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Annie WANTS to Communicate, However Slowly!



Annie has cerebral palsy, with no speech and is also severely visually impaired. Her visual processing was extremely slow and she could only cope with one or two large size symbols at a time.

CALL assessment showed that the effort of trying to listen to what people were saying, think of what she might want to say, visually process a symbol display and a scanning cursor, and coordinate that with a timed switch press (by hand) all at the same time was just too much for her. Frustration ++! She turned out to be much better at using her head to hit a single switch, and to be very good at auditory scanning. By taking the need to use visual processing out of the equation, she speeded up and greatly expanded her range of vocabulary.

The challenge

Annie is now 14, with cerebral palsy and no speech. She is also severely visually impaired. Annie is really sociable and funny and she understands others' language very well – she has a lot more to say than 'yes' and 'no'.

Annie attends a special school for pupils with multiple disabilities including visual impairment. Much effort had gone into helping her to use the small amount of vision she had, but her visual processing was extremely slow and she could only cope with one or two large size symbols at a time.

Our approach

CALL assessment showed that the effort of trying to listen to what people were saying, think of what she might want to say, visually process a choice of symbols and a scanning cursor, and select a symbol by hitting a switch with her hand all at the same time was just too much for her. Frustration ++ !

She turned out to be much better at using her head to hit a single switch and she was an absolute 'whiz' at auditory scanning (aka 'auditory prompts'). In other words, so long as she heard a voice saying each symbol item as the cursor passed over it, she could execute an accurately timed switch press more or less faultlessly. By taking the need to use visual processing out of the equation, she speeded up and greatly expanded her range of vocabulary. Not only could she manage pages with 12 symbols/messages, she learned how to navigate from a 'Home page' to different topic pages, and back again. She found it especially enjoyable to find the page that opened with "I'm the Boss, you have to do what I say" and to command hapless staff to "do ten star jumps"!

In spite of her success, communication is very slow. Annie was therefore better served by complete messages and key words/short phrases; it was not realistic to expect her to form sentences word by word, and thus she did not need a complex device with spelling, internet connection, and all other possible bells and whistles. CALL recommended a DynaVox M3 device, with digital (recorded) voice output, operated by a single head switch, which school staff found pretty simple and user-friendly (alternatives might have been a GoTalk 32 Express; Sounding Board App for iPad).

Impact

Following CALL recommendations, purchase was rapid as Annie's local education authority had been waiting to identify an appropriate aid - just wanted to be sure it was one that would be used (having had past experience of over-complex devices that got left in cupboards…) A wheelchair mount was purchased as well, so that Annie could take her device both around the school and 'out and about' with her family – they seem to have a busy life!

Her communication is slow, there is no denying it, but Annie loves her voice output device and loves being able to speak for herself at last. However slow and effortful it seems to us, it is a huge breakthrough for her!

At the time, there had been discussion about whether blind children would get confused by a 'real person's' voice. In practice, the user didn't get confused. However, over time, it seemed that staff were struggling, and Annie is now trialling an Windows-based DynaVox V Max device, that has text to speech which is quicker to program, and that sounds more consistent than recorded speech.

For CALL, Annie's case raises two huge questions:

  1. Why do so many specialists still overlook the power of auditory scanning as a means of access (and continue to hammer away at what the child can't do – i.e. use vision, instead of what they can do – i.e. use hearing and linguistic ability)?
  2. Why is SHE so highly motivated to communicate in spite of how slow and difficult it is for her, when so many other (perhaps less heavily disabled) children seem to give up so easily or never quite 'get' the point of independent communication? (wish we could bottle it, if we could identify it!) Is it because of something in her environment - what? - maybe the fact that she has a twin as a role model and in a sense as a competitor?