People with aphasia using AAC: are executive functions important?

Background: Many people with aphasia (PWA) who are introduced to augmentative and alternative communication (AAC) struggle to become effective and independent users of AAC. Aims: In this article, we discuss how impairments of executive functioning (EF) might be expected to interact with ability to use AAC effectively. We also review the research literature that has investigated the relationship between EF and response to AAC treatment in aphasia. Assessment tools that may be useful in predicting successful use of AAC by PWA are also discussed. Main Contribution: Results from the few available studies are mixed with respect to the importance of EF to successful AAC use. At present, there is a paucity of research directly investigating which aspects of EF might be the best predictors for response to treatment to learn AAC, although some researchers have reported that EF tasks designed to measure cognitive flexibility (shifting) appear to have some predictive utility. Conclusions: Using terminology from two published models of EF, we suggest that executive attention, which includes working memory, as well as updating, shifting and inhibiting, are all necessary when using AAC for successful communication. This perspective is one that should receive more attention in clinical practice and when designing research on use of AAC by PWA.