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Think about the components of language and choose an AAC system that best matches the way we learn and use language. Think of a voice output communication device as a replacement for articulation. To be effective, one must be able to "talk" quickly without much cognitive thought navigating through the system.
While the client's current language skills are important to consider, you must also look to the future. Don't limit future language and communication growth by recommending a system that has limited potential. There are new communication applications/devices that tout simplicity by offering just a few phrases/words to the client. How will those allow clients to communicate what's in their heart? Look for devices that allow simplification for initial success but growth to larger vocabularies for spontaneous novel utterance generation (SNUG). Is the integrity of the motor plan maintained as language development progresses?
Number of available icons
Choose the most icons per page that the child is able to physically access. Use a key guard if needed to improve accuracy. If you only want to work on four words, hide everything else. This allows for motor patterns to be learned while providing opportunities for success.
If you only offer a grid with four words, and then want to add vocabulary, motor patterns will change OR you will have to add pages. To get 84 words, you would need to navigate through 21 pages if you only had four icons per page. If you have 84 words available on one page, there is no navigation.