Augmentative and alternative communication in daily clinical practice: strategies and tools for management of severe communication disorders (summary)



People who have had strokes often use natural speech in combination with various AAC strategies to improve the effectiveness of their communication. These strategies might change over time as communication needs change.

Interventions to help build stroke patients' communicative competence need to consider a wide variety of factors including the individual, their environments and their communication partners. They should not necessarily be seeking a 'cure', rather to implement strategies to compensate for difficulties.

The perception and attitudes of patients, communication partners and professionals can influence access to and acceptance of AAC methods.

When these issues are addressed early and consistently in patient care then it is more likely that AAC will be viewed positively.

What did the authors do?

The paper describes various aspects of communication competence from an AAC perspective, and looks at specific AAC strategies and technologies to encourage professionals to view AAC as a way of maximising natural speech and language skills.

Areas of communicative competence are considered, including the use of communication to; convey wants and needs, give information, support social closeness and social etiquette and self-communication.

It is suggested that speech and language therapists (SLTs) consider using a variety of strategies to facilitate communication.

People who use AAC need to be able to show competency using their system both expressively and to support their understanding, they, and their care givers, need to be able to demonstrate the technical skills needed to operate their system and keep it up to date. They need to be able to follow the social rules of interaction and overcome the limitations of AAC systems.

Early, direct training in each of these areas, and how to modify strategies as skills change, is identified as a means of improving communicative competence.

The paper looks at the use of AAC strategies for people with acquired motor speech disorders and/or aphasia, suggesting possible strategies to be considered.

There is a brief consideration of possible reasons for people with aphasia abandoning AAC strategies and the suggestion is made that using an approach to intervention that emphasises competence and inclusion rather than deficits, and involves other people within the AAC users social circle, might increase the rate of acceptance of AAC systems.


The use of AAC strategies and systems can be beneficial to adults with acquired disorders, and help improve quality of life. However overcoming negative attitudes and perceptions and selecting the most appropriate systems presents many challenges.

The development of more 'mainstream' communication support systems, such as mobile communication apps, might increase acceptance of devices, but introduces their own difficulties in terms of funding and technical support.

The authors conclude that the needs of people with severe communication impairments are diverse, as are considerations to be taken in identifying possible support systems. Early provision of appropriate resources to aid the regaining of communicative competence might lead to greater acceptance of AAC systems and the development of functional communication using a combination of natural speech and language and AAC strategies should be the aim of interventions.

Things you may want to look into:

The effect of remnant and pictographic books on the communicative interaction of individuals with global Aphasia 

Promoting acceptance of augmentative and alternative communication by adults with acquired communication disorders

Bill's experiences after a stroke

Terry using a communication aid after a stroke

Augmentative and Alternative Communication (AAC) for adults with severe aphasia: Where we stand and how we can go further

Weblinks - aphasia / stroke

Factsheet - What is a stroke?

Factsheet - What is Aphasia?

Factsheet - Dysarthria and Dysphasia

Added to site October 2014