Sibling Day March 16, 2009
Sibling Day March 16, 2009
Using Adaptive Technology to
Help People Communicate
March 5, 2013
Toni Southern, M.Cl.Sc., Reg. CASLPO
Karin Kouvelas, M.A., Reg. CASLPO
Augmentative Communication Clinic
John McGivney Children’s Centre
To provide rehabilitative services in the
Windsor/Essex County Community, enriching the
lives of children and youth with disabilities and
special needs, by “helping their abilities grow” to
their fullest potential.
JMCC is part of the Ontario Association of
Children’s Rehabilitation Services (OACRS):
• OACRS represents 21
Children’s Treatment Centres
(CTCs) across Ontario
• CTCs serve 60,000 children in
each of their designated
JMCC provides essential services to
increasing numbers of children with special
Medical and technological advances are enabling babies
and children to survive, but with complications/special
In 1978 the Centre serviced 200 children; today that
number has grown to more than 2,300 annually
throughout all areas of Windsor and Essex County.
JMCC provides essential services to children
who face life long challenges that include:
• Birth Defects (Spina Bifida)
• Neurological conditions
(Cerebral Palsy, head
• Neuromuscular conditions
(Muscular Dystrophy )
• Trauma (post surgery
• Illness (cancer, arthritis)
• Cleft lip and/or palate
• Genetic disorders (Down’s
• Developmental delays
• Metabolic conditions
• Cardiovascular and
JMCC Programs and Services:
• JMCC provides programs and services which are medical,
rehabilitative and educational in nature, truly enhancing and
enriching the lives of the children and their families, by helping
them reach their full potential.
• supporting children/youth from birth to age 21.
• services are offered in the Centre through
• out patient program(s)
• JMCC is one of six CTCs to offer an on-site integrated
preschool and Section 68 School
• in the community through contract agreements including CCAC
Home and School Health
• JMCC operates under legislation that has established geographical
boundaries for CTCs - meaning families cannot go elsewhere to
access these publicly funded services despite long local wait times
“Every person, regardless of the severity of his/her
disabilities, has the right to communicate with
others, express everyday preferences and exercise
at least some control over his or her daily life. Each
individual, therefore, should be given the chance,
training, technology, respect and encouragement to
Bob Williams, former U.S. Deputy Assistant Secretary.
Everybody is a genius. But if you
judge a fish by its ability to climb a
tree, it will live its whole life believing
that it is stupid.
~ Albert Einstein
If I were to lose all my possessions except for one, I
would save the power of communication, for by it I
would soon gain all the rest.
McFadden (1995) “... to me and
others like me being able to
communicate puts us into society.
It lets us have a voice.”
• What is communication?
• What is speech?
• What is language?
Telling people what we want, think, feel.
Interacting with others.
Asking for help.
Getting information from others.
Reading and writing.
Participating in life.
• How we produce sounds.
• The quality of our voice.
• How the sounds are sequenced to form words.
The words we use.
The meaning of our words.
The way we combine words to make sentences.
The reception of language.
There is also the pragmatic aspect of how we
combine our language and our speech (tone,
inflection and gestures) to influence the meaning
of our messages.
How do we communicate?
Signs or gestures
Speech or speech generating devices
Possible Communication Difficulties
• Congenital or acquired disorders that affect
the muscles, nerves or areas within the
– Some examples are Cerebral Palsy, ALS,
CVA, TBI, autism, syndromes such as Downs
or Q22 deletion, motor speech disorders.
• Delays in the development of the areas in
the brain responsible for speech and
• Difficulty hearing.
• Loss of limbs.
Does that mean they can’t communicate?
• We communicate in many ways – we laugh, cry,
we wave our arms and use gestures.
• We point or look at what we want.
• We use our face or tone of our voice to make a
message mean something different.
• There are strategies and technologies available
to many individuals.
What are some of the Barriers that people
with communication challenges face?
They are ignored.
They are not spoken to directly.
They are addressed in a condescending manner.
They are shouted at.
They may not be included in decisions.
People may believe that they are drunk or on drugs.
They are assumed to be incompetent.
• Their independence may be compromised.
• They are not given the necessary time to respond.
• They don’t have access to phones/navigating through a
• Discussing account information over the phone can be
tricky. (some companies won’t allow another person to talk on their
behalf even though they are sitting right next to the person. Some
companies won’t allow speaker phones to be used.)
• Access to banking/credit cards requiring signatures/PIN
may be challenging.
• They may require an interpreter or communication aid.
• They may not have access to printed materials.
What is Augmentative and Alternative
• Augmentative Communication is using other ways
to communicate if your speech or hand writing is
• People who use augmentative and alternative
communication (PWUAAC) may use strategies
and/or technology to help them communicate more
• Some examples of augmentative communication
include signs, gestures, pictures (including PECS),
speech generating devices (talkers) and computers.
Myths About AAC
People who use AAC don’t have
As with all people there is a range –
some people have developmental
disabilities and some have higher than
Believed to discourage speech.
Research and clinical experience has
dispelled this myth.
Often viewed as “the answer” or
It is only a tool.
iPad/iPod is universally the best
Many systems are available and
through assessment an individualized
program/system is determined.
Benefits of using AAC
Access to communication.
Control over environment/life/decisions.
Provides a voice.
Access to the community.
Improves relationships with people.
You can say anything to anyone anywhere.
Strategies to Address Barriers
• Assume competence.
• Be respectful.
• Speak directly to the person even if they have an aide or
parent with them.
• Don’t raise your voice.
• Provide increased wait time.
• Ask the person to show you how they communicate. Ask
if they have tips on how you can use it with them. Do they
have a device, do they answer yes/no questions, etc.
• If they have a system - allow them to use it.
• Confirm the message that they have given you to ensure
that you have understood it – but don’t question what they
have said or decisions they have made.
• Offer other ways of giving and getting information – choices,
written material, picture supports, email.
• Be mindful of the difficulty of the reading material being
• Make sure they have access to supportive personnel if
• Offer assistance before giving assistance.
• Accept other forms of “signing”, e.g. stamp for their name or
• Keep the above in mind if you are speaking to a PWUAAC
on the phone.
The Power of Believing
Adapted from Pati King-Debaun
Believe that all individuals can communicate and
have the right to.
Believe that all individuals have the right to choose
and should be given opportunities to do so.
Believe in patience.
Believe each individual has something positive and
valuable to share with you.
Believe that you have something positive to give to
individuals with severe and multiple disabilities.
Believe that if you believe the individual will believe.
Step by Step
• The only app that is authorized by the Ontario
• Cost - $189
• Complex dynamic display communication app.
• Fully Customizable.
• Well promoted by developer – it is the #1
grossing educational app and has been for at
least the past year..
Challenges and Issues
• People are calling us frequently wanting an
iDevice without seeing or having information about
• Previous experience with iDevices has been found
to be detrimental to the use of the device as a
• People who use the idevices are having trouble
because they are distracted by the other apps that
are built into or added onto the idevice.
• The device is not accessible to all users – they
have difficulty using many of the function buttons or
having it reorient when the device is turned.
• Because it is a popular device it makes it more
prone to theft.
• It is not designed for children so it is more fragile
than our other devices.
• It is not always the most efficient system and it
requires a lot of customization to make it work
Considerations for using an App
• Caution to look carefully at any app and evaluate it’s
• Does it encourage communication growth?
• Does it encourage communication vs labeling and
requesting and testing?
• Think about why you want this app. E.g. it may hold
their attention but are they getting anything useful out
• Apps are being developed and marketed quickly
without the benefit of adequate research and design
teams that have been a part of our other devices.
They need to be looked at/reviewed with caution.
AAC Apps (non ADP)
My Talk ($50)
Talk Rocket Go($99)
Scene and Heard ($50)
• Typ-O ($15)
• Predictable ($160)
• Speak it! ($1.99) - text to speech
• Story Kit (free)
• Tap to Talk (free)
• SmallTalk Aphasia (free)
• Pictello ($19)
I Create…Social Skills Stories ($5)
Conversation Coach ($80)
Resources for other communication apps can
be found at:
• People who use Augmentative and Alternative
Communication have a lot to say but often require
more opportunities and strategies to communicate
• There are many strategies that you can use to
increase their success.
• There are a variety of systems available – not just
• PWUAAC face many barriers and unfortunately
often do so in silence.
• Correspondence with Nola Millin -a PWUAAC