• Impact of color: may rely on color to support finding and rec- ognizing an item • Visual field functioning: looks for limits in visual field as well as preferences • Attention to movement: could be used to support or distract • Visual guidance: integrating visual information with motor activities Each of the above-mentioned assessment areas gives import- ant information in developing an AAC intervention that best meets a child’s needs. It will help clarify the specific needs of the child. If we just assume the answers in some of these areas, we can hinder progress and actually make communication more dif- ficult. For example, let’s take the most common intervention strate- gy used when a child has CVI and needs an AAC system— use of high contrast symbols. In general, high contrast symbols are sim- ple images, usually red or yellow on a black background. They have been incorporated as symbol options in many of the high- tech voice output devices. They are also readily available in other symbol programs such as Boardmaker and on the internet. There are many other teaching resources that have been adapted using the high contrast symbol. Sound great—right? The answer—not always. This is actually a common misconception. We need to remem- ber, children with CVI have difficulty UNDERSTANDING what is seen. High contrast symbols may attract students’ attention but it does not help them understand what they are viewing. We need to be sure our students are at a visual level where they are interpreting what they see. In actuality, high contrast symbols can increase visual complexity of an AAC system because they have multiple colors and many of the symbols are the same color. These symbols also do not portray the actual color of the object in real life. For example, cows aren’t yellow. All of this can lead to more confusion for the user. Even more of a problem—present- ing 2D symbols when in actuality, the child needs objects! Again, I repeat, the TVI can help determine how to use color functionally and if the child is ready for 2D symbols. This brings up another area that is often misunderstood when it comes to AAC intervention— the representational hierarchy (listed below). For those in the field of AAC, the use of the visu- al hierarchy (objects, photos, symbols) does not need to be fol- lowed. In other words, a child doesn’t have to be introduced to objects before 2D photos or pictures. Research has shown that for children with CVI, it is critical to find where they are on the hierar- chy, and start there. With intervention, children can improve their ability to visually process what they are seeing.
Developmental Sequence of Visual • Real Objects • Miniature Objects • Partial Objects • Real Photos • Line Drawings (e.g. Boardmaker, Symbolstix) • Bliss Symbolics • Text
CVI Order of Complexity
• Single color objects • Multi-colored objects
• Patterned Objects • 3D Visual Symbols • 2D photographs of familiar ob- jects • Photographs of unfamiliar ob- jects • Realistic color illustrations • Abstract colorful cartoons • Realistic black and white illustra- tions • Abstract black and white draw- ings
Children with CVI that are learning to visually process objects still need access to a robust language system. How can we incor- porate objects into functional activities that reinforce communi- cation? Again, COLLABORATION IS KEY! Let’s take what is known about developing and reinforcing functional communication and mesh it with the information and intervention of the TVI. In discussing how to begin teaching object identification, a big question is, “What objects do I start with?” The answer is to use things common to the child’s environment such as a cup or a ball. From a communication perspective, also consider what concept that object might be used to represent. For example, can the cup be used to represent “drink“ and the ball be used to represent “play,”“PE” or the sensory room ball pit? Looking at object iden- tification and communication together is helpful. When using objects that are the same or bare a strong resemblance to what they represent, one runs the risk of the user confusing the symbol with the referent. To avoid this problem, objects can be attached to a material such as a 2D card. This helps establish a clear bound- ary for the symbol. The size can be determined by the needs of the user and the size of the objects. This also aids in attaching the “symbols” in other areas of the environment such as on tables, walls, doorways, on switches and communication devices. To this end, Adaptivation offers the Tangible Object Cards. There are a total of 65 cards. The plastic cards are 5x7 inches and come with objects attached. There is also room for a 2D symbol on the card if needed. PLEASE NOTE: THESE CARDS WERE NOT DEVELOPED WITH CVI IN MIND! That being said, there is a lot we can learn from their development and use. At the time of their development, there were two schools of thought on developing a more “standard” system of objects, Shared or Individualized (5). The Tangible Object Cards were developed with the “shared “approach in mind. In the world of AAC, we try not to have a different set of symbols for each user. For practical purposes, it is much easier to house, maintain and keep track of a shared set of symbols. The use of a standard set of symbols also offers continuity within an organization. For ex- ample, if a school uses a shared set of symbols, students moving from classroom to classroom will not encounter a symbol they are unfamiliar with.
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