Social Positioning to Increase Communication of Adults With Extensive Support Needs

Social positioning involves positioning individuals with extensive support needs (ESN) in proximity to and facing a communication partner, with access to a speech-generating device (SGD). We used a multiple probe design to evaluate if social positioning would increase the symbolic and nonsymbolic communication of 10 adults with ESN when they were out of their wheelchairs. Dependent variables included (a) SGD activations, (b) eye gaze, (c) vocalizations, and (d) reaching. Visual analysis of the results indicated a functional relation between the introduction of social positioning and increased eye gaze and SGD activations of participants while maintenance data were variable. Implications for service providers and future research directions are discussed.

Promoting functional seated positioning and communication utilising a custom cervical and trunk orthosis in severe traumatic brain injury: a case report

BACKGROUND AND PURPOSE

Published evidence to guide therapists regarding positioning strategies for patients with TBI is limited. This case report describes the development of a custom cervical-thoracic-lumbar orthosis to improve functional seated positioning and communication for an individual with severe traumatic brain injury (TBI).

CASE DESCRIPTION

A man in his 20 s admitted to an inpatient rehabilitation hospital nine weeks after sustaining a TBI. Upon admission, he presented in a vegetative state with severe positioning and postural impairments.

INTERVENTION

Despite evidence of cognitive progression at 7 weeks post-admission, the patient demonstrated persistent postural deficits and limitations in functional activities and communication. To provide additional postural support, a custom cervico-thoracic-lumbar orthosis was fabricated to promote improved function and communication.

OUTCOMES

From the time of admission to post-admission weeks 7-8, the patient progressed on multiple measures: Rancho Los Amigos scale: level II to level VII; Coma Recovery Scale Revised 6 points to 15 points; Disability Rating Scale decreased from 25 points to 12 points. Functional Independence Measure 20 points at 6 weeks post-admission to 23 points at 8 weeks post-admission.

DISCUSSION

Custom cervico-thoracic-orthoses may provide additional postural support to promote improved function in individuals post-TBI. Further studies are needed to provide evidence of custom orthoses' effect on function and communication in this population.IMPLICATIONS FOR REHABILITATIONTo provide evidence of the influence of a custom orthosis on achieving a stable seated postureTo provide evidence of the influence of a custom orthosis on the functional use of an alternative communication device in the traumatic brain injury population.

Analysis of State Organizational Patterns among Students with Profound Disabilities

A review is presented of recent research on state behavior among children and youth with profound disabilities. A model depicting interactions of state with endogenous and exogenous variables is presented along with a discussion of the importance of state diversity potential to this analysis and considerations for investigating and understanding state organization patterns in this population. Applications of the model are illustrated through case studies of four students with profound disabilities who display different state patterns. Measurable attributes of state reveal major characteristics that define functionally profound disabilities and have important implications for intervention.

Facilitating children's ability to distinguish symbols for emotions: the effects of background color cues and spatial arrangement of symbols on accuracy and speed of search

PURPOSE

Communication about feelings is a core element of human interaction. Aided augmentative and alternative communication systems must therefore include symbols representing these concepts. The symbols must be readily distinguishable in order for users to communicate effectively. However, emotions are represented within most systems by schematic faces in which subtle distinctions are difficult to represent. We examined whether background color cuing and spatial arrangement might help children identify symbols for different emotions.

METHOD

Thirty nondisabled children searched for symbols representing emotions within an 8-choice array. On some trials, a color cue signaled the valence of the emotion (positive vs. negative). Additionally, the symbols were either (a) organized with the negatively valenced symbols at the top and the positive symbols on the bottom of the display or (b) distributed randomly throughout. Dependent variables were accuracy and speed of responses.

RESULTS

The speed with which children could locate a target was significantly faster for displays in which symbols were clustered by valence, but only when the symbols had white backgrounds. Addition of a background color cue did not facilitate responses.

CONCLUSIONS

Rapid search was facilitated by a spatial organization cue, but not by the addition of background color. Further examination of the situations in which color cues may be useful is warranted.

Functional Seating for School-Age Children With Cerebral Palsy: An Evidence-Based Tutorial

Purpose

This tutorial is designed to teach speech-language pathologists (SLPs) best practices to support functional seating of children with cerebral palsy (CP) in the classroom and in school-based therapy sessions. This tutorial teaches SLPs to (a) recognize the positive effects of seating intervention, (b) identify the characteristics of functional seating that may produce these positive effects, and (c) realize their role in supporting functional seating for school-age children with CP.

Method

The research reporting positive effects of seating intervention for school-age children with CP is presented according to the International Classification of Functioning, Disability and Health (World Health Organization, 2001). Recommended guidelines for functional seating for school-age children with CP are gleaned from the research evidence. The specific role of the SLP in providing functional seating for children with CP is then discussed.

Conclusion

Seating intervention may produce positive body structure and function, activities, and participation effects for school-age children with CP when appropriate equipment is provided for weight bearing, the pelvis is positioned for stability and mobility, and the body is properly aligned. SLPs can support functional seating for school-age children with CP by communicating with professionals with seating expertise and by invoking and monitoring recommended guidelines for children with basic and complex seating needs, respectively.

Effect of Seated Position on Upper-Extremity Access to Augmentative Communication for Children With Cerebral Palsy: Preliminary Investigation

OBJECTIVE. Our goal in this study was to determine the effect of seated position on upper-extremity access to augmentative communication for a child with cerebral palsy.

METHOD. A single-subject ABAB design was used with one 5-yr-old participant. We compared accuracy and speed of selection of targets on a speech-generating device in the participant’s typical position and in an intervention position. The intervention position conformed to current clinical conventions and research on promoting upper-extremity movement. The intervention position was achieved through simple modifications to the participant’s typical seating.

RESULTS. Accuracy of target selection was moderately improved in the intervention position compared with the typical position.

CONCLUSION. Results provide preliminary empirical evidence of the positive effects of functional seating on access to augmentative communication for children with cerebral palsy. Further research is required to confirm the positive effect of the intervention position across other people who use augmentative communication.

Access to AAC: Present, past, and future

Historically, access in augmentative and alternative communication (AAC) has been conceptualized as the physical operation of AAC technologies; more recently, research and development in the cognitive and social sciences has helped to broaden the concept to include a range of human factors involved in the successful use of AAC technologies in social interactions. The goal of this article is to expand the current understanding of communication access by providing a conceptual framework for examining AAC access, evaluating recent scientific and technical advances in the areas of AAC, and discussing the challenges to accessing AAC technologies for a range of communication activities.

Thomas the Writer

A case study is presented to describe the development of augmentative and alternative communication (AAC) and literacy skills by a 9-year-old child, Thomas, who has quadriplegic cerebral palsy and a central vision impairment. Thomas’s development and progress from birth to second grade is chronicled. Development and use of his AAC system also is described, along with activities for language and literacy development and his inclusion in a second grade classroom.

Development of a physical characteristics assessment (PCA): a checklist for determining appropriate computer access for individuals with cerebral palsy

The physical characteristics assessment (PCA), a newly developed illustrated checklist, is designed for use by allied health and education professionals to identify a viable method for an individual with cerebral palsy to access a computer. The PCA was developed in response to a documented void of such assessments in the literature. The value of PCA was assessed with respect to content validity, clinical utility, reliability (inter-rater), and opinion of persons with cerebral palsy and health and education professionals. Professionals (n = 72) and persons with cerebral palsy (n = 78) from 20 sites in Canada, Chile, England, Israel, Spain, and the United States participated in the study. Statistically, the PCA produced a highly significant (p < 0.001) assessment time savings compared with non-PCA methods. A statistically significant difference in the number of user/computer interface changes during five post-assessment computer training sessions was not shown between the PCA and non-PCA methods. Inter-rater reliability ranged between 90% and 100% (n = 33 pairs). Both persons with cerebral palsy assessed via the PCA and professionals using the PCA gave positive opinions. Overall results support the value of the PCA.