The DYnamic Therapy Associates Blog
I just watched a TED talk by Stella Young titled "Inspiration Porn and the Objectification of Disability." You can watch it below. She sums up her thoughts with this explanation of the social model of disability: "that we are more disabled by the society that we live in than by our bodies and our diagnoses."
"I want to live in a world where we don't have such low expectations of disabled people that we are congratulated for getting out of bed and remembering our own names in the morning. I want to live in a world where we value genuine achievement for disabled people."
Stella Young, TEDxSydney 2014
I've noticed something interesting in my social media journey sharing resources and information for people who are non-speaking and their family and friends: the most popular items I share are those that say, essentially, "assume competence," "expect the same from your disabled child/student that you do from other people their age." "Keep trying to figure out how to help them communicate."
Why are these such profound statements that they are shared, retweeted, copied and pasted onto blogs? Why do children with disabilities have to prove their desire to communicate with as many words as their peers? Why do they have to communicate effectively with pieces laminated paper and Velcro, a 2 button rocking plate switch, a single message button, or a Yes/No app before anyone helps them achieve comprehensive communication. To talk across all environments, all partners, all activities and; most importantly, to say ANYTHING, even the bad stuff we don't want to hear?
Why is every other Kindergarten student tossed right into the class learning science and social studies, biology and literature while our children with disabilities have to PROVE that they can achieve in these subjects before they are allowed to be exposed to the curriculum and to share their school experience with all of their friends in their neighborhood? At a minimum we should give them a chance to join the party.
Assuming competence should be a given. We shouldn't need to be told to do this. No teacher in regular education meets a child at the door expecting failure and therefore limiting their education. Are we so brainwashed by our training that we can only see the disability? Are we sharing this errant notion with parents so convincingly that they too can see only the disability and not the potential in their own child? I cannot tell you how many times a parent has told me that a well meaning professional has tried to help the family "face the reality" of their child's disability. So deeply wrong. Not to assume competence is simply discrimination based on a diagnosis, a physical or sensory difference.
I'm not saying that some of our friends with disabilities don't need supports. But give them a chance to try before you assume they can't. Assume that they want to interact, make connections, and communicate just like you do. Make sure they have a way to do it too. That's OUR job. That is where the supports come into play, when we are expecting our student to achieve with the others and finding they need a little (maybe even a lot) of support. If we start from a perspective of expecting people to interact like their same age peers then our supports become meaningful and pointed toward real world goals.
If you wouldn't be okay spending your life interacting by handing people picture cards or answering "yes" or "no" as people try to guess your meaning or; ignored and manipulated because you are assumed to have nothing of value to say, you must understand that it's not okay for a non-speaking person either. If we truly believe our children are valuable, intelligent, have something to say and want to make connections, we would never be satisfied until they had a way to do it.
And did I mention.....
One year ago my 22 year old friend L. could communicate with a smile and a repetitive whole arm pump when she was happy. At least that's what we thought she meant. Very limited eye contact, no speech and no choice-making. She would consistently reach for a cup of water and would hit a rocking plate switch on the right side to ask for the water. No reaching to get anything else. And she would sleep. A lot.
We were told she was "Profoundly Mentally Handicapped" which meant, "Don't even try. There's no chance. She's an adult. She can't learn. Seriously???? You're getting her a high tech communication device???!!?!? She's not ready."
Today L. came in my office. She independently said, "Hi!" "How are you?" and answered me saying "I'm fine" using her communication device. She reached to touch me with a huge smile. Still no eye contact. After we waited a LONG time she said, "I'm ready" and we headed off to my therapy room. She reached for several items on my table she wanted. She grinned and gave me that happy arm bounce many more times. With a lot of encouragement she told us "I like it!" as she saw her new pages on her device. These are the pages that allow L. to begin to learn to independently move from page to page on her device. We just added these today because she has progressed beyond having her partners pick all of her pages for her.
Dad walked in unexpectedly and she couldn't quite get that "Hi" out by herself but, with a little encouragement followed by a long wait, she continued, by herself, to say "How are you?" and to answer again, "I'm fine." I think we should have had, "I am EXCITED" on her device because she was engaged, expectant and interacting!
On the way out we paused for another long wait time and then got to hear L. say, "I'm ready." "Let's get going!" A quick "bye" from me and L. gave me super fast "see you later!" Smiles all around, for L., me, Mom and Dad.
These days L. has a LOT more people talking with her. More people are interacting with her and she is awake a lot more. She is coming to expect people to talk to her and people are expecting her to respond. Everyone agrees that, of course, we need to ask her opinion before we move her or feed her or touch her. And we all agree that it's okay if she doesn't say what we expect her to say. But we'll assume she has an opinion, is socially motivated and wants to be a part of her world. And we'll make sure she has a way to do that, with her device and lots of relevant pages for all of her environments.
Take that, "Profoundly Mentally Handicapped" diagnosis: meaningless, handicapping, limiting label!
Not for our friends!
Disclaimer: I really am not a static display device fan. Seriously not a fan, as in I groan audibly when one of my new patients tells me he uses a static display device at school for his communication. I hate for children who really need a comprehensive communication system to be given 20 buttons and sent on their way. It makes me clinically insane. If the static display device is part of the AAC system, okay, but if it is THE communication system, ugh. So you can imagine GoTalks haven't been on the top of my go to communication device list.
This app has all the tools of a comprehensive communication app in a build it yourself version. The content that is available is in an early stage of development, but the potential, ENDLESS.
So with this app you have the ability to create a page of 25 buttons and with a few clicks drop it down to a 2 button page. You can access a quick message popup on every page. You can turn on a message window. It's simple to add a photo symbol to a button from your library or camera. Don't have your own photo? A couple of taps and you can search the internet and drop an image on your button. Multiple images can be placed on a single button. Buttons can speak a synthesized message or you can record your own. Not only can you make grids for communication, you can easily make scenes for context based messages. And it SCANS. Craziness! It's an amateur AAC page developers dream. Easy to use, easy to customize with a ton of great features.
There are several options to get started with the GoTalk Now App:
GoTalk Now Free- one book with 3 pages, Free
GoTalk Start- one book with 5 pages, $19.99
GoTalk Now- unlimited books and pages, voices, templates, backup and restore, and sharing via wifi, $80
GoTalk Now Plus- all of use above plus Symbolstix library, Ready, Set, Communicate book and Acapela voices, $150
This app is one to have in every classroom and is also a great simple app to trial AAC with your child. It has potential to help teachers and therapists introduce vocabulary symbols, especially for activity based boards. I believe it has potential to give students an ability to participate in their environment, learn new symbols or to practice more advanced syntax and morphology in a low distraction environment. For my purposes, it has become an exceptional evaluation tool. If you took the time to build it, you could create a communication app with absolutely everything you could possibly need for a 25 location comprehensive communication system.
A real disclaimer: I was given an evaluation version of this app to test out. Then again, I'm given a lot of apps. I only talk about the good ones :)
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!)
...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 know, I know, it's a PECS system...but actually it's a LOT more. As I may have mentioned before, I'm really a high tech kind of person so I walked past the Proxtalker booth many times over the past few years. A quick glance told me all I needed to know- it's a PECS system with a bunch of little cards that would make me and my kids crazy. Okay, so I was wrong. Today we had the pleasure of having Glen Dobbs come out to our office to meet us and show us his Proxtalker and ProxPAD. We have recently reconsidered the Proxtalker and ProxPAD as we began working with more children with visual impairments. The possibility of putting tactile symbols on a voice output system is intriguing. After seeing both the Proxtalker and ProxPAD in action, I agree that it's pretty powerful for these folks, but I was pleasantly surprised at the other features these devices offered for many of our other patients.
What I Liked:
Wish List: (What we would love to see)
Here's a video where you can see the Proxtalker in action, hear Glen's explanation and watch them drive it over with a truck!
After hearing a little buzz about Therapy Box's new AAC app, Chatable, I was excited to get a chance to try it out this month. It has some nifty features that give it a lot of potential for our AAC users.
Features I like:
All in all Chatable is an AAC app with robust options. A great place to start with AAC and, with the help of an SLP to develop a relevant vocabulary set, a system which can meet the needs of many beginning communicators.
I was given a copy of Chatable to review. We are given access to many AAC apps but only discuss ones we believe have therapeutic value for our families.
Features video from Therapy Box
I'm writing this in hopes that someone at ASHA is paying attention. I'm writing in the hopes that our voices together may add some sense to a situation which is hurting children.
When the government's NCCI (National "Correct" Coding Initiative) edits came out in 2011 they only allowed us to do SGD services on the same day as speech/language services IF we billed the codes with a modifier. Our state Medicaid program didn't restrict these two codes together and didn't give us the ability to add the modifier when we billed. Now the state Medicaid program is coming back and asking for their money back saying we shouldn't have billed the codes together without a modifier, despite the fact that their provider manual stated we could bill the codes together and, the fact that they didn't have a way for us to put a modifier into our billing with them. We are an AAC specialty clinic so this impacts 100s of thousands of dollars of payment. So far they asked for $50,000. They gave us a way to go back on EACH claim and add the modifier. There are thousands of claims. They will graciously pay us once these are done. In the meantime they won't pay their bill with us. This week they decided that they are going to review every claim since January 2011.
There are so many things wrong with this situation. Most importantly , what sense does it make that a therapist with an AAC user would NOT also need to work on receptive language? Anyone working with an AAC user knows that they are at a very high risk for receptive language delays and oral motor/feeding and speech needs. The vast majority of these children need to be seen for receptive/expressive language, speech generating device modification/treatment, oral-motor/feeding and behavioral intervention. Why in the world would we force these already overworked parents to drive to therapy 2-3 times a week simply to have these services on a different day? What is the empirical evidence that providing these service on different days benefits the patient? On the contrary, we have patients traveling up to 1 1/2 hours to see us. Making them come twice places an undue burden on their physical health and their emotional well being. To say that this is the "same service" shows ignorance about the distinction between receptive language and expressive modes of communication. To ask these already incredibly challenged patients to learn all that they need to learn in a 30 minute session is beyond ludicrous. I cannot fathom that anyone with any real experience working with AAC patients had any input into the decision to disallow this code pairing.
The NCCI edits are just incorrect in not allowing these codes to be billed together. The only purpose this is serving is to give insurance and a Medicaid/Medicare an excuse to deny services that these children really need. I hope that the purpose of the NCCI edits is not to simply save government money on the backs of handicapped children. It is utterly wrong.
I have no confidence that our voices here in our clinic in Georgia will be heard by the NCCI editors but I would hope ASHA and our community of AAC families and professionals has the ability to add some reason into this terrible oversight that is hurting ACTUAL handicapped children.
At the same time, I sincerely hope that the service we are providing these children in our private practice can continue.
Thanks for any input you can offer or in helping us spread the word about the effect the NCCI edits are having on our children.
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?
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).
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.
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!
In the spring of 2006 (I think, it's been so long I've forgotten) Holly Schneider and I met via phone to talk about a new presentation for the next year's upcoming AT conferences. We talked about finding a solution to a problem that kept cropping up in our practice: parents and professionals were contacting us to come up with AAC goals for their IEP meetings. This was a tricky request since we usually didn't even know the students. Not having a direction to go with AAC seemed to be the biggest problem we saw in the big wide AAC world. We had so many fantastic techniques, tools and ideas floating around but families, therapists and teachers were still struggling to implement AAC. There were many professionals and companies talking extensively about a continuum of skills (Janice Light and Patricia Dowden, in particular). Our devices were even beginning to be organized that way but, we couldn't find a comprehensive system of organizing goals based on Light and Dowden's work. We started our own based on the InterAACT framework of the Dynavox devices. InterAACT is the page set organization developed by the Dynavox Education Team that incorporates the research of Light and Dowden as well as a plethora of research from the field of AAC and more. We dug through research and products already on the market to compile a list of goals. We pulled out our old handouts from presentations on implementation. Nothing we did was original, it was all simply a compilation of the best ideas we could find in the field. We revised, revised and revised. Dynavox marketing folks made it fancy, and then reworked it to make it fancier and then, finally, reworked it again to make it the fanciest.
Finally the Dynamic AAC Goals Grid-2 is officially released, in its entirety. I don't think anyone else cares quite as much as Holly and I do but WE are very excited to finally share our work. Dynavox was key in the development of the DAGG-2 in their support for Holly's time, designing the finished product and their willingness to release it to the public for free. I did the work mostly because I'm an AAC nerd and, although this is Holly's job, she's pretty geeky herself.
So here it is. The main goals Holly and I had over the years were a hope that the tool would be released for free, worked for all AAC users (not just Dynavox) and that it represented the most current research and practice in our field. We hope that you will find it useful; that it will allow you to document the progress your AAC users are making and; that it will help you figure out a road map toward communicative competency. It's not perfect (hence all the revisions) but hopefully it's a start for some people. If you like it, please share! We'd love to hear from people who use the DAGG-2 so that we can continue to refine, polish and fancy it up to meet all of our needs better. You can download it here: https://www.mydynavox.com/Resources/AACGoalWriting If you don't already have a MyDynavox account, you can create one on the right side of the page. You'll then be linked to a list of all the forms. These include forms to evaluate your AAC user's skills, select appropriate AAC goals, plan for implementing AAC into your daily life and to collect data. Forms include the Dynamic AAC Goals Grid-2 (DAGG-2), DAGG-2 Data Sheets and DAGG-2 Schedule Analysis Tools. All forms are writeable which means you can fill them out and save them on your computer without printing.
Hope you like it!
Vicki (and Holly)
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
Super motivating and easy. A great little activity which keep our students focused and talking!
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