Karen Bunning

Examination of the communication interface between students with severe to profound and multiple intellectual disability and educational staff during structured teaching sessions

BACKGROUND Individuals with severe to profound and multiple intellectual disability (S-PMID) tend to function at the earlier stages of communication development. Variable and highly individual means of communicating may present challenges to the adults providing support in everyday life. The current study aimed to examine the communication interface between students with S-PMID and educational staff. METHOD An in-depth, observational study of dyadic interaction in a class within the secondary part of a special school was conducted. The designated educational level was Key Stage 3 under the National Curriculum of England, which is typically for children from age 11 to 14 years attending a state school. There were four student-teacher dyads in the class. The students had multiple impairments with severely limited communication skills. Video capture of dyadic interaction was conducted during five English lessons and sampled to 2.5 min per dyad per lesson. The video footage was transcribed into standard orthography, detailing the vocal and non-vocal aspects. A coding framework guided by the principles of structural-functional linguistics was used to determine the nature of dyadic interaction, comprising linguistic moves, functions and communicative modalities. The relative contributions of student and teacher to the interaction were examined. RESULTS Significant differences were found between the students and educational staff on the majority of the measures. The teachers dominated the interaction, occupying significantly more turns than the students. Teacher turns contained significantly more initiations and follow-up moves than the students, who used more response moves. Teacher communication mainly served the functions of requesting and information giving. Feedback and scripted functions were also significantly greater among teacher turns, with only limited occurrence among the students. Self- or shared-expression was greatest among the students. The modalities of speech, touch, singing and objects were used by the teachers for the purpose of communication, whereas vocalisation and gesture were used by the students. CONCLUSIONS Despite differences in the availability of communication skills, both student and teacher were able to make their respective contributions to the interaction during classroom activity. Features of the student-teacher interface retained critical features seen in studies of more able individuals with intellectual disability. Scaffolding provided by teachers appears to be relevant to the communicative contributions of individuals functioning at the earliest stages of communication. The coding framework based on structural-functional linguistics provides some new potential for examining and enhancing the communication interface between individuals with S-PMID and the people who support them.

“Border crossing” as a route to inclusion: A shared cause with people with a learning disability?

Background: A raft of legislation and social policy has been published in the United Kingdom to progress social inclusion for people with disabilities. Access and participation are central to the notion of inclusive living, which is about being part of a community that is sensitive to the ways of living and the needs of all its members. However, having a disability means that opportunities are not dealt out in equal measure and occupying a “place in society” is rarely an assured thing. The opposite of inclusion is exclusion. This implies barriers to and remoteness from mainstream activity, where fewer opportunities may be available for self‐expression and to influence the actions of others (Scott & Larcher, 2002). Aims: This paper seeks to broaden the debate on inclusion for people with aphasia by drawing on the documented experiences of people with learning disabilities, the development of practice initiatives, and visions for the future. The extent to which the narratives of people with aphasia find resonance in the life course of people with a learning disability gives rise to a simple question: “Is inclusion a shared cause?” Main Contribution: Addressing diverse client groups, such as people with aphasia and people with a learning disability, draws out the common experience, despite their separate traditions of service provision. Living with a disabling condition, whether physical, communicative, or intellectual, whether developmental or acquired in type, means that the usual determinants of social inclusion often appear elusive. Review of UK government policy and assessment of its impact on the two communities (people with aphasia and people with a learning disability) reveals the limitations of a single‐track approach. The need for collaborative action involving multiple agencies at the mutually dependent levels of self, community, and society becomes clear. Synthesis of the literature and practice development initiatives from the two clinical groups serves to strengthen the ongoing debate. The right to be included is shared by all human beings regardless of individual characteristics. It is about having the opportunities to perform roles that are personally meaningful, to develop relationships, to engage in self‐determination, and to have presence in the places that other people occupy. Conclusion: No matter the primary cause of the disability, marginalisation is frequently a feature of the lived experience. For people with aphasia, it is the impact of having a communication difficulty on quality of life that leads to disruptions to sense of self, autonomy and choice, social life and community participation (Cruice, Worrall, Hickson, & Murison, 2003). For people with learning disabilities, it is the incremental disempowerment with regard to the uptake of societal roles as maturation takes place (Barnes, 1997). The concept of “border crossing” is pertinent to the cause of both groups. It captures the many different ways in which individuals break out of the traditional roles cast for people with disabilities, and engage in self‐advocacy. For individuals who grow up with a learning disability “border crossing” is affected by the surrounding social support infrastructure offered by statutory services, which is informed by targeted government policy. For people with acquired language impairment, the terrain is less clear. After the initial medical crisis has passed, it is the individuals personal context (characterised by the roles and responses of marital partner, family members, work colleagues, etc.) rather than statutory service provision, that affects the degree to which individuals are able to resume former life courses.

People with Profound and Multiple Intellectual Disabilities Using Symbols to Control a Computer: Exploration of User Engagement and Supporter Facilitation

ABSTRACT Computer usage features in everyday life for the majority of people in developed countries. Access is a problem for many users with intellectual disability. Action-research was conducted to develop and explore the potential of specially adapted, computer readable symbols for choosing and accessing media on a computer. Five people with profound and multiple intellectual disabilities, aged 15–28 years, took part. The symbols were introduced during computer-based activities across four trials at monthly intervals. Each trial was video-recorded. The vocal, non-vocal, and computer-related aspects of the footage were transcribed into standard orthography. A framework of activity moves based on applied linguistics analysis was used to assess user and supporter engagement. User data were summarised with descriptive statistics. Differences in user-supporter roles during symbol activities were determined by the non-parametric, U Mann-Whitney test. All the users showed some level of basic engagement with the adapted symbols, with certain individuals demonstrating functional usage. Attention levels appeared to increase as the trials progressed. Supporter contributions comprised significant levels of guidance and modelling with the symbols. Tangible symbols to access media on a computer provide some real possibilities for addressing access challenges experienced by this population. Candidacy and the mediating role of supporters require consideration.

Interaction between teachers and students with intellectual disability during computer-based activities: The role of human mediation

Project @pple (Access & Participation for People with intellectual disability in Learning Environments) was about exploring the terms for access and participation in e-learning and the World Wide Web. The current study aimed to explore the role of human mediation in student use of information and communication technology (ICT) in the special needs classroom. Video ethnography was employed to capture user engagement with ICT in a special secondary school for children with severe intellectual disability in the U.K. Five single cases were identified and the data were sampled, transcribed and evaluated for interactional structure and modes of communication. Statistical analysis revealed significant differences between teacher and student communication on all the measures. Teachers occupied significantly more turns than students. There were relatively few opportunities for the student to make a contribution to the interaction process with requests from teachers dominating the dialogues. The teachers communicated through speech mainly, with some gestural support towards aspects of the computer-based activity. This small scale study is illustrative of characteristics found in teacher-talk in other studies of classroom discourse. Engagement in computer-based activities appears to be inseparable from the communication context determined by the type of linguistic support given by the teacher.

Assessing and comparing the outcome measures for the rehabilitation of adults with communication disorders in randomised controlled trials: an International Classification of Functioning, Disability and Health approach

Purpose. To identify the assessment instruments and relevant outcome measures used in randomised clinical trials (RCTs) relating to interventions for adults with communication disorders, and then examine and compare the domains of the outcome measures using the International Classification of Functioning, Disability and Health (ICF) as a reference tool. Method. Published RCTs with primary focus on the effectiveness of rehabilitation for adults with communication disorders were systematically reviewed. Identified RCTs were examined for all the assessments used as outcome measures. Distinctions were made between the use of standardised assessment tools and non-standardised empirical measures. The key concepts examined by the outcome measures were then linked to the ICF using the established ICF linking rules. Results. The systematic review included 24 RCTs in which 11 trials used non-standardised empirical assessment as the outcome measure, and 18 trials included standardised instruments as the outcome measure. It is clear that all the identified items and meaningful concepts from the assessment used in the included studies can be linked to the ICF categories. Of the 108 linked level-two ICF categories, 53%% were linked to ‘body functions’, 36%% to ‘activity and participation’ and 9%% to ‘environmental factors’. Conclusions. A wide range of outcome measures have been used in RCTs of interventions for adults with communications disorders. The ICF provides a clarifying framework for systematically gathering and examining the information about the content of outcome measures and then can be used as a common reference to identify and compare the domains of the outcome measures. The high proportion of elements relating to body functions raises some questions about the purpose and aims of the interventions.

Survey of rehabilitation support for children 0-15 years in a rural part of Kenya.

Abstract Purpose: Information regarding the nature, availability and distribution of rehabilitation services for children with disabilities across developing countries is scarce, and data that do exist are of variable quality. If planning and development are to progress, information about service provision is vital. The aim was to establish the scope and nature of rehabilitation support available to children with disabilities (0–15 years) and their families in rural Kenya. Method: A comprehensive sample comprising service provision in the health and special education sectors was established. Non-governmental and community-based organisations were also included. A survey of rehabilitation services was conducted through examination of service-related documentation and key informant interviews with the heads of services. Results: Rehabilitation comprised hospital-based occupational therapy, physiotherapy and orthopaedic technology; and seven special education establishments plus an education assessment resource centre. There was one non-government organisation and one community-based organisation relevant to children with disabilities. Activities focused on assessment, diagnosis and raising community awareness. Provision was challenged by inadequate staffing, resources and transport. Government funding was supplemented variously by donations and self-sufficiency initiatives. Rehabilitation approaches appeared to be informed by professional background of practitioner, rather than the needs of child. Service documentation revealed use of inconsistent recording methods. Conclusions: The data highlight the challenges of rehabilitation, demanding greater investment in personnel and their training, more material resources, improved access to the community and better recording mechanisms. Implications for Rehabilitation There needs to be greater investment in rehabilitation provision in developing countries. Consideration of community-based initiatives is required to support better access for all. In order to argue the case for improved resources, better skills and mechanisms for recording, monitoring and evaluating practice are needed.

Caregiver perceptions of children who have complex communication needs following a home-based intervention using augmentative and alternative communication in rural Kenya: an intervention note.

Abstract A high level of unmet communication need exists amongst children with developmental disabilities in sub-Saharan Africa. This study investigated preliminary evidence of the impact associated with a home-based, caregiver-implemented intervention employing AAC methods, with nine children in rural Kenya who have complex communication needs. The intervention used mainly locally-sourced low-tech materials, and was designed to make use of the childs strengths and the caregivers natural expertise. A pretest-posttest design was used in the study. Data were gathered using an adapted version of the Communication Profile, which was based on the International Classification of Functioning, Disability, and Health (ICF) framework. The non-parametric Wilcoxon signed-rank test was applied to data from the first two sections of the Communication Profile-Adapted. Qualitative analysis was conducted on the final section. The data provided evidence of statistically significant positive changes in caregiver perceptions of communication at the levels of Body Structure and Function, and Activities for Communication. Also, analysis of the Participation for Communication section revealed some expansion to the childrens social activities. The potential impact of the home-based intervention would benefit from investigation on a larger scale. Limitations of the study are discussed.

ICTs and learning disability: multidisciplinary perspectives on Project @pple

Purpose – This paper aims to present a critical discussion of theoretical concepts that drive the main contributions of the academic partners, by highlighting the contrasting perspectives and identifying areas of commonality.Design/methodology/approach – The paper follows a contextualised approach to debating the issues of access and participation for people with ID in learning environments. Each discipline considers the user of ICT within a social context but draws on the theoretical domains and published literature associated with its own area.Findings – Resonances are to be found across the academic disciplines in terms of an ecological or holistic view of the person with ID as a user of a learning environment. This is what binds the multi‐disciplinary perspective together.Originality/value – This paper is a rare attempt to integrate three distinct academic disciplines to provide a coherent picture of the theoretical perspectives underpinning research by the authors into the development and use of an I...

The perception of disability by community groups: Stories of local understanding, beliefs and challenges in a rural part of Kenya.

Cultural narratives on disability have received much attention over the past few decades. In contexts of poverty, limited information and everyday challenges associated with having, or caring for someone with a disability, different understandings have emerged. A project was set up to promote disability awareness in neighborhood communities in a rural part of Kenya, using a process of reflection and education. This paper reports on the first aspect–reflection. The aim was to investigate local understanding of disability as a co-constructed concept. The research questions were: 1. What cultural beliefs shape local understanding of disability? 2. What challenges are perceived to be associated with disability? A phenomenological approach was adopted. Focus group discussions were conducted with twenty-one community groups involving 263 participants and audio-recorded. The data were transcribed and thematic analysis was carried out. Visual maps were created to illustrate any interconnections, before establishing the final conclusions. Local beliefs attributed disability to: human transgression of social conventions, particularly concerning inappropriate family relations, which invoked a curse; supernatural forces affecting the child; the will of God; unexplained events; and biomedical factors. Challenges associated with disability related to the burden of caregiving and perceived barriers to inclusion, with stress as a shared bi-product. Local understanding of disability in this rural part of Kenya demonstrated overlapping explanations and plurality of beliefs. Two possible interpretations are offered. Firstly, oscillation between explanatory lines demonstrated instability, affecting broader acceptance of disability. Secondly, and more positively, in the face of challenges, the desire to make sense of the existing situation, reflected a healthy pluralism.

A preliminary investigation into communication in the special needs classroom during Key Stage 3 English lessons

A preliminary study was conducted to investigate the communicative roles performed by teacher and pupil during Key Stage 3 (KS3) English lessons. Two classes of a special school were involved in the study. Data collection employed video capture of teacher—pupil communication during timetabled English lessons. The data were transcribed and analysed in terms of interaction structure, communicative functions and modes. Significant differences between teachers and pupils were observed with regard to interactional structure: the teachers occupied more turns and used a higher number of initiating and follow-up moves than the pupils; the pupils used more response moves than the teachers. Analysis of communicative functions revealed significant differences between teachers and pupils, with teachers using more requestives and feedbacks. The exception was the informative function, which showed no significant difference between the groups. In terms of communicative modes, teachers used significantly more speech, although no significant differences were recorded on the measures of sign and gesture. This small-scale study illustrates the use of the initiation—response—follow-up sequence in communication within the classroom. Teacher use of multi-modal communication appears to reflect those used by the pupils in the study. Implications for future research and practice are considered.