Sunday, August 12, 2007

Do we need technology for this?

Any reader of my blog knows that I am a huge fan of assistive technology as well as AAC. I also know that technology is a tool, a means to an end, not the end itself.

This summer I have had the privilege of providing educational services to a pre-schooler who has multiple special needs, including quadriplegia and severe communication impairment. My assignment was twelve sessions over six weeks, covering for the homebound pre-school teacher who was taking the summer off. The IEP had a goal to indicate more/all done using a rocking plate switch. It also had other single switch activation and choice making goals (by reaching/touching with hands).

After five sessions I became frustrated with the more/all done switch because it meant me putting down other teaching materials to hold up the switch at the exact right spot for good access and phrasing all questions in a more/all done format. (Yes, I know there are all sorts of solutions to that problem, however as a teacher for just twelve sessions it wasn't in my power to enact any of those solutions.)

I had been thinking about attaching yes/no symbols to the underside of his tray and teaching the use of those for questions, but had not made up the symbols yet when I was at that fifth session. On the spur of the moment I explained to the boy, modeling as I talked, that a nod meant yes and a shake meant no. I used hand-over-hand (or I guess head in this situation) to show him how the movements felt.

For the rest of the session I asked choice questions first in a yes/no format and then in a point to symbols/objects format to confirm the choice and found that he had about 70% alignment between the two methods. During session six we worked on yes/no (in addition to the written goals), with pointing back up (and more/all done with the switch for questions that were naturally in that format).

Three days passed between session six and session seven and during that seventh session I asked a yes/no question and he gave his version of a nod (more like a slow raising and dropping of his head) and his nurse became very excited. The nurse explained that she didn't know we were working on nod and shake and that over the weekend she thought that he was nodding yes, but she didn't know he had been taught that. Mom and the nurse then entered the room to ask about the yes/no. They wanted to know which one they should use, the rocking plate switch or the head movement system. I told them both, that the switch was for more/all done and the head system for yes/no.

The mom was happy because the head nod/shake was much more portable and universal than the rocking plate switch, but she was worried that her son would not learn how to use technology.

I worry that in our field we aren't seeing the forest for the trees. The technology is, in this case, a way to communicate. It is not the only possible way to communicate and it is not automatically a better way to communicate because it is a neat gadget.

Years ago I had a (relatively high functioning) student with low intelligibility whom the speech therapist wanted to try on a hand held communication device. It turns out the student did need technological intervention, but not through an AAC device, through hearing aids. The coolness of the (at the time) new device distracted the SLP and I both from noticing why the student had low intelligibility. Several years later a different speech therapist sent the student for hearing tests and the rest is history. Today the student does use a very minimal, very low tech means of AAC in addition to his greatly improved speech for interactions with unfamiliar listeners in the community, but that is it. Almost everyone else understands him.

Of course for every story of inappropriate technology being presented because of the "cool" factor, there are three more of technology not being presented because of the F's (fear, funds, familiarity and family follow-through). As professionals in the intensive special needs field we need to help each other find balance between these two extremes. We can all start by education ourselves. A good place to start is the QIAT website.

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