Assistive and Instructional Strategies for Communication

Accessing Communication Boards and Devices

The foundation for successful AAC use is ensuring the student can physically access their communication board or device. This begins with proper positioning, often requiring tools like slant boards, wheelchair trays, or adjustable desks to place the system within the student’s visual and physical reach.

 

For students with motor impairments, pointing devices like head pointers, mouth sticks, or light beams may be necessary. An occupational therapist is a key partner in determining the right positioning and access tools. The chosen access method—whether direct select, scanning, or encoding—depends entirely on the student's unique physical, sensory, and cognitive abilities.

Direct Select

Direct select is the most straightforward and fastest access method. It involves the user directly touching or pointing to the symbol they wish to communicate. This method is preferred for students with the necessary motor skills. Adaptations like head pointers, trackballs, or keyboards can make direct selection possible for those who cannot use a finger. This method works for both electronic and non-electronic devices. A key consideration is page-turning; solutions like page turners, tabs, or electronic devices that change screens automatically are essential for students who cannot turn pages independently.

Scanning

Scanning is used when students cannot point directly. A switch highlights choices one at a time, and the student activates it to select. Different scanning styles and patterns allow flexibility based on ability.
Scanning can also be done manually by a communication partner who points to symbols until the user signals a selection.

There are several scanning techniques:

• Automatic Scanning: Choices are highlighted automatically; the user activates a switch to select.

• Inverse Scanning: The user holds a switch down to move the highlight and releases to select.

• Step Scanning: The user activates a switch to move the highlight one step at a time.

• Directed Scanning: The user uses multiple switches or a joystick to move a highlight up, down, left, or right.
  

  
  

  
  

  Encoding

  Encoding allows students to communicate through codes rather than direct selections. Systems like Morse code or abbreviation expansion reduce physical effort while increasing speed. This efficient system reduces the number of motor actions needed to communicate. 

  
  

  Formal systems include:

• Morse Code: Using dots and dashes (via a switch) to represent letters.
• Abbreviation Expansion: Typing a short code (e.g., "EMD") to produce a full phrase ("I want to eat at McDonald's").

• Minspeak: Selecting a sequence of icons to generate words and sentences.

Encoding can also be used with low-tech eye-gaze boards, where a partner decodes a message based on the user's eye movements between letters and numbers.

Vocabulary Selection

Selecting the right vocabulary is a personalized and dynamic process critical for students with physical and health needs. It should be tailored to the individual to express needs and direct their own care. An effective eight-step process involves:

1. Brainstorming vocabulary with the student and team.

2. Listing all possible physical/health concerns and communicative functions (demands, questions, requests).

3. Prioritizing vocabulary based on health importance.

4. Selecting messages feasible for the student to learn.

5. Identifying future vocabulary targets.

6. Choosing appropriate symbols, signs, or phrases (using peer input for age-appropriateness).

7. Arranging vocabulary for quick and easy access, especially for urgent messages.

8. Continuously evaluating and updating the vocabulary as health needs change.

   
   

   Vocabulary to Express Health and Physical Needs

   
   

   This vocabulary falls into two categories: general and specialized. General messages include words like "hurt," "sick," "headache," or using a body diagram to point to pain. Specialized vocabulary is specific to the student's procedures. 

    

   For example:

   Specific general vocabulary including "headache," "stomach ache," "nausea," "dizzy," and "tired."

   Indicate what the student wants done, such as "Call parent," "Need medication," "See nurse:' "Go home" or "Lie down."

   Vocabulary for Performing Health Care Procedures

   When students cannot physically perform procedures, they can still direct caregivers using AAC. This gives them independence and control. Vocabulary should cover each step of a procedure, as well as corrections if something goes wrong. These words or symbols can be placed on special pages of a device, ensuring the student always has access when needed.

   For example:

   It could include such phrases as "Stop, you are doing it wrong," "The food is going in too quickly," or "The barrier for the colostomy is cut too large." 

   
   

   Instructional Strategies for AAC

   Teaching AAC use requires systematic, integrated instruction. Key strategies include:

   • Integration: Embedding practice into natural daily activities.

   • Consistent Access: Ensuring the student always has their device and communication opportunities are planned.

   • Reinforcement: Responding to all communication attempts consistently and predictably.

   • Prompting: Using prompts (e.g., least-to-most, time delay) to teach symbol use, followed by immediate reinforcement.

   • Modeling: Communication partners using the student's device to talk to them demonstrates its purpose and use.

   • Partner Training: It is critical to train all communication partners (school staff, etc.) to understand and respond to the student's system effectively.