In the Western Kentucky schools, assistive technology evaluations provided for school-aged children by contracted agencies often resulted in basically the same recommendations that were made for geriatric patients in nursing homes. Extremely costly items with a single purpose were often purchased, used for a period, and then shelved. The concept of assistive technology for communication had never been adapted to the school setting with its distinctive needs.
For many years I brought technological accommodations to patients in nursing homes. Each patient could expect to have everything from call lights to communication devices adapted to their accessibility needs. After 11 years in this setting, changes in Medicare reimbursement resulted in my entering the school system. As I adapted my technology skills to the classroom, I soon realized this new environment presented unique challenges that would need to be handled in innovative ways.
Shortly after entering the school setting, I received my certification in assistive technology and became the assistive technology consultant for the 25-district Western Kentucky cooperative. I was faced with the enormous challenge of developing a commonsense approach for the purchase and training of assistive technology in the school setting. I felt that communication items needed to be perceived as "cool" by students, be cost efficient in their initial purchase, and upgradeable so as not to be quickly outdated. School staff needed to have knowledge of the devices for quick repairs with limited downtime. These unique requirements drove the creation of a continuum of augmentative and alternative communication (AAC) devices that focused on the combination of upgradeable adaptive software and hardware devices.
This continuum is designed to meet the needs of students with varying cognitive and physical skills. At the most fundamental level, it addresses the needs of students who are unable to recognize cause and effect relationships. The final stage is independent freedom of communication using a portable board that has limitless possibilities for communicative expression, academic performance, and easy accessibility.
The process begins at the most basic level of the continuum by observing what sensory stimulation the student is exhibiting and then giving these behaviors a purpose. For instance, if the student is grasping at textures, provide a uniquely textured switch and use it to activate a stimulating item or toy. If the switch itself is a squishy, crinkly, fuzzy, or gel type, students will be quick to activate it and shortly make the connection between their action with the switch and activation of an item.
Once cause and effect is established, then the student can be moved nearer to communication by laying a foundation for the concept of making a choice. This is facilitated with the addition of a unique switch for the activation of another item that is rewarding to the student. Once students demonstrate understanding of differentiated switch activation and initiation of its connected item, they are ready to expand their experience to the use of a desktop computer.
An inexpensive computer adaptation allows the teacher to use the student's familiar switches with switch-activated software. To avoid any gaps in understanding, software that is easy to program allows students to continue use of their familiar switches while activating onscreen digital photographs and auditory representations of the items they were previously activating. As a result, students make a smooth transition to the desktop computer. The toy they once activated in real life is stored in the computer and can be activated in the same manner as before. Most students easily make this transition from real item activation to virtual item activation.
Simultaneously, students are introduced to a four-switch communication device that is used when they are not working on the computer. This device allows a picture referent to be placed over each of four buttons. A verbal response is made upon activation, and the item referenced is activated. This stage allows the student to continue to use switch-activated items for communication and recreation while learning choice-making skills.
Now that the student is using the computer and understands the basics of making choices, a choice-making software package is recommended that allows easy addition of graphics from a digital camera or other source. This software allows for insertion of familiar digital images and sounds into the computer. These images can be presented on screen and arranged in a board format with two to six items to choose from. Upon correct selection of an item, fun graphics and sounds are presented for reinforcement. The teacher is able to quickly change choices and make upgrades. This software virtually never becomes obsolete. At this point true communication is emerging and the student is gaining skills to prepare for a more complex communication system.
Once the student is able to make choices, it is time to build boards on the computer that can talk. Talking boards may be built with clipart graphics or with actual pictures depending upon the student's cognitive level. Software can be used to create talking boards on the PC that, once again, never becomes outdated since the teacher can constantly make changes in the boards. When these boards are paired with a touchscreen, a fantastic communication system is established. Once these boards are created, students are reinforced for their communication choices in a real way. As communication emerges, the teacher is able to link numerous boards and begin creating a limitless vocabulary for multiple environments.
To facilitate mobile communication, a talking photo album is provided. We have purchased these devices at many department stores for as little as $10. The talking photo album allows the student to have 24 or 36 talking communication messages with a corresponding picture. The main goal of this device is to teach the student to take care of a communication tool and use it properly. With the introduction of portable communication and the use of onscreen boards built on their PCs, students are being prepared for the highest level of technology for their communication and academic needs.
This final stage is achieved when the talking boards created on student PCs are downloaded into a tablet PC. The tablet is lightweight, portable, has a removable keyboard, touchscreen, and a wonderful voice quality. Any student can use this device to communicate in any environment and then enter the classroom and use the tablet PC as a full functioning academic computer. The software within the tablet allows modification for special user needs. The tablet PC can use scanning or touchscreen input. One of the greatest benefits is the acceptance by school technicians, who understand its use and can often remedy software or hardware problems. Since this device is a fully functioning computer, upgrades become available each time the school buys a site license. There is no chance of abandonment of the tablet since the software can be modified to meet the needs of any other student or the teacher who may wish to use it.
The best feature of this continuum of communication for AAC in the schools is that there is no waste and the least amount of obsolescence possible. All items are relatively inexpensive and can be used in multiple ways to meet the needs of many students. Since students come and go quickly, these products can be adapted to the ever-changing caseloads of speech-language pathologists. When students graduate, they will have been trained to use an item that is common in the real world, with multiple capabilities, and is considerably less costly than a designated device.