Case Study: Understanding Symbols on an AAC device

This week I worked with a 21-year-old CP lady, Ms F, whose expressive communication is limited to a few hand gestures and a glottal ejective for ‘yes.’ Her receptive language is reportedly good and she recognises some high-frequency sight words (in Arabic). Her cognitive ability is believed to be within the normal range. No results from standardised assessments are available and the information is based on a translated discussion with mum.


During the session it became clear that Ms F could recognise symbols representing familiar objects (such as ‘ice cream’) but struggled to recognise symbols for more abstract concepts (such as ‘me’ and ‘like’). She was able to select symbols to repeat subject-verb-object sentences once these were modelled for her on an AAC device. However, when we sneakily moved the symbols around on the board Ms F then selected the abstract symbols based on their previous position; thus building an erroneous sentence. The familiar object symbols were retrieved without error although with less efficiency than before.


This activity indicated that Ms F was storing information on the location of the abstract symbols on the device rather than memorising the image and its meaning. What is interesting is that she did not seem to notice that we had moved the symbols, thus indicating that no trace of the image had been stored or she was not attending to the image. Storing and recalling an image is made more effective through assignment of meaning based on existing vocabulary and a phonetic label rehearsed through the phonological loop. Instead she seemed to rely on the location of the ‘button’ stored using the visual spatial scratchpad.

This isn’t just an issue that would affect Ms F when symbols are inevitably jostled around on a device. This indicates that she doesn’t truly assign meaning and communicative intent to her use of the device. She is mimicking motor movements more than initiating and engaging in natural conversation.


Aided Language Stimulation is recommended to help Ms F add meaning to the symbols and through practice become a competent and natural AAC user. Appropriate scaffolding from her communication partners is encouraged to ensure that she builds on successful experiences. Further understanding of her receptive language skills is required for this.

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