PrAACtical Considerations: Prestored Messages in AAC, Part 1

Prestored messages are an important tool in any AAC user’s communicative toolkit and, when included in thoughtful ways, can enhance conversations and build vital interaction skills. Today, we introduce a series of posts to explore their role.

Prestored messages are utterances longer than a single word that have been programmed into an SGD, AAC app, or appear in a communication book or board. These can be stored as: 

• Phrases (e.g., We are out of…; I want to wear my…; Can you help me with…?);
• Sentences (e.g., I am 7 years old; Please get my medicine out of my purse. It’s in the front pocket of my backpack; My address is 123 Daisy Lane); and
• Narratives (e.g., I communicate with this special iPad. I can understand everything you say. It will take me about a minute to respond. Please wait quietly when I am composing my message; We had so much fun this weekend! My Nana & Pop-Pop came to visit & they brought a salt lick for the deer. Pop-Pop fixed it to a tree outside the window.)

Like everything in AAC, there are tradeoffs in using prestored messages. 

Advantages

• Prestored messages make it easier and faster for AAC users to share predictable messages with their communication partners. 
• When combined with single words and/or spelling, prestored messages can give the AAC user a good balance of autonomy and flexibility. 
• They allow AAC users with very limited language skills to share more complex information with their communication partners.
• Using prestored messages reduces fatigue, especially in people with limited energy due to degenerative conditions.

Disadvantages

• Prestored messages lack the flexibility of a word-by-word approach. Once a message is programmed, it stays in that form and cannot easily be modified in the context of a conversational exchange. Yes, I might order a small coffee with one sugar on most days but I didn’t sleep well last night so today and I need an extra large dose of caffeine. My prestored message (“May I have a small Americano with one sugar, please?”) isn’t going to help me.
• Preparing messages in advance is a risky proposition because it presumes that we know exactly what the AAC user will want to say. We’re actually not all that good at that, even when we know the AAC user well. 
• When overused, AAC tools with more prestored messages than single word vocabulary can make language learning difficult. Without access to lots of single words, most AAC learners will struggle to advance their language skills.
• Long messages generally embody many different concepts, making it hard to select a symbol to store them under. Consider a prestored message that tells about your most recent vacation or has explains how to complete a particular task or relay information to a medical provider. What symbol would you select for each of those? Unless the AAC user can read, they’re stuck with a single symbol to represent these complex ideas, and that can be problematic.
• It is impossible to symbolize most prestored messages with images that make sense to pre-literate AAC users. We generally select an image that matches the main idea of the message, but that leaves a lot of room for ambiguity. Let’s try some examples to explore this issue.
  • What symbol would you use for this message: Can you tell me what time it is? 
  • Now, envision symbols for these messages: 
    • When are we going?
    • Tell me when it’s time to get ready.
    • What time will that happen?
    • Is it time to go?

Prestored messages are almost always used in conjunction with single words and often with spelling, too. Using ONLY prestored messages, is too limiting for most AAC users. While they make communication faster and easier, they only allow you to express something that is already in your AAC system. With prestored messages alone, we’re unable to create novel messages. AAC users generally need more flexibility. They usually want to create their own messages in addition to using those that someone else stored in their AAC system. 

The proportion of prestored messages to single word vocabulary matters. Some people, such as those with ALS and others who fatigue easily, will need a lot of prestored messages. Others will use them on occasion and need fewer prestored phrases, sentences, and narratives. For many AAC users, this changes over time.

In future posts, we’ll explore categories of presstored messages. Stay tuned as we look at the use of prestored messages for emergencies and time-sensitive situations, questions, routines, conversational transitions, and more.