Training, Collaboration and AAC Interface Modifications for Children with Cortical Visual Impairment: Results of a Survey of the United States

Abstract

Aim: Augmentative and alternative communication (AAC) interfaces are highly visually based systems (Wilkinson & Jagaroo, 2008) that may be difficult for children with cortical visual impairment (CVI) to use without modification and personalization.  Many children with CVI also have communication difficulties and require the use of AAC to express their daily wants, needs, thoughts, and opinions. For children with CVI who rely on AAC, speech-language pathologists (SLPs) need to consider how to create appropriate AAC interface designs. Most AAC interfaces can be customized to meet children’s needs; however, there is limited information on which modifications should be made (Boster et al., 2021). There are many features available such as the ability to change background colors, outline with color, change contrast, and adjust individual symbols that can be adjusted and vision professionals have suggested such modifications can support access for children with CVI (Boster et al., 2025). Additional information is needed to explore SLPs’ access to information about CVI, identify possible vision professionals they collaborate with, and investigate the current methods SLPs use to make modifications to AAC interfaces.

Method: RedCAP was used to develop an online survey to address the research questions. The online survey was distributed across the United States via use of social media, special interest groups, and word of mouth to SLPs. A total of 71 licensed SLPs completed the survey. Data was collected from multiple choice and Likert scale questions. Data was exported to a Microsoft Excel Workbook for data analysis. Quantitative analysis consisted of calculation of totals and percentages. Data analysis is complete.

Results: Results indicated that most participants (n=60) reported no training in CVI. Most participants did report consulting with a TVI or vision specialist (n=47). While the participants reported consulting with these professionals, it should be moted that they do not consult them often. Most reported working with a vision specialist every couple of months (n=12) or yearly (n=13). The participants in this study reported most often collaborating on the following for children with CVI who use AAC: environmental considerations (n=39), color contrast (n=37), and symbol size (n=30). Participants in this survey reported using a variety of AAC strategies with children with CVI. Most reported using grid displays (n=46) while fewer used visual scene displays (VSDs) (n=14).  Participants reported that they “almost always” edit interfaces for children with CVI (n=21). Unfortunately, editing is viewed as time intensive with 15 participants indicating that they could spend over an hour editing displays. Participants also noted a range of barriers to editing including time (n=48), lack of knowledge (n=24), and limited access to fellow colleagues for input (n-24).

Conclusion: SLPs work with vision professionals to edit AAC interfaces for children with CVI. SLPs use a range of interface modifications but face barriers to editing such as time constraints and lack of knowledge. Additional educational opportunities and research on AAC interface modifications is needed to support children with CVI.