Journal of Associated Medical Sciences

The validity and reliability of modified cough transport outcome using slower airflow for assessing mucus viscoelasticity

Aung Aung Nwe — 2024-09-04

Background: The cough transportability technique reflects changes in mucus rheology. However, the necessity of high airflow rates, such as 8 L/s, to carry out this technique limits its utility, as specialized setups or equipment are required.

Objective: This study aims to identify practical alternatives to higher airflow rates and utilize easily accessible equipment, such as mechanical air pumps (2 L/s).

Materials and methods: Mucus simulant gel (MSG) of 4 viscoelasticity and sputum from patients with bronchiectasis were collected and prepared. All samples underwent standard airflow cough transport (sCT) and modified cough transport (mCT). Additionally, three rounds of each MSG and two rounds of sputum underwent mCT.

Results: A Pearson correlation analysis between mCT and sCT revealed very high (r=0.986, p=0.014) and high (r=0.771, p<0.001) in the MSG and the sputum of bronchiectasis patients, respectively. The test-retest reliability of mCT revealed ICCs of 0.997 and 0.926 in the MSG and sputum of patients with bronchiectasis, respectively.>

Conclusion: mCT could be an alternative to sCT, offering a more accessible option for conducting cough transportability

Momordica charantia L. with Oxy Combination of Momordica charantia L. with oxytetracycline enhanced antibacterial and antibiofilm activities against some multidrug-resistant bacteria

Wisatre Kongcharoensuntorn — 2024-09-05

Background: Momordica charantia L., the common name for bitter gourd, frequently used as a vegetable and in traditional medicine to treat wounds, peptic ulcers, parasites, and worms. Regarding of finding alternative ways to cure nosocomial infection caused by multidrug-resistant bacteria, bitter gourd in combination with some antibiotics may be a practical choice to reduce the cost of therapy and be devoid of side effects from antibiotics.

Objective: This study aimed to determine the antimicrobial, antibiofilm, and synergy effects of ethanol extract from bitter gourd in combination with conventional antibiotics, ampicillin, and oxytetracycline against some drug-resistant bacteria.

Materials and methods: The antimicrobial activity was tested by broth microdilution, and the lowest concentration that inhibits the visible growth of each microorganism was recorded as MIC. A checkerboard microdilution assay was designed to test the synergistic effect of bitter gourd extract. A crystal violet staining assay was carried out to test antibiofilm activity

Results: The bitter gourd extracted by ethanol revealed antibacterial activity with a MIC range of 1.25-80 mg/mL. Synergistic effects of bitter gourd extract with ampicillin and oxytetracycline were effective against P. mirabilis and drug-resistant P. aeruginosa growth by FICI at 0.141 and 0.63, respectively. The results found that bitter gourd exhibited antibiofilm activities against E. coli ATCC 25922, drugresistant P. aeruginosa, and Methicillin-Resistant Staphylococcus aureus (MRSA) at 2-4 hours after starting inoculum and the inhibitory efficacy values were 37.62%, 71.14%, and 69.87%, respectively.

Conclusion: The ethanol extract from bitter gourd had antibacterial effect, synergy effect when mixed with ampicillin and oxytetracycline.

Preliminary study: Exploring the influence of healthcare services and antibiotic discontinuation among pulmonary tuberculosis patients with self-administration in Western Thailand: A case-control study

Saikaew Chuachan — 2024-09-05

Background: Outpatients generally use self-administration, which might result in defaulting from treatment.

Objective: This study evaluated the association between patient treatment discontinuation and health service.

Materials and methods: This retrospective case-control study was conducted in a TB clinic at Makarak Hospital, Kanchanaburi Province, Thailand. Participants who completed and discontinued treatment from 2017 to 2021 were surveyed using questionnaires.

Results: A total of 198 patients with TB who discontinued (N=49) and completed treatment (N=149) were analyzed. Associated factors of discontinued treatment in those who were male were (OR=8.41, 95%CI: 1.55-45.61), not receiving support from a family member (OR=33.75, 95%CI: 3.22-353.76), and waiting time of more than 3 hours for health services (OR=9.39, 95%CI: 1.98-44.64).

Conclusion: Prolong treatment delivery services that exceed more than 3 hours and living without family support were associated with drug discontinuation in patients with TB who were self-administration treatment. These factors should be considered to enhance TB treatment success and infection control.

Motivational factors influencing research completion: A literature review for occupational therapy and health professions

Paolo Miguel P Bulan — 2024-09-05

Background: Graduate education, particularly at the master’s and doctoral levels, is crucial in developing advanced professional skills and fostering a researchoriented mindset. However, many students struggle to complete their research due to various motivational and institutional challenges. This literature review examines the factors influencing research completion in graduate school to provide insights into occupational therapy and related health professions, emphasizing the importance of intrinsic and extrinsic motivational factors.

Objective: The primary goals of this review are to (1) identify the intrinsic and extrinsic motivational factors that influence research completion, (2) explore the barriers to research completion at the graduate level, and (3) propose motivational strategies that graduate programs can adopt to support research completion among occupational therapy and other health professions.

Materials and methods: A literature search was conducted across multiple databases, including the ASEAN Citation Index, EBSCO, Google Scholar, and Scopus. The review focused on studies published between 2010 and 2024 investigating motivational strategies, barriers, and research completion in graduate school. A total of 17 peer-reviewed articles met the inclusion criteria and were subjected to frequency and thematic analyses to identify key themes and patterns.

Results: The thematic analysis revealed four key themes: (1) intrinsic motivation and personal growth, (2) external support and institutional resources, (3) barriers to research completion, and (4) improving support systems. The findings highlight that intrinsic factors such as personal satisfaction and ambition are crucial for research completion, while external factors like mentorship, institutional resources, and cultural context play significant roles. Identified barriers include imposter syndrome, inadequate supervision, and time management challenges. Enhancing mentorship, strengthening institutional support, and developing student skills are recommended to improve research completion rates.

Conclusion: This review underscores the importance of addressing intrinsic and extrinsic motivational factors to support research completion among graduate students in occupational therapy and related health professions. By implementing targeted strategies that enhance mentorship, provide robust institutional support, and develop essential research skills, graduate programs can significantly improve research outcomes and advance evidence-based practice in health professions.

The roadblocks to business ownership: Analyzing the challenges Thai physical therapists face despite entrepreneurial education

Jirakrit Leelarungrayub — 2024-09-07

Background: The field of entrepreneurship poses significant challenges for undergraduate students and physical therapists in Thailand. Entrepreneurial intention, entrepreneurial courses in the physical therapy curriculum, and personality qualities are likely the prominent influencers. The social-environmental factors, access to resources, and perceptions of opportunity are also suggested to play a role of the secondary influencers on entrepreneurship. Regrettably, there is a lack of empirical evidence about the impact of these effects on entrepreneurial concepts within physical therapy.

Objective: This study aimed to ascertain the mutual correlation and assess the primary and secondary influencers for entrepreneurship among undergraduate students and physical therapists.

Materials and methods: A cross-sectional study was conducted on 120 physical therapy students and general physical therapists. An online, structured questionnaire with a five-point Likert scale for primary and secondary influencing factors was designed. All questions’ content validity and reliability were determined before being applied to all respondents, and a significant relationship was identified with Barlette’s test. The Kaiser-Meyer-Olkin Measure (KMO) and the measure of sample adequacy (MSA) were used to assess the overall feasibility of factorial analysis. Finally, the IBM SPSS AMOS program analyzed the influence on entrepreneurship with structural equation modeling (SEM).

Results: The results from 120 responses (74 females and 46 males), 64 undergraduate students, and 56 general physical therapists were 25.81±6.62 years (21-51 years old). All questions showed good reliability. All influencing factors showed a significant relationship and feasibility through factor analysis (FA). Furthermore, the primary factors showed that personality traits strongly influenced entrepreneurship compared to entrepreneurial intention. However, the curriculum had a meager impact. In addition, secondary influencing factors, such as opportunity perception, access to resources, and social-environment factors, highly influence entrepreneurship.

Conclusion: Personality traits and entrepreneurial intention are the most influencing factors, but the course in the curriculum is less influential for entrepreneurship. On the other hand, opportunity perception, access to resources, and social/environmental factors are also the secondary strong influencing factors among physical therapy students and general physical therapists.

A web-based decision support system to support occupational therapy services in promoting active ageing

Supawadee Putthinoi — 2024-09-07

Background: Dealing with the consequences of Thailand’s ageing population is a significant challenge. The growing usage of Information and Communication Technology (ICT) has the potential to support healthy and active ageing.

Objective: This study aimed to develop a web-based Decision Support System (DSS) and evaluate its usability.

Materials and methods: Research and Development (R&D) was a study design. It was divided into two phases: the development of the web-based DSS and its usability.

Results: The web-based DSS was designed under the requirements of the users and comprised seven components: 1) the login page; 2) the main page; 3) the register page; 4) active ageing measurement; 5) decision-making for older people; 6) the Occupational Therapy (OT) recommendations system; and 7) exporting information. A System Usability Score (SUS) of 80.41 in the usability test showed that the web-based DSS was very user-friendly and had excellent efficacy, efficiency, and satisfaction.

Conclusion: The web-based DSS effectively enhanced ageing for older people.

Psychometric properties of the self-report questionnaire on occupational balance in university students with game addiction

Naphatsorn Phuprasoet — 2024-09-10

Background: The prevalence of adolescents and young adults playing games on the internet is increasing worldwide. However, excessive game playing can cause game addiction among adolescents. Studies have demonstrated that game addiction increases the risks of physical and mental health problems, leading to occupational performance issues. Nevertheless, what level of game addiction impacts occupational health issues is controversial. Therefore, this study focused on occupational balance, an individual’s perception of a proper amount and diversity of activities. The study demonstrated that occupational imbalance could lead to a decrease in an individual’s occupational performance. However, an appropriate instrument for screening occupational balance in young adults with game addiction has never been studied yet, especially in a Thai version.

Objective: This study aimed to develop a self-report questionnaire on occupational balance for Thai university students with game addiction.

Materials and methods: The questionnaire consisted of 21 items divided into four dimensions, including the individual’s perceptions of participating in meaningful activities, having the proper proportion of time to perform occupations, having the appropriate variety of professions, and being satisfied with their health and well-being. In addition, the psychometric properties of a questionnaire were investigated.

Results: The questionnaire had sufficient validity and good internal consistency for screening occupational balance in Thai university students with game addiction. The questionnaire was divided into four dimensions, each with good construct validity and internal consistency.

Conclusion: The questionnaire was valid and reliable for evaluating occupational balance for Thai university students with game addiction. This information can provide a new occupational therapy instrument for identifying occupational balance in the population with game addiction.

Analyzing dprE1 gene variations in drug-resistant Mycobacterium tuberculosis isolates from Northern Thailand

Zayar Phyo — 2024-09-23

Background: DprE1 has been discovered as a highly promising candidate for eradicating multidrug-resistant tuberculosis (MDR-TB) due to its localization and crucial role in cell wall synthesis. Several DprE1 inhibitors in clinical trials target different binding sites on the DprE1 protein. However, mutations in these binding sites can result in resistance to these inhibitors. Nonetheless, only a few reports exist on the sequence analysis of the dprE1 gene in drug-resistant clinical isolates, especially in Thailand, a country with a high TB burden.

Objective: To investigate the genetic variations in the dprE1 gene among drugresistant clinical Mycobacterium tuberculosis (Mtb) isolates from Northern Thailand and to examine mutations known to confer resistance to specific inhibitors.

Materials and methods: Drug resistance profiles of 19 clinical Mtb isolates from Northern Thailand—11 multidrug-resistant Mtb, 2 isoniazid-resistant Mtb, and 6 rifampicin-resistant Mtb-were assessed using the agar proportion method and Sanger sequencing. New PCR and sequencing primers were designed to cover the entire length of the dprE1 gene. Mutation profiles were detected by performing DNA alignment against the reference strain, M. tuberculosis H37Rv, using BioEdit Sequence Alignment version 7.2.5. The distribution of these mutations was assessed through the Basic Local Alignment Search Tool (BLAST) server. Visual representation of amino acid mutation regions in DprE1 was generated using the PyMOL 3.0.

Results: The mutation at codon 387 associated with benzothiazinone (BTZ) compounds was not observed in the dprE1 gene of any clinical isolates. The most common mutation profile, C→T at codon 459, was found in 73.68% of clinical isolates. However, this is a silent mutation and probably indicates genetic polymorphism. Non-synonymous substitutions in the dprE1 gene were detected: A356T in one INH-R isolate and V400I in two RIF-R isolates. BLAST analysis revealed that the A356T mutation in the INH-R isolates had a 100% match with sixteen Mtb strains from other regions. Interestingly, the V400I mutation in the RIF-R isolates had not been reported, making this the first documentation of such a finding.

Conclusion: Although no mutations directly linked to resistance against current DprE1 inhibitors were found, mutations in the DprE1 binding sites could affect the efficacy of these inhibitors. This study highlights the significance of mono-drugresistant strains that acquire dprE1 mutations, potentially complicating future TB treatment targeting DprE1.

Assessment of dose uniformity and optimal CT number for virtual bolus in breast VMAT planning

Rusdchai Chaisuttee — 2024-10-03

Background: ICRU Report No. 83 proposes using the Flash Region in the strategic design of breast cancer treatment. However, concerns persist regarding the delivery of the designated radiation dose to breast cancer patients undergoing Volumetric Modulated Arc Therapy (VMAT) with virtual bolus in the irradiation plan.

Objective: This study aimed to assess dose uniformity in breast VMAT treatment with a virtual bolus, validate the planning dose by comparing it with nanoDotTM measurements on a Rando phantom, and determine the optimal CT number for the virtual bolus in breast VMAT planning. Materials and

Materials and methods: To assess dose uniformity in the breast VMAT plan, nine nanoDot™ dosimeters were placed on the breast of Rando phantom, followed by CT simulation and VMAT treatment planning. The clinical target volume (CTV) and organs at risk were contoured, and the planning target volume (PTV) boundaries were expanded by 5 mm and 10 mm for virtual bolus thicknesses of 10 mm and 15 mm, respectively. The CT number of the virtual bolus varied from 0 to -700 HU. The planning doses at 9 points were determined, and the coefficient of variation (%CV) was calculated. Additionally, measurements at these 9 points were performed using nanoDot™ dosimeters. The calculated and measured doses were then compared. Finally, VMAT treatment plans with a virtual bolus were implemented in 10 breast cancer patients, using the virtual bolus with varying CT numbers as in the phantom study to evaluate the optimal CT number of the bolus.

Results: The doses among the 9 points for each plan were uniform, with a %CV of less than 4. For calculated dose validation, the percentage differences between the measured and calculated dose for all treatment plans, with variations in the CT number and the bolus thickness, were within ±5%. To determine the optimal CT number for the virtual bolus, the breast cancer treatment plan that met the dose criteria for tumors and organs at risk was the plan with a CT number of 0 HU for both virtual bolus thicknesses of 10 and 15 mm.

Conclusion: Virtual bolus provides uniform dose distribution for breast VMAT planning, which measurements from nanoDotTM can validate. The appropriate CT number for the virtual bolus is 0 HU for both bolus thicknesses. In future studies, measurements should be conducted on actual patients.

Analysing the effectiveness of cognitive behavioural therapy in university students with ADHD: A systematic review

Gabriella Maraschin — 2024-10-10

Background: Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that begins in childhood and often persists into adult life. University students with ADHD frequently experience great difficulty with global academic functioning, resulting in higher drop-out rates and, consequently, higher unemployment rates.

Objective: This literature review aims to analyse the effectiveness of cognitive behavioural therapy (CBT) interventions to reduce ADHD-related symptoms in university students with ADHD.

Materials and methods: A literature search was conducted via EBSCO database in October 2023 using key terms: ADHD OR attention deficit hyperactivity disorder AND cogniti* intervention OR cogniti* therapy AND college student* OR university student*. The inclusion criteria were studies using cognitive behavioural therapy as their primary intervention for individuals with ADHD who are enrolled in university or college and are 18 years or above in age.

Results: Seven out of 115 papers were deemed eligible and were included in this review. This review’s studies included four randomized control trials and three before and after open trials. Three key themes were identified through data extraction: intervention design, outcome measures used, and effectiveness of interventions on ADHD-related symptoms. All the studies tailored their CBT intervention toward university students. There was a statistically significant improvement in core domains of ADHD-related impairment, in particular, inattention (N=7), overall executive functions (n=5), and hyperactivity-impulsivity (N=1).

Conclusion: While the current findings suggest positive results of CBT for reducing ADHD-related symptoms in university students with ADHD, further research should explore the sustainability of these gains over the long term. Due to the lack of explicit published study on this topic in the United Kingdom, further research should be conducted in the UK to assess the applicability and effectiveness of tailored CBT interventions within the British university environment.

Validity and reliability of the Thai Shortened Token Test

Natha Trisakdipol — 2024-10-11

Background: The Token Test (TT) helps evaluate language comprehension in individuals with aphasia. This test can detect comprehension difficulties, even in mild aphasia cases. In Thailand, the other language tests for aphasia focused primarily on multiple aspects of language, which took a long time to evaluate. The Shortened TT, which has fewer commands, has been chosen to be translated for this study. Previously, the Shortened TT was translated into Thai using only forward translation and had not yet been evaluated for its psychometric properties. Thus, this study focuses on translating the Shortened TT into Thai using a forward and backward translation process and determining its validity and reliability.

Objective: To translate, validate, and determine the reliability of the Thai Shortened TT.

Materials and methods: The Shortened TT was translated using forward and backward translation. Following the completion of the translation process, five expert speech-language pathologists (SLPs) evaluated its content validity using the Content Validity Index (CVI), the Content Validity Index for Items (I-CVI), and the Content Validity Index for Scales (S-CVI). Then, it was administered to 12 normal participants and 12 aphasia participants to determine the test-retest, intra-, and inter-rater reliability using the Intraclass Correlation Coefficient (ICC).

Results: The Thai Shortened TT’s content validity was satisfied at CVI=0.920, I-CVI=0.800-1, and S-CVI=0.983. The test-retest, intra-, and inter-rater reliability were excellent. In the normal group, they were 0.943, 0.985, and 0.974, respectively; in the aphasia group, they were 0.985, 0.999, and 0.999, respectively.

Conclusion: This study indicated that the Thai Shortened TT can be utilized and is suitable for clinical evaluation regarding its content validity and reliability.

Application for acoustic assessment: A pilot study in Parkinson’s patients

Worapol Boonyaban — 2024-10-24

Background: Patients with Parkinson’s disease (PD) often experience speech impairment that impacts their daily lives. In speech therapy for PD patients, it is important to use instruments to evaluate acoustic characteristics and support rehabilitation programs. However, in Thailand, access to acoustic assessment instruments is limited due to their high price and lack of portability.

Objectives: This study’s aim was to develop an application for acoustic assessment (AAA) and to conduct a pilot study of the application among healthy aging (HA) and aging PD subjects.

Materials and methods: This study was a developmental research design comprising three distinct phases. Phase one focused on the development of the AAA and evaluation of the accuracy and precision of the application. In phase two, a comparative analysis was conducted between AAA and Praat, a speech analysis software package, among twenty HA. Five acoustic parameters: loudness, jitter, shimmer, high frequency (Hf₀), and low frequency (Lf₀), were used to determine concurrent validity. Phase three compared both AAA and Praat with twenty aging PD subjects, examining the concurrent validity and reliability, and comparing the acoustic parameters of HA users with those of the aging PD cohort.

Results: In phase one, the AAA shows strong accuracy ranging from 96.86% to 99.59% and high precision, with a Coefficient of Variation (%CV) of 1.65%-3.78%. In phase two, the concurrent validity of AAA compared with Praat in HA exhibited significant and very strong correlations (r_s ≥ 0.90, p > 0.05) in all acoustic parameters, except for shimmer, which showed significant and strong correlations (r_s = 0.73, p = 0.00). In phase three, the concurrent validity of AAA compared with Praat in aging PD subjects exhibited significant and very strong correlations (r_s ≥ 0.90, p > 0.05) in loudness, Hf₀, and Lf₀, whereas significant and strong correlations were shown in jitter (r_s = 0.85, p = 0.00) and shimmer (r_s = 0.82, p = 0.00). The Intraclass Correlation Coefficient (ICC) exhibited excellent reliability in all acoustic parameters (r > 0.90). When comparing the HA and aging PD subjects using AAA, significant differences (p < 0.05) were observed in all acoustic parameters, except for Lf₀
(p < 0.55).

Conclusion: The AAA demonstrates high concurrent validity and reliability. It can effectively be utilized for testing in PD groups, serving as an alternative tool for evaluating acoustic characteristics and aiding in treatment planning.

Sensory processing and social participation in children with autism spectrum disorder: A systematic review

Deepak Vignesh Raj S S — 2024-10-25

Background: Children with autism spectrum disorder experience various challenges, in which difficulties in social participation represent a significant area of concern. Research studies indicate that autistic children who experience more challenges in sensory processing tend to demonstrate lower social competence. Therefore, a comprehensive synthesis of the evidence exploring the link between sensory processing and social participation is needed to develop targeted interventions and support strategies to enhance social functioning in children with autism spectrum disorder.

Objective: This systematic review aimed to investigate the impact of sensory processing on social participation in children with ASD aged 3-18 years.

Materials and methods: The review involved a comprehensive search across electronic databases such as Scopus, PubMed, and OTseeker. The McMaster Critical Review Form for Quantitative Studies was used to evaluate the methodological quality of the included articles.

Results: A total of 4,158 records were identified through database searches and manual searches. Following the title and abstract review, 10 studies were selected for the full-text review, which led to the inclusion of 8 studies in the systematic review that met the predefined criteria. Among the 8 studies, 7 studies reported a significant correlation between sensory processing and social participation in children with ASD. Specifically, sensory over-responsivity, under-responsivity, and seeking behaviors were found to influence the child’s ability to comprehend, interpret, and respond to social cues effectively, thereby increasing the social challenges commonly associated with ASD.

Conclusion: This systematic review underscores the evident impact of sensory processing difficulties on social participation among children with ASD. It highlights the critical role of sensory processing in facilitating successful social functioning across diverse contexts and emphasizes its importance in enhancing overall social well-being in children with ASD.

Prevalence and antimicrobial resistance of Salmonella isolated from pork in the Northern part of Thailand

Kanitapon Supadej — 2024-10-30

Background: Salmonella is one of the most common foodborne bacteria frequently isolated from pork. It pose significant public health risks due to its potential to harbor antimicrobial resistance (AMR) genes. The emergence and spread of multidrug-resistant (MDR) Salmonella strains are of particular concern as these can be transferred to humans through food or contaminated environments.

Objective: To determine Salmonella’s prevalence and antimicrobial resistance determinants from pork at retail markets in the Northern part of Thailand.

Materials and methods: Salmonella was isolated and identified from 173 pork samples. The isolates were serotyped using the slide agglutination test with somatic- (O) and flagellar- (H) antigens, and tested for antimicrobial susceptibility using 23 different antimicrobials using the disc diffusion method. By polymerase chain reaction (PCR), the extended-spectrum β-lactamases (ESBL) genes (blaTEM, blaSHV, blaCTX-M-1, blaCTX-M-2, blaCTX-M-8/25 and blaCTX-M-9), quinolone-resistance determining region (QRDR) including gyrA, gyrB, parC and parE, plasmid-mediated quinolone resistance (PMQR) determinants including qnrA, qnrB, qnrD, qnrS, and aac(6’)-Ib-cr were determined.

Results: In this study, 98.8% of the samples were identified as Salmonella. Among these, 72.5% of isolates showed resistance to at least 1 antimicrobial agent and 48.5% were MDR. Ampicillin/tetracycline/trimethoprim-sulfamethoxazole (AMP/ TE/SXT) was the most common phenotypic resistance pattern. The results revealed that 4 ESBL genes (blaTEM, blaCTX-M-1, blaCTX-M-2, and blaCTX-M-9) were detected in 3 isolates- identified as ESBL producers. Moreover, all 9 quinolone-mediated resistance determinants were observed in quinolone resistance isolates.

Conclusion: The results demonstrated that most MDR isolates harbored quinolone resistance determinants. We report the distribution of MDR in Salmonella strains isolated from pork and the correlation between the phenotypic and the genotypic susceptibility. These findings raise great concern about the spread of resistant Salmonella strains in the Northern part of Thailand.

A Review Article: Designing Grid Displays in AAC Systems to Enhance Accuracy and Reduce Latency in Symbol Searching

Wansiya Kamonsitichai — 2024-10-21

Augmentative and Alternative Communication (AAC) systems support individuals
with complex communication needs. This review article examines factors influencing
the design of grid displays in AAC systems to enhance symbol searching accuracy
and reduce latency. Four key areas are identified: the organization of symbols, color
cues, visual crowding, and symbol location. Effective symbol organization, such as
semantic-syntactic and schematic displays, can facilitate efficient communication,
while color cues may improve visual attention and memory recall. Managing visual
crowding and strategically placing symbols based on visual field biases and motor
control abilities are also crucial. By optimizing these elements, speech-language
pathologists can develop AAC displays that improve user communication outcomes.
The findings provide guidelines for designing user-centered AAC systems tailored
to individual cognitive, motor, and sensory needs.