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


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.

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

- By Sulata Ajit, Sankalp school, Chennai


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 download the attachment at the end of this page. 

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

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


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

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