Visual Communication Supports for the Assessment of Swallowing and Somatosensation in Adults With Down Syndrome

Purpose: This article describes practical strategies for enhancing swallow assessments for individuals with intellectual or cognitive disabilities through the inclusion of visual communication supports (known as augmentative and alternative communication [AAC]). These strategies were developed to support understanding and self-expression during the swallow assessments for individuals with Down syndrome, as part of a large research study. Over the last 2 years, these supports have been integrated into swallow assessments with 14 adults with Down syndrome. Method: Clinicians and researchers with expertise in swallowing and AAC collaboratively designed and refined visual communication aids to enhance understanding and task completion of swallowing-related assessments, including the Mann Assessment of Swallowing Ability, Iowa Oral Performance Instrument, spontaneous swallowing frequency, food avoidance inquiries, and lingual somatosensation testing. A summary table of assessments and suggested strategies is provided. All study procedures were approved by the Institutional Review Board (IRB #00022372) at The Pennsylvania State University. Results: Our observations suggest the integration of AAC enhances the accessibility of swallow assessments for individuals with intellectual disabilities, supporting their participation in these assessments. Many participants referenced the visual aids, such as videos, as key to their understanding of what to expect and what to do during assessments. These observations are consistent with research showing that multisensory modalities and adaptations can improve functional outcomes for people with Down syndrome. Conclusions: Incorporation of visual supports may be useful for clinicians and researchers seeking to improve accessibility in swallow assessments for diverse populations. Clearly, dedicated research is necessary to examine these observations systematically.