JCPSLP November 2017
and interact, and perform sometimes physically and cognitively challenging skills. They need to: • autonomously create their message; • recognise the symbols that represent it; • use working memory to hold the message; • initiate the interaction; use motor movements to indicate that they have something to say; • filter extraneous auditory and visual stimuli; • wait and attend while the options are presented; • anticipate when the option they want is coming up; • attend to visual and/or verbal stimuli; • determine the item/s they need; and • perform a motor movement to signal when the item they want is presented (Burkhart and Porter, 2006). When PAS is used, the communication partner is involved in co-constructing the message. The communication partner needs knowledge and skills to perform at least two roles during communicative interactions: operating the scan; and participating in the exchange in an interactive way (Burkhart & Porter, 2006). When communication partners operate a scan, there are several things they need to remember: • When the scan is auditory, the communication partner needs to differentiate between their “scanning” voice and their social interaction voice. The scanning voice needs to be monotone and rhythmical, so that the partner doesn’t lead the communicator, or provide extraneous auditory information that needs processing (Burkhart, 2016; Porter, 2012). • During PAS, items should be presented as a list rather than a series of questions. This reduces the extra language that may be difficult for the individual with CPCSN to process and allows them to problem-solve and initiate rather than become prompt dependent (Burkhart, 2016). • The list of choices may be presented several times to allow the individual with CPCSN to learn and anticipate the item they want and organise their body to respond. • Each list needs to offer a “way out” or an option for indicating “none of these”, “something else” or “finished”. Individuals with CPCSN may not respond to a list of options, either because they do not understand the task, or because they may not want to select any of the items offered (Burkhart, 2016). • The items for selection must be presented systematically, in the same order each time, to allow the individual with CPCSN to develop familiarity and through it, following PODD operational conventions, column by column, then item by item, pointing at the symbols they are speaking. J signals “yes” to the symbol he wants by extending and raising his right arm. He tells his communication partner to move to the next column or item by holding his right arm down to indicate “no”. He navigates through his book in this way until he indicates that he has completed his message. J accesses a robust vocabulary to express a variety of communication functions. His communication partners don’t know what he wants to say when he starts saying it, but they work together to create his message. It is autonomous communication, although it does not happen independently and requires a competent communication partner to co-construct the message.
Reichle, 2008; Horn & Jones, 1996; White, Carney & Reichle, 2010). Scanning as a selection method requires the selection set to be presented systematically. The communicator waits until the desired item has been presented, and then signals in some way to select it. Items are often selected by activating a switch, particularly when the selection set is presented electronically (e.g., speech generating device) (Beukelman & Mirenda, 2013). Scanning can also occur without technology using PAS. The focus for this paper is on PAS, a non-electronic method for selecting and interacting with AAC. During PAS, the communication partner presents or highlights items for the communicator to respond to, and watches and/or listens for signals from the communicator. PAS may be used with or without a physical AAC system. In any environment, words or objects may be scanned to support choice making and promote active participation for the person with CPCSN (Burkhart, 2016). These words or objects are presented to the individual as a list and the individual waits until the item they want is presented, and then they respond with a “yes” signal to select it. The items may be offered visually (i.e., shown to the individual with no auditory input), or as auditory cues (e.g., reading through the alphabet), or the scanner may use auditory plus visual cues (i.e., symbols are spoken aloud as they are pointed to), depending on the skills and needs of the individual with CPCSN. Visual symbols or objects are more concrete and less transient than auditory symbols, and during PAS, a communication partner may highlight, or show these for longer if necessary. During auditory scanning, the order that the items are presented is the arrangement or layout of the AAC system (Porter, 2012). Individuals who utilise PAS may use vocalisation, body movement including eye gaze, facial expression, or change in affect to signal acceptance or rejection of a presented symbol. Some individuals may use a recognisable gesture, such as a head nod or shake, to respond yes/accept or no/ reject to the scanned items. In other instances, movements may be idiosyncratic and subtle (e.g., blinking, raising an eyebrow or arm). The team supporting the individual with CPCSN must look for at least one discrete and reliable motor movement, which can be used immediately or shaped over time, to signal acceptance during a scan (Burkhart, 2016). The communication of a message using PAS requires skill on both sides of the communication dyad. The individual with CPCSN needs to be motivated to engage J is a 6-year-old boy who loves listening to Justin Bieber, reading or listening to books, and playing with his dog and his sister. He loves swimming and hanging out with his friends and going to school and being outside. J has spastic quadriplegic cerebral palsy, GMFCS level 5, and a severe vision impairment. He does not sit, stand, walk, talk, eat, drink, dress, or do anything without assistance. But J has a small amount of intentional control over his right arm and uses it to communicate. J uses PAS and a 20 cell per page PODD (Pragmatic Organised Dynamic Display) communication book (Porter, 2012) to tell his mother about school, to ask his friends to come and play and to comment on his favourite singer. When J has something to say, his communication partner holds his PODD book in front of him and reads
JCPSLP Volume 19, Number 3 2017
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