Giving a voice to individuals with apraxia of speech
AAC in apraxia of speech
AAC Gives People a Voice While Speech Develops
For some people with speech apraxia, knowing what they want to say is much easier than physically producing the words. Augmentative and Alternative Communication (AAC) provides another way to communicate while speech skills are developing or when speech is difficult to understand. AAC can include gestures, signing, communication boards, pictures, written language, apps and speech-generating devices.
AAC Does Not Mean Giving Up on Speech
Introducing AAC does not mean that speech therapy stops or that someone has “failed” to develop speech. AAC can be used alongside motor-speech therapy. The aim is to give the person an effective way to communicate now while continuing to develop their speech where appropriate. ASHA specifically identifies AAC as part of communication intervention for people with Childhood Apraxia of Speech (CAS).
AAC Can Support Language Development
A person may have much more to communicate than their speech currently allows them to express. AAC provides opportunities to practise vocabulary, combine words, ask questions, comment, tell stories and take part in conversations. This is particularly important when severe speech difficulties might otherwise restrict opportunities to develop and demonstrate language skills.
AAC Can Reduce Communication Frustration
Being repeatedly misunderstood can be extremely frustrating. AAC gives the person another way to make their needs, thoughts, choices, and feelings understood. It can also provide a way to repair a conversation when speech is unclear. The goal is not simply to request things, it is to enable the person to participate more fully in everyday communication.
AAC Can Be Used Alongside Speech
Communication does not have to be either speech or AAC. A person might say a word, point to a symbol, use a gesture and select words on a communication device within the same conversation. AAC can supplement speech when speech alone is not sufficient. Current research specifically examining children with CAS describes AAC as having a complementary role in their management, with early AAC intervention potentially improving communication outcomes.
AAC Should Be Considered Early
A person does not need to reach a particular age or demonstrate that speech therapy has “failed” before AAC can be considered. AAC can be introduced when speech is not currently meeting the person's communication needs. The appropriate system will vary between individuals and should consider their communication, language, motor, sensory, cognitive and everyday participation needs. AAC should therefore be viewed as another route to successful communication—not as a last resort.
AAC Organizations
ACE centre
UK charity specialising in AAC and assistive technology, including assessment, advice, training, resources, and specialist support.
Website:
https://acecentre.org.uk/
Resources:
https://acecentre.org.uk/resources
AAC Language Library:
https://acecentre.org.uk/language-library
Training:
https://acecentre.org.uk/learning
Communication Matters
The UK branch of ISAAC supporting AAC users, families, and professionals through information, advocacy, research, and events.
Website: https://www.communicationmatters.org.uk/
AAC information: https://www.communicationmatters.org.uk/about-aac-systems/
ISAAC – International Society for Augmentative and Alternative Communication
International organisation bringing together AAC users, families, clinicians, researchers and organisations.
Website: https://isaac-online.org/
AAC resources: https://isaac-online.org/english/about-aac/aac-resources/
CALL Scotland / AAC Scotland
Provides AAC, assistive technology, accessible learning information, training, and support.
CALL Scotland: https://www.callscotland.org.uk
AAC Scotland: https://www.aacscotland.org.uk
Training:
https://www.callscotland.org.uk/training/
Webinars:
https://www.callscotland.org.uk/professional-learning/webinars/
RCSLT – AAC Clinical Information
RCSLT – AAC Clinical Information
Professional clinical information and guidance relating to AAC.
Free AAC resources
Global Symbols
Provides AAC symbol resources designed to support different languages, cultures and communication systems, alongside free AAC learning materials.
Website:
https://globalsymbols.com/
Training resources:
https://globalsymbols.com/about/training-resources
Training platform:
https://training.globalsymbols.com
PrAACtical AAC – Stepping Into AAC
A free structured programme helping families and communication partners introduce AAC and use modelling in everyday situations.
Main site:
https://praacticalaac.org/
Stepping Into AAC:
https://praacticalaac.org/stepping-into-aac-home/
Embedded YouTube video: I would verify a specific PrAACtical AAC video before embedding it.
AAC in the Cloud
AssistiveWare Free AAC Resources
A free online AAC conference with a substantial archive of presentations covering AAC practice, research, technology and lived experience.
Website:
https://www.aacconference.com/
Past sessions:
https://www.aacconference.com/past_sessions.html
AssistiveWare Free AAC Resources
AssistiveWare Free AAC Resources
AssistiveWare Free AAC Resources
Articles, communication boards, modelling guidance, webinars and practical AAC support.
https://www.assistiveware.com/resources
Sensory App House – PiCom
AssistiveWare Free AAC Resources
Sensory App House – PiCom
Free picture-based AAC software with text-to-speech and recorded voice options.
https://www.sensoryapphouse.com/getpicom/
Project Core
AssistiveWare Free AAC Resources
Sensory App House – PiCom
Provides free Universal Core Vocabulary communication systems, implementation resources and professional-development materials.
Website:
https://project-core.com
Communication systems:
https://project-core.com/communication-systems/
Quick Start Guide:
https://project-core.com/quick-start-guide/
Professional development:
https://project-core.com/professional-development-modules
AAC Technology & Access
Tobii Dynavox
Tobii Dynavox
Tobii Dynavox
Speech-generating devices, TD Snap, Boardmaker, eye gaze and alternative access technology.
Website: https://www.tobiidynavox.com/
UK website: https://uk.tobiidynavox.com/
Resource Centre: https://www.tobiidynavox.com/pages/resource-center/
Smartbox
Tobii Dynavox
Tobii Dynavox
Grid software, Grid Pad communication devices, eye-gaze systems and alternative access.
Website: https://smartboxaac.com/
Support for professionals: https://smartboxaac.com/aac-for-professionals/
Try Grid: https://smartboxaac.com/try-grid/
AssistiveWare
Tobii Dynavox
AssistiveWare
Developer of Proloquo and Proloquo2Go.
Website: https://www.assistiveware.com/
AAC learning: https://www.assistiveware.com/learn-aac
CoughDrop
Pretorian Technologies
AssistiveWare
Cross-platform AAC software with communication boards and cloud-based team support.
Website: https://www.coughdrop.com/
Support: https://www.coughdrop.com/learn
Sensory App House
Pretorian Technologies
Pretorian Technologies
Developer of PiCom, Sensory Boards and switch-accessible applications.
Website: https://www.sensoryapphouse.com/
PiCom: https://www.sensoryapphouse.com/getpicom/
Sensory Boards: https://boards.sensoryapphouse.com/
Pretorian Technologies
Pretorian Technologies
Pretorian Technologies
Switches, switch interfaces, voice-output communication aids and alternative access equipment.
Website: https://www.pretorianuk.com/
AAC device accessories: https://www.pretorianuk.com/aac-device-accessories/
Media resources: https://www.pretorianuk.com/media-resources/
Training & CPD
Ace Centre Learning
Tobii Dynavox Learning Hub
Tobii Dynavox Learning Hub
Training in AAC, Assistive Technology, access, communication partner skills and implementation.
https://acecentre.org.uk/learning
YouTube: https://www.youtube.com/user/acecentre
Tobii Dynavox Learning Hub
Tobii Dynavox Learning Hub
Tobii Dynavox Learning Hub
AAC courses, webinars, product training, assessment resources and professional learning.
Training: https://uk.tobiidynavox.com/pages/training
Learning Hub: https://learn.tobiidynavox.com/catalog
Smartbox Academy
Tobii Dynavox Learning Hub
AssistiveWare AAC Learning
Free and paid AAC education covering Grid, implementation, access, literacy and communication partner skills.
https://smartboxaac.com/ukie/smartbox-academy/
AssistiveWare AAC Learning
AssistiveWare AAC Learning
AssistiveWare AAC Learning
Free learning covering AAC modelling, communication partners, vocabulary, literacy, and AAC implementation.
https://www.assistiveware.com/learn-aac
Global Symbols Training
AssistiveWare AAC Learning
Global Symbols Training
Free AAC and Assistive Technology learning modules.
https://globalsymbols.com/about/training-resources
Training platform: https://training.globalsymbols.com
CALL Scotland Training
AssistiveWare AAC Learning
Global Symbols Training
Professional learning around AAC, Assistive Technology and accessible education.
https://www.callscotland.org.uk/training/
Free webinars: https://www.callscotland.org.uk/professional-learning/webinars/
CENMAC
Stepping into AAC
AAC in the Cloud
Assistive Technology and AAC support with online training for professionals.
Website: https://cenmac.com/
AAC modelling training: https://cenmac.com/online_training/modelling-aac/
AAC in the Cloud
Stepping into AAC
AAC in the Cloud
Free AAC conference and recorded professional development presentations.
https://www.aacconference.com/
Past sessions: https://www.aacconference.com/past_sessions.htmls.
Stepping into AAC
Stepping into AAC
Stepping into AAC
tepping into AAC - Angelman Syndrome Foundation
Great podcast discussing using gestures along with AAC
S7 E7: Early Intervention Featuring Erin Sheldon | Awe and Wonder Podcast: AAC & AT
Types of AAC
Object symbols
Real objects or miniature objects can represent activities, people, places or choices. These may be useful for individuals who need highly concrete representations.
Photographs and picture symbols
Pictures can be used individually, on communication boards, in books or on visual displays.
Communication boards and books
A person points to words, letters, photographs or symbols to communicate.
Picture exchange
A person gives or selects a picture or symbol to communicate a request, comment or other message.
Written communication
Writing, typing, alphabet boards, whiteboards, tablets and phones can provide effective AAC for people with sufficient literacy skills.
Single-message voice output devices
A button plays a prerecorded message. These can be useful for participation, turn-taking and predictable communication opportunities.
Multi-message devices
Several buttons provide access to different recorded words or messages.
Dynamic-display speech-generating devices
Touchscreen AAC systems can contain hundreds or thousands of words. Selecting a symbol or word produces speech and may open further vocabulary pages.
Text-based AAC
Text-based AAC
Some people with acquired or progressive speech apraxia may prefer systems centred on typing, prediction and text-to-speech rather than symbols.
Sign language-Choosing and Using Signing Approaches
Why Sign Language May Help
This section includes standard signing,
tactile and adapted signing approaches which may support people with apraxia of speech who also have hearing, vision, or other sensory needs. They can help with understanding, expressing choices, and everyday participation. They support communication rather than treat apraxia itself.
Choose approaches around the person’s abilities, preferences, and comfort with touch, alongside speech therapy and other communication tools.
They give an individual with apraxia of speech a way of communicating that can be used alongside or instead of speech.
Understanding the Different Approaches
Sign Languages
British Sign Language (BSL), American Sign Language (ASL), and Irish Sign Language (ISL) are distinct languages with their own grammar, vocabulary, and communities. Sign language is not universal.
Signing to Support Spoken Language
Sign Supported English, Makaton, and Signalong use signs alongside spoken language. These approaches serve different purposes from a full sign language.
Tactile Communication
Some people access communication through touch. Options include on-body signs, tactile signing, and alphabets communicated through the hands.
Understanding and Expression
Receptive communication means understanding another person’s message. Expressive communication means communicating your own thoughts, feelings, choices, and needs. Consider both when planning support.
Choosing an Approach and Respecting Choice
Start With the Person
Consider their preferences, language, hearing, vision, movement, sensory needs, and existing communication methods. A diagnosis alone does not determine the most suitable approach.
Communication Partners and Community
Consider the languages and approaches used by family, friends, school, and the wider community. A Deaf person’s access to a full sign language and Deaf community should remain part of planning, including when they have additional disabilities.
Touch, Consent, and Bodily Autonomy
Explain and offer touch in an accessible way. Respect withdrawal, discomfort, and refusal. A lack of resistance should not be treated as agreement. Seek specialist guidance where preferences are difficult to interpret.
Professional Support
Involve the person and their communication partners. Relevant specialists may include a speech and language therapist, Teacher of the Deaf, Qualified Teacher of the Visually Impaired, and deafblind communication specialist.
Use More Than One Method
Signing can sit alongside speech, writing, objects of reference, photographs, symbols, Braille, or communication devices. The aim is reliable understanding and expression across everyday situations.
British Sign Language — BSL
Sign Supported English — SSE
What Is BSL?
BSL is a natural visual language used by Deaf communities in Britain. It has its own grammar and uses hand movements, facial expression, and body movement.
How It Works
BSL supports understanding and expression, including full conversations, learning, relationships, and abstract ideas. It also has regional variation.
Important Considerations
BSL is different from signing English word for word. It is also distinct from ASL and ISL. Look for learning opportunities connected to qualified teachers and Deaf communities.
Further Information
British Deaf Association:
Sign Supported English — SSE
Sign Supported English — SSE
Sign Supported English — SSE
What Is SSE?
SSE combines spoken English with signs drawn from BSL, following English word order. Not every spoken word needs to be signed.
How It May Help
It can make spoken communication more visual and support communication between people using English and signs.
Important Considerations
SSE is not a separate language and does not use BSL grammar. It should not be assumed to provide the same language access as fluent BSL.
Further Information
National Deaf Children’s Society:
Makaton
Sign Supported English — SSE
Sign Supported English — SSE
What Is Makaton?
Makaton is a communication programme combining signs, symbols, and speech. It is used by children and adults with a range of communication needs.
How It Works
Signs and symbols support key information in spoken-language order. They may help a person understand messages and express themselves.
Important Considerations
Makaton includes more than signing. Symbols can help someone who cannot sign or prefers another method. UK Makaton draws on BSL signs; programmes in other countries may use their local sign language.
Further Information
The Makaton Charity:
What Is Makaton?
Makaton is a communication programme combining signs, symbols, and speech. It is used by children and adults with a range of communication needs.
How It Works
Signs and symbols support key information in spoken-language order. They may help a person understand messages and express themselves.
Important Considerations
Makaton includes more than signing. Symbols can help someone who cannot sign or prefers another method. UK Makaton draws on BSL signs; programmes in other countries may use their local sign language.
Further Information
The Makaton Charity:
https://makaton.org/TMC/TMC/About_Makaton/What_is_Makaton.aspx
Makaton New Zealand:
Makaton New Zealand:
Signalong
What Is Signalong?
Signalong is a key-word signing approach used to support people with communication difficulties.
How It Works
Signs are used with speech to highlight meaning and support understanding and expression. UK Signalong is based on BSL signs and follows spoken-language order.
Learning and Everyday Use
Training and resources help communication partners use signs consistently. Choose vocabulary reflecting the person’s interests, relationships, choices, and daily activities.
Further Information
Signalong — The Communication Charity:
TaSSeLs — Tactile Signing for Sensory Learners
What Is TaSSeLs?
TaSSeLs is a tactile communication approach with adaptations for people with complex sensory and physical needs.
How It Works
It includes hand-under-hand signing, additional support and individual adaptations, and on-body methods.
Participation and Choice
The provider identifies hand-under-hand as its preferred method where suitable. The adult’s hand is beneath the learner’s, allowing the learner to participate and withdraw their hand.
Important Considerations
Select and adapt the method to the individual. It should not be described simply as an adult moving someone’s hands through signs.
Further Information
TaSSeLs approaches and adaptations:
Canaan Barrie On-Body Signing
Canaan Barrie On-Body Signing
What Is Canaan Barrie?
Developed at the Royal Blind School in Edinburgh, Canaan Barrie supports communication with children who have visual impairment and multiple disabilities.
How It Works
On-body signs and natural gestures are used within meaningful interactions. Signs can be personalised as communication develops between the child and their partners.
Important Considerations
The aim includes supporting participation and expression. Observe the child’s individual responses and seek guidance on appropriate adaptations.
Further Information
Sight Scotland’s introduction and sign videos:
Signing-Further Tactile Approaches and Resources
Ready? On-Body Signing
What Is Ready?
Ready? is an on-body signing resource available through Dudley Council.
How It May Be Used
Consistent touch cues can help make everyday interactions and forthcoming activities more understandable for people who need tactile information.
Important Considerations
Seek advice about suitability, sensory preferences, and how the person indicates agreement or refusal. Provide opportunities for the person to communicate their own choices.
Further Information
Dudley Council:
Harrow On-Body Signs — HOBS
Harrow On-Body Signs is a tactile communication resource provided by Harrow’s Children’s Sensory Team.
How It May Be Used
Signs delivered through touch provide information for people whose sensory needs make visual communication difficult to access.
Important Considerations
Use the resource with appropriate specialist guidance. Agree how signs will be introduced, how partners will use them consistently, and how the person can accept or decline an interaction.
Further Information
Harrow Children’s Sensory Team:
https://www.harrow.gov.uk/send-local-offer/childrens-sensory-team-cst/2
Deafblind Manual Alphabet
Deafblind Manual Alphabet
What Is Deafblind Manual?
Deafblind Manual communicates letters through touch on the hand, allowing words to be spelled.
How It Works
Communication partners take turns spelling and receiving messages. It can support a wide vocabulary because messages are built from letters.
Important Considerations
It draws on spelling and language knowledge. Consider tactile sensitivity, movement, pace, and familiarity with the alphabet. Methods and alphabets can differ internationally.
Further Information
Sense:
https://www.sense.org.uk/information-and-advice/ways-of-communicating/deafblind-manual/
Block Alphabet
Deafblind Manual Alphabet
What Is Block Alphabet?
Block alphabet involves tracing capital letters onto a person’s palm to spell words.
How It Works
The person identifies letters through touch. Communication partners agree a comfortable pace and how to indicate spaces, corrections, and understanding.
Important Considerations
This approach relies on recognising letters and understanding spelled words. Its usefulness depends on the person’s preferences and access needs.
Further Information
Sense:
https://www.sense.org.uk/information-and-advice/ways-of-communicating/block-alphabet/
Visual Frame Signing
What Is Visual Frame Signing?
Visual frame signing adapts where signs are produced so they remain within the person’s usable field of vision.
How It Works
The signer adjusts position, distance, and signing space. The underlying language or signing approach remains the same.
Important Considerations
This is an access adaptation rather than a separate language. Ask the person what they can see comfortably and review lighting, background contrast, and positioning.
Further Information
Sense:
https://www.sense.org.uk/information-and-advice/ways-of-communicating/visual-frame-signing/
Hand-Under-Hand and Tactile Signing
What Is It?
In tactile signing, a person may place their hands over a communication partner’s hands to feel signs and movement.
How It Works
Partners take turns communicating. The language or vocabulary used depends on their shared communication approach.
Important Considerations
Hand-under-hand interaction supports participation without automatically taking control of the person’s hands. Allow time and freedom to join, pause, or withdraw.
Specialist teaching is important when adapting sign language for tactile access.
Further Information
Sense:
https://www.sense.org.uk/information-and-advice/ways-of-communicating/hand-under-hand-signing/
Tadoma
Tadoma
Tadoma
Tadoma is a way of receiving spoken communication through touch. It is sometimes called tactile lipreading.
How It Works
A person uses contact with a speaker’s face and throat to perceive movement and vibration associated with speech.
Important Considerations
Tadoma is not a sign language or a routine apraxia treatment. It requires substantial specialist training and practice and may not suit everyone. Physical contact must be comfortable and agreed by both people.
Further Information
Sense:
https://www.sense.org.uk/information-and-advice/ways-of-communicating/tadoma/