The Speech and Language Therapist responsible for the patient will make the initial assessment for the suitability for augmentative and alternative communication (AAC), but assessment may also include input from Occupational Therapy, Physiotherapy, Psychology, educational staff etc. It may be appropriate to refer to a specialist AAC service for the assessment and provision of technologically based aids or for more specialist advice. In Scotland there are several centres of communication technology and AAC expertise:

Keycomm: Lothian Communication Technology Service

Call Centre Scotland

FAACT (Fife Augmentative and Alternative Communication team)

SCTI (Scottish Centre of Technology for the Communication Impaired)

AAC contacts NHS Scotland

Given the range of problems potentially experienced by the person who has sustained a brain injury it is important that a comprehensive assessment for suitability is carried out involving all the relevant people. Areas of assessment may include:

  • Communication abilities: including the person’s ability to express themselves, understand language, and their reading and writing ability.
  • Physical abilities : including the person’s ability to speak , gross and fine motor control, active range of arm movements, posture, impairments of perseveration presence of involuntary movements including dystonia.
  • Problems of fatigue.
  • Seating and positional needs, including achieving appropriate base of support to maximise hand/arm/head control and assessment of the most appropriate surfaces to use AAC equipment on.
  • Perceptual abilities: including visual field impairments, the ability to recognise shape and colour, spatial and depth perception, figure ground discrimination and the presence of visual inattention/neglect.
  • Eyesight: including the person’s visual acuity, presence of double vision, need for glasses etc.
  • Dyspraxia: this will involve assessing the person’s ability to execute sequences of voluntary, planned movements.
  • Cognitive abilities: including the person’s ability to maintain attention, remember relevant information, reasoning skills, self-monitoring, their motivation, insight into their difficulties, impulsivity, ability to learn etc.
  • Presence of psychological and psychiatric difficulties: may impact up on the person’s ability to use AAC e.g. depression, anxiety, agitation, restlessness, emotional lability, psychosis etc.
  • Behavioural difficulties: behavioural issues of reduced tolerance, restlessness, disinhibited behaviour, verbal or physical aggressive outbursts etc may limit the ability of the person to use an AAC system successfully and safely.
  • Environmental assessment: with any system of AAC, success also depends on the person having the correct environmental supports to use it. There must be other people present who will support use of AAC, the system needs to be immediately accessible, not put in a cupboard/left behind when someone goes out.  There must be the facility and willingness to keep electrical AAC equipment fully charged, environmental distractions may need to be limited etc. If the person is dependent on pre-prepared picture/written material to express themselves (e.g. picture choice communication boards).  Environmental assessment will also need to consider the type and range of vocabulary the person may require. This information should be used when making up communication boards or folders etc.
  • The best method of ‘accessing’ an AAC system/communication aid to support the person to express themselves. Access methods may include:
    • Typing using fingers.
    • Pointing with hand/fingers.
    • Head pointing. ‘
    • Eye-gaze pointing’ at pictures/words or in order to use a ‘high tech’ device.
    • Using another part of the body that has reliable movement e.g. head movements, cheek twitching, eye-brow raising to operate a ‘high tech device’.

Due to the often complex and severe consequences of Acquired Brain Injury, options for implementing AAC may be limited for some people:

  • It is necessary that the person understands and remembers they have a brain injury, has insight into the consequences of ABI.
  • Has the motivation and patience to use AAC and the ability to recognise when they need to use the AAC system.
  • For the more complex technological AAC systems, the person will require literacy skills, adequate visual skills, patience, and the language and cognitive skills to support the use of AAC.