Charity Rowland

Tangible symbols, tangible outcomes

A 3-year study on the use of tangible symbols (i.e., objects and pictures used as symbols) by 41 children with a variety of handicapping conditions was conducted to follow up on an earlier study by the authors that revealed their utility for children who are deafblind. The vast majority of participants learned to use tangible symbols, allowing them to overcome the restrictions imposed by gestural communication. A number of the participants progressed beyond tangible symbols and learned to use abstract symbol systems, including speech. A few of the participants did not learn to use tangible symbols during the time span available for intervention. Data describing the progress of participants are presented. Participants are grouped according to outcome, and the characteristics of each group are discussed in terms of the communication skills of participants as they began intervention.

Tangible symbols: symbolic communication for individuals with multisensory impairments

Many individuals with multisensory impairments fail to bridge the gap between presymbolic communication and formal language systems such as speech or manual signs. This paper discusses the use of tangible symbols—manipulable symbols (objects or pictures) that bear a clear perceptual relationship to a referent— by individuals who are not able to acquire abstract symbol systems. A sequence of communication development that accommodates the use of tangible symbols is presented, as well as two brief case histories illustrating the acquisition of tangible symbol systems by individuals with multisensory impairments. Finally, data on the progress of nine individuals who were taught to use tangible symbols is presented.

Communication in the classroom for children with dual sensory impairments: Studies of teacher and child behavior

The child with dual sensory impairments (DSI) may be unaware when a potential communication partner is present, may have no clearly recognizable or conventional means of communication, and may have learned that attempts to communicate go unheeded. These factors contribute to the low rates of communication often exhibited by these children and explain why communication training is a high priority in the classroom. In the classroom for students with DSI, it is generally the teacher or instructional assistant who is both the catalyst for, and the receiver of, communicative exchanges with students. Unfortunately, no published data exist to describe the rate of communicative behavior of children with DSI and the attempts of their teachers to encourage communication. This paper reports the results of two studies on the communication-related behavior of children with DSI and their teachers. In Study I, observations of the entire school day were made to determine overall rates of cues for communication provided b...

Early communication and microtechnology: Instructional sequence and case studies of children with severe multiple disabilities

Teachers and speech-language pathologists serving children who have dual sensory impairments combined with severe orthopedic impairments are often at a loss as to how to provide effective communication instruction. No systematic approach has been available to guide teachers through the intricacies of what is necessarily a difficult process. This paper describes the results of a 3-year investigation of the use of microtechnology to enable children with dual sensory impairments and severe orthopedic impairments to communicate. We present here an instructional sequence that applies across the wide variety of children who participated in the investigation. Some of these children initially appeared to have no voluntary behavior at all: others were able to produce some intentional motor behaviors, but these were not under any clear stimulus control; while others had some primitive but unreliable means of signalling, such as gross vocalizations. By the end of the project, all of these children had shown an abili...

Analyzing the Communication Environment to Increase Functional Communication

Many students with severe and multiple disabilities demonstrate severe communication impairments. Efforts to improve communication in these students often embrace a “natural environment” or “milieu” approach, embedding opportunities to communicate within natural, functional activities across the entire schedule of daily activities. In reality, functional activities differ greatly in the degree to which they foster communication. This article describes an environmental inventory designed to allow a teacher or speech-language pathologist to analyze the extent to which a specific activity encourages functional communication for a particular student. The inventory may be used to compare different activities across the students day or to track the improvement of specific activities that initially may show little communicative value for the student. Reliability and validity data for the inventory are presented along with a case study of its use to monitor and guide improvements in a functional activity to increase communication by a young child with multiple disabilities.

Using the Communication Matrix to Assess Expressive Skills in Early Communicators

Many children born with severe and multiple disabilities have complex communication needs and may use no speech or only minimal speech to communicate. Meaningful assessment of their expressive skills to identify communication strengths along a developmental trajectory is an essential first step toward appropriate intervention. This article describes the foundations, structure, properties, and use of the Communication Matrix, an assessment instrument developed specifically to address the challenges of describing the expressive communication skills of children with severe and multiple disabilities. The widely used online version of this assessment tool collects data in an associated database. Sample data on children with specific disabilities generated by this database are presented to illustrate the clinical and research potential of this free assessment service.

Developing the ICF-CY for AAC Profile and Code Set for Children Who Rely on AAC

We describe the ICF-CY for AAC Profile, a tool to integrate information about the multiple factors affecting communication skill development and use in school-aged children with complex communication needs. The Profile uses the World Health Organization’s International Classification of Functioning, Disability and Health − Children & Youth Version () as its framework. We propose that the ICF-CY for AAC Profile constitutes a code set for AAC users and discuss the iterative process of code-set development. The Profile is one component of a proposed process to guide the development of educational goals for children in Grades kindergarten-12 who currently or potentially rely on AAC.

Communication Matrix: A clinical and research assessment tool targeting children with severe communication disorders

The Communication Matrix [20] is an assessment instrument that is designed to evaluate the expressive communication skills of children with severe and multiple disabilities. It accommodates any type of communicative behavior, including forms of augmentative and alternative communication (AAC) such as picture systems, electronic devices, sign language and 3-dimensional symbols; pre-symbolic communication such as gestures, body movements, sounds, eye gaze and facial expressions; as well as the typical forms of communication such as speech and writing. It covers seven levels of communication observed in typically developing infants during the first two years of life. The instrument, which is widely used to assess children with severe acquired and congenital disorders in community and school settings, is appropriate for both inpatient and outpatient pediatric rehabilitation. Data from an associated database demonstrating the value of this tool for clinical service and research are presented.

The Effect of Voice Output on AAC-Supported Conversations of Persons with Alzheimer’s Disease

The purpose of this study was to determine whether the presence or absence of digitized 1--2-word voice output on a direct selection, customized Augmentative and Alternative Communication (AAC) device would affect the impoverished conversations of persons with dementia. Thirty adults with moderate Alzheimer’s disease participated in two personally relevant conversations with an AAC device. For twelve of the participants the AAC device included voice output. The AAC device was the FlexiboardTM containing sixteen messages needed to discuss a favorite autobiographical topic chosen by the participant and his/her family caregivers. Ten-minute conversations were videotaped in participants’ residences and analyzed for four conversational measures related to the participants’ communicative behavior. Results show that AAC devices with digitized voice output depress conversational performance and distract participants with moderate Alzheimer’s disease as compared to similar devices without voice output. There were significantly more 1-word utterances and fewer total utterances when AAC devices included voice output, and the rate of topic elaborations/initiations was significantly lower when voice output was present. Discussion about the novelty of voice output for this population of elders and the need to train elders to use this technology is provided.

AAC to support conversation in persons with moderate Alzheimer's disease.

Even though we know that external memory aids support communication in Alzheimer’s disease, the components of the communication aids for individuals with Alzheimer’s disease have not been studied systematically. The goal of these two pilot experiments was to examine differences in conversational performance of adults with Alzheimer’s disease related to the presence and absence of an aid, the type of symbol embedded in the aid, and the presence or absence of voice output. In Experiment 1, 30 adults with moderate-to-severe Alzheimer’s disease participated in 10-min conversations with and without personalized AAC boards. There was no effect of AAC, regardless of symbol type, and a deleterious effect of voice output. In Experiment 2, modified spaced-retrieval training preceded conversations, standardized prompts were presented, and semantically-based dependent variables were examined. For the 11 participants in the second experiment, there was a significant effect of AAC, showing that the presence of AAC was associated with greater use of targeted words during personal conversations. We discuss new information about the contribution of AAC for persons with Alzheimer’s disease, and demonstrate how the applied research process evolves over the course of a long-term commitment to a scientific investigation.