2001 Conference Proceedings

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AAC Strategies For Beginning Communication With Children And Youth Who Are Deaf/Blind

Janie Cirlot-New, M.S., CCC-SLP
T.K. Martin Center for Technology and Disability
Mississippi State University

Jan Shook, M.S., CCC-SLP
Winona, Mississippi


Development and stimulation of auditory and visual processes for increasing augmentative communication skills for children with dual sensory impairments.

Learning begins at birth. The newborn child must respond to external stimuli immediately upon entering the 'outside world' ...a world filled with sounds, sights, smells, tastes, touches, and movements. How are all of these sensations perceived and processed? Do stimulation... response... processing... cognitive integration... language development happen naturally and without specific instruction or intervention? An age-old theory debated by many and not the focus of this brief proposal for intervention. The sequential steps from perception to integration are mentioned to suggest the very thought that WE KNOW these systems are out of synchrony with the great majority of individuals who require an alternative mode of communication. Children with dual sensory impairments do not acquire these sequential steps without defined stimulation.

It is estimated that dual sensory impairments occur in three of 100,000 births (AZ Deafblind Project). Approximately 11,000 children and youth in the United States may be diagnosed with deaf blindness. Communication and mobility reportedly are the developmental domains most affected by dual sensory impairments. Children and youth with dual sensory impairments must receive specific instruction and intervention in these areas in order to create understanding and to spark an interest in the word around them (AZ Deafblind Project).

An understanding of the neurological processes is necessary to more fully comprehend how the brain perceives, incodes, and decodes information received through the sensory channels. When considering dual sensory impairments we know that at least two channels for reception are impaired. Therefore a specialized therapeutic approach is necessary to assist individuals in the development of communication.

A comprehensive therapeutic approach to communication development must include an integration of sensory integration, communication development, team development, and the continuum of assistive technology for communication.

What is sensory integration? Linking vision with hearing to orient yourself in a strange place, sensing a loss of balance in time to prevent a fall, using your sense of body position to accurately access of a switch, discriminating between touch that conveys comfort from one that threatens physical safety. From basic survival to the most elaborate of cultural inventions, we rely on information from our senses for success in meeting life's challenges each day.

Of course for some this process of information integration is much easier than for others. The senses do not work in isolation. They work together to form the composite picture of who we are, where we are, and what is going on around us. Sensory integration is the critical function of the brain that is responsible for producing this composite picture and the organization of this sensory information for ongoing use (Sensory Integration International, 1985).

Sensory integration (SI) impairment may be subtle in some while overt in others and treatment can be very complex involving several professionals such as occupational, physical, and speech-language therapists, psychologists, neurologists, audiologists, and vision specialists. Sensory integration impairment can interfere with academic learning (reading, spelling, math, etc), social skills, even self-esteem. Research clearly identifies SI problems in children with development or learning difficulties. Independent studies show that a sensory integrative dysfunction can be found in up to 70% of children who are considered learning disabled by schools (Sensory Integration International, 1985). It goes without saying that individuals with dual sensory impairments have sensory integration difficulties by virtue of the fact that the senses, vision and auditory, are impaired.

A multi-sensory approach to augmentative communication provides a platform for providing information through all available channels as well as encouraging responses through all channels.

A comprehensive language therapy plan should include auditory stimulation and training which would include:

Visual stimulation and training should include the following:

With a comprehensive therapy approach, the clinician is essentially "diagnosing" as she provides therapeutic intervention. The child is given multiple opportunities to successfully communicate. In the continuum of determining appropriate prompts from maximum to minimum, the team should investigate the current level of the individual and provide only sensory information necessary for success. The goal always being to use the minimum in order to stimulate cognitive growth and sensory integration.

Participants will review several multi-sensory comprehensive plans, including methods for application of the most simple low-tech stimulus-response formats to high-tech communication devices with speech output. This information will be presented with ideas for implementation in group activities including various age and ability levels. Different intervention methods will be addressed through daily classroom activities such as : circle time, snack time, story time, art, reading, science, math, social interaction, and transition.

Auditory and visual stimulation and training should be a part of every child's augmentative communication intervention sequence regardless of the severity of visual and auditory impairment. The goal of augmentative communication should be to develop effective communication and ultimately translate information into some type of symbolic representation that can be understood by others. Communication for individuals with dual sensory impairments is a continuum involving the use of assistive technology that is integrated into their daily lives and routines, ever changing to adjust for growth and development.


Bush, C. (1979) Language Remediation and Expansion. Tucson, AZ: Communication Skill Builders, Inc.

Gillet, P. (1974). Auditory Processes. Novato, CA: Academic Therapy Publications.

Lowell, E., Stoner, M. Plat It By Ear, John Tracy Clinic, Los Angeles, CA, 1960.

Morgan, E., Watkins, S., (1989) Assessment of Developmental Skills for Young Multihandicapped Sensory Impaired Children, SKI*HI Institute, Logan, UT.

Pinker, S. (1994). The Language Instinct. New York, NY: Harper Perennial.

Schuell, H. (1972). The Minnesota Test for Differential Diagnosis of Aphasia. Minneapolis MN: University of Minnesota Press.

Sensory Integration International. (1985). Sensory Integration. Torrance, CA.

Stout, G & Windle, J. (1992). The Developmental Approach to Successful Listening II (DASL-II) Englewood, CO: Resource Point, Inc.

The Arizona Deafblind Project, "Frequently Asked Questions", Tucson, AZ.

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