her students’ sessions with Emily intently from behind the clinic’s one-way mirror. She guided them to explore Emily’s interest in buttons and strings in conversation, while expanding into other topics that interested her.
Progress was slow and sometimes frustrating, but one day Emily’s mother told Rome that her daughter had used the AAC device for something previously thought impossible: to communicate with another family member on the telephone.
“They could suddenly understand the potential,” Rome recalls. “We were just at a starting point, but it was exciting for the family to see how AAC might help their child communicate.”
Coaching Students, Clients and Families
Studies show that as many as 4 million Americans are unable to reliably communicate using natural speech, and researchers estimate that about 3 percent of all U.S. children have a speech difficulty. Firm numbers are hard to come by and not all of these people are candidates for AAC, but there is broad agreement among speech-language pathologists that technologies like touch-screen tablets and artificial production of human speech are opening the world of verbal communication to more people.
This means the professor’s work at Cal State is more relevant than ever. In addition to teaching and research, Dukhovny oversees students in the use of AAC, as part of more than 375 required hours of supervised clinical contact during their speech-language pathology training. Competition for spots in the multiyear graduate program is extremely competitive, and Dukhovny says all of her graduates (including Froz and Rome, who completed the master’s program in spring 2017) move straight from Cal State East Bay to professional employment.
“For most of our students, focusing their careers on AAC is a specialty that they can work toward if they choose,” Dukhovny says. “As technology continues to be more and more standardized in educational settings and schools, AAC will play a greater role in on-site therapies. The demand for practiced clinicians is already significant and growing.”
Dukhovny was drawn to studying AAC because, she says, it represents an intellectual challenge.
For example, it’s easy to turn a noun into a picture, but how do you make pictures for verbs like “is” and “are,” or other words like “and” or “the”— particularly when the user can’t read?
“Your first instinct when you’re doing AAC with a child is to encode pictures that are easily recognizable,” Dukhovny says.
But to learn to speak — and, logically, to understand spoken language — one needs other sorts of words as well. It’s not enough to know whether an animal is a cat or a dog; for rich, meaningful communication it’s also important to know what an animal is doing, when it’s doing it and why.
Such questions led Dukhovny to research ways to improve AAC interfaces and understand how they can best grow with the user’s fluency.
“I’m interested in figuring out the most effective way to put pictures on a screen, essentially,” Dukhovny says. “It’s a new field, so the research is kind of slim. Everybody has been doing it a little bit differently.”
Specifically, Dukhovny is exploring the spatial relationship between icons, the physical motion (known as motor planning) that an AAC user performs to move between icons, and the connections that motor planning build in an AAC speaker’s brain.
Think of it this way: Every time you type the word “pie” on your laptop, you access letters in the same place on the keyboard, so eventually, you don’t need to look down to find them anymore — you have developed a motor plan. Similarly, if an AAC user learns that the icon for pie can be found in the upper left corner of his screen, he will associate touching that part of the screen with the concept of pie. Based on that idea, Dukhovny has theorized that keeping icons’ screen locations consistent as a user’s vocabulary grows makes an AAC interface more effective.
From Theory to Reality
Augmentative and Alternative Communication developers are taking notice of Dukhovny’s ideas and applying them to their products. John Halloran, an Ohio-based speech-language pathologist and co-developer of the Language Acquisition through Motor Planning approach and a top-rated AAC app called LAMP Words for Life, believes that motor planning is key to success for many AAC users.
“Dr. Dukhovny’s work really helped us,” Halloran says. “She said that the more unique the motor plan is, the easier it is for the person to learn. I think her work has helped a lot of people with autism and other developmental disabilities be better communicators.”
Dukhovny is excited — and perhaps a bit daunted — by the fact that her work is helping to guide new generations of AAC technology and apps that are now in the hands of people everywhere.
“This is the first time that anybody has used my research to inform a product, as far as I know,” she notes, which takes her work far beyond the walls of Cal State East Bay’s clinic.
“It’s not just a hypothetical question anymore,” Dukhovny says. “Every once in a while you see somebody who wasn’t communicating [and] you put a device in their hands, and then they are. It’s kind of a miracle.”
* Details have been obscured to protect the client’s privacy.