Teleintervention for users of augmentative and alternative communication devices: A systematic review

Speech-language skills predict independent living, education, social participation, and employment opportunities. Individuals with complex communication needs often rely on augmentative and alternative communication (AAC) devices to support communication, language, and literacy development. Early and continuous provision of speech-language pathology (SLP) services is essential for assessments and tailored interventions. Access to SLP services can be challenged by numerous barriers, including the more recent COVID-19 pandemic that urged the shift to remote delivery of care, i.e. teleinterventions. Synthesized insights on the provision of tele-AAC interventions were lacking, thus making this shift less straightforward for clinical practice and families.

To address this gap, this study reviewed the existing evidence on the efficacy of tele-AAC interventions provided remotely by clinicians or researchers. Key aspects include intervention setup, AAC technology, outcome measures, procedural modifications, satisfaction, and risk of bias. The review included six studies with 25 participants, varying in diagnosis and age. Two studies used real-time (active) consultation between senior clinicians and pre-professionals, two conducted functional communication training for children with autism, one explored tele-brain–computer interface and one compared tele-AAC with in-person interventions. Outcome measures included independent use of an AAC device, increased number of produced phrases, and successful replacement of idiosyncratic communication with AAC.

Tele-AAC interventions, regardless of delivery method, appear feasible and as effective as in-person interventions across different ages and diagnoses. Functional assessments before and procedural modifications during the intervention are essential for a tailored approach that considers individual needs and capabilities. Caregivers play a critical role in successfully implementing tele-AAC interventions, thus, pre-intervention training is important to ensure high fidelity and minimize burden.

Although with great potential to expand the reach and provide continuity of care, tele-AAC interventions are scarce, with weak to moderate quality and a high risk of bias. Future research with a larger, diverse sample and stronger methodology is recommended.