An Individualized Approach to Augmentative and Alternative Communication for Cortical Visual Impairment: One Family's Progression Toward an Accessible Language System

Vollständiger Abstract

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Purpose: Speech-language pathologists report a desire for guidance to develop and maintain augmentative and alternative communication (AAC) supports that are customized and visually accessible for individuals with cortical visual impairment (CVI; Boster et al., 2021). In 2023, Wilkinson et al. introduced the “CVI/AAC Framework” that offered initial evidence-based considerations and data collection prompts to address this clinical challenge. The current article was written to illustrate the process of the clinical application of the CVI/AAC Framework for a young child with cerebral palsy and concomitant CVI. By demonstrating the team efforts to build a developmentally appropriate aided AAC system that was responsive to the child's CVI and motor support needs, we hope to demonstrate the utility of the framework and promote clinical uptake for decision making. Method: The team, which included clinicians, other professionals, and the child's mother, implemented an iterative approach to AAC assessment and implementation based on ongoing discussions surrounding the CVI/AAC Framework domains and the child's progress. The relative frequency of different topics of discussion and the subsequent types of decisions made were quantified to illustrate the clinical process. Furthermore, a detailed case analysis of the contents of the discussion were extracted from the transcripts. Results: The team met collaboratively for 8 months, resulting in 13 meetings. A total of 97 topics were discussed and coded related to the CVI/AAC Framework or general AAC assessment. Of the topics related to the framework, Domain 1 (characteristics of the individual) accounted for the most discussions followed by Domain 3 (AAC system design choices). Meeting documentation and screen captures of the child's AAC system across time demonstrated changes in the child's linguistic and visual functioning. Conclusions: This clinical focus article illustrates a starting point for implementation of the CVI/AAC Framework as a complementary approach to typical AAC assessment procedures. This approach should prompt clinicians to make individualized AAC changes that support meaningful communication and participation and provide a basis for future systematic research. Supplemental Material: https://doi.org/10.23641/asha.33283830