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The DYnamic Therapy Associates Blog

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

12/5/2014

8 Comments

 
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
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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!

8 Comments
Mary Speelman link
12/6/2014 03:07:01 am

awesome article

Reply
Vicki Clarke
12/6/2014 04:22:22 am

Thanks Mary!! Let us know if you have some other sensory suggestions!

Reply
Gayle
3/15/2015 05:11:31 am

Please continue this post as you flesh out not only which reinforcers worked for each child but also how you helped them move towards functional, meaningful communications with examples of what messages were important to each child.

Reply
Vicki Clarke
3/15/2015 05:59:25 am

That's a good idea, Gayle. We are actually heading out for the next round of trials this week. We are looking at live voice scanning and several devices using auditory scanning for two of the boys. We are doing trials with an iPad app for the third. Typically we start looking at the motivators for basic engagement so that we can base interactions around something we know has high motivation value for the patients. I'm not a fan of just using motivators for requesting so I see us quickly charging forward into control messages, and social messaging. Thanks for your idea!

Reply
Andrea
1/3/2017 11:51:03 pm

Count me in as another person interested in how you get from favorable sensory response to communication!

OTMommy link
3/15/2015 08:07:00 am

this is a great article and I can't wait to research more into EMC!!!

Reply
Vicki Clarke
3/15/2015 08:13:26 am

Thanks! EMC3 has been around a long time but it is extremely helpful!

Reply
Wendi Strickland link
3/18/2017 09:38:06 pm

Hi, ran across this-- we're in VA and work with adults who experience significant disabilities, often at day programs and in group homes, and often without viable communication systems or available equipment or trained staff. We've been trying to put together a good preference assessment, but this captures two birds with one stone. Do you have any feedback on the supplies that you ordered and if you feel they would be relevant to an adult population too? Any tips / ideas would be greatly appreciated, it's tough work out this way!

Thank you so much for posting this!

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    About the Author: I am a SLP who has the distinct fortune of having a job that is also my passion. I have been an AAC Specialist for almost 25 years in schools and my private clinic. I currently own Dynamic Therapy with my husband, Chuck (also of 25 years) who is my business partner and enabler. We have a wonderful staff of SLPs & AAC Specialists who work with us to help our patients. I hope you find my blog helpful as you join me in our journey with our unique and amazing friends! Vicki Clarke, MS CCC-SLP
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