AAC and Multiple Disabilities

1. AAC and Multiple Disabilities Melanie Conaster OTR/L Brenda Del Monte MA CCC-SLP

2. A special “thank you” to all the children and their families for letting us show these beautiful children for educational purposes. The videos don’t lie. They show children doing amazing things…sometimes because of the therapist facilitation and sometimes in spite of the therapist. Nobody is perfect but we are willing to show the do’s and the don’ts.  Video Disclaimer

3. How are we defining “Multiple Disabilities”? • (h) Multiple disabilities means concomitant impairments, the combination of which causes such severe educational needs that they cannot be accommodated in special education programs solely for one of the impairments. The term, multiple disabilities does not include deaf-blindness. (Washington State) WAC 392-172A-01035

4. Areas of Concern • Vision • Hearing • Motor • Sensory • Cognitive • Communication Sometimes the answer is: All of the Above

5. Not a Straight Road to Communication Let’s break it down!

6. Vision • Blind – no vision at all • “Functional” Blindness - A person is functionally blind when he or she has to use so many alternative techniques to perform tasks that are ordinarily performed with sight that his/her pattern of daily living is substantially altered.  Such alternative techniques might include reading a newspaper by listening to it over the telephone or using Braille to read a book.

7. Cortical Visual Impairment • Neurological vision disorder rather than ocular (although they can co-exist) • Disturbed or reduced vision due to various brain abnormalities • Symptoms include variable vision, a limited field of vision and depth perceptive challenges

8. Stimuli needs to address: • Color • Contrast • Simplified symbol set • Lighting • Auditory Support

9. High Contrast

10. AAC Considerations:

11. Apps to check out:

12. E v e r e t t

13. Everett • Age 5 • Down Syndrome • Functionally Blind (can see some light) • Attending Foundation for the Blind for Preschool • Splits time in Special and General Education • Hearing is normal, not crawling yet, non verbal

14. AT Options http://www.ablenetinc.com/Assistive-Technology/Communication https://enablingdevices.com/catalog/assistive_technology_devices_used_in_education/take-talk-series

15. Hearing Impairmenthttp://ada.ky.gov/hearing_imp_def.htm • A hearing impairment is a hearing loss that prevents a person from totally receiving sounds through the ear. If the loss is mild, the person has difficulty hearing faint or distant speech. A person with this degree of hearing impairment may use a hearing aid to amplify sounds. If the hearing loss is severe, the person may not be able to distinguish any sounds. There are four types of hearing loss: • Conductive: caused by diseases or obstructions in the outer or middle ear that usually affect all frequencies of hearing. A hearing aid generally helps a person with a conductive hearing loss. • Sensorineural: results from damage to the inner ear. This loss can range from mild to profound and often affects certain frequencies more than others. Sounds are often distorted, even with a hearing aid. • Mixed: occurs in both the inner and outer or middle ear. • Central: results from damage to the central nervous system.

16. K y a n d e r

17. Kyander • Age: 3 ½ years old • Hearing Loss – Severe to profound • 30% Sensory Neural Hearing Loss; 70% Conductive Hearing loss • Due to a rare genetic disorder – no known cases • Functioning at a 9-13 month level with splintered skills • Tube fed, beginning to crawl, vision in normal, non verbal

18. AAC for Kyanderhttp://saltillo.com/products/nova-chat-10 • Visual Feedback • Tactile Feedback

19. Motor Limitations Motor impairment is a limitation of muscle control or movement of the body. This may result in weakness, poor stamina, lack of muscle control, or total paralysis. Motor impairment can be a result of neurological conditions, cerebral palsy, stroke, or indicative of other diagnosis.

20. Access Methods • Direct Selection: • Touch or • Mouse or Eye-gaze control with dwell • Indirect Selection: • Alternative input method with scanning (such as use of switches)

21. Motor: Access Sites & Movements head eye, chin, mouth finger, hand, forearm elbow, knee, thigh, foot. (www.customsolutions.us)

22. Switches- Size and Sensitivity • Micro Switch • Big Mac Switch

23. Pressure Switches Spec Switch  Buddy Button Pal Pad Switch

24. Gooshy Switch String Switch  Grip Switch

25. Wobble Switch                    Ribbon Switch Ultimate Switch

26. Motor: Access Considerations • Voluntary and repeatable movement • Excursion of movement • Timing Involved • Stabilization of non moving parts (www.customsolutions.us)

27. Switch Training Software & Apps Repetition with Variety http://helpkidzlearn.com/ https://www.judylynn.com/ http://www.janefarrall.com/html/ipad.html

28. Mounts RJ Cooper Magic Arm www.rjcooper.com/tablet-mounts/index.html Mount’n Mover Daessy– Lite Mount http://www.daessy.com/ ModularHose www.modularhose.com Rehadapt Custom Mounting Solutions www.rehadapt.de/products.php Snake clamp http://snakeclamp.com/

29. Communication Strategy Repetition and consistent practice help the student pair physical actions with Yes and No. Yes: Chin Tuck No: Head turns away Assistive Technology The strategy was reinforced by via social interaction and by using switches and single message devices which would say :”Yes” and “No” when action/ movement was Initiated.

30. Communication through Choice Boards &Partner Assisted Auditory Scanning

31. AAC Devices • High Contrast (VI) • Visual Input upon selection (Multiple Disability) • Auditory Preview (VI) • Text, sign, video (HI)

32. S a n t a n a

33. Santana • Age 8 • Dx: Near Drown at 18 months • Hearing: Mild loss • Vision: CVI • Motor: Right wrist movement, right head movement emerging • Cognition: ? • Communication: Cause and Effect, Choice Making

34. Santana’s Functional Needs • Communicate needs/ health and comfort issues • Participation in school activities • Choice making • Body awareness • Interaction with peers www.lburkhart.com/handcvi.htm

35. Santana’s 2014 Goals • When presented 2-4 choices, Santana will use his aid com to make reliable choices on 8/10 opportunities. • More and all done / yes and no • Santana will demonstrate 1-to-1 correspondence with numbers 1-4 on 8/10 opportunities. • Santana will improve interaction skills by participating in greeting friends on 8/10 opportunities • Santana will express an emotion from a field of 3 on 8/10 opportunities

36. iPad, Apps, Mounting Solution CJT Mounting • http://cjtmounting.com/index.php Wobble Switch Super Switch Interface

37. Go Talk Now – Home Page

38. Go Talk Now

39. Sensory Choices

40. Songs Videos

41. TV Toys

42. Academics

43. “Go Talk Now” Other Ideas Scanning Scene Displays Songs & Audio Books

44. Adaptive Accomplishments • Santana now responds “Yes” with a wrist movement within 3 seconds of an auditory choice. • He activates the switch to make choices on the iPad from a field of 4 choices and to activate apps. • He participates in social interaction and activities with peers via the Go Talk app. • He is beginning to work on basic academic skills such as numbers 1-5 and colors using simple academic apps.

45. S e t h

46. Seth • Age 6 • Vision: Ocular and Neurological Impairment from birth as a result from Congenital Human Cytomegalovirus • Hearing Profound loss in Right ear, Moderate loss in Left (Progressive) • Motor: variable, has crawled in the past, whole hand direct select with keyguard • Communication: some vocalizations, non verbal • Cognition: ? - Cause and Effect, Choice Making, Core Words Emerging

47. AT for Seth • Motion Table • Cause and Effect • Cause and Effect • Sensory Light Box App • NovaChat • Actual Objects • Visual Feedback • Tactile Feedback • Auditory Feedback

48. B e l l a

49. Bella • PraderWilli Syndrome • Hearing: Normal • Vision: Farsighted with corrective lenses • Communication: some vocalizations, non verbal • Cognition: ? Choice making, navigation skiils • Motor: Scoots, crawling, direct select with keyguard, now eating by mouth

50. Bella Games • ENGAGING GAMES • So Big • Airplane • Crash!! • Peek a boo