AUGMENTATIVE AND ALTERNATIVE COMMUNICATION STRATEGIES FOR TREATMENT OF ACQUIRED 
COGNITIVE-LINGUISTIC DISORDERS

Release Date:  December 10, 2001

RFA:  RFA-HD-02-002
 
National Institute of Child Health and Human Development
 (http://www.nichd.nih.gov)
National Institute on Deafness and Other Communication Disorders
 (http://www.nidcd.nih.gov)

Letter of Intent Receipt Date:  May 15, 2002
Application Receipt Date:       June 12, 2002

THIS RFA USES "MODULAR GRANT" AND "JUST-IN-TIME" CONCEPTS.  MODULAR INSTRUCTIONS 
MUST BE USED FOR RESEARCH GRANT APPLICATIONS REQUESTING LESS THAN $250,000 PER 
YEAR IN ALL YEARS. MODULAR BUDGET INSTRUCTIONS ARE PROVIDED IN SECTION C OF THE 
PHS 398 (REVISION 5/2001) AVAILABLE AT 
https://grants.nih.gov/grants/funding/phs398/phs398.html.

PURPOSE

The National Center for Medical Rehabilitation Research (NCMRR) at the 
National Institute of Child Health and Human Development (NICHD), and the 
National Institute on Deafness and Other Communication Disorders (NIDCD) wish 
to support research evaluating the use of Augmentative and Alternative 
Communication (AAC) strategies for the treatment of cognitive-linguistic 
disorders.  AAC strategies traditionally have been designed for individuals 
for whom oral speech is not a viable option.  Common clinical practice has 
expanded AAC use to a tool for cognitive retraining or remediation.  Although 
technological developments offer the potential for vastly improved 
communication and inclusion for some individuals with severe communication 
disorders, technology alone does not result in successful communication.  
And, while AAC interventions have become increasingly common across the age 
range, the research base underlying the design of AAC technology, 
intervention strategies, and treatment potential across communication 
disorders remains quite limited.  To move beyond the traditional application 
of AAC as a communication modality for persons with severe motor disorders to 
applications for persons with cognitive/linguistic disorders, three 
interrelated areas of research that require further investigations emerge:

o  Use of AAC as a research tool to provide theoretical insights into the 
nature of normal and impaired language and cognition. 

o  Development of AAC as treatment tools to facilitate language recovery and 
use (production and comprehension).

o  The efficacy of applying AAC as communication modalities for individuals 
with acquired cognitive/linguistic communication disorders.

This Request for Applications (RFA) seeks research that will address these 
research needs and contribute to a better understanding of the principles 
underlying AAC theory and practice.  

HEALTHY PEOPLE 2010

The Public Health Service (PHS) is committed to achieving the 
health promotion and disease prevention objectives of "Healthy People 2010," 
a PHS-led national activity for setting priority areas.  This Request 
for Applications (RFA) is related to one or more priority areas.  
Potential applicants may obtain "Healthy People 2010" 
at http://www.health.gov/healthypeople.

ELIGIBILITY REQUIREMENTS

Applications may be submitted by foreign and domestic, for-profit and non-profit 
organizations, public and private, such as universities, colleges, hospitals, 
laboratories, units of State and local governments, and eligible agencies of the 
Federal government.  Racial/ethnic minority individuals, women, and persons with 
disabilities are encouraged to apply as Principal Investigators.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research project grant 
(R01) mechanism.  Responsibility for the planning, direction, and execution of 
the proposed project will be solely that of the applicant.  This RFA is a one-
time solicitation.  

Specific application instructions have been modified to reflect "MODULAR GRANT" 
and "JUST-IN-TIME" streamlining efforts that have been adopted by the NIH.  
Complete and detailed instructions and information on Modular Grant applications 
have been incorporated into the PHS 398 (rev. 5/2001).  Additional information 
on Modular Grants can be found at 
https://grants.nih.gov/grants/funding/modular/modular.htm.

FUNDS AVAILABLE                                                                  

The NICHD intends to commit approximately $2 million in total costs [direct plus 
Facilities and Administrative (F&A) costs] in FY 2003 to fund up to six new 
grants in response to this RFA. The NIDCD intends to commit approximately 
$750,000 in total costs [direct plus Facilities and Administrative (F&A) costs] 
in FY 2003.  An applicant may request a project period of up to five years and a 
budget for direct costs of up to $250,000 per year.  Although this program 
is provided for in the financial plans of the NICHD and NIDCD, awards pursuant 
to this RFA are contingent upon the availability of funds and the receipt of 
a sufficient number of meritorious applications.  

RESEARCH OBJECTIVES

Background 

Augmentative and alternative communication (AAC) is an area of clinical 
practice that attempts to compensate for the impairment and disability 
pattern of individuals with severe expressive communication disorders.  
Traditionally, AAC systems have played a significant role as an output mode 
for the expression of messages for individuals for whom oral speech is not a 
viable option.   This role is essential and permits individuals to have an 
immediate and visible communication effect on their environment.  

Over the past two decades, substantial progress has been made in the 
development of a range of AAC options in addition to writing, including 
picture and symbol systems, to facilitate communication needs.  AAC systems 
have evolved from limited alternative typing systems for persons with well-
developed literacy skills, to sophisticated communication devices.  These 
systems allow a variety of access control methods, message storage and 
retrieval strategies and voice, as well as print output, for persons with a 
wide range of cognitive and language skills.  The availability of AAC 
technology has also changed dramatically with the availability of 
sophisticated low-cost computers.  

In parallel, interest in applying AAC principles to persons with 
cognitive/linguistic disorders is increasing.  With functional communication 
as the primary goal, people with cognitive/linguistic communication disorders 
are being provided with AAC options soon after neurologic injury.  AAC 
strategies may provide alternative or additional means of information 
transfer.  These areas may recover at varying rates, and it is important that 
the content of the AAC system remain dynamic.  Cognition and language skills 
may improve while speech production remains severely dysarthric.  In those 
cases, AAC devices have been considered a temporary measure until natural 
speech reemerges.  However, AAC may also be indicated for patients with such 
severe cognitive impairment that it is difficult to assess the severity of 
the language or motor speech impairments, let alone the extent to which these 
impairments contribute to the individual's communication competency. 

The application of AAC as a tool for cognitive retraining or remediation is 
common practice, although there has been limited systematic research 
demonstrating its effectiveness or evaluating the relationship between the 
cognitive and linguistic aspects of AAC use.  For people with 
cognitive/linguistic communication disorders, AAC design and implementation 
issues may be different from those with motor impairment or even cognitive 
developmental disabilities.  Damage to unique linguistic and cognitive 
processing modules may prevent a direct application of the AAC interventions 
developed and used successfully by individuals with motor impairment.  And, 
although AAC systems may not easily replace the damaged cognitive-linguistic 
systems of the person with severe deficits, some selective applications of 
AAC technologies and strategies have reportedly helped increase the quality 
and functionality of interactions.  

Other examples of AAC strategies applied to this population include 
techniques that function as "processing prostheses" or "memory aids."  
Communication systems have been developed that allow patients to maintain 
sentence elements long enough to assemble them into larger structures and to 
monitor and complete these intermediate structures without the time pressures 
of normal communication.  By allowing patients to construct sentences 
piecemeal, monitor their utterances, rehearse utterances before recording a 
final version and maintain semantic associates of words while searching for 
the target, these computerized communication systems have been shown to 
markedly increase the grammatical structure of agrammatical speech.  It is 
believed that such systems function by reducing on-line processing demands 
and may serve to ameliorate quite different processing impairments.  

Computerized iconic-based communication systems have also been used as a 
treatment platform to significantly improve the ability to comprehend and 
verbally produce utterances.  Recent data suggests that individuals with 
severe aphasia, for example, appear to have a preliminary ability to use non-
verbal visual systems to communicate concepts in structured situations.  
However, without contextual training, few subjects generalize alternative 
symbols communication to real-life contexts.  These results have implications 
for the design of AAC for patients who are able to produce some lexical items 
and structures.  The efficacy of communication systems that provide highly 
structured narrative and can maintain sentence elements, highlights the need 
for further research exploring the application of AAC techniques for persons 
with cognitive/linguistic difficulties.  Equally important are the insights 
into the nature of the disorder that such findings provide.  

There are a number of challenges that preclude the direct application of AAC 
technology to individuals with cognitive/linguistic communication disorders, 
and highlight the need for further targeted research.  Among these are the 
lack of a match between the communicator's spectrum of abilities and needs 
and the particular cognitive and linguistic skills required to use AAC 
strategies effectively; the challenge of learning AAC strategies; and the 
fact that cognitive/linguistic disorders affect each of the levels of 
processing that AAC techniques require.  Information-processing impairment 
may constitute the largest portion of communication impairment.  For these 
individuals, attention, perceptual and memory challenges may be particularly 
evident when engaging in new learning with an AAC strategy.  Even when 
communicators with cognitive/linguistic disorders are able to learn to use 
basic components of AAC strategies in a controlled environment, these 
strategies often break down when faced with the complexities of real-life 
communication.  These limitations need to be considered when applying AAC 
strategies to this special population.  

Research Scope

Research responsive to this RFA may include, but is not limited to, projects 
designed to:

o  Examine the theoretical framework that assists in the intervention and 
rehabilitation of individuals with acquired cognitive/linguistic disorders 
using AAC systems and the influences of cognition on the selection, design 
and use of AAC technology.

o  Examine the interaction between AAC and restoration of communication 
skills in adults.   

o  Develop effective intervention strategies that apply AAC technology to 
acquired cognitive/linguistic disorders.

o  Develop research collaboration between investigators in the complementary 
fields of AAC and neuropsychology/aphasiology.

o  Develop outcome measurement strategies that are appropriate to evaluate 
AAC competence and use.

o  Explore the impact of AAC intervention on communicative function. 

o  Delineate the linguistic demands of AAC strategies for communicators for 
persons with acquired cognitive/linguistic disorders.

o  Develop studies that bridge what is known about cognitive/linguistic 
abilities, the AAC process and potential clinical interventions.

o  Provide strategies to enhance visual representation to reduce cognitive 
processing demands for communication.

o  Examine the cognitive/linguistic demands of specific AAC strategies on 
communication.

o  Design research that will allow examination of the cognitive/linguistic 
challenges inherent in AAC strategies.

INCLUSION OF WOMEN AND MINORITIES IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of the NIH that women and members of minority groups and 
their sub-populations must be included in all NIH-supported clinical research 
projects unless a clear and compelling justification is provided indicating 
that inclusion is inappropriate with respect to the health of the subjects or 
the purpose of the research. This policy results from the NIH Revitalization 
Act of 1993 (Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 
(https://grants.nih.gov/grants/guide/notice-files/NOT-OD-02-001.html); 
a complete copy of the updated Guidelines are available at 
https://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm.  
The amended policy incorporates: the use of an NIH definition of 
clinical research; updated racial and ethnic categories in compliance with 
the new OMB standards; clarification of language governing NIH-defined Phase 
III clinical trials consistent with the new PHS Form 398; and updated roles 
and responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable; 
and b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS

It is the policy of NIH that children (i.e., individuals under the age of 21) 
must be included in all human subjects research, conducted or supported by 
the NIH, unless there are scientific and ethical reasons not to include them.  
This policy applies to all initial (Type 1) applications submitted for 
receipt dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines on the Inclusion of Children as Participants in 
Research Involving Human Subjects," published in the NIH Guide for Grants and 
Contracts, March 6, 1998, and available at: 
https://grants.nih.gov/grants/guide/notice-files/not98-024.html.

Investigators also may obtain copies of these policies from the program staff 
listed under INQUIRIES.  Program staff may also provide additional relevant 
information concerning the policy.

URLS IN NIH GRANT APPLICATIONS OR APPENDICES

All applications and proposals for NIH funding must be self-contained within 
specified page limitations.  Unless otherwise specified in an NIH 
solicitation, Internet addresses (URLs) should not be used to provide 
information necessary to the review because reviewers are under no obligation 
to view the Internet sites.  Reviewers are cautioned that their anonymity may 
be compromised when they directly access an Internet site.

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS

NIH policy requires education on the protection of human subject participants 
for all investigators submitting NIH proposals for research involving human 
subjects.  This policy announcement is found in the NIH Guide for Grants and 
Contracts Announcement dated June 5, 2000, at:  
https://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT

The Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) 
cited publicly and officially by a Federal agency in support of an action 
that has the force and effect of law (i.e., a regulation) may be accessed 
through FOIA.  It is important for applicants to understand the basic scope 
of this amendment.  NIH has provided guidance at:  
https://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application.  In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

LETTER OF INTENT

Prospective applicants are asked to submit a letter of intent that includes a 
descriptive title of the proposed research, the name, address, and telephone 
number of the Principal Investigator, the identities of other key personnel 
and participating institutions, and the number and title of this RFA. 
Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows NICHD staff to estimate the potential review workload and 
plan the review.

The letter of intent is to be sent to Dr. Beth Ansel at the address listed under 
INQUIRIES, below, by May 15, 2002.

APPLICATION PROCEDURES 

The PHS 398 research grant application instructions and forms (rev. 5/2001) 
at https://grants.nih.gov/grants/funding/phs398/phs398.html must be used in 
applying for these grants. This version of the PHS 398 is available in an 
interactive, searchable format.  For further assistance contact GrantsInfo, 
Telephone 301-710-0267, Email:  GrantsInfo@nih.gov.

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS

The modular grant concept establishes specific modules in which direct costs 
may be requested as well as a maximum level for requested budgets. Only 
limited budgetary information is required under this approach.  The 
just-in-time concept allows applicants to submit certain information only 
when there is a possibility for an award. It is anticipated that these 
changes will reduce the administrative burden for the applicants, reviewers 
and NIH staff.  The research grant application form PHS 398 (rev. 5/2001) at 
https://grants.nih.gov/grants/funding/phs398/phs398.html is to be used in 
applying for these grants, with modular budget instructions provided in 
Section C of the application instructions.
Submission Instructions  

The RFA label available in the PHS 398 (rev. 5/2001) application form must be 
stapled to the bottom of the face page of the application and must display 
the RFA number HD-02-002.  A sample RFA label is available at 
https://grants.nih.gov/grants/funding/phs398/label-bk.pdf.   Please note this 
is in the pdf format.  Failure to use this label could result in delayed 
processing of the application such that it may not reach the review committee 
in time for review.  In addition, the RFA title and number must be typed on 
line 2 of the face page of the application form and the YES box must be 
marked.

Submit a signed, typewritten original of the application, including 
the Checklist, and three signed photocopies, in one package to:

CENTER FOR SCIENTIFIC REVIEW
NATIONAL INSTITUTES OF HEALTH
6701 ROCKLEDGE DRIVE, ROOM 1040, MSC 7710
BETHESDA, MD  20892-7710
BETHESDA, MD  20817 (for express/courier service)

At the time of submission, two additional copies of the application should 
be sent to:

Director, Division of Scientific Review
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 5E03F, MSC 7510
Bethesda, MD  20892-7510
Rockville, MD  2085 (for express/courier service)

Applications must be received by June 12, 2002.  If an application is received 
after that date, it will be returned to the applicant without review.

The Center for Scientific Review (CSR) will not accept any application in 
response to this RFA that is essentially the same as one currently pending 
initial review, unless the applicant withdraws the pending application.  The CSR 
will not accept any application that is essentially the same as one already 
reviewed.  This does not preclude the submission of substantial revisions of 
applications already reviewed, but such applications must include an 
Introduction addressing the previous critique.

REVIEW CONSIDERATIONS

Upon receipt, applications will be reviewed for completeness by CSR and 
for responsiveness to this RFA by NICHD.  Incomplete and/or non-responsive 
applications will be returned to the applicant without further consideration.

Applications that are complete and responsive to the RFA will be evaluated 
for scientific and technical merit by an appropriate peer review group 
convened by the NICHD in accordance with the review criteria stated below.  
As part of the initial merit review, all applications will receive a written 
critique and may undergo a process in which only those applications deemed to 
have the highest scientific merit, generally the top half of the applications 
under review, will be discussed, assigned a priority score, and receive a 
second level review by the NICHD National Advisory Council.

Review Criteria 

The goals of NIH-supported research are to advance our understanding 
of biological systems, improve the control of disease, and enhance health.  
In the written comments, reviewers will be asked to discuss the 
following aspects of the application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these goals.  
Each of these criteria will be addressed and considered in assigning the 
overall score, weighting them as appropriate for each application.  Note that 
the application does not need to be strong in all categories to be judged 
likely to have major scientific impact and thus deserve a high priority score.  
For example, an investigator may propose to carry out important work that by 
its nature is not innovative, but is essential to move a field forward.

(1) Significance:  Does this study address an important problem?  If the aims of 
the application are achieved, how will scientific knowledge be advanced?  What 
will be the effect of these studies on the concepts or methods that drive this 
field?

(2) Approach:  Are the conceptual frameworks, design, methods, and 
analyses adequately developed, well integrated, and appropriate to the aims of 
the project?  Does the applicant acknowledge potential problem areas and 
consider alternative tactics?

(3) Innovation:  Does the project employ novel concepts, approaches or methods?  
Are the aims original and innovative?  Does the project challenge existing 
paradigms or develop new methodologies or technologies? 

(4) Investigator:  Is the investigator appropriately trained and well suited to 
carry out this work?  Is the work proposed appropriate to the experience level 
of the Principal Investigator and other researchers (if any)?

(5) Environment:  Does the scientific environment in which the work will be done 
contribute to the probability of success?  Do the proposed experiments take 
advantage of unique features of the scientific environment or employ useful 
collaborative arrangements?  Is there evidence of institutional support?

In addition to the above criteria, in accordance with NIH policy, applications 
also will be reviewed with respect to the following:

o  The adequacy of plans to include both genders, minorities and 
their subgroups, and children as appropriate for the scientific goals of 
the research.  Plans for the recruitment and retention of subjects also will 
be evaluated.

o  The reasonableness of the proposed budget and duration in relation to 
the proposed research.

o  The adequacy of the proposed protection for humans, animals, and 
the environment, to the extent they may be adversely affected by the 
project proposed in the application.

SCHEDULE

Letter of Intent Receipt Date:    May 15, 2002
Application Receipt Date:         June 12, 2002
Peer Review Date:                 October/November 2002
Council Review:                   January 2003
Earliest Anticipated Start Date:  April 1, 2003

AWARD CRITERIA 

Criteria that will be used to make award decisions include:

o  scientific merit (as determined by peer review)
o  availability of funds
o  programmatic priorities.

INQUIRIES

Inquiries concerning this RFA are encouraged.  The opportunity to clarify 
any issues or questions from potential applicants is welcome.
 
Direct inquiries regarding programmatic issues to:

Beth M. Ansel, Ph.D., CCC-SLP
Director, Clinical Practices Research Program 
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 2A03, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 402-2242
FAX:  (301) 402-0832
Email:  Beth_Ansel@nih.gov

Lana Shekim, Ph.D.  
Program Director  
Voice and Speech Program, SPB  
National Institute on Deafness and Other Communication Disorders  
6120 Executive Boulevard, Suite 400-C, MSC 7180  
Bethesda, MD  20892-7180  
Telephone:  (301) 496-5061  
FAX:  (301) 402-6251  
Email:  shekiml@nidcd.nih.gov

Direct inquiries regarding fiscal matters to:

Christopher Myers
Grants Management Branch
National Institute of Child Health and Human Development
6100 Executive Boulevard, Room 8A17H, MSC 7510
Bethesda, MD  20892-7510
Telephone:  (301) 435-6996
FAX:  (301) 402-0915
E-mail:  cm143g@nih.gov

Sara Stone  
Chief, Grants Management Branch  
National Institute on Deafness and Other Communication Disorders  
6120 Executive Boulevard, Room 400B, MSC-7180  
Bethesda, MD  20892-7180  
Telephone:  (301) 402-0909  
FAX:  (301) 402-1758  
Email:  Sara_Stone@nih.gov

AUTHORITY AND REGULATIONS

This program is described in the Catalog of Federal Domestic Assistance Nos. 
93.929 and 93.173.  Awards are made under authorization of Sections 301 and 
405 of the Public Health Service Act as amended (42 USC 241 and 284) and 
administered under NIH grants policies and Federal Regulations 42 CFR 52 and 
45 CFR Parts 74 and 92.  This program is not subject to the intergovernmental 
review requirements of Executive Order 12372 or Health Systems Agency review.

The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and promote the non-use of all tobacco products.  In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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