augmentative and alternative communication - Oxley College of Health Sciences

augmentative and alternative communication

Freedom of speech: TU’s speech-language pathology students and faculty deploy latest technology to support expressive communication

When you were in elementary school, did you ever stealthily pass a handwritten note to a friend while your teacher’s back was turned? Have you ever nodded approvingly as a colleague presented her ideas at a meeting or sent a smiley-face emoji to a friend while texting? These and myriad other forms of familiar non-verbal communication are examples of augmentative and alternative communication (AAC).

For most people, AAC – which roughly boils down to communication that happens without talking – is a common addition to speaking. Speech-language pathologists, however, deploy AAC technologies to help people for whom speaking is either a major challenge or even an impossibility; for example, children with autism or cerebral palsy, and adults with aphasia or who have suffered a stroke or a traumatic brain injury. “Speech-language pathologists help people engage with the world around them,” remarked master’s student Cassie McGough; “AAC technologies support that work.”

AAC for all ages

At The University of Tulsa, students in the Department of Communication Sciences and Disorders have the opportunity to acquire essential AAC-related skills and knowledge through their coursework at both the undergraduate and graduate levels. Master’s students are also able to deepen their engagement with AAC by participating in a clinical practicum. In addition, TU is the only university in Oklahoma that delivers AAC assessments for community members who have complex communication needs, both children and adults. Graduate students conduct these through the on-campus Mary K. Chapman Speech & Hearing Clinic, and the hope is one day to be able to expand this service beyond the university.

One of the linchpins of the AAC training made available at TU is Clinical Assistant Professor of Speech-Language Pathology Ronda Marfechuk. Certified for the past 14 years as an assistive technology professional (ATP) by the Rehabilitation Engineering Society of North America, Marfechuk explained AAC as “an area of speech-language pathology that helps individuals who don’t have natural speech to communicate.”

In speech-language pathology treatments, she observed, AAC can be something as low-tech as a pen and paper, as medium-tech as a push-button device that speaks individual words or as high-tech as digital tablets not dissimilar from an iPad. “As technology advances,” Marfechuk said, “AAC tools are becoming smaller and contain more vocabulary and abilities in the area of eye gaze. Experiments are also now underway to develop switches that can read the brain in order to activate them and generate speech.”

Of course, the humans using and benefiting from AAC are the prime concern for speech-language pathologists. “Working with little ones who haven’t yet spoken, these devices are a way to enhance and support their language development,” McGough commented. Now in her final semester of graduate school, McGough is also passionate about hospice work at the other end of the life spectrum, and she noted that AAC technology can be a great help in that context. “For some hospice residents, the muscles that work to enable speech are very weak, which means they are unable to communicate their wants and needs. So, if they have a device they are able to activate to say ‘I love you’ to a family member or ‘I need my pain medicine’ to a nurse, that’s what AAC is able to accomplish.”

Clinical experiences and community service

One of the benefits of studying speech-language pathology at TU is the opportunity to engage in clinical experiences. For Marfechuk’s students, these include working with people who require AAC technology. Clinical observations and interventions take place at the university’s Speech & Hearing Clinic, which welcomes a wide variety of patients from age 2 to beyond 90. It also occurs within community organizations, such as The Little Light House and The Center for Individuals with Physical Challenges.

During the fall 2019 semester, for example, students in Marfechuk’s course on communication modalities and special populations spent five sessions working directly with children at The Little Light House. The sessions focused on teaching how to use AAC. Working in pairs, students also had the opportunity to do an evaluation for an AAC device, write a report and make recommendations based on their findings.

“A lot of time parents will feel defeated,” noted master’s student Claire Collard, “because they hadn’t expected to have a child who they will never hear say ‘I love you’ or even just a simple ‘I’m hungry.’ Being able to provide that bridge for parents – whether in the classroom, clinic or a place like The Little Light House – is amazing. It’s about helping parents form a bond with their children.”

Clarey Sharum, a speech-language pathologist at The Little Light House, emphasized the impact of the therapy and training sessions TU students delivered:

The Little Light House is fortunate to have an ongoing partnership with the TU speech-language pathology program. We are so grateful for the graduate students’ hard work and interest, as well as for their loving spirits, which they continually show toward our kiddos who require AAC assistance.

These emerging speech-language pathology professionals expertly helped the children develop their confidence and communication skills. In addition, their efforts and dedication provided the Little Light House with 10 completed AAC reports. Once these are submitted through the children’s insurance providers, it could allow several of them to receive their very own speech-generating device.

These AAC devices will certainly be life-changing to these children and their families. It will allow young people who do not have a voice to be able to walk down their school hallways greeting their teachers, expressing their needs in the classroom, engaging with their peers at lunchtime and much more.

Marfechuk underscored not only the importance of such clinical experience to the professional development of future speech-language pathologists but also the enthusiasm for and personal satisfaction her students derive from those encounters. “Indeed, most of our master’s students graduate with over the maximum number of required hours in clinical work,” she noted. “I’ve had a whole bunch of great experiences using AAC with my clients,” remarked one of those students, Elizabeth Dorre. “So many of my clients improve their communication using a device and I see so much satisfaction – even joy – on their faces when they are able to make a request or express an emotion. This makes me so motivated to keep going.”

AAC travels the Mother Road

Another sign of the vibrancy of AAC at TU is the decision to make these systems the focus of 2020’s annual Route 66 Conference on Communication Disorders (Feb. 28): Building Blocks for Successful AAC Intervention. Anna Petersen, the co-chair of this year’s conference and a fourth-year student in the undergraduate speech-language pathology program, commented, “I have seen firsthand how important AAC can be for clients who are not making the progress they need without additional tools and support. AAC opens the door for people who can’t use the typical speech pathways. As research and technology advance, AAC therapy techniques are only going to improve.”

The presenter for the 2020 conference is Trina Becker, an associate professor at Eastern Illinois University in the Department of Communication Disorders and Sciences, as well as the director of that university’s Speech-Language-Hearing Clinic. Commenting on the value of having such an expert lead the conference, Petersen noted, “I’m really excited that TU is hosting Trina Becker because she will be able to provide practical and meaningful training for implementing AAC with maximal results. I specifically hope to learn more about how to train communication partners because effective communication is, after all, a two-way street.”


Now’s a great time to explore a career as a speech-language pathologist. Check out TU’s renowned undergraduate and graduate communication sciences and disorders programs.