Thursday, 26 February 2015

How Do I get This Kid to Communicate - Part 3 - Using our iPad to Communicate

Using his Choice Board clipped to
an acrylic stand
 Hi All, Well I thought it was about time to talk about how we got lucky and our son started to use his iPad to communicate.  It was a LONG process that we thought would NEVER happen.  I have thought at length on just HOW he started to use the iPad to actually talk and choose items.  What was it that finally worked?  What did we do?  What was the miraculous thing that made it all happen?
I wish I could say I had an answer for that, but alas, I don't.  Thinking back over it I suppose there was a lot of different things that all culminated with success.  Some of it was the low tech PECs training and choice boards, some of it was the early AAC Apps like Talking Cards being used and modelled, and some of it was pure luck and him being ready.

The 'AHA!' Moment

One day about 2 years ago we were all sitting around the table after having breakfast, our son was happily mucking about with his iPad as he often did going in and out of Apps just checking out what they all were and what they did.  He had been randomly going into the 'Talking Cards' app off and on and just listening to what each button said and we had learnt to ignore most of this exploring.
 We figured it wouldn't hurt him to just explore rather than us model or force him to use it. Up until this point he had never really initiated any choosing on the iPad using his App.  It was all forced choosing with us modelling and hand over hand button touching to get the correct answer and then be given what he had requested.  He seemed to understand it but never get the point and wouldn't really try without being 'made' to do it.  He was pretty passive and would only use his PECs Choice Placemat to choose anything.  By this time those placemats had started to get flung and he was obviously over those too.  But back to our original tale...

This particular morning he was quite interested in the AAC App, randomly listening to what each button said and trying them out.  When he started tapping 'BALL' we looked at him and said 'Ball? Ok, I'll get one for you'.  He looked stunned and watched us go out of the dining room.  I duly came back with a ball and sat there playing with it expectantly.  He got a little agitated and vocalised, but we ignored him.  I asked him to repeat what he'd said on the App and he looked confused.  I then told him if he wanted the ball he needed to ask with his iPad.  He looked at the iPad, looked at us, then complained vocally again.  I looked at hubby and said 'Would you like the BALL?', he said 'Yes, I would like the BALL'.  So I passed it to him.  I then signed Ball and asked for it back.  We did this for a few minutes with our son getting most annoyed.  I pointed to his iPad each time and said 'Ask for the BALL'.  He eventually touched the button again and we said 'Great! heres the ball'.  His face flooded with that expression we all know as 'OH! I get it'.  Suddenly it dawned on him what had happened and he was very excited.  I asked for the ball back and he gave it to me.  Then I played with it for a bit and he again hit the 'BALL' button and I gave it to him and said 'Yes, you can have the BALL'.  We did this back and forth for a few more minutes and he was SO excited.
Using his iPad whilst in
 his Hip Spica Cast
That was our big breakthrough.  We were on school holidays he was trapped again in a hip Spica cast thanks to another hip surgery and couldn't do much but we had something we could work on.  It was from then on that his use of AAC on the iPad just took off.

Talking Cards to Proloquo2Go

We started to add extra buttons and choices to Talking Cards as his level of choosing and wanting to use the iPad to choose got better and more consistent.  All through those 6 weeks of the school holidays he got better and better.  We were using it mostly to choose food items, but he also used it to choose what he wanted to watch on TV, where he wanted to go to, for a walk, to the park, for a swing or even to the swimming pool.  He really started to enjoy using the iPad to control things and he became empowered quite quickly.  The lovely thing about it all was his frustration levels went down as he was finally able to say that he really preferred honey on his toast not jam! (this was by constantly asking for honey when asked if he wanted jam on his toast).
Then school holidays finished and he returned to school. We sent along the iPad but never told school that he was using it to communicate, his teachers and aides continued to use his Choice Book which was a series of pages within an A5 Flip Book. After a few weeks of school we admitted that our son was using the iPad to choose at home and that he was rather good at it.  The School SLT was amazed as were all his teachers.  When they saw just how good, they then encouraged and expected him to use it to choose and converse.
Our Talking Cards Folders
However, Talking Cards was really limiting, no matter how much I tried to setup the varying folders with useful buttons it really wasn't setup for an emerging communicator like our Son.  I started to research AAC usage and read a LOT of blogs, webpages, joined facebook groups and generally upskilled myself on HOW to setup AAC Apps for basic communication.  Both myself and the School SLT realised quite quickly that his Talking Cards App was never going to work for long.
So I downloaded and setup ' Sounding Board'.

Here's another disclaimer: in a previous life I used to be a Senior Microsoft Computer Engineer and a both a DBase & Web Programmer, so I am comfortable with technology.  Configuring Sounding Board and setting up a flowing AAC App of choices and folders was quite my cup of tea and I found it easy.  Therefore I don't suggest you do this unless you feel confident you can.  Its an excellent free App, and if you can set it up with a series of folders and get it to work for you, go ahead and do it.
For a few weeks it worked really well, but if we needed to add more buttons to his folders often Sounding Board would break and I would have to recreate the folders all over again.  I could never get a good resolution from Ablenet the developers of Sounding Board so I had to regroup and think of another App that would do the job.
Sounding Board Main Page setup (the arrows show links to other pages)

By now I had to been researching on the web for a LONG time and knew of a few Apps, had seen YouTube videos, knew the costs and was aware of AAC apps that may help.  But right now our Son was keen on the way I had setup things and we really didn't want to blow all that work.  By now he had been using his iPad to 'talk' for about 6 months. So what AAC app could we use that we could setup to be like his current AAC apps?  From what I could tell the NZ$300 App Proloquo2go was the best option. But it was expensive.  So we waited until iTunes Cards were having a 25% off sale.  We brought enough iTunes $50 cards to make up $300 and brought Proloquo2go essentially for sale! Well at least with a 25% discount!

On the Proloquo2go Journey we go...  

I then spent a few long nights watching Assistiveware Video Tutorials and I went with a Basic Communication user first off with standard folders.  I started to modify that setup quite quickly to look much like his Talking Cards setup and have the same sort of flow as Sounding Board. So despite installing Proloquo2go I never used it configured 'out of the box' and instead attempted to create a system that 'flowed' easily for him.  A sort of  'mind map' based on how I thought he might make sentences, and from the experiences we were already having with him.  Not once did I think that far ahead in my design of the folders or buttons. For some time this setup really worked, it was based on what he was saying right then, and he loved it
 because it was getting him what he WANTED.  I never really understood language acquisition and certainly not in relation to my son.  I didn't really know what he knew and what he didn't.  His iPad communication was proving he knew and understood a lot.  Here was our conundrum, we had it setup to provide 'sentence starters'.  The most often used folders were 'I WANT', and 'FOOD'.  In the FOOD folder I had it set based on eating times, so food items were grouped in BREAKFAST, LUNCH, DINNER and SNACKS.  Over time I needed to add in Core Words so he could start to enlarge his vocabulary.  This is when we hit problems, he had always had some core words thrown in there, his top line of his setup always had YES, NO, MORE and FINISHED.  Obviously I WANT was core words too, but he wasn't using them in context he was using them because I had 'made' him use them in order to get to where he wanted to be, which was often eating Munchos or cheese!
The School SLT was asking us to include more Core Words and we needed to start adding them in.  So cue more long nights watching videos, reading blogs, and getting on the Proloquo2go parents FB group.  Its here I think I will leave this blog entry as its another story in itself how we progressed Proloquo2go and added core words into his vocabulary.  Believe it or not our story as you have read it so far still has about 2-3 more chapters to go!

Thanks for reading my blog and stay tuned for the CORE WORD CONUNDRUM!

This is a slightly advanced version of our original Proloquo2go home page.  You'll see how each folder is basically a 'sentence starter'.  If he touched 'I WANT', it would speak that to the sentence strip you see above all the buttons, he could then touch FOOD folder, and in that folder a SNACKS Folder, and in there CHEESE.  The sentence Strip would then have 'I WANT CHEESE' on it and he could push the strip to say that sentence out loud. 

Friday, 20 February 2015

Neoprene iPad sleeve turned into a carrier

Hi all I thought you'd all like to see the hack of my sons old neoprene iPad sleeve turned into an inexpensive carrier for him. Unfortunately he needs his iPad in so many places & as he's not completely wheelchair-bound it needed to be more portable than a fixed mount on his wheelchair. Also the fact he's self-propelled in the wheelchair meant any mount would get in his way. 
So I quickly made a carry case to hopefully solve a problem at school. 
It's yet to have been fully tested in the school environment so I'll let you know how it goes. 

Here's a photo of the back of it

Wednesday, 18 February 2015

Tutorial - creating an Older Childs Onesie from an Adult Mens Tshirt

Ages ago my son underwent Hip Surgery to correct hip dysplasia in his Right hip/leg.  At the time he was 6 years old and quite big and we thought we'd get away with long 8 year old tshirts.  But alas he was cast quite wide and the large adult nappy he wore wasn't a pretty sight!  So I had to quickly come up with something for him to wear.  It was summer, so he was going to be hot.  He was also going to have to go to school off and on.  I didn't want him looking totally silly.  So what to do?

Make something of course!

So I went to the sales and brought lots of cheap Mens Medium size tshirts and adapted them.  I am sure I am not the only one who has found a need for larger children to wear onesies or rompers.  So as I like to share heres the link to my Tutorial in PDF format:

Older Kids Onesie Tutorial PDF (Google Drive)

The rompers were done slightly differently by placing a pair of older childrens shorts folded up on top of the bottom of the folded Mens Tshirt.  I then cut around the leg area to shape it into shorts.  Overlocked the bottom edges and then turned under to bind the cut edge.  I then sewed snap tape onto each edge and it was done!

Monday, 9 February 2015

Thinking of a Core Vocabulary

Even though I have yet to have continued our jump to iPad communication story yet and explained quite where we're at I would add in something of interest I recently discovered online.

As I am sure you have read in my previous posts about our communication journey, I label things, give them nouns and point them out to my son so hes aware that things have words associated with them.  This naturally leads to symbols and eventually awareness of symbols as a language.  Letters themselves are symbols, and those letters make up a word that we recognise as a word once we have learnt to read.  For kids like our son he may not understand words in the written form but he is learning to associate symbols of another form - pictures, and associate them with words.  I don't know if he really understands the letters form a word, but he definitely has learnt the associated symbol picture which is often just a photo of the object.  These pictures are often nouns, food items, clothing items, desirable things like TV Programs etc.  But they most definitely aren't a 'core word', like I, ME, HAVE, WANT, GO etc.  Hes started to learn those words have purpose on his iPad and uses them to make sentences.  Mostly thats because I have put desirable items within folders that have a core word like GO or WANT as their title.  So he simply goes to his WANT folder and within that he can find his FOOD folder and eventually his MUNCHOS button.  By this time he has created a sentence saying I WANT, FOOD, MUNCHOS, mostly without trying.  Hes learnt this over time and with modelling help from myself and other people in his life. But I have wondered for a LONG time how to teach him the concept words.  Words like LOVE, LIKE, HERE words that have meaning but no real associated symbol as such.  Can I get him to create a sentence like I LOVE YOU using just buttons on his iPad?  So I am in that phase right now trying to wrap my head around core word concepts and teaching my son how to use them.  Hes currently stuck in that choice level communication of wants and needs, and any elaborate sentence making is limited.  As I have chosen to be his iPad AAC Programmer I need to understand him and the concepts of language.  But returning to my original point of this post:

I read this facinating page: for-the-love-of-core-and-labels-labels-labels
and the concepts they discuss with labelling items struck me and made me re-evaluate my 'noun' based labelling around our house.  Now I think I will go around replacing my labels with more useful 'sentence' labels as this quote from the above link says " label things around the classroom or the home with core word phrases to help learners with delayed language acquisition gain additional exposure to functional core word meanings in the context of their play and learning environment."

So lets see where this leads in our ever changing journey!

Cheers, Vivien

Monday, 2 February 2015

How Do I Get This Kid to Communicate? - Part 2 (Next Level)

Welcome to 2015!

Well its been a long time coming this blog post.  Mostly because I couldn't think of just HOW we got to this point and remember back to just when he started using the iPad.  We were early adopters of the iPad buying it from Apples Online store and waiting a good month for it to arrive from China.  It was one of the early iPad 2's.  Back then I had seen a few iPads in stores with Proloquo2go on it and other AAC (Augmentative and Alternative Communication) Apps.  I didn't think our son would ever really use one let alone understand it back then.  My Husband 'gifted' the Talking Cards App to us via iTunes and we installed it.  I originally set it up with just a few of his favourite food items, and used some of the buttons that came with it.  It was a good simple App, and back then his iPad2 had a reasonable microphone.  It was tricky having both the inbuilt voice (an american female voice) and my own saying the words I had against each button.  Back then it was simple words like FOOD, DRINK, MUNCHOS, CHEESE etc.  Even though we showed the app to him he never really understood it or used it.  We had a bigger problem back then - tactile defensiveness  with his hands.  He also lacked motor control or any sort of fine motor understanding.  So he could barely get past a fly swat type thump of the iPad screen and certainly couldn't individually point a finger and stroke or touch easily.  So we had to work on finger isolation first and that was going to take time.

Finding our Fingers

When we first got the iPad we were using a PC computer and a switch we borrowed from the special needs toy library to play simple switch based games.  All those games required just a 'smack' of the big button switch so he never had to isolate a finger and even though he could pick up crackers, hold a cup or bottle etc.  we were still in the process of helping him to hold onto spoons, cup handles etc and he really didn't have the strength to do that easily.  We were SO excited when he reached out and unfolded his fingers and picked up a cracker using a scooped hand one day.  So thats where we were at, working on motor skills of using his hands properly.  He had no easy pincer grip so that had to be taught too.  So instead I installed simple cause and effect Apps on the iPad like 'Baby Finger' and 'Sound Touch' .  We also purchased 'Injini' which was expensive but has turned out to be worth more than we paid for it over the years.

I spent a quite a few times during the day sitting with my son on my lap grasping his right hand and prying out his index finger and then getting him to touch the iPad hoping the cause and effect apps would motivate him.  At first he got grumpy, resisted, pulled his hand away, and sometimes cried.  I kept at it over the months and eventually he got more and more interested at playing with it.  During that time it was always hand over hand help, although as time went on I was able to leave him for a moment or two to 'flyswat' the screen and it didn't matter as Apps like Baby Finger were so forgiving and any touch on the screen would result in a response and that was motivating for him.
At this time we weren't really doing much Low Tech communication apart from a few cards and the labelling of items around the house,  but nothing formal.  I was doing some Makaton sign language at him but really getting no response, he was quite passive in his world and allowed me to dictate whatever he wanted to eat and do.  He did have his favourite foods, yes even then Munchos were a favourite.  I was also helping him eat finger food whilst sitting in a highchair and would put small items like Munchos in front of him and assist him to eat them.  Slowly but surely we got to understand his hands and he got better and better at isolating his fingers and I needed to help him less and less.  Even now 4 years later he still has trouble with his fine motor skills and can have difficulty in touching buttons on the iPad, he tends to use his second finger rather than his index finger.

Early iPad Communication 

So now to our initial foray into iPad AAC.  Well as mentioned above we had 'Talking Cards' Installed modelling' how to use it.  What we did was setup a series of expectations.  If he wanted cheese then we would sit there with the cheese nearby but out of his reach.  He would obviously get agitated and vocalise rather loudly! When he did that I would go to his iPad in front of him and press the FOOD folder and then touch the CHEESE button whilst explaining to him why I was doing that and what I wanted him to do.  I would then grab his hand and get him to do the same steps.  He would often resist and get a bit annoyed.  But I would persevere and once he had allowed me to get him to touch the CHEESE button then I would hand him a piece of cheese.  Slowly he seemed to understand what was expected.  It wasn't always consistent, when he was at preschool they didn't tend to follow through or remember to ask him to use his iPad and I never insisted they use it and encourage him to communicate.  So eventually he got bored with the whole thing and gave up using his iPad to communicate.  There was a dispute with his then SLT who believed he was just being random and appeared to have no understanding of what he was doing or what the buttons meant.  She thought we were pushing him too fast and needed to take a step back to the Low Tech method first.  In some cases she was right, but we totally believed in our son and his ability to 'get' things and being much smarter than others gave him credit for.
and did spend a little bit of time '
In those early days it was more a choice board system of desirable items that he tended to eat or want to watch on TV.  We threw in a few other important words like Cuddles, Swing etc but it was basically a menu of 'wants'.  He was never consistent and began fly swatting and never really stuck with it. So we gave up using the iPad to communicate and went back to a mix of signs, cards, and worked on him having a consistent YES or NO instead.  Quite by chance we worked out he was clapping for YES and that changed everything because we were finally able to ask him direct questions and get a YES response.  Because of that we used the iPad even less and instead concentrated on reinforcing his clap for YES response whilst trying to encourage a NO.  Generally a NO for him was a non-response or a look away and disinterested.  So we go onto giving him physical choices in front of him instead of picture cards.  If he wanted toast we put a jar of jam and a jar of honey in front of him and asked him to touch which one he wanted on his toast.  We still sometimes do this with him but expect him to choose now on his iPad!

Giving up on the iPad and going back to Low Tech

So by now we had decided the iPad was only going to be used as a toy with education items and motivating cause and effect apps and the Talking Cards was forgotten.  In tears I went to his SLT and agreed I wasn't getting anywhere and could she help?
It was at this point we decided on PECs and starting a formal series of lessons implementing PECs and going through the phases with our son.  So over a few months we spent a day a week with the SLT doing proper PECs phase training with him, and he responded pretty well quite quickly.
 Eventually just before he transitioned to school at the age of 5 1/2 years old we discovered he couldn't make it past phase 3 as he was unable to physically move so couldn't grab a PECs card go find a communication partner and hand them the card to get what he wanted.  We tried other methods to test if he was capable of doing that but never found a useful way to make it work.  Then we had the problem of him becoming fixated on the sound and feeling of the velcro dots on the back of the cards and he started to rip the cards off the PECs book and throw them away or just enjoy pulling them on and off! So at home we gave up on PECs cards and looked for another solution.  It was then we went to the Low Tech placemats and started modelling those as mentioned in our first Blog entry on our communication journey.

So how did we eventually get to using the iPad to communicate?

I will leave that to another blog entry as thats another LONG story!
Keep posted for Next Level - Getting him to want to use the iPad

Thanks for following my blog!