What is ACC?

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Augmentative and Alternative Communication (AAC) interventions use and/or teach the use of a system of communication that is not verbal/vocal.

There are two types of AAC systems – aided and unaided

Unaided systems These AAC systems don’t need any equipment. They use gestures and hand signs – for example, Key Word Sign – to support speech, or as the main way of communicating.

Aided systems These AAC systems can be low-tech or high-tech.

Low-tech systems use equipment like cards, boards or books with photos or pictures that represent tasks, actions or objects. These tools can be used to understand what people are saying, ask for what they need, make comments and answer other people’s questions. Picture Exchange Communication System (PECS) and visual timetables are examples of this kind of system.

High-tech systems include speech-generating devices (SGDs). Also, many apps have been designed for use with iPads and Android devices to help with the development of communication skills.

Autism CRC findings on AAC

3 systematic reviews [1-3] at the practice level. The report findings suggested that the general outcomes of AAC for autism has an ‘emerging level of evidence’. In contrast, facilitated communication was identified as having an ‘unestablished level of evidence’ and a ‘null effect’.

Core Autism characteristics

Social communication = Low to moderate quality with inconsistent therapeutic effect

Related skills and development

Communication = Low quality, positive effect
Motor = Low quality, positive effect
Social emotional/challenging behaviour = Low quality, positive effect
Play = Low quality, positive effect
General outcomes = Low quality, inconsistent therapeutic effect

Education and participation

Academic skills = Low quality, positive effect

Family wellbeing

Caregiver satisfaction = Moderate quality, inconsistent therapeutic effect

Author (year)	Study aim/objective	Methods/participant characteristics/outcome measures	Outcome/summary	Quality of included evidence +/- conclusion (High/Moderate/Low/Very Low)
Ju, Yang [4]	To systematically evaluate the acceptability of high-tech AAC among ICU patients who are voiceless guided by the technology acceptance model (TAM).	Systematic Review - narrative synthesis Inclusion criteria Study Design -Randomised controlled trials -Quasi-experimental studies -Observational trials -Case reports -Qualitative research Study Participants -Age above 18 years old -Stayed in ICU -Temporary loss of the voice because of medical intervention, including but not limited to endotracheal intubation, tracheostomy, mechanical ventilation, laryngectomy, and head and neck surgery Types of Intervention -High-tech AAC: Using electronic devices to generate voice (e.g., speech-generating device, eye-tracking device, voice output communication aid, computer communication system) Language -English and Chinese Joanna Briggs Institute quality assessment tool used	18 studies included with a total of 914 patients Quality of the studies were low (n = 8) and moderate (n = 10). four high-tech AAC intervention types: portable computer software (n = 4), dedicated AAC devices (n = 5), software application (n = 6) and eye-tracking devices (n = 3) Psychological impact — 6 studies found that patients have a positive psychological impact after using high-tech ACC. eye-tracking devices can increase patients’ happiness and self-esteem. Symptom management - Six studies described the positive influence of high-tech AAC on symptom management. Eye-tracking devices were found to decrease patient confusion and may serve as a useful device to decrease delirium. ICU patients also strongly agreed that high-tech AAC can better manage and report their pain needs Ease of use - In all studies, the average learning time of high-tech AAC for patients was approximately 15 min (range: 1-30 min).	`redacted: s47C - deliberative processes` Only a narrative synthesis, and few RCTs included. Lower quality studies have high levels of bias which means higher quality studies may find differing results. Methods performed by authors were of good quality. Overall, the current studies indicated that high-tech AAC has broad acceptance and high value for the outcomes and experience of voiceless patients in the ICU.

Attitude toward using high-tech AAC - reported that voiceless patients felt quite satisfied with and adapted to high-tech AAC during their ICU stay. >90% of patients were interested in continuing to use the high tech AAC.

                                                                                Patient factors - The patients’ cognitive state
                                                                 and level of sedation had a huge impact on
                                                                      communication. Deterioration/fluctuation status
                                                                      caused fatigue, difficulty concentrating, memory
                                                                                       loss and poor motor-control skills among
                                                                                    patients, which also made the use of high-tech
                                                   AAC harder or even impossible

Light, McNaughton [5] To investigate theBarbosa, de Systematic Review 13 included studies results presented inOliveira [6] previous studies on Inclusion criteria AAC use in children with Studies published in English were Down Syndrome (DS) eligible if they met the following observing the different criteria: (1) study of children with a instruments used for diagnosis of DS, and (2) assistive communication technology and/or AAC analysis in this population. There were no restrictions regarding sample size, time of publication or the type of study design.

                               PEDro scale used to determine study
                                        quality

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Logan K, Iacono T, Trembath D. A systematic review of research into aided AAC to increase

social-communication functions in children with autism spectrum disorder. Augmentative and Alternative Communication. 2017;33(1):51-64. 2. Steinbrenner J, Hume K, Odom S, Morin K, Nowell S, Tomaszewski B, et al. Evidence-Based Practices for Children, Youth, and Young Adults with Autism. 2020. Available from: https://fpg.unc.edu/publications/evidence-based-practices-children-youth-and-young-adults- autism-spectrum-disorder-1.

 National Autism Center. Findings and conclusions: National standards project, phase 2.

Author Randolph, MA; 2015. Available from: https://www.nationalautismcenter.org/national- standards-project/phase-2/.

 Ju X-X, Yang J, Liu X-X. A systematic review on voiceless patients’ willingness to adopt high-

technology augmentative and alternative communication in intensive care units. Intensive and Critical Care Nursing [Internet]. 2020 2020/11/07/:[102948 p.]. Available from: http://www.sciencedirect.com/science/article/pii/S0964339720301518. 5. Light J, McNaughton D, Caron J. New and emerging AAC technology supports for children with complex communication needs and their communication partners: State of the science and future research directions. Augmentative and Alternative Communication [Internet]. 2019 2019/01/02; 35(1):[26-41 pp.]. Available from: https://doi.org/10.1080/07434618.2018.1557251. 6. Barbosa RTdA, de Oliveira ASB, de Lima Antão JYF, Crocetta TB, Guarnieri R, Antunes TPC, et al. Augmentative and alternative communication in children with Down’s syndrome: a systematic review. BMC Pediatrics [Internet]. 2018 2018/05/11; 18(1):[160 p.]. Available from: https://doi.org/10.1186/s12887-018-1144-5.

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