Wednesday, December 31, 2014
Thursday, November 20, 2014
A communication breakdown happens when there's a disconnect between the sender of a message (the speaker) and its receiver (the listener).
Think about how often this happens in daily life--even for adults with normal hearing and typical speech skills (the ability to speak loudly, to clearly articulate sounds, etc). Maybe I take special notice of my own communication breakdowns because I hate repeating myself----but it happens pretty often. Now imagine how often it would happen if you couldn't speak clearly.
Listen to Maya speak in the video below. You may be able to guess what she's saying, but it's more likely that you won't. In the second loop of the video I provide context and captions---clues that serve to repair the breakdown, and everything becomes more clear.
Maya's speaking life is more or less one big communication breakdown. I expect that this will shift, that as her articulation improves she will be more understood, but I also expect that the shift will happen slowly. Unfortunately, people are so eager to understand her speech, to validate and encouraging her speaking, that they often jump in, make assumptions, and kind of run her right over. She'll say "bug" and they'll reply "Bus? Yes, you rode a bus to school. Your bus is yellow, right? Do you like to ride the bus?" More unfortunately, when these breakdowns happen Maya tends to just stare blankly at her listener, or wanders away to something different. Rarely (very very rarely) does she take the initiative to stand her ground, to tell the listener they misunderstood, to try to get her point across. She doesn't try to repair the breakdown, she gives up.
This isn't unexpected, really. It's taken her a long time to speak at all, and if she tries and it doesn't work . . . well, then what? She's got a limited repertoire of speech sounds, and it's hard to think on your feet and come up with another way to more clearly express something that you couldn't say the first time. More than that, communication partners speak quickly, change topics quickly, and move on quickly. Life doesn't pause while you try to come up with another way to say "bug." She also has had a lifetime's worth of experience of not being able to keep up verbally. Frankly, I'm consistently impressed at her dogged pursuit of speech, and the amazing proliferation of speech and sound attempts that have occurred over the past 2 years. And, while sometimes she can use her talker to clarify what she's saying, sometimes the word (or sentence) she was saying just isn't there---or maybe she doesn't think to switch from speech to AAC.
And so, communication repair has become a huge target of ours. We are determined to empower her to become frustrated when people don't understand, to assert herself and say "No, that's wrong!", and then to draw on a variety of tools to help clarify and re-communicate her point.
Step One: Provide the Tools
I started by creating a page in Maya's talker (she uses the Speak for Yourself app) that can be easily used for communication repair. The ideas for the words and phrases on this page came from a variety of SLPs and AAC families, gathered primarily in a few FB groups. (A lot of these came from a great draft in the SFY user group.)
If you're an AAC person, there are two things to note. First, this page uses a fair number of phrases and sentences. In general, I like having one button per word, but I think that in times of communication breakdown an AAC user should be able to protest/redirect very quickly. Second, I have maximized the motor planning of a SFY user by stacking the buttons in the same location as things that they are related to on the primary page. For example, the phrase "slow down" is located in the same area (right column, fourth button down) as the word "down" on the primary page.
The information presented below, including the list of repair phrase and the color coding, can be downloaded and printed here.
Here is a master list of the phrases included on this page--since the buttons can only hold a certain number of characters, it's difficult to guess what they all mean. (The word in parentheses shows which location the word is under, when they are related.)
This is clearly the more difficult step. How do we get her invested? We've learned that she is much more likely to use a new communication skill if she's had the opportunity to practice it . . . but it's difficult to practice repair. If you're the listener, it's hard to model how she should give clues (and sometimes it's hard to realize you've misunderstood in the first place). If you try to create fake misunderstanding scenarios, it's a gamble whether the AAC user will play along. And the idea has to be explained, too . . . "hey, if I don't understand you you should tell me to stop, ok?"
Enter one of our awesome speech therapists, who created a fantastic social story to introduce the idea of communication repair. The book starts by giving voice to the frustration of a communication breakdown, then moves on to lay out the two important parts of communication repair: stop the listener and let them know a breakdown has occurred, then try to use other tools to relay your point.
Here's what the book looks like:
The entire book can be downloaded here (as a PowerPoint file) and can be modified with your own photos or screenshots.
The book was introduced featuring one strategy from her communication repair page, "It starts with . . . ". This is a great technique for Maya, and one that she used spontaneously in the past, but she never had a button to basically say "now I'm going to tell you the first letter." New pages will be added to the book as different strategies are introduced and practiced during speech sessions. I'm going to send a copy into school and have shared it with our other therapists, so that they know what we are working on and can be mindful of potential communication breakdown and our repair strategies.
I hope that this page will help Maya become a more assertive communication partner. She has the right to be understood, and she has the right to say "Hey! You're not correct! Stop talking and listen to me!" Now it's our job to make sure that she has enough practice with it that it will jump to mind when a breakdown occurs, and that she feels like it's worth her time and effort to work through the repair process.
Friday, October 31, 2014
Lemmy has CVI, so his buttons are rainbow colored with high contrast black and white icons.
Thursday, October 30, 2014
3. A will, but not a way: For kids with disorders like apraxia or other neurological conditions, there are times when their body does not follow the directions being sent out by their brain. They may be thinking "reach out and touch the scissors, reach out and touch the scissors" but then see their arm reach forward and their hand make contact with the glue. If I stand up and quickly spin in place several times, no amount of me thinking "now run in a straight line!" is going to make that actually happen. It's a physical limitation. Modifications can be made to tests and testing environments to attempt to minimize these effects, but neurological motor planning troubles must be taken into account as a possible source of false negatives.
Wednesday, October 29, 2014
It's the final Throwback Thursday post of AAC Awareness month (but happening on a Wednesday so that today I can write something new for tomorrow). For the grand finale of TBT, here is my master AAC post: Communication Before Speech.
This post is a compilation of my best AAC posts, filled with external links, and sprinkled with counterarguments to the anti-AAC comments that I see time and time again (Just use sign language! Have you tried supplementing with fish oil?).
Communication Before Speech
Tuesday, October 28, 2014
First up, The Language Stealers. From the video's YouTube description:
As part of the Radiowaves Street Life project, funded by Youth In Action for the British Council, and with additional funding from Co Durham Youth Opportunity Scheme, animator Vivien Peach working with us at Henderson House, Chilton. We made Language Stealers to promote our 'Equality Without Words?' campaign and the language boards of core words we are making.
Language Stealers is a story of attribution, exposing the real barriers to communication for students with speech and motor impairments as being more to do with the situation they find themselves in than anything to do with their disposition. If nobody gives us a way to say or write the core words, or only gives us lesson nouns to go on class worksheets but no literacy instruction, then how dare they attribute our language delay to lack of ability?
Next up, the Voice by Choice Comedy Sketch. This makes me smile every time I see it! Set in the context of adult AAC users at a speed dating event, it's also a commentary on some of the challenges that AAC users face: time lag, mishits, and limited voice selections. (You need to know that "bugger" is "used to express annoyance or anger" ---although not as commonly here in the US. Urban dictionary info here.) From the video's YouTube info:
This comedy sketch was written and stars Lee Ridley (aka Lost Voice Guy) and looks at the funny side of going speed dating whe you use a communication aid.
Monday, October 27, 2014
I also saw that they have a webcast too, but haven't had time to check it out.
Literacy can be tricky business for functionally nonverbal people (it's difficult for me to imagine sounding out words without being able to use my voice to do so), but it's probably the second most important thing I can work on with Maya---my goals have been "get her a voice, then get her reading."