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Dr. Caroline Ramsey Musselwhite

Sunday, November 8, 2020

Device Adoption and Abandonment

I wrote this in a response to a question posted in the ASHA Special Interest Group SIG 12. Somebody asked if we could define which AAC systems or vocabularies are more likely to be adopted long term or abandoned to collect dust on the shelf. I have modified the format slightly to create this blogpost.



I myself have devices in my home that are still on the shelf gathering dust because I could not bear to throw them away or bother to take them to electronic recycling center. A couple that come to mind – an old iPod, a pager, an old PDA, and even a cell phone. That doesn’t mean they weren’t great devices; the technology just changed and I moved on to other things. And the AAC tools that I have used with my clients have changed over the years, as well. If I dug through my boxes, I am sure I would find old spare batteries and screen protectors that don’t fit anything any more. And some light and mid tech devices that have corroded batteries, waiting for the perfect person to donate them to.  I loved these things so much that I was afraid to let them go, and instead forced them into exile on my shelf.


What Is Long Term Device Adoption?

I think sometimes there is a fundamental problem in identifying “long term AAC device adoption.” We are becoming aware of how critical it is to provide multiple modes of expression to people who are not able to consistently access intelligible verbal speech. What we need to be careful of is avoiding mandating modes and discriminating against those who value other methods of expression over high tech AAC systems.  We all choose different methods of expression depending on the dynamics of the interaction. So, when asked if a person uses AAC, we may get different answers from that person, from his/her communication partners, and from the casual observer. 


Expectations of Outcomes.

Another consideration is the expected outcome from long term adoption of AAC. For some people, using symbol-based AAC is a way to reduce the stress of verbal speech in specific instances. Over time, the AAC tools used may vary, even throughout a single day. Others learn to visualize and integrate some techniques to become more verbally fluent and foster friendships with those who take time to learn their speech patterns. Using high tech AAC may be less frequent, but not necessarily less valued by those individuals and the people who care about them. 


Using Literacy to Support Communication.

Another end goal for AAC is having the tools necessary to say “whatever you want, whenever you want to whomever you want (Gayle Porter).”  In the AAC Profile (Tracy Kovach), achieving the highest levels of operational proficiency with a communication device includes being able to program it independently.  Most communication applications are currently configured in a way that customizing and saving messages to be used at a later date requires at least some literacy skills.  Achieving the highest levels of proficiency in strategic skills may also incorporate literacy skills.  Finding where words are located in robust pre-programmed systems is easier when you can access the letters of the alphabet (e.g., look for pages of verbs that begin with “S,” or search for words that start with “B” at the beginning of an alphabetized category page).  Vocabularies such as WordPower Basic 60 are highly robust and support sentence-building, morphology, and even spelling patterns (pages for phonetics, word families, and word prediction).  The same can be true for many grid-based robust AAC vocabularies (Crescendo, Snap + Core First, SuperCore for Grid).  But once they have achieved a level of literacy, many adults will use other tools that are more integrated into their other communication tools. If they can use the keyboard on a computer, smart phone or tablet, they are likely to use that instead of trying to start from an AAC app because it is one less step. Again, this wouldn’t diminish the value of AAC for certain situations – if they find using social media and email a more comfortable method of connecting with others, the use of other AAC tools may not be as prevalent in day to day interactions. Individuals who need alternate access are likely to use other adapted on-screen keyboards and may or may not identify them as AAC if not tied to speech output (such as the use of alternate keyboard in Grid, Communicator, or even Essence).


Inherent Differences in Language Systems.

There is also a significant difference in symbol-based strategies for word retrieval. People who use semantic compaction and icon sequencing (e.g, Unity, Unidad, LAMP Words for Life, Speak for Yourself) learn different ways to expand their vocabulary exponentially based on icon combinations. Having everything on the home page has potential to provide quick access to thousands of words without using spelling.  I have known many adults who use icon sequencing long term and have figured out ways to integrate this system into other social media by using it as an alternative keyboard. 

Summary.

I don’t know if this necessarily answers your question, but may help you figure out another way to ask more specific questions. Think about whether you are asking the people who are teaching AAC, learning AAC, or living with a family member who had diminished capacity for intelligible speech. Think about why somebody might adopt a different piece of technology over time and remember not to jump to the conclusion that what was used earlier was any less valuable just because it isn’t being used now.  

Consider asking about the value of a tool that may have had only a brief period of brilliance, but nonetheless was life-changing. For some of the people that I have connected with, people who use AAC have lifelong relationships with their speech/language pathologist. So even though many people I am friends with on Facebook don’t use AAC with everybody, and may not even use it very often, it was what drew is together in the first place. Identifying as someone who loves AAC and values multimodal expression makes me part of a diverse community. 


Look for me in lots of Facebook groups, connecting with people who use and/or advocate for use of AAC. Wish me luck in creating my new website: LanguageAACtivist.xyz


Deanna K Wagner, MS/CCC-SLP

Email: outandabout@therapyone.com


Saturday, October 24, 2020

Un Poco Loco about Disney’s Coco (Celebrating Day of the Dead)

Posted by Deanna Wagner, after watching the virtual Day of the Dead Celebrations.

"AY MI AMOR, the way you keep me guessing, you make me 

UN POCO LOCO"

Although using AAC in more than one language can be challenging, we need to remember that it isn't just words.  Communication is connection - to our families, our culture, our feelings.  

Are you feeling “Un Poco Loco” this time of year? The Disney/Pixar movie “Coco” reminds of the depth of vocabulary when we provide access for English-Spanish communicators.  Released in 2017, this movie was showing again at Harkins theaters this month and is available for purchase at Target, Wal-Mart and streaming on Amazon.  And you can get the soundtrack on Spotify, iTunes, Apple Music, and Google Play.  In this movie a young aspiring musician sets out on a journey to discover his family’s traditions.  Why am I mentioning it?  Because it is absolutely beautiful!  Beautiful to watch and beautiful to listen.  The switching back and forth between English and Spanish used to share memories that are ingrained into the cultural message in this movie was so perfect and seamless.  

Learn more about the movie here:  https://en.wikipedia.org/wiki/Coco_(2017_film)

And be sure to listen to this amazing bilingual song on YouTube! Poco Loco

Check out Disney’s activities at this link. https://movies.disney.com/coco

Day of the Dead is an awesome time to talk about our families, memories, and favorite stuff.

 


And look for opportunities to celebrate and support switching between English and Spanish (in your AAC systems and in all the ways you use to express yourself) to celebrate the richness of language and culture.  Last month I shared a table with some of the apps I have been exploring in order to share with families who speak both languages.  

Look for the table at the bottom of this post: Building My Spanish Language Skills

You can also find the table on PrAACticalAAC.org as part of my guest blog from October 19, 2020. 


Live Drawing During Storytelling: Using Book Creator

 Live Drawing During Storytelling

by Caroline Ramsey Musselwhite 

 WHY.  So, I'm trying to 'up my game', making Literacy Group more interactive. My group has told me in the past that they really like it when I show videos where an artist illustrates as they describe. So, I decided to try to illustrate it as I shared the folk tale.  

 

WHAT.  Live illustration of a folktale.  We are studying Scotland in Literacy Group, and I wanted to share
a folktale.  I found a great website with a wide range of tales:  Fairytalez

 

You can search that website by region, and I found a lovely story that was listed as both short (less than 5 minutes) and easy (simple vocabulary, with limited local dialect).  I chose The Gillie Dhu  because it met
those criteria, was interesting, and would be easy to illustrate.


HOW.  I read the tale a few times, and picked some parts that would be easy and interesting to illustrate.  I chose the Book Creater app, as it's quite simple, but allows very quick access to:  typing, inserting photos, drawing, and recording.  The drawing was especially helpful, because it includes:

- multiple colors

- three choices for line thickness, and, most importantly,

- and undo button!!

 Before the Storytelling.   First, I started the story, making about 14 pages with text.   I drew a couple of pictures in advance, to save time (e.g., Jessie).  I also stored a few pictures in advance (e.g., Gillie Dhu, animals), to make it go more quickly. 

During the Storytelling.  I I'm not an artist by any stretch, but I was quickly able to:

- Add to drawings.  For example, I drew in the woods as I illustrated the page describing how Jessie walked in the woods.  When she started crying, I added tears to her face.  On another page, the


Gillie Dhu says to Jessie:  “Your tear-drops are falling like dew on the blue flowers at your feet!”  So I quickly drew both teardrops and blue flowers at her feet.


- Insert photos.  As I got to the part about the Gillie Dhu, I inserted his photo.  Similarly, I added each animal as the Gillie Dhu talked about knowing all the parts . . . the rabbit's path, the hare's path, the fox's path, etc.

 

 

REVIEW.  Happily, this first adventure went really well. I think it added to the story engagement (e.g., pulling in animal pics as I narrated, drawing her home
'live). It was a way to add visual supports that were kind of animated. At the end, one student used her eye gaze device to say MOST POWERFUL and another said. LOVE IT. GREAT. GOOD JOB. Really really made my day!

 

Sunday, September 27, 2020

Building My Spanish Language AAC Skills

By Deanna Wagner

  

As an AT professional who supports families who speak Spanish at home, I am always looking for ways to brush up on my AAC vocabulary and Spanish terminology.  I am not a native speaker, so I have a lot to learn!  


Here are 5 ways I have built up my Spanish skills over the years:

  1. Traveling and making friends in other countries.  Immersion experiences really help us to feel confident that we are not just learning the words, but really figuring out how they work.  This is a good lesson for people using AAC.  Getting better at speaking the language through interactions with native speakers gives us both experiences and feedback.  I have not always been great at this, but keeping in touch afterwards has also helped me to build my skills.  I have shared my insecurities about social conversations with my travel companions and they now help me by chatting occasionally with me on Skype, Zoom, Facebook Messenger Live and WhatsApp.

  2. Studying the programming menus to learn the technical words.  My travel companions have not always been knowledgeable about AAC terminology.  The best way for me to start learning this type of vocabulary was to switch the programming menus in the communication devices I was using (see table below).  Even before iPads this was possible with the communication devices I was working with from Prentke Romich Company (now the Accent product line) and Dynavox (now using Snap Core First on TobiiDynavox devices).  Now I do this regularly with all of the software and apps that I have.  One thing I have noticed is that not all vendors have localized translations.  So sometimes I will need to make modifications to match vocabulary that is used where I live.  Sometimes families are unfamiliar with technical AAC vocabulary terms, and some prefer to learn/use programming menus in English.  In the table below I will share some of my findings with regards to technical vendor translations.  As bilingual English-Spanish communication apps are becoming more and more robust, I find that I can find more and more resources that have been translated to both languages (i.e., programming menus, manuals, quick starts, and help menus).  I find it helpful to use 2 devices or to print and compare the documents in English and Spanish. I also added a Spanish keyboard to my iPhone and iPad, so I can take advantage of word prediction, completion and corrections localized to my area. Find steps to add another keyboard here.

  3. Joining social media groups (like Facebook and Instagram), and looking for bilingual English/Spanish groups.  I have found connecting with others on a social and professional basis to be extremely valuable.  For example, in a recent post in the Bilingual Speech Language Pathologists Facebook group, we had over 30 comments to an inquiry about how bilingual therapists who are not native speakers can improve their Spanish.  Some of my favorites included: watching slow news in Spanish, soap operas with captions turned on, switching the phone to Spanish language settings, asking for help at local Spanish-speaking businesses (ordering food, finding things in the store), taking a class (or hiring a tutor), and setting aside time to practice chatting with native speakers. Did you know that when somebody posts in another language Facebook provides an instant translation?  The great thing about this is that you can decide to switch back to the original to compare how something might be said in both languages.  I have encouraged some of my friends who speak Spanish to post comments on my posts in Spanish so I can work on my social commenting vocabulary, too.  Snap Core First en Español is another Facebook group with about 4 posts per week. When we can check the average activity beforehand, it helps to make the decision about whether or not to join a private Facebook group.

  4. Checking AAC vendor pages for translated content.  Sometimes I change the search language on Google, and that helps me find information about implementation.  I have found wonderful implementation resources in Spanish on the Saltillo Chat Corner, a few lesson plans/materials in Spanish on the AAC Language Labhttps://aaclanguagelab.com/lesson-plans, Assistiveware Spanish-language pulldown menus (for all of their blogs and most of the resources), and some materials on the TobiiDynavox pages in Spanish.  I have searched for page sets in the Grid Explorer from SmartBox, but have found more pages localized for Spain than for my area.

  5. Doing shared reading and other literacy activities using Spanish-language materials.  I actually joined a shared reading group as a helper so I can practice listening to stories and songs for young AAC users.  Using children’s books, songs and fingerplays are a great way to practice my Spanish.  I have been exploring the Year of Core words in English and looking for versions of stories that are either in Spanish or bilingual. There are a few.  A great example is The Mitton (El Mitón) by Jan Brett.  YouTube has some great options of songs and stories for learning Spanish.  YouTube has settings to add captions and slow down the speed.  When importing YouTube videos into Google Slides or EdPuzzle I can decide where to start and stop the videos to practice finding the words in an AAC system.  I really love Super Simple Songs, and they have been translated so I that way I get the opportunity to use a familiar tune with new words.



Table of communication apps

App

Programming menus automatically translate

Menu language can be switched

Translated help menus and guides

Core is consistently located (motor plan)

Category words are consistently located

Robust AAC

GoTalk NOW+

Y

N

Y

n/a

n/a

Limited vocabularies pre-programmed in English. Add your own Spanish pages

Grid for iPad

Y

N

Y

most

N

Core, Category & Spelling in English and Spanish (Spain)

LAMP WFL

Y

N

Y

Y

Y

Core, Category & Spelling in English and Spanish (Latinamerican)

NuVoice on Accent

N

Y

Y

Y

Y

Core, category, some phrases, & spelling with Unidad (localized icons)

Proloquo2go

Y

Y


Most

Some

Core, Category & Spelling in English and Spanish (Latinamerican option)

Proloquo4text

Y

Y


n/a

n/a

Spelling-based app with phrase support

Snap Core First

N

Y


Most

Yes - organized by English order (alphabetized)

Core, category, phrases & spelling

Snap Scene

Y

N

Y

n/a

n/a

No - only recorded

Sounding Board

Y

N

Y

n/a

n/a

No - only recorded






Saturday, August 8, 2020

Coronavirus MELTED!

 Coronavirus M-E-L-T-E-D!

What does that mean?  We’re all trying to figure out ‘The New Normal’ since Covid19 might be with us for . . . years?  I've been trying to find a 'formula' for making decisions on what to do, where to go.

This is my new ‘Formula’ for deciding what feels safe to me.  

I’m giving numerical values to 6 factors to consider.  This is the overview.  I’ll describe each in more detail below.

M = Masks:  If needed, are they worn (appropriately!) by most people

E = Exposure:  Are the people I’m with high risk for exposure?

L = Location:  Is this a fairly safe location re: Covid 19?

T = Time:  How long is the time of contact?

E = Exhalation:  Are people engaging in excessive exhalations?

D = Distance:  Are all people maintaining appropriate physical distancing?

 

Rating Scale:  0 – 3 for each factor

0 = No risk

1 = Low risk

2 = Medium risk

3 = High risk

Examples for each factor:

M = Masks

0 = not needed   1 = all people wearing masks appropriately  2 = 75% of people wearing masks appropriately  3 = 50% or more people not wearing masks or wearing them haphazardly

 

E = Exposure

0 = not needed (only with my immediate family, all of whom are extremely careful)   1 = all people have low exposure, similar to mine  2 = with anyone who has moderate exposure (e.g., goes to large group events)   3 = with a group of people of unknown exposure

 

L = Location

0 = not needed (in nature only w/ bubble partners)   1 = outside, at least 10 feet away from others  2 = inside, large area, well ventilated, not many people   3 = inside, crowded, possible poor ventilation

 

T = Time

0 = < 5 minutes  1 = 5 – 15 minutes    2 = 15 minutes to 1.5 hour     3 = > 1.5 hour

 

E = Exhalations

0 = not needed (silence)   1 = other people, no heavy breathing  2 = some people exhaling (singing, talking loudly, shouting)   3 = Many people exhaling strongly (singing, loud talking, shouting)

 

D = Distance

0 = N/ A            1 = at least 6 feet apart    2 = 4 feet apart                     3 = 2 feet apart

 

How Will I Use This:  Examples

Grocery Store Total: 10:   M= 2;  E= 3;  L= 2;  T= 1;   E= 1;   D= 1

Decision:  I am changing my grocery store.  I will go somewhere with more people wearing masks appropriately.  Also, the new grocery store has a checker making sure that all people are wearing masks, and limiting the # of people who are there.

 

Eating Lunch with Friends Outside, Sitting 10 Feet Apart:  Total: 7

M=1  E=1  L=1  T=2  E=1  D=1

Decision:  This is an important social connection that is safe and delightful.

 

Kayaking with a Friend – Driving Separately:  Total: 4

M=0  E=1  L=0  T=2  E=1  D=0

Decision:  This is an important social connection that is safe and even giving me exercise!!

 

Shopping At An Outdoor Venue (e.g., Popup Craft Table):  Total: 6

M=1  E=2  L=1  T=0  E=1  D=1

Decision:  This is an important social connection that is safe

 

Going to Eat at a Restaurant Inside:  Total:  10

M=2  E=3  L=2  T=1  E=1  D=1

Decision:  While I REALLY want to do this, it does not feel safe to me at this point. 

 

Eating Outside at a Restaurant with Small Party (Not Going Inside Even To Be Seated Or Pay): Total:  6

M=1  E=1  L=1  T=1  E=1  D=1

Decision:  This feels much safer to me, because I have more control over the people I am coming into contact with, and don’t need to worry factors outside my control such as: poor ventilation, people who do not wear masks when not eating, etc.    

 

Going to a Bar: Total:  18

M=3  E=3  L=3  T=3  E=3  D=3

Decision:  Are you flipping KIDDING me?  I enjoy bars.  But this is just NOT the time!!!

CAROLINE'S CLUE GAME FOR AAC!

 Caroline's Clue Game:

WHATI love playing vocabulary password with learners who use AAC.  But I’ve also enjoyed playing ‘clue’ as a ‘starter’ activity. 

WHYClue is a great way to:

1) Model language on an AAC system, especially words that describe an item

2) Help students develop critical thinking skills

3) Build engagement!

HOW:  

Here’s how it works.  I think of something fun to share, then model the language using an AAC system.  Several teens I work with love to see my jewelry, so I keep the jewelry offscreen, and give them four choices.  I just bought new earrings with an owl on one (see picture).  That will be a great topic for a game of Caroline's Clue!

 

Sample Script:

 

Me:  I GOT NEW EARRINGS.  MIGHT BE . . . CATS,  OWLS, PARROTS, HUMMINGBIRDS.

<Partner writes those four choices on a whiteboard>

 

Me:  CLUE ONE.  IT CAN FLY. 

 

<Partner helps student decide which one to cross out – they remove the cat>

 

Me:  CLUE TWO.  IT IS A BIG BIRD.

 

<Team decides to cross out the hummingbird>

 

Me:  CLUE THREE.  IT DOES NOT TALK.

 

<Team talks about the negative.  They decide to cross out the parrot because it DOES talk.>

 

Me:  CLUE FOUR.  IT CAN <‘I’m going to the alphabet’> H-O-O-T.

 

<Team agrees that it’s the owl> 

 

Me:  YEP.  NEW OWL EARRINGS!  WHAT DO YOU THINK?

 

RELATED:  Check out the Vocabulary Password for more activities!  

AAC Intervention Vocabulary Password Tip