In 2014, the year of the International Communication Project (ICP, 2014), we are pleased to have had the opportunity to edit this special issue of Developmental Neurorehabilitation on ‘Communication Rehabilitation’. The eight papers in this issue relate to diverse populations – children with autism; with profound and multiple disabilities; with cerebral palsy; with Childhood Apraxia of Speech (CAS); and people with severe communication disabilities. Across the papers, three main themes are highlighted: the importance of multimodal communication within approaches, the impact of interventions upon parents and teachers in early intervention and special education settings, and the participation and inclusion of children in activities that improve their communication and are enjoyable.
Four of the eight journal articles in this special issue relate to the implementation and effects of a range of communication interventions for children with Autism Spectrum Disorder (ASD) that expand the communication modalities available for communication. The findings of Tan, Trembath, Bloomberg, Iacono and Caithness suggest that some children with autism and little or no functional speech may acquire fringe vocabulary using the Key Word Sign approach. This study adds to research supporting the use of both core and fringe vocabulary in Augmentative and Alternative Communication (AAC) interventions for children with ASD. Couper et al. compared children with ASD's acquisition of manual signing, mobile technology with a speech generating application, and picture exchange. They found that although children learned use of vocabulary by all three modes, the children showed a preference for using a speech generating device to request preferred items. This study highlights the importance and value of considering children's preferences when implementing AAC interventions.
While there is encouraging evidence for the benefit of interventions for children with neurodevelopmental disabilities in controlled trials, outlined by McCabe, Macdonald-D'Silva, Van Ree, Ballard and Arciuli, Tan et al. and Couper et al. there is little research to date on the impact of interventions upon their communication partners, particularly parents and early intervention teachers. Communication interventions involve parents and other parties as communication partners, consequently it is important to understand not only the benefits of intervention strategies, but also the difficulties that those expected to implement the strategies every day, or in every interaction experience. Also, parents and early intervention teachers are increasingly under pressure to implement technological interventions proposed by professionals and commercial companies who may be situated far away. This is particularly true for families living in rural and remote areas.
The implementation of a classroom-based communication intervention, the ‘mentor-model’, with four children with profound and multiple disabilities is outlined by Bennett, Arthur-Kelly, Foreman, and Neilands. The authors explored not only students' needs and support strategies in a special education classroom, but also the challenges faced by teaching staff in improving and maintaining student outcomes. This study indicates that a mentor model is beneficial in helping classroom teachers to modify and adapt their own teaching behaviors in their efforts to improve communicative outcomes by providing individualized programs for children with profound and multiple disabilities. This model holds promise for interventions in other settings, for example, family homes where close collaboration between stakeholders is beneficial but not always easily achieved.
The two papers by Donato, Shane, and Hemsley, and Allen and Shane both highlight factors affecting the feasibility of implementing effective interventions at home and in early intervention settings. Using focus groups, Donato et al. explored the stakeholder educators', health professionals' and parents' views on the feasibility of using a broad range of visual supports to increase the language of children with ASD in early intervention settings. This study highlights not only the facilitators for a successful program but also the barriers to successful implementation. These results could usefully be applied to a range of intervention settings, to help ensure that both facilitative strategies and barriers to successful interventions are recognized and managed where possible prior to the implementation of programs.
Basing their arguments in the current literature, Allen and Shane discuss the possible associations between stress experienced by parents of children with ASD, AAC, and mobile technologies. The use of mobile technologies in communication interventions is increasing with some promising results reported in the research. Nevertheless, little is known about how the use of mobile technology interventions may impact on parents of children with ASD, a group who report high levels of stress around their child's communication issues. The authors conclude that more research is required to understand the overlapping areas of stress, AAC and mobile technologies. Indeed this paper highlights that AAC is a truly a multi-disciplinary area that overlaps a range of disciplines and concepts that traditionally have been overlooked in many intervention programs. These papers beg further attention be drawn to the potential impact of increasingly intensive interventions upon parents and educators, and therefore upon the feasibility and sustainability of the interventions. While children might prefer or need technology that offers speech generation capability, the impact of the use of these technologies on parental stress must be considered if promising interventions using these devices are to be feasible for use in day-to-day situations by parents at home and in the community.
The paper from Anderson, Balandin and Stancliffe adds to recognition that stakeholder views are important to consider in AAC intervention, a strong theme in this special issue. The authors asked parents of children who needed to learn to use newly acquired speech generative devices at home about their perceptions of existing supports. Parents encountered several barriers to receiving necessary services and supports, and noted the impact that intervention approaches had on their feelings of autonomy, empowerment and confidence. Given that parents may be expected to conduct the bulk of AAC intervention with limited support this paper can be usefully linked with that of Bennett et al. recognizing the importance of collaborations across all stakeholders and the possible benefits of a ‘mentor model’ including peers who have experience in AAC interventions.
The need for information and support and training in technologies is highlighted across this special issue. Hemsley, Palmer and Balandin outline a suggested methodology to research the training needs and effectiveness of an online training module for the use of Twitter, as a means to increase information exchange in people with communication disabilities. Despite recognition that Twitter is a useful social medium for keeping connected and up to date across a wide range of topics, little is known about how it might be used to benefit the range of stakeholders in the field of AAC. This paper describes one way of undertaking research into this new area and indicates some of the potential benefits of such an approach. It remains to be seen if the field of AAC embraces this use of a social media.
Reference
ICP (2014). International Communication Project. Available from: www.communication2014.com