"It is vital that healthcare professionals are aware of and use public resources such as the UTAC, in order that they familiarise themselves with such techniques"

In the April edition of the FlashTICSS newsletter we shared a video of the talk Marc Coronas gave at the Official College of Doctors of Barcelona. Here, we ask him to give us more details on the Augmentative Techniques of Communication Unit, what services they offer, what their work involves and what impact it might have on our sector. Coronas holds a Degree in Psychology and is an Associate Professor at the Department of Cognition, Development and Psychology of Education at the University of Barcelona.

• What is the UTAC and what is its role?

The UTAC is an external service belonging to the University of Barcelona’s Faculty of Psychology. It includes the Sírius UTAC, in collaboration with the Catalan government’s Ministry of Labour, Social Affairs and Families and Education UTAC, in collaboration with the Ministry of Education. The UTAC’s major role is to provide advice (which includes assessment, direct support and monitoring) for users, family members, professionals, organisations and businesses, regarding Augmentative Communication and support technologies in general.

• Who are your users?

The people we mostly deal with are those who are unable to speak, or those who have serious difficulties in using speech to communicate, either permanently or temporarily. A person with amyotrophic lateral sclerosis (ALS), for example, who has lost the ability to speak, a child with cerebral palsy who has never spoken, or a person intubated in an ICU, who is fully conscious but who unable to speak.

In other cases we get asked for help by people who don’t have any difficulty communicating but who, normally as a result of a motor disability, require the use of support technologies to increase their level of autonomy in daily activities such as using a computer, or getting about on their own.

The most frequent conditions among users of the service are cerebral palsy, intellectual disability, aphasia, autism spectrum disorders, ALS, muscular dystrophy, ataxia, cranioencephalic trauma, multiple sclerosis and spinal muscular atrophy.

• What services do you offer?

The Sírius UTAC carries out the assessment and monitoring of users who contact us directly or through their families. If necessary, we travel to people’s homes to carry out the assessments. In the second stage of the process, we also help to set up and implement any support technologies that may be required in each case. In addition, at the institutional level, we offer advice and training to professionals from Early Childhood Development Centres [ECDCs], occupational workshops, care homes, hospitals and so on.

In the field of health, in recent years we have worked with health centres such as the Vall d’Hebron Hospital, Santa Creu i Sant Pau Hospital, Bellvitge Hospital, the Hospital Clínic of Barcelona, the Mutual University Hospital of Terrassa and the University Healthcare Network of Manresa. In certain cases, we have collaborated with speech therapy and phoniatrics teams, while in others we have worked directly with Intensive Care Units, and in others with care units dedicated to a specific condition, such as Amyotrophic Lateral Sclerosis.

• What kind of coverage do you have in this sector?

Both in the fields of education as well as those linked to the Department of Labour, Social Affairs and Families (ECDCs, Occupational Workshops, Care Homes, etc.), the degree of implementation and awareness of the service is pretty good, which means the use of Augmentative Communication systems is becoming increasingly common.

On the other hand, in other areas such as healthcare, it appears to be proving more difficult to take advantage of the resources offered by Augmentative Communication. In other countries, we’ve heard of great experiences in this regard, one of the health centres that excels in this area is the Boston Children’s Hospital, in which the team led by John Costello does a great job, both in terms of research and in caring for patients of all ages.

• What is Augmentative Communication?

Augmentative and Alternative Communication Systems are different forms of expression instead of spoken language, which aim to increase and/or compensate for difficulties with communication and language experienced by many people with disabilities (whether temporary or permanent).

Augmentative and Alternative Communication is not incompatible but rather complementary to the recovery of natural speech. Instead, it can promote success in this area, where possible. There’s no question, therefore, that it should be introduced at as early an age as possible, as soon as difficulties in the development of oral language are observed, or shortly after an accident or illness has caused its deterioration. There is no evidence that suggests that the use of AAC inhibits or interferes with the development or the recovery of speech.

• What kinds of techniques exist? Does it involve digital technology?

Augmentative and Alternative Communication use various systems of symbols, involving pictures (photographs, drawings, pictograms, words and letters) and gestures (mime, gestures and hand gestures). In the case of the former, this also requires the use of support products. The various systems of symbols adapt to people with very different needs in terms of their age and motor skills, and cognitive and linguistic abilities.

Support products for communication include technological resources, such as electronic communicators, which may consist of computers, or tablets with special software, which have synthesized voices that convey what the user writes or selects.

In some cases, however, the best solution doesn’t involve using technology, but rather non-electronic media such as panels and communication books.

• What are the most commonly used digital or mobile technologies in this sector?

There are specialised apps and software in the field of Augmentative Communication which increasingly make it easier to respond to these kinds of needs. In terms of the access to technology as a result of motor difficulties, it can’t happen through conventional channels (a keyboard, mouse, or a touch screen) we have support products that allow access through alternate means such as head movements and even eye movements.

• What needs does your user profile have that are currently not met?

We have increasingly more options and technological solutions that better-respond to our users’ needs. Unfortunately, in our field, too often, the problem is not that we don’t have a good solution, but the fact that professionals involved with the person who need it aren’t even aware that such resources exist. Which is why we think it’s important that health professionals are aware of and use public resources such as the UTAC, in order that they familiarise themselves with such techniques.

• How do you see the future of existing technologies? Do you think they will change much?

In the world of Augmentative Communication, we increasingly use devices intended to be used by the general public, which mean that any developments will reflect those made in mobile technologies in general. We hope that the devices will become even more portable, with batteries that allow for greater autonomy and that their operating systems incorporate accessibility options as far as possible

On the other hand, some of the products that up until now people with disabilities have been using in a very way specific have also undergone major changes. This is the case of eye-tracking devices that over the last year have spread to the general public as peripherals for video games. This means the price has dropped considerably for the end user, meaning more people with disabilities can access such technology.