1. Using AVAZ to Enhance Communicative Abilities of a Child with Cerebral Palsy
- By Sita Sreekumar, NISH, Trivandrum (2014)


Sita Sreekumar - Audiologist & Speech Language Pathologist, Department of Audiology and SpeechLanguage Pathology, National Institute of Speech and Hearing, India. Email: sitas@nish.ac.in


Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments. Affected children can experience mild to severe difficulties in expression. Those with little or no functional speech frequently rely on non-speech communication systems to augment or replace natural speech. These systems include speech generating devices (SGDs). AVAZ is a portable speech synthesizer which can be controlled by the gross motor movements of a child with cerebral palsy.


This case study describes the outcomes of a pilot investigation that utilised AVAZ as a means of enhancing functional communication in a young girl with cerebral palsy.


A 7-year-old girl with cerebral palsy and complex communication needs was trained for 10 sessions to develop requesting ability by pointing to the desired pictures on the AVAZ.


After the training sessions, the child showed improvement in social interaction and functional communication.Conclusions and Implication: The collaborative efforts of an inter-disciplinary team, comprising a speech pathologist, a physiotherapist, parents of the child and a social worker, made it possible to enhance the child’s confidence and functional communication using AVAZ.Hence it is important to pursue client-oriented, innovative and collaborative intervention approaches among team members.Key words: Cerebral palsy, complex communication need, speech generating device, functional communication.

    View  complete paper here.

2. iPad: efficacy of electronic devices to help children with autism spectrum disorder to communicate in the classroom

- By Sulata Ajit, Sankalp school, Chennai (2017)


Children with Autism Spectrum Disorder (ASD) are known to have difficulty in social communication, with research indicating that children with ASD fail to develop functional speech (Lord and Rutter, 1994). Over the years a number of Augmented and Alternate Communication (AAC) devices have been used with children with ASD to overcome this barrier and to facilitate communication. This article examines an Indian AAC tool called AVAZ (meaning sound), which is the first of its kind in India. The project reported also looks at the effectiveness of using AVAZ and the use of iPads by children with ASD in the classroom. Additionally, the article examines the suitability of using iPads for all learners in the spectrum. Twenty children between the ages of 4 and 10 years were selected to trial the use of AVAZ. They received three sessions weekly of 45 minutes over a period of 10 weeks. The feedback of the special educators who trained the children was analysed. The findings of this small scale study indicates that the children preferred using the AVAZ app and the iPad to pen and paper. Huguenin (2004) too indicated similar reports in using Information and Communication Technology (ICT) in enhancing children's motivation to learn and communicate. The trainers felt it could be used as an educational tool, and many more educational concepts could be added. Research also suggests that ICT can be used as a tool to tutor for educational purpose (Means, 1994). The AVAZ app could be recommended to children with ASD who are included in mainstream schools. This study was conducted at Sankalp, a special school in Tamil Nadu, Chennai.

Source: View complete paper here or in Google drive here or download the attachment at the end of this page. 

Research Rationale

Difficulties with language and communication are a key feature in the discussion on autism. So, while training children with autism, we must work separately for speech, language and communication. Children with autism have difficulty especially in allocating attention and using gestures such as pointing for joint attention. Some children on the autism spectrum remain non-verbal and some are verbal. Verbal children can repeat words or talk about their favourite cartoons but they struggle to use their vocabulary for communicating with others. This makes it very important to provide an alternative method of communication for children with autism.

Augmentative and Alternative Communication(AAC) includes all forms of communication other than oral speech that are used to express thoughts, needs, wants and ideas. AAC Systems are sometimes categorised into unaided and aided systems. Unaided AAC includes facilitated communication and sign language. Aided AAC Systems split into low and high-tech systems. Low-tech augmentative and alternative communication includes communication boards, picture exchange communication systems (PECS) and picture-based AAC systems other than PECS. High tech augmentative and alternative communication include mobile devices and voice output communication such as speech generating devices.


Different forms of AAC that are extensively used for children with Autism are sign language, Picture Exchange Communication system(PECS) and Assistive Technology devices. Through this presentation, I aim to explain how AAC and assistive technology helped my son to learn Communication skills and how our family is able to have a better quality of life, due to this.

Source: View complete paper here - Developing Communication skills using Assistive Devices and Technology

4. Advancement to higher communicative functions with transition to iPad app – a case report

- By NISH (National Institute of Speech and Hearing), Trivandrum (June 2019)


Children with complex communication needs (CCN) develop severe limitation in communication functioning due to restricted access to environment, limited interactions with their communication partners, and few opportunities for communication (Light, 1997). In order to overcome these challenges and to enhance communication abilities, Augmentative Alternative Communication (AAC) can be introduced in intervention. This single case study reports the improvements in communication skills when the child made a transition from a communication book to an iPad speech generating app. Participant was a 7 year old child with multiple disability and CCN who was undergoing intervention using communication book and transited to an AAC app namely AVAZ. A comparison of pre and post-therapy communicative function was carried out using tool Communication Matrix to understand the improvement. When the child made transition from a communication book to a iPad speech generating AAC app, significant improvement was observed in all communicative functions namely refusal, obtaining, social purpose and for gathering information. After a total of 10 training sessions, the child advanced from level of using concrete symbols to a level of “Language” i.e. using a combination of abstract symbols for communication. This case report indicated that transition to an iPad AAC app had significant benefits on improving communication skills which in turn had positive impact on linguistic and literacy skills. Consequently, an improvement in levels of motivation and confidence was noted. Hence, providing access to the appropriate AAC device/technology in ongoing intervention is the foundation to building effective communication skills.

  • Implications for rehabilitation
    • Importance of ongoing assessments to understand the varying communication demands of AAC user.

    • The timely decision of selecting appropriate AAC devices.

    • Transition to appropriate AAC device to address higher communicative functions.

    • Documenting evidence-based practices using AAC in a developing country like India.

Source - View complete paper here - Disability & Rehabilitation: Assistive Technology - By NISH Trivandrum

AVAZ application (trial version) - A voice for the nonverbal children with autism spectrum disorder: A pilot study

- By Jay Vijay Sonawane, Hansa Varshneya (Feb 2020)

(Department of Occupational Therapy, JKKMMRF College of OT, Namakkal, Tamil Nadu)

Background: Children with autism spectrum disorder (ASD) who are nonverbal lack communication skills. These children with ASD are unable to express their needs verbally even if they want to. The introduction of indigenous augmentative and alternative communication system (AAC) can be helpful in improving the social interaction. By using AAC, these children with ASD can easily communicate their needs with parents, teachers, or caregivers. Objective: The objective of this study is to evaluate the importance and need of AVAZ application in special school-going children with ASD. Study Design: A pilot study for short term on small sample was conducted. Methods: A sample of eight special school-going children with ASD was selected. Each child had downloaded AVAZ application trial version on their smartphone from the Google Play Store. The number of sentences formed by the children over a period of 21 days was analyzed. The responses were recorded in the AVAZ application. Results: Percentage improvement was noted in forming relevant sentences through the application of each child from the 1st to 21st session ranging from 28.5% to 40%; five children showed the improvement but three children did not form any sentence neither relevant nor nonrelevant. Conclusion: Our study showed that the use of AVAZ application can be helpful in improving social interaction and can be utilized as a supporting tool for functional communication with others and for the better learning process in children with ASD.

Keywords: Augmentative and Alternative Communication System, Autism Spectrum Disorder, Communication, Occupational Therapy, Social Interaction

Source: View the complete paper here

AAC Intervention for Stroke Survivors - An Anomic Aphasic Case Study

- By Mohammed Eliyas, Sivaranjani Balasubramanian -


Aphasia is an impairment of language that is a consequence of a cerebral insult or damage affecting

the speech production and/or comprehension, as well as the ability to read or write. Etiology of

Aphasia is multifactorial, most commonly in the form of a stroke (Cerebrovascular Accident),

especially in older individuals. The type of aphasia is determined based on multiple factors such as the

site of lesion, signs and symptoms and also through patient’s clinical presentation. Rehabilitation for

stroke survivors plays a major role in communication effectiveness. Computerized Intervention

method provides a prognostic factor in the treatment for adults with aphasia. AAC devices (high-tech)

are used to enhance communicative effectiveness of aphasic individuals who are less likely to use

strategies/techniques that the caregiver can use to foster interactions between themselves and the

aphasic individual outside the treatment setting. Other factors that determine the success of the

intervention are the intensiveness and the duration of intervention. This study focuses on one such

intervention of an adult Anomic Aphasia patient using a high tech AAC computerized application

known as Avaz. The results showed that the client was able to perform much better in terms of the

word retrieving abilities and is now able to communicate well.

Keywords: Augmentative and Alternative Communications; Anomic Aphasia; Language intervention;

Avaz; High tech.

Source: View complete paper here

7. Capitalizing on technology for developing communication skills in autism  spectrum disorder: a single case study

- By Veena Mohan, Suja Kurian Kunnath, Vineetha Sara Philip, Lakshmi Santha Mohan & Neethu Thampi (2017)

Purpose: In this case study, we discuss the application of a patient-centred clinical approach that led to the use of an assisted communication platform to combat severe communicative deficit in a child with autism spectrum disorder (ASD).

Methods: Initial assessment at four years of age revealed that the patient had rudimentary communication skills, with significant sensory integration dysfunction manifested as oral, olfactory, and tactile seeking behaviours; self-stimulatory behaviour; and complete dependence on caregiver for activities of daily living. Intensive, multi-disciplinary intervention resulted in minimal improvement in communicative skills and sensory seeking over six months. Subsequently, a tailor-made picture-assisted communication training with the mother as the communication facilitator was adopted. This approach was abandoned due to the patient's poor response and mother's low acceptance of picture-based interaction. A preference for printed material was observed in the patient. Accordingly, further management was focused on employing a computer-based interactive platform that the patient was taught to use over the course of a few months as a part of augmentative and alternative communication (AAC) intervention program. This resulted in a remarkable improvement in the child's skills that now allowed for a better intentional communication of his thoughts and needs.

Conclusions: This study highlights the importance of revisiting conventional rehabilitation strategies for communicative deficits and tailoring them according to the patient's needs and preferences. It also emphasises that besides excellent observation skills, clinicians must be willing to consider technology based approaches in patients responding poorly to traditional approaches in order to develop effective interventional programmes. Implication for Rehabilitation The current study highlights the importance of exploring the application of technology based intervention for building communication skills in the early stages of rehabilitation for persons with communicative deficit. It also emphasises the need for excellent observation skills among clinicians so that the peculiar interests of children with ASD may be applied in designing training programmes to overcome communication barriers. Additionally, clinicians should familiarise themselves with the latest assistive technology-based rehabilitation approaches and be willing to explore newer approaches if traditional ones fail to yield satisfactory outcomes. Use of technology-based interventions to reduce dependence among persons with disability would be beneficial, both socially and economically, in developing countries with limited resources.

Keywords: Technology; augmentative and alternative communication; autism spectrum disorder; communication; intervention; reading and writing.

Click here for Link 

Refer to the attachment below for full paper.