Claire
May 2021
Who is Claire?
Claire is a spunky girl who knows what she wants and what she wants to talk about. Unfortunately, sometimes her body doesn’t want to cooperate with her, making accessing tools difficult. Claire is a typical 9-year-old who is curious about everything around her especially when and where her family members are going and when are they going swimming. She is surrounded by a devoted and very busy family, being the youngest of four siblings, which works just perfectly for Claire who enjoys being on the go and in the middle of everything. She is another individual who is a total communicator whether it is a yes/no nod done with sass, approximated all done sign, positively or negatively toned vocalizations, or a suggestive goodbye wave Claire gets her point across. She has also been using an Accent 1000 from Prentke Romich Company with Unity 84 sequenced for the last year to be able to expand on her language and communication skills.
Claire’s journey with AAC has been a bit of windy road. It started with an AAC report that recommended the use of a Big Mac for basic communication interactions. After meeting Claire and observing how much she was communicating and trying to communicate nonverbally she started trials with an iPad with Proloquo2Go with a 15 button overlay with the focus on communication partners modeling communication and direct selection, although Claire’s access was impeded at the time, she was successful with direct selection through a finger point with support from a keyguard, a plastic grid around the buttons. Unfortunately, a significant seizure negatively affected Claire’s motor control and other access points were looked at as direct selection did not seem like a viable option, after several months of trying. She trialed several devices that utilized eye-gaze access and settled on Prentke Romich Accent with Unity. During the assessment and trial period much thought went into the vocabulary overlay. We, family and clinician, considered Claire’s struggles with access (Eye gaze is NOT as easy as one might think) and weighed navigational demands, Claire’s current language level and potential language level when deciding on vocabulary level. Within Unity there are several vocabulary levels, 12, 28, 45, 60, 84, 144 and within each level there is one-hit and sequenced (where a button selection links to another page). After much thought we went with Unity 84 Sequenced as it gave Claire access to a higher level of language. Eye gaze access would continue to be practiced and used as well as partner assisted access to decrease any frustration she may have while learning the vocabulary.
TechTip: Ease of Access via Lite-Tech
What is goal/purpose?
For individuals with complex communication needs (CCN), as well as motoric deficits the ability to access communication can be a large barrier. Also... just because someone has a motoric deficit doesn’t mean they don’t move, or don’t enjoy moving. So, positioning, flexibility, and portability can contribute to difficulties with access.
How is it used?
For Claire, access to lite-tech, paper-based communication supports are important. Lite-tech supports are where Claire demonstrates the most initiation and independence. Although the high-tech AAC offers her access to a larger vocabulary, access to the high-tech tool is limited, at times, due to positioning and the task. When not at a table Claire is able to scoot and initiate communication with her lite-tech, life-sized, interactive language board to communicate beyond items in her physical environment (request a bath, ask to eat, share that she was tired, etc.). When Claire has the supports and is positioned optimally, high-tech AAC is her way to access communication. However, lite-tech AAC supports her independence at home, with multiple tasks and positions.
Assistiveware shares some more examples of the use of both lite-tech and high-tech. https://www.assistiveware.com/learn-aac/high-tech-or-light-tech-aac-for-any-situation
Most AAC companies have access to files to support speech therapist, special education teachers and families in making lite-tech supports:
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Proloquo2Go: https://www.assistiveware.com/products/proloquo2go#download-core-word
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PRC: https://aaclanguagelab.com/resources?category=manual-boards
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Tobii/Dynavox: https://us.tobiidynavox.com/products/core-first-communication-books
How is it accessed?
The interactive board is assembled and adapted by Kristen Flynn and Andrea Saville White, M.A.CCC-SLP from a life-size manual 84 core board from Prentke Romich Company. Kristen used two posters and cut one of them up and used Velcro to make the words selectable. Then, Andrea supported expansion of key vocabulary for Claire with the larger pages which reflected some of the sequenced vocabulary under that button. The top pages were an addition once Claire’s communication was expanding beyond the language board.
Communication partners also use the lite-tech language board for aided language stimulation when modeling language expansion and phrase construction.
TechTip: Realize Language
Realize Language from Prentke Romich Company is a tool used to import data from a communication device to measure, monitor, and maximize an individual's AAC use. Data collected provides the parent, clinician or educator with when the device is being used (to identify what was working in those moments to generalize to other moments), analyze the data to identify the parts of speech being used, and a vocabulary cloud or wordle that shows words that are used more often as larger text than others. Realize Language is a visual referent for the family, educator and clinician to monitor progress.
What is goal/purpose?
For Claire and her team, we use the data from Realize Language to provide input on what needs to be modeled or targeted. Aided Language Stimulation is not marked separately within the data, so we know that some of the data we see is what we are modeling and using. We know that when using eye gaze Claire will often rest her eyes at midline and there are common words she references, so we know to take those words out of the sampling (thank, thankful).
How is it used?
We review the data collected each month to identify what might be lacking, such as question words or prepositions. So if, as a team, we want to work on Claire asking where questions, such as "where is Dad" or "where are we going?" then next month we should see where in our wordle. We are also working on embedding descriptors into her responses and will hope to see more adjectives in her next month's sample. Yes, we know that this might be from us modeling, but we know if we model and use vocabulary, we tend to see Claire understanding and using these words later on.
How is it accessed?
Realize Language allows us to export a report with the visuals as shown above to reference and compare the difference over months. Sometimes it is difficult to see progress when we look at day-to-day data. Being able to take a broader look at data along with objective data on prompting levels allows us to see the progress or areas of need. We see patterns based on the theme or topic of interest for Claire. This past month we were focusing on interjections and were excited to see good, groovy, awesome, oh, yikes, oops, please, wow, and sorry. Claire and her mother were reading The One and Only Ivan book, so we are not surprised to see Ivan, crayon, and animal.
TechTip: PRC's Literacy Planner
Prentke Romich Company has recently published (last year and this year) a Literacy Planner for learners who use AAC. The 2020 Literacy Planner seemed to focus on a younger leveled audience, with more picture books. The 2021 Literacy Planner focused on higher level chapter books without many images in it. Both planners have a lot of extension activities that incorporate the vocabulary and themes. Claire’s mom was the one who first found the 2020 Literacy Planner on the AAC Language Lab. It was a concise planner with ease to follow outlines, video links, and directions.
What is goal/purpose?
Communication, vocabulary, literacy, and fun. The planner has consistent and predictable activities you go through and reference before you begin reading, when reading and following completion of reading the book. This helps the learner build their own inferencing skills, describing character traits, learn vocabulary within context of a book and learn what they like and don’t like about different texts. For Claire this planner provided her mother structured activities to model AAC use during as well as literacy activities to expand her literacy skills and vocabulary.
How is it used?
Claire and her mother’s favorite activity from the Lesson Plan is the grab bag activity, which is one of the activitiies to build background knowledge prior to reading the book. After building background knowledge you move over to the Getting Ready to Read activities, such as pointing to the author, reading the title, making a comment, etc. And then, during the Reading, reference the items from the grab bag, listen for a certain letter sound in words, etc. After the reading it includes activities to review the chapter and reflect.
The grab bag activities involve taking the list of items or pictures of items suggested by the planner and putting them in a bag. Then you use the Book Bag Bag Grab worksheet to describe each of the items. As you read the book you then fill in who used the item.
Here is a video of Hillary explaining and completing a Book Bag Grab activity with items from one of the books we are reading this summer at camp. This example does not use the Grab Bag graphic organizer but does go through some of the steps of the activity.
How is it accessed?
The Literacy Planner is available as a PDF. You can also reach out to your local PRC representative for a paper copy of the planner.
