Myth:
Before using high-tech communication devices, it is necessary to first use low-tech means of assisted communication
Communication
Do we ask young children of orderly development to point to pictures with their fingers before they begin to communicate with speech? Of course not.
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Newborns communicate by voice long before they can even point to a picture. They try to get our attention by crying, and by "cooing" they join the conversation. Even when children begin to point to objects and pictures, this is often accompanied by vocalizations and/or attempts to pronounce words. They are aware of the power of communication with their own voice long before they can say their first words, and they develop their communication skills at the same time using different communication methods (pointing, facial expression, speech).
What about children and adults who have complex communication needs? Should they first demonstrate the ability to use low-tech tools of assisted communication (hereafter PK) before receiving a communication device?
Before we continue, it is important to know that there is PK without aids and PK with aids . Unaided PK includes various vocalizations, gestures, facial expressions and manual signs. PK with aids can be divided into two categories - low-tech and high-tech. Low- tech consists of graphic symbols, real objects, communication books, etc. High-tech PK is represented by various software and devices that produce speech or tablets intended for PK, etc.
Some compare learning to use PK to learning to ride a bicycle. Children start by riding on toys, then ride tricycles, bicycles with auxiliary wheels and finally regular bicycles. Do people with complex communication needs start with gesturing, then move to photos, to simple pictures, then to a communication board with a small number of pictures offered, to a communication book and finally to a communication device? Do they have to start from a "simple" communication device before using a more complex one?
The progression of skills in some areas (such as learning to ride a bicycle) could support the belief that there is a progression in the mastery of PK skills from the unaided level, through the low-tech, and all the way to the high-tech level. Surely an individual would need to demonstrate the ability to use "simpler" forms of communication before gaining access to more advanced communication devices, right?
Or the process of introducing PK is more similar to mastering the skill of walking. We are equipped with a fully functional "tool" (legs), but with skill improvement and richer experience, the complexity of its use increases (eg crawling, standing, walking, running). Can a person with complex communication needs use a device with content that will support successful communication now, but also in the future, when language skills and needs improve? Let's explore in more detail the advantages of this approach to PK.
High-tech communication devices
Van de Sandt-Koenderman (2004) cites several advantages of using high-tech communication devices along with other forms of communication instead of using only low-tech aids for people with aphasia. We will list some of them:
- High-tech communication devices are easier to personalize because they can be changed instantly, so there is no need to search for and print the appropriate symbols or text. Modern and personalized devices are more likely to be used than systems that do not have the latest information or are very general.
- High-tech communication devices can be prepared in advance and stored for later use. This can be especially important when composing messages takes longer than is practical in real-world situations.
- High-tech communication devices can have a speech output that can serve as an aid to an individual's speech or can replace their speech. Some high-tech devices allow people to record their speech to be used in different situations.
- High-tech communication devices can be more motivating than low-tech communication devices. A wide variety of available messages on a communication device can encourage independence in communication.
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Additional benefits from high-tech communication devices apply to people with aphasia and other diagnoses.
- High-tech communication devices combine several communication functions in one communication act . For example, when with the help of a communication device it is said: "Your shoelace is untied", this gains attention, but also communicates a message (Schepis et al., 1996). The chances of successful communication are greater with both of these functions.
- The voice output serves to model the speech of PK users (Blischak, 2003). Modeling is not the primary purpose of PK, but it is useful anyway.
- Voice output increases an individual's conversational ability when interacting with less familiar communication partners who may not understand what their pictures, written words, gestures, or other forms of communication mean.
- High-tech communication devices enable communication with people who are not in the immediate vicinity (e.g. they are more than half a meter to a meter away, in another room or on the phone) using loud speech, a recording with which a certain need is expressed, and in some cases by sending a text message or email.
Does the use of a communication device eliminate other methods of communication?
High-tech communication devices, low-tech PK means, speech, gesturing, facial expressions, pointing and other forms of communication are parts of a complete communication system (Beukelman and Mirenda, 2005). High-tech communication devices and low-tech tools and techniques can and should be used together. Just as we reach for a tool attached to our belt, we will reach for the tool that best suits the situation (eg gesturing instead of speaking during a ritual). Just like working on a project where we use various ways of recording ideas, for example with a computer, sticky notes, mind maps or a white board, we will also use various tools in communication to convey our ideas.
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Skilled PK users state that they choose their communication method depending on the situation (eg using an alphabet board with familiar partners and a communication device with less familiar partners). Low-tech tools are extremely important to support the communication device in cases when the device cannot be used (eg at the pool or in the bathtub) or when it is not available (eg not charged or under repair). De Sandt-Koenderman (2004) notes:
"After analyzing the most advanced computer communication aids for people with aphasia, the clear conclusion is that each aid will be used in conjunction with other low-tech assisted communication strategies and, of course (if possible), with speech."
Also, it is understandable that people with several different difficulties will have complex communication needs and will use several forms of PK .
For the end...
The introduction of PK tools and techniques is not a strict sequence whose steps must be followed. It is a series of decisions that are made and regularly reviewed , depending on the current and future skills and needs of each person. The introduction of PK tools and techniques, especially more advanced tools and techniques, creates opportunities to learn and nurture successful communication, both now and in the future, with the development of language skills and needs.
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LITERATURE:
Beukelman, D. and Mirenda, P. (2005). Augmentative & alternative communication: supporting children & adults with complex communication needs, 3rd edition. Baltimore: Paul H. Brookes Publishing.
Blischak, D., Lombardino, L. and Dyson, A. (2003). Use of speech-generating devices: in support of natural speech. Augmentative and Alternative Communication , 19 (1), 29-35.
Schepis, M., Reid, D. and Behrman, M. (1996). Acquisition and functional use of voice output communication by persons with profound multiple disabilities. Behavior Modification , 20, 451-468.
Van de Sandt-Koenderman, M. (2004). High-tech AAC and aphasia: Widening horizons? Aphasiology , 18(3), 245-263.
