Friday, 20 June 2014

Something to say.....Augmentative Communications

5 of our children have varying degrees of apraxia, with one child that also goes mute when overwhelmed.  The severity of our children's apraxia is also complicated by their seizures, when they are having multiple seizure activity their speech tends to regress.  Our children's communication/speech needs are overseen by a team of registered speech therapists who work on articulation, augmentative communications and feeding.

What is childhood apraxia of speech?
Childhood apraxia of speech (CAS) is a motor speech disorder. Children with CAS have problems saying sounds, syllables, and words. This is not because of muscle weakness or paralysis. The brain has problems planning to move the body parts (e.g., lips, jaw, tongue) needed for speech. The child knows what he or she wants to say, but his/her brain has difficulty coordinating the muscle movements necessary to say those words. 

As the children's speech is not understood by most people, in fact sometimes we even have difficulty understanding them, we have needed to use various forms of communication.  All of our children with apraxia also have mild to moderate intellectual disabilities which impacts their abilities using augmentative communication.  

All of our children are taught basic sign language from the time that they are "placed" with us.  We use the signing time DVDs to teach sign language along with the older members of the family modelling basic "sign language" while verbally speaking.  The children have very sloppy signs because of their fine motor difficulties but paired with speech it does give you another clue as to what they are saying.  The draw back to sign language is that the person that you are communicating with also needs to know sign language.

All 5 of the children at a young age started using "Picture Exchange communication" this is a very basic, inexpensive source of communication.  The children are provided pictures of basic items that they may request.  They are taught to communicate by passing the picture to the person that they are speaking with.  As they progress they will have pictures to make a full sentence when requesting.  This system works well to start with when the child's vocabulary is limited but as they progress they need more and more words/pictures.

For one child we tried a Springboard lite talker.  The idea behind this was good but I found that it took a long time to program and then my son (even with the child locks on) was able to erase everything I spent hours programming in a matter of seconds.

We then moved onto Proloquo2go an app that is available on tablets and apple products.  This comes with different pre programmed options and is very easy to program.  You do need to have a charged device to use the program.  As it is on an electronic device you are limited by the environment that you are using it in.  We also had an issue with a couple of our children being so random in what they wanted to say that we didn't always have the words programmed.  

Our youngest son is currently using a tech speak to learn that he can push a button and "say" something.  We are using this with activities to encourage his communication.  He has various cards made up, so if we for example, are playing "Mr Potato head" we can push the button when requesting or speaking making it game like to start.  We also have cards for storybooks that we commonly read so that he can interact with us about the story.  As his abilities increase he will move on to a more complex communication program.

Most of the children are currently using the PODD system.  This system like all the others also has it's benefits and drawbacks.  With this system the children each have binders with their words.  As they learn they communication partner (mom, dad, teacher) is responsible for turning the pages.  The child touches the picture and the communication partner speaks the words.  This system is set up in a way that we speak forming complete sentences, for example they are not pushing a button or passing you a card that says something like "car" - with other programs you have to guess/determine what is meant - do they see a car, do they want to go for a ride in a car, do they want to play cars.  Also these pages can be printed on waterproof paper making them more durable.  One issue that we have is the children are functioning at different levels so their binders have different words resulting in 5 binders that should go with them where ever they go.  This also makes it that we as their communication partner have to determine what level we are speaking at.  As the children advance it is my understanding that we will also have the option of using this program on a tablet.

Giving our children a way of communicating is extremely important and also reduces frustrations that our children are feeling (frustrations that come out as negative behaviour).  There are many options available and it is a case of finding something that works for you and your child.  For us we use one system until it is no longer functioning well for us or until we find something that better meets our current needs, depending on the child's developmental level.  

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