Date of Award

Fall 12-2021

Document Type


Degree Name

Doctor of Philosophy (PhD)


Rehabilitation Sciences


Kinesiology and Rehabilitation

Committee Director

Rachel Johnson

Committee Member

Corrin Gillis

Committee Member

Shana Pribesh

Committee Member

Eric Schussler


Individuals using augmentative and alternative communication (AAC) are supported by many AAC stakeholders and communication partners. Clinical decision making and AAC assessment models consider the capabilities and access needs of the individual using AAC, as well as opportunity barriers and supports imposed by communication partners and environments. The purpose of this research was to investigate opportunity barriers and supports identified by two critical AAC stakeholders: speechlanguage pathologists and caregivers. The first study investigated characteristics of AAC service provision reported by post-professional speech-language pathologists. Speech-language pathologists reported lack of perceived knowledge related to AAC service delivery, inconsistent use of AAC modalities, and persistent barriers to AAC service provision. The second study analyzed parent, guardian, and caregiver perceptions of AAC interventions for school-aged children. Caregivers preferred family-centered rather than patient-centered service delivery models to facilitate AAC use by their child. The third study investigated experiences and contributing factors of stress in adult caregivers of children using AAC. Caregivers’ stress was impacted by the multiple enveloping systems. Within the family, caregivers’ experiences of stress were predicted by number of children and the caregivers’ educational level. Stress was mitigated by support systems which meet caregivers’ needs and expectations. This research reveals opportunity barriers and supports are a critical component to AAC service delivery and clinical decision making as perceived by speech-language pathologists and caregivers. Sustainable and adequate AAC service delivery requires AAC stakeholders to recognize opportunity barriers and implement supports to facilitate the long-term participation and communication of individuals using AAC. Augmentative and alternative communication service delivery in the absence of explicit consideration for communication partners and environments does not address opportunity barriers for the individual using AAC.


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