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COMMUNICATION
MATTERS
APRIL 2005 Volume 19 Number 1
THE JOURNAL OF COMMUNICATION MATTERS / ISAAC (UK)
IN THIS ISSUE REGULAR COLUMNS
Communication on the Move CASC News
Doncaster Communication Aid User Survey Diary Dates
Evaluation of the Communication Aids Project (CAP) Hot News
Matching Person & Technology - Workshop Review Product News
Minspeak in the 21st Century: A Language Development Model Publication Reviews
MyLanguage StoryBags Trustees News
North Yorkshire Communication Aids Partnership
Role Model Involvement Project
Through My Eyes
Shut That Door!
Specialist Equipment Services for Disabled People
COMMUNICATION MATTERS JOURNAL
VOLUME 19 NUMBER 1
APRIL 2005
CONTENTS
2 Through My Eyes
Toby Hewson
5 The Role Model Involvement Project
Katie Clarke
11 Matching Person & Technology - Workshop Review
Matthew Nakonesky
25 MyLanguage StoryBags
Noreen Brown
29 Evaluation of the Communication Aids Project (CAP)
Cover: ‘Uplifting’ - a photograph in the ‘Through My Eyes’ - Report Summary
exhibition (page 2)
Dave Mitchell
31 How are we doing? The Doncaster Communication Aid
User Survey
Kevin Gosden
41 North Yorkshire Communication Aids Partnership -
NYCAP
Ann Underwood
CM2004 NATIONAL SYMPOSIUM PAPERS
7 Minspeak in the 21st Century: A Language
Development Model
COMMUNICATION MATTERS JOURNAL Sian Baker
ISSN 0969-9554
13 Specialist Equipment Services for Disabled People
Communication Matters / ISAAC (UK)
c/o The ACE Centre
- Report Summary
92 Windmill Road Emlyn Williams
Oxford OX3 7DR, UK
Tel & Fax: 0845 456 8211 17 Shut That Door! How Combining Environmental
Email: admin@communicationmatters.org.uk Controls and the National Curriculum can be a
Website: www.communicationmatters.org.uk
Huge Motivator
Registered Charity No. 327500
Company Registered in England & Wales No. 01965474 Debi Taylor
Editors, Design & Production 37 Communication on the Move
Sally Millar Email: sally.millar@ed.ac.uk Melanie Inglis, Gwenda Jones, Kerry Hill & Chris Bradshaw
Patrick Poon Email: admin@communicationmatters.org.uk
Advertising and Overseas Subscriptions
Tel & Fax: 0845 456 8211 REGULAR COLUMNS
Email: admin@communicationmatters.org.uk
22 Trustees News & Hot News
Copy Submission
Preferred text format: Microsoft Word 23 CASC News & Product News
Preferred graphics/photo formats: JPEG, TIFF
Copy deadlines: 17 June 2005 (Vol 19 No 2) 24 Diary Dates
28 October 2005 (Vol 19 No 3)
The Communication Matters Journal is the official PUBLICATION REVIEWS
publication of Communication Matters / ISAAC (UK),
and is an ISAAC affiliated publication. 43 Augmentative and Alternative Communication:
This Journal provides a forum for discussion, and views expressed in
any section of this publication are the views of the writer(s)
Developmental Issues
exclusively: publication in this journal does not constitute
endorsement by Communication Matters / ISAAC (UK) or ISAAC of 43 Listening to Children 2004
those views expressed. This is in no way affected by the right of the
Editors to edit all copy published. Publication of advertisements in
this journal is not an endorsement of the advertiser nor of the
44 Supporting Children with Speech and Language
products and services advertised. Communication Matters reserves Difficulties
the right to reject or cancel without notice any advertisement.
Copyright for all published material is held by Communication
Matters / ISAAC (UK) unless otherwise stated.
Printed by Crowes of Norwich
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 1
PAPER PRESENTED AT THE CM2004 NATIONAL SYMPOSIUM, UNIVERSITY OF LEICESTER, SEPTEMBER 2004
Through My Eyes
TOBY HEWSON
Email: tobyghewson@btopenworld.com
Let me introduce myself: I am diag- We hope when we show you these pic- my photo displays a sense of inner
nosed as having athetoid cerebral palsy. tures they will help you to understand peace and change throughout the sea-
What that means is that a small part of better the various points of view. Per- sons of your life. By being part of this
my brain does not work like other peo- haps some of those views might resonate project I have learnt that there are many
ple’s. So for example, when your brain with your own life experiences. issues facing all people in their every-
says stand up, sit down, walk, talk, put a day lives.”
spoon or cup to your mouth – you do. So here it is: ‘Through My Eyes’
It’s not complicated, you just do it! But
my brain does not allow me to do it.
Uplifting
So instead of walking I have my electric
Perspective
wheelchair, instead of talking I have my
Liberator. And I need help to do some
things so this is a chance for me to in-
troduce you to Mary and Di who are my
personal assistants (PAs). I have four PAs
who work for me on either a 24 hour or
48 hour shift system seven days a week.
I live in a Local Authority Bungalow in
West Sussex. I live a very busy life. I go
to college – generally for a day each Dean’s choice of photograph is called
Alice’s photograph ‘Perspective’ stands ‘Uplifting’. Dean says, “I wanted to meet
week. I visit mainstream schools in term
for taking time out to think. It is the view new, like-minded people and also be in-
time – sometimes two or three each
from the South Downs Way behind her volved with something outside of the
week to help the children and teaching
house, where she goes for a walk when day centre I attend whilst raising issues
staff understand about disability. I travel
she needs some space. that are very important to me.
a lot playing a sport called Boccia at in-
ternational level – so in the last three From working on the RITE Project, Alice “My photo means, ‘In the midst of it all’.
years I have been to New Zealand, the learned how busy everyone’s lives are, This project has enabled me to expand
Czech Republic, the United States, how much energy and commitment it my knowledge of other places outside of
Canada and Belgium, to name but a few. takes to really work together, and how my usual routine. I have also learnt that
good it feels when it works. there are many more people in my situa-
In 2004, I was in Brazil to attend the tion and lots of things need to change if
ISAAC Biennial conference on augmen- we are to have a voice in society.”
tative and alternative communication,
after which I am spent two weeks in
South Africa with my Mum and Dad on Keyboard Alternatives
holiday. So although I have cerebral palsy
I hope you will also see me for what I am:
a person, just like you are, but different.
What I want to share with you is an exhi-
bition called ‘Through My Eyes’. We
prepared this exhibition by working to-
gether in a project called ‘RITE’
organised by the Dare Foundation at the
University of Brighton. In simple terms
a group of service users and service This is Joe’s photograph ‘Shoreline’. Joe
providers came together to talk about says, “I became involved with the RITE
our experiences and then we chose project as it was a new venture within EA says of the photograph, “I became
some pictures to illustrate our feelings. what was a new job role for me. To me, involved in the project because I have a
2 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERS
concern for the way students often fail project seemed very interesting and a part in the RITE project she was very
to have the support needed during a great, exciting opportunity to raise aware- keen to be involved in something that
transition process from college or uni- ness for young people with disabilities. not only involved users of our service
versity to work. but where the control of the project was
“My photos are a symbol of flight, free-
“My photo highlights the question equally balanced, rather than led by the
dom, reflection of us as people,
‘Which is the right solution for me and provider of services. It seemed like a
breakdown of boundaries, beauty and
can I communicate it to someone else?’ blank canvas with endless possibilities
nature.
I feel there are choices to be made and She told me that she took this photo
“I’ve learnt to see things from every-
yet one never really knows which one when she was on holiday in Thailand.
body’s angle and gain a greater
will be right until one has tried it. It is Julia was struck by the trust the bird had
understanding of the view point from
also rare that this option is given in life in the young man not to harm him, that
all concerned both service users and
even if a person had communicated the monk took the time to “communi-
providers.”
their preferences. This applies in col- cate” with this beautiful bird and that
lege, in employment and especially with they communicated without words. The
assistive technology.” key messages were that successful
I do understand
communication needs interest in oth-
Every cloud has a silver lining ers, time, imagination to find alternative
ways to communicate and desire to
make contact.
Julia spends her whole working life work-
ing with people with communication
difficulties, it has always been in an ‘ex-
pert’ role. It has re-enforced for her the
fact that she is far from an expert!
Paul has called his choice of photograph Julia said, “I have thoroughly enjoyed
‘I do understand’. Paul told me: “I was working on a project where others have
asked by a service user if I would get taken the lead, where we have let our
involved in the RITE project. I was happy imagination flow and where everyone
This is Cherie’s photograph. Cherie told to do so, both to support my service has valued the contribution (however
me that her photo shows a series of user and to explain ways in which the small) made by each member of the
cards produced by colleagues at the public can raise awareness of disability group.”
University of Brighton to help inform related issues.
lecturers and support staff about differ-
“My photo is of my brother in laws’s
ent disabilities and how to make teaching
first signs of recognition following a
Security
accessible for all.
serious accident in March 2003. He has
She explained that exploring new teach-
cerebral palsy. My photo is extremely
ing practices can sometimes feel
important to me. It highlights my per-
daunting and this is why the caption is
sonal experience of disability, the fact
‘Every cloud has a silver lining’. She went
that I deal with many aspects of it in my
on to say, “It has been refreshing to work
private life as well as at work.
in an equal way on a shared vision of
what the members of the team believe “I have learnt that there are lots of is-
to be important and to communicate sues that need to be raised concerning
this with a wider audience. Most impor- disability. For example offering disa-
tantly we have worked in a way that has bled people access and opportunities
reflected the principles we discuss in to pursue their chosen goals and eradi-
this exhibition, namely, if we give each cating the public’s stigmatism that
other enough time, we can achieve what surrounds disability, the inability rather
we want to achieve.” than the ability, of a disabled person.”
Fiona’s photograph is called ‘Security’.
She says, “When I found out about the
Flight Simple Communication RITE project I felt it would be very ben-
eficial for me and also an opportunity to
meet other people, build new friend-
ships and to share our experiences.
However, I wanted to achieve something
and use my experience to help others.
“I have a condition called cerebral palsy
and have been living independently for
two years now. My pictures capture how
important my independence is and how
this stems from the support I have from
This is Gemma’s photograph ‘Flight’. friends and family around me which has
Gemma says, “I was supporting Dean at Julia’s picture is called ‘Simple Commu- given me security and confidence to live
the first workshop and thought the nication’. When Julia was invited to take independently and deal with the chal-
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 3
lenges I face now and in the future. Even years I have worked as a facilitator with
though we all lead different lives, I feel the DARE Foundation and was de- ISAAC 2004 CONFERENCE
that through this project we’ve worked lighted to be invited to facilitate Team NATAL, BRAZIL
towards a common goal and have posi- 1 during their six-month workshop pro- by Caroline Gray
tively challenged the assumptions that gramme with the RITE project.
still exist with people in society about I thoroughly enjoyed the conference!
“During many discussions with the
how individuals with a disability access,
Team it was obvious that lack of time I thought the Brazilian team did an
live and overcome barriers and stere-
was a really important issue for every- excellent job in organising and run-
otypical views.”
one. We all need more time – to ning it (not an easy task) - it was a
communicate effectively, to build re- really accessible conference.
lationships, to find out about people’s I went to some very interesting talks.
Burning Question needs and expectations, to provide
flexible and appropriate services.
I especially liked the idea presented
by the school from Argentina whereby
nine words helped to put a conver-
“My photographs focus on the fact that
sation into context. Before talking
time is constrained by the way services
to someone who answers predomi-
are organised and that there should be
nantly with ‘yes’ and ‘no’, first you
greater recognition that different peo-
ask “Do you want to tell me some-
ple need different amounts of time.
thing, ask something or do
“I’ve learnt so much from taking part in something?” then you ask whether
this project but perhaps, most impor- “Is it something that happened in
tant of all, is not to make assumptions. the past, that is happening now or
By taking time to look behind the ‘la- that is going to happen in the fu-
bels’ imposed on us by society, and ture?” And lastly you ask “Is it
working together, I have learned to rec- something to do with home or school
ognise each individual’s abilities, value or somewhere else?”
their experiences and understand their I was impressed by the work being
needs.” done in South Africa and enjoyed the
This is Graham’s photograph entitled talk by Maureen Casey and Kitty
‘Burning Question’. Graham told me: “I Uys. It was lovely to see some of
feel that the RITE project’s work could Carol Goossens’ ideas working in a
prove invaluable to FE Colleges as they Black Fish very different context. Carol was in
strive towards an inclusive environment the audience and I think she ap-
by seeking the views of existing and preciated the work too.
potential students.
I went to some very useful talks
“These views inform us of the good and about autism and liked the work
not so good practice happening in the being done by the Autistic Unit at
sector and by reflecting on this prac- Oslo University. I also really liked
tice colleges can widen participation and the ‘autigym’ presented by Bea Kunst
effectively meet the needs of a broader from the Netherlands - very practi-
range of students. The students who are cal ideas about managing children
involved with the project bring a wealth with autism in a mainstream gym
of personal experience that colleges situation - the ideas could transfer
and other service providers would be to other situations as well.
advised to tap into, ultimately for all par- I heard a very interesting talk by a
ties’ benefit. And finally – this is my photograph
person who uses AAC on the prob-
‘Black Fish’.
“I have found that this particular project lems of travelling by air as a
has provided me with a valuable insight I decided to get involved with the wheelchair user. Now, I am even
into the thoughts and vision of others.” project after Graham Vagg from Chich- more impressed by the wheelchair
ester College told me about it. I have users who managed to get to Brazil,
found it interesting and good to talk and the Brazilian Para-Olympic team
Time Constraints about my needs and aims. getting to Athens.
The main thing I have learnt from this Hilary Johnson from Australia gave
project is that it is important to work an interesting session on setting up
together and that to do this we all need a model of service over a large area
more time! for people with complex communi-
My picture represents holidays that I cation needs. And I was interested
have been on and different exciting to hear a talk entitled ‘Everything
challenges. breaks all the time’ a review of VOCA
durability given by Nahum Sloan.
I thought the posters were excel-
lent and learnt a lot about all sorts
of things from them. I was delighted
that the Brazilian group won the
This is Pauline’s photograph called ‘Time poster competition.
Constraints’. Pauline says, “For some Toby
4 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERS
The Role Model Involvement Project
KATIE CLARKE
1 Voice, PO Box 559, Halifax HX1 2XT Email: info@1voice.info Tel: 0845 330 7862
1 Voice – Communicating Together Five Role Models came to our Role We are delighted to be holding our next
creates opportunities to bring together Model Involvement Project event on 3 event on 16 and 17 July 2005 at Lilleshall
people who use AAC and their families to 4 July 2004 at Hothorpe Hall, kindly National Sports Centre, nr Newport,
to share ideas, information, skills and sponsored by Communication Matters. Shropshire. It’s in a wonderful accessi-
personal experiences. In a beautiful manor house in its own ble venue set in attractive grounds and
1 Voice realises the importance for disa- grounds, the Role Models spent their parkland.
bled children, young people and their time between socialising in the bar area We are continuing with the Role Model
families to have successful disabled and attending workshops. By the time Project in an informal way and invite new
adults using communication aids as role it was 4pm on the Saturday the Role Mod- Role Models to attend and be part of our
models. Disabled adult Role Models play els had put together their own Job inspiring team. We are also inviting teen-
a vital part in the running of the organi- Description and Person Specification agers to attend on the Saturday and to
sation and provide inspiration and after hours of work and discussion. give this group of young disabled peo-
motivation to parents, children and our On the Saturday afternoon families ple the opportunity to share issues
team of volunteers at events. It was for from around the country joined the Role around being a user of AAC.
this reason that we decided to bring to- Models and, in between the 1 Voice Once again we are asking families to join
gether a number of successful adult AGM, had the opportunity to meet new us for the Saturday night (and our AGM)
users of AAC from around the country, families and to be reunited with old and to attend the National Network Day
all of whom have something to share friends. The venue was a delight for the on the Sunday.
and inspire children with AAC needs younger AAC users and their brothers
and their families. We wished to con- Families can choose if they wish just to
and sisters to explore. The sun shone
sult with team of Role Models to find come for the Network Day which prom-
for our National Network Day on the
out from themselves just what makes ises to be a chance to have fun, meet
Sunday. We had over 80 people attend-
a good Role Model. lots of people who use AAC, enjoy the
ing, including our great entertainer, our
treasure hunt around the grounds and a
We hoped that by listening to the views of wonderful team of volunteers and disa-
buffet lunch. For more information
the Role Models we would be able to build bled sports leaders, and our families and
please ring 0845 330 7862.
on good practice and improve the work Role Models. Thanks to Awards for All
already carried out by our organisation. for making this happen. Katie Clarke
Do you love having fun?
Do you have a child under 12 who uses alternative communication? Are you a teenager
or an adult using augmentative communication? Are you a family member of a young communication
aid user? Do you work with children and young people who use AAC? If you answered yes join us at…
Role Model Project Teenagers Workshop Annual General Meeting
Friday 15 July from 4pm Saturday 16 July from 10am Saturday 16 July at 8pm
AAC Role Models (aged 16+) AAC users (age 12+) working with All members welcome
role models Accommodation available
National Network - Family Fun Day
Lilleshall National Sports Centre, Shropshire
Sunday 17 July from 10am
For full details of how to become a role model, attend the Teenager’s Workshop, become a
member and attend the AGM or to join us at the family Fun Day Contact: 0845 3307862
Reg Charity No: 1087615 www.1voice.info PCS symbols used with kind permission of Mayer-Johnson Inc
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 5
Calling all users of communication aids!
What would you think to an aid that you
control by speaking/vocalising?
Barnsley Hospital and Sheffield University are carrying out a project to
develop a voice input voice output communication aid.
We are looking for people who use communication aids or who are
interested in aids to complete a questionnaire to help us make the device
as useful and acceptable as possible.
If you would like us to send you a questionnaire please contact:
Rebecca Palmer (speech therapist) or Peter O’Neill (software engineer)
Community Sciences Centre,
Northern General Hospital,
Herries Road, Sheffield S5 7AU
Telephone: 0114 2715920 or 01226 730000 ext 3903
E-mail: r.l.palmer@sheffield.ac.uk, or Peter.ONeill@bhnft.nhs.uk
Please indicate whether you would like to receive your questionnaire:
a) in the post (return stamped envelope provided)
b) on an e-mail attachment
c) an electronic version online
d) over the telephone
6 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERS
PAPER PRESENTED AT THE CM2004 NATIONAL SYMPOSIUM, UNIVERSITY OF LEICESTER, SEPTEMBER 2004
Minspeak in the 21st Century
A Language Development Model
SIAN BAKER
c/o Prentke Romich International Ltd, Minerva House, Minerva Business Park, Lynchwood Peterborough, Cambs. PE2 6FT, UK
The twenty-first century has seen the dawn of a new era for
AAC. New funding arrangements in England have provided
the opportunity for greater language development. This is
because, in obtaining a communication aid sooner, children
are able to explore their world earlier, and so develop their
learning and increase their vocabulary, to further explore their
environment. As Bruner (1990) stresses: “…language is
acquired…through use…”
WHAT EFFECT HAS THIS HAD?
Learning to use an AAC device and the formal development
of an individual’s expressive language have never been inti-
mately linked. With the new challenge of an earlier
introduction to an AAC device it has been imperative to
strengthen that link. To achieve this has required an over-
haul of our programs and a complete revision of the support
offered with them. It will not just be the children who will
benefit from this; adult augmented communicators will also
find that the revision of programs and development of sup-
port will enable them to progress more speedily to fast and
effective communication.
HOW HAS MINSPEAK MET THIS CHALLENGE?
The Minspeak program we have reviewed is the Language,
Learning and Living (LLL) program developed in the 1980s.
The senior program is the LLL 128-location program and it is
important to reassure all those using this, on any of our de-
vices, that there has been no radical change to the
philosophical basis on which this was developed. LLL’s philo-
sophical roots and icons are the bedrock from which we
have developed a new family of Dynamic LLL MAPs ( Minspeak
Application Programs). These MAPs provide an introduction
to Minspeak, via 4, 8 and 15 location ‘teaching’ programmes,
with transition to the full 45 and 84 location LLL MAPs. It is
also important to add that those using the old, smaller dy-
namic MAPs (including the original Stepping Stones-based
LLL 45) will continue to be supported, although we have es-
tablished case studies where transition has actually improved
communication because of the additional vocabulary now
available.
WHERE DID IT ALL COME FROM?
The fundamental basis of our programs is Minspeak, a lan-
Figure 1 The LLL 4, 8 & 15 location programmes have been developed
guage that allows a small number of picture (or icons) to
to provide an introduction to the full LLL 45 and LLL 84
represent thousands of different words, phrases, sentences programmes, by using the same icons to represent language
and topics. It achieves this by each icon having many differ- across all MAPs, and maintaining architectural consistency as
ent meanings, depending on the context and order of use. closely as possible.
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 7
Our smaller programs were essentially days or whatever time span suits the
by using transparent single meaning pic-
written for specific clients and the individual. As augmented communica-
tures wherever it makes sense to do so.
icons did not look the same as in LLL tors progress they build on prior learning
128. Combinations of sequences were and incorporate that into the next CHOOSING THE WORDS
also different, again developed to meet stages of language development.
All the vocabulary in these MAPs has
a particular need at the time. We must
been identified for a reason. Language
not forget that AAC was very new when WHO IS IT FOR? ASSESSING MINSPEAK
development is not possible unless the
these programmes were developed and In order to help the professional iden-
correct vocabulary is programmed into
many would obtain a device never to tify the skill base required to use this
the device. We therefore explored aca-
move, usually because they were a teen- particular programme and symbol set
demically researched vocabulary lists to
ager or adult before we were able to (Language, Learning and Living), and es-
ensure that the necessary vocabulary
ascertain their specific needs and they tablish whether or not Minspeak is the
was included, and this wealth of experi-
could gain funding. Changes in circum- best methodology for developing their
ence from academia and AAC
stance have got to bring changes in what language, we have included an assess-
professionals ensured that key words
is on offer, and there must be an oppor- ment package.
appeared appropriately. Core vocabulary
tunity to progress as language develops
in particular needed careful considera-
and the needs of the individual demand
tion, but ‘fashionable’ vocabulary also
more language opportunities.
had to be considered. The academic
lists were then combined with the Na-
DEVELOPING THE SOLUTION
tional Literacy Strategy word list – whilst
When a toddler begins to speak we do
this list is for literacy development our
not suddenly find that they are lectur-
augmented communicators will still
ing us on the meaning of life, with all
need to communicate these words and
the language requirements that pos-
will probably, for example, use their de-
sesses! Their language is limited to their
vices to link to a computer to develop
needs, and their initial interactions with
literacy skills. We established strong
family and immediate friends. So their
academic foundations, but we also re-
AAC program needs to provide for this, Figure 1 The LLL Assessment Tool enables the alised that this was only part of the
BUT it must also give the opportunities assessor to test the user's ability to
picture, and our new MAPs were trialled
for the subsequent language that will recognise pictures, link them in
sequences and to categorise them ‘in the field’ from their earliest concep-
develop as the individual interacts with
tion, to ensure that key vocabulary was
their world, as Bruner states within the This is again staged in order to help pro- included and appropriately pro-
quote outlined earlier. Just as with the fessionals determine whether or not the grammed. An example of the value of
speaking person, the more language is individual can handle the concepts re- this ‘practitioner input’ was that the aca-
used the more it develops, and there quired in order to use the LLL demic word lists ordered ‘could’ and
must be opportunities for this to occur. multi-meaning picture symbol set with ‘give’ differently to the reality of the way
As augmented communicators Minspeak. It can also be used as a they were used in practice. Care was
progress onto programs offering more teaching resource to begin with, as well taken in their programming to take ac-
language opportunities they do not want as being used as an assessment tool. count of this.
or need the aggravation of icons that A simple tick sheet helps through the
change their appearance or sequences assessment processes to ensure we MORE SUPPORT FOR THE MEMORY – THE
that alter. Consistency in icons and icon recommend the most appropriate com- IMPORTANCE OF MOTOR PLANNING
sequences is absolutely essential. The munication system. The last point about order of vocabulary
practical implications of this are that the
An essential requirement of increased and programming of the device required
person using the communication aid
funding is an assessment process us to very carefully consider motor plan-
must recognise the same icons as they
which informs effectively the suitabil- ning issues. Studies tell us that people
progress from one programme to the
ity of a particular communication with cerebral palsy, traumatic brain in-
next, and the only learning taking place
methodology, which is why we deliber- jury and a wide variety of neuro-
then relates to the increased opportu-
ately included this in the MAP degenerative conditions depend on
nities not re-learning sequences. As
development process. motor planning to perform single move-
speakers we do not change languages as
In summary therefore, the concrete ments to an even greater degree than
our language progresses, neither should
practical outcome of this theoretical their non-disabled peers.
augmented communicators have to!
framework is: the assessment tool, plus A well-developed motor plan allows
PROGRESSION AND TEACHING – A DOUBLE the LLL 4, 8, 15, 45 and 84 Dynamic people to perform actions without
SOLUTION Minspeak Application programs (MAPs). thinking, i.e. automatically. Our aim in
For some augmented communicators setting this idea at our MAPs was to aid
the progression from one MAP to the BUT WHAT ABOUT MEMORY OVERLOAD? the speeding up of communication.
next can assist in learning the icons and With the ultimate aim of reducing the With the MAPs increasing in size, main-
their sequences, helping to promote memory requirements of individuals by taining a consistent architecture within
confidence and providing manageable using a multi meaning picture set with and between the MAPs was a tall order.
goals which are easily achieved. We all less symbols to learn, we did not disre- But we applied motor planning princi-
like to see progress as we achieve new gard the attributes of some single ples as much as possible, to help
goals and we all feel completely over- meaning pictures. After all, a cup is a augmented communicators establish
whelmed if presented with too much cup … is a cup, and so as the individual patterns and develop automaticity for
too soon. This transition process may develops their knowledge of Minspeak frequently used words, ultimately to pro-
take as little as an hour or two, a few there is a purposeful helping hand given mote speedier communication.
8 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERS
HOW DO YOU MARRY LEARNING A SYMBOL to create the appropriate menu for the
SET WITH DEVELOPING EXPRESSIVE individual.
LANGUAGE?
In addition, there are ready-made prac-
Using language with a communication
tice sheets which can be printed and
aid is a daunting challenge for both the
sent home, or put in an individual’s lan-
professional as well as the augmented
guage development folder. In ALL cases
communicator. Even with the creation
the icons and their ‘address’ on the
of an LLL assessment tool and the 4, 8,
overlay are given so that the supporting
15, 45 and 84 location MAPs, where
adults, who are used to working with two
does one start? What does one teach
figure coordinates, can find icons easily.
first? History has required us to teach
the symbol set independently of devel- TO SUMMARISE
Figure 3 Dawn Seals worked closely with
oping language, but did this happen to
the development team Language is now intimately linked to the
the speaking population? Definitely not.
symbols used to create it. As you have
So why should it be any different for an
witnessed, we have deliberately linked
augmented communicator? opment as the individual learns the
the LLL symbol set to language devel-
As we developed the MAPs, we also symbol set needed to create this lan-
opment, thereby allowing seamless
combined Speech and Language guage.
development of both language and how
Therapy theory with practice ‘in the The practical application of these prin- it is created.
field’ to inform our support materials. I ciples is a new Teaching Guide, which
Our approach, using theory and practice,
have already explained the assessment replaces the manual. The LLL 4, 8 and
is not new. Piaget, and Knowles and
schedule drawn up for quick access, 15 MAPs have been ordered in the way
Masidlover, have used this technique in
which will help establish the ability of expressive language is likely to develop.
producing their work. But it is how we
the individual to use the Language, The 45 and 84 location MAPs have a will continue to develop our MAPs, with
Learning and Learning symbol set and wealth of language that makes this im- the aim of helping the augmented com-
Minspeak. The SLT theory which helped possible. There is therefore a menu municator become proficient in the use
inform our work included the Derbyshire showing the likely order in which ex- of their new technological voice box, as
Language Scheme and the AAC Curricu- pressive language will develop. With well as developing their language skills.
lum. detailed references to the pages on
One of our Beta testers, who transferred
The practical issues surrounding the de- which this language will be found in the
from the original LLL 45 MAP to the new
velopment of the Derbyshire Language Teaching Guide, the professional can
LLL 45, and then on to the new LLL 84
Scheme are the same as in our case. easily build the appropriate programme
MAP, commented: “This is my dream
“The scheme was not put together on a and personalise their menu for language
machine”.
theoretical basis and tried out to see if development.
it worked,” we are told by Knowles and A common complaint amongst our col- Sian Baker, Education Consultant
Masidiover (1982). leagues in schools in particular is the REFERENCES
The correct balance of theory and prac- reduced time available to spend on de- Bruner, J. (1990) Acts of Meaning. Harvard Univer-
tice ensure that we get as close as veloping individual resources – our sity Press, Cambridge.
possible to achieving an effective sup- response to this is the inclusion of all Knowles, W. and Masidlover, M. (1982) Derbyshire
port mechanism. We wanted to pay Language Scheme.
resources on a CD for quick access.
Robertson, J. and Atkinson, S. (1999) The Core
attention to reality in the support mate- Quickly, a professional (from SLT to AAC Curriculum. SCOPE, London.
rials which will help the professional support staff) can find the appropriate Piaget, J. (1972) The Psychology of the Child. Ba-
plan their program of language devel- sheets in the Teaching Guide required sic Books, New York.
www.communicationmatters.org.uk
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10 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERSWorkshop Review
Matching Person & Technology
MATTHEW NAKONESKY
Regional Rehabilitation Centre, Hunters Road, Newcastle-upon-Tyne NE2 4NR
Email: matthew.nakonesky@nap.nhs.uk
On 18 November 2004, Marcia J Scherer, Associate Professor of Physical Medicine and Rehabilitation at the University of
Rochester Medical Center, USA, presented her Matching Person and Technology workshop in Newcastle-upon-Tyne. This article
is a review of the workshop and of the Matching Person and Technology Assessment Process.
‘Living in the state of stuck’ is not only client quite rightly in the centre, with formation and contacts for ordering the
the title of a Marcia Scherer publication the milieu then technology forming fur- assessment forms.
and the name of a song by one of her ther rings within the circle. On the The MPT Assessment Process actually
clients, but is also an excellent way of outside of the circle were the key contains a series of assessment tools
setting the scene for this one day work- words: Evaluate, select, accommodate and forms to be worked through. The
shop aimed at professionals working and use. This outer circle should be an process was more succinctly portrayed
with clients who require assistive tech- ongoing and continuous process. With in a flow chart on the day, however, here
nology. The goals of the workshop and this client focused approach in mind, is my attempt to summarise this proc-
ultimately the ways in which profession- Marcia also discussed the important ess. The first form that might be used in
als can alleviate this ‘state of stuck’, steps in any user-focused assistive the process would be the Initial
were to identify a variety of resources technology assessment and some of Worksheet for the Matching Person and
to facilitate matching people with tech- the questions they raise. Technology Process. This explores the
nology and ways in which to collate key 1. Goals and dreams: These should be client’s limitations, strengths, goals and
information about our clients to ensure discussed in depth with the client, desirable intervention in a range of do-
the most appropriate assistive technol- which will also help build rapport be- mains, including dexterity, mobility and
ogy is selected. The Matching Person and tween the professional and the client. speech/communication. The next form
Technology (MPT) Assessment Process, in the process would be the History of
2. Need for assistive technology: Is
developed by Marcia, was presented as a Support Use form. This looks at the same
assistive technology needed or would
tool to help achieve these goals. range of domains, however prompts the
other forms of support be more ben-
Before looking at the MPT Assessment eficial? person to think what support they cur-
Process in depth, Marcia presented rently have and have used in the past
3. Readiness for assistive technology:
some background theory that helped and the support still required now.
Are they motivated to learn how to use
put her assessment tool into perspec- With these preliminary forms completed,
such devices?
tive. She stressed the importance of The Survey of Technology Use (SOTU)
focusing on the client, the milieu (envi- 4. Assistive technology and lifestyle
would then be used if the clinician
ronments of use) and the technology. fit: Is the environment ready? Is there a
wanted to identify technologies that the
When focusing on the client, the issues good level of acceptance from others?
individual is comfortable with or has had
of gender, age, adjustment to circum- How easy will it be incorporated?
previous success with. Then there are
stance, functional needs and lifestyle 5. Comfort with use: Not just physical four technology specific tools. The first
need to be considered. Within the mi- comfort, but emotional comfort. is called the Assistive Technology Device
lieu, influencing factors include cultural With that background in place, Marcia Predisposition Assessment (ATD PA). This
differences, economic status, atti- proceeded to explain the MPT Assess- tool is used to help the client select
tudes, physical barriers and legislative ment Process with the help of a very assistive technologies. The remaining
or political climate. Important aspects useful information CD. Some of the in- three tools are more specific to a par-
of technology were highlighted, includ- formation below has also been taken ticular client population. The Educational
ing performance, cost, availability, and from the website of the institute that Technology Predisposition Assessment
appearance of the technology. Marcia works at, The Institute for Match- (ET PA) assists students to use technol-
The above areas were portrayed as rings ing Person and Technology. The website ogy to achieve their educational goals.
within a circle. (See the ‘Key Informa- address is www.members.aol.com/ The Workplace Technology Predisposition
tion’ box at the end of the article.) The IMPT97/MPT.html and contains good in- Assessment (WT PA) can be used by
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 11employers who introduce new tech- With the ATD PA presented in depth, SUMMARY
nologies into the workplace and who train Marcia invited the audience to provide Overall, the ATD PA and the whole MPT
people in their use. And finally, the Health their feedback and thoughts. One point Assessment Process is an excellent
Care Technology Predisposition Assessment raised was that throughout the work- method for focusing on the individual
(HCT PA) which is aimed at health care shop, the ATD PA was generally and then considering their environment
providers who recommend technology presented as being used by single dis- and also the different aspects of tech-
as a form of health maintenance. ciplines. However, the audience nology. With this focus on the client’s
certainly felt that this tool would be well preferences and perspectives, the ATD
During the workshop, the ATD PA was
used within a multidisciplinary team and PA facilitates a joint approach for the
the main focus of the day. This con-
would promote joint working. Marcia client and health professional/team to
sists of a range of forms. The initial form
both acknowledged and embraced this select the most appropriate technology
consists of 54 items to answer which
point. for that individual client, particularly when
provides an initial baseline about the
Another suggestion was that the tool there are several alternatives to choose
client’s view of their functional capa-
would be inaccessible to clients with from. Given that there are continued de-
bilities (9 items), their well being/quality
significant communication difficulties. velopments and new products frequently
of life (12 items) and the client’s tem-
The possibility of presenting this tool launched in the field of assistive tech-
perament and personal characteristics
in a different format was discussed, nology, the need to be more selective will
(33 items). The first two areas are rated
with one format called ‘Talking Mats’ only increase. The MPT Assessment pack-
on a five point Likert scale from either
being offered as a possible solution to age would be a very useful tool to have in
poor or not satisfied to excellent or very
making the tool more accessible. Con- any clinical setting that recommends
satisfied.
sidering most clients with significant assistive technology, and one on which
The results from these 54 items can be the entire multi-disciplinary team can
communication difficulties are likely to
interpreted by identifying both positive work jointly.
benefit greatly from assistive technology,
and negative ratings from the first two
it would be a worthwhile effort in adapt- Matthew Nakonesky
sections and any recurring themes
ing the ATD PA to meet this need. Specialist Speech & Language Therapist
within the third section. This initial form
also prompts the client and therapist to
identify goals to be achieved in 6
KEY INFORMATION
months time and goals to be achieved
within one year. With this initial infor- x The Matching Person and Technology (MPT) Assessment Process is a user-focused
mation gathered, the therapist should assistive technology assessment process.
then identify a range of assistive tech- x The MPT Assessment Process approach can be best summarised in this diagram which
nology devices that reflects the client’s outlines the key areas of a user-focused assessment:
responses and that the client can trial
for a short period.
The second form of the ATD PA is then
used to compare these devices on how
successfully they met the client’s de-
sired outcomes over the short trial
period. Each device is rated from 0 to 5
(ranging from not applicable to all of the
time) on 12 items related to the actual
device and the client’s experiences of
the device. Three of the 12 items are
given more weighting by the client and
these are examined more closely when
making the final choice of which de-
vice is the most appropriate. The device
with the highest rating overall is consid-
ered to be the most appropriate device
for the client and should then be pro-
vided for a longer trial period.
Following this longer trial and with the
concept of ‘outcome measures’ being Source: Institute for Matching Person & Technology, Inc Copyright 2000
an ever present theme in best clinical
practice, the client should return after
x It is made up of a series of assessment tools and forms, with the Assistive Technology
3-6 months and complete the follow up Device Predisposition Assessment (ATD PA) one of the key tools.
forms of the ATD PA. These forms are
very similar to the previous 2 forms, so x The ATD PA provides a baseline of the client’s views on their functional capabilities, well
being and personal characteristics. It also facilitates comparison of assistive technology
therefore the client is re-rating him/
devices and provides outcome measures based on the client re-rating themselves.
herself on these previous aspects.
These can then be compared to their x With continued developments and new products launched in the field of assistive
initial scores, thereby indicating technology, there is a need to be more selective. The MPT Assessment Process is one
tool that would assist this selection process.
whether the assistive technology de-
vice has in fact been useful and x Further information and details on how to order the assessment can be found at the
successful in meeting the client’s de- following website: www.members.aol.com/IMPT97/MPT.html
sired outcomes.
12 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERSPAPER PRESENTED AT THE CM2004 NATIONAL SYMPOSIUM, UNIVERSITY OF LEICESTER, SEPTEMBER 2004
Report Summary
Specialist Equipment Services for
Disabled People - the need for change
EMLYN WILLIAMS
Electronic Assistive Technology (NW), Walton Centre for Neurology & Neurosurgery, Lower Lane, Liverpool L9 7LJ, UK
With health and social care provision yet for many disabled people assistive Three recommendations from the Re-
in the United Kingdom presently under- technology, environmental improve- port of the Royal Commission on Long
going major reorganisation, both the ments and carer support can be equally Term Care (1999) [2] and ‘Fully Equipped
Royal College of Physicians and the In- important. (2002) [3]’ are especially relevant:
stitute of Physics and Engineering in The document focuses on four • Personal independence can pro-
Medicine are keen to ensure that the modalities of assistive technology (com- mote social inclusion and relieve
relevance of specialist equipment serv- munication aids, computer access, pressure on acute health care facilities.
ices for disabled people is properly environmental control systems and
identified and recognised. Telecare) and identifies issues that de-
• Services should be easier to access
and there should be more consistency
They recognise that technology offers termine their effective and timely
in assessment and eligibility.
many people enhanced ability, greater provision.
independence and a lesser depend- Much of the technology is available in • Adequately funded and integrated
ence upon others. home and workplace and already offers equipment services should be part of a
Much is readily and cheaply available, disabled people a greater independence, coordinated NHS and social service pro-
but whilst the numbers of disabled peo- but there remain some individuals with vision.
ple able to benefit increase, equipment needs so complex that they require spe- Modernising Social Services and The NHS
services often lack the coordination cialist assessment and provision. Plan [4,5] proposed the amalgamation of
and the expertise to deliver it effec- Whilst equipment may be common- local authority and NHS equipment serv-
tively. This is especially so when there place and mass produced, the ability to ices under the guidance of the
is need to configure and integrate elec- customise it, to design bespoke solu- Integrating Community Equipment Serv-
tronic and computer based tions and to safely integrate disparate ices (ICES) project.
technologies for the effective and safe technologies one with another, requires
usage of communication aids, compu- This seeks to build upon local strengths,
considerable specialist expertise. The
ter access, environmental control developing links with smaller and more
availability of this expertise is critical:
systems and Telecare. specialised providers and introducing a
much of the equipment can be readily
single operational manager and equip-
Nationwide there is wide variation in and cheaply accessed, but many disa-
ment stock in each locality.
patterns of service delivery, so the in- bled people require coordinated
ter-disciplinary working group has patterns of professional input if they The working group welcomes the thrust
prepared a discussion document and a are to use it effectively and safely. of the principles and guidelines that
series of recommendations to stimu- underpin the ICES project [6].
There is nothing new in having technol-
late debate and thereby promote a ogy compensate for functional However, it is keen to emphasise that
better and a more equitable provision. impairment. Walking sticks have been optimal outcomes are achieved only
A summary of the document and its used since ancient times, wheelchairs when services offer the specialist ex-
recommendations is presented in this for hundreds of years and simple envi- pertise of clinical scientists and
paper, on behalf of an inter-disciplinary ronmental control systems for nearly technologists, physicians and thera-
working group set up by the Royal Col- half a century. pists and enable them to collaborate
lege of Physicians and the Institute of Sequential reports have highlighted the confidently and easily with each other,
Physics and Engineering in Medicine. relevance of assistive technology and with other services and with service
electronic and computer based sys- users.
INTRODUCTION tems have increased its efficacy: - yet All too frequently, poor coordination and
Medical intervention can increase lon- still it remains under-resourced and un- outdated patterns of funding perpetu-
gevity and improve the quality of life, der-utilised [1]. ate confusion and delay provision.
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14 VOL 19 NO 1 APRIL 2005 COMMUNICATION MATTERSRECOMMENDATIONS sionals to maintain and develop their It is important to maintain and further
1 . Specialist equipment services for skills. develop the expertise that can offer
disabled people should be widely With there being a shortage of special- bespoke provision and competent pro-
and equitably available. ist professional expertise and an urgent fessional supervision across the
need to increase opportunities for train- breadth of equipment services.
2 . Complex need and the integration
of disparate technologies should be ing, research and development, services It is also important that equipment be
overseen by specialist equipment of a size, standard and critical mass that provided on the basis of assessed need,
services. can justify the necessary investment rather than on the availability of dedi-
are proposed. cated funding.
All too often, specialist equipment serv-
ices are little known and little 5 . Clinical governance offers a
SUMMARY
understood by professionals, by disa- framework within which specialist
professionals should facilitate and Within the totality of health and social
bled people and by the wider
oversee a coordinated provision. service expenditure, the cost of spe-
community.
cialist equipment services is small, yet
Their availability varies widely and there 6 . Supernumerary training posts
effective, timely provision can
are those that remain difficult to access should be established to facilitate
potentiate existing lifestyles, enhance
– adhering to rigid patterns of eligibility training, promote innovation and sup-
independence, reduce dependence on
and requiring guaranteed funding prior port professionals seeking to further
others and lower the cost of care.
to undertaking clinical assessment. develop their expertise.
However, whilst provision is delivered
It is important that assessment is en- Experienced clinicians and technolo-
through ill-coordinated and inad-
trusted in a timely manner to skilled gists are critical to the effective and
equately resourced services, such
professionals working within an inter- safe deployment of assistive technol-
opportunities will not be realised.
disciplinary setting that enables them ogy, yet they remain a very limited
resource. The working group is convinced that the
to readily access expertise complemen-
key to better provision is a heightened
tary to their own. The document proposes that clinical
awareness of the opportunities offered
scientists should oversee the develop-
3 . Evolving equipment services by EAT coupled with an increase in the
ment and operation of services and
should build upon established pro- number of the specialist professionals
recognises the need for technologists
vision so as to harness and better (clinical scientists, technologists, physi-
and therapists to develop expertise, to
deploy experienced specialist per- cians and therapists) whose expertise is
participate in on-going patterns of clini-
sonnel. essential to delivery of safe, efficient and
cal governance and to have opportunity
4 . Specialist services require substan- cost-effective services.
to further develop their competencies.
tial investment in expertise and
Although specialist expertise in EAT Emyln Williams
infrastructure and should serve Consultant in Rehabilitation Medicine
has been historically linked with high
catchments in excess of one million
cost - low volume provision, much elec-
people.
tronic and computer based technology
All Electronic Assistive Technology The full text of the discussion docu-
is now available on a low cost, high vol-
(EAT) services use modern remote con- ment can be downloaded without charge
ume basis.
trolled equipment because it is cheaper, from www.rcplondon.ac.uk/pubs.
Nevertheless there remains need for
more effective and more reliable than It is also available in booklet form at a
specialist input if equipment is to be
older hardwired systems. Most offer cost of £7.00 from Publications Depart-
used to best advantage and there are
timely emergency provision, but all too ment, Royal College of Physicians, 11 St
always those requiring the special ex-
frequently routine provision can take Andrews Place, London NW1 4LE, UK.
pertise of professionals able to ensure
many months. [7] Please send any comments you may
that disparate technologies operate
Implementation of the ICES project of- safely together and in proximity one to have regarding the document to:
fers opportunity for specialist and kim.billingham@rcplondon.ac.uk
another.
community equipment services to col-
laborate more effectively one with 7. Budgetary provision for specialist
another and to better target provision to equipment services should be sourced
REFERENCES
user need. jointly from local authorities and Spe-
1. Audit Commission (2004). Assistive technology
cialist Commissioners. – Independence and well-being 4. Audit Com-
It is suggested that community equip-
8. Services should highlight any fi- mission, London.
ment services should offer:
nancial shortfall rather than tolerating 2. The Royal Commission on Long Term Care
• local or ‘near user’ availability of sim- (1999). With Respect to Old Age: A Report by
inappropriate and delayed provision. the Royal Commission on Long Term Care. The
ple stock items;
Most equipment services struggle to Stationery Office, London.
• smart house technology, safety
3. Audit Commission (2002). Fully Equipped 2002 –
meet demand from historically limited
monitoring and Telecare in partnership Assisting Independence. Audit Commission, Lon-
and poorly coordinated budgetary allo-
with community alarm providers; don.
cations. Many meet financial targets by
• access to specialist services able to delaying provision, even though they
4 Modernising Social Services (1998). Department
of Health. The Stationery Office, London.
safely meet and integrate the require- recognise that thereby they deny ben- 5 The NHS Plan (2000). A plan for investment – a
ments of users with complex need. efit to potential users. plan for reform. The Stationery Office, London.
These specialist services require catch- The document welcomes the pooling 6. Integrating Community Equipment Services
ment populations of a size sufficient (2002). Commissioning Guidelines.
of local authority and NHS budgets as ICES, London. website: www.icesdoh.org
to justify the cost of their staffing and part of the ICES project, but considers
support facilities, together with a body 7. Downton, J., Shakespeare D.T. and Williams E.
it imperative that monies for specialist EAT (NW) Annual Report (2004). The Walton
of users large enough to enable profes- services be specifically identified. Centre for Neurology & Neurosurgery, Liverpool.
COMMUNICATION MATTERS VOL 19 NO 1 APRIL 2005 15You can also read
