"The silence of speechlessness is never golden. We all need to communicate and connect with each other--not just in one way, but also in as many ways as possible. It is a basic human need, a basic human right. And much more than this, it is a basic human power."
(Williams, cited in Beukelman & Mirenda, 2005, p. 3)
This quote brings to the fore the importance of communication, eloquently explaining the intrinsic human need and desire for communication and giving insight into a life in which it is lacking. It is extremely difficult to imagine life without the ability to speak and be heard, to establish closeness with others through shared experience and social interaction. However, health and educational services appear to neglect the importance of being able to communicate effectively, compared to the emphasis given to trying to improve the physical status of people with disability. While research into occupational therapists' engagement with communication disorders is lacking, the profession is uniquely placed to recognise and advocate for the role communication plays in all aspects of participation.
Augmentative and Alternative Communication (AAC) is a means of enhancing communicative ability that offers exciting, new possibilities. The American Speech--Language--Hearing Association defines AAC systems as having "four components (symbols, aids, techniques, and/or strategies) incorporated to enhance an individual's communication. AAC aids include: communication books, communication boards, charts, mechanical or electronic devices including those that speak, and computers" (Reichle, Beukelman, & Light, 2002, p. 2). AAC examines ways in which people with limited vocal ability can extend their communicative repertoire by supplementing or replacing spoken words. There is accumulating evidence that with recent advancements in AAC technology, people with communication issues can overcome barriers to effective communication, which is vital to enabling participation in occupation, creating relationships and establishing themselves as participants in society.
The discussion below presents the contribution communication makes to health and well-being, and participation in life. It then profiles AAC users, before presenting the evidence supporting AAC use. Accumulating knowledge of AAC provision for children and adults is outlined and future developments considered. The article concludes with a plea to therapists to advocate for AAC for clients with communication needs.
Communication for well-being
Communication is multimodal (Higginbotham, Shane, Russell, & Caves, 2007); it is a highly complex capacity that is required by humans to "be" in the world (Latham & Miles, 1997). If we accept that communication is a vital component of participating in occupation, then lacking the ability to communicate must have a detrimental effect on health and well-being. That assertion is supported by The World Health Organization's (WHO) 2001 publication, The International Classification of Functioning, Disability and Health (ICF), which proposes relationships between communicative capacity, body structures, factors in the environment and participation. The ICF represented a paradigm shift in the way professionals view health and disability, moving away from the impairment based approach of disease to a performance based view of health and functioning (McCarty & Morress, 2009). The ICF is accepted by many as an all encompassing theoretical framework for describing people's health and well-being.c
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In this model, an individual's functioning in a specific domain can be conceptualised as influenced by health condition, environmental and personal factors. As a dynamic relationship exists between these entities, intervention to change any factor, domain, structure or condition creates the possibility of affecting other aspects (WHO, 2001). Viewed from this perspective, the goal of AAC is to overcome activity limitations and reduce participation restrictions. …