The extent of motor impairment is heterogeneous in the Rett syndrome population. Examples include communication books and choice boards (Ganz et al., 2013, 2014 Reichle et al., 2019 Simacek et al., 2016). Low-tech AAC does not include any electronics. Mid-tech AAC (e.g., microswitches) includes some speech-output technologies but lack certain features found in high-tech devices, such as text-to-speech and sentence construction. High-tech devices allow for computer interface and involve digitized or synthesized speech. High-tech AAC includes speech-output technologies, such as Tobii devices activated by eye-gaze as well as iPads or tablets activated manually on touch screens. AAC materials vary in their level of technological advancement (i.e., low-, mid-, and high-tech Reichle et al., 2019 Simacek et al., 2016). Previous studies on communication interventions have incorporated a variety of AAC modalities for individual participants with Rett syndrome (e.g., Byiers et al., 2014 Sigafoos et al., 1996 Simacek et al., 2016 Stasolla et al., 2014 see Amoako & Hare, 2020 and Sigafoos et al., 2009 for a review). Aided AAC includes using materials or devices as a tool for producing functional communication (Ganz et al., 2013, 2014 Reichle et al., 2019). ![]() Although some individuals with Rett syndrome do retain some speech (Bartolotta et al., 2011 Zappella et al., 2001), most typically lose almost all abilities to use natural speech (Bartolotta et al., 2011 Byiers et al., 2014 Sigafoos et al., 2009) thus, individuals with Rett syndrome would benefit from acquiring the ability to use augmentative and alternative communication (AAC) (Sigafoos et al., 1996, 2009 Simacek et al., 2016) to communicate with communication partners, such as family members, teachers or caretakers, and other community members.ĪAC involves various levels of support to individuals who need either a supplement to or replacement for natural speech. The prevalence of Rett syndrome is about one in every 10,000–15,000 girls (Amir & Zoghbi, 2000 Ellaway & Christodoulou, 2001). Rett syndrome is characterized by a regression period in early childhood, typically resulting in severe impairments in communication and motor skills (Amir & Zoghbi, 2000 Ellaway & Christodoulou, 2001 Hagberg, 1985 Hagberg & Zoghbi, 2002 NINDS, 2023). Rett syndrome is a rare neurodevelopmental disorder associated with a mutation in the X chromosome that primarily affects females. This paper is a companion to Girtler et al. Implications for future research and practice pertaining to AAC of individuals with complex communication needs are discussed. Each participant exhibited idiosyncratic response patterns in terms of use of their high- and low-tech AAC modalities during instruction but ultimately demonstrated the ability to use both modalities to make requests. Parents conducted all sessions with remote coaching from a research assistant via telecommunication. For all participants, the number of sessions to criterion and cumulative number of trials with independent requests during simultaneous or alternating instruction in the use of a high- and low-tech AAC modality were investigated. The purpose of the current study was to investigate the use of high- and low-tech AAC modalities by three individuals with Rett syndrome given similar instruction for using both modalities. ![]() The vast majority of individuals with Rett syndrome do not utilize natural speech and therefore require alternative and augmentative communication (AAC).
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