Over the past 20 years the potential for Augmentative and Alternative Communication services to support people with communication impairment has increased significantly. Here, Anna Reeves, ACE Centre Manager, explores the technological advances of specialised and mainstream communication technologies and the impact that technology has on improving the lives of people who need this to communicate.

It is estimated that 273,931 people in England (0.5 per cent of the population) may need to use Augmentative and Alternative Communication (AAC) at some point in their lives. Despite this, surveys show that the number of people who actually have access to such communication services is much lower.

AAC encompasses various communication methods that can be used to help people express their opinions, thoughts and preferences, enabling them to increase social interaction and, in turn, self-esteem. This includes simple systems such as signing and using picture charts, as well as more sophisticated techniques involving powerful computer technology.

Assistive technology (AT) refers to the equipment, software, programme or product systems that can be used to increase, maintain or improve the capabilities of individuals with communication and learning disabilities.

Anna Reeves, ACE Centre Manager.

Anna Reeves, ACE Centre Manager.

ACE Centre, the UK national charity that provides AAC and AT assessment, training, information and equipment services for children and adults, can see first hand how such technological advances can have an immense impact on quality of life.

Established initially as a project in the mid-1980s with funding from the Department for Education, Lord Sainsbury’s Trust and The Gatsby Charitable Foundation, the ACE Centres in Oxfordshire and Oldham became one national charity in 2012. The demand for ACE Centre core services remain as significant now as when it was first established.

Through ACE Centre’s dedicated team of teachers, occupational therapists, speech and language therapists and specialists, we help to transform lives by supporting people of all ages with complex speech and language impairments, physical impairment or learning disabilities (such as cerebral palsy, autism, stroke or motor neurone disease) to communicate, learn, live more independently and achieve their potential.

The development of locally commissioned AAC and AT services has always been at the heart of ACE Centre’s vision to improve access and provision of technology for children and adults to support their communication.

There is currently significant variability in access to AAC/AT expertise and provision within the professional workforce for children and adults. The Office of the Communication Champion (OCC) report additionally notes the following estimate of economic benefits of providing high-tech AAC:

It has been estimated that every disabled young person whose employment status changes from permanent unemployment to permanent employment as an adult as a result of use of communication aid will realise benefits in the order of £500,000 over a working lifetime.


Exploring the technology

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New innovations, such as eye-gaze technology, are increasing the opportunities for people with profound communication impairments.

There are approximately 220 communication aids available in the marketplace according to SpeechBubble – the comprehensive database of AAC solutions run by ACE Centre – with many requiring different software applications, means of accessing the communication aid and mounting options, and all of which depend on the needs of the individual.

The cost of such aids and peripherals can vary from hundreds of pounds to well over £15,000, and consequently expensive mistakes can be made, especially when specialist AAC services are not employed in an individual’s needs assessment. Ultimately this means that AAC and equipment is all too often abandoned.

There is, however, the potential for much of the technology to reduce in price, particularly if procurement opportunities are used creatively in close co-operation with manufacturers and suppliers. New innovations, such as eye-gaze technology, are increasing the opportunities for people with profound communication impairments to express themselves for the first time and these innovations tend to come down in price at larger volumes.

With medical advances resulting in sustaining the lives of more people with complex needs for longer, the number of those who rely on this technology to communicate is increasing.

Examples of AT include computer access devices, environmental controls and wheelchair controls. Computer access devices allow people who have problems using conventional controls (e.g. keyboards or mice) to use a computer.

Adaptations to assist with computer access can include:

  • Alternative keyboards, e.g. alternative keyboard layout.
  • Alternative mice, e.g. trackball, joystick, touchpad, head tracking or eye gaze.
  • Additional accessibility software, e.g. on screen keyboards, word prediction, speech recognition.
  • ‘In built’ accessibility settings.

An environmental control (EC) system can provide a level of independent control of many devices in the home for people with significant physical disabilities. EC may be suitable for those who struggle to control equipment because of difficulties with using their arms or hands. Even with the smallest of movement, EC users can:

  • Let people in/out of the house.
  • Call for attention.
  • Control telephones, computers, lights, sockets, TVs, DVD players, stereos, curtains and windows.

Specialised wheelchair control is another example of where technology brings independence. Non-standard controls can enhance driving and integration with other devices.

Examples of specialised controls include:

  • Switch controls.
  • Integrated controls.
  • Custom mounted controls, e.g. chin mounted.
  • Alternatives to joysticks, e.g. head control.

Specialised controls can provide independent mobility for those with extremely limited movement or difficulty with fine control.

The availability and sophistication of the functionality of AAC and AT continues to evolve at a significant rate. However, there is still a paucity of knowledge on how to access independent professional advice, or funding for provision and training, and support in AAC/AT’s implementation amongst many health and education professionals — as well as amongst service and organisational leads and commissioners.


Accessing training and support

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ACE Centre offers a wide portfolio of training and has long believed that investment in the skills, knowledge and competency of the local professional workforce for children and adults with disabilities is critical.

The AAC/AT evolution has paralleled a significant reduction in the local support services that have the expertise in using AAC and AT to support children, young people and adults with special educational needs and disabilities. Consequently, potential cannot be harnessed when insufficient support is in place for those who need AAC and AT.

Training providers exist but access to them is limited by inadequate signposting and competing educational, health and social care priorities that do not reflect the long-term benefits of investing in AT and AAC. This may be due, in part, to a lack of awareness of its availability and insufficient budgets, but there is also still too low a level of accessible research for commissioners and policy makers to justify investment.

ACE Centre offers a wide portfolio of training and has long believed that investment in the skills, knowledge and competency of the local professional workforce for children and adults with disabilities is critical. However, offering training and development opportunities cannot be fully effective unless there is greater awareness of the importance of this issue at a national level, and recognition of this within national policy and funding streams.

ACE Centre has been working with key AAC and AT stakeholders to establish an All Party Parliamentary Group (APPG) for Assistive Technology. An APPG is an informal group of MPs and Peers who join together to pursue a particular topic or interest. It is essentially run by, and for, members of the Houses of Commons and Lords, although many groups, including individuals and organisations from outside Parliament, such as ACE Centre, can partake in their administration and activities.

Whilst governed by strict parliamentary rules, APPGs can be an effective means by which to raise awareness within government of the need for long-term investment in the technologies. They also, and possibly more significantly, can raise awareness of the need for local professionals who can work with children and adults with disabilities and special educational needs in their area.

Significant progress has been made in the development of AAC and AT equipment, yet we face a real need for improved awareness of what is available, training on its use, robust evidence of real-life impact for those using it, and identified budgets to meet this need. The establishment of this APPG is a step in the right direction towards achieving this.

For further information about ACE Centre, visit www.acecentre.org.uk, or call the free telephone advice line: 0800 080 3115.

To keep up to date with the latest developments in the field of AAC and AT, subscribe to the ACE Centre free e-newsletter: http://aacinfo.email/ or follow on Twitter @ACECentre or Facebook: https://www.facebook.com/ACECentre.uk

A number of useful and informative videos are available on the ACE Centre YouTube channel: https://www.youtube.com/user/acecentre

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About Contributors

Anna Reeves has been manager of ACE Centre since 1997. Since starting her career as a classroom teacher, Anna has contributed to the AAC recommendations within the Bercow Review of Services for Children and Young People with SLCN and contributed to the establishment and development of NHS regional AAC funding of communication aid equipment and assessment model for adults in the North West of England. Between 2009 and 2013, Anna was also employed in a part-time capacity as Department for Education funded National AAC Coordinator, supporting Jean Gross CBE to develop a new model of national AAC commissioning for the Government. Anna has since secured the NHS England contract for ACE Centre to deliver Specialised AAC services across the North West and Wessex and Thames Valley specialised commissioning regions.

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