Understanding Assistive Technology to Support the people with Intellectual Disabilities

Communication is a fundamental part of the human life that plays an important role in day-to-day interactions. It has been identified that people with intellectual disabilities (ID) may experience difficulties with communication. Having difficulties with this fundamental part of the life, people with ID may face huge difficulties that prevent them from expressing their needs, desires, and perceptions. With the development of science and technology, several Augmentative and Alternative Communication (AAC) tools have been developed to address this condition. An AAC tool is a way for some people to communicate their needs, preferences and ideas.

Communication has been defined as ‘any act by which one person gives or receives from another person information about that person’s needs, desires, perceptions, knowledge, or affective states’.[1] Communication is one of the basic human rights. Lesley Cogher states that ‘communication occurs when two or more people correctly interpret each other’s language and/or behaviour’.[2] People who cannot speak face problems in ‘getting information, building relationships, participating in education and employment and being safe’[3]. As some people with ID may be unable to interpret the language of others and/or behavior correctly, they may not be able to express their basic needs, desires, and perceptions or to gather knowledge; and they rely on AAC tools. Special augmentative aids like picture and symbol communication boards and electronic devices are available to help people special needs to express themselves potentially increasing ‘social interaction, school performance, and feelings of self-worth’[4]. According to Kelker, assistive technology enables 1) to perform functions that can be achieved by no other means; 2) to approximate normal fluency, rate, or standards–a level of accomplishment that could not be achieved by any other means; 3) to access for participation in programs or activities which otherwise would be closed to the individual; 4) to concentrate on learning or employment tasks, rather than mechanical tasks. It also increases endurance or ability to persevere and complete tasks that otherwise are too laborious to be attempted on a routine basis; provides greater access to information, supports normal social interactions and participations in the least restrictive educational environment.[5]

An estimated 200 million people with ID belong to all socio-economic groups in all nations in the world[6]. Estimates in the academic literature indicate that ‘hundreds of millions of children are daily exposed to risks for cognitive impairment’.[7] Several earlier researches showed that people with ID suffer discrepancies in multiple aspects of communication, including written, expressive, and receptive modes.[8] Adults with mild to moderate ID often face difficulties with language and speech[9] and 90% of children with severe ID have some type of language disorder.[10] Having difficulties with this fundamental aspect of life, people with ID face huge problems that prevent them from expressing their basic needs, desires, and perceptions and from gathering knowledge. In education, students with ID face many challenges in obtaining quality education as many of them are unable to communicate properly with their teachers and with fellow students. Even in areas such as ‘health care, individuals with ID often face cognitive challenges in communicating their needs, understanding and adherence to recommendations or treatments’.[11] Given different communicative challenges confronted by people with ID, ‘it stands to reason that the most effective ways to communicate with these people may be different from the ways in which information is routinely communicated with persons who do not have ID’.[12] Thus, people with ID may be being denied basic rights.

The rapid growth of information and communication technologies (ICTs) and the Internet have changed the ways in which people facilitate their communications. Different ICT-based approaches and methods are used by the people with ID. ICT research has explored several approaches for the support of people with ID. However, to support in communication for the people with ID, four different methods[13] are being used. Multiple interactive devices have been developed for the rehabilitation of children with ID and most of them introduced through the means of software education platforms.[14] Various communication tools for iOS, Android and Windows operating systems have been developed to address the communication challenges faced by people with ID. Numerous mobile and tab applications of different AAC tools have been developed in past couple of years as growing number of families are adopting and embracing the use of iPads and other mobile technologies as AAC systems.[15] DynaVox communication devices[16] can give individuals living with ID a voice and provide them with the tools they need to communicate with the world around them. MAS[17], a technology enhanced learning platform, provides several tools that supports learning and monitoring for people with special needs, including adaptive games, data processing and monitoring tools. AssistiveWare[18] develops assistive technology software for iOS and Mac OS X. ‘Proloque2Go’ – the most well-known of all the assistive communications apps on the iPad that cost around $189 was developed by AssistiveWare. ‘iCommunicate’ for iPad allows to record custom audio in any language that cost around $50. Apart from these tools, ‘iComm’, ‘My Talk Tools Mobile’, ‘iConverse’, ‘Voice4U’, ‘Look2Learn’ are several other communication tools for people with ID. However, none is free open sourced AAC tool.

Using a clinical approach Gosnell et al. (2011) has recommended communication Apps people with ID should use.[19] Alliano et al. (2012) reviewed 21 iPad applications for Augmentative and Alternative Communication Purpose.[20] An organization named ‘The Arc’ working for the people with intellectual disabilities in USA found some barriers to technology use by people with ID. First, the lack of information about the availability of the device; 2) the cost of devices; 3) the unavailability of assessment information; and 4) limited training on device use and device complexity.[21] Other researchers also identified those barriers ‘exist in terms of the financial and organizational feasibility of specific envisioned products, and their limited potential to reach the consumer market’.[22] Cognitive access helps someone with disabilities to use a computer programme; onscreen messages should last long enough or provide wait time to consider whether to press a computer key. However, cognitive access is not carefully considered during the technology development efforts. As individuals with ID have a range of learning and processing abilities, it is difficult to develop assistive technology solutions that are appropriate for all.[23] So, much has yet to be improved to attain major success in helping communication for people with ID. From the practical perspective, many of the existing communication tools have limited capabilities in their performance. Most of the communication tools for people with ID have limitations (e.g., the interaction is not natural, intuitive, or physical).[24]

Thus, it can be hypothesized that different communication tools could provide huge support in terms of communicating to people with IDs.  But the lack of proper AAC tools evaluation process can have serious consequences for individuals with AAC needs.[25] Very few studies have been conducted to assess relevance, effectiveness, efficiency and sustainability of different communication tools for people with IDs.  Innovative approaches, proper and effective needs analysis, user-centered design, and rapid evolutionary development are essential to ensure that technically feasible communication tools meet the real needs of persons with ID.[26]

The present era of ICTs offer various opportunities to general public, including access to mobile technology and mobile apps; access to information; use of social networking sites to share information; and etc. However, the individual with ID’s needs varies, and it is important to understand whether an individual with ID is getting and right AAC tools and accessing right support that they need. To understand this, AAC tools feature match for individual with IDs is another important aspect in the AAC evaluation process. An inappropriate feature match for the individual with IDs could lead to rejection of the AAC device which would not be helpful at all for any individual with IDs who needs an AAC device. Thus, the AAC tools evaluation must involve proper procedure to match features against the needs of the people with ID.[27]

Braddock. et al. rightly identified, efforts must be made by disability rights advocates, tool designers and manufacturers to promote better integration of future systems so that forthcoming duplications of personal support technologies and assisted care systems technologies do not quickly become outdated. They also suggest that these tools will need to operate seamlessly across multiple real-world environments in the home, school, community, and workplace.[28]

Therefore, there is a need to review different communication tools for people with ID from the perspective of relevance, effectiveness, efficiency and sustainability of those tools.

As people with ID may experience difficulties with communications, this type of review would help to understand the quality of communication tools, which could be used to improve communication skills of people with ID. This type of review would potentially help end-users, parents, teachers and other relevant stakeholders to identify the best communication tools in terms of efficiency, effectiveness and sustainability. Such review will also help to identify suitable AAC tools for the users and help not to re-invent the same tool rather improve the existing tools.

[1]ASHA. (1992) National Joint Committee for the Communicative Needs of Persons with Severe Disabilities, 1992, p. 2 and the definition is approved by the American Speech-Language Hearing Association. 

[2] Cogher L (2005) Communication and people with learning disabilities. In: Grant G, Goward P, Richardson M, Ramcharan P (eds). Learning Disability: a Life Cycle Approach to Valuing People. Open University Press, Maidenhead: 260-84.

[3] See Augmentative and alternative communication  www.speechpathologyaustralia.org.au/library/…/Factsheet_AAC.pdf

[4] See Augmentative and alternative communication  www.speechpathologyaustralia.org.au/library/…/Factsheet_AAC.pdf

[5] Kelker, K.A. (1997). Family Guide to Assistive Technology. Parents, Let’s Unite for Kids (PLUK).  Accessed on-line at http://www.pluk.org/AT1.html

[6] ‘Status and Prospects of Persons with Intellectual Disability’ accessed on 20/09/2015 and available at http://bit.ly/28WD8h5

[7] Olness, K. (2003). Effects on Brain Development Leading to Cognitive Impairment: A Worldwide Epidemic. Journal of Developmental & Behavioral Pediatrics. 24(2): 120-130.

[8] Belva, B.C., Matson, J.L., Sipes, M., & Bamburg, J.W. (2012). An examination of specific communication deficits in adults with profound intellectual disabilities. Res Dev Disabil, 33, 525-529.

[9] Cheslock, M.A., Barton-Hulsey, A., Romski, M., & Sevcik, R.A. (2008). Using a speech-generating device to enhance communicative abilities for an adult with moderate intellectual disability. Intellect Dev Disabil, 46, 376-386.

[10] McLean, L.K., Brady, N.C., McLean, J.E., & Behrens, G.A. (1999). Communication forms and functions of children and adults with severe mental retardation in community and institutional settings. J Speech, Language & Hearing Res, 42, 231-240.

[11] Ward, R.L., Nichols, A.D., & Freedman, R.I. (2010). Uncovering Health Care Inequalities among Adults with Intellectual and Developmental Disabilities. Health & Social Work, 35, 280-290.

[12] Cheslock, M.A., Barton-Hulsey, A., Romski, M., & Sevcik, R.A. (2008). Using a speech-generating device to enhance communicative abilities for an adult with moderate intellectual disability. Intellect Dev Disabil, 46, 376-386.

[13] Four different methods are: Interactive Environments, Virtual environments, Avatars for autism and Serious Games, Telerehabilitation for Autism. 

[14] Marnik and Szela, 2008., Marnik, J. and Szela, M. (2008).  Multimedia program for teaching autistic children. Information Tech. in Biomedicine, ASC 47:505512. And also in Luneski et al., 2008., Luneski, A., Konstantinidis, E. I., Hitoglou- Antoniadou, M., and Bamidis, P. D. (2008). Affective computer-aided learning for autistic children. 1st Workshop of Child, Computer and Interaction (WOCCI 08). Chania, Greece.

[15] Caron, J., Costello, J., & Shane, H. (2014, July). Mobile devices and app selection: Who’s driving the decision process? Mini-seminar presented at the 2014 biannual meeting of the International Society of Augmentative and Alternative Communication, Lisbon, Portugal.

[16] More at http://www.dynavoxtech.com/conditions/intellectual-disability/communication/what-is-aac/ Accessed 02/01/2016

[17] M.D. Lytras et al. (Eds.): TECH-EDUCATION 2010, CCIS 73, pp 11-17, 2010, Springer-Verlag Berlin Heidelberg 2010.

[18] More at http://www.assistiveware.com/ accessed 03/01/2016.

[19] Gosnell, J., Costello, J., & Shane, H. (2011, September). Using a clinical approach to answer “what communication Apps should we use?”. Perspectives on Augmentative and Alternative Communication, 20, 87–96.

[20] Alliano et. al. (2012). A review of 21 iPad Applications for Augmentative and Alternative Communication Purposes published in Perspectives on augmentative and alternative communication.

[21] The Arc, 2005. Technology for People with Intellectual Disabilities. USA.

[22] Braddock. et al. Emerging Technologies and Cognitive Disability. Journal of Special Education Technology. 19(4), Fall 2004.

[23] The Arc, 2005. Technology for People with Intellectual Disabilities. USA.

[24] Diehl et al., 2012., Diehl, J. J., Schmitt, L. M., Villano, M., and Crowell, C. R. (2012). The clinical use of robots for individuals with autism spectrum disorders: A critical review. Research in autism spectrum disorders, 6(1):249–262.

[25] Scherz, J., Dutton, L., Steiner, H., & Trost, J. (2010, November). Smartphone applications useful in communication disorders. Miniseminar presented at the 2010 annual meeting of the American Speech-Language-Hearing Association, Philadelphia, PA

[26] Braddock. et al. Emerging Technologies and Cognitive Disability. Journal of Special Education Technology. 19(4), Fall 2004.

[27] McBride, D. (2011). AAC Evaluations and New Mobile Technologies: Asking and Answering the Right Questions. AAC TechConnect, Inc. Accessed on 12/06/2016. Available at http://www.aactechconnect.com/wp-content/uploads/2011/02/McBridePerspectives1.pdf

[28] Braddock. et al. Emerging Technologies and Cognitive Disability. Journal of Special Education Technology. 19(4), Fall 2004.

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