A scoping review of AAC interventions for children and young adults with simultaneous visual and motor impairments: Clinical and research Implications

Figures & data

Figure 1. Flowchart of source identification and inclusion process.

Table 1. Search strategies and yields for electronic database search.

Database	Search strategy	Yield
ProQuest (Multiple Databases)	“augmentative alternative communication” OR AAC OR “speech-generating device” OR SGD OR VOCA OR PECS OR “communication symbol” AND “multiple disabilities” OR “Profound Intellectual Multiple Disabilities” OR deafblind AND “visual impairment” OR sensory motor impairment (limiters: peer-reviewed, scholarly journals, English)	174
PubMed (Medline)	“augmentative alternative communication” OR AAC OR speech-generating device AND multiple disabilities OR profound intellectual and multiple disability OR deafblind AND vision AND motor	15
Psychinfo (Proquest)	“augmentative alternative communication” OR AAC OR PECS OR VOCA OR “communication symbols” OR SGD OR speech-generating device AND multiple disabilities OR “profound intellectual multiple disabilities” OR severe disabilities OR deafblind AND visual impairment OR vision impairment OR motor impairment (limiters: peer-reviewed, English)	28
ERIC	“augmentative alternative communication” OR AAC OR “speech-generating device” OR PECS OR “communication symbols” OR VOCA AND “multiple disabilities” OR “PMID” OR “PMLD” OR deafblind	6

Table 2. Summary of the studies of AAC intervention with individuals with multiple disabilities.

Participant characteristics (n = 55)	Number of cases	Percentage of cases
Age
Preschool (0–5 years)	8	15%
Elementary (6–10 years)	24	44%
Adolescent (11–17 years)	19	35%
Young adult (18–21)	4	7%
Gender
Male	34	62%
Female	21	38%
Ethnicity
Not reported	52	95%
Reported	3	5%
Primary diagnosis
Cerebral palsy	37	67%
Unspecified multiple disabilities	3	5%
Other	15	27%
Vision
Visual impairment unspecified	33	60%
Cortical visual impairment	6	11%
Blind	16	29%
Motor level GMFCS
Level 1	2	4%
Level 2	0	0%
Level 3	2	4%
Level 4	22	40%
Level 5	29	53%
Communication prior to intervention
Unaided AAC	55	100%
Mid-tech AAC	6	11%
High-tech AAC	2	4%
Intervention characteristics (n = 25)
Primary intervention purpose
Teach participant to request	16	64%
Teach participant to make choices	5	20%
Teach participant to respond yes/no	1	4%
Increase communicative functions	2	8%
Increase communicative turns	1	4%
Instructional strategies
Social pragmatic	4	16%
Highly structured	21	84%
AAC introduced
Unaided AAC	1	4%
Low-tech AAC	6	24%
Mid-tech AAC	3	12%
High-tech AAC	15	60%

Note. GMFCS: Gross Motor Function Classification System (Palisano et al., 2007).

Table A1. Summary of coded variables: AAC intervention studies with individuals with multiple disabilities.

Study authors and design	Participant case (sex/CA/Dx/vision status/GMFCS/hearing status/cognitive status)	Study purpose	Outcome measurement	AAC	Effect size Tau-U^a; Gain score^b	Certainty of evidence
Ali et al. (2011); MBD	Sameera: F, 7, CP, VI, Level IV, NR, moderate	Teach participant to request preferred items	Percentage of correct requesting trials	Adapted PECS (tangible symbols)	1.0; +84.4%	Preponderant; good interobserver reliability and procedural integrity
Cosbey & Johnston (2006); MBD	Brianna: F, 4;7, CP, VI, level V, WFL, NR Sonja: F, 6;6, CP, VI, Level V, WFL, CI-NS	Teach SGD use to request preferred items from peers	Frequency of SGD requests	SGD	.71; +4.6 .43; +3.5	Conclusive
Fleury et al. (2019); ABAB	Tracey: F, 14, TBI, CVI, Level III, WFL, severe/profound^b	Evaluate a wearable AAC with 4 social messages	Frequency of activations	Wrist-worn, fabric-based SGD	- (no baseline)	Inconclusive; no stable baseline, experimental control, or reliability
Harding et al. (2011); pre-test post-test	B: M, 6;4, PMLD, VI, Level V, WFL, NR	Teach participant to make choices	Frequency of correct choices	Signs, gestures, objects	- (no baseline)	Inconclusive; no baseline data
Holyfield, Caron, et al. (2018); MBD	Jose: M, 18;11, CP, CVI, Level V, NR, CI-NS Nathan: M, 13;11, Trisomy 18, VI, Level V, HI, CI-NS	Evaluate the effect of mobile VSD AAC technology on turns taken	Frequency of communicative turns	Tablet with Easy VSD application	1.0; +29 1.0; +15	Conclusive
Ivy et al. (2014); MBD	Paul: M, 8, MDS, VI, Level I, WFL, CI-NS^b Chris: M, 5, septo-optic dysplasia, VI, Level I, WFL, CI-NS^b Darren: M, 6, cerebellar atrophy, VI, Level IV, WFL, CI-NS^b	Teach participants to request preferred items via modified PECS	Percentage of correct requesting trials completed independently (phases 1 & 2)	Adapted PECS (tangible symbols)	1.0; +98.1% .87; +83.1% 1.0; +92.6% .92; +53.1% 1.0; +91.1% 1.0;+93.3%	Preponderant; good inter-observer agreement, unstable baseline (some participants)
Ivy et al. (2020); MBD	Iggy,:M, 7;2, Baraitser-Winter syndrome, VI, Level III, HI, NR Brice: M, 4;5, cytomegalovirus, VI^b, Level IV, HI, NR Lizzy: F, 5;3, Lennox-Gastaut syndrome, VI, Level I, HI^b, NR	Teach participants to request preferred items via modified PECS	Percentage correct in requesting trials (independent; phases 1 & 2)	Adapted PECS (tangible symbol); GoTalk button	1.0; +96.7% 1.0; +94% 1.0; +97.8% 1.0; +94.3% 1.0; +88.4% .68; +62.3%	Conclusive
Lancioni et al. (2001); MBD	Participant 1: M, 9;7, CP, VI, Level IV, NR, severe/profound Participant 2: M, 13;3, CP, VI, Level IV, NR, severe/profound	Teach participants to request preferred stimuli	Frequency of responses	Multiple microswitches connected to voice output	- (session data collapsed)	Suggestive; no procedural integrity
Lancioni et al. (2003); MBD	Sara: F, 17;3, CP, VI, Level IV, NR, severe/profound Jim: M, 19;4, CP, VI, Level IV, NR, severe/profound	Teach participants to make requests and choices	Frequency of request activations and frequency of these followed by choice	Microswitches connected to voice output and control box	- (session data collapsed)	Suggestive; no procedural integrity
Lancioni et al. (2004); MBD	Tania: F, 17;3, CP, blind, Level IV, NR, severe/profound Ronny: M, 6;7, CP, VI, Level IV, NR, severe/profound	Teach participants to make requests and choices	Frequency of microswitch activations to request; requests followed by choice making	Microswitch	- (session data collapsed)	Suggestive; insufficient interobserver reliability, no procedural integrity
Lancioni, O’Reilly, Sigafoos, et al. (2006); MBD	Joe: M, 9;2, CP, blind, Level IV, WFL, severe/profound Sonia: F, 12;3, CP, VI, Level IV, WFL, severe/profound	Teach participants to respond “yes” or “no” to preferred and non-preferred stimuli	Percentage of correct responses by participant	Microswitch	- (session data collapsed)	Suggestive; insufficient interobserver reliability, no procedural integrity
Lancioni, O'Reilly, Singh, et al. (2006); MBD	Lena: F, 15;8, cerebropathy, VI, Level V, NR, severe/profound Shirley: F, 9;9, cerebropathy, VI, Level V, NR, severe/profound Tricia: F, 7;0, cerebropathy, VI, Level V, NR, severe/profound	Teach participants pairs of responses and evaluate choice-making	Frequency of participant responses	Microswitches	- (session data collapsed)	Suggestive; no procedural integrity or interobserver reliability
Lancioni, Singh, et al. (2006); ABAB	Kevin: M, 9, cerebropathy, blind, Level V, NR, severe/profound	Teach choice-making to offered stimuli	Percentage of microswitch activations to preferred and non-preferred stimuli	Microswitch (left eyebrow movements)	- (session data collapsed)	Inconclusive; no experimental control, procedural integrity, or interobserver reliability
Lancioni et al. (2007); MBD	George: M, 12;5, cerebropathy, blind, Level V, NR, severe/profound Pam: F, 14;4, cerebropathy, VI, NR, severe/profound	Teach participants to respond “yes” or “no” to preferred and non-preferred stimuli	Frequency of head and hand responses Percent selection of preferred and non-preferred stimuli	Microswitch	- (session data collapsed)	Suggestive; no procedural integrity or interobserver reliability
Lancioni et al. (2008a); MBD	Joe: M, 11, CP, blind, Level IV, NR, severe/profound Albert: M, 10, CP, blind, Level IV, NR, severe/profound Jessie: F, 15, CP, VI, Level IV, NR, severe/profound	Teach participants to request	Frequency of responses by participants	Microswitch; SGD	- (session data collapsed)	Suggestive; no procedural integrity
Lancioni et al. (2008b); MBD	Darrell: M, 16, CP, blind, Level IV, NR, severe/profound Joyce: F, 18, CP, VI, Level IV, NR, severe/profound	Teach participants to use technology to request social contact	Frequency of responses by participants	Microswitch; SGD	- (session data collapsed)	Suggestive; no procedural integrity
Lancioni, O’Reilly, et al. (2009); MBD	Robin: NR, 8;2, CP, VI, Level V, NR, severe/profound Gary: M, 9;2, CP, blind, Level V, NR, severe/profound Lois: M, 6;0, CP, VI, Level V, NR, severe/profound Steve: M, 18;2, CP, blind, Level V, NR, severe/profound Simon: M, 9;9, CP, VI, Level V, NR, severe/profound Jill: F, 8;9, CP, blind, Level V, NR, severe/profound Jody: F, 8;5, CP, VI, Level V, NR, severe/profound Lewis: M, 16;5, CP, VI, Level V, NR, severe/profound Peter: M, 5;3, CP, blind, Level V, NR, severe/profound Mary: F, 13;4, CP, blind, Level V, NR, severe/profound	Teach participants to use technology to request social contact	Frequency of responses by participants	Microswitch; SGD	- (session data collapsed)	Inconclusive; no experimental control
Lancioni, Singh, et al. (2009); MBD	Kathy: F, 18;7, CP, blind, Level V, NR, severe/profound Penny: F, 16;1, CP, VI, level V, NR, severe/profound Paul: 9;9, CP, VI, Level V, NR, severe/profound George: M, 15;3, CP, blind, Level V, NR, severe/profound	Teach participants to make choices for preferred stimuli (Study 1- computer; Study 2 - social)	Frequency of participant responses	Microswitch connected to a computer	- (session data collapsed)	Suggestive; no procedural integrity or interobserver reliability
Lancioni et al. (2011); ABAB	George: M, 17;4, blind, level V, NR, severe/profound	Evaluate technology to choose and send messages to partners	Frequency of messages sent and received by participant	Microswitch interfaced with computer	- (session data collapsed)	Suggestive; no procedural integrity
Lancioni et al. (2018); non-concurrent MBD	Lois: M, 10, MDS, VI, Level V, NR, mild cognitive impairment	Teach participants to request activities	Percentage of session with independently selected leisure	Pictures	- (session data collapsed)	Suggestive; no procedural integrity or reliability
Mathy-Laikko et al. (1989); ABAB	LS: F, 8;10, CP, CVI, Level IV, HI, severe/profound^b	Teach participant to request social interaction from caregiver	Frequency of switch activations	4 switches with different tactile surfaces and voice output	- (session data collapsed)	Suggestive; no procedural integrity or reliability
Schweigert (1989); ABAB	Shannon: F, 7, CP, CVI, Level V, HI, CI-NS	Evaluate textured microswitch to request caregiver attention	Number of switch activations	Microswitch	.74; +4.7	Suggestive; no procedural integrity or reliability
Schweigert & Rowland (1992); Modified ABAB	Brian: M, 3, CP, Level IV, VI, HI, NR Jordan: M, 5, CP, Level IV, VI, HI, severe/profound Ben: M, 2, severe hypotonia of all limbs, Level IV, VI, HI, NR	Teach participants to: gain attention, request, make choices, use symbols	Frequency of switch activations	Tactile symbols, microswitch, unaided gestures	- (session data collapsed)	Inconclusive; no experimental control or procedural fidelity, unstable baseline
Snodgrass et al. (2013); MBD	Chad: M, 9, DS, CVI, Level III, HI, CI-NS	Teach participant to request preferred items via modified PECS	Percentage of correct use of MORE, DONE, NEW	Adapted PECS (tangible symbols)	.58; +90 .24; +83.3 1; +88.3	Suggestive; procedural fidelity across six different adults, nonconcurrent baseline
Walker & Wegner (2021); case study	Jacob: M, 14, CP, Level V, CVI with esotropia and astigmatism^b, WFL, NR	Evaluate eye-gaze training programs to teach participant to operate and communicate with an AAC system	Mastery level in the eye-gaze training programs Number utterances per session Number of gaze points per session	Tobii I-12 with C4 software	- (no baseline)	Inconclusive; no experimental control, baseline measures, or interobserver agreement

Note. CA: chronological age; Dx: Diagnosis; GMFCS: Gross Motor Function Classification System; WFL: within functional limits; NR: Not Reported, HI: hearing impairment; VI: visual impairment; CVI: cortical visual impairment; MBD: multiple baseline design; SGD: speech generating device; CP: cerebral palsy; CI-NS: cognitive impairment non-specified; MDS: multiple disabilities.

^aFor studies with more than one DV, Tau-U and gain scores are listed for each DV by participant in order of listed DVs.

^bStudies that reported formal assessment measurements.

Table B1. Summary of coded variables: Partner training intervention studies.

Study authors and design	Participant case (sex/CA/Dx/vision status/GMFCS/ hearing status/cognitive status) Communication partner (age, role)	Study purpose	Outcome measurement	AAC	Effect size^a (Cohen’s d for group; Tau-U for single case), Gain score	Certainty of evidence
Holyfield, Light, et al. (2018); pre-test post-test control group design	Van: M, 13, MDS, blind, Level IV, WFL, NR 24 middle school aged peers	Teach peers to interpret communicative behaviors	Frequency of correct interpretations	High-tech tablet with EasyVSD application	d = 0.9; +9.5	Conclusive
Sigafoos et al. (1993); MBD	Steve: M, 18, NR, Level IV, VI, NR, moderate cognitive impairment	Instruct partners to increase turn-taking and choice-making opportunities for participants	Frequency of opportunities provided by partners for turn-taking and choice-making Number of correct participant responses to turn-taking and choice-making	Unaided	.3; +.3 .6; +1.3	Inconclusive; insufficient baseline measures reported
	Kathy: direct care staff in a habilitation program				1.0; +1.7 1.0; +3.0
	Kim: F, 18, seizure disorder, Level IV, VI, HI, moderate cognitive impairment				.7; +1.3 1.0; +3.0
	Sara: direct care staff in a habilitation program				1.0; +4.2 1.0; +4.3

Note. CA: chronological age; Dx: Diagnosis; GMFCS: Gross Motor Function Classification System; WFL: within functional limits; NR: Not Reported, HI: hearing impairment; VI: visual impairment; CVI: cortical visual impairment; MBD: multiple baseline design; MDS: multiple disabilities.

^aFor studies with more than one DV, effect size and gain scores are listed for each DV by participant in order of listed DVs.

Table C1. Demographic table of all individual participants.

Study	Participant	Sex	Age (years)	Primary diagnosis	Visual impairment	GMFCS level (motor)	Hearing status	Intellectual disability
Ali et al. (2011)	Sameera	F	7	Cerebral palsy	VI	IV	NR	Moderate
Cosbey & Johnston (2006)	Brianna	F	4;7	Cerebral palsy	VI	V	WFL	NR
	Sonja	F	6;6	Cerebral palsy	VI	V	WFL	not specified
Fleury et al. (2019)	Tracey	F	14	Traumatic brain injury	CVI	III	WFL	Severe/profound
Harding et al. (2011)	B	M	6;4	Profound and multiple disabilities	VI	V	WFL	NR
Holyfield, Light, et al. (2018)	Van	M	13;0	Multiple disabilities	Blind	IV	WFL	NR
Holyfield, Caron, et al. (2018)	Jose	M	18;11	Cerebral palsy	CVI	V	NR	not specified
	Nathan	M	13;11	Trisomy 18	VI	V	HI	not specified
Ivy et al. (2014)	Paul	M	8	Multiple disabilities	VI	I	WFL	not specified
	Chris	M	5	Septo-optic dysplasia	VI	I	WFL	not specified
	Darren	M	6	Cerebellar atrophy	VI	IV	WFL	not specified
Ivy et al. (2020)	Iggy	M	7:2	Baraitser-Winter syndrome	VI	III	HI	NR
	Brice	M	4;5	Cytomegalovirus	VI	IV	HI	NR
	Lizzy	F	5;3	Lennox-Gastaut syndrome	VI	I	HI	NR
Lancioni et al. (2001)	Participant 1	M	9;7	Cerebral palsy	VI	IV	NR	Severe/profound
	Participant 2	M	13;3	Cerebral palsy	VI	IV	NR	Severe/profound
Lancioni et al. (2003)	Sara	F	17;3	Cerebral palsy	VI	IV	NR	Severe/profound
	Jim	M	19;4	Cerebral palsy	VI	IV	NR	Severe/profound
Lancioni et al. (2004)	Tania	F	17;3	Cerebral palsy	Blind	IV	NR	Severe/profound
	Ronny	M	6;7	Cerebral palsy	VI	IV	NR	Severe/profound
Lancioni, O’Reilly, Sigafoos, et al. (2006)	Joe	M	9;2	Cerebral palsy	Blind	IV	WFL	Severe/profound
	Sonia	F	12;3	Cerebral palsy	VI	IV	WFL	Severe/profound
Lancioni, O’Reilly, Singh et al. (2006)	Lena	F	15;8	Cerebropathy	VI	V	NR	Severe/profound
	Shirley	F	9;9	Cerebropathy	VI	V	NR	Severe/profound
	Tricia	F	7;0	Cerebropathy	VI	V	NR	Severe/profound
Lancioni, Singh, et al. (2006)	Kevin	M	9;0	Cerebropathy	Blind	V	NR	Severe/profound
Lancioni et al. (2007)	George	M	12;5	Cerebropathy	Blind	V	NR	Severe/profound
	Pam	F	14;4	Cerebropathy	VI	V	NR	Severe/profound
Lancioni et al. (2008a)	Joe	M	11;0	Cerebral palsy	Blind	IV	NR	Severe/profound
	Albert	M	10;0	Cerebral palsy	Blind	IV	NR	Severe/profound
	Jessie	F	15;0	Cerebral palsy	VI	IV	NR	Severe/profound
Lancioni et al. (2008b)	Darrell	M	16;0	Cerebral palsy	Blind	IV	NR	Severe/profound
	Joyce	F	18;0	Cerebral palsy	VI	IV	NR	Severe/profound
Lancioni, O’Reilly, et al. (2009)	Robin	NR	8;2	Cerebral palsy	VI	V	NR	Severe/profound
	Gary	M	9;2	Cerebral palsy	Blind	V	NR	Severe/profound
	Lois	M	6;0	Cerebral palsy	VI	V	NR	Severe/profound
	Steve	M	18;2	Cerebral palsy	Blind	V	NR	Severe/profound
	Simon	M	9;9	Cerebral palsy	VI	V	NR	Severe/profound
	Jill	F	8;9	Cerebral palsy	Blind	V	NR	Severe/profound
	Jody	F	8;5	Cerebral palsy	VI	V	NR	Severe/profound
	Lewis	M	16;5	Cerebral palsy	VI	V	NR	Severe/profound
	Peter	M	5;3	Cerebral palsy	Blind	V	NR	Severe/profound
	Mary	F	13;4	Cerebral palsy	Blind	V	NR	Severe/profound
Lancioni, Singh, et al. (2009)	Kathy	F	18;7	Cerebral palsy	Blind	V	NR	Severe/profound
	Penny	F	16;1	Cerebral palsy	VI	V	NR	Severe/profound
	Paul	M	9;9	Cerebral palsy	VI	V	NR	Severe/profound
	George	M	15;3	Cerebral palsy	Blind	V	NR	Severe/profound
Lancioni et al. (2011)	George	M	17;4	Cerebral palsy	Blind	V	NR	Severe/profound
Lancioni et al. (2018)	Lois	M	10;0	Multiple disabilities	VI	V	NR	Mild
Mathy-Laikko et al. (1989)	LS	F	8;10	Cerebral palsy	CVI	IV	HI	Severe/profound
Schweigert (1989)	Shannon	F	7;0	Cerebral palsy	CVI	V	HI	not specified
Schweigert & Rowland (1992)	Brian	M	3;0	Cerebral palsy	VI	IV	HI	NR
	Jordan	M	5;0	Cerebral palsy	VI	IV	HI	Severe/profound
	Ben	M	2;0	Severe hypotonia of all limbs	VI	IV	HI	NR
Sigafoos et al. (1993)	Steve	M	18;0	NR	VI	IV	NR	Moderate
	Kim	F	18;0	Seizure disorder	VI	IV	HI	Moderate
Snodgrass et al. (2013)	Chad	M	9;0	Down syndrome	CVI	III	HI	not specified
Walker & Wegner (2021)	Jacob	M	14;0	Cerebral palsy	CVI with esotropia and astigmatism	V	WFL	NR

Note. M: male; F: female; GMFCS: Gross Motor Function Classification System; NR: not reported; VI: visual impairment; CVI: cortical visual impairment; WFL: within functional limits; HI: hearing impairment.

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