3.5.1 What is MMC and AAC?

Multimodal Communication (MMC) is a term for describing the use of different modes of communication (Iacono, 2019). Most people communicate through different modes of communication including speech, writing, facial expression, body language, gestures, hand signs, and symbols/pictures.

Augmentative and Alternative Communication (AAC) is the use of modes of communication that supplement, replace, or facilitate existing spoken language skills (Speech Pathology Australia, 2017). People with limited/no speech or literacy abilities are more reliant on modes of communication such as facial expression, body language, gestures, hand signs, and symbols/pictures.

Augmentative refers to modes of communication that supplement or facilitate spoken language (i.e., AAC is used in addition to spoken language). For example, someone with a speech sound disorder may use both spoken language and AAC to help others understand them, or may only use AAC in particular situations.
Alternative refers to modes of communication that replace spoken language (i.e., someone may always use AAC instead of spoken language).

3.5.2 Types OF AAC

AAC may be described as unaided or aided.

Unaided AAC: Relies on body or hand movements and does not require additional materials/aids. For example, body language, facial expressions and hand/body signs.

Aided AAC: Requires the use of additional materials/aids. Aided AAC can either be high tech or low tech.

• Low tech: Uses non-electronic materials. For example, paper-based symbol boards, communication books, or pen/paper to write.
• High tech: Uses electronic systems. For example, voice output devices such as a communication system on an I-pad or text to speech functions on a computer.

The types of AAC that a person may use varies widely depending on the individual person’s communication needs, abilities, and preferences. Many people use more than one type of AAC for efficient communication. For example, a person may use both signing (unaided) and a high tech voice output I Pad app (aided) in the same conversation. Some people may use different types of AAC depending on the situation or their communication partner. For example, a child may choose to use a low-tech communication book to communicate with friends in the playground and a high tech text to speech device when speaking in front of the class.

The following video outlines the speech pathologists’ role in working with people who require AAC systems to facilitate communication.

^{Speech pathologists and assistive technology by Speech Pathology Australia}

3.5.3 WHO USES AAC

Anyone who is not able communicate all their needs effectively across all communicative situations may benefit from AAC.

AAC may be used long-term (e.g., by people with life-long conditions) or may be used temporarily (e.g., whilst someone is recovering from oral surgery).

AAC may be used by people with:

• Complex Communication Needs (CCN).  This term used to describe communication difficulties that occur alongside cognitive, physical, perceptual, and/or sensory impairments (Speech Pathology Australia, 2017).  For example, people with Cerebral Palsy, Down Syndrome, and Autism often described as having CCN.
• Speech sound disorders.
• Craniofacial anomalies (e.g., cleft palate).
• Acquired brain injury (e.g., stroke or head trauma).
• Degenerative diseases (e.g, multiple sclerosis).
• Selective Mutism or social anxiety.

View the following videos for examples of people using AAC to communicate.

1. Ariel is a child with cerebral palsy who communicates using a voice output device (Dynavox) that she accesses using eye-gaze.

2. Key Word Sign (unaided AAC) being used to promote language development in babies and toddlers at risk of communication disorders.

3. Lee Ridley (aka “Lost Voice Guy”) is a non-speaking stand-up comedian who uses a voice out device. Lee’s comedy act won Britain’s Got talent in 2018.

4. Harper and Angela both use a low tech PODD (Pragmatic Organisation Design Display) book, facial expressions, and body language to communicate.

5. Bob has aphasia and uses a voice output device (Lingraphica). In this video he is giving a speech at his son’s wedding using AAC.