AAC and Multiple Disabilities

Melanie Conaster OTR/L

Brenda Del Monte MA CCC-SLP

Video DisclaimerA special “thank you” to all the children and their families for letting us show these beautiful children for educational purposes.The videos don’t lie. They show children doing amazing things…sometimes because of the therapist facilitation and sometimes in spite of the therapist. Nobody is perfect but we are willing to show the do’s and the don’ts.

(h) Multiple disabilities means concomitant impairments, the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term, multiple disabilities does not include deaf-blindness.(Washington State) WAC 392-172A-01035

How are we defining “Multiple Disabilities”?

Areas of ConcernVisionHearingMotorSensoryCognitiveCommunicationSometimes the answer is: All of the Above

Not a Straight Road to Communication

Let’s break it down!

VisionBlind – no vision at all“Functional” Blindness - A person is functionally

blind when he or she has to use so many alternative techniques to perform tasks that are ordinarily performed with sight that his/her pattern of daily living is substantially altered.  Such alternative techniques might include reading a newspaper by listening to it over the telephone or using Braille to read a book.

Cortical Visual ImpairmentNeurological vision disorder rather than ocular

(although they can co-exist)Disturbed or reduced vision due to various brain

abnormalitiesSymptoms include variable vision, a limited field

of vision and depth perceptive challenges

Stimuli needs to address:ColorContrastSimplified symbol setLightingAuditory Support

High Contrast

AAC Considerations:

Apps to check out:

Everett

EverettAge 5Down Syndrome Functionally Blind (can see some light)Attending Foundation for the Blind for PreschoolSplits time in Special and General EducationHearing is normal, not crawling yet, non verbal

AT Optionshttp://www.ablenetinc.com/Assistive-Technology/Communication

https://enablingdevices.com/catalog/assistive_technology_devices_used_in_education/take-talk-series

Hearing Impairmenthttp://ada.ky.gov/hearing_imp_def.htm

A hearing impairment is a hearing loss that prevents a person from totally receiving sounds through the ear. If the loss is mild, the person has difficulty hearing faint or distant speech. A person with this degree of hearing impairment may use a hearing aid to amplify sounds. If the hearing loss is severe, the person may not be able to distinguish any sounds. There are four types of hearing loss:

Conductive: caused by diseases or obstructions in the outer or middle ear that usually affect all frequencies of hearing. A hearing aid generally helps a person with a conductive hearing loss.

Sensorineural: results from damage to the inner ear. This loss can range from mild to profound and often affects certain frequencies more than others. Sounds are often distorted, even with a hearing aid.

Mixed: occurs in both the inner and outer or middle ear. Central: results from damage to the central nervous system.

Kyander

KyanderAge: 3 ½ years oldHearing Loss – Severe to profound30% Sensory Neural Hearing Loss; 70% Conductive

Hearing loss Due to a rare genetic disorder – no known casesFunctioning at a 9-13 month level with splintered

skillsTube fed, beginning to crawl, vision in normal, non

verbal

AAC for Kyanderhttp://saltillo.com/products/nova-chat-10

• Visual Feedback• Tactile Feedback

Motor LimitationsMotor impairment is a limitation of muscle control or

movement of the body. This may result in weakness, poor stamina, lack of muscle control, or total paralysis. Motor impairment can be a result of neurological conditions, cerebral palsy, stroke, or indicative of other diagnosis.

Access Methods

Direct Selection: TouchorMouse or Eye-gaze control with dwell

Indirect Selection: Alternative input method with scanning (such as use of switches)

Motor: Access Sites & Movements

head eye, chin, mouth finger, hand, forearm elbow,

knee, thigh, foot.

(www.customsolutions.us)

Switches- Size and Sensitivity 

Micro Switch

Big Mac Switch

Pressure Switches

    Spec Switch                      

Buddy Button Pal Pad Switch                                                                  

  

Gooshy Switch  String Switch                                                                                                                                                                  Grip Switch 

Wobble Switch                    Ribbon Switch

Ultimate Switch

Motor: Access Considerations

Voluntary and repeatable movement Excursion of movement Timing Involved Stabilization of non moving parts

(www.customsolutions.us)

Switch Training Software & Apps

Repetition with Variety

http://helpkidzlearn.com/https://www.judylynn.com/

http://www.janefarrall.com/html/ipad.html

Mounts

Mount’n Mover

RehadaptCustom Mounting Solutionswww.rehadapt.de/products.php

Daessy – Lite Mounthttp://www.daessy.com/

ModularHosewww.modularhose.com

Snake clamphttp://snakeclamp.com/

RJ CooperMagic Armwww.rjcooper.com/tablet-mounts/index.html

Communication Strategy

Repetition and consistent practice help

the student pair physical actions with

Yes and No.Yes: Chin TuckNo: Head turns away

Assistive Technology

The strategy was reinforced by via social interaction and by using switches and single message devices which would

say :”Yes” and “No” when action/

movement was Initiated.

Communication through Choice Boards &Partner Assisted Auditory Scanning

AAC DevicesHigh Contrast (VI)Visual Input upon selection

(Multiple Disability)Auditory Preview (VI)Text, sign, video (HI)

Santana

SantanaAge 8Dx: Near Drown at 18 monthsHearing: Mild lossVision: CVIMotor: Right wrist movement, right head

movement emergingCognition: ?Communication: Cause and Effect, Choice Making

Santana’s Functional Needs

Communicate needs/ health and comfort issues Participation in school activities Choice making Body awareness Interaction with peers

www.lburkhart.com/handcvi.htm

Santana’s 2014 GoalsWhen presented 2-4 choices, Santana will use his aid

com to make reliable choices on 8/10 opportunities.More and all done / yes and noSantana will demonstrate 1-to-1 correspondence

with numbers 1-4 on 8/10 opportunities.Santana will improve interaction skills by

participating in greeting friends on 8/10 opportunitiesSantana will express an emotion from a field of 3 on

8/10 opportunities

iPad, Apps, Mounting Solution

CJT Mounting http://cjtmounting.com/index.php

Super Switch InterfaceWobble Switch

Go Talk Now – Home Page

Go Talk Now

Sensory

Choices

Songs

Videos

TV

Toys

Academics

“Go Talk Now” Other Ideas

Scanning Scene Displays

Songs & Audio Books

Adaptive AccomplishmentsSantana now responds “Yes” with a wrist movement

within 3 seconds of an auditory choice. He activates the switch to make choices on the iPad

from a field of 4 choices and to activate apps.He participates in social interaction and activities

with peers via the Go Talk app. He is beginning to work on basic academic skills such

as numbers 1-5 and colors using simple academic apps.

Seth

Seth Age 6Vision: Ocular and Neurological Impairment from birth as

a result from Congenital Human CytomegalovirusHearing Profound loss in Right ear, Moderate loss in Left

(Progressive)Motor: variable, has crawled in the past, whole hand

direct select with keyguardCommunication: some vocalizations, non verbalCognition: ? - Cause and Effect, Choice Making, Core

Words Emerging

AT for Seth•Motion Table • Cause and Effect

•Cause and Effect • Sensory Light Box App

•NovaChat• Actual Objects• Visual Feedback• Tactile Feedback• Auditory Feedback

Bella

BellaPrader Willi SyndromeHearing: NormalVision: Farsighted with corrective lensesCommunication: some vocalizations, non verbalCognition: ? Choice making, navigation skiilsMotor: Scoots, crawling, direct select with

keyguard, now eating by mouth

Bella GamesENGAGING GAMES

So BigAirplaneCrash!!Peek a boo

Lily

LilyannaAge 11Dx: Atypical Rhett’sVision: CVIHearing: NormalMotor: No voluntary movement; EyeGazeCognition: ? – Choice Making, Core WordsCommunication: Tobii I-Series

Camden

CamdenAge 3Dx: Pelizaeus-Merzbacher Disease(Rarest form of Leukodystrophy)Vision: CVIHearing: NormalMotor: spastic CPCognition: ? Communication: Tobii I-Series

Eye GazeTobii I-Series 15” - www.tobii.com/assistive-technology/global/products/hardware/tobii-i-series/

Sensory Guruwww.sensoryguru.com/products/i-series/Flopper Stopper www.rjcooper.com/flopper-stopper/

No Shortcut to Ongoing Evaluation

1. Know diagnosis and then challenge each aspect

2. Know preferences so you have a “hook” (Likes and Dislikes Checklist)

3. Provide Multiple opportunities to succeed

4. Use a Team Approach

Critical Considerations: Outcome Trial usage Continually monitoring progress All environments

Gathering Data Form

Tools Selection and Trials

Tools and Trials Con’t

Learning Software & SupportsBoardmakerhttp://www.mayer-johnson.com/ Unique Learning Systems & News2Youhttp://www.mayer-johnson.com/ Classroom Suitehttp://www.cambiumlearningtechnologies.com/ Life Skills Software and Apps by Attainment Company

http://www.attainmentcompany.com/

Resources for AAC Data Collections

Beukelman, D. R., & Mirenda, P. (2005). Augmentative alternative communication: Supporting children & adults with complex communication needs (3rd ed). Baltimore: Paul H. Brookes Publishing Co., Inc.

Burkhart, Linda J. & Musselwhite, Caroline (2001) Can We Chat? Scaffolding Conversations for Struggling AAC UsersL http://www.lburkhart.com/canwecha2p.pdf

iCAN. (2000). Why is choice-making important? Retrieved January 2011, from: http://www.autismnetwork.org/

Kintsch, A., & DePaula, R. (2002). A framework for the adoption of assistive technology. Retrieved from: citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.124.3726&rep=rep1&type=pdf

References Wisconsin Assistive Technology Initiativehttp://wati.org/ The Magical BoxResources: CVI and Complex

Communication Needs www.curlewapps.com/Blog.html Linda Burkhart and John Castell0 www.lburkhart.com/lindaJohnCVIhandout.pdf American Printing House for the Blindhttp://www.aph.org/cvi/define.html Simplified Technology by Linda J. Burkharthttp://www.lburkhart.com/index.html

Additional Resources

Family Center on Technology and Disability- Instruction Technology in Early Childhood: A New Way for a New Day

www.fctd.info/assets/newsletters/pdfs/307/FCTD-TechVoicesmar13.pdf?1372995063

Integrating Technology in the Classroom: a Teacher’s perspective

www.fctd.info/assets/newsletters/pdfs/306/FCTD-TechVoices-135.pdf?1369774667

iPad and Apps: Learning tools for Young Children with Multiple Disabilities

http://idahotc.com/Portals/0/docs/2013webinars