2001 Conference Proceedings
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"NO PREREQUISITES"- THEORY INTO
PRACTICE
Jamie Judd-Wall, Executive Director
Kathleen King, Consultant
Technology and Inclusion
Box 150878, Austin, TX 78715-0878
Phone: voice/message: (512) 280-7235
FAX: (512) 291-1113
Email: jamie@taicenter.com
Web site: www.taicenter.com
Abstract
Our center is a non-profit assistive technology training center in
central Texas. We work with Medicaid waiver programs, school
districts and rehabilitation programs. We refer to the folks we
work with as clients. Our clients range in age from 3 years old to
55 years old, though in the past we have had clients who are
younger and older.
In our client training program we have put the 'no prerequisites'
theory of VOCA use into practice in the AAC training program we
will present. Based on research and culminating with a recent
article series by Locke & Stagsetter, we have developed an
augmentative communication training program which began with for
individuals with autism and has expanded to include individuals
with cortical blindness, traumatic brain injury and encaphalopathy.
One hallmark of the training program is the immediate use of voice
output devices. Our clients are talking from day one.
We use a highly a structured communication environment,
individually designed motivational routines and the addition of a
voice output device to a PECS like routine has resulted in
significantly faster symbol learning, more frequent exchanges, and
higher rates of initiation than training programs with symbol use
alone.
In 1998-99, we piloted the program with individuals with autism and
mental retardation. In 1999-2000 we have expanded to include
individuals with cortical blindness, traumatic brain injury and
encaphalopathy Since our presentation last year, we have increased
the number of individuals participating. To date, we have had
measurable growth in over 100 individuals' communication abilities.
Every person has shown improvement in communication abilities with
decreased behavioral outbursts, increased initiation behaviors,
increased meaningful use of symbols to communicate, increased
communication topics and increased compliance.
The training program is a five phase process. The traditional PECS
strategies, the exchange of the picture symbol for the desired
object, is enhanced through the use of voice output technologies.
Early in the process, we use simple tools, such as the TechTalk (a
digitized speech, battery operated portable communication device)
or IntelliKeys (a programmable expanded keyboard for either
Macintosh or Windows computers). Later in the training the
equipment used moves to more sophisticated technology, such as
dynamic display communication software and hardware, such as
Speaking Dynamically Pro, and a touch screen such as the
TouchWindow or a portable VOCA such as the Dynamo.
Hallmarks of the training process include (1) the immediate use of
voice out devices and (2) the early introduction of 'social
commenting'. These serve two very important purposes: first our
clients experience the increased partner attention and response
rates that research shows us accompany the use of voice output
devices and secondly they quickly move past basic needs to more
normal conversational patterns. These conversation type exchanges
invite the communication partner into a verbal exchange so that the
focus of the process quickly moves from the exchange of items to
the exchange of feelings and information.
In Phase 1, the process is a simple expansion of the PECS training
process. A velcro responsive base overlay is created for the
device. Velcro hook fabric is attached to the picture (for our
clients with cortical blindness we have created a set of tactile
symbols.) The device is programmed with requests for the items as
represented by the picture. As the picture is removed from the
device and handed to the trainer, the request statement is made by
the device.
As soon as the client is able to independently participate in the
picture exchange, Phase 2 begins. He/she is moved to a dynamic
display system. In this process, the picture is touched rather than
removed and handed to the trainer. Upon touching the picture, the
voiced request is made by the device and the desired item is
provided (in VERY small quantities). Typically the desired item is
food, although we frequently have students whose desired item is a
physical interaction such as tickle or bounce. We routinely move
the pictures on the screen to be sure that the student is actually
attending to the content of the picture, not just randomly touching
the screen.
In Phase 3, social comments are added to the training process. As
the client requests the desired item, the display changes to an
array of 2-5 social comments such as "This is fun", I'd like more
please", and "Thank you" . In order to return to the screen with
the food or play requests, the client needs to make a social
comment. The screen then automatically returns to the set of
desired options. Many clients will work on various sets of desired
items at the Phase 3 level for quite some time. Clients at this
phase are functional initiators of communication and interact well
with their trainers. However they are not yet independently able to
select communication topics or solve problems in the communication
process.
In Phase 4, the client is taught how to select and switch between
communication topics. Typically we will have clients who have 3-4
sets of desired requests with which they have been successful in
past sessions. We then introduce the topic setters,a single board
with snack, TV, computer games, and play time. As the client
selects the topic setter, the screen changes to the familiar
request set. The social comments page is fortified with termination
statements such as "I'm finished", "That's enough" or "Let's do
something different." The selection of a termination statement
results in a return to the topic setting page. At the early stages
of Phase 4 training client may return to the same topic area
repeatedly as they familiarize themselves with the topic setting to
requesting sequence. For many clients termination of an activity is
an anxiety producing time and may cause unwanted behaviors. This
extended practice in termination and initiation is an important
learning time because it teaches the client how to end and begin
desired activities. We have seen a substantial reduction in
unwanted behaviors as clients overcome the anxieties of activity
termination.
Finally in Phase 5, we add problem solving. What happens if you eat
all of the most preferred food item ... or the batteries on the
vibrating pillow wear out? How do you choose an alternate activity
when the desired, but unavailable, activity is still visible on the
choice board? What happens when you ask to eat but it's time to
work? In traditional PECS the picture representing the unavailable
option is removed from the set of items presented to the client.
However, in electronic communication this means creating a new
program every time some food is consumed or some toy is left on the
bus... not a very reasonable option! In Phase 5 we add statements
to the social comments page to reflect these situations. Comments
such as "I ate it all", "It's all gone" and "What else can I
eat/play with?", "It's time to work, lets get a snack when we're
done." help clients learn that something can be visible on the
choice set put not physically available.
As you can imagine, many clients find these skill sets a
challenging to master. The training is intense. Clients may spend
long periods of time on a single comment, especially at the Phase 5
level. We have found that if we allow a client to express the
desired thought, even if they need to say the same thing over and
over, that we reduce unwanted behaviors, such as tantruming and
self-injurious behaviors, almost to the point of extension.
Our successful expansion of the number of clients and range of
disabilities served in the program continues to support our belief
that our success can be replicated by others.
References:
Dynamo, Sentient Systems Technology, 2100 Wharton, Pittsburgh, PA
15203
IntelliKeys, IntelliPics, Overlay Maker by IntelliTools, 55
Leveroni Ct, Novato, CA
Speaking Dynamically, TechTalk by Mayer Johnson Co., Box 1579,
Solana Beach, CA
Touch Window by Edmark Corporation, Box 97021, Redmond,
WA
Peggy Locke & Mary Stagsetter, Bringing the World of Voice to
Individuals with Severe Disabilities, parts 1-3 of 4, Closing the
Gap, March-August 2000
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