What is assistive technology?

Assistive technology is any kind of technology and/or tool that can be used to enhance the functional independence of a person with a disability. Often, for people with disabilities, accomplishing daily tasks such as communicating with others, going to school or work, or participating in activities can be a challenge. Assistive Technology (AT) devices are tools to help overcome those challenges and enable people living with disabilities to enhance and have access to a quality of life, that may otherwise not be known, and lead more independent lives.

Thursday

Complex Communication Strategies

What is communication and how do we communicate without verbal language?
Working with individuals who have complex communication, it can be very challenging. I try remind others that just because a person can’t speak doesn’t mean they don't have anything to say, it might mean that we haven't figured out a way for them to say it yet. Communicating is so much more than expressing our wants and needs. Communication is a basic human need. Among other things, it allows a person to connect with others, make decisions that affect their lives, express feelings and feeling a part of a community.

What is communication?
  • Communication is any time one person gives or receives information from another person. Communication is interactive and involves at least 2 people
  • Communication is the most efficient and organized method for transmitting information. For most people that means speech or writing but for students who are nonverbal it looks different. It may be a combination of vocalizations, gestures (including some signs), body language and/or pictures.
  • Communication is done with a purpose/reason; such as sharing needs or wants, having social interaction. The primary functions of communication is to: Express wants and needs, exchange information, for social closeness and for social etiquette.
  • Communication skills help to increase independence and control over one's environment.
  • Communication partners need to be sensitive to and respond to a variety of signals. A person will stop trying to communicate if they feel they are not being recognized and responded to.
  • Communication is not just speech. Any number of non-verbal modes may be used, such as facial expression, or body language. According to Linda Hogdon in her book, Visual Strategies for Improving Communication, communication is:
    • 55% Visual – things we see like gestures, facial expressions, body movements, objects in the environment
    • 37% Vocal – intonation patterns, rate, and intensity or volume
    • 7% Verbal
    Consider this: When a child has difficulty responding vocally to their parents’ speech, the parents in turn often lessen their speech output to the child. They also tend to anticipate and meet the child’s needs before a request of any kind could be initiated. This in turn decreases the number of opportunities for communication and communication development becomes less important. Eventually the individual may learn to be passive and helpless ( what we often call "learned helplessness"). 

    Individuals with significant cognitive and communication challenges may not readily initiate communication. A number of barriers can hinder the acquisition of communication, choice making and literacy skills for individuals with significant disabilities. 
    1. Attitudinal barriers
    2. Low expectations
    3. Limited opportunities
    4. Professional training
    5. Inadequate adaptations and support tools
    Our challenge is to help those with limited or no speech to communicate as best as they can in order to have control in their environment and to be able to have social relationships with others, in order to prevent loneliness and isolation from others.It starts with us!

    Be Patient! Respond to all of your child or adult's communication attempts. Treat random actions and sounds as intentional communication. Your responses to their actions and sounds will help them to understand that those sound and actions have an effect on others, therefore they can have some control and choices in their life. And, please, please, please provide choices often throughout their day. We all deserve to have a choice.


    Remember Natural Consequences and set High Expectations:
    • Presume competency
    • Respond as if utterance were purposeful
    • Consider receptive language
    • Positive attitude/Believe they can
    Communication Functions include not just requesting an item or an activity. We communicate in many ways. Consider:
    • Protesting
    • Commenting
    • Greeting
    • Asking
    • Directing
    • Suggesting
    • Telling
    • Choosing
    There are a variety of ways in which we can communicate:
    • Real words and phrases
    • Sign language or modified sign
    • Pointing or exchange of pictures
    • Vocalizations and sounds
    • Leading gestures
    • Pointing gestures
    • Reaching gestures
    • Pushing objects (away or toward)
    • Holding or pointing to real objects
    • Facial expressions
    • Eye gaze
    • Head nod or shake
    • Body orientation
    It is important to watch for different ways he/she may be communicating. Develop a communication friendly environment. Get to know your student and build a relationship through observing and making interactions. 
    • Watch for subtle and unconventional communication cues.
    • Observe communication intentions in a wide variety of settings.
    • Recognize and respond to the student's communication attempts.
    • Provide wait time for response to requests.
    Those who do not speak need ways to communicate with others.  Often, messages need to be created quickly and on the spot. Even those who use a dedicated Augmentative-Alternative Communication (AAC) device need other strategies and possible tools to offer a quicker way to produce, respond and participate. Devices such as the BIGmack and Step-by-Step Communicator are effective to create situation-appropriate messages. Having a voice allows a person to actively participate in on-going activities. When language is used in a functionally it can help to learn the meanings of words and phrases in context. 

    A voice (using any type of system needed by the student, including a output device, communication book, eye gaze, etc.) can be used to: 
    • Gain attention or initiate a conversation
    • Ask for something
    • Greet or to say good-bye
    • Having give and take conversations
    • Actively participating in a group
    • Asking and answering questions
    • Giving Directions
    • Taking Turns
    (See other posts on this blog about using switch communicators, developing a communication dictionary and choice making strategies.)

    Please honor and respect that if a person has complex communication needs, it does not mean they do not have something to say. 

    Resources:
    • A valuable tool to print and post and share with parents, educational assistants, general education teacher and even other students: "Communication Bill of Rights". 
    • Stepping Stones to Developing Communication Strategies This is a general framework for selecting expressive skills to work on with the student. Although they are all basic skills, they are very functional in that we all use these skills, only in more sophisticated ways. For example, we all communicate that we are aware of others by looking at them, or speaking with them. At the end of the handout, there is a checklist to identify those communication skills that the student already demonstrates and the ones that he is presently working on.  
    • Learn how your student can make choices, have a voice, and communicate in other ways: Communication and Social Strategies 
    • My favorite resource for providing brief descriptions along with 30 second videos on various Muti-Modal communication strategies is from the Bridge School.  I often use these with staff as they are quick and to the point. Having visuals of each strategy is extremely helpful.