Implementation of Augmentative & Alternative Communication ...
The Alternative & Augmentative Communication / Cortical ...
Transcript of The Alternative & Augmentative Communication / Cortical ...
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The Alternative & Augmentative Communication / Cortical Visual Impairment Matrix
Chris Russell, New York Deaf-Blind Collaborative: [email protected]
Jennifer Willis, Connections Beyond Sight and Sound: [email protected]
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AAC: Context and Challenges
Significant mismatches between communication systems and visual access:
▪ Communication that is visually inaccessible
▪ Communication that is visually accessible, but inappropriate in terms of communication development (current expressive levels)
▪ Phase I example: eye gaze system
▪ Phase III example: complex 2D iPad system, child is currently a pre-symbolic communicator
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Sensory Access
• CVI Phase and Characteristics
• Preferred learning channels
Communication Level Access
• Presymbolic/Symbolic• Prelinguistic/Linguistic
A Balanced Communication Plan
• Multi-sensory access
• Universal Design
• Multimodal communication
• Provide a robust AAC program
receptively
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Multiple Modes / Multiple Systems
Aided Unaided No-tech Light-tech High-tech
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The bridge from early communication
(behaviors) to first words and language
CONCRETE MODES
OF COMMUNICATION:
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Tangible Symbols (Transitional Concrete)
Can be:
whole objects
parts of objects
associated objects
textures or shapes
line drawings
Photographs
Consider:
level of iconicity / abstraction
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Does the student have symbolism?
The understanding that a symbol refers to an event/activity, object, person
SYMBOL → REFERENT
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ICONICITY – Conceptual & Visual Complexity
(CONCRETE → ABSTRACT)
ICON → INDEX → SYMBOL
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Is this your experience with water?
Iconicity (like novelty) is
relative to individual experience.
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Symbol Hierarchy
shoeSpoken words
Signs
Whole/identical
object
Partial/Asscoiated
object
Photo/ Picture
Symbol
Tangible Symbol
Print/ Braille
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Even photos can be visually/conceptually complex…
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Uses of Tangible Cues/Symbols - Levels1) Anticipation of an activity
▪ To learn symbolism – connection between a symbol and referent
▪ Reducing stress in transitions
2) Transitional communication systems (more complex uses for children/youth who have symbolism
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Tangible Symbols: Clarifying Tactile Traditions
Traditionally used for students with ocular visual impairments, based on tactile properties, NOT visual
• Communication purpose is to bridge presymbolicand symbolic modes, develop symbolism• Provide a CONCRETE referent
• NEVER intended to be an end, rather a means to an end (symbolism)
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Concrete Symbols: Considerations for CVI
Complexity: symbolic and visual
• Adaptations – based on Range• 3D/2D, color, complexity, etc
Select based on visual properties, NOT tactile • This is the opposite for ocular VI/tactile
learners
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• What are the CVI adaptations?
• What are the communication modifications?
CVI:• Partial objects (not yet 2-D)
• Black backdrop (visual clutter)
• Red rectangle highlight• Red tape on rim of finished
box
Communication – Levels and Modes:
• Concrete (tangible) symbols• Visual sign with tactile
modifications• Constant contact/tactile support
• Speech / audition• Prompts / wait time
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Systems that grow with the child
From 3D to 2D From Pre-symbolic to Symbolic Developing complex language
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Photos and Line Drawings
Which do you think would be more abstract?
Who should use photos / line drawings?
• Enough vision?• For CVI – Phase 2 or 3• Understanding of
what the photo / drawing represents
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Visual components must also be conceptually appropriate
• Based on communication assessment• Collaboration with team/SLP
Line drawings are very abstract!
?
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http://www.pathstoliteracy.org/strategies/sequence-board-child-cvi
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Case Study: Henry (mid-Phase II on CVI Range)
Shared courtesy of Rachel Bennett
• Henry’s able to attend to very familiar 2D pictures on
the iPad, but it is a challenging visual processing task
for him so he easily gets visually fatigued.
• His tactile calendar system allows him access and to
stay anchored throughout the day no matter his visual
fatigue or how he’s feeling.
• Recently, he’s been able to recognize a 2D image of
familiar icons on his iPad presented in an array of 1-2.
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Phase I Intervention: Most Characteristics
NO visual processing of 2-D
Maximize visual access to modalities but don’t expect visual fixation
Goal: Building
visual behavior
Looking is a goal in itself
High level of environmental control
Auditory scanning?
What if DB?
Tactile components?
MULTIMODAL
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Tactile Adaptations
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What about auditory scanning or
motor memory access for Phase I?
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Integrate accessible switches into self-
directed visual experiences based on
CVI Range during down-time
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Multisensory overstimulation is
observable… if you’re paying attention.
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Phase II Intervention
Goal: Integrate Vision and Function
What needs to be adapted visually in order
to elicit and sustain visual attention at targeted
points in a routine?
• Able to use vision in
activities, with adaptations
and opportunities
• Early → Late Phase II
• Level of visual
adaptation needed
• 2D emergingCVI Schedule & Planning Tools
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Phase II & III and Language/Symbolism
You don’t need symbolism and language to reach Phase late II & Phase III (ventral stream processing)
but…
How do you identify, recognize and discriminate 2D symbols if you do not yet have symbolism & language?
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Partner-Assisted Scanning
● Facilitate use of current receptive vocabulary
● Teach new symbols/words
● Develop visual skills
● Pair with other modes
● Expand: levels of selection
● Can be used across multiple forms
Partner assisted scanning on
an iPad with a yellow
cardboard square cutout/guide
Reliant upon responsive communication partner
Pointing, showing, speaking messages a student will select
(Burkhart & Porter, 2012; Hanser, 2007)
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Don’t forget about visual fields!
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Eye Gaze Systems: When are they appropriate?
• Eye to object contact (4-5 at earliest on Range)
• Visual localization skills• Consider fatigue
• 2-D?• Depends on the use:
communication system or visual exploration/games?
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E Tran Board
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Phase III Intervention
Salient feature - what specific part of the symbol gives it unique meaning?
“Critical component” (Bent & Buckley, 2013)
Goal: Refinement of the CVI Characteristics
• Demonstrate visual curiosity
• Can process 2-D• Need
adaptations to support learning and visual vocabulary
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Color Considerations
• Contrast / bright colors• AVOID Pastels: difficult for
CVI, optic nerve atrophy, optic nerve hypoplasia
• Vary the position of colors, use colors to stand out
(Kreuzer & King, 2004; Kreuzer, 2007)
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More Considerations for Symbols
• As conceptually concrete as the student needs
• Complexity of symbol & array• What’s the Complexity Framework (Tietjen)
• Visually DISTINCT when placed alongside other symbols
• Consider the student’s discrimination, identification & recognition skills
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Don’t limit the number of cells on a device; Limit the number of cells used in the array
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High tech or low tech?
“Having an AAC device doesn’t make you a communicator any more than having a piano makes you a musician.” – PraacticalAAC.org
Does the student know the symbols already?
Or is he/she learning them while using the AAC display?
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Modeling Communication
Accessible modeling visual access processing time
Honor the child’s
existing mode(s)
of communication
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More on modeling AAC
Social modeling – will peers be
communicating too?
• Possibility of a level on the display for when the student is fatigued or most impacted by multisensory complexity (credit to Lynn Elko)
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Make a low-tech backup!
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Salient Feature Instruction of Symbols
Can this be done in the context of communication routines with the symbols?
Does it need to be taught “on the side”?
▪ With printed versions of symbols, on a separate display?
▪ Do these salient features then need to be incorporated onto the symbols on the AAC device?
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Parent Example: “Explain Everything” app
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Specific High-Tech AAC Programs
Proloquo2Go
Snap + Core
GoTalk Now
TouchChat
Speak For Yourself
LAMP
Others…
Consider potential for:
- Modifications to layout and array
- Ability to mask cells- Modifications to individual
symbols- Ability to use photos
- Output display (auditory, visual text)
The program is not the most important thing… but some programs are less adaptable
than others.
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Overall display
Spacing of array
Individual symbols
Presentation and use
Consider adaptations to…
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Speak For Yourself (full array)
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Speak For Yourself (beginning word set)
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TouchChat (example)
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Stages in the development of a display…
Visual complexity, conceptual complexity:
• Photos
• Line drawings, abstract 2D symbols
• Color highlights to salient features
• Sight words (bubbled, not)
Is the student expected to access the display
visually throughout the day, or are other channels
being used (motor memory, auditory scanning,
combination)?
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Keyguards?
Colored Keyguard
http://www.laseredpics.biz
Pros• Emphasize spacing
between symbols• Color outlines• Tactile/3D outline
Cons?
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Keyboard Adaptations
BigKeys
Pimpmykeyboard.com
Is this TOO FAR?
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Remember, it’s not just about
material adaptations… Consider:
Placement and presentation of materials
Positioning of the student
Complexity of the environment
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Environmental Considerations & Presentation
Complexity
Light Color
Visual Fields
Distance
Movement Visual Novelty
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Beware of glare!
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Balancing Sensory Access
• Limit visual demands when focusing on auditory access • Literacy example, mid-Phase II: Sight word
instruction in short, intense intervals; Reading comprehension with audio books at grade level
This requires planning…CVI Schedule, CVI Learning Media Profile
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Visual & Tactile Modifications to Sign
Phase I: • Tactile Sign / Hand-Under-Hand Modeling
All Phases: Consider background complexity (clothing, backdrop)
Phase II (Early → Late):• Visual sign at near, tactile supports still needed• Consider visual field preferences - tracking• Reduced complexity of backdrop is critical• Allow for “looking away” in visually guided reach
Phase III: • Visual sign may be accessible at increased
distance• Tactile modifications still may be needed in
complex or novel environments
Accessible Back-channeling:VisualTactile
AuditoryCombination/TOTAL COMM.
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http://www.bridgeschool.org/transition/multi
modal/eye_gaze_boards.php
Videos & Resources