Building Better Aided Language Measures: Speech-Language Pathologist Perspectives

Abstract

Aim: The research literature is replete with studies designed to develop and document the rigor of spoken language measures, but this has largely been absent in augmentative and alternative communication (AAC) literature. That is, developing aided language measures that are reliable, valid, developmentally sensitive, and clinically feasible is a pressing need (Bean et al., 2023; Lee et al, 2022).  Ensuring the clinical feasibility of measures has been particularly neglected, not only with aided language but also in spoken language. In both cases, language measures that are readily applicable in clinical settings are critical (Lee et al., 2022).  One way to bridge this existing gap between research and clinical practice is to implement community-engaged research (Douglas et al., 2023). This involves the inclusion of practitioners as key players in research projects.

To address this need, we conducted focus groups with AAC specialists to inform the further development and refinement of our pragmatic, semantic, and grammatical measures that are under development. Research questions included: 1) What contexts do AAC specialists currently use for data collection? 2) What alternate coding methods do AAC specialists use? 3) What are AAC specialists’ perceptions on the proposed measures fit and usability in a clinical setting?

Method: This study explored AAC clinical specialists’ perceptions of proposed pragmatic, semantic, and grammatical aided language measures through a series of four focus groups conducted via Zoom. PRISM framework (Glasgow et al., 2024) was used to further guide exploration of implementation construct including innovation characteristics (i.e. characteristics of aided language measures), recipient characteristics (e.g., SLPs’ clinical beliefs and expertise), external environment (e.g., insurance reimbursement rules), and implementation and sustainability infrastructure (e.g., current data collection systems, team-based workflow). Participants included 6 speech-language pathologists (SLPs) with at least 5 years of experience working with AAC and with (at least 25 people who use AAC). All participants had experience in more than one setting (at least one year with preschool aged) and experience with both autistic and nonautistic AAC users. Each focus group lasted approximately 90 minutes and was recorded then transcribed. A rapid qualitative analysis approach was used for deductive analysis of focus group findings and included accounting for the number of coders on the team, creating summary tables, and designing the calibration process (Kowalski et al., 2024). Once all summary tables were finalized, the coders and lead evaluator met to conduct synthesis through matrix analysis (Kowalski, 2024). Basic themes were compared across the focus groups and organized into global themes where basic themes aligned. Following consensus, member checking was conducted to ensure accurate representation of participants’ statements and ideas.

Results: Six global themes emerged from the data analysis: (1) measures can be used to support the funding process, (2) measures can support communication partner understanding and use, (3) measures can guide clinical decision-making, (4) current data collection approaches vary for proposed measures, (5) measures need to work across AAC technologies, modalities, and contexts, and (6) current clinical practice barriers may influence the effectiveness and feasibility of measures. Additional themes unique to each set of measures are also explored.

Conclusion: Findings indicate overall positive perceptions of the proposed aided language measures. Measures were viewed as essential to supporting AAC device funding efforts, monitoring progress, and bringing awareness to broader language needs. The adoption and sustainability of the measures are shaped by all PRISM dimensions and should be considered in future refinement of the aided language measures.

Reference List:

Bean, A., Harris, K., Kim, H., DiGiovine, C., & Sonntag, A.M. (2023). A scoping review of communication outcomes measures in augmentative and alternative communication. Assistive Technology, 37, S65–S86. https://doi.org/10.1080/10400435.2023.2251041

Douglas, N., Hinckley, J., Grandbois, K., Schliep, M., Wonkka, A., Oshita, J., & Feuerstein, J. (2023). How a Power Differential Between Clinicians and Researchers Contributes to the Research-to-Practice Gap. American Journal of Speech-Language Pathology, 32(2), 803–810. https://doi.org/10.1044/2022_AJSLP-22-00207

Glasgow, R.E., Trinkley, K.E., Ford, B., & Rabin, B.A. (2024). The Application and Evolution of the Practical, Robust Implementation and Sustainability Model (PRISM): History and Innovations. Global Implementation Research and Applications, 4, 404-420. https://doi.org/10.1007/s43477-024-00134-6

Kowalski, C.P., Nevedal, A.L., Finley, E.P., Young, J.P., Lewinski, A.A., Midboe, A.M., & Hamilton, A.B. (2024). Planning for and assessing rigor in rapid qualitative analysis (PARRQA): a consensus-based framework for designing, conducting, and reporting. Implementation Science, 19(71). https://doi.org/10.1186/s13012-024-01397-1

Lee, J. P., Binger, C., Harrington, N., Evelyn, S., Kent-Walsh, J., Gevarter, C., Richardson, J., & Hahs-Vaughn, D. (2022). Aided Language Measures: Establishing Observer Agreement for Communicators in Early Language Phases. American journal of speech-language pathology, 31(3), 1394–1411. https://doi.org/10.1044/2022_AJSLP-21-00341