Cortical Visual Impairment and AAC

After yet another opportunity to listen to Linda Burkhart (http://www.lburkhart.com/index.html) at ATIA, we've been all excited about our work with children who have cortical visual impairment. Cortical visual impairment is a condition which causes the child to have a decreased ability to respond to and interpret visual information (http://www.tsbvi.edu/Outreach/seehear/fall98/cortical.htm.) When we encounter those children who are not visually attentive, who don't watch television and don't attend to a communication device we start to consider adaptations that are success for children with cortical visual impairment. Although we can't diagnose this condition, we are finding that standard strategies for CVI are effective in improving many of our patients' attention to and use of their communication devices.

Quick and easy strategies to try include:
- Decrease the size of the symbol. At times a smaller target requires less focal area and is easier for the child to see.
- Increase the contrast between the symbol/button and the background (for example use a black background with a bright yellow, pink or red symbol)
-Add movement to increase the child's attention to a symbol location. We use video clips inside small buttons to draw the child's gaze to the location of the message.
- Use brightly colored backgrounds for each button that contrast with the other buttons on a page (color response is often preserved in children with CVI)
- Decrease visual "clutter" of symbols (strategies can include using simple line drawings with limited detail and coloring)
- Maintain consistent appearance of symbols. Children with CVI show better visual recognition of familiar images.
- Maintain consistent placement of symbols on pages so that the child can use motor memory skills to locate familiar, taught messages

We have a new little friend, Justin, who is using many of the above strategies. In his first two visits he was introduced to 2 large buttons on both the Dynavox M3 and the Dynavox V. He showed very little visual attention or use of the buttons for communication.

His therapist, Jessica, decided to try some of our techniques for CVI with impressive results. She took Justin down to a 1 1/2" button, brightly colored on a black background. Justin has moved from a simple field of two requests for "more" and "all done" to beginning to learn basic navigation by selecting "Quick Fires" on his home page and then "more" to request his favorite movie song- in 2 weeks! Excellent! Here are two short clips of his last two sessions with us (visit #3 and #4 at our office).

Justin's 3rd visit: http://www.youtube.com/watch?v=ahWztYaFJ6c
Justin's 4th visit: http://www.youtube.com/watch?v=DYCWiyJYWHg

Socialization vs. Content with SGD users? Which to tackle first?

Today I noticed with 2 of my kids, during a 60 minute session, I got more independent interaction during our social time (15min), than I did during our content structured activity time (45min). As a professional, I want to teach a topic; “label this, match this, find this” and report good data but, as a friend, I want my kids to be able to interact, have an opinion and voice it! When a child is finally given a voice with his/her SGD, we need to listen to it, BUT first we need to teach them how to use it! Sometimes, it is easier to focus on what content they do or don’t know vs. if they can greet someone, request or reject something and have an opinion about something.Let’s teach our children how to interact socially and voice their thoughts and opinions, then we can tackle the content.

Jocelyn Bremekamp, CCC/SLP, Dynamic Therapy Associates, Inc.

AAC: Whose Job Is It??

Question of the Day:
At what point does it become not only our student/child's responsibility to learn, but our own responsibility to keep up with the technology that allows them to do so?  AAC technology is an amazing gateway to communication for so many of our children.  Unfortunately most of them struggle to learn the new "language," week after week in therapy, only to have partners who are not willing to simply keep up with them.  To become an effective communicator using a speech generating device, it is imperative that communication partners learn the system enough to provide at least minimal support, if not appropriate adult models of interaction.  Being the teacher, therapist or parent of a child who speaks through technology means that you have been given the gift of hearing a special child's thoughts.  Don't' throw it away because you won't take the time to learn their language.
Ideas:

• Join your child/student in therapy.  You will learn the location of messages s/he is learning.  You will have models of interaction techniques to try yourself.  You can provide key information about important goals to the therapist in order to meet your needs at home/school.
• Ask your therapist to videotape several sessions of therapy to share with his other partners.
• Participate in Intervention Planning:  a process of examining your child's day and determining priority goals for her communication.
• Spend an hour talking with someone using ONLY the child's communication device.  It's a great way to learn the location of messages, appreciate the challenges of communicating with a device and, problem solving missing messages.
• Make sure you and your child/student are being assisted by an experienced AAC therapist.  This is not an easy process and the assistance an AAC specialist can provide is invaluable.

The most important idea to keep in mind is that we never give up on communication!  The technology exists to help almost EVERY SINGLE PERSON communicate in some way.  Don't be the handicap that limits a child's potential!  If you need help, please talk to a knowledgeable AAC therapist for ideas.  There's always something that can be done to help.

Vicki