RESNA 26th International Annual Confence

Technology & Disability: Research, Design, Practice & Policy

June 19 to June 23, 2003
Atlanta, Georgia

A 15-year Retrospective Study of the Outcomes of Students with Severe Speech and Physical Impairment who Use AAC

Mary Hunt-Berg, Ph. D., CCC-SLP & Christine Toomey, M. S.
The Bridge School
Hillsborough, CA 94010


This session presents results of a retrospective study examining AAC and assistive technology use patterns and long-term outcomes for former students at the Bridge School. The Bridge School provides intensive AAC, assistive technology, and educational support services to school-aged children with severe speech and physical impairment. This presentation will share results of data analyzed from archived school records, interviews with former students and families, and several outcome measures and will address past and current patterns of AAC and assistive technology use, satisfaction with Bridge School services, current communication partners and environments, quality of life, and self-determination.


The field of augmentative and alternative communication (AAC) urgently needs outcome data to ensure accountability, justify costs, and to strengthen our scientific foundation for clinical practice (e.g., 1). For a number of reasons, outcomes research in the area of assistive technology, including AAC, lags behind this type of research in other rehabilitation-related areas (2). The variability of devices and services provided, range in stakeholder perspectives and levels of accountability, difficulties of initiating outcomes research in a clinical setting, and a lack of appropriate outcome measurement tools are some of the reasons cited for limited outcome data in AAC.

For the past fifteen years, the Bridge School, a nonprofit organization in the San Francisco Bay Area, has provided educational, AAC, and assistive technology services to school-aged children with severe speech and physical impairment. Bridge School is a full time transitional placement, and a primary student-centered outcome targeted by Bridge School is the development of function, particularly in the area of communication. The Bridge School also aims to make positive impacts on less direct outcome domains including quality of life. Each student at Bridge School has individualized goals designed to achieve the following:

Individuals who use AAC communicate using multiple modalities, both aided and unaided, during communicative interactions. To achieve their goals, intervention at Bridge School incorporates a range of assistive technology approaches for communication, education, and social participation. Upon achievement of these goals, students return to their respective local school district to continue their education with support from Bridge School staff as needed. Over the years, former students and their families anecdotally have reported a range of long-term outcomes, both positive and negative.

This presentation is based on a larger study looking at a range of long-term outcomes of former Bridge School students. In the past year, Bridge School's Board of Directors sponsored a retrospective study to gain a better understanding of its programming variables over the past fifteen

years with a range of students with severe speech and physical impairment and to measure former student long-term outcomes. These data will be used to inform its own clinical practices and to increase accountability in future years, and to provide useful long-term outcome data for broader dissemination in the AAC field.

Research Questions


Twenty-eight former Bridge School students and their families were invited to participate in the study. Of the sixteen families who responded to the introductory letter, 15 consented to participate. Former students ranged in age from 9 to 25 years. All have a diagnosis of cerebral palsy and severe speech and physical impairment. Descriptive data from three data points (first and last years at Bridge, follow-up) will be summarized for each former student in domains of speech, receptive and expressive language, cognition, and other skill areas related to communication using the following data collection methods:

  1. Archival data review - Archival data sources include documents (student annual individual education plans, assessment reports, progress reports) and other records such as student work samples or overlays from communication devices. An electronic database was developed using Filemaker Pro to capture relevant variables from the clinical records for greater ease of examination. Selective data entry was conducted by trained professionals (one special educator and three speech language pathologists) each having over 5 years of experience working with students who use AAC in special education settings. Both student descriptive variables and Bridge School program variables were of interest for this study. Student descriptive variables included diagnoses, developmental and skill levels reported, communication modalities and AAC technologies, selection techniques, representational strategies used and communication partners reported. Bridge program variables included number of years each student attended Bridge, classroom description, communication goals, objectives, technologies, and types and levels of services provided.
  2. Follow-up Interviews- A combination of interviews and measurement tools were selected and administered based on their sensitivity to the types of AAC outcomes targeted by Bridge School. Open-ended participant and family interviews are being conducted to gather information regarding current educational and vocational placements and services received. Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners (3) was used to gather data regarding current participant skill profiles, communication modalities and technologies used, and communication partners. The Quality of Life Profile for People with Physical and Sensory Disabilities (4) was administered. This tool measures quality of life across a number of domains. In addition, former students, a family member and paid professional (e.g., current speech pathologist) are interviewed using Social Networks. Self-determination was measured using ARCs Self-determination Scale (5).


Data collection and analyses is ongoing. Currently (11/02) preliminary data analyses for 8 of the 15 participants is complete. We expect all data collection to be completed for all participants by early March 2003 and analyzed by April 2003. Preliminary analyses reveal the changing nature of available assistive technologies and related goals and services over the 15-year period. A range of quality of life scores associated with positive perceptions by students and families will be discussed. Preliminary analyses of Social Networks data indicates that students continue to use a range of AAC technologies in interactions with some, but not all, partners in their respective educational and vocational settings, e.g., most students do not use AAC technologies with their most familiar communication partners, but use AAC technologies consistently for interactions in other situations. Preliminary analyses also indicate positive levels of satisfaction with assistive technologies and services provided by Bridge School.

In reporting these data, researchers recognize the limitations of a retrospective outcomes study (e.g., 6). Because of the retrospective nature of this study, it was not possible to determine direct impacts of specific AAC technologies and services on various outcomes and measures must be interpreted cautiously. Even so these data provide important insights in the areas of assistive technology use over time, functional communication, clinical status, satisfaction with the outcomes of services and perceived quality of life and self-determination of a group of individuals who participated for at least three years in an intensive educational program designed to optimize the use of AAC technologies to enhance communication and access to education. In presenting these data, researchers will include both group data and individual case examples in an effort to describe the outcomes of former Bridge School students. Finally, researchers will describe how this study has informed and influenced the ongoing prospective longitudinal study of assistive technology outcomes also currently underway at the Bridge School.


  1. DeRuyter, F. & Jutai, J. (2002). Assistive Technology/AAC Outcomes. 2002 Interactive Webcast Series in AAC, Nathaniel H. Kornreich Technology Center, May 30, 2002.
  2. DeRuyter, F. (1997). The Importance of outcome measures for assistive technology service delivery systems. Technology and Disability, 6, 89-104.
  3. Blackstone, S. W. & Hunt-Berg, M. (2002). Social Networks: A Communication Inventory for Individuals with Complex Communication Needs and their Communication Partners. Monterey: Augmentative Communication, Inc.
  4. Renwick, R., Rudman, R., Raphael, D., Brown, I. (1998). Quality of Life Profile: People with Physical and Sensory Disabilities. Toronto, Canada: University of Toronto.
  5. Wehmeyer, M.L., & Kelchner, K. (1995). The Arc's Self-determination Scale. Arlington, TX: The Arc National Headquarters.
  6. Fuhrer, M. J. (1999). Assistive Technology Outcomes: Impressions of an Interested Newcomer. Paper presented at the International Conference on Outcome Assessment in Assitive Technology, Oslo, Norway.
RESNA Conference Logo