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AAC Chicks

The DYnamic Therapy Associates Blog

Training ABA Language Targets for Nonspeaking Students using Speech Generating Devices (dedicated or via mobile devices)

6/18/2015

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We met this adorable little fellow, Michael, today who is an emerging communicator using the Speak For Yourself app. Michael has ABA specialists who help him learn many new skills. Our chat with his mother reminded me of this tip sheet I created a while ago to help our ABA professionals working with us to teach language to AAC users.  AAC users have unique needs when working with an ABA protocol.  Here are a few ideas that may help!


Implementation Notes: Because the student is producing language in an alternative form than speech, his training for tacting and manding will have some slightly different considerations than for speaking patients.  There are 2 types of prompts which can be used to teach communication via a speech generating device:  stimulus prompts and response prompts

Response Prompts:  Prompts provided by the partner (backward chaining with physical prompts, direct point cues, direct verbal cues, indirect cues and natural cues).  Independent tacting on an SGD (speech generating device) requires navigation to reach vocabulary.  Interventionists can remove this requirement to simply target tacting by using “partner assisted navigation” where the therapist goes to the page where the vocabulary item exists and then asks the patient to label the presented photograph by touching the corresponding symbol on the page.

Independent manding on an SGD also requires navigation.  If you want the patient to exhibit the skill of manding in isolation of the navigation demand, similar to tacting, the therapist uses partner assisted navigation to take the student to the appropriate page and then expects the student to select the desired item to request.

In order to achieve independent tacting and manding on his communication device, the student must master navigation.  Navigation is taught through backward chaining in the following sequence:

o   Therapist navigates to the appropriate page for the student, student is asked to mand/tact on that specific page.

o   Therapist demonstrates navigation to the appropriate page, student is asked to mand/tact on that page

o   Therapist navigates to one page that links directly to the specific page where vocabulary is targeted.  Student is asked to select the button that links to the targeted page and then asked to mand/tact on that page. ex: therapist navigates to a dictionary (“things” or “my words” page) and the student is asked to select the appropriate category button

o   Therapist gradually backs out of navigation, teaching one page navigation at a time until student can navigate from the main page to the specific vocabulary page.


Stimulus Prompts:  prompts that are embedded in the page sets    Stimulus prompts are visual and position cues that are part of the presentation of the vocabulary.  They can include the following:

·        color coding,

·        hiding extraneous buttons/messages,

·        shape cues and

·        position cues on the page of the device. 

If the training is completed on the student’s regular page set, the student will be able to use motor planning to assist him in navigation.  Clinical evidence and research indicates that this motor planning is often attained even in the absence of an understanding of categorical, grammatical or functional vocabulary organization.  Students simply learn the motor movements/locations on the screen required to get to the desired vocabulary.  They use visual images to assist in the initial learning stages but, like adults who type on a keyboard, students learn the position of the linking buttons to increase their rate of communication over time.

By simplifying learning through stimulus and response prompts, students can learn independent navigation of their devices in order to produce language spontaneously.  Prompting teaches words in the context of the student’s language system rather than on random pages that cannot be accessed independently by the student for future communication.

And remember, the most important thing about communicating using an AAC system, is COMMUNICATION!  Establishing social relationships is one of the most important functions of language development and communication so, whenever possible, sit down and have a good 'ole unstructured chat!

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AAC and Medical Needs

5/29/2015

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AAC plays an important role in helping our families navigate medical procedures, tolerate hospital/ doctor visits and, explain their healthcare needs.

Kasey's mom Tracey describes her experience after surgery, "Kasey was groggy and on lots of medication post surgery, but when offered her T10, she navigated to "more"! We'd been giving her sips of apple juice and she clearly wanted more."

Here's a blog post I wrote for PrAACtical AAC on the subject of AAC and serious medical procedures:

http://praacticalaac.org/praactical/a-praactical-look-aac-at-dynamic-therapy-associates/

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

12/5/2014

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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!

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Aided Language Input and the Amazing Translator Box

10/24/2014

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Kendal and I have had some wonderful conversations.  He's been telling me about his favorite music (country!), his new temporary home, his opinion about some of the people in his life...  Kendal and I have known each other for many, many years.  We've struggled through traditional therapy, YouTube infused visits, extremely short visits as he was determined not to join me and now we've settled down into this nice relationship.  I've always loved Kendal but now I can say I truly enjoy interacting with him.  The difference is that now Kendal and I really understand each other.  Kendal and I interact with both of us using his communication device as a "translator box."  Kendal struggles greatly with comprehending spoken language.  His social and environmental awareness greatly exceeds his understanding of verbal language.  Sometimes we think he hears that Charlie Brown teacher voice when we talk.  

The technique I use most with Kendal is Aided Language Input.  Very simply stated, I use Kendal's device, the NovaChat 10, to talk to him.  The visual symbols paired with my (Charlie Brown teacher) speech help Kendal understand me so that he can participate in our conversations.  I touch symbols on his device which correspond to the words I'm saying. The value of aided language input is that Kendal is able to see someone communicate the same way he does.  He has a model for how aided communication works.  There is no pressure for him to imitate my model.  If he wants to participate, awesome! If he just wants to listen, that's okay too.  Either way Kendal is learning language and building relationships.  Kendal's mom is amazing and she uses this technique as much as possible at home and in the community.   Kendal seems calmer and happier as a result of his improved understanding and ability to offer his own opinions.  He's found a great deal of satisfaction in being able to tell us about the other people in his lives and their ups and downs in caring for him.  We've also seen an increase in Kendal's understanding of our words.  He's responding more and more to our verbal language.

You'll see in our video that Kendal pays close attention to my symbol selection and then reads the message window text.  He obviously understands and "gets" my jokes as we take turns talking. Since Kendal primarily communicates using 1-2 symbols per message,  I used to simplify my messages to just a few symbols per statement.  Now I use 4-7 symbols per statement because he's shown me he understands.  There are some really wonderful resources on the internet to explain how Aided Language Input works. Here's a great compilation from PrAACtical AAC:   http://praacticalaac.org/tag/aided-language-input/


We thought we'd just show you! 
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Let's Play Board Games!  Adapting Games for Children with Severe Speech and Physical Impairments

7/28/2014

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When I first meet a child for therapy, I always ask parents to tell me what their child likes to do.  What characters, what toys, what games, what videos, what books....  So many times parents of children with severe speech and physical impairment look at me like I'm a little crazy when I ask about board games.  "Well, she would probably like them but she can't do it."  Since that sounds like a challenge, I have been adapting board games for many years. (Plus, I like games and my own kids are getting too old to play Candyland with me anymore!)  

The first step is to make sure your child has a means to communicate general control messages within the game:  gestures/hand signs, communication device pages specific to the game ("my turn," "you go," "draw a card," "go fish," "oh no..." or core words to say "go," "me," "like," "I," "you," "want," "turn..."

The next step is to make sure the child has some way to indicate their choices specific to the game. For games that include color or number choices, that's a usually simply a matter of using their communication device to indicate a choice.  If your game has very specific choices, like this Shrek Memory Game...

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...you can just add numbers (or colors, or letters) to the playing pieces so your child can use his/her device to make a selection.  For this game, Alli uses her communication device to pick 2 numbers to guess where the two halves of Gingerbread Man are hiding.



The next step is to make sure the game is as visually and physically accessible as possible.  Here's a Candyland Game I adapted to help kids with fine motor difficulty move and place their pieces without sliding and falling. We tap out each move so our kids with visual challenges can hear how far the players pieces are moving.

I put velcro dots (soft side) onto each square of Candyland and, velcro dots (hard side) onto the bottom of the little playing pieces.  This allows children who can move the pieces, a target and a little sticky support to keep their pieces on the correct square.  For my friend Gwendolyn and her family, this little trick means that her Mom can hold the board up as close as necessary to help this sharp little girl with cortical visual impairment see the pieces better.
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The final step is to forego any self-dignity and get into it!  You can make a paperclip exciting if you are enthusiastic enough.  When you expect your child to be able to participate fully and to have FUN, they will gain the confidence to jump in and play.  Remember, they probably think they can't do it either, since no one ever helped them try.  The long and short of it is to assume that there is SOME way for all children to participate in a board game.  Usually, it's really all about communication.  Sometimes it's about physical access but, if you can't figure out the physical access then, it's really all about communication to tell people what you want your game pieces to do!  Which, of course you know, we really like anyway! :)

Happy Playing!
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App Combos- Mixing Up Some Favorite Apps to Meet Language Goals

6/2/2014

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I have been fortunate enough over the years to have had access to wonderful software from a variety of manufacturers.  Although I have my favorite products, they never have everything I want for my therapy goals so I find myself mixing and matching components of my activities to make them just right!  I think it is great fun to throw all the different developers ideas into one sandbox where they can all happily play together (at least in my world!).  I love to slap one developer's symbols into another developer's software and throw it all on another developer's device.  I'm positive they LOVE that too. The good ones, anyway!

iPads are wonderful and the amazing array of apps is dizzying.  Nonetheless, apps are significantly less robust than full blown software.  So, here we are, back in the sandbox, pulling in the best ideas from one app to supplement the fabulous ideas of another.  A little enthusiasm and app switching savvy and we have therapy activities that are more meaningful and motivating than if we only used one app at a time the way nature (or the developer) intended.  Something like this  bunny dog who will sit on command and go for walks with you but doesn't bark or bite.  And must be potty trained. The best of all worlds.

Why combine apps?
  • Increase motivation! Some of our apps are simply fun to play. Once a child loves a particular app, just adding the images of the app into another more, eh hem, educational app, makes the app more motivating.  All you have to do to get a screen shot is click your Home Button and the Power Button on top of the iPad at the same time and it will snap an image of whatever is on the screen.  Like these...
Peek-A-Boo Barn has a bouncing barn with animals that knock on the doors to come out. Adorable!  We practice our greetings when the animals pop out. Clicker Sentences let's us write about our activity, include a picture and print to take home.
Balloonimals  let's kids blow  up balloons and wiggle them into silly animated characters.  Kids can take a photo and see the animals in different locales.  Abitalk Sentence Builder let's you create sentences from your own images so we can write about our animals.   (These are from my former intern, Katie Millican).
  • Slow down the images so that you and the child have more time to talk specifically about the picture without the app charging ahead to the next action/picture/direction.  There are some really nice images in apps that deserve a second or so to process and discuss before moving on to the next "clickable" option.  At times, as quick as we therapists are, we're not faster than those little student fingers.   Kids are great at changing pages before the pesky SLP can, good grief, talk about it.
First Phrases (Hamaguchi) is one of our "go-to" apps for teaching students verbs and simple phrase creation.  We watch the animation and when cued to repeat the phrase, our kids either verbally repeat OR use their speech generating devices to make their own 2 word phrase.  Super motivating and targets basic, common verbs.  This app very nicely doesn't charge ahead  until you activate an arrow but, as I mentioned before, kids are FAST!  After we play this game, we use our Speech Box app with screen shots of the First Phrases animation scenes so we can sort through a pile of pictures and decide which ones to talk about.  Speech Box is a great library of "boxes" of pictures.  It seems the developer was thinking of providing an easy access to sets of articulation cards (it comes with these) but it has a wonderful, broad set of photos AND allows you to add your own (screen shots of First Phrases in this case).

I use this concept for YouTube videos as well.  Those little jokers go by super fast and there are ALL of those "suggested" (and sometimes "suggestive") videos to grab attention.  Figure out what video is a favorite and just snap a few screen shots of it to drop into another app.
  • Reinforce a concept introduced in one app by elaborating on it with another app 
First Words International  is another fantastic Hamaguchi app that teaches early developing single noun vocabulary in categories (vehicles, animals etc).  It is truly a wonderful app that introduces multiple examples of the targeted word (5 different buses appear on-screen) and then presents the targeted word on a display with 4 random pictures distractors.  Students are asked to find the "bus" on the page.  Then students get to "spin the wheel" where, magically, a picture of the targeted word appears and they are asked to label it.  We label with our voices, signs or our AAC device.  Just to "cement" the concept in a little more firmly, we'll watch a video of the targeted word on our VideoTouch apps (animals, vehicles and instruments) or listen to it's sound effect on SoundTouch app.  These are great apps that give multiple example videos or photos & sound effects for common nouns.

I'm definitely not done with this idea.  I've been scanning all my older, but still amazing materials books onto my iPad , with the FasterScan HD app, coloring them in with HELLO Crayon app (thanks to suggestions from the Twitterverse) and saving them into Dropbox app so I can whip them out at a moments notice for therapy, to print out for homework or to share with my therapists.  So much you can do with that silly little iPad!
What are YOUR favorite apps to combine?  Leave us a note in our comments so we can learn from each other!
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Increasing MLU:  Help Students Enjoy Sentence Building With Speech or AAC

5/29/2014

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Today was a day of Story Creating using Story Creator App by Innovative Mobile Apps.  This is one of the best apps.  It also happens to be free.  This app lets you import a picture from your camera roll, type text to describe the picture and record yourself reading the text.  For therapy we use it to help our patients to be motivate to write (and speak) multiword phrases about their favorite topics.  So far this week we've made books about sweets, baseball, creepy characters, Disney (of course) and countries where we want to travel.  

THIS IS HOW WE DO IT
  1. The therapist gathers a set of pictures for each student.  
  2. The student picks a favorite picture to place on each page.  
  3. The therapist, or student, types out her message. 
  4.  Therapists model the sentence touching symbols on the student's communication device.  
  5. The student then constructs his message on his communication device and record his phrases. 
  6. The therapist views the recording and matches each word with the recording so when the sentence is read, the exact spoken words are highlighted. 
  7. Email the completed storybook home to share with our family  


Super motivating and easy.  A great little activity which keep our students focused and talking!

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Cody Out and About in The Community

5/17/2014

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Hello, all! This post was inspired by Kate Ahern’s session titled “Bringing AAC Home” at ATIA in Orlando that Vicki and I attended. She had some great ideas and insight about our kiddos using their AAC devices at home and in the community. Many of us don’t have the opportunity to provide services to our clients outside the speech clinic (at home, in the community, at school), so we don’t always know how much their voice is heard when we aren’t in therapy. This does not mean, of course, that their needs aren’t met. I understand there are many things that need to be done at home and using an AAC device can sometime s be viewed as “homework” that may or may not get done. 
These thoughts during Kate’s session of course made me think of a “rockstar” mom who always comes to therapy with great stories about her son, Cody. I have some amazing families who consistently use their children’s devices in every aspect of their lives, but this family is exceptional and I wanted to share a great story. Cody has Cerebral Palsy and uses a Tobii I-15 eye gaze device to communicate. He’s only had it a few months, but consistently surprises us with his quick wit, humor, and attitude. I want to take this opportunity to share one of the best stories about Cody and how he uses his device in the community. Below is the email I received from Cody’s mom after I saw them sitting in our parking lot after therapy one day:

“Hi Jenna!
First, my funny story from yesterday.  So, I had to get a new tire put on the car due to my careless curb-job (which was the best one I think I've ever done).  I had to find out which Ford dealer had a tire like my other ones.  Cody was getting ill.  He likes to see you then eat lunch.  He doesn't like sitting in the car if we are not moving! So, he was cranky during lunch and the dealer said it would be 2 hour wait.  I was so nervous and the anxiety set in.  I know what Cody is capable of when he does not want to do something. 
          So we go to Woodstock and we wait and wait and wait.  The child was an angel!! We tried to download games to his computer and I was so stressed out, I couldn't ever figure it out!  He didn't let out a peep.  He played the games that were already on his computer and then I said, hey, lets talk.  So I asked him a few questions and he never responded.  So I decide to check out facebook on my phone.  His screen was at his home page.  All of I sudden I heard ‘not fair, not fair, not fair, I don't like it, I don't like it, I don't like it’ Everyone look up and Cody had a big smile on his face.  I asked him if he was tired and it was unfair he had to spend his afternoon at the dealer he said ‘uh-huh’!!!  I thought I would fall out of my chair laughing!!  Then he kept looking at ‘gross, gross, gross’ I asked him if he could something a little nicer, and I got no response. 
          He was saying ‘different, different’ then looking at the TV.  I asked him if they should change the channel.  He said ‘uh-huh’.  Crack me up!!  So long story but we got our tire and were on our merry way!”

This is such a great story for many reasons. First: Cody’s mom takes his device EVERYWHERE and sets it up for him-even if he doesn’t appear to have something to say. Second: We all ask our kids so many questions- and when she stopped asking, he sure gave an opinion! Third: I should’ve mentioned that Cody’s mom drives him to see me from about 45 miles away (that’s almost Tennessee so the travel takes a few hours) and they have amazing attendance.Fourth: We don’t have much “formal” knowledge of Cody’s literacy skills, so he is either reading the words or has already learned the symbols and navigation of the device from his home screen. Either way, he’s amazing!Finally: This parent is doing everything she can to allow her son to communicate as often as those of us with natural voices. I don’t give them homework because I know they create their own J Please enjoy the pictures I’ve included as proof!


Jenna





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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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Suite 603/604, 3105 Creekside Village Dr NW, Kennesaw, GA 30144