Tangible symbols, tangible outcomes

Design of aided augmentative and alternative communication systems for children with vision impairment: psychoacoustic perspectives

Children with complex communication needs often have multiple disabilities including visual impairments that impact their ability to interact with aided augmentative and alternative communication (AAC) systems. Just as the field benefited from a consideration of visual cognitive neuroscience in construction of visual displays, an exploration of psychoacoustics can potentially assist in maximizing the possibilities within AAC systems when the visual channel is either (a) not the primary sensory mode, or (b) is one that can be augmented to ultimately benefit AAC outcomes. The purpose of this paper is to highlight background information about psychoacoustics and present possible future directions for the design of aided AAC system technologies for children with visual impairments who rely on auditory information to learn and utilize AAC.

Interventions for children with deafblindness-An integrative review

BACKGROUND

Deafblindness is a rare condition, and its prevalence has been reported to be approximately 1 in 27 000 new-borns worldwide. For individuals with deafblindness, lifelong interventions and support are needed to be able to develop communication, be active and preserve a good quality of life. Because little is known about what kind of support and interventions can be offered to children with deafblindness, the aim was to summarize and disseminate research findings regarding this topic.

METHODS

Integrative review principles were employed. Systematic searches in eight databases and additional manual searches were conducted. The inclusion criteria were as follows: original studies published between 2000 and 2021 examining either interventions for children between 0 and 18 years of age with deafblindness or interventions aimed at children with deafblindness but offered to their relatives or professionals working with them. Studies on support for family members were also sought. Study characteristics were described, and key findings were synthesized into categories based on their similarities.

RESULTS

Of the 6268 identified original studies, 32 were included. The key outcomes from the included studies were synthesized into three categories, with two categories illustrating the goal/intention of the intervention (social interaction and communication, motivation and participation) and one focusing on or identifying the action taken to benefit the child (adaptation of the educational environment). Social interaction and communication was the dominant category, covering 24 of the 32 included studies.

CONCLUSIONS

This review concludes that there are a limited number of evaluated interventions for children with deafblindness. In many cases, the interventions were adapted to the individual child's needs, and most of them were found within the area of social interaction and communication. More research is needed to strengthen the level of evidence for interventions for children with deafblindness.

Instructional strategies to support shared reading with learners who are deafblind

The field of deafblindness has developed evidence-based practices in communication development and intervention, but very little research has been published on literacy. This study examined the survey responses of 84 participants from 25 states, and 10 follow-up interviews to learn more about emerging instructional ideas specific to shared story reading, also known as interactive reading. The thematic analysis resulted in eight themes and associated instructional strategies. Attentional and engagement strategies included unique considerations due to the impact of deafblindness on accessibility and meaning-making. Teachers, interveners, and parents used practices grounded in both the child-guided approach and systematic instructional approach. They shared vocabulary acquisition strategies, pointing to the link between vocabulary and comprehension. Drawing and writing strategies were used to create text and in extension activities. Touch and tactile strategies were used in preparing materials and during shared reading sessions. Participants applied a variety of comprehension strategies including repetition, prediction, and questioning. Across the survey and interview responses, it was evident that participants understood the role of integrating individually appropriate receptive and expressive communication modes/forms in shared reading activities.

Children Who Are Deaf/Hard of Hearing with Disabilities: Paths to Language and Literacy

Students who are Deaf with Disabilities (DWD) comprise an extremely heterogeneous population. Similar to students who are d/Deaf or hard of hearing (DHH), students who are DWD vary in terms of degree, type, and age at onset of hearing loss, amplification, and preferred communication method. However, students who are DWD are also diverse in terms of type, etiology, and number and severity of disability(ies). Presented in this article is an overview of DWD followed by foci on Deaf with learning disabilities, Deaf with intellectual disabilities, Deaf with autism spectrum disorder, and deafblindness. Particular attention is given to communication, language, and literacy development.

The Application of Werner and Kaplan's Concept of “Distancing” to Children who are Deaf-Blind

Through the process of distancing, children develop an understanding of the differences between themselves and others, themselves and objects, and objects and representations. Adults can support progressive distancing in children who are congenitally deaf-blind by applying strategies, such as the hand-under-hand exploration of objects, the selection of communication forms that are based on children's level of representation, the use of cues for recall that are based on children's experiences, and modeling of more complex play schemes.

Gestures Expressed by Children who are Congenitally Deaf-Blind: Topography, Rate, and Function

This descriptive study examined the topography, rate, and function of gestures expressed by seven children who are congenitally deaf-blind. Participants expressed a total of 44 conventional and idiosyncratic gestures. They expressed 6–13 communicative functions through gestures and 7 functions through a single type of gesture. They also expressed idiosyncratic gestures and used specific gestures for functions other than those that are typically associated with those gestures.

A Field Study of a Standardized Tangible Symbol System for Learners who are Visually Impaired and have Multiple Disabilities

Introduction

The study reported in this article tracked the learning rate of 43 children with multiple disabilities and visual impairments who had limited to no verbal language across seven months of classroom-based intervention using a standardized set of tangible symbols.

Methods

The participants were introduced to tangible symbols on a daily basis during a seven-month field study. The tangible symbols were embedded into the curriculum during daily classroom routines and were used in addition to any other forms of expressive or receptive communication that were already in place in the classroom. The data were collected daily from teachers and therapists. Throughout the seven-month period, data were recorded for 30,220 opportunities to use tangible symbols. The participants had 2 to 9 recorded opportunities to use tangible symbols per day throughout the study.

Results

Over a four-month period, the participants identified 46% of the tangible symbols to which they were exposed, and cognitive, language, play, and symbolism skills were not factors related to the successful acquisition of tangible symbols. The strongest predictor of outcome was independent ambulation, and seven symbols were the most often identified. In addition, decontextualized pre- and posttesting proved less effective as a measurement tool than did daily classroom probes immediately following activities.

Discussion

The results suggest that even children with the most severe impairments were able to identify the use of many of the tangible symbols.

Implications for practitioners

One implication of this research is that data collection allows teachers or therapists to measure progress in the acquisition of tangible symbols objectively and that it fosters the development of goals for the students’ Individualized Education Programs.

Mary's Case: An Illustration of Interprofessional Collaborative Practice for a Child With Severe Disabilities

PURPOSE

The principles of interprofessional collaborative practice (IPCP) are illustrated through the case of Mary, a child with severe disabilities.

METHOD

Mary's experiences from early childhood to young adulthood are highlighted by both optimal and less-than-ideal examples of clinical services and collaborative practice. The range of collaboration illustrates potential variations in service delivery. Thematic comments and resources are provided by professionals experienced with and committed to IPCP who represent the following four disciplines: occupational therapy, physical therapy, special education, and speech-language pathology.

CONCLUSIONS

Although potentially challenging, IPCP is a dynamic practice methodology appropriate for speech-language pathologists and others serving persons with severe disabilities.

The Trifocus Framework and Interprofessional Collaborative Practice in Severe Disabilities

PURPOSE

Individuals with severe disabilities are a diverse group of learners with complex communication needs. This article presents a synthesis of the literature addressing the five strategies of the trifocus framework, with its triadic structure of learner with disability, communication partner, and environment. The application of interprofessional collaborative practice (IPCP) to the implementation of trifocus framework communication strategies is emphasized.

METHOD

A literature search was conducted using Google Scholar and EBSCO to identify literature and research studies on IPCP and communication intervention for learners with severe disabilities, published 1994-2015, and then organized within the trifocus framework. The trifocus strategies are enhancing sensitivity, utilizing routines, increasing communication opportunities, modifying the communication environment, and augmenting input. Studies that included at least one participant with severe disabilities and their communication partners were considered. A secondary search was then conducted by reviewing the articles referenced in the original articles.

CONCLUSION

Effective IPCP in communication intervention considers the learner's characteristics, the knowledge and skills required of communication partners, and effective environmental arrangements to support communication. Future research should include clear participant descriptions, documentation of fidelity measures, and evidence of generalization to support professionals to know when findings are relevant to the individuals they serve.

What We Write about When We Write About AAC: The Past 30 Years of Research and Future Directions

For the past 30 years, the Augmentative and Alternative Communication (AAC) journal has both documented and instigated change in the field of AAC. We reviewed the papers published in the AAC journal from 1985-2014 in order to identify trends in research and publication activities. Intervention research made up the largest proportion of the four types of research (i.e., intervention, descriptive, experimental, and instrument and measurement development) reported in the journal. Intervention research has most commonly focused on the individual with complex communication needs, and most frequently on younger individuals (aged 17 and younger) with developmental disabilities. While much has been learned in the past 30 years, there continues to be a need for high quality research in a large number of areas. There is a special need for reports of interventions with older individuals with complex communication needs as a result of acquired disabilities, and for information on effective interventions for the communication partners of persons with complex communication needs.

The potential for developing a tactile communication system based on Blissymbolics

OBJECTIVE

To be useful for tactile communication, tactile stimuli need to be discriminable from each other. The objective of this study was to determine whether raised-line renderings of Blissymbols have the capacity for being developed into a tactile communication system as measured by their tactile discriminability.

METHODS

Tactile discrimination of Blissymbols was measured by performance on a task in which participants were asked to feel a target raised-line Blissymbol and then to find the target within an array containing the target and raised-line Blissymbol foils.

RESULTS

The vast majority of tactile Blissymbols had tactile discrimination scores of 90% accuracy or better.

CONCLUSION

Most raised-line Blissymbols can be tactilely discriminated from each other, indicating that they have the potential for being developed into a tactile communication system.

Observing the use of tactile schedules

This article explores the use of tactile schedules in a heterogeneous sample of children with congenital blindness and varying degrees of additional disabilities. Basic conditions for the use of tactile schedules are proposed and discussed. Child behaviour indicative of some particular functions that can be attained with the use of tactile schedules, such as sense of agency and increased predictability and communication, is described and discussed. The role of the teacher is emphasized throughout the article.

Initial evidence of the reliability and validity of a three-dimensional body rating scale for the congenitally blind

Research on body dissatisfaction has grown significantly. However, valid and reliable instruments for measuring body dissatisfaction in the congenitally blind have yet to be developed. In three studies, we report on development, test-retest reliability, and concurrent and content validity of the Three-dimensional Body Rating Scale (3BRS) for the congenitally blind. In Study 1, 58 people with congenital blindness (28 women, 30 men; M age = 36.7, SD = 13.1) numerically ordered models of the 3BRS and models of the Two-dimensional Body Rating Scale (2BRS), from very thin to the very fat. In Study 2, the construct validity and reliability of the 38RS was assessed. The same participants from Study 1 chose the 3BRS model that represented their ideal body and the 3BRS model that represented their actual body. Two weeks later, a re-test was done. In Study 3, 16 experts judged the content validity of the 3BRS. The psychometric properties of the 3BRS, its utility, and its limitations are discussed along with considerations for future research.

AAC technologies for young children with complex communication needs: State of the science and future research directions

Augmentative and alternative communication (AAC) technologies offer the potential to provide children who have complex communication needs with access to the magic and power of communication. This paper is intended to (a) summarize the research related to AAC technologies for young children who have complex communication needs; and (b) define priorities for future research to improve AAC technologies and interventions for children with complex communication needs. With the realization of improved AAC technologies, young children with complex communication needs will have better tools to maximize their development of communication, language, and literacy skills, and attain their full potential.

The effect of color on the recognition and use of line drawings by children with severe intellectual disabilities

Line drawings are commonly used as communication symbols for individuals with severe intellectual disabilities. This study investigated the effect of color on the recognition and use of line drawings by young children with severe intellectual disabilities and poor verbal comprehension who were beginning picture users. Drawings where the color of the picture matched the object and where the color of the drawing did not match the object were used, as well as black and white line drawings. Tentative findings suggest that some students with intellectual disabilities may find it more difficult to recognize and line drawings where the color does not match the object compared to line drawings where the color of the drawing does match the color of the object.

Intentional communication acts expressed by children with severe disabilities in high-rate contexts

The purpose of this study was to identify the rates of communication expressed by 17 children with severe disabilities in high-rate school contexts while piloting a new coding system for intentional communication acts (ICAs). The following nine characteristics were used when coding ICAs expressed in both child initiated and adult initiated communicative interactions: joint attention, form of communication, use of pause, persistence, repetition, repair, expression of pleasure or displeasure when understood or misunderstood, expression of pleasure or displeasure to communication partner's message, and evidence of comprehension. Children communicated 1.7 - 8.0 ICAs per minute in the highest rate contexts. Nine of the 34 high-rate contexts were speech clinical sessions, six were activities that included eating, 30 were familiar activities, and four were novel activities.

Describing participants in AAC research and their communicative environments: Guidelines for research and practice

PURPOSE

People who use augmentative and alternative communication (AAC) vary widely in their skills and communication needs. Interventions have been developed to meet different needs, but have met with varied success. Attempts to discover why interventions succeed or fail are hindered by the lack of detailed description of the research participants and the environments in which they communicate. This paper reviews the information commonly given about AAC research participants and presents guidelines for the description of people who use AAC, their conversation partners and their communicative environments.

METHOD

Electronic databases were searched for AAC intervention research reports published between 1990 and 2004. Data on research participants and their communication environments were extracted from reviewed papers. Information given in published papers and variables known to affect communication were presented to an expert group. A modified Nominal Group technique was used to decide what information should be reported in AAC intervention research.

RESULTS

Guidelines for participant description that link with the World Health Organization International Classification of Functioning, Disability and Health were developed from the results of the nominal group.

CONCLUSIONS

Detailed information is needed to demonstrate efficacy of AAC interventions. Guidelines for participant description are presented and discussion of their utility is now needed.

The effect of aided language stimulation on vocabulary acquisition in children with little or no functional speech

PURPOSE

To describe the nature and frequency of the aided language stimulation program and determine the effects of a 3-week-long aided language stimulation program on the vocabulary acquisition skills of children with little or no functional speech (LNFS).

METHOD

Four children participated in this single-subject, multiple-probe study across activities. The aided language stimulation program comprised 3 activities: arts and crafts, food preparation, and story time activity. Each activity was repeated over the duration of 5 subsequent sessions. Eight target vocabulary items were taught within each activity. The acquisition of all 24 target items was probed throughout the duration of the 3-week intervention period.

RESULTS

The frequency and nature of the aided language stimulation provided met the criterion of being used 70% of the time and providing aided language stimulation with an 80:20 ratio of statements to questions. The results indicated that all 4 participants acquired the target vocabulary items. There were, however, variations in the rate of acquisition.

CONCLUSIONS

This study explores the impact of aided language stimulation on vocabulary acquisition in children. The most important clinical implication of this study is that a 3-week intervention program in aided language stimulation was sufficient to facilitate the comprehension of at least 24 vocabulary items in 4 children with LNFS.

Perceptions of communication before and after a speech pathology intervention for an adult with intellectual disability

BACKGROUND

The aim of this study was to explore, from the perspective of key communication partners, the meaning of a communication intervention and associated changes for an adult with severe intellectual disability (ID).

METHOD

The parents and key support workers of Mark, a 22-year-old man with ID and complex communication needs, were interviewed. The interviews were conducted prior to and following a speech pathology intervention and were guided by a communication inventory based on the concept of social networks. Interview transcripts were analysed qualitatively, with a focus on the subjective meaning of communication changes. These changes were explored according to both the specific information sought through the inventory and additional information provided.

RESULTS

The findings were organised into three key themes relating to Mark, his familiar communication partners (i.e., parents and disability support workers), and the community. Information obtained from the interviews indicated that Mark's reported communication level remained stable across the intervention. However, an in-depth analysis of the interview transcripts revealed some gains in his communication skills. From the perspective of Mark's familiar communication partners, key sub-themes emerged which were related to changes in ascription of responsibility for developing skills and strategies to enhance Mark's communication. Furthermore, greater participation by Mark in his home community was evident.

CONCLUSIONS

The findings are discussed in terms of the assessment of an individual's communication through interactions with communication partners, and how changes associated with an intervention can be best understood from analysis of rich data.

A discussion of individual variability, in activity-based interventions, using the niche concept

BACKGROUND

Activity-based intervention has been defined as a child-directed, transactional approach that uses logically occurring antecedents and consequences to develop functional and generative skills by embedding intervention of children's individual goals and objectives in routine, planned or child-initiated activities. In this approach, clear goals and objectives that are functional and embedded in a play activities or routines are developed. The teacher mediates the child's environment to facilitate learning with the child directing the teacher on the pace, duration spent on the objective. Learning and development in this framework occur through both a carefully planned environment and adult facilitation. Progress made by a child using this approach focuses on observational data that describe if the child is able to respond in functional and generative ways. While activity-based interventions are usually provided for a group of children, progress is measured by describing individual children's responses. Individual variations in the children's progress, despite exposure to the same interventions are an area that is seldom discussed. This article aims to explore the niche concept and its application to explaining this variation between individuals.

METHODS

Four children participated in this single-subject, multiple-probe study across four participants. A 3-week long activity-based aided language stimulation programme was developed. The effect of the programme was determined by describing the individual participants understanding of the 24 targeted vocabulary items.

RESULTS

The results of the activity-based language programme are presented and the variability among the participants is discussed using the niche concept. The role of the niche concept in individual development is described and the implications thereof are discussed.

CONCLUSIONS

Finally, activity-based intervention research is placed in a systems perspective and possible outcome measures of this intervention are discussed from a multidimensional ecological perspective.

Speech and language therapy to improve the communication skills of children with cerebral palsy

BACKGROUND

The production of speech, language and gesture for communication is often affected by cerebral palsy. Communication difficulties associated with cerebral palsy can be multifactorial, arising from motor, intellectual and / or sensory impairments, and children with this diagnosis can experience mild to severe difficulties in expressing themselves. They are often referred to speech and language therapy (SLT) services, to maximise their communication skills and help them to take an independent a role as possible in interaction. This can include introducing augmentative and alternative communication (AAC) systems, such as symbol charts or speech synthesizers, as well treating children's natural forms of communication. Various strategies have been used to treat the communication disorders associated with cerebral palsy but evidence of their effectiveness is limited.

OBJECTIVES

To determine the effectiveness of SLT that focuses on the child or their familiar communication partners, as measured by change in interaction patterns. To determine if individual types of SLT intervention are more effective than others in changing interaction patterns.

SEARCH STRATEGY

Searches were conducted of MEDLINE, CINAHL, EMBASE, PSYCH INFO, LLBA, ERIC, WEB of SCIENCE, NRR, BEI, SIGLE up to December 2002. References from identified studies were examined and relevant journals and conference reports were hand-searched.

SELECTION CRITERIA

Any experimental study containing an element of control was included in this review. This includes non-randomised group studies and single case experimental designs in which two interventions were compared or two communication processes were examined.

DATA COLLECTION AND ANALYSIS

L Pennington searched for and selected studies for inclusion. J Goldbart and J Marshall independently assessed separate random samples each comprising 25% of all identified studies. Two reviewers independently abstracted data from each selected study. Disagreements were settled by discussion between the three reviewers.

MAIN RESULTS

Eleven studies were included in the review. Seven studies evaluated treatment given directly to children, four investigated the effects of training for communication partners. Subjects in the studies varied widely in age, type and severity of cerebral palsy, cognitive and linguistic skills. Studies focusing directly on children suggest that this model of therapy delivery has been associated with increases in treated communication skills by individual children. However, methodological flaws prevent firm conclusions being made about the effectiveness of therapy. In addition, maintenance of these skills was not investigated thoroughly. The studies targeting communication partners describe small exploratory group projects which contain insufficient detail to allow replication, have very low power and cannot provide evidence of effectiveness of this type of treatment.

REVIEWERS' CONCLUSIONS

Firm evidence of the positive effects of SLT for children with cerebral palsy has not been demonstrated by this review. However, positive trends in communication change were shown. No change in practice is recommended from this review. Further research is needed to describe this client group, and its possible clinical subgroups, and the methods of treatment currently used in SLT. Research is also needed to investigate the effectiveness of new and established interventions and their acceptability to families. Rigour in research practice needs to be extended to enable firm associations between therapy and communication change to be made.

Toward Functional Augmentative and Alternative Communication for Students With Autism

Many individuals with autism are candidates for augmentative and alternative communication (AAC) systems, either to supplement (i.e., augment) their existing speech or to act as their primary (i.e., alternative) method of expressive communication. The purpose of this article is to summarize research and directions for future research with regard to two questions related to the delivery of AAC supports to these individuals: (a) What AAC modality is preferable to use? and (b) What do we know about the use of voice output communication aids with people with autism?