Considerations in Customizing a Core Language System for

Considerations in Customizing a Core Language System for Persons using Auditory Scanning By Alicia Alverson

augmentative communications

Considerations in Customizing a Core Language System for Persons using Auditory Scanning

Finding appropriate and efficient generative language solu- tions has been historically difficult for persons with complex com- munication needs who use auditory scanning. As a field, we are constantly improving the language programs available for per- sons using alternative access; however, I find careful customization is needed for any out-of-the box language system that I recom- mend. Along with Heather Duvall, Cassie Sementelli, and Michele Bishop, I helped in customizing and designing a language system for Douglas; a person with complex communication needs using two-step auditory scanning. We created this language system be- fore the advent of Core Scanner™ by Prentke Romich Company (PRC) and I continue to recommend this language system to peo- ple I work with, today, as well as use the principles used to create it when customizing other language systems to better meet the needs of persons using auditory scanning. Douglas needed a language system that allowed him to gener- ate novel thoughts and expressions. It was not enough to simply change the access method of an out-of-the box language pro- gram and use it with Douglas. The language systems available at the time (such as, but not limited to, Unity®, Word Power™ and Gateway©) were not appropriate to use in this manner, because they were designed having a person using direct selection in mind. A variety of factors change when considering the needs of a person using auditory scanning, including: the visual and audito- ry information gleaned and needed by a user to navigate through a language system, auditory prompts, motor planning, language organization, frequency of word use, grid real estate and morpho- logical and syntactic complexity considerations (Sementelli et al.,

2012, October). For Douglas, we started with a version of MinTalk, by Gail Van Tatenhove, and transformed it into an auditory scan- ning language program, capitalizing on frequency of word use, information gained from auditory prompts paired with visual in- formation gained from multi-meaning picture symbols, and the conceptual framework of how MinSpeak® programs (like Unity®) were organized to organize Douglas’ system (Sementelli et al., 2012, October). Visual and Auditory Information/Prompts Douglas needed his language system to capitalize on motor planning and take advantage of auditory prompts to give per- tinent information on his location within the language system. When you think about a direct selector (without vision impair- ment) using a language system they, are able to gain visual infor- mation from the picture symbol as well as the location of a word within the grid of the language system, arguably simultaneously. How do we give that same information to someone accessing a system using switches, any type of auditory scanning, with unre- liable vision and motor planning difficulties? You offer the same visual information (changing visual aspects, as appropriate – i.e., high contrast symbols) while capitalizing on the auditory infor- mation of the scan. You build this information carefully within the system, in order to allow the user to build motor patterns based on the information they hear. We tried to make the auditory prompt information of Douglas’ system relevant, through careful- ly arranging the language program. His language system was set up to scan row/column, with row prompts being a color. The color

Alicia Alverson is a speech and language pathologist (SLP), working at Providence Children’s Development Institute, in Portland, OR. She specializes in augmentative and alternative communication (AAC), working with chil- dren and young adults in pediatric outpatient clinic and pediatric skilled nursing facility settings. She has also worked in the schools in specialized classroom settings, working with students using AAC. Prior to working as an SLP, Alicia worked as a caregiver for a person with complex communication needs, where she gained mentorship and experience in creating generative language systems for auditory scanners and served as an advocate in the person’s school to train educators in how to use and incorporate a generative language communication device into a general education setting..

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Figure 1. Main Screen

really is quite arbitrary, however, we were able to group like visual and auditory information to make the name of the color relevant. For example, ‘yellow row’ indicated words or picture symbols re- ferring to people. See Figures 1 and 2. A learner could certainly memorize locations of all the words within their device without them being arranged as we did, how- ever, this becomes much like memorizing a route to the nearby coffee shop without being able to use an sensory information. Memorizing three blocks forward and two blocks right gets you to the coffee shop works, until the walker forgets or loses track of where in their motor pattern they are (perhaps because of a mis- step due to body incoordination or developing, but not mastered scanning automaticity). There is no useful information in under- standing the context of where that person is in relation to a whole system, and therefore their entire learning process is based only on rote memory, instead of also understanding context. Much more comprehensive and contextual is understanding that the coffee shop is three blocks in front of my house and I turn right at the green house, with the willow tree. If my motor pattern is interrupted, I still have relevant contextual information that will get me to the coffee shop. We wanted Douglas to be able to understand the context of where he was within his language system, so he did not need to know every location and motor pattern of every word in his lan-

guage system in order to use it to find words he had not yet been shown, modeled or practiced. He could understand how patterns got him to words and where he may look for new words, much like a person using direct selection understands they when they are looking in the Unity® icon of a rainbow, they see the colors of the rainbow and are given a hint that that is where colors might live; and that we often pair colors with art, so words about art may live there as well. This information allows the user to make informed guesses on where a word they have not used before is. This was especially important for Douglas, as he was at risk for his motor execution going awry, due to the complexity of his body. We accommodated for the visual and auditory needs in Doug- las’ system with auditory row and column (icon) prompts. Row prompts were a somewhat arbitrary color (button/symbol back- ground of icons in said row) that described the color of the given row with like information contained in the row. The patterns are two-fold, as information on the main screen could not be sorted in the same ways. Throughout the system (with the exception of customized fringe vocabulary pages), the rows were sorted “ac- tivity” or “quick row,”“yellow row,”“green row,”“blue row,”“orange row,” with the colors representing parts of speech or word func- tions (See Figures 1 and 2). Yellow = people words. Green = action words. Blue = phrases. Orange = describing words; and the activi- ty rows containing fringe vocabulary (mostly nouns).

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Closing The Gap

Motor Planning, Language Organization and Real Estate While we did not want Douglas to rely on automaticity of mo- tor patterns in order to navigate through his device; it was very important that he had access to consistent motor patterns, so he could develop motor automaticity. This was accomplished by the way icon symbols were sorted. Starting with the first row on the main and sequence pages, these are always where fringe vocabulary or quick words live (see Figures 1 and 2). As with other MinSpeak® programs, this is where the language system became highly customizable to Douglas and his experience with vocabulary. An important question that may be forming is: why would you put fringe vocabulary (the least used vocabulary when implementing a core language system) in the row with the least amount of hits to access? There are a few reasons. To start, activity rows (a concept of MinSpeak® systems) were part of the program that we customized off of and lived in the first row. The activity rows lend themselves well to fringe vo- cabulary; and in a system made for a direct selection there is not a motor consideration for a first row versus a second row. However, we did not leave this here simply because that is what we had to work with; it lent itself well to natural motor planning. Due to the location of the activity rows, we were able to provide natural and quick access to “quick words” on the main screen. Also, the way the scan pattern is programmed in PRC devices, it would take a

The main screen was sorted as similarly as we could with some secondary context conventions. Yellow remained the people row. Green became icon pictures and names of things we generally do or use inside. Blue became icon pictures and names of things we generally do or use outside. Orange became icon pictures and names of things we do with our body. By having similar naming conventions on the main screen as the second sequence screen, Douglas was able to create motor plans by understanding that the row colors always stayed consistent. Additionally this informa- tion was reinforced in low-tech ways of using his picture symbols, talking about words as being a “yellow word”, or “green word”, and so on. An additional piece of information was the prompt names of the icon symbols bridging to the sequence screen. They generally described the icon symbol chosen. For example, the picture of a toy box and toys was “play”. We worked with Douglas on creating mental images of each auditory prompt using the visual informa- tion we (and Douglas at times was) were able to gather from the icon. Because we customized his system based off of MinSpeak® symbols, it was important for Douglas to learn the concept of multi-meaning symbols in order to navigate through his language system and make informed guesses on where vocabulary lived, that he hadn’t used or learned the location. So, while still taking advantage of motor planning, Douglas did not have to rely solely on motor patterns to navigate through his language system.

Figure 2. Sequence Screen of “your hand”

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double hit to get into the first row, on the second sequence. For Douglas, his select switch was the switch in his scanning array that he used least often; therefore, it was not as natural of a motor sequence (although learnable). So, it was not necessarily detri- mental to give up this conceivably easier to access row for fringe vocabulary, and it was possibly advantageous. Moving down the rows, they were then sorted by types of words/parts of speech. This pattern remained consistent through- out the device. Much like when finding the main verb in a Min- Speak® based program at the Action Man location, verbs are al- ways found in the green or third row of Douglas’ language system (see Figure 2). This pattern carries through for all word types – nouns, pronouns/people words, actions, phrases and adjectives/ describing words. Giving these consistent patterns allows for au- tomaticity to happen in motor planning, increasing efficiency of expression. (Van Tatenhove, n.d.). Related to motor planning is real estate (or the value of the lo- cation of single button) of the language system. In direct selection systems real estate is not as important of a factor as one button is not necessarily easier to access than another; albeit direct selec- tion can have its own set of access difficulties depending on the user. Real estate was critical when arranging Douglas’ language system. Scanning already has efficiency working against it, there- fore we needed to consider where and how we were going to lay out language in conjunction with frequency of word use. For Douglas’ system we used frequency of word use and fine-tuned our arrangement with word importance to Douglas. For exam- ple, “eat” and “drink” are frequently used core words. Eating and drinking is not a big part of Douglas’ life. While he certainly still has things to say with these words, it did not warrant them being more easily accessible than other, more relatable words. When thinking about real estate in a language system de- signed for scanning, we did not determine linearly, but by number of switch hits (moving and selecting) it would take Douglas to get to a single word. These hit numbers will differ for single- and two- switch scanners, but relationally will give the same information, when also considering the auditory information and wait time single-switch scanners will still have. For example, in Douglas’ lan- guage system, “touch” (see Figures 1 and 2) is a two-hit sequence in MinSpeak® terms, but takes seven switch hits (five moves and two selects) to navigate to. You will see that the number of se- lections, remains consistent with the Unity® and MinSpeak® hit patterns, two selects is the same as a two-hit sequence. Instead of counting hits for each word, we looked at the grid of icons as a (partial) pyramid, tilted on its base, with dimensionality added as Douglas progressed into sequential screens. The first button in the first row takes the least amount of switch hits (two) to ac- cess. The second button in the first row and the first button in the second row take the next, least amount of switch hits (three) to access. The third button in first row, second button in the second row, and first button in the third row take the next least amount of switch hits (four) to access; and so on. While the system could not

be organized on a purely one-to-one ratio with frequency of word use to least amount of hits, due to the already established motor pattern “categories” (yellow, green, blue, orange row, etc.); the real estate pyramid guided us in where to place our multi-meaning icons within their motor pattern “category.” The “eat” and “drink” examples I mentioned earlier come in to play here. “Eat” and “drink” and the vocabulary within their icon symbol were mostly related to eating and drinking; and because we decided this set of vocabulary was not essential to have near the top of the pyramid, quicker to access, we moved them towards the base, giving oth- er more highly sought after words better real estate. Additionally, because they were towards the base of the pyramid, they had less language content inside of them, versus icons closer to the top, were filled with more language. See Figure 3. Lastly, we did add (mostly core) phrases into Douglas’ lan- guage system. Important to note, is that the phrases we chose were likely word combinations and could be combined with oth- er core words, still maintaining the generative natures of Douglas’ language system. They were not necessarily a singular unit. We wanted to offer Douglas the same efficiency tool that Unity® of- fers with pronoun/verb combinations (i.e.,“I want”,“you need”,“we like”, etc.). Due to the high frequency of uses for the words in these combinations, it made sense to combine them into a single motor pattern instead of always having to use two motor patterns. We offered these phrases both in statement and question phrases, in a similar location pattern to Unity®. The statement phrases live in the pronoun icon with which they are associated. The question phrases live in the icon symbol of the verb with which they are associated. Since these phrases did not take up all of our fourth row (or blue row) real estate within the language system, we were able to create other phrases that we determined would be ideal for Douglas to say efficiently, adding a social and pragmatic lan- guage component within the language system, such as “pay at- tention,” or “not cool.” Morphological and Syntactical Considerations Another important consideration for Douglas’ language sys- tem was understanding that when it took at minimum two hits to say any single word and up to 20+ switch hits (for a two-step scanner) to say to a single word (in a core language based sys- tem), we needed to take into consideration our desire for Douglas to use correct syntax and how this affected his efficiency. Was it important for us that Douglas used correct syntax or more im- portant for him to be able to get his expressions across more ef- ficiently with one, two or three words that were not necessarily grammatically“correct”nor in the syntactically correct word order, but had meaningful context and were novel, generative and au- tonomous? We went for novel, generative and autonomous. It is not to say that his language system could not grow and become more grammatically complex as he grew in his automaticity, but we knew that quick access to rich content words was crucial for him to be generative in his language use and overcome ineffi-

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Closing The Gap

Figure 3. Sequence Screen, “Drink”

ciency barriers. It is also not to say that we completely negated morphology and syntax in our teachings. We continued to use correct grammar when we spoke and provided accurate spoken language models. Additionally, I am also not suggesting that one must give up morphology and syntax for generative language, but simply that we needed to weigh it against the efficiency cost. We decided to forgo having various verb tenses, superlatives, and plural nouns readily available in Douglas’ language system, as it would have increased the amount of hits required for him to say a single word or taken up valuable real-estate. We instead went with the base forms of all words with the acceptance that his expressions may not always look pretty, but certainly still got his point across. When combined with partner assisted auditory scan- ning, we have been able to clarify and communicate with Douglas when his messages may have multiple meanings depending on context, or work with him to add additional words for more specif- ic meaning and understanding. We did not completely take away the option to conjugate verbs, create superlatives, or plurals, but moved these function buttons into a page that was not compet- ing for prime real estate. The system we created for Douglas, with further customization, could also have morphological features in a similar way that CoreScanner™ has added them to their most complex user area. Douglas’ language system provides an example of another

way that creating and arranging language systems could be suc- cessful. We are growing as a field in the products we are putting out for auditory scanners, however, I would argue a single one still is not ideal for all users. When I am working with auditory scan- ners I continue to take the characteristics of Douglas’ language system in mind to more adequately fit the auditory and motor planning needs of persons using auditory scanning. I continue to use Douglas’ system as an option for other users. Just like choos- ing between Unity®, LAMP™, Word Power™, Snap+Core, or other language systems on the market, I continue to make the same feature matching decisions when considering Douglas’ system, an out-of-the box system and/or customizing them. References Sementelli, C., Bishop, M., Duvall, H., & Alverson, A. (2012, Octo- ber). Give Me a C(L)UE: Reworking our Beliefs about What Individ- uals who Use Auditory Scanning Need in a Communication and Language Set. Presented at 30th Annual Closing the Gap Confer- ence, Minnapolis, MN. Van Tatenhove, G. (n.d.). Core Vocabulary with Generative-In- dependent Communicators in Inclusive Classrooms. Retrieved from http://www.vantatenhove.com/files/handouts

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