Context Based Communication for AAC Users

Editor's Notes

• #3: VICKI How we came to embrace context based: Avoided initially in lieu of core words, left to right sentence building, subject-verb-object, semantic categories, grammar etc. Linguistic skills we were taught to target in graduate school- These are really metalinguistic skills we expect for patients operating at a language age of 6-8 years. Most of our patients were functioning with language skills similar to 18 mos-3 years. Our patients had attention, memory and learning difficulties and were simply not making progress in independent navigation and use of their devices. Context based is more pragmatically and functionally organized. We found after years of instruction that we had patients who were stuck at a one word level, not progressing in their ability to navigate using categories or motor planning or simply did not succeed in recognizing and using abstract symbols.
• #4: ELISABETH 1.) For example, the environment you might be in would be the bathroom/bedroom/Chick-fil-a. Each environment would have a communication page with messages specific to the current place. These communication pages are different than an activity board in that they are developed to meet needs of the environment, rather than a specific activity (ie. bubbles, play-doh). 2.) People typically think context-based means ‘scenes’. The reality is that it does not necessarily include just scenes but can also refer to grid displays of contextually relevant messages. 3.) The focus is not on Subject+Verb+Object sentence creation but rather fluid conversations via single-button messages. 4.) The only way this works is if the messages are VERY specific to what the child wants to say.
• #5: ELISABETH We will be going through a way to systematically plan what messages are needed, specific to the person you are working with. There are forms and tools in your handout to help you plan and implement a successful context-based communication system.
• #6: ELISABETH For the next hour, we will be discussing the reasoning behind context-based communication and what it actually looks like out in the world with real patients. (Read points) Increase rate of learning social, interactive and control messaging Narrowing the field of potential messages to those appropriate to the environment Messages are contextually relevant, familiar and significant Symbols are more concrete and require less learning Increase access to messages through independent navigation Increase rate of interaction for frequently used messages Provide a means to introduce novel environments to decrease anxiety and increase successful interactions
• #7: ELISABETH These are concerns people have about context-based communication. 1.) The word ‘go’ might be in different locations on different pages, which MIGHT limit a person’s ability to use motor-planning to access a message. 2.) As we mentioned earlier…. 3.) For example, the tools to develop syntax and morphology are not available. Correct sentence structure, verb tenses, and word endings aren’t supported. 4.) It refers to the ability to create new sentences (ie. She helps me, he helped me), allowing the ability to be specific.
• #8: ELISABETH 1.) We rarely use context-based communication in isolation. There almost always is a combination of context-based AND core pages in a user’s device. Even if we are at a very basic teaching stage of core vocabulary development, we always include it in devices. 2.) LACK OF CONSISTENT PLACEMENT OF WORDS Use the placement of the word in the patient’s core vocabulary pages to drive the location of semantically similar messages in subsequent context-based pages 3.) Extensive modification needs. Yes, it does in fact take a great deal of modification in the beginning. It takes an hour or two of planning combined with 4-5 hours of modification in order to set up a comprehensive communication system that can be used in ALL environments. Keep in mind though that you don’t have to do this all at once (ie. work on one environment at a time). To make this manageable: Use of systematic collection of messaging needs in environments Train family or primary care providers to make basic modifications in real time as needed. You don’t introduce an entire language system to a child all at once, so why would you have to have his or her system perfectly set up in order to intro context-based concepts
• #9: ELISABETH Narrowing the field of potential messages to those appropriate to the environment Messages are contextually relevant, familiar and significant Symbols are more concrete and require less learning Now we’ll be taking a look at our patient Anne’s communication pages
• #10: ELISABETH Anne is one of our kids who has… Difficulty with comprehension of abstract symbols Appears to be not motivated by social interaction Social interaction is challenging. She typically communicates ONLY for requesting objects. We need to expand her functions of communication. GO TO BEDROOM PAGE->CLOSET-> BOOKS-> She is learning how to ask questions, make comments, and make actions requests without the navigation demand. I made an effort on this page to consider placement of messages- buttons on this page match where they would be located in other areas of the pageset (ie. ‘I can read it” is in the same location as “I” on Gateway, “read it” is in the same position as “read” in Gateway, “Let me see it” is located in the same position as ‘see’ under Gateway actions, “What’s that?” and “Wait” are in the same positions as their respective buttons in the ‘My Phrases- wants & needs/ questions”
• #11: ELISABETH Anne is one of our kids who has… Difficulty with comprehension of abstract symbols Appears to be not motivated by social interaction Social interaction is challenging. She typically communicates ONLY for requesting objects. We need to expand her functions of communication. GO TO BEDROOM PAGE->CLOSET-> BOOKS-> She is learning how to ask questions, make comments, and make actions requests without the navigation demand. I made an effort on this page to consider placement of messages- buttons on this page match where they would be located in other areas of the pageset (ie. ‘I can read it” is in the same location as “I” on Gateway, “read it” is in the same position as “read” in Gateway, “Let me see it” is located in the same position as ‘see’ under Gateway actions, “What’s that?” and “Wait” are in the same positions as their respective buttons in the ‘My Phrases- wants & needs/ questions”
• #12: VICKI Faster access to environmentally significant messages Conceptually easier- match photo to environment- no need to understand categories Don’t need to understand categories or associations to navigate to messages
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• #15: ELISABETH (READ this)
• #16: ELISABETH Kasey is a highly determined girl who wants to be as independent as possible. She demonstrates: Decreased rate of communication secondary to motor difficulties Social motivation is limited by the effort necessary to interact Working to increase independence in the community One of Kasey’s favorite activities is going to Chick-fil-a. In this video, you will see Kasey using the iPad with Compass software to order lunch.
• #17: ELISABETH Here you see the pageset that she used in the video. Note how Kasey was able to independently navigate through these pages to order food. Note that Chik Fila is regularly occurring, thus what is happening is that we are increasing rate of communication of routine phrases less navigation less activation of buttons less segmented messages
• #18: VICKI Robert: Social anxiety Difficulty with delayed gratification Anxiety with functional demands Strong motivation to communicate and participate Faster communication to decrease anxiety during functional living activities Uses core for requesting, describing, basic responding in familiar environments with familiar partners for motivating activities
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• #22: VICKI-show but not detailed discussion Basically we rarely if ever use context based pages in isolation- pair with core vocabulary, social messaging and keyboards
• #23: VICKI Even if we are using a core words multimeaning icon organizations, we may still use a discussion of context during the learning stages of navigation. Doesn’t have customized context based pages but is learning through the use of associating symbols with environmental demands for some multimeaning icons- for example: bathroom leads to verbs, adjectives and nouns used in the bathroom; bedroom leads to nouns/verbs/adjectives used in his bedroom
• #24: VICKI Visual Processing Considerations: CVI color preferences -variable level of vision loss with fluctuation over time -poor attention to visual stimuli- complex visual and environmental stimuli -delay in response to visual stimuli -difficulty visualizing new surroundings or objects (better with familiar images) -light gazing -better vision for animated displays (moving objects) difficulty with central vision (use peripheral vision) Symbol Comprehension: level of abstraction the patient understands: photos, drawings, symbols- Do they need actual photos of their environments or can they use drawings of a generic living room? Does the device we are considering have the tools we need to create and use visual scenes? Do we need to use grids? Physical Access: do we need a keyguard? Can we make the scene fit the keyguard to have the hotspot line up with the grid?
• #25: ELISABETH Dynamic Therapy Intervention Planning Form is in your handout & the DAGG (Dynavox Schedule of Daily Routines) is available for a free download from the Tobii Dynavox website. Easy to follow and provide the steps for creating a complete context-communication system. In our clinic, we sit down with each patient and their family to fill them out, in order to make sure the communication system we’re providing the patient with will fully meet their needs.
• #26: ELISABETH Here’s a sample of the Dynamic Therapy Intervention Planning filled out.
• #27: ELISABETH show but not detailed discussion And here’s a sample of the Dynavox Schedule of Daily Routines form filled out
• #28: VICKI- show but not detailed discussion
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