Abstract
This case study chronicles the development of a multimodal augmentative and alternative communication (AAC) system by a hearing impaired, physically disabled adult, Cathy. Beginning with her first experience with formal education at age 13, Cathy expanded her use of communication modes from typing and manual signs to communication boards and, finally, at age 35, to use of a voice output communication aid (VOCA). This ongoing process is documented, with emphasis on the gradual integration of each successive communication mode into Cathy's total AAC system and her multimodal use both across and within communicative situations. Cathy's functional use of her various communication modes is described along with implications for future AAC development.