JCPSLP Vol 21 No 3 2019

Multimodal communication

An exploration of multimodality in augmentative and alternative communication Teresa Iacono

The aim of this paper was to trace the evolution of how multimodality has been considered in the field of augmentative and alternative communication (AAC) and the potential implications for clinical practice. Early reference to the notion of multimodality appeared to reflect concerns about AAC decision-making that resulted in recommendations for single modality systems and the exclusion of people from AAC interventions. Providing people with AAC, regardless of their underlying symbolic capacity, has been a reaction to the rejection of a candidacy model and the adoption of the participation model. However, a potential danger may arise from expecting individuals who are pre-intentional to acquire symbolic skills. In line with the participation model, AAC can be used appropriately for these individuals for mediating responses from people in their social environments, while providing opportunities for symbol communication. T he terms multimodality and multimodal communication have become so ubiquitous in speech-language pathology (SLP), and more broadly, communication disorders literature and practice, that there seems little reason to explore the concept. Yet the growing use of the term speaks to an ongoing evolution of the profession’s understanding of communication disorders and scope of practice, and the role of augmentative and alternative communication (AAC) in supporting the Classification of Functioning, Disability and Health (World Health Organization, 2001), SLP has extended its focus over the years from reducing impairment, such as through developing or restoring speech and language, to improving function and participation, and considering contextual environmental and personal factors in assessment, goal- setting and intervention practices (Speech Pathology Australia, 2017). This focus is particularly evident in the field of AAC, in which the notion of communication in any and communication of individuals with varied needs. As a profession influenced by the International

all modalities that are available to the individual has been embraced. Hence, in AAC, multimodal has come to include all forms of conventional communication: speech, signs, well-recognised gestures, graphic symbols, and traditional orthography (Speech Pathology Australia, 2012). It has also come to encompass informal and less conventional forms; examples are idiosyncratic gestures and behaviours, facial expression, vocalisations, and even problem behaviours (Speech Pathology Australia, 2012). And of course, there is overlap across formal and informal modalities. Deaf sign language across countries, including Auslan, is a case in point in that facial expression and directionality add linguistic information to the handshape, location and movement of individual signs (Musselwhite & Louis, 1988). Despite widespread and perhaps intuitive understanding of what multimodality means and comprises, SLP appears to have embraced the concept and practice in only relatively recent times. Multimodal communication as a term did not appear in the 2015 revised SLP scope of practice (Speech Pathology Australia, 2015). It did appear in the revised 2017 version of the document identifying competencies and standards expected of people entering the profession: that is, entry-level Competency Based Occupational Standards (Speech Pathology Australia, 2017). This change may have arisen because of the inclusion of AAC as a form of multimodal communication in a clinical guideline developed to assist SLPs to use evidence-based approaches to design and implement AAC for clients with complex communication needs (Speech Pathology Australia, 2012). The question is: why did this change come about? Exploration of the evolution of multimodal concepts within the field of AAC and how it has come to inform practice, perhaps, at times with some confusion and misunderstanding, may offer some insights. The aims here were to trace how understanding multimodal communication has evolved in the field of AAC and to address potential misperceptions that could have implications for clinical practice. Multimodal as more than one type of AAC Within the AAC literature, the term multimodal appeared in early discussions and research into the benefits of using more than one type of AAC in an effort to counter practices that appeared to favour single systems. Survey research conducted across United Kingdom (UK) schools for children with severe intellectual and physical disability, and autism,

KEYWORDS AUGMENTATIVE AND ALTERNATIVE COMMUNICATION CLINICAL DECISION- MAKING COMPLEX COMMUNICATION NEEDS MULTIMODAL THIS ARTICLE HAS BEEN PEER- REVIEWED

Teresa Iacono

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JCPSLP Volume 21, Number 3 2019

Journal of Clinical Practice in Speech-Language Pathology