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Introduction
This is an Introduction to Level 1 where we will
Think about the difference between speech and language and what communicaton means
Consider the overlaps between the three components
Languagerefers to a whole system of words and symbols—written, spoken or expressed with gestures and body language—that is used to communicate meaning.
Communication“is fundamental to children’s development; children need to be able to understand and be understood. Communication is the foundation of relationships and is essential for learning, play and social interaction.” Quote originally from the Communication Trust now Consortium (UK).
*Some Signs and Symptomswhen "children and young people have challenges with talking and understanding words"
Activity - Understanding Speech, Language and Communication
Drag the words to the appropriate column - You may find overlaps and you may not agree where a word should be placed! Some could be in two places, but only one position is allowed in this case.
Its not all about speech !
This
YouTube video is an exchange of thoughts that might make you smile!
Make some notes in your reflective journal about what you think are the most important types of interactions that are taking place.
More tips to encourage language
Between 12 to 36 months most toddlers will start on the exciting journey
of learning the languages around them. They can usually name the people in their family, point to pictures and objects as they are said and experiment with two to four, or more, word sentences. They follow simple instructions and will copy words
that are used by others to express their needs and wants. or just for the fun of talking.
When language does not develop during these times there are many professionals who can help with delayed communication skills and in a YouTube video a Speech and Language Therapist (also known as a Speech Therapist, Pathologist or Logopedist in
some countries) provides five tips for encouraging a toddler's language. Which ones do you feel familiar with?
Activity - Encouraging communication
This activity is all about us! Think about how we make sure we are helping to make effective communication possible.
Sensory story telling
Sensory storytelling uses all of our senses to tell a story that is easy to follow and take part in
Even the most ordinary events can be made more exciting and interesting. Think about:
Going to the toilet – guessing how many strides it takes you or the number of people you will meet on the way.
Getting ready for the next class or going home – making up a story which has ‘and then’ after each ‘event’ until the ending: “and then you will be back at home”.
Working with children who have cognitive impairments (Mencap YouTube video)
Think how you feel when you cannot understand another language, such as when you travel alone. What sort of difficulties and anxieties arise?
We have to find other ways of making ourselves understood otherwise we become isolated and frustrated.
Children normally start to understand pictures, make
gestures, point and build eye contact, use body language as well as vocalise at a very young age. These forms of unaided communication remain very important throughout our lives. They continue to complement our verbalspeech and language.
However, when we want to express our needs and wants or start to make requests, if these cannot be achieved by learning to speak symbols can become a form of aided communication.
Many young children start with pointing but can benefit from learning more gestures, alongside the use of pictures, when starting to communicate, especially if their receptive (understanding) and expressive language skills are delayed or they
are non-verbal. This may be due to cognitive, physical or sensory disabilities which can be:
congenital (occur at birth) such as Down's Syndrome, Autism or Cerebral Palsy,
acquired (happen due to an accident) for example a brain injury or
degenerative (the result of a debilitating disease) resulting in dysarthria with a slurring of speech or ataxia with poor articulation.
The range of different types of disability can be enormous, as can the varying degrees of speech and language difficulty, so it is important to understand the overall picture in order to learn how to help individuals overcome the barriers.
Symbol Iconicity
AACSymbols, like many images can have different meanings depending on the context and can be used in different ways. They can represent people, objects and actions as well as be descriptive, but most importantly they need to feel familiar and guessable
- not confusing or opaque. "Iconicity" can be important. This is the extent to which a symbol represents an intended meaning. This is not always easy. The symbol needs to make sense within the user's social setting, be part of the culture and represent all
the various aspects of a user's life.
Presenting children with pictures and talking about signs and symbols in everyday life is important. But, learning to use symbols for communication is a bit like learning to play the piano – it does not happen without practice.
AAC and Culture
“Language is a cultural phenomenon” (Huer, 2000) and so it is important to consider this when
developing an AAC system for a child with complex communication needs who may use symbols that might not have been designed with their community ot localisation in mind.
There needs to be flexibility in the choice of symbols even though we require a consistency of design to make them easier to learn.
We also want symbols that encourage the child to feel comfortable using them.
Symbols need to reduce frustration and allow for making that all important request or sharing of an exciting moment.
Some children become very used to certain images and introducing alternatives can cause anxiety. Changes need to occur with care. Always introduce new symbols that are an appropriate match to the child, the setting and the task in hand allowing a sense
of success when it has been chosen.
Activity - A simple memory game for playing with symbols
Challenge your memory! Examples of freely available AACsymbols from different countries
Symbols when created by local designers, who understand the context,
language and social setting can result in better outcomes. Research carried out by the Global Symbols team using the symbol voting system has demonstrated this
Much more detailed information will be provided in Level 2 and 3, this is just an introduction to the subject.
Getting Started with AAC
As you watch this video think about the number of ways Maya finds her Voice?
When you ask a very young child a question and they are just learning to talk they may reply with a gesture, point or make an attempt to say a word. Hopefully you will give them support and enhance what they have said, possibly by gently saying
the word or phrase in the correct way or elaborating on what has been said. You encourage their communication skills and enhance their language - the same is true for symbol users.
If a structured approach is needed
for a few symbols being used in an interactive setting it might help to try the Picture Exchange Communication System, where symbols can be used to request an item. Training is
provided to follow a set pattern of symbol use that allows a child to learn to make choices and communicate needs when in the past they have found it hard to initiate communication. It has been found to help those children who have been diagnosed
on the autistic spectrum. However, it can be restrictive if the symbols are not to hand and it is not possible to provide a symbol immediately when a new idea comes to mind.
It may help to use the Pragmatic Organisation Dynamic Display (PODD) using natural language stimulation, where symbols are used alongside verballanguage.
The PODD book is similar to a grid display and can be used with an online app. The principle is all about modelling but the communication partner initially guides the conversation and observes the AAC user for reactions, if they are
unable to indicate the symbols they wish to choose. Any interaction is interpreted and the communication continues with page or screen turning occurring by the communication partner.
A demonstration of PODD with Tasman and Regan
Different AAC Systems - Visual Scene Displays
Research has shown that when young chidren
are working with pictures they may find Visual Scene Displays (VSDs) easier to use. These can be a photograph or picture on a tablet that has
items for a conversation. It may be any scene such as a familiar room with favourite toys or the kitchen with food and drink, the car or outdoors with animals. You can see how hotspots can be used for text in the example below but usually
you would record sounds and speech, labelling items or asking questions to encourage interaction.
Activity - Getting started with VSD and Interaction
Try taking a photograph and pick out points that could initiate a conversation - How many open ended questions can you ask and how would you encourage your young AAC user to interact?
Did you find that the conversation tended to be initiated by you as a communication partner and the vocabulary was limited to what was available under your potential hotspots. Maybe you needed a collection of symbols to support the topic?
So in order to expand vocabulary and generate more language it is time to move on to a grid format with various layouts that allow for a more flexible approach to vocabulary building. This does not mean topics are lost, but those frequently used words are easier to reach. These are often called Core Boards.
Introduction to Core Vocabulary Communication Boards
It is important that multiple AAC systems are used in line with
multimodal forms of communication or total communication. An electronic aid may be impossible to use in the bath and single communication board or small set of cards, such as a keyring of important symbols, may be more useful on occasions.
Different types of communication boards can be developed for a range of tasks, settings and be personalised to suit the user, the linguistic structures of a language as well as the topics being discussed.
Summary
Remember we want the symbols chosen to enable AAC users to not only understand language but to also:
Engage with different settings and generate language that will in turn aid possible literacy skill development.
But communication activities do not need to be formal! Play, interactive games and having fun are key motivators for communication as you will find when you follow through the modules to come.
What we mean by a continuum of systems and devices
What range of devices do we have available to us
Starting from low to medium and then high tech on the AAC journey.
The aim is to illustrate some of the ways in which symbols can be used with the various types of assistive technologies (AT).
Key Points to Remember
Enhance abilities by making sure the design of the AAC system will provide for the highest level of language that can be achieved
The AAC tools and AT strategies and techniques need to cope with the immediate communication needs, as well as anticipated future communication needs.
Aim to overcome barriers by offering support in the use of AAC systems at every possible moment.
Always encourage any intended interactions and skills building through consistent feedback
Activity - Aided and Unaided AAC systems
We talk about unaided and aided AAC systems when we start out on the AAC journey. This is not a complex idea.
Think about which of the following interactions would be considered aided or unaided as you match the labels to the images below.
Communication Boards that are easy to use as a No / Low Tech aid
When you start with one or two pictures of objects,
or simple choices with symbols, it is the communication interactions that are important in order to encourage understanding and expressions of intent, whether they are verbal or non-verbal. Before we look at some uses of assistive technology
you might like to learn how to make a simple symbol or picture board or chart that can be used in a ring binder or portable device such as a PicSeePal. This chart will just use pictures
available on the internet, not symbols designed especially for AAC.
In this case the communication board or chart will be a single page of images or symbols that you can make using Google Slides. We will introduce you to other chart making apps later - The YouTube video has a transcript.
Activity - Features for designing a board
You have been asked to build a communication chart for a particular child and you have been given the vocabulary list to use on a grid with a number of cells. Complete the crossword activity below, as a way of confirming some of the features you will need to
think about. You will be taken to another page and then return to this topic.
These devices tend to be battery operated and can be used
for simple messages. In the main image at the top of this topic, you can see two girls with a single button device which can have recorded messages or allow access to electronic (battery operated) toys and more complex AAC devices.
The child learns to activate the switch in any way they can - often it might be with a fist, hand, head or even between the knees. You will learn much more about switch access as we go through the levels on this course.
Many devices in the early stages are used for simple yes/no and single word/phrase recordings or requests.
Make a simple table or list in your reflective journal and
find the features of at least 5 AAC devices from companies you know or Inclusive Technology. Only add the ones you feel are relevant to helping you make device choices in the future. These are commercial products that can be used in multilingual situations and they will change names and types over time.
You may not find some are available in your country, but it is learning about the types of device rather than the actual make that is important. Understanding the features available will be important when thinking about which device is most suitable for a child at a certain time for the tasks they need to undertake whilst planning to progress from one device to another in the future.
High Tech Devices
High tech systems depend on mains power and batteries.
They may be known as speech generating devices (SDGs) or Voice Output Communication Aids (VOCAs). They may run on computer type operating systems or be dedicated aids with many features that link to environmental aids as well as offering sophisticated
communication systems such as those available from Inclusive Technology.
Feature matching, where we match the child's needs to the features of the device, is necessary and it is not something that just happens once in the AAC journey. We often think about solutions being within a continuum of options based upon both language progression, and device features. The type of devices that are likely to enhance
this AAC journey often require additional strategies to make interactions possible. Think about:
output methods - text to speech or visual means on an electrinic device.
compatibility and interoperability - devices and systems if a child has access to more than one.
robustness and reliability - a systems longevity will be a concern and back ups will be needed!
Overview of Low, Medium and High Tech Devices
"In reality, AAC is a spectrum, with different systems spanning along a continuum. There are high-tech,
low-tech, and no-tech options, with each selection factoring in the cognitive, motor, and cultural needs of those utilizing it." Hopf, R. (2016). The augmentative/alternative communication spectrum.
A YouTube video from 'Stepping into AAC' provides a 4.03 minute overview of several different types of technologies that you may find in any AAC situation. Not all will be available in all countries or settings but the speaker talks about the need to 'Make Space for AAC' throughout the day what ever system is used.
Summary
There are many different types of AAC systems and devices available.
Planning for success is at the heart of good provision.
The range of devices available all need careful evaluation against the users’ skills and abilities, the environment, task involved and support available. See Levels 2 and 3
In this fourth topic of Level 1 you will need to have a paper-based communication chart ready for the activities and a person willing to act as a communication partner!
You will find out about different aspects of ‘direct access’ with touch based low-tech and paper-based communication systems
You will explore ways of using low-tech aids that introduce language but only require a single response from a child.
Direct Access Options
Communication systems can be adapted to be
accessed by children with physical impairments associated with complex physical disabilities such as cerebral palsy or muscular dystrophy. But is not just physical difficulties, changes can also be made for children with dyspraxia, which is
common amongst autistic children.
There are a range of access methods that can be applied to low-tech paper-based communication solutions such as activity boards and communication books. Remember throughout the course you may see the word board and chart being used interchangeably.
Pointing
Most children will prefer to use a single finger to point to symbols on their communication aid But many children with complex communication needs will find this difficult due to the level of control required. Here are some of the solutions:
Adaptations
For accuracy you could try make the symbols larger. But be warned that bigger targets are not always easier for people who use large and uncoordinated movements. Larger symbols in a given area results in less symbols per page, which increases the navigation
between pages which can be inefficient and tiring for the child.
Fist Pointing
Some children who find finger pointing difficult
will use fist-pointing, where an entire closed hand indicates the symbol required. In practice often the child will rotate their wrist and use different parts of their hand depending on the location of the symbol on the board.
It is also possible to use feet to select symbols, and some people even use their nose, although this can have postural implications.
Some children can grip a stylus which allows large movements with fine precision as does not require rotation of the wrist or extension of the finger. There are lots of different shapes and sizes of stylus available and they can also be custom made or
3D printed. The selection of stylus depends on the grip and orientation of the child’s arm and hand.
Activity - Practice Pointing
With a communication partner take the communication chart or board you created
in the AAC Systems and Devices topic and try some different pointing methods. Try using your fist to point and even your feet. Ask the communication partner what is easy and what is difficult for them. Make some notes in your reflective journal.
More Access Options
Eye pointing
Some children use eye pointing, pointing to specific symbols with their eyes, to access paper-based communication aids. This requires communication partners who are good at watching eye movements while using specific skills to build messages and check
that they’ve understood. It is possible to use eye pointing with standard communication boards or books, but often an E-Tran frame is used.
The e-Tran (Eye Transfer) frame is frequently used by children who
find it easier to communicate using their eyes rather than their hands or feet. The e-Tran frame is made up of rectangle of usually transparent plastic with a window cut in the centre. The symbols are arranged around the outside. By watching the child’s
eyes carefully it is possible for the communication partner to follow their gaze and confirm selections of symbols.
Both fist and eye pointing generally require larger, and therefore fewer, symbols on the communication board or page. This reduces the vocabulary on every page, which restricts the words the child is able to use. One way to solve this is to use colour
encoding which divides the board into 2 or more colours. Small symbols are then grouped and each labelled with a colour. Using this method a child can point to the group and then to a colour. With six colours this permits six times as many symbols
on any given page.
It is also possible to do this using numbers or shapes, something that should be considered for children who have visual difficulties.
With a communication partner try using eye-pointing to
communicate using your communication board. How easy is this for the communication partner? How do you confirm with the partner that they have selected the correct symbol? What happens if they make a mistake? Write down your thoughts and experiences
in the reflective journal.
Partner Assisted Scanning
Some children will communicate most easily using partner assisted scanning (PAS), also known as mediated scanning. Sometimes this will be a ‘back-up’ method for when they are too tired or otherwise unable to take their usual approach to access the paper-based
communication aid.
PAS involves the communication partner listing things that the child might want to say. The child indicates when they reach the right one, usually through a non-verbal ‘yes’ response. It is common practice for the communication partner to use a board
or a book containing the vocabulary so that it is presented the same way each time. This helps the child learn the layout of the vocabulary and can predict when to prepare to give their ‘yes’ response. This is usually the least efficient way to access
a communication aid but can be effective for children who find the other access methods difficult.
In this video you will see a demonstation of PAS from the ACE Centre where the non-speaking person is an adult just to illustrate the method of pausing to gain an answer. A YouTube transcript is available
PAS is sometimes combined with eye pointing and in this case the child will look in the direction of a group of symbols and the communication partner will step through them one at a time until the child provides their ‘yes’ response.
Activity - combining elements of access methods
Return to your communication board. Can you find a
way to combine eyegaze and partner assisted scanning to make it as efficient as possible for a communication partner? Note down any ideas in your reflective journal.
Communication Partner Skills
With all paper-based communication aids there is a significant emphasis on the communication partner’s involvement in interpreting and supporting the AAC user. Learning to closely observe someone’s movements while checking that you have correctly interpreted
those movements take practice. Additionally it is often expected for you to make predictions of words and entire phrases (although this depends on the individual child and should be confirmed beforehand). Finally, it is vital that the communication
partner retains what has been said so that the entire sentence can be recapped and confirmed. This is not always as easy as it sounds so some people choose to write down each letter or word as it is produced.
Activity
Challenge your memory! Try a short multiple choice quiz.
Summary
Low-tech aids can be efficient to communicate with but often require careful design to make them as accessible as possible
Most low-tech aids are limited in vocabulary available, but encoding can be used to increase this significantly
Partner Assisted Scanning works with just about anybody who can concentrate and is motivated to use it
This topic explores the idea of ‘progression’ for
communication aid users:
Simple communication aids are useful for emergent communicators
But the requirement to ‘progress’ from simple to complex devices is an AAC myth
Think about tomorrow’s communication needs as you think about today’s!
The Progression Model
In the past it was often assumed that children will start their language journey using single message devices such as BIGMacks with photographs and eventually, through a series of new devices, work their way towards an electronic device with thousands
of symbols. Although BIGMacks and other single message devices have their role, it is no longer widely considered true that most children should start with them and then change their device often.
Read the content under the four tabs (headings) before completing the activity below.
There are problems with the old progression model. The issue being that these more simple devices or 'low tech' don’t provide space for children to grow into; to develop and explore new vocabulary and practice using a communication aid. If a device
is programmed with just 2 or 3 symbols then they can only say 2 or 3 things. This is fine until they have mastered the technique because unless somebody is ready to quickly replace the device, they can be stuck for the foreseeable future.
Starting with a ‘robust’ vocabulary. Often what is now considered ‘best practice’ is to start with a device with a big vocabulary, but hide (or ‘mask’) lots of the symbols that aren’t being used. Some apps such as CoughDrop support this vocabulary
scaling automatically. While most symbols are hidden at first, the ones that are displayed retain their same location, even years later when the device is full of symbols. This draws on the benefit of muscle memory, or motor planning, whereby
the location of the symbol is as important as the symbol itself. Learn more about what is meant when we talk about a robust vocabulary in AAC.
Too many symbols? If during the assessment or afterwards,
it is felt that there is too much vocabulary on the screen at any given time, contributing to inattention and lack of motivation, it is easy to be flexible. The typical way to deal with this situation is to hide or ‘mask’ symbols until you
feel that the child is ready. Thus we can start with two cells with symbols or buttons (just as one would with a low tech aid) such as ‘more’ and ‘stop’, before gradually adding new symbols as their language develops. Most AAC apps on tablets
and dedicated communication aids offer this option. It can also be easily achieved when using paper-based communication aids.
Masking is when we hide one or more symbols on a board
Using masking helps to:
Reduce distraction caused by having too many symbols that that are not immediately useful
Keep the few core words/symbols always in the same position to develop sequential motor patterns
Lower cognitive load when learning the system
Provide positive feedback with fewer words/symbols that are easier to learn
But it is important not to remove words that could be useful and to be able to quickly unmask them and not to presume a certain level of competence. Look at the sample boards made by the TechOwl AAC Community.
Activity - AAC Myths (True or False)
Test your memory with this quick quiz!
Presuming competence
In order to provide a more complex communication
aid than you feel the child might be able to use involves the assumption that the child is more capable than you might think. When people encounter a child or adult with a communication disability we tend to assume that they have intellectual disabilities
as well, or that they have limited capacity to learn new things. Often it will take a long time for these AAC users to learn to use their system to its full extent, and sometimes the device may need to be made simpler. The important thing is that
they are given the opportunity to exceed expectations.
"Presuming competence for AAC users is based on two principles. These apply to all human beings, regardless of diagnosis or degree of difference.
However, there are some pitfalls regarding the presumption of competence which are covered very neatly in an article from the American Speech & Hearing Association (ASHA) which you can find in the further reading section.
Summary
Mid-tech and low-tech solutions tend be quite restrictive but do have their uses
Starting from single message devices and working towards devices with more
vocabulary may result in significant disadvantages for some children
Starting with a large vocabulary and ‘masking’ or ‘hiding’ some symbols can be more effective for many AAC users
By ‘presuming confidence’ we can often provide children with complex solutions that will grow as they do
If you have a BIGmack (or equivalent) it is what can be called a 'single message device'... download this ABC of Single Message Ideas Wall Poster. This poster was created by CALL Scotland, in collaboration with Tony Jones of TalkSense.
Understanding the needs of the children who are potential AAC users.
Involving families in the assessment and the intervention process and decisions
Communication Partners
Anyone who connects with the child can be thought of as a Communication partner
Families, carers, friends and those who get to know the AAC user, as well as professionals are essential to the support that will be needed throughout the day to encourage use of AAC systems and any other forms of communication where
speech and language are delayed or a child is
non-verbal.
'Family centred training' is an approach used in many countries in the field of special education and especially in AAC, but may be known under different names.
In recent years the role of families, siblings and parents has been emphasized in the planning process when making decisions for children with communication disorders. This is particularly important when using AAC to ensure successful outcomes.
Activity - Confidence in Developing partners
Imagine you are working with parents or carers of a child
and your are asked some questions about introducing AAC to encourage communication skills.
Evaluation of Skills
If you did not feel very confident when answering the three questions in
the quiz you are not alone. There are many more testing statements in the questionnaire designed by Amy Starble and colleagues on "Family-Centered Intervention and Satisfaction With AAC Device Training". However, when you are anxious about your skills reach out to your colleagues and remember it is the families and carers who will be your main supporters in
the AAC journey you are taking with a child at this stage. The freely available symbols used in the above exercise come from the Jellow symbol set and the one in this section is from the ARASAAC symbol set - both sets come with several languages and are linked on Global Symbols.
Activity - Understanding Needs
Can you remember when you last listened to a family’s concerns and
priorities, before designing appropriate activities and educational resources for a child using AAC or for one with special needs?
Think about using open ended questions that begin with “how” or “what” not “do” or “did” and ask for their ideas about strategies before making suggestions.
Check Points when Understanding the needs of the family
What are your goals or expectations for the AAC device that your child will receive?
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What are their priorities for your child?
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What experiences have they had with AAC in the past (good, bad, and ugly)?
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What roles might each family member play in the AAC journey?
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How do you think it will affect the relations between the family members?
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How do you think it will affect the relationship with other members of the community or the ability to take your child outside to the community?
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What is the best way for you to learn new AAC-related material?
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What do you think the role of the professionals should be while working with you on the AAC device?
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What are your greatest concerns?
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More options...
Involvement
Now watch this short video and check the impact of Sophia’s parents’ feedback on the choice of AAC device. A transcript is available. Make
some notes in your reflective journal.
If AAC practice is reduced to short therapy sessions successful outcomes will be harder to achieve. There can be a tendency for limited transfer of skills from therapy to daily life and technology abandonment.
Services provided in the home allow children to focus on communication goals in the setting where they will have the opportunity to practice new skills (Rini 2002)
Summary
Family-centred clinical practice provides parents with the opportunity to be involved in all planning related to communication goals for their child.
Discuss with the family the time required to implement the AAC solution.
Provide the necessary support, training and information for the family to implement the solution.
In this topic we will concentrate on access to high-tech electronic communication devices. We will review:
The types of access method for electronic devices
Direct Access (touch), which is usually the most efficient
Ways to make direct access easier for children with physical impairments
Using devices with built in alternative access methods as well as additional input methods
Pointing at symbols with a Tablet
"This is Oliver, he is 3 years old. Oliver has suspected Childhood Apraxia of Speech which means he understands words spoken to him and knows the words he wants to say in his mind, but is unable to say them with his mouth. This video was taken on 4/2/15
and is his first attempt at using an electronic AAC (alternative and augmentativecommunication) device. He is using the Speak For Yourself app on the iPad for his AAC device."
Direct Access to Devices
Direct Access (usually
through touch) is the most efficient way to access a communication aid but is also the most physically demanding. Many children with physical disabilities find it difficult to stick out a finger and accurately point to a small symbol.
There are lots of things we can do to help with this, such as providing the AAC user with a glove, a stylus, or putting a plastic or metal guard around the symbols. These all work by reducing the number of mistaken symbol presses. A glove usually has
the end cut from one finger, so other parts of the hand can rest or touch the screen without making a selection. A stylus and keyguard work in much the same way.
One access method supported by iOS devices, but not by Android at the time of writing, is the ‘Use Final Touch Location’ feature. This enables children to drag their finger on the
screen, which stabilises their movement, until they reach the symbol they wish to select. Lifting the finger then selects the symbol.
Hold Delays for Inattentive Children
The hold delay has also been found to help children with attention difficulties, or for those who might press the same button several times for the effect of the audio. This is known as ‘perseverating’ and is common amongst autistic children. One remedy
for this is to set a hold delay to around 0.2 seconds so only very purposeful presses will be accepted by the device and converted into speech. Android Touch and Hold Delay settings
Head Pointers
Head pointers are unusual in that there is no physical connection between the child and the access method, i.e. the child is not touching the computer or an input accessory at any point. A head pointer uses a camera tracks the movement of the child’s
head which in turn moves the pointer around on the screen.
Here is very short video illustrating the use of headpointing with Spanish symbols and text to speech.
More will be discussed about eyegaze with high tech devices as an input method in Level 2
Activity - Access Methods
Indirect Access - other ways to access a device
Pointer Control
We can consider pointer control for those children who really struggle with direct access. Usually this is recommended for children with cerebral palsy who may find targeting the symbols difficult, or for children with muscular dystrophy for whom the
range of movement across a screen can be very fatiguing.
Pointer control, as a term, relates to using a standard
mouse to access a computer. Many children with physical impairments will use specialist joysticks, trackballs, and glide pads to access their computers and/or electronic AAC device. Most children will use their hands to operate these mouse alternatives,
while others may use their feet or even their mouths. Mouse alternatives always require some intentional movement from the child (such as moving a finger or an arm) but the accuracy and range required for each type does vary.
As with direct access, there are lots of accessibility options built into the devices to help ignore accidental button presses, or to assist with getting the mouse pointer onto the desired symbol. These are constantly changing and being updated, think about how you will stay up to date with these.
Activity
Using a Windows computer take a look at the ‘ease of access / mouse settings’ in the control panel. Find the pointer speed and try moving the slider to the fastest and slowest settings. You can also change pointer speed on an Android device.
What do you find? What are the advantages and disadvantages for someone with poor motor control when using one speed or the other? Make a note in your reflective journal.
Summary
Direct access is the most conventional way to access a device and is probably the preferred option of all the children you will support
Accessories such as keyguards and gloves can make direct access much easier for children with coordination difficulties
Accessibility settings built into every device can make access easier.
For some children using a pointing device is best, although this is rarely as efficient as direct access
As you watch this video, make a note in your reflective journal about the way AAC is being used in support of vocabulary, interaction, encouragement, modelling, responses and repetition. (No captions or transcript)
Activity Ten Steps to Communication
The Steps to Communication (text doc) are really just a few of the methods that can be used to encourage potential AAC
users to interact with the systems we may introduce. In this activity try to sequence the steps from memory.
There really is no strict order, but by moving the ARASAAC and TAWASOL symbols into their correct places you will get a glimpse of what is involved in one small part of the AAC journey.
Use the resume button when you check your order and find you have mistakes! The correct symbols will stay in place and you get as many chances as you need to complete the activity. Use the retrybutton if you want to do it
all over again!
If you are using a keyboard - Tab into the activity. Use the cursor keys to navigate through the list items, use the spacebar to activate or deactivate an item and the cursor keys to move it.
Communication ideas
The Ten Steps to Communication are explained in greater detail in the slides provided in the Presentation section at the end of this topic
as we come to the end of Level 1 and review all we have learnt. At this stage we have been providing an overview of what is involved when we introduce alternative methods to support communication.
Let's pause again and just think about the conversations and interactions between a very young child and a communication partner. The amount of repetition, gesture and facial expressions. In English there are also games we play such as 'peek-a-boo'
games, 'bye-bye' games, simple shared activities when reading books, singing songs and imaginative play with building blocks or playing with sand. water and toys like cars or dolls.
For those children using AAC it is even more important to allow time for turn taking, intentional reactions and generative language.
Always try to model (point to words on the AAC chart or device as you speak). Modelling is also called 'Aided Language Stimulation' or 'Aided Language Input'.
The problem for the AAC user is that not everyone uses their language system, so they repeatedly need to see the way it should be used in many different situations. Daily routines are an ideal time and the involvement of the extended family and
all the AAC user's friends are very important.
The typical young child develops speech and language at their own pace, being able to practise sounds and words with those around them.
By two years the child tends to use simple phrases such as 'more milk' and to ask simple questions such as 'all gone?' At this age they can also follow simple commands and understand much more than the 50 plus words they can say. Those
around them can undertand what is being said.
By three years the number of words builds rapildy to around 1000, with two or three word phrases, the use of pronouns and much demanding of attention with repetition and total engagement.
Advantages of Modelling
Research has shown that modelling speeds the learning process and can be very motivating when used in all communication settings., It also helps the communication partner to slow down and the process is a collaborative effort when learning where
symbols are to be found and how the AAC system works. The process is also multi modal as it can be visual and with touch, it is not just about hearing the word being said.
It is always important to aim just that bit higher,
to encourage progress from one word to combinations, whilst the communication partner is providing the complete phrase or sentence. Remember the next stage of language development and practise these phrases, not just ‘ball’ but perhaps ‘play ball’
or Do you ‘want the ball’? I want the ball etc.
Mistakes can happen but this gives both the AAC user and yourself a chance to sort out the problem as you wold in a spoken language situation. Find a new word / symbol, think aloud as you delete one word or add another that is needed to complete the conversation. You will learn more about modelling as we go through the levels.
Activity - Reviewing Typical Communication Development
Let's see how these two symbols can be used and bear in mind they may be part of a larger chart where other symbols have been hidden. This is called 'masking' and can be useful to prevent confusion but also allow quick access to more words such
as those found in the top most often used words for AAC in any language. The top 100 most frequently words in English have very
few nouns!
Child reacts positively, points, touches board or toy etc.
Imitation
Copy child's reaction and provide positive feedback
Recast - repeat any error in a corrected and positive wat
Say the word again 'more' and point to the chart and praise.
Activity - Create a simple board
Try out a free online chart creator Boardbuilder to develop your own simple chart for any activity with a wide choice of symbols rather than images. The chart can be printed out or downloaded as an open board format (obf) file to work on Cboard or Coughdropcommunication apps. Possible labels, based on core words in English can be used when searching for symbols. These are seen in the table below and you can colour code by the parts of speech if you are aiming to support phrase or sentence building and later literacy skills. The blanks represent places where other symbols can be added as more vocabulary is learnt - remember 'masking'.
Language Acquisition through Motor Planning (LAMP)
This is an approach to building language with the use of symbols that encourages consistency of motor patterns to help with finding required words as quickly as possible. This is called "LAMP" and is developed by PRC-Saltillo.
LAMP is based upon:
Readiness to Learn – Potential user has the ability
Natural Consequences – linked outcome as a result of choosing a symbol – apple – they see/eat the apple
In the example below you can see we have kept the original positions of the early choice of words and simply added more with some categories for charts that will be on the layers below the home board in a communication book or on a tablet.