Attitudes Toward the Use of Low-Tech AAC in Acute Settings: A Systematized Review

Augmentative and Alternative Communication

Murray, S., & Hopf, S. C. (2022).

Augmentative and Alternative Communication, 38(3), 184-195.

This systematic review investigates the attitudes and perspectives about low-tech augmentative and alternative communication (AAC) in inpatients in acute, intensive care, or rehabilitative settings with sudden onset acquired communication difficulties (e.g., due to ventilation, stroke, traumatic brain injury).

Not stated

2000 to 2020

Peer-reviewed, English-language studies (not further specified)

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Family and care providers reported the following factors were barriers to using AAC with inpatients with communication difficulties:<br /> <ul> <li>a belief that they understood the patient and could communicate on their behalf;</li> <li>frustration with using low-tech AAC (e.g., the time needed for patients to construct a message);</li> <li>lack of AAC availability;</li> <li>the inability to customize or personalize the communication boards/boards lacking appropriate communication topics;</li> <li>concerns that AAC use may hinder the patient's ability to regain their speech and communication; and</li> <li>a feeling that there was an expectation to be competent in AAC use despite minimal or no training.</li> </ul> Family and care providers indicated the following considerations facilitated the use of AAC:<br /> <ul> <li>encouragement to produce their own low-tech AAC devices and problem-solve communication issues;</li> <li>communication/alphabet boards with readily identifiable content;</li> <li>easily accessible AAC options; and</li> <li>increased length of time since the patient's injury/onset of illness.</li> </ul>

Patients reported reluctance to use low-tech AAC in front of healthcare providers due to fear of errors, especially in patients who had low literacy levels. Those that believed that AAC would inhibit their recovery also refused to use AAC tools. Many patients described general communication boards as limiting because they were unable to convey feelings or ask questions about their home life, prognosis, or diagnosis. Despite these barriers, patients indicated even greater levels of frustration, confusion, anxiety, and isolation when no AAC option was available or if partners were unwilling to engage with an AAC tool.<br /><br />Overall, inpatients indicated that communication boards were quick and easy to use with minimal training. Patients who used a visual communication board while intubated or mechanically ventilated reported high satisfaction regarding the ease and effectiveness of communication compared to those who used other communication strategies (e.g., gestures, speech reading, mouthing). Patients also expressed appreciation for communication partners who took the time and effort to use low-tech AAC to receive their messages. While patients preferred to use AAC with familiar communication partners, they also shared that these partners often misinterpreted or misunderstood them without the support of low-tech AAC.