Challenges Thoughts to Consider - New Orleans, Lousiana is a strong connection between literacy and ... Instruction may have been primarily focused on visual skills rather than literacy

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COMMUNICATION STRATEGIES FOR STUDENTS

WITH COMPLEX NEEDS INCLUDING TEACHING CORE

VOCABULARY

Betsy Flener Ed.D.Joni Nygard M.S. CCC-SLP

Flener & Nygard Copyright 2017

Definition

Students with Complex Communication Needs (CCN) are those students who are nonverbal and who have an additional disability. For this presentation that includes students who are blind or visually impaired.


Challenges

■ Blind or low vision with additional disabilities

■ Many have Cortical Visual Impairment (CVI)■ Low muscle tone

■ Many have cerebral palsy and therefore limited movement

■ Cognitive abilities are uncertain■ May have limited interests

■ Many have auditory strengths■ Continuity due to extended absences because of illness


Thoughts to Consider■ There is a strong connection between literacy and

communication: Communication involves symbolic and non-symbolic forms

■ Most early literacy experiences involve social routines between children and adults (Berkowitz, n.d)

■ Many of our reasons for literacy are social

■ Students with complex needs are typically motivated by sensory and social opportunities

■ Language must be taught.Flener & Nygard Copyright 2017

Tools for Access

■ Functional Vision and Learning Media Assessment (completed by TVI)

■ Cortical Visual Impairment (CVI) Range by Roman-Lantzy (2007)

■ Augmentative Communication Evaluation Simplified (ACES)

■ Introductory Workshop Manual: Pragmatic Organization Dynamic Display (PODD)


Assessing Communication

■ Every Move Counts■ Communication Matrix■ Functional Communication Profile■ Augmentative Communication Evaluation

Simplified (ACES)


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Assessing Communication

■ AAC Skills Assessment by Vicki Clark■ Core Word Lists■ Pragmatic Profile of Everyday

Communication Skills in Children■ Social Networks

Flener and Nygard, Copyright 2017

Communication Functions§ Request

§ Protest

§ Ask for help

§ Indicate stop, continue, and more

§ Greet

§ Initiate

§ Comment

§ Yes/ No


Important Information

■ Behavior■ Likes/dislikes


Challenges of Students with Cortical Visual Impairment

■ May be difficult to fully determine the primary sensory channel used since some visual challenges with time may resolve

■ Visual field difficulties

■ May need movement to see

■ Many are auditory learners

■ For students with CP, often their best limbs are on opposite sides of their best line of vision

■ Instruction may have been primarily focused on visual skills rather than literacy and fine motor/tactile and communication


Strategies for Students Who Are Blind or Visually Impaired

■ Audio scanning and switches■ Partner assisted■ Direct selection with high contrast pictures■ Adapted Picture Exchange Communication System

(PECS)■ Eye gaze (can be an option depending on the type and

degree of visual impairment)■ Use of tactile/tangible symbols and/ or textures■ Gestures and affect■ Communication passports


Auditory Scanning

■ Often useful for students who have severe visual and motor impairments

■ Best to begin with menus of less than 4 items or teach groups

■ Best if also give an option to leave or stop the activity■ Can be slow and time consuming but does enable

independence■ Places demands on student in that it requires much

cognitive awareness, understanding phrases, and memory


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Considerations for Students with Limited Mobility

■ Look for most predictable movement■ Movements may often be very small ■ May include the cheek, chin, back of head, finger,

knee, toe, the ability to grasp■ Positioning can often be challenging■ In order to use switches, students need to be well

supported■ Many often person best when side-lying■ Proximity switches can often be an option


What is Core Vocabulary

Core Vocabulary is a small set of simple words that are used frequently and across contexts (Cross, Baker, Klotz & Badman, 1997 as quoted in Baker 2009). These words make up 80% or more of everyday communication and are at the heart of language development (Baker, Hill & Devylder, 2000).


Benefits of Core Vocabulary

According to Hatch, Geist, and Erickson (2015); the benefits of core vocabulary are as follows:• Variety of word classes included• Allows for expression of a variety of

communication functions• Vocabulary is useful across contexts• Vocabulary can be combined to increase

semantic and syntactic complexity


Core Word Lists

Banajee’s Study: http://www.minspeak.com/documents/1-BanajeeList.pdf

Hill conducted over 40 interviews with adult augmentative communicators. The top 100 most frequently words of fluent adult augmented communicators comprise this list and make up 62% words used.

http://www.minspeak.com/documents/5-HillList.pdf


Universal Core 36

I like not want helpit more different who sheyou he where up onin over make get lookstop what turn can someput all that finished whygo do when here whoopen

Hatch, P., Erickson, K. & Geist, L. (2016). Core vocabulary AAC instruction for students with significant cognitive disabilities. . Presented at Assistive Technology Industry Association (ATIA) Conference. February 5, 2016


Universal Core Board

Flener& Nygard Copyright 2017

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Core Vocabulary and Sight Words

■ Early core words are made up of sight words

■ Of Banajee et al’s list of 23 top words used by toddlers, 19 are Pre-K and Kindergarten Dolch Sight Words

■ Of Hill’s 100 list, 64 are Pre-K, Kindergarten, and 1st Grade Sight Words


High Contrast Universal Core 36

Flener & Nygard 2017

Core Vocabulary and Braille

■ Braille alphabet letters when used alone represent whole words

■ Of the Universal Core Vocabulary First 36, there are 8 braille whole word signs


Strategies for Teaching Core Vocabulary

■ Direct selection of basic core words■ Build phrases and sentences using core

vocabulary■ Embedded core vocabulary with partner

assisted, auditory scanning, direct selection, eye gaze

■ Functional and classroom routines


TELL ME: AAC in the Preschool Classroom

Betsy Flener Ed.D. Copyright 2016

Teaching Early Language and Literacy through Multimodal Expression

TELL ME Program

■ A classroom-based approach to teach high frequency words (i.e. Core Vocabulary)

■ Uses repeated reading of 11 storybooks as a context for AAC instruction

■ Designed to be used with any AAC System introducing two-six core words within each book

■ Designed so core words are infused throughout the day


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4 Components of TELL ME

■ Shared reading ■ Shared Writing ■ Classroom centers and routines ■ Home extension activities


Video Example of Repeated Storyline Use in Classroom


https://www.youtube.com/watch?v=X0uvw172S8k

Additional Example of Storybook Use in Classroom


Aided language Stimulation

Aided language stimulation is a communication strategy, where a communication partner teaches a symbol’s meaning. The partner models language by combining his or her own verbal input while selecting the vocabulary on an AAC device, book, etc. In other words, the partner speaks and selects. It is often a good strategy for partner-assisted communication systems. The partner increases the number of vocabulary used as the student progresses.


Aided Language Stimulation■ Aided language stimulation encourages

functional communication within an activity-based framework.

■ The child’s communication partner point to a graphic symbol while simultaneously producing the corresponding spoken word during natural communicative exchanges.

■ Essentially, a multi-sensory approach to receptive language learning as the child hears the word spoken and sees it.

■ Requires planning and is why many ‘engineer’ their classrooms with materials and communication tools are readily available.


Language Acquisition Through Motor Planning

(LAMP)


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VI Options with LAMP


Video Example of Direct Selection with LAMP


Example Embedded Core with Auditory Scanning


Video


Video


Using Participate NOW in GoTalk NOW app with Auditory Scanning


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Modified Participate NOW Menu


Video


Case Study K


■ CVI with cerebral palsy and significant seizure disorder

■ Receives instruction via homebound services■ Mostly is positioned in various comfortable chairs

in the home■ Has stander that does not presently recline■ Other chairs do not allow for connecting a switch■ Has adapted golf cart

Case Study K■ Mostly auditory but will use

eye gaze to look between two moving toys/stuffed animals

■ Uses vision mostly for lighted objects and other lighted materials, and for movement

■ Attends to others mostly by listening

■ Expresses hunger by smacking her lips

■ Will blow with her mouth if she is uncomfortable

■ If asked if she wants to go outside, will look toward the door


Case Study K (cont’d)

■ Motivated by vestibular outdoor activities: riding in the golf cart, floating in the pool, going for a walk in her wheelchair

■ Drinks from a bottle and eats pureed food

■ Limited motor skills: Does not reach out, will grasp a wide object that is placed into her hand for a few seconds

■ When placed in a side-lying position, will turn head to operate a proximity switch

■ Current positioning does not allow for head use


Environment


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K and Routines

Current Routines

§ Eating and drinking§ Riding the Golf Cart§ Going out on the

property§ Reading to her§ Playing with toys

Additional Routines§ Vestibular movement to indicate

“more”: being rolled on a therapy ball, rocked in a chair, etc

§ Routines to encourage looking and taking ”turns” such as spin art

§ Grooming routine with lighted make-up mirror

§ Routines using Powerlink and the following: fan, CD boom box, leaf blower, lamp


K: Tasks and Tools

■ Increase core vocabulary beginning with: “more,” “go,” “want,” “finished,” “not”, and “help”

■ Increase her ability to express wants: “read,” “play,” “ride in the golf cart,” “go to the pool,” etc.

■ Make choices between books, toys, and activities■ Increase her ability to identify if she needs help or if

something hurts. ■ Use routines such as riding in the golf cart to learn

additional vocabulary: “stop,” “fast,” “slow,” “play”


Main Page: K’s Communication Book


https://

Pragmatic Organization Dynamic Display (PODD)

https://www.youtube.com/watch?v=kyV_SVGvT3Q


TactileTalk


TactileTalk and Core Vocabulary

TactileTalk Guidebook and Braille with Core Vocabulary


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TactileTalk Next Steps


iPad Tactile Overlay for Core Vocabulary


Cookie SheetCore Board

https://www.youtube.com/watch?v=mnyv8h6J4rc


Resources

Boardmaker: http://www.mayer-johnson.com/boardmaker-software

LAMP Words for Life app: https://itunes.apple.com/us/app/lamp-words-for-life/id551215116?mt=8.

Participate NOW for GoTalk NOW: https://www.attainmentcompany.com/gotalk-now

PCS High Contrast Symbols: http://www.mayer-johnson.com/nsearch/?keywords=PCS+high+contrast+symbols

Project Core: http://www.project-core.com/about-project-core/

TactileTalk: https://www.attainmentcompany.com/tactiletalk-toolkit


References

AAC TechConnect (2015). ACES module and toolkit approach. Retrieved from http://www.aactechconnect.com/freetools/?form

Baker, B., Hill, K., Devylder, R. (2000). Core Vocabulary is the Same Across Environments, California State University at Northridge (CSUN) Conference, Los Angeles, California. Retrieved on January 10, 2016 from: http://www.minspeak.com/students/documents/2000CSUN.pdf.

Baker, B. (2009). How Minspeak® Allows for Independent Communication by Giving Anyone Access to Core Vocabulary. Semantic Compaction Systems, Pittsburgh, Pennsylvania. http://www.minspeak.com/CoreVocabulary.php#.WHVh4lfw_ow.


References

Banajee, M., DiCarlo, C., & Buras-Stricklin, S. (2003). Core Vocabulary Determination for Toddlers, Augmentative and Alternative Communication, 2, 67 - 73. Retrieved on January 10, 2016 from: http://www.aacandautism.com/resources/commonwords.pdf

Berkowitz, S. (n.d.). Literacy for students with complex communication needs. Retrieved from: http://www.iser.com/resources/complex-communications-needs.html.

Dewart, H. & Summers, S. (1995). Pragmatics profile of everyday communication skills in children. Retrieved on December 2, 2017 from: https://communicationmatrix.org/Community/Posts/Content/8154.


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References

■ Flener, B. & Nygard, J. TactileTalk Toolkit and TactileTalk Guidebook for iPad: Strategies for Functional Communication and Literacy. www.closingthegap.com,dec.2016/jan.2017

■ Goossens', C., Crain, S., & Elder, P. (1992). Engineering the preschool environment for interactive, symbolic communication. Birmingham, AL: Southeast Augmentative Communication Conference Publications

■ Hatch, P., Geist, L., &Erickson, K. (2015). Teaching core vocabulary words and symbols to students with complex communication needs. Presented at Assistive Technology Industry Association (ATIA) Conference. 2015. Retrieved from https://www.med.unc.edu/ahs/clds/files/conference-hand-outs/atia_2015.pdf on November 1, 2016.


References

Hatch, P., Erickson, K. & Geist, L. (2016). Core vocabulary AAC instruction for students with significant cognitive disabilities. . Presented at Assistive Technology Industry Association (ATIA) Conference. February 5, 2016

Hill, K. (2001). The development of a model for automated performance measurement and the establishment of performance indices for augmented communicators under two sampling conditions. Dissertation Abstracts International, 62(05), 2293. (UMI No.3013368). Retrieved on January 4, 2017 from: http://www.minspeak.com/documents/5-HillList.pdf.


References

Hill, K. (2001). The development of a model for automated performance measurement and the establishment of performance indices for augmented communicators under two sampling conditions. Dissertation Abstracts International, 62(05), 2293. (UMI No.3013368). Retrieved on January 4, 2017 from: http://www.minspeak.com/documents/5-HillList.pdf.

Kortsten, J.E., Foss, T.V., & Berry, L.M. (2007). Every Move Counts, Clicks and Chats: Sensory-based strategies for communication and assistive technology. EMC.

Klieman, L. (2003). Functional communication profile: Revised. Austin, TX: Pro-Ed Inc.


References

Porter, G. (2012). Pragmatic organization dynamic display (PODD): Introductory workshop manual. Glen Waverly, Victoria, Australia: Cerebral Education Center. Roman-Lantzy (2007). Cortical visual impairment- An approach to assessment and intervention. New York, NY: AFB Press.Rowland, C. (2013). The Communication matrix for parents and professionals. Retrieved from: www.communicationmatrix.org

Zangari, C. & Wise, L. (2017) Tell me program: AAC in the Preschool Classroom, Verona, Wisconsin: Attainment Company.

What is LAMP? The Center for AAC and Autism. Retrieved on December 2, 2017 from: https://www.aacandautism.com/lamp.


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Challenges Thoughts to Consider - New Orleans, Lousiana is a strong connection between literacy and ... Instruction may have been primarily focused on visual skills rather than literacy