I recently had an article published in Perspectives on AAC that I wanted to share here as I thought it could be useful for others who are on the same journey. You can access the original article at http://sig12perspectives.pubs.asha.org/article.aspx?articleid=2322984.
And to give you a visual to go with the article - the video below has footage of some of the students from this classroom and their fabulous teacher, Fiona.
Communication is Conversation from AssistiveWare
Citation: Farrall, J. (2015). Implementation of iPads for AAC in a specialist school. Perspectives in Augmentative and Alternative Communication, 24(2), 51 - 59.
This paper will discuss the implementation of Proloquo2Go for a group of students in a specialist school. This implementation was planned by the school executive at Malkara School in consultation with a speech-language pathologist from Therapy ACT. During the first term of the implementation, the author was engaged as a literacy consultant by the school and began to consult around this classroom as well from Term 2. This paper will discuss what occurred both before and after the author's involvement.
Malkara School is a specialist school for students with intellectual disability and other disabilities. The school has over 100 students from early childhood through to Year 6. The majority of the students have complex communication needs (CCN).
In 2011, the school executive members reviewed the use of augmentative and alternative communication (AAC) throughout the school day. They found that although some of the students had access to an AAC system, the systems were used minimally. There were also a number of students who needed an AAC system who didn't have one.
The school executive developed a plan to improve communication outcomes for a target group of students, with the intention of learning from this process and then implementing the same practices throughout the whole school. Their plan was to have a specific classroom that focused on using and implementing AAC throughout the school day, supported by input from a speech-language pathologist (SLP).
This plan was inspired by a Proloquo2Go® group that had been run by an SLP for 10 weeks in 2011. Seven students aged 10–12 attended. All had access to an iPad with the AAC app Proloquo2Go (AssistiveWare, 2014). All used Proloquo2Go infrequently at that time. One of the students had previously used a speech-generating device, but for the other students, Proloquo2Go was their first high-technology AAC system.
The SLP demonstrated that the group had achieved good outcomes and recommended that it continue, although she wasn't able to offer continued support. The school executive, the teachers, and the parents of the students in the Proloquo2Go group also felt that the group had been useful. Two of the students left the school at the end of 2011, but it was decided to place the remaining four students in one classroom in 2012 with the stated intention of having a strong AAC focus in that classroom. Two additional students were included who had a recommendation from an SLP for them to use Proloquo2Go.
The six students placed in the Proloquo2Go classroom were all 11 or 12 years of age. They were in their final primary school years, and were transitioning to secondary school within 1 or 2 years. All had a moderate intellectual disability and CCN.
Student A was 11 years of age. She had minimal difficulties with fine and gross motor skills. She spoke a small number of single words that were intelligible to those familiar with her.
Student N was 11 years of age. He was diagnosed with Down Syndrome. He had minimal difficulties with fine and gross motor skills. He spoke a small number of single words that were not always intelligible, even to familiar listeners.
Student H was 12 years of age. He was diagnosed with Down Syndrome. He had minimal difficulties with fine and gross motor skills. He spoke two and three word utterances that were not always intelligible, even to familiar listeners.
Student T was 11 years of age. He was diagnosed with Cerebral Palsy and Spastic Quadriplegia and used a motorized wheelchair for mobility. His fine motor skills enabled him to access the screen of the iPad directly with one finger as long as it was mounted in a suitable position.
Student M was 12 years of age. He was diagnosed with a progressive neurological condition. He had been speaking sentences with several words, but his speech was becoming more dysarthric over time. As a result, his speech wasn't always intelligible to others.
The school provided three of the iPads used by students in the Proloquo2Go classroom and three belonged to individual students. These were either purchased by the family or funded as a speech-generating device. In addition, an extra iPad was purchased for the classroom so that the teacher had access to an iPad to program and practice with. Initially, the school-owned iPads only had Proloquo2Go installed.
In the first 2 weeks of the first term, only one iPad was used in the classroom. This was just used in the morning circle routine. Each student used the iPad one at a time to answer questions. This was very structured and very time-consuming. In Week 3, one iPad per student was introduced. Again, implementation was limited to the morning circle routine. While this was highly repetitive and scripted, it gave staff and students the confidence and skills to navigate categories within Proloquo2Go. It also gave the students the opportunity to practice some conversational rules such as turn-taking.
As the term progressed, Proloquo2Go use extended into the curriculum. Students used it to participate in balanced literacy instruction. Pages were programmed to discuss the purpose in daily Guided Reading (Cunningham, Hall, & Sigmon, 1999). The keyboard was used in word-based literacy activities, such as typing the words in a word family or to answer questions such as “what's a word that starts with m?” The numbers page was used in numeracy activities, particularly “before” and “after” numbers. Students also began to use the iPad for other purposes, such as reading books in Tar Heel Reader (Tar Heel Reader, n.d.) in the Safari© app (Apple, 2014). One student also had a range of leisure apps installed on his iPad as he had limited mobility in leisure time and this increased his recreation options.
The class teacher reported seeing a reduction in challenging behavior due to development of communication skills. The students also saw themselves as communicators and initiated communication with others more frequently. They showed increased social competence (Light, 1989) in a range of ways. For example, they were more likely to respond to other people's questions on the same topic, they would wait for their communication partner to take a turn, and they provided and requested information in structured settings. The class teacher and learning support assistant also observed that most of the students were using more speech than they had at the beginning of the school year. They also showed strengths in operational competence. They were able to turn their systems on and off, open Proloquo2Go, and change the volume as needed.
Although all of these discussed changes were positive, the team had strong concerns about implementation, particularly when looking at moving towards communicative competence (Light, 1989; Light & McNaughton, 2014). The heavy use of phrase-based communication wasn't improving the students' linguistic competence. They were mostly communicating in situations that were highly familiar with scripted-type language routines rather than generating language for themselves. Overall, despite the increase in initiations noted above, the students were mostly responding rather than initiating. Observations in the classroom showed that they were also frequently unable to respond due to lack of vocabulary.
At this time, the team discussed our communicative goals for the students. The aim was for each student to be able to communicate whatever they wanted, to whoever they wanted, in any situation. To achieve this, the team acknowledged that a comprehensive vocabulary set was needed. Core vocabulary was discussed and investigated. Core vocabulary is a relatively small set of words that are used frequently in communication. Core vocabulary can be used successfully in the classroom as part of a descriptive teaching approach (Witkowski & Baker, 2012). Use of core vocabulary gives students the ability to define, describe, predict, explain, and compare in the classroom and outside of it. For example, when discussing koalas, the teacher would use the words “sleep in day” when modeling in the AAC system rather than adding the word “nocturnal.” This descriptive approach shows the student how flexible their vocabulary can be, allows them to practice using words that will be useful both in and out of the classroom, and reduces the need to constantly add fringe vocabulary. Additionally, vocabulary can be combined to produce novel utterances at increasing levels of semantic and syntactic complexity.
Initial investigation into the core vocabulary page set for Proloquo2Go looked like it met the needs of the students in the classroom as it provided access to a comprehensive vocabulary. It also allowed the team to continue to use the same hardware and offered similar routines with programming and maintenance to those already established. The team trialed using the core vocabulary page set in Proloquo2Go to communicate themselves and this trial demonstrated that the core vocabulary page set offered comprehensive vocabulary that met our primary aim for the students. At this stage, Proloquo2Go 2.0 was installed on each student's iPad and the core vocabulary page set was created as a new user.
The Proloquo2Go core vocabulary page set has both core and fringe vocabulary. Fringe vocabulary is organized into categories. All pages in the page set can be customized. The page set is designed to work most efficiently in a layout of 6 columns and 6 rows (Fonner & Niemeijer, 2012). Proloquo2Go offers the option to change this to accommodate for access and vision requirements, but all of the students in this trial were able to directly access the page set with the default configuration. This gave them access to the largest vocabulary set with the minimum number of page turns.
Once the page sets were in regular use, notes and information were collected regarding any customizations needed and these were implemented over time. Personalization of each page set, including information such as the student's name, family, and favorite items, were completed over the first few weeks of the implementation of Proloquo2Go 2.0.
As a transitional step to the core vocabulary page set, the previous Malkara School page sets were also saved as a user on each iPad. This was done because members of the team were concerned how the students would manage the transition to the core vocabulary arrangement. A button was added to the new page set so that students could request the old page set, and use of this was modeled and practiced. However, none of the students requested to return to the previous page set.
Aided language input during this term focused on modeling key words. For example, the class teacher might say, “Let's go outside” and using Proloquo2Go she would model “go out.” Where possible, we limited ourselves to the home page of the core vocabulary page set. This demonstrated to the students how flexible this group of words could be. Aided language stimulation showed them the many and varied ways in which we could use this small but important group of core words (see Figure 1).
Figure 1: The Home Page of the Core Vocabulary Page Set in Proloquo2Go.
Initially, students' use of the core vocabulary page set was limited to familiar situations, such as morning circle. By the end of this term, after several weeks of aided language stimulation, students were still using Proloquo2Go mostly to respond, but all of them were using core words to communicate. Language samples taken from videos at the end of this term showed five of the six students were regularly using one-word utterances, using both core and fringe vocabulary. Four of those five students also used a small number of two- and three-word utterances combining core words or combining core and fringe words. The sixth student, Student T, was regularly using three- and four-word utterances.
General aided language stimulation continued throughout Term 3. Feedback at this time from the learning support assistants was that they were struggling to learn where vocabulary was stored since they had limited access to the app. This meant that they were slower to model and felt less confident doing so. To solve this issue, extra iPads were purchased at this time so that learning support assistants who were regularly in the classroom were able to familiarize themselves with the page set.
Key words continued to be modeled, but when communicating with Student T, the team began to use more little words as he had expressed that he would like to be able to communicate more “correctly.” Student T would often compose an utterance in the message window in Proloquo2Go, check how it sounded, and then correct it himself until all the grammatical morphemes were included and were in correct English order.
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STEP 1: Introduce the new word(s) using focused AIDED language stimulation
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STEP 2: Teach the new word(s) with explicit instruction activities
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STEP 3: Elaborate on the new word meanings with engaging practice activities
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STEP 4: Provide repeated exposure to the new word(s) on an ongoing basis
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STEP 5: Check for understanding and reteach, as necessary.
The SLP gave instructions to the learning support assistant using the word “on” several times (e.g., put the book on the table). The SLP's iPad was connected to the Interactive Whiteboard so that all of the students could see it easily and they were able to see the learning support assistants' responses as well.
The students took turns giving the Learning Support Assistant their own instructions (e.g., “bag on desk”).
The SLP then launched a different app, Clicky Sticky© (Invocore, 2012). In this app there is a background image and the user can place stickers on different parts of the background. The students took turns giving instructions to the SLP about where to put the stickers on the background.
If there was a short period of time available in the class day, the teacher would plug her iPad into the Interactive Whiteboard and the students were given a choice of interactive apps (e.g., Toca Band© [Toca Boca AB, 2013 ] or Clicky Sticky). The students would then give the teacher instructions to play with the app using the focus word. A second aim was often added at this point as the students found this the most motivating activity in the repertoire. The teacher would only follow Student T's instructions if he used grammatically correct sentences. Similarly, she would only follow Students P & A's instructions if they used a 3-word prepositional phrase.
We focused on one preposition for a week and then continued activities with it for several weeks.
Proloquo2Go Classroom Challenges
Due to restrictions with the school Internet service provision, the team was unable to do updates or download voices on the school iPads at school. This meant that the class teacher had to take the iPads home to update them.
The final difficulty was in getting the students and staff to ensure that the iPads were taken everywhere. Heavy duty cases were purchased that had lanyards to facilitate going mobile with the systems, but taking the systems out onto the playground or on excursions continued to be a problem as some school staff were so concerned about the iPads going outside that they actively removed them from the students before recess and lunch breaks.
Proloquo2Go Classroom Outcomes
Throughout 2012, the students in the Proloquo2Go classroom moved from using minimal AAC, to situation-based phrase-oriented AAC in first term, to using real and flexible communication through core vocabulary commencing in second term. The students now used AAC for a range of communicative functions. Functions regularly used by all of the students included commenting, requesting, rejecting, protesting, greeting, naming, giving information, giving instructions, and expressing feelings and emotions. In addition, Student H and Student T also demonstrated use of more advanced communicative functions (Dewart & Summers, 1995) such as talking about past and future events and taunting.
All of the students in the Proloquo2Go classroom made great steps towards communicative competence through the school year. By fourth term they were regularly having conversations of multiple turns with classmates, peers in schools, and their families. Language samples taken from videos at the end of the school year showed that all of the students were using 2- to 3-word utterances, although Student N still used a number of one-word utterances. One of the students, Student H, was regularly using up to 5-word utterances, often using little words, for example “I want to eat your lunch.” Student T was regularly using grammatically correct utterances, such as “I am going to Sydney. I can't wait!”
Malkara School Outcomes
In 2014, this has continued with Proloquo2Go, PODD books, and aided language displays continuing to be used in all classrooms. In Term 3 of 2014, the use of aided language displays had decreased with more classrooms focusing on comprehensive communication systems, generally Proloquo2Go and/or PODD books.
Overall, the success of the Proloquo2Go classroom greatly raised the profile of AAC in the school, as well as providing a great model of AAC practice. This has led to the school becoming much more proactive in the implementation of AAC for all students with complex communication needs. Malkara School created an AAC community within the school where everyone talks using aided language.
Acknowledgements
The author would like to express her thanks to the school executive at Malkara School for their strong advocacy for communication for all students. The author would also like to thank Fiona Barron, the amazing class teacher of the 2012 Proloquo2Go classroom who implemented all the recommendations so brilliantly and the learning support assistants who also were crucial in the success of this project.
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