RESNA 26th International Annual Confence

Technology & Disability: Research, Design, Practice & Policy

June 19 to June 23, 2003
Atlanta, Georgia


 Kim D. Adams, Dana C. Corfield
EquipK.I.D.S. International, Toronto, Canada


Eight AAC devices were used for six months in a rehabilitation clinic for children in a developing nation, Peru. It was desired to learn what design criteria provides the most effective AAC device that clinicians and children will use on a daily basis for socialization and communication of needs. Thirty six questionnaires regarding several design criteria are summarized. A follow up study was performed six months later regarding device functionality, usage, and more detailed design criteria analysis. Several suggested design criteria are presented.


This is an ongoing cooperative project between a group of AT practitioners in the United States and a group of clinicians in a developing nation, Peru. The practitioners include engineers and speech language pathologists who are interested in designing an augmentative and alternative communication (AAC) device that could be fabricated and used in developing nations. The clinicians in Peru, with backgrounds in psychology and neuropsychology, are working with children who need multiple assistive technologies, including AAC, seating and mobility. The most common diagnoses are cerebral palsy (CP), traumatic brain injury and autism. The children stay in a clinic to receive rehabilitation therapy, which historically has entailed primarily physical therapy and some speech therapy. AAC has previously been non existent in Peru, except for the use of gestures. Until a recent shipment of wheelchairs, the children spent most of the day in their beds or on the floor.


What device design criteria must be included in an AAC device to be used with children with moderate to severe physical limitations in a developing nation? What criteria provide the most effective AAC device that children will use on a daily basis for socialization and communication of needs?



Seven children who have CP with moderate to severe physical involvement participated in the study. Children who could use their fingers for direct selection on a membrane keyboard or use their hands for switch selection of up to 8 switches were enrolled. Alternative access sites were not used. The children had normal visual, auditory, and language skills (receptive, comprehensive, expressive).

AT Intervention:

The devices which were introduced at the clinic are shown in the chart in the RESULTS section. All AAC devices used digitized speech to allow communication in the Spanish language with appropriate accents. All devices were portable and their cost ranged up to $450 USD.

The clinicians began using the devices with the children in January 2002. Any questions about the devices were handled via eMail in English through one of the clinicians. A visit by the US engineers and speech language pathologist was made to the clinic in April 2002.

The clinicians worked with the children in one on one sessions lasting 20 minutes to one hour. The devices were used for greetings, games, and to accomplish desired actions (I want chocolate).

Measurement Tools:

The design criteria that the clinicians rated are shown in the table in the RESULTS section. Criteria were rated as being excellent to very bad.

A year from the start date, a systematic review of the AAC devices was made. Four matrices regarding aspects of the devices were filled in:

  1. BASICS: battery type and quantity, instructions in English and/or in Spanish and/or on the back of the device, what options were provided, ie. additional frames and overlays.
  2. FUNCTIONALITY: Was the device presently working? If not, why? Was each feature working? How long do the batteries last?
  3. USAGE: Was the device being used by a child for communication or training, by the clinicians for assessment, by clinicians for demonstration? Had it been used? Experiences. Pros. Cons.
  4. DESIGN CRITERIA: The criteria regarded in the initial study have been placed into the following categories: effectiveness, affordability, reliability, portability, durability, securability, physical security, safety, learnability, comfort/acceptance, operability, maintenance/repairability (Lane et al. 1996). Additional aspects such as flexibility of inputs, error tolerance, etc., have been placed in the criteria matrix also. This matrix will be used later for a more detailed study regarding which design criteria have the most affect on usage.


A summary of the thirty six questionnaires is shown in the following table. 


The clinicians could not make the Talk Trac or Frame Talker work so they were virtually unused. Although the 32 Message Communicator was rated fairly durable, it was not functioning at the time of the year end follow up. Of the items asked by this questionnaire, sound quality and touch pad sensitivity were very important to the clinicians. Not covered by the questionnaire, but also of importance was access to a large vocabulary. Devices which allowed the children to change the levels on their own were preferred. Another important criteria arising in this initial study was tolerance for error.

The following list presents design considerations which stemmed from observations from the matrices.

  1. Few or no removable parts.
  2. Battery operated. If a charger is used, ensure it is rated for the local power supply.
  3. Use locally produced batteries.
  4. Use AA batteries because they are easily found.
  5. Consume very little power so batteries will last longer.
  6. Open the battery compartment without a special screwdriver, but still secure it for durability.
  7. Ensure parts (switch jacks, screws) are in the sizes used locally, imperial or metric.
  8. Put recording and usage instructions on the back of the device
  9. Have instructions in the local language.
  10. The device needs to be mountable and accessible.
  11. The devices need to be very easy to wipe clean with no small crevasses.
  12. Reliable. Local repair shops do not have the training to effectively repair electronic devices, plus, the quality of their parts is low.


By six months into the project, only one AAC device was used by the children, and it was only used when prompted. The main use the clinicians had for the devices was for motivating the children to communicate and for initial introduction to vocabulary. Because of the battery problems, and the fact that the children soon needed a larger vocabulary than the devices could provide, the clinicians abandoned the devices. The one device which could provide a large vocabulary was not reliable. The clinicians turned to making their own symbols on the computer and printing symbol books. They developed their own set of symbols because the symbol sets from the US were not culturally applicable. However, these symbol books have their limitations as well. It is difficult to make the books durable with local materials. Even though it is difficult and costly to deliver products between nations, they purchased some durable books from the US but their condition is also deteriorating due to rough use and drool. A serious limitation is that the clinicians are compromising between making a general symbol book, which is quick to print out, versus making a personalized symbol book, which is more appropriate for the child. Another limitation is that it is very expensive to purchase or refill color printer cartridges.

Hence, it seems there is still a place for AAC devices at the clinic in Peru. The project will be revitalized for two months with a new group of beginning augmentative communicators. Specific projects are planned such as performing plays and reading books using the devices. Previous limitations have been addressed, such as, the children now have personalized wheelchairs that devices can be mounted on, there is a technical person to maintain the devices, and other strategies such as having instructions and batteries on hand will be put in place.

From initial observations, it can be seen that an AAC device must have the criteria shown above. Further information will be available after the next two month project and the detailed analysis of the criteria matrix.


  1. Lane, J.P., Usiak, D., & Moffat, J.A. (1996). Consumer criteria for assistive devices: Operationalizing generic criteria for specific ABLEDATA categories. Proceedings of the RESNA '96 Annual Conference Arlington, VA: pp. 146-148.
  2. MinspeakTM is a registered trademark of Bruce Baker.


WorldVOCA for the generous donation of the AAC devices and Hope Haven International for the generous donation of the wheelchairs.


Kim Adams
EquipK.I.D.S. International,
63 Burrard Road,
Toronto, Ontario M9W 3T4

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