aac and multiple disabilities
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AAC and Multiple Disabilities. Melanie Conaster OTR/L Brenda Del Monte MA CCC-SLP. A special “thank you” to all the children and their families for letting us show these beautiful children for educational purposes. - PowerPoint PPT PresentationTRANSCRIPT
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