Factors contributing to this increase include the rising incidence of autism spectrum disorders ( CDC, 2011, 2014) advances in medical intervention that have resulted in improved survival, albeit with lifelong disability ( Durkin et al., 2016 Hustad and Miles, 2010 Vincer et al., 2006) increased life spans of individuals with communication disability ( Balandin and Morgan, 2001) and increased overall life expectancy ( Gaskin et al., 2016 Segalman, 2011). Although datasets on the prevalence of AAC use are limited, increases in the number of individuals requiring AAC have been observed ( Light and McNaughton, 2012). Additionally, many individuals with other disabilities (e.g., developmental, physical) have co-occurring communication disabilities ( Lawthers et al., 2003 Perry et al., 2004). OVERVIEW OF CONDITIONS BENEFITING FROM AAC TECHNOLOGIES Prevalence of AAC NeedДЄn estimated 1.3 percent of Americans (about 4 million people) cannot reliably meet their daily communication needs using natural speech ( Beukelman and Mirenda, 2013), and the prevalence and complexity of communication disorders increase with age ( Yorkston et al., 2010a). Before proceeding, it is important to note that the research in this field often has focused on specific areas and populations, making generalizations across studies problematic and highlighting the need for AAC-specific research across adult populations ( Bourgeois, 2013). The final section presents findings and conclusions. The chapter next considers voice restoration following head and neck surgery. Evaluation and monitoring, training and adaptation, and access and availability are then addressed in turn.

Next is a review of the clinical considerations entailed in comparing natural speech and technology-based voice output systems. This chapter begins with an overview of the conditions benefiting from the use of AAC technologies, which is followed by a detailed taxonomy of AAC and voice products and technologies. Aided AAC systems include nontechnology assistive products (e.g., communicationД«oards, books) and technology-based products (e.g., speech-generating devices, mobile technologies). AAC systems may be unaided (e.g., signing, gestures) or aided ( Beukelman and Mirenda, 2013). AAC refers to all types of communication other than oral speech (e.g., pictures, symbols, writing, hand gestures) ( ASHA, 2016a). The delicate balance that yields automaticity of natural speech planning, programming, and execution is not replaced by AAC systems, nor does AAC fully mitigate impairments in natural speech production.ДЄlthough the primary focus of this chapter is AAC systems, the discussion also briefly addresses voice restoration technologies that support communication associated with head and neck cancer treatments. Although the severity of impairment plays a role in determining AAC needs and appropriate interventions, other factors include level of communication complexity, skills of communication partners, communication environments and environmental factors, rate of communication, and proficiency at strategic communication, among others.

The primary rationale for individualsвЂ™ electing to use augmentative and alternative communication (AAC) is the inability of their natural speech to meet all of their daily communication needs. With impairment, alterations in speech subsystems become apparent and the complexity revealed. For many, speech is the external expression of language, and the motor skills involved are performed with accuracy and speed, without conscious control ( Netsell, 1982). The ease and simplicity of use of typical natural speech mask the complexity of a speech production process that involves precise control and coordination of respiration, voice, articulation, and language comprehension and expression ( van der Merwe, 2009). Augmentative and Alternative Communication and Voice Products and Technologies

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