Begin at the Beginning: Assessing Motivation, Communication and Voice Output for Children with Complex Communication Needs

We had the opportunity this month to meet some very special boys who have complex communication needs and sensory impairment.  One of our boys is deaf-blind, ambulatory and nonverbal.  One youngster is functionally blind and has severe motor impairment.  He is nonverbal and nonambulatory.  Our last fella is nonverbal, has a severe visual impairment and significant sensory defensiveness.   All three boys are curious, focused when motivated and responsive.  They all communicate primarily through affect, unconventional gestures and vocalizations.

Our AAC evaluation started today using the Sensory Assessment of the Every Move Counts, Clicks and Chats protocol.  This protocol is a systematic way to assess a child's natural sensory motivations, observe and record the function of their emerging communication attempts. Children are given credit for any responses:  affect, quieting, gestures, vocalizations, sign language, symbols or speech. The website says EMC3 is "a sensory based approach to communication and assistive technology for individuals with significant sensory motor differences, developmental differences and autism."  www.everymovecounts.net

The sensory evaluation starts many days in advance with collecting a wide variety of items to present systematically to the children in the following sensory categories:  visual, auditory, tactile, proprioceptive, vestibular and olfactory.  Fun shopping, including some handy dandy toolbox organizers, and this is what we came up with!

Our Sensory Collection:
Olfactory:  snack boxes to hold extract soaked paper towels for vanilla, peppermint and almond; wax melt cubes in lavender and cinnamon scents; car air freshener rear view mirror tags, scentsicles
Vision:  light up spin toy, latch on/off star light, reflective Mardi Gras beads, flashlight, light up bumpy ball, rain stick, lava drip tube, toy tops, disc shooter, reflective pom pom, wind up toys, iPad apps including:  Big Bang Patterns and Big Bang Pictures (volume muted!), Little Bear Sees
Tactile:  rice bag (to put hands and feet in), floam, unscented lotion, light vibration bug toy, feathers, wiggly worm, felt squares, scouring sponge, bag of tiny pom poms, koosh ball
Auditory:  music box, environmental sound apps (Sound Touch app), different genre songs on iPhone, jingle bells, rain stick, tambourine, maraca
Proprioceptive:  sock full of beans/rice (tied off at top!), heavy frog, deep pressure vibrating bug.  We also use our bodies for deep pressure hugs, joint compression, massage
Vestibular:  classroom equipment including swings, rocking chairs, teacher's spinning office chair, sit n' spins; our bodies to bounce, swing and spin!
Gustatory: still in progress!


We packed up all our goodies in an old scrapbook rolling bag and had a great day meeting our new friends with complex communication needs!  The GREAT news?  These boys all had at least a few items/activities which motivated them enough to respond with affect, facial expression, vocalizations, or gestures.  We started a few communication trials and are considering auditory scanning, object symbol communication, high contrast symbols on a dynamic display device and co-active signing.  It will be such a pleasure to see what these boys do as they continue their communication journey!