Augmentative Communication: Clinical Issues. Also published as Physical and Occupational Therapy in Pediatrics, vol. 7, no. 2, Summer 1987.

Augmentative Communication: Clinical Issues. Also published as Physical and Occupational Theraphy in Pediatrics, vol 7, no. 2, Summer 1987

This book is a collection of articles written by several professional members of the Augmentative Communication Team at the University of North Carolina at Chapel Hill, NC. Although the articles reflect the author's involvement in an interdisciplinary team, a stated intent of the book is to help clinicians understand the processes involved in augmentative communication and incorporate them into their own practices, even if they are not members of a formal team.

The first article contains a brief history of the development of augmentative and alternative communication (AAC), along with some general concepts concerning AAC and the use of an interdisciplinary team. The AAC users, teachers, and parents are not included as members of a typical team, an omission that could indicate the presence of a commonly encountered center-based team point of view. The author emphasizes that trial-and-error problem solving is needed in place of technological "quick fixes" in this complex and relatively new field.

The second article covers prerequisites for augmentative communication. The author provides a nice overview of communication, covering both its components and its development. An understanding of these concepts is critical if AAC assessment and intervention are to be effective; they are often overlooked in favor of a focus on communication hardware and technology. The list of prerequisites is somewhat confusing, because it appears to be simply a continuum of skills, rather than a list of specific skills that might indicate when a child is "prepared for an augmentative communication system." Although there may be predictors for successful use of certain AAC systems, including symbolic systems (as the authors seem to intend), the AAC field is rapidly turning away from "prerequisites" and toward determination of an individual's point of entry into the wide range of AAC. The author's discussion of implications for early intervention provides useful information about prelinguistic, nonsymbolic points of entry.

The authors of the third article discuss the need for psychological assessment of children who may use AAC systems. They also discuss some testing considerations. The chapter is interesting, presenting the role of therapists in the psychological assessment of physically disabled children. Again, however, the authors talk about "prerequisites," in this case "cognitive prerequisites." Of special concern was the following statement: "A child's cognitive abilities will determine his or her need for an augmentative communication system."

The author of the fourth article provides an extensive review of the therapeutic positioning literature and discusses a number of important positioning considerations that would be useful to experienced, thoughtful readers. Better synthesis of the literature and further discussion of the implications for AAC might have made the article more useful for those whose knowledge and experience are more limited.

I highly recommend the article on motor assessment for aided and unaided communication, one of the most thorough discussions of the topic I have seen. Many good references and resources are included.

Articles on selection of initial vocabulary and family involvement also were well done. The short article on training provides only a brief look at this critical component of AAC. The article on interaction strategies reviews some of the previous content, but also provides much information that is essential for therapists who interact with individuals who use AAC.

This text does not take a "cookbook" approach to AAC assessment and intervention. It is highly informative, emphasizing the nontechnological, interactional aspects of AAC, which are critical for effective use of AAC systems. It also contains valuable information--with many references and resources--for therapists who need to develop assessment procedures of AAC users and potential users. For these reasons, I highly recommend this volume to physical therapy practitioners and students involved with individuals--particularly children--who use or may use augmentative and alternative means of communication.