D4) Thinking About Thinking for AAC (TAT4AAC)(2014-2020)

Free online resource available at   http://tat4aac.ohsu.edu/
Team Leader: M. Fried-Oken,
Consumer Team: P. Kolden, J. Staehely

Gerry is a 24 year old survivor of a severe traumatic brain injury (TBI). He cannot speak clearly, he is easily distracted, has reduced memory skills, and has poor hand coordination.  He enters a crowded and noisy coffee shop with a friend. His favorite drink, a mocha latte, has recently been programmed into his AAC device and he hopes he will remember where the icon is located. Using visual perception and language processing skills, he locates and presses the ‘Food and Drinks’ icon.  This takes him to another page with words listing mealtimes; his literacy skills help him identify ‘breakfast’, and press it. His selective attention and visual scanning skills for small icons are not reliable; speed of information processing is slowed. The cashier becomes noticeably impatient. Getting distracted, Gerry finally locates ‘hot drinks’ and presses it. He has difficulty alternating his attention  between icons and the word list. He attempts to  press ‘coffee’ but his shaking hand hits ‘home’ instead, navigating him all the way back to the start. Beginning to fatigue cognitively, his sequencing skills deteriorate.  Try as he might, he cannot find his way back to ‘hot drinks’.   In the end, the AAC device states, “Water please”. Gerry thinks, “What a waste. Next time I’ll just stay home instead.”

Challenge
Learning to use AAC technology is complex.   Some of the cognitive demands that  AAC technologies and applications present to the user include, but are not limited to, visual scanning, attention to working memory, sequencing, and executive function. Most research on cognition and AAC investigates what the user brings to the task and how to improve the skills of people who have challenges. This project will instead present information about the technology, asking, “What does the device or app demand from the user?”
Goal
We proposed to develop, evaluate and distribute an online resource that summarizes literature in the fields of AAC and cognition to support clinical problem solving, for team communication, and for capacity building among students, clinicians, and device developers.
Thinking about Thinking for AAC (TAT ₄ AAC) was developed to provide references about the cognitive demands of specific features of AAC technologies to encourage stakeholders to consider and compare the cognitive demands of AAC technologies.
Key Development Points and Implications

• The content development for the TAT₄AAC started with a review of feature matching lists to identify specific AAC features which impose a cognitive demand on the user.
• A comprehensive literature review of cognitive theory was conducted to identify those domains related to AAC, specifically: attention, memory and executive function.
• The identified AAC features and cognitive domains were verified with nationally recognized subject matter experts in fields of AAC and cognition.
• A comprehensive literature review was conducted of online databases, texts and relevant journals through combining key terms: specific AAC feature + a cognitive domain.
• Relevant findings were identified through consensus process.
• Literature summaries were generated by the development team to make information easily accessible to clinicians. Each relevant source was summarized and incorporated into the library.
• The final version of the website was beta tested with 72 stakeholders (AAC clinicians; educators; cognitive rehabilitation clinicians; AAC developers and technologists; people who rely on AAC and their parents or spouses; researchers). At that time the title was changed from Cognitive Demands Checklist (CDC), as reviewers commented that the title was too similar to the US Centers for Disease Control and Prevention (CDC).
• There are two parts to the TAT4AAC: an online interactive library and a resulting annotated bibliography. Upon completion of the interactive library, a printable PDF is generated that lists pertinent references and summaries related to the selected AAC features and their cognitive demands.
• The TAT₄AAC is not an assessment tool nor is it a prerequisite of the cognitive skills needed before AAC technologies can be introduced. The TAT₄AAC is not intended to determine eligibility for device trialing, training or purchase nor intended to eliminate device options for persons who use AAC.

This free online resource is available at   http://tat4aac.ohsu.edu/
Information Resources

• AAC features by cognitive domains grid developed for the TAT₄AAC
• TAT₄AAC Quick Guide
• Handout from 2019 ATIA Presentation
• PrAACtical AAC blog post (December 5, 2019)
• Communication Matrix Community of Practice hosted collection (December, 2019)