Background
Methods
Search strategy
Database | Search terms | Articles returned, n |
---|---|---|
1st search in Web of Science | Topic: (assistive technology AND syndrome) AND (language:(“English”) AND type:(“article”) | 45 |
2nd search in Web of Science | Topic: (assistive technology AND down syndrome) AND (language:(“English”) AND type:(“article”) | 4 |
3rd search in Web of Science | Topic: (down syndrome AND augmentative and alternative communication) AND (language:(“English”) AND type:(“article”) | 17 |
1st search in PubMed | (Search details): (assistive technology [All Fields] AND syndrome [All Fields]) | 218 |
2nd search in PubMed | (Search details): (assistive technology [All Fields] AND down syndrome [All Fields]) | 25 |
3rd search in PubMed | (Search details): (down syndrome [All Fields] AND augmentative and alternative communication [All Fields]) | 20 |
1st search in PsycInfo | Any Field: augmentative AND Any Field: alternative communication AND Any Field: “down syndrome” | 0 |
2nd search in PsycInfo | Any Field: assistive technology AND Any Field: “down syndrome” | 0 |
3rd search in PsycInfo | Any Field: assistive technology AND Any Field: syndrome | 56 |
1st search in BVS | All fields: assistive technology AND syndrome | 655 |
2nd search in BVS | All fields: assistive technology AND down syndrome | 14 |
3rd search in BVS | All fields: down syndrome AND augmentative AND alternative communication | 33 |
Selection process
Inclusion criteria
Exclusion criteria
Data extraction and study quality
Author / Year | Country of Origin | Sample | Age / Gender | Instrument Used | Intervention Time | Limitations |
---|---|---|---|---|---|---|
Deckers et al., 2017 [61] | The Netherlands | 30 children with DS | DS (2 to 7) / 16 F and 14 M | Core vocabulary | 15- to 20-min interactions | Three possible limitations of the present study require consideration. First, the sample size is relatively low at just 30 participants. The second limitation is the relatively small language samples collected of 100 words per child. The final limitation is the uneven distribution of words uttered in the three different settings. |
Lorah, 2016 [38] | USA | 7 students: 5 ASD, 2 DS | ASD (8 to 12) / 1 F and 4 M DS (11 to 12) / 2 M | SGDs (Proloqu2Go ™) and PECS | 10 weeks | The first was that baseline data were not collected. The second was the lack of inclusion of a generalization and maintenance measure within the research design. Finally, the inclusion of a standardized preference assessment such as Multiple Stimulus without Replacement would have enhanced the design. |
Lanter et al., 2016 [59] | USA | 1 child with DS | DS (7 years 8 months) / 1 M | Picture-based strategy | 10 continuous sessions | Clinicians and educators should recognize that the methodology used in this case study was more reflective of that which might be conducted in a clinical or educational setting, as opposed to a rigorous research investigation. Although pre-experimental designs exist in the requesting literature using AAC modes of communication, these types of designs fail to provide ‘a convincing demonstration of experimental control’. Pre-experimental designs capture changes in behavior, which explains their frequent use in clinical or educational settings, but do not sufficiently rule out factors beyond the intervention that might explain those changes. Given that the child in this study failed to demonstrate requesting behaviors across multiple baseline sessions, it is unlikely that factors beyond the intervention were responsible for the communication changes observed. |
González et al., 2015 [68] | Spain | 9 children with DS | DS (9 to 29) / 7 F and 2 M | Interactive digital board prototype (whiteboard) | 3 sessions lasting for 1 to 2 h | No limitations disclosed. |
Logan et al., 2014 [57] | USA | 1 child with DS | DS 1 year and 1 month / 1 F | Modified ride-on car | 28 weeks | First, as with any single-subject research design, especially one involving an infant, it is difficult to conclude that changes were a result of the intervention and not simply maturation alone by the subject. It is important to remember that outcome changes are likely due to multiple factors. Second, this study does not meet every criterion of the single-case study research design. Several measures are used that are objective, standardized, reliable, and previously used [18] but are not widely available in a published format with large-scale reference data for comparison. Also, the PEDI was not administered after a reversal/retention phase. Third, it is possible that the extra attention, stimulation, and encouragement received during the intervention phase led to changes in the outcome measures that are unrelated to Natalie’s use of an ROC. |
Wilkinson & Mcllvane, 2013 [52] | USA | 12 participants with DS and 12 with ASD | DS (7 to 22) ASD (7 to 22) 15 F and 9 M | PCS | 2 sessions of 16 trials | Small sample, leading to difficulties in the distribution of subgroups for the instruments used. |
Hu et al., 2013 [64] | USA | 8 participants with DS and 5 neurotypical children | DS (10–28) TD (10–13) 4 F and 9 M | Input techniques (keyboard, mouse, word prediction, and speech recognition) | 2 sessions, taking into account a time of 45 min | The difficulty in accessing many participants, being aware of the severity of the disability, and comparing the performance of the participating groups. In their method, the task was observed by the researchers, and the participants might have felt uncomfortable or distracted. In addition, the time (software usability) was not completely controlled, so some participants had more time to learn and become familiar with the word prediction software. Another point to be considered is that participants are typically less motivated to perform tasks aimed at goals that are not of their choice compared to exploring tasks chosen by participants. |
Brady et al., 2013 [37] | USA | 93 children: 45 with ASD, 15 with DS, and 33 with other rare diseases | DS (3 to 5) ASD (3 to 5) Other (3 to 5) 20 F and 73 M | PECS, SGDs, and Language Signals System | 2 visits, T1 and T2 120 min for each child in T1 and again in T2, 12 months later | Did not record systematically the number of words available for each child through the AAC. Nevertheless, indicative systems such as group size, type of AAC, and language facilitator’s strategies in the classroom were not analyzed. These factors significantly affected the results for acquiring vocabulary, and therefore it was difficult to interpret the longitudinal effects on the instruction variables. |
Barker et al., 2013 [36] | USA | 83 children: 43 with ASD, 11 with DS, 3 with global development delay, 1 with spina bifida, 4 with CP, 13 with other genetic syndromes, 1 with traumatic brain injury, and 7 with unknown etiology. | DS (3 to 5) ASD (3 to 5) Global development delay (3 to 5) Spina bifida (3 to 5) Cp (3 to 5) Other genetic syndromes (3 to 5) Traumatic brain injury (3 to 5) Unknown etiology (3 to 5) 17 F and 66 M | PECS and SGDs | 2 years | Did not consider the cognitive level of children, preventing comparative data reliability. |
Van Der Meer et al., 2012 [35] | New Zealand | 4 children: 1 with ASD, 1 with MSDD, 1 with DS, and 1 with congenital myotonic dystrophy and autistic-like behaviors. | DS (7) / 1 M ASD (10) / 1 M MSSD (5) / 1 M Congenital myotonic dystrophy (5) / 1 M | SGDs and MAKATON | 2 to 4 sessions, 3 to 4 days per week, lasting about 5 min and 10 trials (intervention) and 1 to 6 months’ follow-up | A short intervention time was used, hindering more robust data analysis. |
Allsop et al., 2011 [55] | United Kingdom | 257 children: 11 CP, 7 varying levels of deafness, 2 global developmental delay, and 1 DS | 9 years and 8 months SD = 1.51, age range 4–12 years of age / 134 F and 123 M | Web-based survey (joystick) | 3 trials | A limiting factor for a small number of the children with disabilities was language comprehension. The children who participated with genetic disorders such as DS or global learning delay often had an SA in place because of other language comprehension difficulties that occurred in their day-to-day education. |
Wilkinson et al., 2008 [51] | USA | 26 children: 16 with TD and 10 with DS | DS (11) / 7 F and 3 M TD (3 to 4) / 6 F and 10 M | PCS | Training – 6 sessions; Evaluation – 2 blocks, with 12 experimental stimuli each | Error in recording incorrect stimuli. |
Foreman & Crews, 1998 [8] | Australia | 19 children with DS | DS (2 to 4) / 8 F and 11 M | MAKATON and COMPIC | 4 days | Disclosed no limitations |
Author / Year | Study Design | Methods | Main Outcome | Score PEDro |
---|---|---|---|---|
Deckers et al., 2017 [61] | Cross-sectional study | Spontaneous language samples of 30 Dutch children with DS were collected during three different activities with multiple communication partners (free play with parents, lunch- or snack time at home or at school, and speech therapy sessions). Of these children, 19 used multimodal communication, primarily manual signs and speech. Functional word use in both modalities was transcribed. The 50 most frequently used core words accounted for 67.2% of the total word use; 16 words comprised core vocabulary, based on commonality. | The 50 most frequently used core words accounted for 67.2% of the total word use; 16 words were determined to be core vocabulary based on a commonality criterion. Words in the core vocabulary of young children with DS appear to be similar in syntactic semantic and pragmatic functions to core words identified by research in other populations, although the contribution of content words to the core vocabulary of the children with DS seems higher than in other groups. | 5/10 |
Lorah, 2016 [38] | Experimental | Using an alternating treatment design, teachers and paraprofessionals were instructed to conduct mind training trials using both a PE system and an iPad® Mini with the application Proloqu2Go™ as an SGD, with seven school-aged children with a diagnosis of autism or DS. Following 10 weeks of data collection, the student participants were exposed to a device preference assessment, and teachers completed a social validity questionnaire to assess preference. | The results were consistent with previous research indicating equal acquisition and fidelity of use across both devices, but a general preference for the iPad®-based SGDs. | 4/10 |
Lanter et al., 2016 [59] | Case report | The intervention describes how environmental arrangement and generalized cues were used to promote spontaneous communicative attempts during a reinforcing social-communicative context and explains how prompting and modelling were used to facilitate the performance of effective communication behaviors across multiple requesting opportunities. | The child showed significant increases in his use of functional communication, with collateral gains in speech, as demonstrated by the performance of requests. | 2/10 |
González et al., 2015 [68] | Experimental | The methods and techniques included prototyping, questionnaires (pre–post), thinking out loud, video-recording, and structured observation. In terms of the interaction aspects with the whiteboard, the items evaluated included (a) mouse use, (b) placement of numbers and balls, (c) ball deletion and crossing out, (d) placement of the sign of the operation, and (e) use of sensitive areas established in the worksheet. | The use of the digital board (Divermates – prototype) facilitates the process of interaction and usability, and the attractive design that has been evaluated by the specialists enables it to be adapted to needs related to language, color, font size, use of metaphors, organization, presentation, grouping, and categorization of items. Due to the difficulty in writing, the picture has advantages, since it allows it to be operated with the hand and the difficulties with traditional writing can be forgotten. About subtraction and addition operations, the study population shows that subtraction is more difficult than addition. Participants needed help with fingers and balls (symbolic management) in the numerical counting process (task resolutions). | 4/10 |
Logan et al., 2014 [57] | Case report | Report involving a 13-month-old girl (Natalie) over a 28-week period including 3 evaluation moments: baseline, intervention, and retention. The evaluations were carried out at home with the following schedule: 6 bi-weekly visits for 3 months (baseline), 12 weekly visits for 3 months (intervention), and 4 weekly visits for 1 month (retention). Natalie and her family were recorded in the video during the 28-week study using their ride on car in their home and in the community. | Ride-on car use appears to be feasible, fun, and functional in increasing daily mobility for pediatric populations working toward independent walking. | 2/10 |
Wilkinson & Mcllvane, 2013 [52] | Experimental | Visual perceptual factors such as velocity and precision were evaluated by means of a search task, involving targets that were exposed in different spatial dispositions and internal color in one, with the symbols being grouped by internal color; in the other, the identical symbols had no scheme of agreement. | The visual search was superior in participants with ASD compared to those with DS. In both groups (ASD vs DS), responses were significantly faster when symbols were grouped by color. These results show that the visual and perceptual characteristics of the display may be essential characteristics to be considered during the display construction (device panel). | 5/10 |
Hu et al., 2013 [64] | Experimental | This paper reports an empirical study that investigated the use of three input techniques (keyboard and mouse, word prediction, and speech recognition) by children and young adults with DS and neurotypical children. | Children with TD achieved better performance than participants with DS. The results suggest that some individuals with DS have the skills to enter text at a productive speed and with acceptable accuracy while others are very slow in entering data and the generated text contains a substantial number of errors. The DS group showed a greater variation than the neurotypical group in terms of data entry speed and accuracy. | 4/10 |
Brady et al., 2013 [37] | Longitudinal | These 93 children were assessed at Time 1, followed by 82 of these children after one year being assessed at Time 2. They were exposed to different types of AAC, which were selected by teachers from a list of options, and teachers were asked to record all types of AAC in use for a particular child. Many children have been taught to use multiple forms. Many children added or changed systems throughout this study (therefore, analyses related to specific types of AAC were not possible). | Interventions using symbols by visual image, signs (gestures), and spoken words that may aid in cognitive development and language comprehension (ISF). This hypothetical ISF model reflects positively, since children showed higher levels of ISF, especially those with direct participation of adults at home (domestic environment). | 5/10 |
Barker et al., 2013 [36] | Longitudinal | We developed two surveys (a) to describe children’s use of AAC in preschool classrooms, as well as the use of prompts and question asking, and augmented input by their communication partners; and (b) to describe teachers’ experience, training, and perceived support in providing AAC. We then examined the relationship between children’s experience of AAC, including the use of prompts, question asking, and augmented input by their partners, and the growth of receptive and expressive language for 71 children with developmental disabilities over a two-year period. | It is possible to observe positive effects in the use of PECS and SGDs, since they aid in the production of speech, language expression, and social communication of children with DD. The PECS is the form of AAC most used by schoolchildren. It was observed that more than half of the teachers received vocational training in PECS, while only 25% of the teachers had training in the use of SGDs. | 4/10 |
Van Der Meer et al., 2012 [35] | Longitudinal | We compared speed of acquisition and preference for using SGDs versus manual signing (MAKATON) as AAC options. Four children with DD, aged 5–10 years, were taught to request preferred objects using iPod®-based SGDs and MAKATON. Intervention was introduced in a multiple-probe-across-participants design, and SGD and MAKATON conditions were compared in an alternating-treatment design. A systematic choice-making paradigm was implemented to determine whether the children showed a preference for using SGDs or MAKATON. | All participants showed increased use of SGDs when intervention was introduced, but only three learned under the MAKATON condition. This study shows that individuals with DD often show a preference for different AAC options, and it is important to consider the individual’s preference, as this can be an influential factor in communication skills, communicative function, and ease of acquisition. | 3/10 |
Allsop et al., 2011 [55] | Observational | An interactive web-based survey was developed that stored information within a central database. The survey interface was designed for 4–11-year-olds with and without disabilities. Common accessibility issues were identified using the Web Accessibility Initiative, and then an inclusive design approach was used to improve the usability of the survey interface. The joystick designs were displayed as rotating 3D objects in video clips. | All children could complete the tasks from the survey, although children with disabilities had higher completion times and most required a form of assistance from support assistants and/or sign language interpreters. The use of the web-based survey provided a novel means by which to involve children with and without disabilities in the design of assistive technology devices within a primary school environment. | 4/10 |
Wilkinson et al., 2008 [51] | Experimental | Participants were asked to find a target line drawing among an array of 12. Line drawings represented foods (e.g. grapes, cherries), clothing (e.g. a red shirt, a yellow shirt), or activities (e.g. football, swimming). In one condition, symbols that shared a color were clustered together, creating a subgroup within which to search. In another condition, symbols that shared a color were distributed across the display, allowing each to appear individually. | Grouping symbols of the same color facilitated target location velocity (food, clothing, activities) for all participants in the survey and accuracy for younger children and preschoolers with DS. In the construction of the display design, the internal coloring of the symbols should be considered, especially when dealing with individuals with DS, assisting the visual and perceptual condition. | 4/10 |
Foreman & Crews, 1998 [8] | Experimental | The study used a simple repeated measures technique. All children who participated were encouraged to learn to communicate 12 unique words: three verbal instructions alone, three through the symbol method (COMPIC), three through the signal method (MAKATON), and three through the multimodal method (symbol + sign + verbal). The four treatments (verbal, symbol, signal, and multimodal) were administered successively over four days, with interaction and sequence effects being controlled by a Latin square design. | The multimodal method and signal method resulted in significantly higher scores for all children when compared to the symbol method. However, it can be concluded that the multimodal method of instruction is the most effective way of encouraging children with DS (between the ages of 2 and 4) to communicate the names of objects, since it makes use of three auxiliary tools (verbal, symbol, sign). | 4/10 |
Analyses
Results
Discussion
Instrument | Instrument Objective | Instrument Features | Number of Studies (Instrument) |
---|---|---|---|
SGDs | Improvement of speech (improvement of communication) | SGDs, also known as voice and output communication aids | Lorah, 2016 [38] Barker et al., 2013 [36] Brady et al., 2013 [37] Van Der Meer et al., 2012 [35] |
PECS | Broadening of language skills and social communication | Information system through the exchange of image cards (change the image for the item itself) – discrimination of figures, making sentences | Lorah, 2016 [38] Barker et al., 2013 [36] Brady et al., 2013 [37] |
MAKATON | Language and communication development (signals domain) | Vocabulary with speech, signs, and/or symbols (interactive vocabulary) | Van Der Meer et al., 2012 [35] Foreman & Crews, 1998 [8] |
PCS | Assists the cognitive process (speed and accuracy) through figures and symbols | A pictorial system consisting of designs that mean nouns, pronouns, verbs, and adjectives, or makes use of symbol arrangements (e.g. clothing, shoes, goggles and gloves) used in the “grouped” and “distributed” arrangement with a search focus visual. | Wilkinson & Mcllvane, 2013 [52] Wilkinson et al., 2008 |
Core vocabulary | Improvement of functional language, seeking to achieve more effective communication | Sets of vocabularies described as basic vocabulary consist of high-frequency words and represent various parts of speech or natural text (i.e. mainly function words such as pronouns, conjunctions, prepositions, auxiliary verbs, determinants, interjections, and adverbs). | Deckers et al., 2017 [61] |
Picture-based strategy | Stimulate spontaneous communicative attempts | Three-ring communication folder (~ 7 ″× 5″ × 1 ″) that had three removable pages, each with removable coloured pictures (~ 2 ″× 2″). The first page presents snack items and the second page an immutable series of oral preferred activities reported to promote generalisation. The third page shows a phrase strip indicating the target form (‘I want _____’). | Lanter et al., 2016 [59] |
Interactive digital board prototype | Facilitate interaction (social skills) and give personal autonomy | The digital board interface is a subsystem of the Divermates educational system, which provides educational tools with an attractive design. | González et al., 2015 [68] |
Modified ride-on car | Improvement of daily mobility, aiding communication and socialization processes, plus the fun factor | Modified touring car | Logan et al., 2014 [57] |
Input techniques | Vocabulary analysis, performance, and interaction | Techniques that use computer input devices (mouse, keyboard, word prediction) for evaluating the speed and accuracy of data input | Hu et al., 2013 [64] |
Language Signals System | Cognitive development and 2language comprehension | Acceptable approximations of ASL gestures, which use combinations of hand gestures to represent a phrase, word, letter, number, or a combination of these | Brady et al., 2013 [37] |
Web-based survey (joystick) | Facilitate socialization and communication | A joystick is an input device, equipped with a lever capable of controlling the movement of a cursor on the screen, and one or more buttons capable of controlling certain actions when pressed. The joystick designs were displayed as rotating 3D objects in video clips. | Allsop et al., 2011 [55] |
COMPIC | Language development (symbols domain) | Communication resource consisting of a library of clear and easy-to-understand drawings, called ‘pictograms’, which contain information | Foreman & Crews, 1998 [8] |