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

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Video Disclaimer A special thank you to all the children and their families for letting us show these beautiful children for educational purposes. The videos dont lie. They show children doing amazing thingssometimes because of the therapist facilitation and sometimes in spite of the therapist. Nobody is perfect but we are willing to show the dos and the donts.

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(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 How are we defining Multiple Disabilities?

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

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Not a Straight Road to Communication Lets break it down!

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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.

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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

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

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High Contrast

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AAC Considerations:

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Apps to check out:

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E v e r e t t

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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

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AT Options http://www.ablenetinc.com/Assistive- Technology/Communication https://enablingdevice s.com/catalog/assisti ve_technology_devic es_used_in_educatio n/take-talk-series

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Hearing Impairment http://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.

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K y a n d e r

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Kyander Age: 3 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

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AAC for Kyander http://saltillo.com/products/nova-chat-10 Visual Feedback Tactile Feedback

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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.

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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)

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

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Switches- Size and Sensitivity Micro Switch Big Mac Switch

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Pressure Switches Spec Switch Buddy Button Pal Pad Switch

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Gooshy Switch String S witch Grip Switch

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Wobble Switch Ribbon Switch Ultimate Switch

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

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

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

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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.

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Communication through Choice Boards & Partner Assisted Auditory Scanning

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

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S a n t a n a

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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

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

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Santanas 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

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

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Go Talk Now Home Page

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Go Talk Now

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Sensory Choices

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Songs Videos

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TV Toys

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Academics

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Go Talk Now Other Ideas Scanning Scene Displays Songs & Audio Books

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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.

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S e t h

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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

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

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B e l l a

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Bella Prader Willi 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

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

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L i l y

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Lilyanna Age 11 Dx: Atypical Rhetts Vision: CVI Hearing: Normal Motor: No voluntary movement; EyeGaze Cognition: ? Choice Making, Core Words Communication: Tobii I-Series

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C a m d e n

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Camden Age 3 Dx: Pelizaeus-Merzbacher Disease (Rarest form of Leukodystrophy) Vision: CVI Hearing: Normal Motor: spastic CP Cognition: ? Communication: Tobii I-Series

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Eye Gaze Tobii I-Series 15 - www.tobii.com/assistive-technology/global/products/hardware/tobii-i-series/ Sensory Guru www.sensoryguru.com/products/i-series/ Flopper Stopper www.rjcooper.com/flopper-stopper/

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No Shortcut to Ongoing Evaluation 1. Know diagnosis and then challenge each aspect Know preferences so you have a hook (Likes and Dislikes Checklist) Provide Multiple opportunities to succeed Use a Team Approach Critical Considerations: Outcome Trial usage Continually monitoring progress All environments

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Gathering Data Form

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Tools Selection and Trials

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Tools and Trials Cont

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Learning Software & Supports Boardmaker http://www.mayer-johnson.com/ Unique Learning Systems & News2You http://www.mayer-johnson.com/ Classroom Suite http://www.cambiumlearningtechnologies.com/ Life Skills Software and Apps by Attainment Company http://www.attainmentcompany.com/

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Resources for AAC Data Collections Beukelman, D. R., & Mirenda, P. (2005). Augmentative alternative communication: Supporting children & adults with complex communication needs (3rd ed). Baltimore: Paul H. Brookes Publishing Co., Inc. Burkhart, Linda J. & Musselwhite, Caroline (2001) Can We Chat? Scaffolding Conversations for Struggling AAC Users L http://www.lburkhart.com/canwecha2p.pdfhttp://www.lburkhart.com/canwecha2p.pdf iCAN. (2000). Why is choice-making important? Retrieved January 2011, from: http://www.autismnetwork.org/http://www.autismnetwork.org/ Kintsch, A., & DePaula, R. (2002). A framework for the adoption of assistive technology. Retrieved from: citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.124.372 6&rep=rep1&type=pdf

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References Wisconsin Assistive Technology Initiative http://wati.org/ The Magical BoxResources: CVI and Complex Communication Needs www.curlewapps.com/Blog.html Linda Burkhart and John Castell0 www.lburkhart.com/lindaJohnCVIhandout.pdf American Printing House for the Blind http://www.aph.org/cvi/define.html Simplified Technology by Linda J. Burkhart http://www.lburkhart.com/index.html

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Additional Resources Family Center on Technology and Disability- Instruction Technology in Early Childhood: A New Way for a New Day www.fctd.info/assets/newsletters/pdfs/307/FCTD- TechVoicesmar13.pdf?1372995063 Integrating Technology in the Classroom: a Teachers perspective www.fctd.info/assets/newsletters/pdfs/306/FCTD-TechVoices- 135.pdf?1369774667 iPad and Apps: Learning tools for Young Children with Multiple Disabilities http://idahotc.com/Portals/0/docs/2013webinars