Interaction Between Children With Cerebral Palsy And Their Peers 2:

Understanding Initiated VOCA-Mediated Turns

Michael Clarke and Ray Wilkinson (UK)

This paper is the second in a series of two that examines aspects of interaction between children with cerebral palsy who use voice output communication aids (VOCAs) and their peers. The first paper reported how ‘naturally’ speaking children set up opportunities for the aided speakers to use their VOCAs by asking questions that required VOCA use for an answer, or by specifically prompting VOCA use. This second paper looks at what happened when aided speakers initiated new turns. By that we mean turns that were not a response to ‘natural’ speakers’ questions or prompts.

This second paper focuses on interactions between two pairs of children: Jamal and Colin, and Tina and Lucy. Jamal and Tina use VOCAs and Colin and Lucy do not have communication difficulties. The interaction is analysed using a method called Conversation Analysis (CA). In brief, CA is a method for determining how people in conversation go about organising their interaction.

It was found that when aided speakers initiated turns that related in some way to what the ‘natural’ speaker had just said, then the ‘natural’ speakers tended to understand what the aided speakers wanted to say. However, ‘natural’ speakers nearly always seemed to try to make sense of aided speakers’ turns by relating them to their own turns that had just taken place. This was not always an appropriate strategy, and caused significant breakdowns in understanding then aided speakers wanted to say something new, or something that related to a topic much further back in the conversation. In these situations both children had to work very hard to come to a shared understanding of the meaning of the aided speakers’ turn. This finding could have consequences for the ways in which professionals and aided speakers work together to support aided speakers’ communication skills development.

“I have chosen to live life abundantly” Perceptions of Leisure by Adults who use Augmentative and Alternative Communication

John Dattilo, Gus Estrella, Laura Estrella, Janice Light,

David McNaughton and Meagan Seabury (USA)

An online focus group was used to investigate perceptions of eight adults with cerebral palsy who use AAC systems about their recreation activities and leisure experiences. Six themes emerged from discussions on benefits of leisure and community recreation: improved physical health, enjoyment, improved mental health, increased independence, enhanced social connections, and education of society. Nine barriers to leisure participation were identified including: personal, social, communication, technology, financial, accessibility, safety, transportation, and personal care attendants. Despite numerous barriers to leisure, participants described six supports that helped them overcome these barriers: personal, social, family, personal care attendants, AAC devices, and other assistive technologies. Participants provided recommendations for other individuals who use AAC, their families, and service providers. The finding that participants indicated that a primary reason for being involved in leisure was for enjoyment brings credence to the belief that developing skills to engage in recreation activities of sufficient scope and variety is important. Enjoyment motivates people to do things that contribute to their development and enjoyment contributes to functional improvements. The more skills people master, the more likely it is that they will view an activity as presenting a manageable challenge. Therefore, it is helpful to encourage people to develop an array of recreation skills that contribute to meaningful leisure. This research supports the contention that leisure and recreation is important with respect to the time devoted to it and potential benefits associated with it. This study also extends “consumer driven” research that supports the value of leisure and the need to provide a supportive environment so people using AAC systems can make and communicate their preferences. Once individuals are empowered to communicate their preferences, they are better able to act on these preferences so that they might experience enjoyment associated with leisure.

Further Considerations of Visual Cognitive Neuroscience in Aided AAC: The Potential Role of Motion Perception Systems in Maximizing Design Display

Vinoth Jagaroo and Krista Wilkinson (USA)

Current augmentative and alternative communication technologies allow animation within visual symbol displays. Clinicians therefore have the option of incorporating motion-based effects into AAC displays. Yet despite their increasingly widespread availability, there is a virtual absence of associated research that might help guide clinicians in this decision-making process.  Questions that remain unanswered include: How many motion-based symbols should be presented on a single display?  Is there some maximum limit, beyond which the visual display simply becomes overwhelming?  Should the motion-based symbols on a display move all at once, or sequentially?  What kinds of motion are best used for specific purposes?

The lack of research in support of daily clinical decision making is a critical and potentially serious concern. Our proposal in this paper is fairly simple: We should examine the rich potential source of evidence and ideas from the basic science of visual processing and cognitive neuroscience. Our immediate goal is to introduce and exploit basic science concerning visual motion perception as it might relate to the construction of aided AAC displays. We begin by detailing a range of specific possible applications of motion effects to AAC symbols. We then describe different types of motion, highlighting in particular ones with important implications for aided communication. We wrap up with a description of the relevant neuro-cognitive theory concerning the neurological and theoretical bases upon which our suggestions for clinical practice are based.

“A Child Needs to be Given a Chance to Succeed”:

Parents of Individuals who use AAC Describe the Benefits and Challenges of Learning AAC Technologies

David McNaughton, Tracy Rackensperger, Elizabeth Benedek-Wood,

Carole Krezman, Michael B. Williams, and Janice Light (USA)

Parents of children who use AAC play a critical role in supporting a child’s use of augmentative and alternative communication (AAC), but we know relatively little about their view of supports and barriers to the effective use of AAC technology. We asked parents of children with complex communication needs to participate in a focus group discussion on the acquisition and use of AAC. The discussion was held on the internet  - the lack of face-to-face interaction may have influenced the conversation, but we also believe that the ability to log on and participate at any time convenient to the parent may also have enabled participation for people leading extremely busy lives! The on-line conversation addressed issues such as issues in the selection of AAC technology, knowledge and skills needed to use AAC technology, barriers to learning AAC technology, teaching the individual, educating society, and recommendations to others. We hope this study is of interest to professionals who provide services to individuals who use AAC, AAC researchers and manufacturers, and of course to individuals who use AAC and their parents.

Message Retrieval for Survivors of Traumatic Brain Injury

Rebecca Burke, Kimberlee Wassink, Tracy Martin and Anthony Seikel  (USA)

Speech language pathologists face a variety of challenges in establishing effective communication devices for their clients. One clinical decision is how the individual will find their desired message. High technology augmentative and alternative communication (AAC) devices provide a variety of word retrieval strategies. This study compares the use of alphabet, place, and topic for finding messages for survivors of traumatic brain injury. Individuals with traumatic brain injury often have co-occurring difficulties with memory and organizational skills, which will impact their use of AAC devices. Another consideration for effective communication is speed and efficiency. Earlier research found that survivors of head injury were most effective using the method of alphabet to retrieve  words, but survivors actually preferred to use topic to find messages. This research addressed this conundrum by eliciting a communicative interaction using a delayed recall question. For example, the researcher would ask, “A nurse gives you a shot at the doctor’s office. Now you will use the computer to answer the following question, who gives you a shot at the doctor’s office?). Participants then found the answer by selecting from a list of topics (e.g., medical care), places (e.g., doctor’s office), or the letters of the alphabet (e.g., ‘n’).  Results showed that alphabet is significantly more accurate than place and significantly faster than place and topic. Alphabet is less cognitively ambiguous for literate individuals. A final session was conducted to provide the survivors of traumatic brain injury with all word retrieval methods. Participants chose to retrieve words using all three strategies. Alphabet was used more frequently (43%) as compared to topic (27%) and place (31%). Therefore, alphabet is the most effective strategy for literate survivors of head injury, but it may not be their first choice of word retrieval methods.

Automatic Word Recognition: The Validity of a Universally Accessible Assessment Task

Karen Erickson, Sally Clendon, James Cunningham, Stephanie Spadorcia, David Koppenhaver, Janet Sturm and David Yoder (USA and Australia)

We have been working for more than a decade to develop a reading assessment specifically for people who use AAC.  Our goal is to create an assessment that helps us understand each individual’s profile of strengths and weaknesses relative to reading so that we can plan appropriate, individualized interventions. In this article, we offer the first published evidence that one of the unique ways we assess word identification is actually testing what we planned for it to assess, automatic word identification. In our work, word identification is used as it has been long used in reading education to differentiate pronouncing printed words (orally or silently) from other kinds of word reading that involve linking meaning with words. Word identification describes the connections that readers make between the spelling of individual words and their vocal or subvocal pronunciation of those words. Automatic word identification describes the process of word identification that does not involve decoding.  In automatic word identification, readers rapidly recognize the entire spelling of a word and attach it to a pronunciation in their memory without having to systematically process the spelling.  The automatic word identification assessment described in this article is still under development, and it reflects only one part of the complete reading assessment that will eventually include a measure of decoding, silent reading comprehension, and listening comprehension. Our current research is examining the automatic word identification assessment described in this article, as well as an assessment of silent reading and listening comprehension with people who use AAC.

Effectiveness of Multifaceted Narrative Intervention on the Stories Told by a

12 year-old Girl who uses AAC

Gloria Soto, Betty Yu and Jennifer Kelso (USA)

Children using AAC need support to move beyond basic, functional communication to experience genres of communication involving complex language that is needed for academic and interpersonal success. The ability to form oral narratives, for example, is an important foundation for self-expression through the lifetime, interpersonal relationship building, and transitioning from oral to written communication. This study describes and evaluates an intervention package targeting oral narratives in a school-aged child who uses AAC. The intervention package incorporates elements evidenced by the current clinical literature to be essential for narrative development, including (a) the provision of a wide range of narrative opportunities and experiences, (b) appropriate listener responses, and (c) support through the use of visual cues. The strategies described show promise for enhancing the linguistic and structural complexity of narratives constructed by children who use AAC. It may provide clinicians and educators with a basis for developing intervention programs for supporting narrative development.