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Augmentative and Alternative Communication System (AAC) for Social Inclusion of People With Complex Communication Needs in the Industry Simone Krüger MSc

ab

& Ana Paula Berberian PhD

ac

a

Tuiuti University of Paraná, UTP, Curitiba, Brazil

b

National Research Funding Agency CNPq “Technological Development”, Curitiba, Brazil

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Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil Accepted author version posted online: 06 Dec 2014.

Click for updates To cite this article: Simone Krüger MSc & Ana Paula Berberian PhD (2015) Augmentative and Alternative Communication System (AAC) for Social Inclusion of People With Complex Communication Needs in the Industry, Assistive Technology: The Official Journal of RESNA, 27:2, 101-111, DOI: 10.1080/10400435.2014.984261 To link to this article: http://dx.doi.org/10.1080/10400435.2014.984261

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Assistive Technology® (2015) 27, 101–111 Copyright © 2014 RESNA ISSN: 1040-0435 print / 1949-3614 online DOI: 10.1080/10400435.2014.984261

Augmentative and Alternative Communication System (AAC) for Social Inclusion of People With Complex Communication Needs in the Industry SIMONE KRÜGER, MSc1,2∗ and ANA PAULA BERBERIAN, PhD1,3 1

Tuiuti University of Paraná, UTP, Curitiba, Brazil National Research Funding Agency CNPq “Technological Development”, Curitiba, Brazil 3 Pontifícia Universidade Católica de São Paulo, São Paulo, Brazil

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Inclusion of people with special needs in the labor market has been increasing in some regions of Brazil as a result of the Articles 6 and 7 of the Constitution of the Federal Republic of Brazil and the Quota Law (No. 8.213/91, Art. 93) which entitle people with disabilities to work in order to improve their social condition. To support persons with complex communication needs in the workplace, 40 graphic symbols termed “symbols of industrial expressions” were developed within the framework of the COMMUNIS package. The symbols were developed for a company of the food sector in the Metropolitan Region of Curitiba, Brazil. Individual interviews were held with the human resources professionals, as well as with employees with complex communication needs in order to identify problems, assess requirements, and generate a list of specific symbols to develop. The symbols were then validated with regard to their ease of recognition. Only five symbols needed revision. The results suggest that it is possible to develop a set of symbols for the workplace that are judged to be iconic by human resources professionals and employees with complex communication needs. Keywords: inclusion of people with special needs, complex communication needs, augmentative and alternative communication, communication disability

Introduction Language and communication, with respect to human, cultural and social developments of people with Complex Communication Needs (CCN), should be regarded as primal elements for attaining communication goals. However, enabling people with CCN to develop language skills involves other means of communication, where oral language can be augmented or alternatively represented. With that challenge in mind, one tool that can aid people with CCN in achieving their communication goals is Augmentative and Alternative Communication (AAC). A definition for AAC is given by the International Society for Augmentative and Alternative Communication as being, “extra ways of helping people who find it hard to communicate by speech or writing” (International Society of Augmentative and Alternative Communication [ISAAC], 2013). AAC is an excellent resource which can promote an understanding of what is being conveyed in conversation. By using AAC, people with CCN will be able to establish dialogical interactions, which are needed for the development of their individuality. In such cases, AAC can support the expressive and ∗

Address correspondence to: Simone Krüger, Tuiuti University of Paraná, UTP, Rua Margarida Dallarmi, 101, 82015690 Curitiba, PR, Brazil. Email: [email protected]

receptive language needs of both employees with and without CCNs in their efforts to communicate with each other in the workplace. AAC constitutes a valuable and rich resource in order to facilitate or even make Social Inclusion possible. AAC can serve in this case as an alternative and effective way to promote social interactions towards a more active participation of AAC users in society. There are two main types of AAC (http://www.asha.org): signs and gestures, which do not need any extra external devices and are called unaided systems; and aided systems, which consist of symbol-based systems with additional equipment such as picture charts, books, and talking computers, VOCAs (Voice Output Communication Aid). More recently, new tools are emerging such as apps for Tablets and iPad. “AAC can help people understand what is said to them as well as being able to say and write what they want” (ISAAC, 2013). The use of symbols for communication is already widespread. Common examples today include symbols used on road signs to help us drive safely, on food labels to help choose what to eat, and on computers and smart phones (as icons) to help us select the program we want to use. Pictures and symbols are so important in supporting inclusion and in developing understanding, expressive, interactive communication and literacy that the use of such resources to create a visual environment should be the expected norm of good practice rather than a “special case.” In other words, the issue is not when we should use pictures and symbols, but rather how we should extend

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102 the use of pictures and symbols further, developing even more effective use of those (Millar, 2003). For this reason, pictures and symbols could be included in various forms of documentation and record keeping to make these more accessible to people with CCN, thereby involving such persons in developing choice and decision-making skills and in making their views and preferences known (Abbott, 2000; Beukelman & Mirenda, 2006, 2012, 2013; Blackstone & Berg, 2009; Zabala, 1996). AAC tools have also been helpful to enhance the social inclusion in education and daily life (Batorowicz, Mcdougall, & Shepperd, 2006). Symbol-based AAC tools have been developed and adopted in several countries. In Brazil, the most commonly AAC tools are: Blissymbolics (Bliss), Picture Communication Symbols (PCS) (Johnson, 1981, 1985), and the British Widgit system (Reily, 2006), each of which is briefly described below. Bliss is a graphical system of visual communication based on pictographic writing/ideographic Chinese divided into indexical (i.e., figurative and non-figurative), but recognizable symbols and arbitrary symbols, defined by convention, as well as symbols expressing grammatical functions (Reily, 2007). One hundred basic symbols are provided that may be recombined to form many expressions. Functional categories of the Bliss system are: people and personal pronouns, verbs, nouns, adjectives, and adverbs; miscellaneous (prepositions, conjunctions, adverbs, alphabet, numbers, colors, and dates), all represented by different colors in order to organize communication boards. The arrangement of symbols on the board is aligned with the phrasing of the Portuguese language. One of the most used systems in Brazil is PCS (Moreira & Chun, 1997; Reily, 2006; Wolff, 2006), which consists of a set of over 10,000 pictorial symbols, figures, and words. According to Reily (2006), PCS is commonly used for at least two reasons: The graphic symbols are easily recognizable, and the kit with User’s Manual and the Boardmaker software (which generates symbols and expressions) is marketed in Brazil. In addition, for aided systems, Boardmaker SDP software with voice synthesizer for Brazilian Portuguese can be also employed. PCS also adopts the same strategy as the Bliss AAC system for sorting the pictographic symbols, dividing those into six semantic, grammatical categories of the language. More recently, the Widgit system for inclusion and accessibility has been introduced in the Brazilian market with a positive impact in Special Education, developed in partnership with British schools. Widgit covers an ever-increasing range of topics, including a wide selection of curriculum areas. Although each of the aforementioned pictographic systems has its own characteristics, all are represented by different symbols with the aim of helping people with speech difficulties to communicate effectively in different contexts. Presently, the proliferation of inexpensive mobile technology is dramatically changing the way people with CCN manage everyday needs (McNaughton & Light, 2013). Mobile touchscreen devices such as tablets and iPads offer a broad spectrum of communication options as well as other functions. The number of communication apps and tablet platforms are increasing more rapidly than AAC hardware or software ever did. In Brazil, there are some AAC apps that can meet the needs of individuals with CCN. In the Brazilian industrial sector, symbols are normally used to signal, warn, and provide rules and precautions to be taken

Krüger and Berberian in certain sectors. Specific graphic symbols are used for work safety, which conform to guidelines by regulatory bodies such as the International Society of Automation (ISA), whereas other graphic symbols are task-specific. To date, no AAC systems have been implemented in this sector that specifically have the aim of socially including employees with CCN. However, in order to include people with CCN, the use of AAC systems in industry would be a key tool for enhancing the employability of people with such disabilities. Employing these people is already part of current policies in Brazilian companies as a result of the implementation of Law 8.213/91 Article 93, the so termed “Quota Law.” Apart from the benefits to social inclusion, improving the communication skills of people with CCN will also affect their quality of life. Through improved communication skills, employees with CCN will achieve enhanced integration in the workplace and feel a part of society with access to the same rights as everybody else. For this to become a reality, employees with disabilities need to be ensured that there are available resources in a work environment that can facilitate their overall communication. That was the rationale behind the development of the COMMUNIS system. The objective of this article is to present a novel AAC system “COMMUNIS,” developed within the scope of a broader research project. COMMUNIS consists of a set of symbols represented as graphic cards, allowing the use of AAC in places where access to computers and AAC devices is not provided. COMMUNIS is also aimed at those who need a communication kit for quick access in interactions in the work environment (special schools, clinics, hospitals, and industries). One of the relevant categories in COMMUNIS is the industrial expressions set, which is discussed in this article. Forty graphic symbols were developed and validated with potential AAC users in a given factory.

AAC, Employment, and Its Use in the Industrial Sector The social inclusion of people with CCN as well as their integration in the work environment has been a common topic in several conferences and Education meetings worldwide (Gil, 2005). The industrial sector environment has been undergoing several changes within the last decades, starting with the assistencialist model of the 1970s, through the social integration model of the 1980s, and reaching the present situation, from the 1990s, which is focused on social inclusion (Bahia & Schommer, 2010). In Brazil, the introduction of the person with disabilities in the social context was officialized with the article 208, III of the Brazilian Federal Constitution of 1988, which establishes the right to special education of all pupils and students with any sort of disability. In the work environment, a milestone was an International Labor Organization convention (Convention Number 159), which grants adequate procedures for professional rehabilitation of people with CCN, promoting their inclusion in the industrial sector. To guide the process of inclusion of people with disabilities in Brazil in the labor market, the Brazilian Law No. 8.213/91 was passed, the “Quota Law,” a specific quota to ensure people with special needs and people who were injured while performing work related activities (in rehab) a workplace in the

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Alternative and Augmentative Communication System (AAC) in the Industry Brazilian labor market. This is mandatory for industries with over 100 employees; the quota varies between 2% (for 100 up to 200 employees) and 5% (over 1000 employees). Moreover, it is established in such law that rehab or disabled workers should be dismissed only upon the hiring of a substitute worker under similar conditions. According to the Brazilian Census Bureau (Instituto Brasileiro de Geografia e Estatística [IBGE], 2010), around 24% of Brazilian employees exhibit some sort of disability, a high percentage due to the reinforcement of the Quota Law. About half of those employees with disabilities earn a monthly income corresponding to the current Brazilian minimum wage (about US$300 per month). Among employees with disabilities, approximately 35% show some sort of mental impairment; however, those are the last in the ranking of employability. Industries, given their social role, are being challenged with the Quota Law to implement programs that ensure and welcome people with CCN in the workplace so that their hiring is not only the result of temporary assistance and/or simply the fulfillment of the law. One can monitor the progress of movements and initiatives aimed at inserting people with CCN in the work context by looking at adaptations made in the physical space as well as observing cultural changes for facilitating the inclusion of people with disabilities, including comprehensive educational practices that result in equal opportunity of access to the labor market (Araujo & Schmidt, 2006). According to national data from RAIS (Social Information Annual Report [RAIS], 2011), there were 325,291 formal employees with disabilities and rehabilitated in December 2011. Such an expressive figure suggests a relative success of the Quota Law. However, it is noteworthy that despite the progress of initiatives that aim to ensure the space of people with disabilities in the labor market, there are still significant difficulties that hinder an effective inclusion. According to Bahia and Schommer (2010), this situation is related, among other factors, to the high competitiveness in the labor market, low job opportunity rates in the formal sector, lack of information about disabilities, and lack of qualified professionals that can handle people with disabilities. Another relevant aspect, according to RAIS, is that industries with over 100 workers represent only about 1.5% of the total amount of industries in Brazil. The Quota Law is, however, targeted at this industry size. International Literature Shows Some Initiatives Towards AAC Use in Industries Bryen, Cohen, and Carey (2004) state that in the North American context employment rates are lower for people with significant physical and speech disabilities who rely on technology for mobility and communication. Bryen, Slesaransky, and Brown Baker (1995) and McNaughton and Bryen (2002) support this negative view of employment of individuals who depend on AAC. Reinforcing the need of using AAC as a facilitating resource for workers’ inclusion with CCN, McNaughton and Bryen (2002) conducted a research with eight individuals with cerebral palsy who used AAC and were employed full time. The subjects participated in a focus group discussion; the authors found out that one of the barriers to employment was limitations of AAC technology support. McNaughton and Bryen (2002) suggest a list

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of recommendations for improving employment outcomes for individuals with cerebral palsy who use AAC technology: • To develop a real-time translation program that understands the speech of individuals with speech impairments; • To develop a hands-free access to the on/off option on AAC devices; • To develop a wider range of easily portable AAC systems; • To develop a way for AAC users to have private telephone calls; • To develop an AAC system that can vocalize thoughts; • To improve the integration of AAC systems and computer technologies through better collaboration between AAC and computer manufacturers; • To include AAC users on the device development team. Other studies on successful experiences in community-based jobs also suggest recommendations for improving employment opportunities for AAC users and directions for future research (Light, Stoltz, & McNaughton, 1996; McNaughton & Bryen, 2002, McNaughton, et al., 2002). Another study by McNaughton, Light, and Arnold (2002) with employers and co-workers indicates that the use of AAC in the industry is contingent on the reliability of AAC technology as a positive factor for employment. Bryen et al. (2004) show that training programs for AAC users can be essential for enhancing their employability such as the ACETS initiative (Augmentative Communication Employment Training and Supports). Once employed, some factors will have an impact on AAC users to maintain their job, such as personal characteristics, technology, supportive coworkers, personal care assistance, and family supports (McNaughton & Bryen, 2002). Beth and Staples (2003) describe the development and implementation of a communication and literacy intervention (CALI) program designed for a group of adults with developmental disabilities at a sheltered workshop/supported employment facility in northern Utah. The CALI program took place in an employment and training center (ETC); participants received speech and language services through the sheltered workshop, with the expectation that they would work toward acquiring skills considered by staff to be prerequisite to less restrictive community employment. Fewer studies on the use of AAC in Brazilian industry have been found. A literature review on the field of AAC indicates that AAC systems were implemented in Brazil firstly in special schools and clinics. Later, aiming at social school inclusion, research has been undertaken on the use of AAC in elementary schools as a learning support tool aiming at the inclusion of students with disabilities in Brazilian regular schools (Deliberato, 2009; Nunes & Silveira, 1999). For the last five years, AAC has been gradually implemented in primary schools aimed at the improvement of language skills particularly in conjunction with assistive technologies (Deliberato, Manzini, & Guarda, 2004; Pelosi, 2008; Schirmer, 2011). AAC has been primarily used with autistic subjects since the 1970s (Macedo & Orsati, 2011; Nunes & Hanline, 2007). In the industry, AAC is still hardly used by employees with CCN. The PCS software Boardmaker is relatively costly, and there is a limited willingness to invest in such technologies for facilitating the social inclusion of employees with disabilities.

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104 Native AAC systems are generally free of charge but require special training and adaptations (developing communication boards or specific graphic symbols for the industry). Some AAC projects in the industry have been developed with the aim of including people with cerebral palsy and their work capabilities, which can be largely enhanced by new tools for assistive technology and alternative communication. This is the case of “Associação Nosso Sonho” with their pioneering project “Bem vindo a nós,” which proposes the hiring of people with cerebral palsy by the construction firm Tecnisa (Costa et al., 2013). A recent project developed at the Graduate Program in Computer Education of the Federal University of Rio Grande do Sul (Piovesan, Medina, & Passerino, 2013) is aimed at developing software based on virtual reality, which generates an immersive environment for preparing people with CCN for being included in the labor market. A company provided the sectors in which the research subjects could work, allowing footage and photographs to be taken of the work environment as well as informing about the expected tasks and routines. This research is ongoing with the development of the “virtual world of the workplace,” where simulations of the main functions of the subjects can be performed. Instructions will use AAC systems which will be provided and tested in such virtual environment.

AAC Systems Based on Card Use for Industrial Use With regard to the use of alternative communication systems in the industry, the use of cards directly related to the task and to particularities of the enterprise/factory can facilitate job fulfilling and help memorize relevant tasks. The particularity of some tasks reinforces the need of developing specific cards, often not properly represented in commercial systems such as PCS. Several studies describe the use of cards or sight words (defined by Browder & D’Huyvetters, 1988 as a discrete, observable response that is controlled by a printed stimulus) as a feasible means of learning academic subject matters and linguistic contents by persons with intellectual impairment. In the industrial sector, Browder and Minarovic (2000) showed that, from a case-study with three illiterate employees with moderate mental retardation, upon training, the subjects had their ability enhanced to read job-specific sight words, use verbalized selfinstruction and self-monitoring checklist, and self-initiate work tasks, which lead to increased employer satisfaction. With regard to the use of cards and sight words, Cuvo and Klatt (1992) taught community-referenced sight words and phrases to adolescents with mild and moderate mental retardation; results showed rapid acquisition of the communityreferenced sight words in the training conditions and generalization from the cards and videotape conditions to the community sites. Browder and Roberts (1993) showed that card drills provide students with a means to memorize information such as sight words and several academic matters, thus being useful in educational practice. Similar findings have been reported by Ruwe, McLaughlin, Derby, and Johnson (2011) with middle school students, pointing to the relevance of cards for literacy instruction; reading sight words has shown to be a necessity for independence, safety, and higher-level reading experiences (Meadan, Stoner, & Parette, 2008).

Krüger and Berberian The findings of such studies point to the relevance of using sight words and cards (which can contain task-specific graphic symbols) in companies and schools. The present study is focused on the use of AAC cards in industries, as a means of promoting social inclusion and facilitating interactions of persons with CCN in the industrial sector. The research was funded by the two governmental funding sources, one of which (Serviço Nacional de Aprendizagem Industrial [SENAI]) promotes work qualification (such as courses and training) and the other (Serviço Social da Indústria [SESI]) provides social services and products for local industries. The idea was to provide employees with CCN, which had restricted access to personal computers, a “personal communication kit” which could support their everyday communication needs in the workplace.

Iconicity Graphic symbols do not possess only one specific meaning, as such meaning is primarily defined by the user’s interpretation. According to Vasconcellos (1999), AAC symbols do not convey only one meaning; indeed, a number of studies show that the degree of iconicity depends on a higher homogeneity in its interpretation (Bloomberg, Karlan, & Lloyd, 1990; Capovilla, Macedo, Duduchi, & Thiers, 1997; Capovilla, Gonçalves, Macedo, & Duduchi, 1997; Gonçalves, Capovilla, Macedo, Duduchi, & Thiers, 1997; Luftig & Bersani, 1988; Mirenda & Locke, 1989; Musselwhite & Ruscello, 1984; Nunes & Silveira, 1999; Thiers & Capovilla, 1998, 2006). Youth with moderate and severe CCN can develop differing levels of learning, retaining, and using arbitrary symbols for communication (Romski & Sevcik, 1996). Bruner (1968) explains the process of developing representational skills among children. The first level is termed “enactive stage,” when the child basically relies on visual actions. This process is followed by “iconic representation,” during which the child begins to connect symbols to stimuli. The final level of representational development is symbolic, which relies on the child’s ability to internally represent a referent based on an abstract concept. If the child does not have an understanding of the referent, the greater iconicity or ease of recognition of the symbol may not affect his or her learning of its meaning either. The iconic symbol may appear as arbitrary as a non-iconic symbol to the learner if he or she has no prior understanding of the referent. Therefore, novel AAC systems require a thorough evaluation of the degree of iconicity or ease of recognition they possess, not only with regard to the understanding of the icon but also to fully understanding the nature of the actions involved. Thiers and Capovilla (2006) define iconicity “as the degree of isomorphism between symbol and the referent represented by it or the degree to which the meaning of a symbol is transparent to a naive observer unfamiliar with the symbol.” Previous studies show that higher degrees of iconicity facilitate the learning of new symbols, and this applies both to individuals with intellectual impairment as well as to subjects with normal cognitive abilities (Meraku, 2008). Mizuko (1987) explored the ease of learning Blissymbols, PCS symbols, and Picture Ideogram Communication System (PIC) symbols by three-year-old children without disabilities/CCN (MAHARAJ, 1980). In this study, the highly iconic PCS and PIC were more

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Alternative and Augmentative Communication System (AAC) in the Industry readily learned by the three-year-olds than the Blissymbols (i.e., iconic visual-graphic symbols are easier to be learned and understood than arbitrary ones). Similarly, Fuller and Lloyd (1992) compared the ease of recognition of several AAC systems and suggested that the PIC system reached the highest percent match with regard to iconicity tests. The study of Hetzroni, Quist, and Lloyd (2002) with preschoolers with communication disorders suggests that novel Blissymbol meanings could be alternatively conveyed via computerized instructions, though the use of a computerized medium for observational symbol learning would require further investigation. Barton, Sevcik, and Romski (2006) explored the learning of arbitrary lexigram-referent relationships versus comparatively more iconic Blissymbol-referent relationships by four pre-school-age children with both developmental and language delays, through a computerized medium and observational experience and found that all of them demonstrated symbol-referent relationships. However, three of the four participants in understanding demonstrated at least emerging symbols-referent relationships. Another cause for concern is the level of abstraction of the symbols used. In a study conducted at the Neuropsycholinguistics lab at the University of São Paulo, Brazil, two teenage girls with cerebral palsy were asked to identify PIC symbols. It was found that 73% of nouns were correctly identified, although only about 50% of verbs/actions and 35% of adjectives/descriptives were matched to their true meanings. The authors concluded that the graphic representation of nouns and actions as pictographic symbols were determining factors for their rapid identification, whereas descriptives are much less understandable, as they are based on ideograms (Capovilla, Nunes, & Macedo, 1998). Mirenda and Locke (1989) carried out an experiment aimed at the recognition of pictographic symbols representing common nouns using real objects, photos, and the AAC systems PIC, REBUS/Widgit, Bliss, and PCS. Research findings showed that pictographic systems yielded a higher degree of recognition, after real objects. Bloomberg et al. (1990) carried out a similar research aimed at the translucence of the same set of systems looking at different categories: nouns, actions, descriptives, and adverbs. Twenty students were surveyed with regard to the ease of recognition of a set of symbols, to which they were asked to give scores 1–7. The ease of recognition of the nouns was higher, followed by verbs/actions, and, finally, by adjectives/adverbs. A similar study was carried out in Brazil by Thiers and Capovilla (2006), with regard to the translucence of the international AAC systems PIC, PCS, and Bliss, as compared to the Brazilian AAC system IMAGOANAVOX (Capovilla, Macedo, et al., 1997). Eleven undergraduate students were asked to rank from 1 to 10 the degree of iconicity of 464 items (304 nouns, 120 verbs/actions, and 40 adjectives/adverbs). The AAC system IMAGOANAVOX yielded the highest iconicity scores, followed by PCS and PIC. (In the case of the present research, IMAGOANAVOX was not considered as a viable option, as it is a high technology AAC tool where several multimedia resources are employed, such as short movies, graphic symbols, and written words, whereas the aim was to develop a card-based system.) We also found other research initiatives refer to problems arising from (bad) translation and lack of equivalence in translation of graphic symbols for use in AAC. Alant (2005) noticed that

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when 94 rural, Zulu-speaking children, aged eight years, were asked to identify PCS symbols, the translation of the label used as a stimulus for indicating which symbol it represents could elicit different responses from the participants depending on the specific translation. From a 36-symbol overlay display, only four symbols were incorrectly identified less than 50% of the time, while the largest group of symbols was incorrectly identified between 91% and 100% of the time. The errors were analyzed in respect of three categories: unfamiliarity with the symbol used; unfamiliarity with the associations used; and directionality. Research findings highlight the need for further research on the adequacy and validation of specific graphic symbol systems within particular contexts. Regarding the importance of their ease of recognition, in this article, the symbols developed within the COMMUNIS project as industrial expressions were validated.

Methodology The COMMUNIS system consists of a set of symbols represented as graphic cards, aimed at those who need a communication kit for quick access in interactions in the work environment (special schools, clinics, hospitals, and industries). It is a novel set of AAC symbols, as they were developed by the research group together with a graphic designer and in collaboration with the Federal University of Parana, based in Curitiba, Brazil. One of the relevant categories in COMMUNIS is the industrial expressions set, which was partly (40 graphic symbols) validated in this study. Data were gathered from semi-structured interviews using protocols developed by the authors. All interviews were taped and, in a later stage, transcribed. Interview protocols consisted of open questions based on a literature review. The definition of the 440 symbols/cards was based on the methods used in a PhD Thesis (Paura & Deliberato, 2014), whose purpose was to evaluate the vocabulary of children with CCN from age 2 to 12 years. The word list developed by Paura and Deliberato consisted of 269 items which were included in the COMMUNIS word list. The definition of the remainder of the symbols/cards was based on the Evaluation Protocol of Communication Skills for NonSpeaking Students in Family Situation (Delagracia, 2007) that was adapted to use with illiterate persons with CCN and cognitive disabilities, aged 15 and above, at a boarding special school (the Charity “Pequeno Cotolengo Paranaense,” http:// www.pequenocotolengo.org.br/). The cards of the COMMUNIS system were divided into seven categories: social expressions, people, verbs and actions, adjectives, substantives, miscellaneous (time concepts, colors, alphabet, numbers) and industrial expressions. The selection of industrial symbols was based on needs reported by 10 employees at a given factory. Data were gathered for the validation stage according to the procedure described below. Initially, a survey was carried out in order to estimate the number of medium to large companies within the Metropolitan Region of Curitiba (MRC; a city located in southern Brazil, currently with a population size around two million people), that had employees with disabilities among their staff. Phone contacts were made with 20 companies located in the MRC, randomly

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106 selected from the list provided by SESI, a public institution which offers social services and products for local industries. From the 20 contacted companies, eight agreed on a scheduled visit to the Human Resources sector. Such visits were aimed at the presentation of the research project. Among the 20 companies visited, only one company, which happened to be in the food industry, formally agreed to participate in the research. In a follow-up contact with the participating company, a meeting was held with the Human Resources Director and the person responsible for the employees with CCN in order to explain the project objectives and to provide explanation on AAC and practical ways of its use in the industry. Two interview protocols were developed by the team. One was aimed at employees who worked with colleagues with CCN, and the second protocol, which contained AAC symbols, was aimed at employees with CCN. The interview round with employees with CCN was administered by researchers well-versed in AAC. Non-structured interviews were started at an office in the Human Resources department, firstly with the human resources analyst responsible for employees with CCN, who reported on the needs and difficulties generally encountered in the sectors related to work safety and personal hygiene. Four people were interviewed: an environmental technician, a work safety technician, a speech therapist, and the head of the sector where the employees with disabilities were working. The environmental technician and the work safety technician reported their difficulties and needs, suggesting situations when graphic symbols could be useful. The speech therapist, responsible for the audiometric tests, reported difficulty for the employees with CCN in understanding the need to wear ear plugs and their prophylactic importance. The head of the sector (the bakery) gave important hints regarding difficulties in interaction between employees with CCN and other employees. All this feedback was relevant for defining which interventions would be needed to improve employee interactions and to help in the learning of new tasks. The five employees with CCN interviewed performed different tasks at the bakery; some would work on the dough, others worked on the toppings, and so on. They are all illiterate and have cognitive disabilities (see the Appendix). All interviews were individualized, recorded, and later transcribed. From the identification of the needs of CCN employees, three categories were created: a) Questions; b) Payments; and c) Feelings, and from the identification of the suggestions of the staff, three more categories were created: a) Person Hygiene; b) Place Cleaning; and c) Workplace Safety. A list of 40 symbols was selected based on information from the interviews. This was the basic criterion of the industrial expressions cards, comprising 40 graphic symbols (Figure 1 and Figure 2), which were drawn by an illustrator (graphic designer from the publishing team “Kaigangue”), under the supervision of an expert in Graphic Design, coordinated by the School of Design at the Serviço Nacional de Aprendizagem Industrial (SENAI). With the aim of developing specific graphic symbols for the industry and using the background color concept of Bliss and PCS, the COMMUNIS system was conceived. The 440 symbols that compose the kit can be used in the workplace and in different sectors, as they were conceived based on generic categories as in Paura (2009). Among the 440 symbols that make up the kit, only 40 were developed as “industrial expressions” that were specific

Krüger and Berberian

Fig. 1. Examples of symbols used as industrial expressions in COMMUNIS.

to this particular company in the food sector. The rationale was that most expressions could be used in similar companies, with similar activities. The validation of the cards consisted of an iconicity test of a set of cards by regular employees and those with disabilities. To carry out the validation, surveys were conducted in the cafeteria during lunch break; 33 employees in total volunteered to do the test. For identification purposes, only name and sector of each participant were asked. The investigator presented verbally the target symbol referent in an array of eight symbols

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Alternative and Augmentative Communication System (AAC) in the Industry

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Fig. 2. Examples of symbols used in other categories in COMMUNIS.

and asked the participants to point the target referent. The array was arranged according to the six categories: personal hygiene, workplace safety, workplace cleaning, questions, payments, and feelings. The investigator sat in front of the individual participant with the Iconicity Check List. The symbols contained no corresponding written definition. No pre-defined order was adopted for the score sheet evaluation. An Iconicity Check List contained the different possible meanings for the 40 symbols, and after each meaning, a tick box for “yes” or “no” answers was provided, with some space left for

comments on each item. Thus, the goal was that participants’ answers would match the written descriptions for a given symbol. First, the written descriptions would be read out loud by the investigator (participants had to point the corresponding symbol). For example, for Figure 1, the descriptors “pull up on your ear” and “put the ear plug in your ear” could be suitable for two of the individual images as taken independently. However, when the group of images are taken as a whole, the command, “put in the ear plugs using your hand over your head,” as in Figure 3, was recognized 100% of the time.

don't bring your cellphone with the other hand, insert ear plug pull ear upwards and sidewards put ear plugs using your hand over your head white boots wash hands up to the elbows smoking forbidden shaving payment brush teeth wear ear plugs wash hands punch in recycle organic recycle metal recycle plastic recycle paper keep walls clean it's not allowed to take food outside the refectory don't put your feet on the wall use unfragranced deodorant keep finger nails short and clean beware of the steps hair net (men) apron throw toilet paper in the bin hair net (women) wear complete uniform (men) white trousers don't leave food in drawers and cupboards may I ask? how-which white overalls keep your workspace tidy throw rubbish in the bin wear complete uniform (women) I'm NOT OK don't leave rubbish all over I'm OK don't bring valuables 0

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Before each evaluation, the researcher would explain the objectives of the research, and after this, the participants signed, individually, the consent term.

From the Iconicity Check List, symbols were evaluated according to the employees’ understanding. Figure 3 shows the 40 symbols (their written meaning) sorted according to their match scores in percent. It is noticed that the vast majority of symbols (33 out of 40 or 83%) obtained 100% accurate answers (Figure 4; i.e., a high level of iconicity). Some symbols, however, were difficult to interpret. Such responses indicated the need for revising the graphic symbols developed, suggesting a cut-off minimum of 80% matching for each symbol. Thus, out of 40 symbols designed, only five needed further revisions by the researchers and publishing team. Some studies suggest that nouns are generally more iconical than verbs, adjectives, and adverbs (Capovilla et al., 1998). Indeed, among the five cards with low scores, two abstract expressions (“I am OK,” “I am not OK”) had low scores as they require imageability effects which are difficult to get for translucent judgment as other researchers report (Fuller & Lloyd, 1991). As mentioned above, the cards which proved hardest to recognize were open to different meanings and, thus, to the user’s interpretation (Bloomberg et al., 1990). At first glance, there is no clear relation in our findings between the ease of recognition of the symbols and their actual meaning when the level of abstraction required is taken into consideration. Results obtained in other studies involving iconicity tests suggest the level of recognition to be higher for nouns than for actions, descriptive phrases, and adverbs (Bloomberg et al., 1990; Capovilla et al., 1998). The least-recognized symbol was for an action (“don’t bring valuables”), with less than 50% of the employees recognizing it. However, two descriptive phrases that represent mood attributes, “I am OK” and “I am not OK” yielded higher scores. The symbols that achieved 100% recognition were mostly actions, while nouns were included in those with lower scores. Nevertheless, a breakdown of scores shows a clearer picture. The average recognition for each type of structure was: 94% for nouns, 94% for actions, and 63% for descriptives. Histogram 35 30 Number of items

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Fig. 4. Histogram of matches.

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Results

The median was more favorable to the action symbols: 99% for actions, 93% for nouns, and 63% for descriptives. Although the amount of symbols in each category is not equal (30 symbols represent actions, eight symbols represent nouns, and only two are for descriptives), results suggest that, in general, descriptives are harder to represent by graphic symbols (Bloomberg et al., 1990). Despite the fact that not all symbols were easily recognized, the more familiar users become with the COMMUNIS icons, their more the icons’ effectiveness improves (Thiers & Capovilla, 2006).

Conclusions Results provide evidence of the good iconicity of pictographic symbols of the industrial expressions of the COMMUNIS AAC system, from a validation test with workers with and without disabilities. It is worth mentioning that there is no nationwide survey showing the use of AAC systems as linguistic resources for promoting CCN inclusion in the labor market. AAC systems are not commonly used in the industry, and this fact can explain the difficulties presented at the beginning of this study when scheduling meetings with different companies for the presentation of the research project. From the analysis of the conceptual framework, it was found that in order to benefit the quality of life of people with disabilities and CCN, among several factors, a key aspect is to provide employment options where they can develop their potential and gain independence and autonomy. There is no doubt that this process requires structured and planned actions, making the state, society, and industry responsible for placing of such people in the labor market. Thus, the development of communication tools with the use of alternative communication systems in the industry can be a decisive action for fair and equal inclusion of people with disabilities and CCN in the labor market.

Limitations and Avenues for Future Research The development of a specific AAC kit for the Brazilian industry can serve as a benchmark for linking AAC and the inclusion of people with CCN in the labor market. From such experience, a great need for furthering studies in the field of AAC and its use in industries is suggested, which should include the validation step as a way for providing a more flexible and context-oriented communication tool. The main limitation of this study was that employees at one single industry were surveyed. In addition, from the validation step, symbols were perfected in a later stage, and there was not a renewed presentation of the set of symbols to the same or other employees. Another aspect to consider is that due to the privacy terms in the consent form that was signed by participants, the breakdown of responses from employees with and without disabilities is not available. Nevertheless, the authors think that the merit of this article is to present the communication system COMMUNIS and its rationale and the first step of a validation procedure that could (and should) be adopted when introducing novel AAC systems. Different studies should aim at the development of COMMUNIS so that such a tool could serve not only as a

Alternative and Augmentative Communication System (AAC) in the Industry supported employment facility (Foley & Staples, 2003), but also support employees’ integration with others during breaks (Balandin & Iacono, 1999). COMMUNIS or similar work-dedicated AAC systems could also be introduced in other labor sectors such as in health clinics or in therapeutic practice. It is suggested that further studies promote the investigation of the social validity of a vocabulary that could be used in different situations (Bornman & Bryen, 2013). The COMMUNIS kit has beencommercialized since 2011, and there is a strong urgency to evaluate which sectors are using such kit in order to adapt or create new specific categories.

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Alternative and Augmentative Communication System (AAC) in the Industry Appendix Questions Administered to Staff Working With Colleagues With CCN

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Have you worked with a disabled person and in which sector? Have you ever had any difficulty working with a colleague with disabilities? What difficulties do you most commonly find in employees with disabilities? (with suggested answers “understanding tasks” and “interacting with other employees”) In your opinion, what measures could help employees with disabilities to overcome their difficulties? What images/symbols would you suggest to assist the routine work of employees with disabilities? What other resources do you think might also help?

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Questions Administered to CCN Employees How long have you been working with us? At which sector? Do you have any particular difficulties to perform your tasks? In your view, which resources could improve your performance? Are you aware of AAC systems? Do you think that a communication board with images could improve your performance and thus promote a better relationship with your colleagues? What are the attitudes of your colleagues towards your condition?