Children with severe speech and physical impairment who use augmentative and alternative communication (AAC) present unique challenges in literacy development. Traditional reading instruction has not met these students' needs. Occupational therapy and speech therapy provide supports to mediate limitations to literacy instruction. A systematic review of 286 articles identified six reporting improvement in emergent literacy and child participation. These articles are synthesized here, offering instructional strategies including modeling AAC use, adapting materials, subvocal rehearsal of words/phonemes, contextual learning, and differentiated instruction. Recommendations for future research include quality outcome measures, dosing clarification, and participation in motivating social interactions during literacy activities.