Augmentative modes of communication for the severely speech- and motor-impaired

There is a large population of individuals whose speech impairments are so severe that they are unable to communicate effectively or fully through the speech mode alone. For these individuals, augmentative communication techniques which can supplement their speech (if any) should be implemented to provide them with a fully functional communication system. A variety of different techniques and approaches has been developed, each with advantages and disadvantages for individuals having different skills, handicaps or constraints. Clinical work to date has shown that these approaches do not impede the development or use of speech, where it is functional, in a significant portion of the population. There is some evidence that they enhance the development of intelligible speech. Selection of the appropriate technique, however, is complicated, since there are many factors, including physical, cognitve, language and environmental, that must be considered in selecting the appropriate aid. For this reason, selection is best carried out by an interdisciplinary team which is specially trained for this purpose. Advances in the field, both in terms of information and training as well as in the development of new aids, is moving quite rapidly at this time, and it is expected that dramatic advances in the appropriate care and rehabilitation of individuals with severe and extreme communication impairment will be seen over the next 5 to 10 years.