Basic Access Methods

• Basic Access Methods

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    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 discover a way to get more vocabulary on to communication boards using encoding
    • You will explore ways of using low-tech aids that introduce language but only require a single response from a child. 

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    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. 

    Using a Stylus

    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. 

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    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. 
    

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    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. 

    E-Tran Frame

    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. 

    Encoding

    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.
    

    Watch this video to discover the way colour is used to help with symbol choices. Transcript available.
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    Activity - Practice Eye Pointing

    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. 

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    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.

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    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.

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    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. 

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    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 
    • Consistent partner communication skills are vital for low-tech communication board users

  • Further Reading 

    More on paper-based systems and adapting low tech as free resources from the Ace Centre that provides a full description of alternative access approaches to low-tech / paper-based resources

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    URL

    Parents’ and Teachers’ Guide to Getting Started with AAC URL
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    Reflective Journal 

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    Journal

    Reflective Journal - Access strategies
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    Presentation slides

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    URL

    Access methods for low-tech communication aids URL

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