Children With Cortical Visual Impairment and Complex Communication Needs: Identifying Gaps Between Needs and Current Practice

Design Characteristics of Augmentative and Alternative Communication Interfaces for Children With Cortical Visual Impairment: Results From Two Focus Groups With Vision Professionals

PURPOSE

The purpose of the current study was to gain insight on augmentative and alternative communication (AAC) interface designs for children with cortical visual impairment (CVI). Children with CVI frequently require AAC and specific interface supports, and customization may be necessary to support access and use of speech-generating devices.

METHOD

A focus group methodology was selected to gain feedback from vision professionals on helpful AAC features for children with CVI. Participants included eight teachers of the visually impaired and one optometrist. Two virtual 1-hr focus group sessions were conducted and recorded for thematic analysis.

RESULTS

Three primary themes and eight subthemes emerged from the transcripts of the focus groups. Themes included characteristics of the AAC interfaces such as background, high contrast, and symbolic representation; characteristics of children with CVI (preferred colors, visual field preference); and the development of AAC interfaces over time.

CONCLUSIONS

Vision professionals have identified characteristics of AAC interfaces that should be considered when working with children with CVI. Future collaboration with such professionals is needed to further inform the design of current and future AAC technologies to allow speech-language pathologists to meet the unique needs of this population.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28279184.

A Systematic Literature Review on School-Based Speech-Language Pathology Collaboration Research

PURPOSE

School-based teams are called to be collaborative in order to appropriately and effectively serve students. Speech-language pathologists play crucial roles on school-based teams. This systematic review sought to synthesize existing empirical evidence on collaborative perceptions and experiences in research that included school-based speech-language pathologists (SLPs).

METHOD

A systematic literature review was conducted, which included Boolean search methods of the Science Citation Index Expanded, Social Sciences Citation Index, Education Resources Information Center, Academic Search Complete, Education Research Complete, and PubMed databases. Through an abstract, text screening, and progeny search process, 26 articles met the study's inclusion criteria. Relevant data were extracted from each article, analyzed, synthesized, and organized into themes to answer the research questions.

RESULTS

The main findings from the systematic review were organized into (a) study design and participants; (b) purpose, definitions, and collaborative activities; (c) perceptions of collaboration; (d) engagement in collaboration; (e) facilitators and barriers; (f) collaboration and telepractice; and (g) differing findings based on demographic factors.

CONCLUSIONS

Underscoring the complexity of school-based collaboration, researchers have utilized varied designs and frameworks to explore collaborative perceptions and experiences in research including school-based SLPs. While SLPs generally view school-based collaboration as valuable, engagement in collaboration is not as clear-cut. The number of facilitators and barriers described, variability in frameworks and definitions, and limited disaggregation across demographic factors underlie the need for continued research and have implications for policy and practice.

Aided Communication With Individuals Who Have Multiple Disabilities That Include Visual Impairments: A Meta-Analysis

PURPOSE

Despite several decades of research focused on improving early symbolic communication for individuals with multiple disabilities, relatively limited focus has been placed on individuals who also have visual impairments. To establish what is currently known about aided language adaptations for this population, a meta-analysis was conducted to examine augmentative and alternative communication (AAC) intervention approaches for individuals with multiple disabilities that include visual impairments.

METHOD

Six relevant databases were systematically searched. Seven hundred eighty-nine articles were narrowed to eight intervention studies that met the design standards set for this review.

RESULTS

Of the eight intervention studies that met design standards, five used modified versions of the Picture Exchange Communication System and three used a combination of approaches such as communication partner instruction plus environmental arrangement. Most studies used low-tech AAC such as tangible symbols, photo cues, and communication books, and most focused on improving independent requesting. Overall, the studies indicated positive findings for increasing pragmatic language skills such as requesting, turn-taking, and student-to-peer interactions. However, the total number of participants across studies was extremely limited (i.e., 19 participants total). Clearly, much additional research is required to devise adequate accommodations for individuals with multiple disabilities, including visual impairments, and to expand communicative functions beyond simple requests.

CONCLUSIONS

The use of visual impairment accommodations appeared largely effective for the included aided AAC interventions, although consultation with visual impairment specialists was not consistently reported across the included studies. More rigorous research must occur within this population to better inform clinical practice and future studies.

Teletraining to Teach Communication Partners to Support Students With Multiple Disabilities Including Cortical Visual Impairment and Emerging Symbolic Communication in Communicating Choices

PURPOSE

The purpose of the current study was to investigate the impact of a teletraining to teach adult communication partners the "Communicating Choices-Cortical Visual Impairment (CVI)" strategy to support participation for students with multiple disabilities.

METHOD

A nonconcurrent, multiple-probe, across-participants design was implemented with four adult communication partner (i.e., speech-language pathologist, paraeducators, and parent) and student dyads to determine the effects of a teletraining administered over a video-calling platform on the partner's implementation of the substeps from the Communicating Choice-CVI strategy. Dyads completed a randomly predetermined number of baseline sessions, two teletraining sessions to instruct the partners in the strategy, and five intervention probes.

RESULTS

Results of the study indicated that communication partners successfully implemented an increased number of the strategy substeps following two short teletraining sessions and that all students communicated choices in every opportunity when they were provided with a structured opportunity. Communication partners reported that the strategy was successful for the students and that the strategy could be applied to other contexts or students.

CONCLUSIONS

This study provides evidence for the importance of communication partner training for students with complex needs in domains such as vision and communication. Furthermore, the Communicating Choices-CVI strategy may lead to increased opportunities for academic participation, social engagement, and self-determination for students whose opportunities to take on active roles in educational settings are often severely restricted.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.28108139.

Augmentative and alternative communication for individuals with post-stroke aphasia: perspectives of South African speech-language pathologists

This qualitative study aimed to describe speech-language pathologists' (SLPs') perspectives on augmentative and alternative communication (AAC) use for people with post-stroke aphasia focusing on: (a) current AAC practice, (b) factors that influence the use of AAC, and (c) the success and relevance of AAC interventions. Semi-structured interviews took place with ten South African SLPs with experience in aphasia intervention. The transcribed interviews were thematically analyzed using a six-phase process of inductive and deductive analysis within a phenomenological framework. All the participants use AAC with their clients, employing a variety of approaches that reflect their diverse settings, experiences, and perspectives on AAC. AAC use is complex, and SLPs make conscious choices considering multiple factors. Barriers to use were often associated with limited resources in the low- and middle-income country (LMIC) context, but most participants retained a positive view of AAC, actively working to circumvent barriers to use. Participants consistently emphasized the vital role of partners in communication interactions, linked to the importance of defining AAC broadly. It is necessary to advance the integration of AAC into rehabilitation plans to improve communication and social participation outcomes for people with post-stroke aphasia, especially in LMICs such as South Africa.

Parents' Perceptions of Eye-Gaze Technology Use by Children With Complex Communication Needs

PURPOSE

Some preschool students with complex communication needs explore eye-gaze computer technology (EGCT) and adopt computer-based augmentative and alternative communication (AAC). The objective of this study was to follow preschool explorers of EGCT who are now school aged to describe the children's use of technology and parents' perceptions of its utility for communication, participation, or leisure.

METHOD

Ten parents completed survey questions by Internet and phone and reported their perceptions of nine children's effectiveness in the use and acceptance of AAC and the support they received in implementing technology. The results are reported as a descriptive study.

RESULTS

All children in this research continue to use AAC technology in school and most at home. Many children who tried and obtained EGCT while in preschool continue to use that technology. Most parents agreed that the children understood how to use the devices, which enhanced the children's communication, and that the parents received sufficient support. Most children were limited in their use of the devices for leisure and control of their environments.

CONCLUSIONS

Computer-based AAC for school-aged children who trialed it when they were in preschool appears to be a powerful means for them to communicate and participate. However, the technology appears not to be used to its full capabilities to support the children's agency to control environments and to pursue leisure. Teams may want to consider how to support children in using their AAC devices to meet multiple needs. The study was limited by its small sample size and its descriptive nature. Additional research on this subject is needed.

Speech-Language Pathologists' Approach to Alternative Access for Augmentative and Alternative Communication for Children With Motor Impairments

PURPOSE

This study examined the processes that speech-language pathologists (SLPs) use during an augmentative and alternative communication (AAC) assessment with children with motor impairments to determine alternative access solutions. These children often are the most vulnerable to a poor fit of their AAC system, which alternative access is an integral part. Although there is an abundance of information as to what types of considerations should be made during these assessments, there is no guidance as to how the assessment is completed. The goal of this study is to build evidence about the process.

METHOD

A collective case design was used to gain detailed insights into the decision-making process. Interviews and vignette responses were two components of the data collection. Each of the five SLPs, or cases, who participated in the study transcripts was analyzed in isolation as part of a within-case analysis. Once each SLP's process was understood, a cross-case comparison was completed to ascertain similarities or differences across the five.

RESULTS

The cross-case assertions are presented in this article. Although the SLPs individually reported a lack of defined process, a clear systemization became evident when considered collectively. The SLPs all focused on the child, isolated motor access skills, and used a process of experimentation over time to build their final recommendations.

CONCLUSIONS

These results have implications for SLPs working with children with motor impairments who may benefit from AAC intervention. The shared framework can serve as a roadmap to other SLPs, especially those with less experience with these types of complex cases. The varying teaming approaches to support these cases are also discussed.

"It's like a guessing game all the time": parent insights on barriers, supports, and priorities for children with cortical visual impairment and complex communication needs

Parents of children with both cortical visual impairment (CVI) and complex communication needs offer unique perspectives on their children's journeys to receiving proper diagnoses, supports, and interventions, such as augmentative and alternative communication (AAC). This study explored the lived experiences, supports, and barriers identified by parents through a qualitative phenomenological approach. Nine parents of children with both CVI and complex communication needs were interviewed virtually. Results indicated five themes descriptive of the parents' experiences: Challenges Piecing Together a CVI Diagnosis; Dealing with Low Expectations of Others; Parents Empowered to Take Action; Guessing Game to Determine Appropriate AAC to Accommodate CVI; and Aligning Professional Practice with Parent Priorities. Whereas some of these themes echoed the experiences of parents of children with complex communication needs (such as those with cerebral palsy) who were not specifically diagnosed with CVI, other themes were unique to this set of parents including the uncertainty of AAC design and intervention given the challenges of CVI and the necessity of more than one way for children to communicate given their visual challenges. This study highlighted the dire need for continued investigation to determine effective AAC interventions for individuals with CVI.

An Evidence-Based Approach to Augmentative and Alternative Communication Design for Individuals With Cortical Visual Impairment

PURPOSE

This article highlights the contributions of three pillars of an evidence-based practice approach (service providers, researchers, and families/clients) in the development of a framework to offer a way forward for professionals, families, and technology companies to support optimal visual and communication outcomes of individuals with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC). By providing available research findings as well as practical information and lived experiences, the article offers clinical considerations and design features that can lead to addressing the unique needs of these individuals.

METHOD

This article reviews literature concerning what is known about CVI and describes in detail and from multiple viewpoints important features required in AAC systems to support individuals with CVI and enable them to communicate effectively.

RESULTS

Components necessary for teams, communication partners, and AAC designers to optimize AAC system design in CVI are presented using external research evidence as internal evidence from lived experience to support their importance.

CONCLUSIONS

An AAC system design that is tailored to the unique visual processing characteristics in CVI is likely to promote positive communication outcomes. The presentation of the lived experience of an individual who has CVI themselves illustrates the need for individualized assessments and interventions that incorporate and reflect the research presented here.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.23902239.

Reason-Based Recommendations From a Developmental Systems Approach for Students With Needs Across Functional Domains

PURPOSE

This tutorial aims to introduce school-based speech-language pathologists (SLPs) to developmental systems theory as a framework for considering interactions across functional domains, such as language, vision, and motor, for students with complex needs.

METHOD

This tutorial summarizes the current literature on developmental systems theory in its application to working with students who have needs in multiple domains of functioning in addition to communication. A hypothetical case of a student, James, with cerebral palsy, cortical visual impairment, and complex communication needs, is presented to illustrate the primary tenets of the theory.

RESULTS

Specific reason-based recommendations are presented that SLPs can put to practice with their own caseload in direct response to the three tenets of developmental systems theory.

CONCLUSIONS

A developmental systems approach will be useful in expanding SLP knowledge of where to begin and how to best serve children with language, motor, vision, and other concomitant needs. The tenets, including sampling, context dependency, and interdependency, and the application of developmental systems theory can be instrumental in providing a way forward for SLPs struggling with the assessment and intervention of students with complex needs.

"Even though a lot of kids have it, not a lot of people have knowledge of it": A qualitative study exploring the perspectives of parents of children with cerebral/cortical visual impairment

BACKGROUND

Cerebral/Cortical Visual Impairment (CVI) is the leading cause of visual impairment in children and can negatively impact participation in daily activities.

METHODS AND PROCEDURE

This qualitative study used virtual focus groups and an online questionnaire to understand the perspectives of families with children who have CVI. Constant comparison analysis was used to analyze focus group transcripts and extract themes. The PEDI-CAT and an online questionnaire were administered to characterize the study population.

OUTCOMES AND RESULTS

Four themes were identified: (1) Awareness of CVI and its effect on the child and family, (2) Parent experiences, (3) Child factors and functional implications, and (4) Supports that enhance child development/vision.

CONCLUSIONS AND IMPLICATIONS

Findings from this study highlight the substantial impact that lack of CVI awareness had on parent experiences. Lack of awareness led to late diagnosis, missed intervention opportunities, and caregiver burden. Due to insufficient resources, parents had to educate themselves and service providers about CVI and advocate for their child's needs. Healthcare and educational providers who work with pediatric neurodevelopmental populations must be knowledgeable about clinical features of CVI, task and environmental adaptations to support vision and implementation of family-centered care.

Profiles of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication: A Retrospective Examination

PURPOSE

Cortical visual impairment (CVI) is the most common cause of visual impairment in children today and can impact the outcomes of children who rely on augmentative and alternative communication (AAC). This study provides baseline data of 13 children with CVI who used AAC during their first year of participation in an integrated CVI program. One purpose was to describe similarities and differences in the student's demographic, functional vision, communication, and educational profiles. A second purpose was to examine differences in students described with different communicator profiles.

METHOD

Archived student records were de-identified and reviewed using a systematic coding scheme. Two researchers independently reviewed and coded all student records. Reliability was established. Measures included CVI Range scores; supports for positioning, mobility, vision, and writing; AAC systems, including modes, access methods, and language representation; communicative competence; self-determination; literacy; and mathematics.

RESULTS

The study yielded a rich description of similarities and differences among students at baseline and led to careful consideration of differences among the participants with emergent communicator and context-dependent communicator profiles.

CONCLUSIONS

Currently, limited evidence exists that informs practice regarding AAC assessment and intervention for children with CVI. This article describes a small sample of children with CVI who use AAC. Results underscore the need for educators and practitioners to ensure that vision functioning in students with CVI is evaluated carefully and regularly when conducting AAC assessment and intervention and formulating communication or education goals.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21357684.

The Effectiveness of Sensory Integration Interventions on Motor and Sensory Functions in Infants with Cortical Vision Impairment and Cerebral Palsy: A Single Blind Randomized Controlled Trial

Cortical vision impairment (CVI) and Cerebral Palsy (CP) lead to decrement in sensory and motor functions of infants. The current study examined the effectiveness of sensory integration interventions on sensory, motor, and oculomotor skills in infants with cortical vision impairment. Thirty-four infants with and CP aged 12−18 months were enrolled to the study. The infants were randomly divided into two groups as the control and intervention groups. The intervention group took sensory integration intervention 2 days a week for 8 weeks in addition to conventional physiotherapy 2 days a week for 8 weeks. The control group only received the conventional physiotherapy program 2 days a week for 8 weeks. The duration of the treatment sessions were 45 min for both interventions. Before and after the intervention, sensory processing functions were evaluated with the Test of Sensory Functions in Infants (TSFI), and motor functions were evaluated with the Alberta Infant Motor Scale (AIMS). There was a statistically significant difference between the pre- and post-test mean TSFI total and AIMS scores in the intervention group and control group (p < 0.001). The intervention group mean TSFI scores were more statistically significant than the those of the control group. Mean post-intervention AIMS scores did not differ between groups. Sensory integration intervention delivered with the conventional physiotherapy program was more effective than the conventional physiotherapy program in increasing sensory processing skills in one measure in infants with CVI and CP.

Working with children with cortical visual impairment who use augmentative and alternative communication: implications for improving current practice

The aim of this study was to describe how professionals from multiple disciplines (e.g., speech-language pathologists, teachers, occupational therapists) in the United States reported challenges they face in delivering services to children with cortical visual impairment (CVI) who use augmentative and alternative communication (AAC). Three surveys were utilized to identify barriers to and priorities for improving educational and clinical services and in-service and preservice education from the perspectives of professionals in school, community, and university settings. Results suggest that current service delivery models may not be meeting the needs of either children with CVI who use AAC or the professionals whose job it is to provide them with services. Professionals in community-based settings appeared to encounter more barriers. Findings help to support a discussion about approaching AAC interventions for children with CVI who use AAC by adopting interprofessional collaborative practice (IPCP) and interprofessional education (IPE) models, which reflect long-standing best practice guidelines for AAC service delivery and are encouraged by multiple professional organizations.

Creating a Path for Systematic Investigation of Children With Cortical Visual Impairment Who Use Augmentative and Alternative Communication

Purpose There is limited information about how to support children with cortical visual impairment (CVI) who require augmentative and alternative communication (AAC). An initial review designed to explore the available evidence was used to outline critical needs in moving research and intervention forward for children who use AAC and have CVI. Method Previous systematic reviews, six databases, and theses and dissertations were systematically searched, along with reviews of the resulting works cited. An initial yield of 575 articles was narrowed to 10, which discussed AAC interventions that included children with CVI. Results Three interventions were technology based, and seven were instructional based. The use of textured microswitches was the most frequent form of technology intervention, with the frequency of switch activations being the most frequently coded outcome. Overall, the studies represent explorations in the area rather than systematic lines of inquiry. Conclusions While evidence shows at least some children with CVI have been included in AAC research to date, the inclusion is more incidental than deliberate. Issues such as clear descriptions of the vision capabilities and needs of participants may have impacted study results.