研究背景：越來越多的電腦化輔助溝通系統廣泛應用於臨床失語症者的復健，確實能有效地促進失語症者的整體溝通能力與效率。輔助溝通系統的使用，需要認知能力及長期訓練才能有效操作，而訓練目的在於有效地使用輔助溝通系統產生有效的溝通句子。對於中風非流暢型失語症者，藉由輔助溝通系統的使用訓練，隨著漸漸熟稔操作，最後是否能在不同溝通情境中獨立地使用輔助溝通系統做有效的溝通。
研究目的：為了支持輔助溝通系統對於中風非流暢型失語症者的臨床應用，本研究使用國內研發的輔助溝通系統「圖文蘋果派」 (Voice Symbol for iPad)，探討中風非流暢型失語症者在溝通情境中溝通句子的正確完成率與訓練成效、以及不同溝通情境的類化成效。
研究方法：以單一受試跨受試者多探試設計 (Multiple Probe Across-Subjects Designs) ，實施三位中風非流暢型失語症者的「圖文蘋果派」使用成效研究，分基線期、處理期與維持期三個階段。資料蒐集包括：(1)每個階段測驗的溝通情境下，溝通句子的正確完成率；(2)維持期類化的溝通情境下，溝通句子的正確完成率。研究資料以視覺分析圖來呈現與分析，並以C統計考驗來輔助分析。並使用中文化的溝通效益測驗，由主要照顧者評量參與者溝通獨立性的表現，以及調查社會效度與使用滿意度。
結果：輔助溝通系統「圖文蘋果派」使用之後，所得結果如下：(1)三位參與者對於溝通情境溝通句子的正確完成率皆有顯著增加，並且維持顯著的使用訓練成效；(2)三位參與者皆有良好的類化成效，且認知功能較好者的類化成效比較好；(3) 參與者與主要照顧者皆滿意輔助溝通系統的使用；(4) 社會效度方面，治療人員比起主要照顧者更認同輔助溝通系統的使用效果；(5)主要照顧者對於參與者獨立溝通表現的感覺程度方面，除了一位參與者有些微減少之外，其他兩位皆有大幅增加。
討論：臨床治療環境下，輔助溝通系統「圖文蘋果派」可協助中風非流暢型失語症者的溝通句子表達。「圖文蘋果派」的使用訓練會受認知功能與個人特質影響，而不同溝通情境下的類化成效會受認知功能影響。

Background: Computerized augmentative and alternative communication (AAC) is increasingly applied in clinical aphasia rehabilitation because it has been proven effective at enhancing the communication skills and efficiency of people with aphasia. Effective use of AAC requires a strong cognitive ability and prolonged training, which is aimed at training people with aphasia to generate communicative sentences through the use of AAC device. This study attempts to determine whether people who developed non-fluent aphasia after a stroke can effectively use AAC device to independently communicate in different communication situations after becoming familiar with operating such device.
Objective: To support the clinical application of AAC in treating people with non-fluent aphasia after a stroke, this study explored the effectiveness of training people who developed non-fluent aphasia after a stroke to use the AAC application software developed in Taiwan, the Voice Symbol for iPad. Subsequently, the accurately completed percentage of communicative sentences and the generalization outcomes of the AAC device were investigated under different communication situations.
Method: This study adopted a multiple probe across-subjects design to investigate the effectiveness of training three people who developed non-fluent aphasia after a stroke to use the Voice Symbol for iPad. Three phases were explored in this study, namely the baseline, intervention, and maintenance phases. The following data were collected: the accurately completed percentage of communicative sentences during each phase under the tested communication situation; and the accurately completed percentage of communicative sentences during the maintenance phase under a generalized communication situation. The collected data were illustrated and analyzed using visual analysis, supplemented with the C statistical test. Before and after the research was conducted, a Mandarin version of communicative effectiveness index was employed to assess the perception of primary caregivers regarding the ability of the participants to communicate independently. After the research was conducted, the social validity and user satisfaction with the AAC were investigated.
Results: After the participants used the Voice Symbol for iPad installed in the AAC, the following results were obtained: (1) the three participants exhibited significant improvement in the accurately completed percentage of communicative sentences, and the training effectiveness was significantly maintained; (2) the three participants exhibited good generalization effect, and better cognitive function resulted in better generalization effect; (3) the participants and primary caregivers were satisfied with using the AAC; (4) regarding the social validity, the therapists identified with the effect of the AAC device more than the primary caregivers did; and (5) the perception of primary caregivers regarding the ability of the participants to communicate independently, except that one participant showed slightly unsatisfactory performance, the other two exhibited substantially improved independent communication skills.
Conclusion: In a clinical therapeutic setting, the Voice Symbol for iPad installed in the AAC can help people who developed non-fluent aphasia after a stroke to express communicative sentences. The training effectiveness of using the Voice Symbol for iPad was influenced by individual cognitive function and personal traits, and the generalization outcomes obtained under different communication situations were affected by cognitive function.

中文部分
王耀毅 (2009)。輔助溝通系統對成人非流暢性失語症患者溝通訓練
之研究。高雄師範大學聽力與語言治療研究所碩士論文。未出版
，高雄市。
元鼎國際開發有限公司 (2014)。VoiceSymbol for iPad圖文蘋果派。
上網日期：民國103年7月21日。取自：
http://www.unlimiter.com.tw/item-soft003.html
杜正治 (2006)。單一受試研究法。臺北市：心理出版社。
邱大昕 (2011)。誰是身心障礙者—從身心障礙鑑定的演變看 [國際健
康功能與身心障礙分類系統](ICF) 的實施。Social Policy，15(2)。
張彧 (2003)。羅文斯坦職能治療認知評量--中文版施測手冊。
上網日期：民國103年7月21日。取自：
http://ntur.lib.ntu.edu.tw/handle/246246/158009
楊熾康 (2011)。溝通與電腦輔具產品分級。上網日期：民國103
年7月16日。取自：http://repat.sfaa.gov.tw/files/28-17溝通與電
腦輔具產品分級.pdf
廖宥蓁、曾進興 (2008)。失語症患者功能性溝通的需求與表現。臺
灣復健醫誌，36(2)，75-87。
鍾玉梅、李淑娥、張妙鄉、徐道昌 (1998)。簡明失語症測驗 (CCAT)
之編訂與應用。聽語會刊(13)，119-137。
鍾玉梅、李淑娥、張妙鄉（2003）。簡明失語症測驗：指導手冊。臺北市：心理出版社。

英文部分
Atanasoff, L. M., McNaughton, D., Wolfe, P. S., & Light, J. (1998).
Communication demands of university settings for students using
augmentative and alternative communication (AAC). Journal of
Postsecondary Education and Disability, 13(3), 32-47.
Beukelman, D., & Mirenda, P. (2005). Augmentative and alternative
communication: Supporting children and adults with complex
communication needs (3rd eds.). Baltimore, MD: Paul H. Brookes
Publishing Co.
Beukelman, D. R., & Ball, L. J. (2002). Improving AAC use for persons
with acquired neurogenic disorders: Understanding human and
engineering factors. Assistive Technology, 14(1), 33-44.
Beukelman, D. R., Ball, L. J., & Fager, S. (2008). An AAC personnel
framework: Adults with acquired complex communication needs.
Augmentative and Alternative Communication, 24(3), 255-267.
Beukelman, D. R., Fager, S., Ball, L., & Dietz, A. (2007). AAC for adults
with acquired neurological conditions: A review. Augmentative and
Alternative Communication, 23(3), 230-242.
Beukelman, D.R., Garrett , K.L. ,& Yorkston , K.M. (2007).
Augmentative Communication Strategies for Adults with Acute or
Chronic Medical Conditions. Baltimore, Maryland：Paul H.
Brookes.
Blackstone, S. W., Williams, M. B., & Wilkins, D. P. (2007). Key
principles underlying research and practice in AAC.
Augmentative & Alternative Communication, 23(3), 191-203.
Cook, A. M., & Hussey, S. M. (2008). Assistive technology: Principles
and practice (3rd eds.). St. Louis, MS : Mosby, Inc.
Darrigrand, B., Dutheil, S., Michelet, V., Rereau, S., Rousseaux, M., &
Mazaux, J.-M. (2011). Communication impairment and activity
limitation in stroke patients with severe aphasia. Disability &
Rehabilitation, 33(13/14), 1169-1178.
Davis, T., Barnard-Brak, L., Dacus, S., & Pond, A. (2010). Aided AAC
systems among individuals with hearing loss and disabilities.
Journal of Developmental & Physical Disabilities, 22(3), 241-256.
Dorze, G. L., & Brassard, C. (1995). A description of the consequences of
aphasia on aphasic persons and their relatives and friends, based on
the WHO model of chronic diseases. Aphasiology, 9(3), 239-255.
Eyongakpa Tabi, E. (2012). Aphasia and communication-A literature
review. Retrieved from https://scholar.google.com.tw/scholar?as_q=Human+Aging+and+Elderly+Services+2012&as_epq=Aphasia+and+communication&as_oq=&as_eq=&as_occt=any&as_sauthors=&as_publication=&as_ylo=2012&as_yhi=&btnG=&hl=zh-TW&as_sdt=0%2C5&as_vis=1
Fager, S., Hux, K., Beukelman, D. R., & Karantounis, R. (2006).
Augmentative and alternative communication use and acceptance
by adults with traumatic brain injury. Augmentative and Alternative
Communication, 22(1), 37-47.
Garrett, K. L., & Kimelman, M. D. Z. (2000). AAC and aphasia:
Cognitive-linguistic considerations. In D. Beukelman, K. Yorkston,
& J. Reichle (Eds.), Augmentative and alternative communication
for adults with acquired neurologic disorders (pp. 339–374).
Baltimore, MD: Paul H. Brookes.
Garrett, K. L., & Huth, C. (2002). The impact of graphic contextual
information and instruction on the conversational behaviours of a
person with severe aphasia. Aphasiology, 16(4-6), 523-536.
Hedvall, P.-O., & Rydeman, B. (2010). An activity systemic approach to
augmentative and alternative communication. Augmentative &
alternative communication, 26(4), 230-241.
Hodge, S. (2007). Why is the potential of augmentative and alternative
communication not being realized? Exploring the experiences of
people who use communication aids. Disability & Society, 22(5),
457-471.
Hough, M. S., & Johnson, R. K. (2008). Use of AAC to enhance
communication in an adult with chronic severe aphasia. Paper
presented at the 2008 Clinical AAC Research Conference,
Charlottesville, VA.
Hough, M. S., & Johnson, R. K. (2009). Use of AAC to enhance
linguistic communication skills in an adult with chronic severe
aphasia. Aphasiology, 23(7-8), 965-976.
Jacobs, B., Drew, R., Ogletree, B. T., & Pierce, K. (2004). Augmentative
and alternative communication (AAC) for adults with severe
aphasia: Where we stand and how we can go further. Disability &
Rehabilitation, 26(21/22), 1231-1240.
Jette, A. M. (2006). Toward a common language for function, disability,
and health. Physical Therapy, 86(5), 726-734.
Johnson, C. J., Beitchman, J. H., & Brownlie, E. B. (2010). Twenty-year
follow-up of children with and without speech-language
impairments: family, educational, occupational, and quality of
life outcomes. American Journal of Speech-Language Pathology,
19(1), 51-65.
Johnson, R. K., Hough, M. S., King, K. A., Vos, P., & Jeffs, T. (2008).
Functional communication in individuals with chronic severe
aphasia using augmentative communication. Augmentative and
Alternative Communication, 24(4), 269-280.
Katz, N., Itzkovich, M., Averbuch, S., & Elazar, B. (1989). Loewenstein
occupational therapy cognitive assessment (LOTCA) battery for
brain-injured patients: Reliability and validity. American Journal of
Occupational Therapy, 43(3), 184-192.
Kent-Walsh, J., & Light, J. (2003). General education teachers'
experiences with inclusion of students who use augmentative and
alternative communication. Augmentative and Alternative
Communication,19(2), 104-124.
Koul, R., Corwin, M., & Hayes, S. (2005). Production of graphic symbol
sentences by individuals with aphasia: Efficacy of a
computer-based augmentative and alternative communication
intervention. Brain and Language, 92(1), 58-77.
Lasker, J., & Bedrosian, J. (2001). Promoting acceptance of augmentative
and alternative communication by adults with acquired
communication disorders. Augmentative and Alternative
Communication, 17(3), 141-153.
Lasker, J. P., & Garrett, K. L. (2006). Using the multimodal
communication screening test for persons with aphasia ( MCST‐
A ) to guide the selection of alternative communication strategies
for people with aphasia. Aphasiology, 20(2-4), 217-232.
Lasseter, L. H., & Lasker, J. P. (2007). Making device decisions for a
client with global aphasia using an AAC-aphasia assessment
protocol. Paper presented at the 2007 Clinical AAC Research
Conference, Lexington, KY.
Light, J. (1997). “Let's go star fishing”: Reflections on the contexts of
language learning for children who use aided AAC. Augmentative
and Alternative Communication, 13(3), 158-171.
Lomas, J., Pickard, L., Bester, S., Elbard, H., Finlayson, A., & Zoghaib,
C. (1989). The communicative effectiveness index: Development
and psychometric evaluation of a functional communication
measure for adult aphasia. Journal of Speech and Hearing
Disorders, 54(1), 113.
Lund, S. K., & Light, J. (2007). Long-term outcomes for individuals
who use augmentative and alternative communication: Part III –
contributing factors. Augmentative & Alternative
Communication, 23(4), 323-335.
Matas, J., Mathy-Laikko, P., Beukelman, D., & Legresley, K. (1985).
Identifying the nonspeaking population: A demographic study.
Augmentative and Alternative Communication, 1(1), 17-31.
McNaughton, D., & Bryen, D. N. (2002). Enhancing participation in
employment through AAC technologies. Assistive Technology,
14(1), 58-70.
McNaughton, D., Rackensperger, T., Benedek-Wood, E., Krezman, C.,
Williams, M. B., & Light, J. (2008). "A child needs to be given a
chance to succeed": Parents of individuals who use AAC describe
the benefits and challenges of learning AAC technologies.
Augmentative & Alternative Communication, 24(1), 43-55.
McWhirter, B. T. (1990). Loneliness: A review of current literature, with
implications for counseling and research. Journal of Counseling &
Development, 68(4), 417-422.
Mirenda, P. (2003). Toward functional augmentative and alternative
communication for students with autism: Manual signs, graphic
symbols, and voice output communication aids. Language,
Speech & Hearing Services in Schools, 34(3), 203-216.
Murphy, J., Markova, I., Collins, S., & Moodie, E. (1996). AAC
systems*: obstacles to effective use. International journal of
language & communication disorders, 31(1), 31-44.
National Aphasia Association. (1987). The impact of aphasia on patients
and family: Results of a needs survey. New York: National Aphasia
Association.
O'Connor, B. P. (1995). Family and friend relationships among older and
younger adults: Interaction motivation, mood, and quality. The
International Journal of Aging and Human Development, 40(1),
9-29.
Parette, H. P., Huer, M. B., & Brotherson, M. J. (2001). Related service
personnel perceptions of team AAC decision-making across
cultures. Education and Training in Mental Retardation and
Developmental Disabilities, 36(1), 69-82.
Plowman, E., Hentz, B., & Ellis, C. (2012). Post-stroke aphasia
prognosis: a review of patient-related and stroke-related factors.
Journal of Evaluation in Clinical Practice, 18(3), 689-694.
Rautakoski, P. (2008). Can AAC methods help the communication of the
adults with severe aphasia and their families? Retrieved from
https://scholar.google.com.tw/scholar?hl=zh-TW&q=Can+AAC+m
ethods+help+the+communication+of+the+adults+with+severe+aph
asia+and+their+families%3F+&btnG=&lr=
Ribitzki, T. A. (2003). Efficacy of computer-based voice output
communication intervention in persons with chronic severe
aphasia (master's thesis, Texas Tech University). Retrieved from
https://repositories.tdl.org/ttu-ir/bitstream/handle/2346/18222/3129
5017075630.pdf?sequence=1
Rispoli, M. J., Franco, J. H., van der Meer, L., Lang, R., & Camargo, S. P.
H. (2010). The use of speech generating devices in communication
interventions for individuals with developmental disabilities: A
review of the literature. Developmental Neurorehabilitation, 13(4),
276-293.
Robey, R. R., Schultz, M. C., Crawford, A. B., & Sinner, C. A. (1999).
Review: Single-subject clinical-outcome research: Designs, data,
effect sizes, and analyses. Aphasiology, 13(6), 445-473.
Rokach, A. (2001). Strategies of coping with loneliness throughout the
lifespan. Current Psychology, 20(1), 3-17.
Sarno, M. T. (1997). Quality of life in aphasia in the first post-stroke year.
Aphasiology, 11(7), 665-679.
Sigafoos, J., & Drasgow, E. (2001). Conditional use of aided and
unaided AAC a review and clinical case demonstration. Focus
on Autism and Other Developmental Disabilities, 16(3), 152-161.
Sigafoos, J., O'Reilly, M. F., Seely-York, S., Weru, J., Son, S. H., Green,
V. A., & Lancioni, G. E. (2004). Transferring AAC intervention to
the home. Disability & Rehabilitation, 26(21/22), 1330-1334.
Simmons-Mackie, N., Raymer, A., Armstrong, E., Holland, A., &
Cherney, L. R. (2010). Communication partner training in aphasia:
A systematic review. Archives of Physical Medicine and
Rehabilitation, 91(12), 1814-1837.
Stoner, J. B., Angell, M. E., & Bailey, R. L. (2010). Implementing
augmentative and alternative communication in educational
settings: A case study. Augmentative & Alternative Communication,
26(2), 122-135.
Togher, L., McDonald, S., Code, C., & Grant, S. (2004). Training
communication partners of people with traumatic brain injury: A
randomised controlled trial. Aphasiology, 18(4), 313-335.
U.S. Department of Health & Human Services (2014). What
acuses aphasia ? Retrieved July 17, 2014, from
https://www.nidcd.nih.gov/health/voice/pages/aphasia.aspx#causes
van de Sandt-Koendeman, W. M. E. (2004). High-tech AAC and
aphasia: Widening horizons? Aphasiology, 18(3), 245-263.
van de Sandt-Koenderman, W.M.E., Wiegers, J., & Hardy, P. (2005). A
computerised communication aid for people with aphasia.
Disability & Rehabilitation, 27(9), 529-533.
van de Sandt-Koenderman, W. M. E., Wiegers, J., Wielaert, S. M.,
Duivenvoorden, H. J., & Ribbers, G. M. (2007a). A computerized
communication aid in severe aphasia: An exploratory study.
Disability & Rehabilitation, 29(22), 1701-1709.
van de Sandt-Koenderman, W. M. E., Wiegers, J., Wielaert, S. M.,
Duivenvoorden, H. J., & Ribbers, G. M. (2007b). High-tech AAC
and severe aphasia: Candidacy for TouchSpeak (TS). Aphasiology,
21(5), 459-474.
van der Meer, L. A. J., & Rispoli, M. (2010). Communication
interventions involving speech-generating devices for children with
autism: A review of the literature. Developmental
Neurorehabilitation, 13(4), 294-306.
Wallace, S. E., Hux, K., & Beukelman, D. R. (2010). Navigation of a
dynamic screen AAC interface by survivors of severe traumatic
brain injury. Augmentative & Alternative Communication, 26(4),
242-254.
Wallace, T., & Bradshaw, A. (2011). Technologies and strategies for
people with communication problems following brain injury or
stroke. NeuroRehabilitation, 28(3), 199-209.
World Health Organization (2001). International Classification of
Functioning, Disability and Health. Geneva, Switzerland: World
Health Organization.