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Survivors of traumatic brain injury (TBI) use augmentative and alternative communication (AAC) to compensate for communication impairments. However, various cognitive impairments resulting from TBI affect AAC intervention and, thus, require special consideration. The purpose of this article is to address four areas that professionals who provide AAC may need to consider as part of their service provision to people with TBI: (a) the evolution of AAC use during the recovery process, (b) the effect of cognitive impairments on multimodal communication, (c) appropriate message representation, and (d) difficulties with AAC navigation resulting from cognitive impairments. Finally, this paper provides some suggestions and some areas of future research related to survivors of TBI use of AAC.

Instructing individuals with aphasia in the usage of AAC strategies and devices is a challenging endeavor. Not only does this population present with a wide range of linguistic impairments, but many individuals also demonstrate cognitive deficits, which may adversely affect communication. This paper will summarize the wide variety of cognitive deficits demonstrated by individuals with aphasia, specifically attention, memory and executive functioning problems. In addition, we will review the impact of these cognitive impairments on communicative competence. Finally, we will discuss an intervention, the Multimodality Communication Training Program (MCTP), designed to address the cognitive impairments that influence AAC intervention.

Eye control and switch scanning are commonly considered as augmentative and alternative communication (AAC) access options by people with amyotrophic lateral sclerosis (ALS) at the same clinical intervention point. Choosing optimal access methods must be supported by performance and qualitative feedback, as well as considerations of cognitive changes sometimes associated with ALS. We present quantitative and qualitative data comparing access methods used by five people with ALS and five adults without ALS. Each participant accessed an on-screen keyboard during repeated exposure to two conditions: single switch scanning and eye control. Participants were required to copy sentences presented on a computer screen. Keyboard letter organization was held constant between conditions, and rate enhancement and word prediction techniques were not used. Measures of speed and accuracy revealed a significant speed advantage for eye control and a significant accuracy advantage for single switch scanning. Speed and accuracy for both access methods improved with practice. Predictably, people with ALS performed significantly slower than participants without ALS using both access methods. Participants rated eye control as the more efficient access method overall. Participants without ALS rated both access methods significantly more fatiguing than people with ALS. Post study interviews revealed that eye control was the preferred access option for people with ALS. Clinical implications and extensions of this study are discussed.

This article describes the timing of AAC in the rehabilitation of individuals with acquired cognitive-linguistic deficits. Core concepts surrounding the timing of remediation and compensatory rehabilitation programs are explored including mutual exclusion, the perception of "giving up," acceptance, fear of permanency, and the definition of compensation. A hybrid approach to rehabilitation, which encompasses both remediation and compensation, is proposed.