AAC research and practice

Stake of newspapers tied with rope

Last week I was grateful to be invited by the AAC journal club team to host a session which asked: What has changed with AAC technology and what next?

The AAC journal club is a lively forum where speech and language therapists come together to discuss chosen papers in the context of clinical work. In past years, therapists have informally met for discussions and after work drinks in some of the lovely pubs of Camden, London. In its online edition, attendees participated from all over the UK.

For the discussion, I chose four papers that have separately considered some of the complexities around adopting AAC technologies within people’s conversations and ultimately, within their lives.

Waller, A (2018) Telling tales: Unlocking the potential of AAC technologies. International Journal of Language and Communication Disorders, March/April 2019, Vol 54:2 159-169 doi: 10.1111/1460-6984.12449

Smith, M.M. & Murray, J. (2011) Parachute without a ripcord: The skydive of communication interaction. Augmentative and Alternative Communication, 27:4, 292-303, doi: 10.3109/07434618.2011.630022

Light, J., McNaughton, D., Beukelman, D., Fager, S.K., Fried-Oken, M., Jakobs, T., & Jakobs, E. (2019) Challenges and opportunities in augmentative and alternative communication: Research and technology development to enhance communication and participation for individuals with complex communication needs, Augmentative and Alternative Communication, 35:1, 1-12, DOI: 10.1080/07434618.2018.1556732

Ibrahim, S., Vasalou, A., Clarke, M. (2018) Design opportunities for AAC and children with severe speech and physical impairments. In Proceedings of the 2018 CHI Conference on Human Factors in Computing Systems, 227:1-227:13. CHI ’18. New York, NY, USA: ACM. https://doi.org/10.1145/3173574.3173801.*

*Note: Yes, this last one may appear like a shameless plug, but I was invited to talk about my paper and chose the other three articles as they offered related discussion points.

The discussions were incredibly stimulating and the best part for me was hearing from colleagues about their experiences of negotiating expectations about what communication therapy can and should entail. Some of the key take home from our discussions are summarised below. These are mainly reflections from how the discussions related to my own clinical practice.

  • In the past, I’ve spent a scandalous amount of time trying to operationally manage children’s AAC technologies (software updates, resolving tech issues, personalising vocabulary and symbol sets, reorganising screen layouts for access issues etc). Yes, these aspects are also a part of it, but they also take away from the valuable time that is needed to plan useful interventions that reflect the complexities of children’s lives.
  • Prioritising linguistic goals is undoubtedly important for supporting access to inclusion, but there is a balance to be struck. There are many other interactional and technological aspects that are in desperate need of attention.
  • Speech therapy interventions should prioritise autonomy. This is no different if working with very young children or adults. Choosing to focus on formal teaching contexts alone means that young adults leaving educational settings quickly find themselves with a limited set of resources that were context dependent from years gone by. Therapists have a key role in supporting people who use AAC to develop strategies and tools that advance agency to communicate with different people in different places.

Huge thank you to Clare Parsons, Ruth Carr and Samia Malik for coordinating the event and to all the SLTs who attended the session. I really enjoyed the discussion!

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Throughout 2021, a central part of my ESRC postdoctoral fellowship will be to disseminate the findings of my doctoral research that investigated communication involving children with severe speech and physical impairments and their social groups.

The aim is to share this work beyond academia so that the findings can be translated as meaningful insights for practice*.

I will focus on producing resources for three main communities:

  • Families
  • School and therapy teams
  • Industry

I’m really looking forward to creating and sharing these resources as well as holding events that will communicate some of the fascinating insights from empirical research. I hope that the findings will be useful in helping to consider the interventions and technologies we choose for supporting communication.

To access these resources and to hear about news and events held throughout 2021, please sign up to the project’s termly newsletter.

*Until now, and throughout the course of my PhD, the focus has been on sharing this research within academia through conferences and journal publications. A list of research outputs that were generated between 2015-2020 can be found in the work menu item.

Cultivating Care

photo of yellow green red and brown plastic pieces on surface that shows they are connected through a web

For the benefit of three years down the line, when the pace of London life will likely resume to ‘business as normal’, I’m writing this post as daily routines are disrupted, relations protracted, and thoughts linger a little while longer. Like many others who are reflecting on the social impact of the corona virus pandemic, the past few weeks have made me acutely aware of how care practices are being enacted right now; what this means for how care can be cultivated, and what I choose to leave behind.

In my PhD research, one of the most unanticipated insights was observing the ways that children with severe speech and physical impairments enacted care practices with others. Care was a key value, evident both through children’s forms of engagement and through the subject matter of what they communicated.

For instance, when children in my study spent time out of school or in hospital for extended periods, a networked arrangement of people, technologies, artefacts and processes all allowed for care to be enacted as an ongoing process. I watched as children repeatedly asked after their friends and made cards for them in their absence. ‘We miss you’ cards were physically created, electronically transported and digitally remade in new contexts. People, crafted materials and online platforms and processes all allowed for these co-created and ongoing practices to take place (see also Light & Akama, 2014 and Brown & Choi, 2018 for more discussion on designing for care).

Care was expressed through material objects, like decorating children’s belongings in their absence and making cards, but also by finding affinity in what children said they liked to do, by trading stories and creating common ground. Care was evidenced through closeness and touch; holding hands, leaning on each other, and perhaps most powerfully, being at another’s side.  

Fast forward to March 2020, I observe how similar arrangements are both cultivating and inhibiting care. Having spent the past two weeks largely by myself, my laptop and mobile phone have been a lifeline for care. Regular video and audio calls, messaging, exchanges of funny memes and videos, as well as daily YouTube yoga and mindfulness sessions, are all collaboratively practiced in one form or another. Added to this, in my working hours, regular video calls, emails, chat forums (and hopefully more social virtual coffee and lunch breaks) are all reinforcing networks of care in my daily routine, in the absence of closeness and touch.

What is less helpful, are those shared ‘beware’ threads and videos that are making their rounds. I appreciate that these are probably shared with all good intention, but they do nothing more than exacerbate panic and stress. No, I won’t keep my groceries outdoors for 5 days before bringing them in the house, nor will I use that 50% homemade Cypriot ‘zivania’ brandy I have in my cupboard to clean my worktops (I mean, seriously…).

Right now, I’m trying to turn down the volume of all that unnecessary chatter to learn from insights gained from children. Right now, I’m attending more to making care. Right now, I’m making in a physical sense and drawing on technology and networks to remake this in new and care-ful ways. I highly recommend it!

Transcription, representation and children’s voices

Image from British social reform newspaper, published 1869 - 1932


A large focus of my PhD work has been on finding ways of hearing and amplifying the voices of non-speaking children with physical disabilities. Generating children’s voices that are faithful to what children want to express about their values and priorities, as well as legitimately capturing how communication happens has been a central issue.


For a long time, I’ve thought the data that was generated has been so rich with many implications for design, education, therapy and more. Children’s meaning making practices revealed new complexities and highlight some of the incredibly strategic and expert ways that they achieved their communication goals. Finding ways of conveying this whilst keeping the data alive has been such a challenge. Of course, my interpretations have a big effect on shaping the findings, but regulating this interpretive effect and transcribing examples from the data that closer align with child centred accounts has been an enormous challenge.


The issue of transcription has been problematised in different fields with a growing concern for treating transcription as a form of transduction (Cowan & Kress, 2017), with the products of this work becoming documents (Cowan, 2017). As I attempt to ‘tie things together’ in writing up and working on my transcriptions, I’ve increasingly questioned how (and whether) my representations of the data are portraying what children appear to prioritise. I’ve taken a social semiotic multimodal approach to transcribing (Bezemer & Kress, 2016; Kress, 2010) that embraces the many different modes that people use, distributing value that is traditionally placed on speech. I’ve attempted to document simultaneous actions, structural arrangements, proximity, looking behaviours and other aspects through time marking, line drawings, emboldening text, and other ways. I imagine that this is not something I’m going fully address (or be happy with) through the PhD work but hopefully it will act as a starting point for the next bit!


Having not been satisfied with using tradition orthographic transcription methods that represent how communication is organised around talk, I’ve looked to other examples that deal with ways of representing people. Some of these cases are situated within academic research, for example Bezemer et al, 2011; Cowan, 2017; Mavers, 2011, others have been drawn from the art world.


I recently managed to visit the latest Van Gogh exhibition at the Tate Britain and despite the crowds, had the opportunity to ponder on how his works represent people. As the show focused mainly on the ways that Van Gogh was inspired by and inspired British artists, the show captured situated influences of the time, for instance, Charles Dickens and the British social reform newspaper ‘The Graphic’. The texts that accompanied art works describe how Van Gogh wanted artists to contribute to society through the ways in which they portrayed the people. Looking at some of the works as someone who is removed from the time and context within which they were produced, I was struck by the focus on struggle and angst. Offset against what is known about Van Gogh and mental illness, his works (and how they are curated) are designed to document these themes.

Image from 'The Graphic' newspaper. Exhibited at EY Van Gogh Exhibition at Tate Britain.
Image from British social reform newspaper, ‘The Graphic’ newspaper, published 1869 – 1932. Exhibited at EY Van Gogh Exhibition at Tate Britain.


Image of illustration and page from Charles Dickens' Hard Times
Illustration and page from Charles Dickens’ Hard Times





Image of sketch by Van Gogh titled 'Worn out'. Man leans on his knees holding his head in his hands, sitting on a wooden chair.
Vincent Van Gogh – Worn Out, 1881

In a related way, I’m constantly intrigued by how artists convey their mark in representing people. For instance, my drawing class teacher Frank Gambini (see: https://www.instagram.com/frankgambinoart/) has an alternative and somewhat stylised way of representing people that can appear shocking for the sitter. Other artists prioritise technical precision in figurative works, or alternatively use a multitude of techniques for hiding and revealing different foci (for example, Alain Urrutia’s works often deal with ways of concealing and exposing).

Portrait drawing of female face. Charcoal on paper
Frank Gambini, 2019

Portrait drawing of female face. Charcoal on paper
Alain Urrutia, 2017


These examples have somewhat strayed from the issue in question, which is: how do I go about capturing children’s voices? Well in a divergent way, I’m getting there.


Whereas the examples drawn from the art world have documented ways of representing by prioritising what the artist perceives as central in representation, I (as a social sciences researcher) have a different priority. For example, instead of foregrounding human struggle, people’s personalities or conveying my technical skill, my intended goal is to present what children appear to prioritise through their communication experiences. There may also be an element of wanting to convey technical skill (it’s an examined PhD thesis!), conveying children’s personalities, struggle, expertise and many other aspects too, as transcription does not happen in a vacuum.


On the matter of representation, I acknowledge that children’s voices are in dialogue with the voices around them. Through triangulation, different data sets are helping to confirm inductively generated ideas. This gradual movement between data and interpretation; as well as interpretation through documenting in different ways, is helping to build a picture that captures some of the complexities of what is happening and why this might be.




Bezemer, J, & Kress, G. R. (2016). Multimodality, learning and communication: a social semiotic frame. London ; New York: Routledge, Taylor & Francis Group.

Bezemer, J, Murtagh, G., Cope, A., Kress, G., & Kneebone, R. (2011). ‘Scissors, Please’: The Practical Accomplishment of Surgical Work in the Operating Theater. Symbolic Interaction, 34(3), 398–414. https://doi.org/10.1525/si.2011.34.3.398

Cowan, K. (2017). Visualising Young Children’s Play: Exploring Multimodal Transcription of Video-recorded Interaction (Doctoral thesis, unpublished). UCL Institute of Education, London, UK.

Cowan, K; Kress, G; (2017) Documenting and transferring meaning in the multimodal world: reconsidering “transcription”. In: Serafini, F and Gee, E, (eds.) Remixing Multiliteracies: Theory and Practice from New London to New Times. Teachers College Press: New York.

Kress, G. R. (2010). Multimodality: a social semiotic approach to contemporary communication. London ; New York: Routledge.

Mavers, D. (2011). Children’s drawing and writing : the remarkable in the unremarkable (1st ed). Retrieved from https://trove.nla.gov.au/work/37196806

A jack of all trades?

jack of hearts playing card on dark background

The start of the year proved itself to be an adrenaline (and coffee) filled journey of presenting my PhD project and discussing new directions with many people – old friends and new. It also coincided with a decision to take on more clinical work, at a point where I felt somewhat distanced from the children, families and colleagues who were so embedded in my life up until now. Having genuinely missed playing with children and getting my teeth into clinical decision-making dilemmas, I decided to do so, albeit in small doses. Whilst this was practically manageable, it also highlighted the disconnect between two very separate perspectives of my clinical and academic working life.

The primary focus of my clinical work has always been to look for barriers for communication in children’s lives at the impairment level and beyond. Academically, it has been more to do with looking for solutions that address things just as they are. Now, of course, clinically the next step would always be to begin to provide scaffolds, rehab, learning etc, that’s still the second step, having first dug deep to understand the nuances of difficulties at different levels. Conversely, the design-oriented, solution-focus perspective will also always look to understand barriers but the attitude with which investigating happens is different.

At the start of my studies, it was this disconnect that drove me to change my practice in the hope of bringing new solution-focused sensibilities to designing for communication involving children who have severe speech and physical impairments and their social groups. I’m now starting to think that perhaps there isn’t such a disconnect at all but just a need to tune down the saturation levels of both perspectives. There’s definitely merit in both ways of thinking, but as a clinician who is side-stepping into interaction design studies, I need to be aware of how much my judgements and reasoning can help or hinder the voices of children who are rarely heard in technology design.

At the CHI conference this year, our paper was part of the ‘designing to empower‘ session where, to my delight, I met two other speakers who were ‘clinicians-turned-HCI-researchers’ (is that a thing?)

I immediately hit it off with the wonderful LouAnne Boyd and we spent the coffee breaks and then afterwards many emails discussing parallel good points and challenges in our split working lives. Through the wonders of social media (yes, it worked out this time), I was then connected with Yao Du who went on to lead a reflective experience report the three of us wrote for this year’s ACM ASSETS conference. The whole thing has been pretty cathartic to say the least. Through our joint writing practice I’ve realised that in coming into HCI research from another discipline I’m not expected to be a jack of all trades. For example, it would be pretty comical for me to attempt to ‘programme’ in a computer science sense, I’ll stick to programming devices in the way we know it in speech therapy, thanks. Instead, in keeping my clinical identity whilst tuning down the saturation levels at times, I can draw on clinical reasoning and assessment skills to not give voice so much as amplify what children are already saying.

Here’s the link to the ASSETS paper:

From Behavioral and Communication Intervention to Interaction Design: User Perspectives from Clinicians



jack of hearts playing card on dark background

A video study on AAC use in conversations

line drawing of two girls facing each other with their eye gaze devices mounted in front of them. Their deivces are blocking their view of each other.


I’m so delighted to share details of my first full paper co-authored with Mina Vasalou and Mike Clarke. It’s to appear in the CHI 2018 proceedings and has been awarded an honourable mention.


Design Opportunities for AAC and Children with Severe Speech and Physical Impairments


My PhD project is loosely split into three slices which inform each other. The first slice investigates how high tech AAC devices are used in conversations involving children and adults in school, with design implications in mind. The second slice is exploring how communication manifests more broadly; with and without technology. The focus is on how children with severe speech and physical impairments communicate meanings about themselves and their lives. The third slice is looking at representing this information from a child-centred perspective with empathy. The broader goal is to generate a tool for design that prompts new ways of thinking about how digital technologies can advance communication. (wow. my whole phd in six sentences 😉 )


The paper documents the first part of the project, examining how communication is created when AAC is present. I focus on analysing video data from conversations in school involving five child participants, their peers and adults. Please get in touch to share your thoughts.


line drawing of two girls facing each other with their eye gaze devices mounted in front of them. Their deivces are blocking their view of each other.
‘AAC as a material object’

Theorising communication

Photo image of 'Brothers', a sculpture by David Breuer-Weil which depicts two figures leaning in and joined by the head. The sculpture is installation in the church gardens at St Pancras, London.



Since my last post, I’ve spent a considerable amount of time studying some of the different perspectives on communication. In a bid to understand how my own thoughts align with or differ from established theories I tentatively made a mental note of the assumptions I hold. Of course, my assumptions were initially overwhelmingly concerned with interpersonal communication (something to do with being a speech therapist, perhaps) but I also started to consider broader communication that departs from interpersonal interaction.


I’ve found myself dipping into all sorts of chapters, articles and discussions that somehow conceptualise the nature of communication, and to say that the proposed assumptions of others are poles apart would probably be something of an understatement. What started as a narrow(ish) literature search on theories of communication gradually evolved into philosophical minefield on the study of being. In an attempt to cap this somewhat I summarise some useful reflections on some of the different theories.


Linguistic theory prioritises how language functions. This is probably less useful for explaining how non-verbal children communicate. Having said that, Grice’s maxims and discourses on intention and politeness have some definite application for explaining conversational phenomena in all situations.


Work from the Bakhtinian circle offers insights for how social constructionism has developed. The idea that individuals have a uniqueness that is shaped by and shapes ‘being’ is interesting. Proposing both an active and passive participation in being implies that identity construction is shared by all. Also, the perceptions we bring to a situation impacts on how communication is achieved. In the context of the notion of ‘generationing’ of children, Alanen (2001) suggests that when constructions of ‘childhood’ change, constructions of ‘adulthood’ also change due to the internal relations between the two.


Whilst not directly referred to as constructivist at the time, Piaget’s studies were concerned with understanding how human beings know the world, empirically investigating the emergence and progression of knowledge through applying mental transformations in social environments. He proposed that knowledge develops overtime through processes of assimilation, accommodation and adaptation, terms commonly used in biology. He continued to describe that new neural pathways become shaped though interactions with the world, termed construction.


Studies of the naturalistic body have influenced work on the relationship between the body, self identity and society from a biological basis for example, work on gender and racial discourses. Whilst naturalistic approaches continue to exert influences for popular images of the human body to date, they are insufficient for understanding the social importance of the human body as they have largely treated it as ‘a receptor, rather than a generator, of social meanings and relationships’.


Foucault’s work had to be included somewhere. The idea that the body is influenced by external forces has widely been referenced. This has famously been depicted through the representation of the panopticon prison whereby a circular building of cells makes prisoners believe that they are always on surveillance from a central watch tower position. However, overlooking the discourses in which the body inhabits would take a disembodied perspective of the body’s existence which can’t explain lived experiences. Why is this relevant here? Well communicative acts of the body manifest in the context of other communicative acts.


In discussing the body, Haraway’s work cautions us to be mindful of dualisms that unduly separate constructions of reality from mind-related reality. This framing acknowledges that knowledge is socially constructed through contextualised embodiment.


Considering the embodied ways that meaning is made, Kress proposes social semiotics which is centred on how signs are constructed through form and meaning. Considering the resources that people use to construct signs, this perspective credits the many resources that are used (beyond words and speech).


In a separate direction of enquiry, Latour takes a non-anthropocentric perspective, reminding us of the processes of interaction with endless other materials beyond humans alone. There have been many recent applications of this for thinking about communication (e.g. internet of things). For situated communication involving children who have severe speech and physical impairments, beyond communicating with other people, material objects (everyday objects and ‘special’ assistive ones) hold communicative value.


I could continue with this reflection on perspectives as there are many others that I’ve missed, but I’ll stop there for now. I imagine my next post will be sooner than the last. I promise it will offer more clarity on how these perspectives have informed my analysis (-:


Photo image of 'Brothers', a sculpture by David Breuer-Weil which depicts two figures leaning in and joined by the head. The sculpture is installation in the church gardens at St Pancras, London.
Photo image of ‘Brothers’, a sculpture by David Breuer-Weil which depicts two figures leaning in and joined by the head. The sculpture is installation in the church gardens at St Pancras, London.