Universal Access in the Information Society

, Volume 16, Issue 1, pp 115–128 | Cite as

Augmentative and alternative communication devices for aphasia: the emerging role of “smart” mobile devices

  • Karyn Moffatt
  • Golnoosh Pourshahid
  • Ronald M. Baecker
Long paper


Recent advances in mobile technology offer new directions for augmentative and alternative communication (AAC); however, it remains unclear whether they meet the needs of individuals with aphasia. This paper reports on research seeking to understand this changing landscape. A Web-based survey of aphasia-oriented clinicians helped illuminate device adoption trends. Observations of group therapy sessions featuring high-tech AAC use and focus groups with the clinicians from those sessions provided further nuance and insight into usage and adoption. It was shown that “smart” mobile devices are garnering acceptance as a promising platform for high-tech AAC; however, contrary to the authors’ expectations, these devices are not being paired with mobile versions of traditional picture dictionaries. Rather, clinicians reported appropriating generic applications to complement other (non-high-tech) communication strategies, suggesting new opportunities for design.


Augmentative and alternative communication (AAC) Aphasia Mobile technology Communication support 



The authors are thankful for financial support from NSERC, the GRAND Networks of Centres of Excellence of Canada, the University of Toronto Connaught Fund, and MyVoice Inc. They additionally thank their fellow members of the TAGlab, many of whom helped shape this work with thoughtful suggestions and feedback, and especially Rachelle Campigotto who assisted with some of the focus group sessions. Finally, they are most grateful for the many clinicians and individuals with aphasia who graciously donated their time and energy to this research.


  1. 1.
    Al Mahmud, A., Gerits, R., Martens, J.B.: Xtag: designing an experience capturing and sharing tool for persons with aphasia. In: Proceedings of the 6th Nordic Conference on Human–Computer Interaction: Extending Boundaries, NordiCHI ’10, pp. 325–334. ACM Press (2010)Google Scholar
  2. 2.
    Al Mahmud, A., Martens, J.B.: Amail: design and evaluation of an accessible email tool for persons with aphasia. Interact. Comput. 25(5), 351–374 (2013)CrossRefGoogle Scholar
  3. 3.
    Allen, M., Leung, R., McGrenere, J., Purves, B.: Involving domain experts in assistive technology research. Univers. Access Inf. Soc. 7(3), 145–154 (2008)CrossRefGoogle Scholar
  4. 4.
    Allen, M., McGrenere, J., Purves, B.: The design and field evaluation of phototalk: a digital image communication application for people. In: Proceedings of the 9th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’07, pp. 187–194. ACM Press (2007)Google Scholar
  5. 5.
    Ardila, A.: A proposed reinterpretation and reclassification of aphasic syndromes. Aphasiology 24(3), 363–394 (2010)CrossRefGoogle Scholar
  6. 6.
    Beukelman, D.R., Ball, L.J.: Improving AAC use for persons with acquired neurogenic disorders: understanding human and engineering factors. Assist. Technol. 14(1), 33–44 (2002)CrossRefGoogle Scholar
  7. 7.
    Beukelman, D.R., Mirenda, P. (eds.): Augmentative and Alternative Communication: Management of Severe Communication Cisorders in Children and Adults, 3rd edn. Paul H Brooks Publishing Co, Baltimore, Maryland (2006)Google Scholar
  8. 8.
    Boyd-Graber, J., Nikolova, S., Moffatt, K., Kin, K., Lee, J., Mackey, L., Tremaine, M., Klawe, M.: Participatory design with proxies: developing a desktop—PDA system to support people with aphasia. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’06, pp. 151–160. ACM Press (2006)Google Scholar
  9. 9.
    Braun, V., Clarke, V.: Using thematic analysis in psychology. Qual. Res. Psychol. 3(2), 77–101 (2006)CrossRefGoogle Scholar
  10. 10.
    Campigotto, R., McEwen, R., Epp, C.D.: Especially social: exploring the use of an iOS application in special needs classrooms. Comput. Educ. 60(1), 74–86 (2013)CrossRefGoogle Scholar
  11. 11.
    Cohene, T., Baecker, R., Marziali, E., Mindy, S.: Memories of a life: a design case study for Alzheimer’s disease. In: Lazar, J. (ed.) Universal Usability, pp. 357–387. John Wiley & Sons, New York (2007)Google Scholar
  12. 12.
    Daemen, E., Dadlani, P., Du, J., Li, Y., Erik-Paker, P., Martens, J.B., De Ruyter, B.: Designing a free style, indirect, and interactive storytelling application for people with aphasia. In: Proceedings of the 11th IFIP TC 13 International Conference on Human–Computer Interaction, INTERACT ’07, pp. 221–234. Springer (2007)Google Scholar
  13. 13.
    Davies, R., Marcella, S., McGrenere, J., Purves, B.: The ethnographically informed participatory design of a PDA application to support communication. In: Proceedings of the 6th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’04, pp. 153–160. ACM Press (2004)Google Scholar
  14. 14.
    De Leo, G., Leroy, G.: Smartphones to facilitate communication and improve social skills of children with severe autism spectrum disorder: special education teachers as proxies. In: Proceedings of the International Conference on Interaction Design and Children, IDC ’08, pp. 45–48. ACM Press (2008)Google Scholar
  15. 15.
    Demmans Epp, C., Campigotto, R., Levy, A., Baecker, R.M.: MarcoPolo: Context-sensitive mobile communication support. In: Proceedings of the Annual Rehabilitation Engineering and Assistive Technology Society of North America Conference/International Conference on Technology and Aging, RESNA/ICTA ’11. RESNA (2011)Google Scholar
  16. 16.
    Demmans Epp, C., Djordjevic, J., Wu, S., Moffatt, K., Baecker, R.M.: Towards providing just-in-time vocabulary support for assistive and augmentative communication. In: Proceedings of the 2012 ACM International Conference on Intelligent User Interfaces, pp. 33–36. ACM Press (2012)Google Scholar
  17. 17.
    Devlin, S., Unthank, G.: Helping aphasic people process online information. In: Proceedings of the 8th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’06, pp. 225–226. ACM (2006). doi: 10.1145/1168987.1169027
  18. 18.
    Dickey, L., Kagan, A., Lindsay, M.P., Fang, J., Rowland, A., Black, S.: Incidence and profile of inpatient stroke-induced aphasia in Ontario, Canada. Arch. Phys. Med. Rehabil. 91(2), 196–202 (2010)CrossRefGoogle Scholar
  19. 19.
    Garrett, K.L., Lasker, J.P.: AAC and severe aphasia—enhancing communication across the continuum of recovery. Perspect. Neurophysiol. Neurog. Speech Lang. Disord. 17(3), 6–15 (2007)CrossRefGoogle Scholar
  20. 20.
    Goodglass, H., Kaplan, E., Barresi, B.: The Assessment of Aphasia and Related Disorders, 3rd edn. Lippincott Williams & Wilkins, Philadelphia (2001)Google Scholar
  21. 21.
    Hallowell, B., Chapey, R.: Introduction to language intervention strategies in adult aphasia. In: Chapey, R. (ed.) Language Intervention Strategies in Aphasia and Related Neurogenic Communication Disorders, 5th edn. Lippincott Williams & Wilkins, Philadelphia (2008)Google Scholar
  22. 22.
    Hayes, G.R., Hirano, S., Marcu, G., Monibi, M., Nguyen, D.H., Yeganyan, M.: Interactive visual supports for children with autism. Pers. Ubiquitous Comput. 14(7), 663–680 (2010)CrossRefGoogle Scholar
  23. 23.
    Hux, K., Manasse, N., Weiss, A., Beukelman, D.: Augmentative and alternative communication for persons with aphasia. In: Chapey, R.E. (ed.) Langauge Intervention Strategies in Adult Aphasia, 4th edn, pp. 675–689. Williams & Wilkins, Philadelphia (2001)Google Scholar
  24. 24.
    Johnson, J.M., Inglebret, E., Jones, C., Ray, J.: Perspectives of speech language pathologists regarding success versus abandonment of AAC. Augment. Altern. Commun. 22(2), 85–99 (2006)CrossRefGoogle Scholar
  25. 25.
    Kane, S.K., Linam-Church, B., Althoff, K., McCall, D.: What we talk about: designing a context-aware communication tool for people with aphasia. In: Proceedings of the 14th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’12, pp. 49–56. ACM, New York (2012). doi: 10.1145/2384916.2384926
  26. 26.
    Lasker, J., Bedrosian, J.: Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders. Augment. Altern. Commun. 17(3), 141–153 (2001). doi: 10.1080/aac. CrossRefGoogle Scholar
  27. 27.
    Linebarger, M., McCall, D., Virata, T., Berndt, R.S.: Widening the temporal window: processing support in the treatment of aphasic language production. Brain Lang. 100(1), 53–68 (2007). doi: 10.1016/j.bandl.2006.09.001 CrossRefGoogle Scholar
  28. 28.
    Linebarger, M.C., Romania, J.F., Fink, R.B., Bartlett, M.R., Schwartz, M.F.: Building on residual speech: a portable processing prosthesis for aphasia. J. Rehabil. Res. Dev. 45(9), 1401–1414 (2008)CrossRefGoogle Scholar
  29. 29.
    Mamula, K.B.: Dynavox Makes Push for Larger Market Share. Pittsburgh Business Times, Pittsburgh (2009)Google Scholar
  30. 30.
    McGrenere, J., Davies, R., Findlater, L., Graf, P., Klawe, M., Moffatt, K., Purves, B., Yang, S.: Insights from the aphasia project: designing technology for and with people who have aphasia. In: Proceedings of the 2003 ACM Conference on Universal Usability. CUU ’03, pp. 112–118. ACM, New York (2003)Google Scholar
  31. 31.
    Moffatt, K., McGrenere, J., Purves, B., Klawe, M.: The participatory design of a sound and image enhanced daily planner for people with aphasia. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’04, pp. 407–414. ACM Press (2004)Google Scholar
  32. 32.
    Nicholas, M., Sinotte, M.P., Helm-Estabrooks, N.: C-speak aphasia alternative communication program for people with severe aphasia: importance of executive functioning and semantic knowledge. Neuropsychol. Rehabil. 21(3), 322–366 (2011)CrossRefGoogle Scholar
  33. 33.
    Nikolova, S., Tremaine, M., Cook, P.R.: Click on bake to get cookies: guiding word-finding with semantic associations. In: Proceedings of the 12th International ACM SIGACCESS Conference on Computers and Accessibility, ASSETS ’10, pp. 155–162. ACM, New York (2010). doi: 10.1145/1878803.1878832
  34. 34.
    Piper, A.M., Weibel, N., Hollan, J.D.: Write-n-speak: authoring multimodal digital-paper materials for speech-language therapy. ACM Trans. Access. Comput. 4(1), 2:1–2:20 (2011)CrossRefGoogle Scholar
  35. 35.
    Samasio, A.R.: Signs of aphasia. In: Sarno, M.T. (ed.) Acquired Aphasia, 3rd edn. Academic Press, Waltham (1998)Google Scholar
  36. 36.
    van de Sandt-Koenderman, M.: High-tech AAC and aphasia: widening horizons? Aphasiology 18(3), 245–263 (2004)CrossRefGoogle Scholar
  37. 37.
    Shinohara, K., Wobbrock, J.O.: In the shadow of misperception: assistive technology use and social interactions. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’11, pp. 705–714. ACM, New York (2011)Google Scholar
  38. 38.
    Simmons-Mackie, N.N.: Social approaches to the management of aphasia. In: Worrall, L., Frattali, C.M. (eds.) Neurogenic Communication Disorders: A Functional Approach, 1st edn. Thieme, Stuttgart (2000)Google Scholar
  39. 39.
    Simoes-Perlant, A., Thibault, M.P., Lanchantin, T., Combes, C., Volckaert-Legrier, O., Largy, P.: How adolescents with dyslexia dysorthographia use texting. Writ. Lang. Lit. 15(1), 65–79 (2012)CrossRefGoogle Scholar
  40. 40.
    Steele, R.D., Weinrich, M., Wertz, R.T., Kleczewska, M.K., Carlson, G.S.: Computer-based visual communication in aphasia. Neuropsychologia 27(4), 409–426 (1989)CrossRefGoogle Scholar
  41. 41.
    Tee, K., Moffatt, K., Findlater, L., MacGregor, E., McGrenere, J., Purves, B., Fels, S.S.: A visual recipe book for persons with language impairments. In: Proceedings of the SIGCHI Conference on Human Factors in Computing Systems, CHI ’05, pp. 501–510. ACM, New York (2005)Google Scholar
  42. 42.
    True, G., Bartlett, M.R., Fink, R.B., Linebarger, M.C., Schwartz, M.: Perspectives of persons with aphasia towards SentenceShaper to go: a qualitative study. Aphasiology 24(9), 1032–1050 (2010). doi: 10.1080/02687030903249350 CrossRefGoogle Scholar
  43. 43.
    Waller, A., Denis, F., Brodie, J., Cairns, A.Y.: Evaluating the use of TalksBac, a predictive communication device for nonfluent adults with aphasia. Int. J. Lang. Commun. Disord. 33(1), 45–70 (1998)CrossRefGoogle Scholar
  44. 44.
    Waller, A., Newell, A.F.: Towards a narrative-based augmentative communication system. Int. J. Lang. Commun. Disord. 32(s1), 289–306 (1997)CrossRefGoogle Scholar
  45. 45.
    Weinrich, M., McCall, D., Weber, C., Thomas, K., Thornburg, L.: Training on an iconic communication system for severe aphasia can improve natural language production. Aphasiology 9(4), 343–364 (1995)CrossRefGoogle Scholar
  46. 46.
    Williams, M.: AAC 101: crash course for beginners. Altern. Speak. 1(1), 1–8 (1994)MathSciNetGoogle Scholar
  47. 47.
    Woudstra, M., Al Mahmud, A., Martens, J.B.: A snapshot diary to support conversational storytelling for persons with aphasia. In: Proceedings of the 13th International Conference on Human Computer Interaction with Mobile Devices and Services, MobileHCI ’11, pp. 641–646. ACM Press (2011)Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Karyn Moffatt
    • 1
  • Golnoosh Pourshahid
    • 2
  • Ronald M. Baecker
    • 2
  1. 1.School of Information StudiesMcGill UniversityMontrealCanada
  2. 2.Technologies for Aging Gracefully LabUniversity of TorontoTorontoCanada

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