Full Text PA-96-032
NIH GUIDE, Volume 25, Number 7, March 8, 1996
PA NUMBER:  PA-96-032
P.T. 34

  Communicative Disorders, Speech 

National Institute on Deafness and Other Communication Disorders
The National Institute on Deafness and Other Communication Disorders
(NIDCD) invites applications for the support of research studies on
issues related to the communicative competence of users of
augmentative and alternative communication (AAC) systems.  Such
research may lead to a better understanding of the impact of AAC on
the development or restoration of communicative competence of
individuals with the severe communication difficulties commonly seen
in association with developmental or acquired disorders, such as
brain injury, and diseases or disorders affecting the oral motor
system.  It may also define the ways in which augmentative and
alternative strategies can influence all phases of communication
development and activity.  Findings from these studies will direct
the establishment and refinement of tools and intervention strategies
enabling the development or recovery of communicative function.
The Public Health Service (PHS) is committed to achieving the health
promotion and disease prevention objectives of "Healthy People 2000,"
a PHS-led national activity for setting priority areas.  This PA,
Communicative Competence of Users of Augmentative and Alternative
Communication (AAC) Systems, is related to the priority area of
diabetes and chronic disabling conditions.  Potential applicants may
obtain a copy of "Healthy People 2000" (Full Report:  Stock No.
017-001-00474-0 or Summary Report:  Stock No. 017-001-00473-1)
through the Superintendent of Documents, Government Printing Office,
Washington, DC  20402-9325 (telephone 202-512-1800).
Applications may be submitted by domestic and foreign, for-profit and
non-profit organizations, public and private, such as universities,
colleges, hospitals, laboratories, units of state and local
governments, and eligible agencies of the Federal government.
Foreign institutions are not eligible for First Independent Research
Support Transitions (FIRST) (R29) awards.  Applications from minority
individuals, women, and individuals with disabilities are encouraged.
The support mechanisms for grants in this area will be the individual
investigator-initiated research project grant (R01) and the FIRST
(R29) award.
Oral speech is not possible for individuals with severe communication
disorders.  Demographic research in several countries reveals that
from 8 to 12 persons per 1000 have such severe communication
disorders that they cannot meet their daily communication needs using
only natural speech and handwriting.  The 2 to 2.5 million Americans
in this group are all ages and have various disorders.  Some examples
are:  young children with developmental disabilities, teenagers and
young adults with traumatic brain injury, middle-aged adults with
multiple sclerosis and brain stem strokes, and older adults with
amyotrophic lateral sclerosis, Parkinson's disease, and cortical
During the past twenty years, many new technologies and intervention
strategies have been used to assist these individuals in
communicating.  The overall effectiveness of AAC interventions has
been documented in a number of anecdotal reports, single case
studies, and few group studies.  It is apparent that following
intervention, many individuals who were previously unable to
communicate are able to communicate much more effectively.  However,
there has been little systematic investigation of the impact of AAC
systems on the development or restoration of communicative competence
of children and adults with severe communication disorders.  The
impact of AAC systems, system features, and intervention strategies
on all phases of communication development and use requires
evaluation.  In addition to these primary research goals, many other
issues related to understanding the communicative competence of AAC
users need to be explored.
Communication and language development studies of children using
augmentative communication have centered largely on alternative modes
of communication used in conjunction with specific instructional
approaches.  This has provided ways of correcting language deficits
and the subsequent or accompanying developmental difficulties often
found in this population.  Several investigations have reported
positive language outcomes, including increases in vocabulary size
and use and production of multi -symbol utterances.  However, the
long-term process of communication, language, and literacy
development through augmented means, as well as the broader
educational and social implications of this process, has not been
analyzed in detail.  It is important to determine how the process of
communication, language, and literacy learning through augmented
means progresses, the theoretical framework underlying this process,
the conditions that best facilitate it, and its broader impact on the
development of children with a wide range of disabilities.
The goal of AAC is to foster and support the development of
communicative competence so that individuals who require AAC can
participate as fully as possible in home, school, work, and community
environments.  Little is known, however, about the communicative
competence of people who use AAC, or about the skills, strategies,
and techniques that contribute to their communicative competence.
For example, there is not an accepted definition of or reliable and
valid method to measure the communicative competence of those using
AAC.  The systematic identification of the communicative variables
that affect perceptions of communicative competence of AAC users from
both the social and personal perspectives, may be a first step.
Identifying such variables has implications for selecting valid
targets for communication intervention, which bear directly on issues
related to quality of life.
Successful AAC use depends on a functional compatibility between the
motor, cognitive, linguistic, and sensory capabilities of the user
and the operational requirements imposed by the AAC system itself.
Many aspects of this user-system interface have not been studied
thoroughly.  These include issues that relate to the special needs
considerations across the life span, such as the needs of a child in
the early stages of communication and motor development, the special
needs of the elderly, the specific requirements of an individual
recovering from injury, or the rapidly changing requirements of a
patient with a degenerative disorder.  For all AAC users, it is
important that techniques be developed by which the AAC system can be
efficiently customized to reflect the changing needs of the
individual.  Related areas of the user-system interface that require
study are the mechanisms by which residual motor gestures may be
recognized by AAC smart systems, and how consistent communication
results may be obtained for an individual for whom access involves
fluid rather than discrete motor movements.
In both educational and medical care arenas, treatment efficacy and
outcome studies are needed.  Although there is considerable anecdotal
evidence of the impact of AAC intervention on the communicative,
social, and educational experience of persons with severe
communication disorders, there is less information available about
the impact of AAC on the vocational lives of these individuals.
Furthermore, decisions regarding public policy and health care need
to be based on more than anecdotal reports.  To this end, empirically
based outcomes research on all aspects of AAC interventions is
urgently needed.
The purpose of this PA is to encourage systematic, hypothesis-driven
investigations, considering a variety of experimental design
methodologies.  The impact of AAC systems and system features on the
development or restoration of communicative competence in children
and adults with severe communication disorders needs to be known.
Examples of topics that may be addressed in applications submitted in
response to this program announcement include, but are not limited
to, the following issues:
o  Impact of AAC technologies on the enhancement and development of
communication, language, literacy, and natural speech of persons with
severe communication disorders.
o  Influence of user variables (e.g., knowledge, skills, and learning
style) on AAC system effectiveness.
o  Impact of AAC system features on communicative competence of users
and listener perception of user competence.
o  Development of tools and strategies to measure communicative
competence (i.e., operational, linguistic, strategic, and social
competence) of children and adults who use AAC systems.
o  Determination of the factors that are related to success and
failure of existing AAC interventions across the age span for a
variety of communication disorders and communication contexts.
o  Development of tools to measure the comprehension of symbols in
individuals who are unable to respond in a standard communicative
o  AAC intervention outcome studies in the areas of communication,
language and literacy, that include individuals with both
developmental and acquired conditions, across causes, across the life
span, and in differing environmental and social contexts.
o  Evaluation of the impact AAC strategies have on user-peer,
user-teacher, and user-family social interactions.
It is the policy of the NIH that women and members of minority groups
and their subpopulations must be included in all NIH supported
biomedical and behavioral research projects involving human subjects,
unless a clear and compelling rationale and justification is provided
that inclusion is inappropriate with respect to the health of the
subjects or the purpose of the research.  This new policy results
from the NIH Revitalization Act of 1993 (Section 492B of Public Law
103-43) and supersedes and strengthens the previous policies
(Concerning the Inclusion of Women in Study Populations, and
Concerning the Inclusion of Minorities in Study Populations), which
have been in effect since 1990.  The new policy contains some
provisions that are substantially different from the 1990 policies.
All investigators proposing research involving human subjects should
read the NIH Guidelines for Inclusion of Women and Minorities as
Subjects in Clinical Research, which have been published in the
Federal Register of March 28, 1994 (FR 59 14508-14513) and reprinted
in the NIH Guide for Grants and Contracts, Volume 23, Number 11,
March 18, 1994.
Investigators also may obtain copies of the policy from the program
staff listed under INQUIRIES.  Program staff may also provide
additional relevant information concerning the policy.
Applications are to be submitted on the grant application form PHS
398 (rev. 5/95) and will be accepted at the standard application
deadline as indicated in the application kit.  Application kits are
available at most institutional offices of sponsored research and may
be obtained from the Grants Information Office, Office of Extramural
Outreach and Information Resources, National Institutes of Health,
6701 Rockledge Drive, MSC 7910, Bethesda, MD 20892, telephone (301)
710-0267, email: girg@drgpo.drg.nih.gov.  The title and number of the
program announcement must be typed in Section 2 on the face page of
the application.
Applications for the FIRST Award (R29) must include at least three
sealed letters of reference attached to the face page of the original
application.  FIRST Award (R29) applications submitted without the
required number of reference letters will be considered incomplete
and will be returned without review.
The completed original application and five legible copies must be
sent or delivered to:
6701 ROCKLEDGE DRIVE, ROOM 1040 - MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)
Applications will be evaluated for scientific and technical merit by
an appropriate peer review group convened in accordance with NIH peer
review procedures.  As part of the initial merit review, all
applications will receive a written critique and undergo a process in
which only those applications deemed to have the highest scientific
merit, generally the top half applications under review, will be
discussed, assigned a priority score, and receive a second level
review by the appropriate national advisory council or board.
Review criteria are:  scientific, technical, or medical significance
and originality of proposed research; appropriateness and adequacy of
the experimental approach and methodology proposed to carry out the
research; qualifications and research experience of the Principal
Investigator and staff, particularly, but not exclusively, in the
area of the proposed research; availability of the resources
necessary to perform the research; appropriateness of the proposed
budget and duration in relation to the pro posed research; and
adequacy of plans to include both genders and minorities and their
subgroups as appropriate for the scientific goals of the research.
Plans for the recruitment and retention of subjects will also be
Applications will compete for available funds with all other
applications assigned to the NIDCD.  The following will be considered
in making funding decisions:  quality of the proposed project as
determined by peer review; availability of funds; and program
priorities among research areas of the program announcement.
Written, telephone, and email inquiries concerning this PA are
encouraged; the opportunity to clarify any issues or questions from
potential applicants is welcome.
Direct inquiries regarding scientific content to:
Beth Ansel, Ph.D.
Division of Human Communication
National Institute on Deafness and Other Communication Disorders
Executive Plaza South, Room 400-C
6120 Executive Boulevard, MSC 7180
BETHESDA, MD  20892-7180
Telephone:  (301) 402-3461
FAX:  (301) 402-6251
Email:  Beth_Ansel@nih.gov.
Direct inquiries regarding fiscal matters to:
Sharon Hunt
Grants Management Office
National Institute on Deafness and Other Communication Disorders
Executive Plaza South, Room 400-B
6120 Executive Boulevard, MSC 7180
BETHESDA, MD  20892-7180
Telephone:  (301) 402-0909
FAX:  (301) 402-1758
Email:  Sharon_Hunt@nih.gov
This program is described in the Catalog of Federal Domestic
Assistance No. 93.173  Awards are made under authorization of the
Public Health Service Act, Title IV, Part A (Public Law 78-410, as
amended by Public Law 99-158, 42 USC 241 and 285) and administered
under PHS grants policies and Federal Regulations 42 CFR 52 and 45
CFR Part 74.  This program is not subject to the intergovernmental
review requirements of Executive Order 12372 or Health Systems Agency
The PHS strongly encourages all grant and contract recipients to
provide a smoke-free workplace and promote the non-use of all tobacco
products.  In addition, Public Law 103-227, the Pro-Children Act of
1994, prohibits smoking in certain facilities (or in some cases, any
portion of a facility) in which regular or routine education,
library, day care, health care or early childhood development
services are provided to children. This is consistent with the PHS
mission to protect and advance the physical and mental health of the
American people.

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