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A Case Study from Mayfield Special School

D.O.B Nov 1993

M is a young man with complex learning difficulties. He has a diagnosis of Cerebral Palsy with Spastic quadriplegia, hearing loss (he wears aids in both ears) and poor vision in his left eye.

M has no functional speech but enjoys social interaction, is very motivated to communicate and has a wicked sense of humour! It has been important that intervention to support communication started in infancy and developed to meet M’s needs. Alternating floppiness, variable muscle tone and strong extensor thrust with strong asymmetrical tonic neck reflex have been significant factors in developing control of switches and use of switches has always been slow and effortful for M. He has good control of individual fingers.

EARLY YEARS (CDC Assessment Apr 95)

M was unable to bring his arm forward across midline but head control was improving and he could bring his head to midline. He could bring hands together in midline and hold an object between both hands. M interacted socially, laughing, and had a keen regard for faces. He responded to auditory and visual stimuli.

M made babbling noises but verbal output was very restricted. He vocalised with open vowel sounds and a range of intonation patterns and showed definite likes and dislikes - expressed through vocalisation, gesture and body language. He used the same strategies to seek attention and interaction with mum. From an early age he was motivated and interested in communication generally.

THE AAC JOURNEY

March 1997 – 98

M was introduced to using an ECHO 4 operated by using Big Mac as a switch for messages to and from home and school. He was beginning to understand cause and effect - using a switch in response to questions eg ‘what did you do at school today.’

Big MackM responded to his own name by laughing and vocalising. Eye-pointing was developing and M could match objects from a choice of 3. He understood familiar commands within context and was able to make choices based on preferences. Vocalisation was tuneful but limited with no words consistently spoken.

COMMUNICATE REPORT Jan 1999

M was assessed by Communicate and it was agreed that his head movement could not be used to activate switch.

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Recognition of pictures was increasing which was essential preparation for using AAC. A 2nd switch was introduced to enable M to say ‘yes’ and ‘no’ with ECHO 4. He could press 2 jelly switches under own his motivation but not following instructions.

Jelly Bean Switches

It was recommended that M have access to an e-tran frame for making choices , photos for yes and no be fixed to tray, and switch use extended to 2 with ECHO 4

YES an NO symbols

COMMUNICATE REPORT June 2002

M was using number of strategies - verbalisation, yes/no on tray, rebus and PC symbols offered as choice of 2, thumb up sign for ‘good’ and a 4Talk4Pic4 encompassing approximately 20 symbols. It was recognised, however, that current methods did not offer opportunity for expansion or independent use. It was further recommended that communication needed to be symbol based, transportable, secured to tray or wheel chair, have speech output, and could gradually expand symbols offered.

He was assessed using a Dynovox with 8 symbols on screen but upper limb control to directly access AAC has always been an issue and although M could select it was very effortful and time consuming.He was successfully using 4 switches to control movement of his wheelchair. It was therefore suggested that a second switch array be provided, identical to the wheelchair array to operate AAC.

COOMUNICATE REPORT SEPT 2005

M was using a 4 switch array to operate 4 messages per level on 4 talk 4. He had a 5th switch to toggle between wheel chair and communication.

4talk4 with 4 switches

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By this time M had progressed to working on switch use with scanning. He used one switch on his array as a single switch with simple build software programmes and to move through a set of pictures/photos on screen, stopping when he reached the one he wanted. He could repeatedly press the switch in his own time - but purposeful switching remained effortful.

M’s vision had been in question but it was decided that he was able to see as well as hear his options on screen.

It was recommended that AAC include visual and auditory prompts, 2 switch operation - step and select, voice output, be portable and include environmental control capacity to allow M to operate TV music systems etc which it was felt he would find motivating. Also, expandable capacity to address M’s developing requirements.

This resulted in an extended loan of a MightyMo MT4 communication aid. Training in the use of the aid and software was given to parents and staff. The MightyMo has a series of menus and sub-menus which give access to a large vocabulary of words.

Mighty Mo

SEPT 2010

It was agreed that M would benefit from direct computer access by increasing learning opportunities which are appropriate for Matthew’s cognitive ability, increasing independence and further developing communication skills. He is now using an HP Touchsmart tm2laptop with touchscreen which is fixed to his tray. It has a rotating, folding screen with touchscreen similar to an iPad.

Software has been deliberately limited so that Matthew is not overwhelmed by choices and he learns to use the programmed which are most useful to him. My Zone is used to present a customised desktop which currently displays 3 large folders at a time for M to choose an area of activity. There are 8 folders set up at the moment - games, communication (linked to Boardmaker) Dinner, Music, Books , Cookery, Towards Independence and Numeracy - but these can be increased as required. M can also access the internet . Recorded sounds enable him to contribute when participating in the after-school choir.

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M continues to use the Mighty Mo at home for communication but initial indications are that access to a touchscreen computer will significantly improve M’s opportunity for communication, learning and independence.