Using different methods to communicate: how adults with severe acquired communication difficulties make decisions about the communication methods they use and how they experience them (summary)



It is recognised that assistive technologies, including augmentative and alternative communication (AAC) can be beneficial in helping improve the quality of life for adults with complex needs. People with acquired communication difficulties have to make many decisions about new technologies and also learn how to use them.

Involving communication aid users in decision making about which systems to use and in what situations is known to be beneficial but does not always happen.

Adults with acquired communication difficulties often use more than one communication method, which might include newer mobile technologies as well as traditional AAC systems. Communication systems used might include social media, Skype and e-mail.

What did they do?

The study aimed to explore how adults with severe, acquired communication difficulties experience and make decisions about the communication methods they use. The researchers wanted to look at user's perceptions of different communication methods and how they chose which method to use in different situations and with different people.

Seven men with acquired neurological disorders took part in the study. They had all used AAC for at least six months. Participants were interviewed face-to-face using the communication method of their choice. Further information was gathered from five of the participants via e-mail interviews. Two of the men did not have access to e-mail.

What did they find?

Analysis of the information gathered led to four main themes developing; communicating in the digital age, encountering frustrations, role and identity changes and seeking a functional communication interaction.

Participants who used e-mail said it was their preferred method for some interactions as it gave extra time to construct messages, resolved the issues of timing and reduced speed of communication present in face-to-face interactions, gave opportunity to correct errors and stopped people making judgements based on physical appearance.

The ability to easily access the internet using a communication system, and appropriate methods of accessing the system were considered important.

The slow rate of communication using AAC was the most common frustration together with issues around physical access, the effort required to use a device and lack of reliability.

Becoming non-verbal and using AAC affected both participant's sense of self-identity and the way they felt they were viewed by other people.

Communication aids were generally felt to be essential, but their effective use was often dependent on them being made available by others and on other people understanding how they are used.

Participants also considered how the choice of communication method can limit or support 'good' communication, based on a number of factors including speed of communication and voice quality. These things contributed to changes in the way participants communicated before needing AAC.

Participants were keen to be on-line and found that use of the internet increased their social interactions, potentially reducing loneliness and supporting the development and maintenance of friendships.

Mainstream devices such as iPads that enabled the integration of a range of features including internet access, music etc., in portable devices were generally the preferred option, provided they could be physically accessed.


The choice of method used to communicate is individual and professionals need to take this into consideration when working with clients with acquired neurological conditions.

The findings of the study indicate the benefits of social media, digital communication and mainstream technologies as communication methods for people who use AAC. In order to best support a person-centred approach to making decisions about communication systems speech and language therapists need to be well-informed about developments in these areas.

More research is required into the use of social media by people with communication difficulties.


The study involved only a small number of people, all male, from one hospital, so the results cannot be widely generalised and further research is needed.

Things you may want to look into:

Real-Life Challenges in Using Augmentative and Alternative Communication by Persons With Amyotrophic Lateral Sclerosis

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

Added to site Dec 2015