The Joseph Robert Shaw Foundation

Helping Children Recover from Brain Injury

Another Great Wordless Picture Book

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Every once and awhile you stumble upon a book that seems to magically connect with a particular student in a way that you could not predict. A friend had given me a massive box of hand-me-down books, and inside I found the wordless book, Wonder Bear. It was not a book I was familiar with, but since I’ve had such success with wordless picture books I decided to try it with Joey. I thought it would give us many opportunities to talk and describe the pictures, but I had no idea it would engage Joey as much as it did. 

The pictures tell the story of a boy and girl planting a garden – and while the girl plants watermelon seeds, the boy plants hat seeds. They go to sleep in the garden and wake up to find that the hat seeds have grown a stalk of beautiful flowers, and out of the flowers emerges a bear with a magic hat. The bear takes the children on a series of adventures, pulling different types of animal and magic from his hat. 

Joey loved this book, more than I expected him to. 

The silly monkeys, the wonder inside the hat, the explosion of flowers… all of it seemed to fill Joey with wonder. More than anything, he loved when the bear turns leaves into sea creatures who then take the children, bear, and monkeys on a journey through the sky.

In fact, Joey loves this part so much that he cries when I turn the page. He used to cry when he was younger and a book ended but I have not seen that in while. I was surprised to see his face pull into his forlorn “don’t end it yet” look. With prompting, he began to ask for me to turn back to the last page instead of crying that I’d turned the page. We spent quite a while in the pattern of me turning the page, him asking to go back, me turning back to this magical page and the two of us talking about it for a bit. Then me – finally thinking he was ready to move on – turning the page again to try to move the story onward. Only to repeat the use of the back request. 

This book pulled Joey into it so much that I heard more vocalizations from him than usually. He orally labeled what was going on in many of the pictures – with up, go, the /m/ for monkeys, no, and other vocalizations. His whole body leaned into the book, his eyes wide as it was clear he was organizing himself to talk. 

I am so glad I happened to stumble upon this book. I will be adding it into my wordless picture book collection and highly recommend that you do as well. 

What Does the Data Say?

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Now that Joey and I have been back in person for over a month I wanted to take a look at his data and see how he is doing. While I feel like we still haven’t gotten back into the swing of the eye gaze, I am very aware that what I “feel” might not always be accurate. Sometimes I need to step back and look at what the data tells me.

For Joey’s use of the eye gaze device within ten minute time samplings, he is showing a slight decline since the winter. In January, February, and those few weeks we were able to meet in March Joey was using the device fluidly, with an average of 25 hits per ten minutes. However, in February he was down to around 16 hits per ten minutes, so his average of 21 hits in July is not that far off. (January was as high as 28). 

Interestingly enough, his attempts at communicating orally have increased since we’ve been back. He is more likely to attempt to verbally produce a word, and his verbal attempts include more vowel sounds than they did before. I often find him matching a verbal utterance with a look towards what he wants, as though he is hoping to use social-eye-gaze referencing along with a verbal approximation to communicate. He often does that more than using his device unless I prompt him to do otherwise.

One element of the data that struck me was that within the last few weeks, Joey’s intentionality of using the device has balanced out. Last fall I began measuring how Joey uses the device to participate in communication exchanges. I looked at when Joey is: 

  • Responding to another person in a communication exchange
  • Initiating a communication exchange
  • Producing a word or phrase not intended to be a part of a communication exchange
  • Producing a word by accident or “mishitting” a word on the device
  • Reading a word in a text

There are times when Joey uses the device rapidly, but is not intending to communicate with anyone, and other times when Joey has many mistakes that interfere with his message. Lately, however, Joey’s been showing a balance between the amount he initiates and responds in a conversation – with a decrease in producing random words. This balance is ideal – we want Joey to be able to use the device as anyone would to communicate with their voice – to answer questions but also to share insights and advocate for ones’ own needs. In the beginning of last year we saw that Joey was primarily using the device to respond to questions, but was not initiating conversational exchanges at all. Now, Joey is as likely to make observations or share insights with his communication partner as he is to respond to a question.

We seem to be getting back on track. If his overall use of the device is decreasing but his purposeful use of it is increasing, we are doing even better than we were before. Who knows what this school year holds in store for Joey’s communication. 

Honoring Total Communication

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Before I was back in person with Joey his Occupational Therapist and I touched base. Although each person on a child’s team has a speciality, nothing in development happens in isolation – a child cannot learn to communicate without also developing their motor skills – and vice versa. Typical development occurs with systems relying on one another, and when development is disrupted each system must continue to be addressed. In truth, I think Joey’s OT and I wish we were able to collaborate more frequently. I can always tell when he has made sudden gains in OT because the gains coincide with progress in his communication and academics.

This time, his OT and I wanted to connect over his communication. Unfortunately, an eye-gaze AAC device is difficult to use during OT anytime, but it is nearly impossible during tele-health sessions. And without an ability to effectively communicate his preferences, Joey (and everyone) was becoming increasingly frustrated. 

As you can read here, she began focusing on basic signs so that he would have some way of making requests or expressing his wishes. But she wanted to know – was this disruptive to his AAC work, or was there something better to use during their OT sessions?

None of us communicate solely with one manner of communication. In a basic conversation with someone our gestures and eye gazes can communicate as much as our words do. However, as teachers and professionals we often get caught up in teaching one method of communication and forget to honor a child’s total communication. We become so focused on using certain words or a certain modality that we forget a child may be trying to tell us something in another manner. While sometimes we want to see the child use a specific communication technique – using words instead of crying – we also need to honor that there can be multiple acceptable ways to express our wants and needs. Sign language, gestures that everyone understands, eye gaze, and verbalizations can all serve to signal the message a child wants to get across – in a manner that will allow the child to stay regulated and feel safe. 

I was thrilled to hear that Joey was using the signs appropriately. The first time we were back in person I asked Joey to show me what he’d learned. With the help of his assistant he was able to quickly demonstrate each sign. Now that I know his version of each sign I am able to honor it within our group. When he is having difficulty getting his eyes to correctly line up with his device so he can make a request he fluidly goes into using the sign for please and then pointing to what he wants. Now that we have included total communication into his session I can honor what he wants, help him remain regulated and know that I am hearing him. I can always model using the device to make the request after I have fulfilled it by simply saying “Another way to ask might be” and selecting the buttons. Often, I notice that Joey knows where the words are on his device and would select them if he could, but organizing his body in order to make the correct selection can become frustrating. After a few attempts he will use another communication method. 

The flexibility Joey uses to move between communication techniques is one of his strengths. The more people Joey can effectively communicate with, the more engaged he will become and the more successful he will be.

 

Using Wordless Shorts to Inspire Language

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A few weeks ago I was able to watch a webinar from Lauren Enders in regards to fun activities to jumpstart AAC learning. Last week I shared how much the need for making our lessons fun and connecting with our students resonated with me, particularly as we begin to meet with our students in person and may feel pressured to make up for lost time.

I loved many of the ideas Ender shared, and one that I cannot wait to use with Joey is to use wordless animated short videos. Although I have always loved wordless books it had never occurred to me to use wordless videos to encourage language use.

In order to get the most language out of using these videos, Enders sited Rachel Madel and Susan Berkowitz who recommended first setting your intention with your student, then watching, pausing the video, modeling the language using the AAC device, and then rewinding and watching again – either to repeat your model or to allow the student to produce the language themselves if they are ready. 

First of all, not only had it never occurred to me to use these videos, I did not even know these videos were out there! I fell into a rabbit hole of watching wordless shorts and dreaming of all the possibilities. The best videos are the ones that are full of age-appropriate humor. Enders points out one called Jurassic Farts, which involves dinosaurs farting. May not be dinner-time conversation, but what young child doesn’t want to giggle and talk about farting dinosaurs? 

I’m excited to try Ornie the Pig with Joey. The pig is determined to get a snack on top of the refrigerator. Think of the prepositions and verbs that you can use to tell what is going on as the pig struggles, as well as words that describe all the emotions the pig is feeling while he tries (and fails) to reach the cookies. 

Take time to explore some of the wordless shorts out there and find ones that may be perfect for your communicator! There is so much potential for not just language, but for facilitating laughter with these short, silly videos! This blog also has a great list!

Language is about Connection

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This past week I had the opportunity to listen in to AAC Learning webinar by Lauren Enders. It was chalk full of ideas, tips, and resources, and I am sure I will slowly reflect on them over time. The tips and ideas made me miss Joey and my work with him so much. I cannot wait to be back in person!

The first tip Enders gave was to ask yourself – “Would this be fun for me?” 

This question resonated with me. Our goal for teaching communication on the AAC is for children to be able to fluently use it, and have the desire to do so. AAC users must be engaged and motivated to communicate. Although as adults we can easily check a box and note that we taught a new word or skill, teaching does not translate to learning. What’s more – we do not want our students to simply learn where the words are – we want them to own the words. The words need to get into their long-term memory, which means we need to do our best to make the learning fun, motivating and truly meaningful. 

We communicate with one another in order to connect with one another, either to have a need met or to feel safe. When we connect with another person we are creating a mental model of who are we as an individual, and who our communication partner ends. When we teach using the AAC we must keep this in mind – in order to be a communication partner we must be connected to our partner – they must trust that we will listen to them. Being able to find all the words on their device flawlessly will not help them truly communicate if they do not have meaning behind the words – or if they do not trust that anyone will listen when they speak. 

These two messages – the need to make it fun and the need to connect – were excellent reminders to me, particularly as our communities begin to open back up. Many of us are anxious to help our students make up for lost time during the closures. Instead of worrying about a child’s output and packing more words into their vocabulary, we must first regulate our own emotions. Are we having fun? Are we connecting? Are we focused on the speaker and not just what is spoken?

Allowing ourselves to reconnect, reunite, and laugh with our students will move us closer to making progress. 

Saturday Serenade

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