Muhammad Sikander Ghayas Khan  ( Riphah College of Rehabilitation Science, Riphah International University Lahore. )
Qurrat-ul-Ain  ( Final Year MBBS Student, Dow University of Health Sciences, Karachi. )
Muhammad Usman Azam  ( Islamabad College of Boys, G-6/3, Islamabad. )

Madam, this is a humble effort to bring this significant issue to the knowledge of public and the intelligentsia through your reputed journal.
Persons with severe disability were unable to communicate and comprehend. Communication disability affects multiple aspects of life, accesses to health care, self-perception, independence, and all the other routine activities of daily life that individuals encounter. According to ASHA (American Speech Language Hearing Association) around 2 million Americans are unable to speak adequately well to meet their basic wants and needs.¹ To replace or enhance the language skills which include both spoken and written language skills people with speech and language impairment use Augmentative and alternative communications (AAC) methods.² Speech and language impairment can be congenital or acquired it may be due to cerebral palsy, Parkinson\\\'s disease, apraxia of speech in children or amyotrophic lateral sclerosis. Whatever the problem is, Augmentative and alternative communications (AAC) can be used as temporary or permanent tool.²
There is great diversity of Augmentative and Alternative communication systems used these days.³ For example signing and body language is used as an un-aided method of communication. Where as a variety of pictures, communication boards or devices are used to generate speech as aided method of communication. These systems can either be used alone or in combination. Enhancement techniques such as prediction or encoding are used to enhance spoken communication in which the user is offered guesses of the word/phrase. To find out the appropriate devoice clinician assess the abilities and necessities of a user, to find out the motor, cognitive, visual, communication and language strengths and weaknesses.² Whereas in the family centered approach the beliefs and ethnicity of the family concerned is also required. AAC does not at all hinder the development of speech but in many cases it might increase the speech production to some extent. People who use AAC often report of having satisfying relationships or life activities, but we have to keep in mind that AAC does not guarantee the increase in literacy or getting a job.⁴
We believe that communication is for all, and hopeful that this humble effort will bring this important issue to the knowledge of all concerned. It will also help the people with the above stated speech disorders remove their disabilities and a day will come very soon when everyone will have access to the methods of effective communication, and no one will have to spend lifetime or years even days in silence.

1. Schlosser RW, Raghavendra P. Evidence-based practice in augmentative and alternative communication. Augment Altern Commun 2004; 20: 1-21.
2. Wandmacher T. Adaptive word prediction and its application in an assistive communication system. [Thesis] University Tubingen, Tours; 2009.
3. Hourcade J, Pilotte TE, West E, Parette P. A history of augmentative and alternative communication for individuals with severe and profound disabilities. Focus Autism Other Dev Disabl 2004; 19: 235-44.
4. Mirenda P, Mathy-Laikko P. Augmentative and alternative communication applications for persons with severe congenital communication disorders: an introduction. Augment Altern Commun 1989; 5: 3-13.