Visual Scenes - What Do They Mean to Our Students

The big trend right now in AAC is visual scene displays (VSDs). All of the major AAC manufacturers (Dynavox on InterAACt, PRC (PRC calls them context scenes), Boardmaker SDP, low tech VSD devices by Enabling Devices and on the Boardmaker Activity Pad) are offering VSD on their devices, some companies are even offering them to the exclusion of traditional grids of symbols or photos or they are making it very, very difficult to use traditional grids of symbols photos within their software (hours of reprogramming VSDs to grids - this is true on InterAACt on the emerging communicator level).

However many of those involved with the decision when choosing AAC hardware and software do not have any idea what research has been done on VSDs and whether or not they would be beneficial to the individual who will be using the AAC device. Then the device arrives and suddenly there is this huge demand to learn how to use VSDs or reprogram to avoid the VSDs.

The research on VSDs seems to be primarily done on older (elderly) AAC users who have aphasia and secondarily done on those with autism spectrum disorders. There is some theroretical writing about VSDs and young children, but not much research. There is little research on VSDs in other populations (cerebral palsy, brain injury, Down Syndrome, Fragile X, etc.), nor is there any research on VSDs when the access method is not some kind of direct selection (i.e. for those who use auto- or step-scanning). Where there is research, i.e. this study for small children, the sample size is small (n=5) or the research focuses on personally relevant VSDs (photos of a person's actual surroundings as opposed to abstract drawings). This leaves decision makers in a void of information and presents a challenge when working with individuals outside of the areas that have been researched (everyone except young children, those with ASD and those with aphasia).

There is an assumption that visual scene displays reduce cognitive load, but this likely varies by individual (i.e. some individuals may find VSDs easier, but others may find traditional grids with no questions as to what is selectable vs. what isn't easier. If you are a PC user think about whether or not you like to view folders in thumbnail, icon, list or another format. This varies from person to person and task to task. The need for VSD may also change based on the persons style of learning - highly visual people, like most people with ASD may prefer the VSDs while others may prefer traditional grids). There is also an assumption that visual scenes will act as a visual cue to prompt conversation, but while this is possible it is also possible that a VSD can act as a distractor and lead away from the point that needed to be made (think about how often we write in IEPs to decrease visual distraction as an accomodation).

In short we don't know what visual scenes mean to our students. We are left where we are often left when teaching those with low incidence multiple or severe disabilities: direct trials and data collection is the only way to determine what will work and what won't. That means in the current trend of VSDs it is even more important than previously to rent an AAC devices for an extended period of time and run trials of the different types of software (with VSDs like InterACCt software and without VSDs like Gateway software) before you order. Additionally it is imperative that trials be done on the most current software available because if the software has changed the ability to access it may also change.


Bibliography of VSD research and presentations:

• Beukelman, D., Deitz, A., Hux, K., McKelvey, M., & Weissling, K. (2005). Performance in chronic aphasia using visual scenes interface with AAC. The ASHA Leader, 139.
• Beukelman, D., Dietz, D., Hux, K., McKelvey, M. Weissling, K. (2005). Visual scenes: An AAC prototype for people with aphasia. The ASHA Leader, 139.
• Dietz, K, McKelvey, M, & Beukelman, D (2006). Visual scene displays (VSD): New AAC interfaces for persons with aphasia. Perspectives on Augmentative and Alternative Communication, 15, 13-17.
• McKelvey, M., Dietz, A., Hux, K., Weissling, K, & Beukelman, D. (2007). Performance of a person with chronic aphasia using personal and contextual pictures in a visual scene display prototype. Journal of Medical Speech Language Pathology, 15, 305-317.
• Shane, H. (2006). Using Visual Displays to Improve Communication and Communication Instruction in Persons with Autism Spectrum Disorder. Perspectives on Augmentative and Alternative Communication. 15:1, 7-13.
  
• Ongoing Research

The AAC run down on visual scenes

• CallTalk (runs on BM/SDP, The Grid) - traditional grids
• Chailey Communication System (runs on Mind Express) - traditional grids
  
• Communicate 4 (BM/SDP, it originally ran on DV4s) - traditional grids
  
• Dynavox InterAACt - default visual scenes, elimiating is difficult
  
• Dynavox Gateway - traditional grids
• Express Talk (runs on Mind Express) - traditional grids
• Ingfield Express (runs on Mind Express) - traditional grids
• PRC Lite Devices - visual context scenes (not sure if default or optional)
• PRC Devices - Unity/Minspeak on a traditional grid, some have "learning scenes" option
• Point to Pictures (JR Cooper devices) - traditional grid
  
• Symbol Chat (runs on The Grid) - traditional grids
  
• Talking Screen - traditional grids
  
• TALK Boards (runs on BM/SDP) -traditional grids, text based, not for emergent communicators
  
• Velocity (runs on DV, SM/SDP) -traditional grids
• WordPower (runs on DV, PRC, BM/SDP, The Grid) - traditional grids, not for emergent communicators

Hardware/Software Mentioned (what board sets above run on)

• Dynavox
• PRC
• Boardmaker Speaking Dynamically Pro (aka BM/SDP)
• The Grid
• Mind Express
• Talking Screen
  

Beware the Flavor of the Month

Every few months I receive an e-mail from somewhere in the world, usually from a parent, occasionally from a teacher, about a student who has just received or is about to receive a very expensive AAC (augmentative/alternative communication device). Invariably the e-mail tells of how the child has or is getting this new device and it is the wrong device for him or her. This baffles me because there are more than thirty companies selling dynamic display AAC devices (see left) and even more selling access systems and low tech AAC. Here are the most common reasons why the device is wrong for the child:

• the device is far too complicated for the child
• the device is far too simple for the child
• the parent/teacher/speech therapist does not know what to do with the device and will not be getting any training
• the child does not want a device/wants nothing to do with the device
  
• the device is not physically accessible to the child (does not scan, did not come with key guard, etc)
• the device would have been ok, but has been programmed poorly
• the device would have been ok, but has never been taken out of the box
  
• the child cannot see the screen/text/icons and the device does not have auditory prompting/auditory prompting has not been programmed
• the device is too heavy/is not portable
  
• the device cannot be seen in the sun
• the battery life is too short
  
• the child has severe aggressive behaviors and the device is likely to be destroyed
• the device has not be trialled with the student in real life settings
  

Here are the reasons why the child is getting the wrong device (according to the e-mails):

• "they were sick of waiting" (and now they will have to wait five more years for insurance/the school district/etc to pay for the right device)
  
• "they are getting everyone the same device" (flavor of the month)
• "the sales rep told us this was the right device for him" (of course they did, their job is SALES)
• "the other devices were too expensive" (aka they didn't want to take the time to do all the paper work to get funding for a more expensive device or they don't believe in this child enough to do the work for him or her)
• "they don't need a trial because he is so good at PECS" (passing pictures isn't the same as dynamic display with voice output)
• "they will teach her not to throw it" (I believe AAC decreases negative behaviors, but you don't start teaching that with an $8,000 device)
• "I think the specialist ordered it because she wants to play with it!" (we all like tech gadgets, but that isn't a good enough reason to order the wrong device for a child)
• "they were trying to be helpful" (see the end of this blog entry for an example)
  

In the end, like everything in special education, parents need to be out there advocating for their children. They need to "believe but verify" when the experts gives them information. When it comes to something as important as communication it is best to have a second and even a third opinion.

Here are my choosing an AAC device tips for parents/advocates:

• Make sure the person/team evaluating your son or daughter for an AAC device is an expert at three things 1) speech/language and cognitive development, 2) current AAC and access options and 3) your child.
  
• Don't trust sales representatives, while they are generally good and well meaning people; they are sales people whose goal is to sell. Definitely don't trust sales reps if they have been selling for less than three years or cannot answer questions about the device (for example we asked one company rep about eye gaze tracking and he brought us the Smart Nav which is head tracking not eye gaze tracking and in the same session he told us it was not possible to program random responses so I had to log onto the knowledge base and show him it was). A sales person has no part in an AAC evaluation.
  
• Make sure that the process of choosing a device, an access system and a mounting system is done by the assessment/educational team.
  
• If the sales rep tells you something new is coming out on the market call or e-mail research and development (not just different sales reps) at the company to verify that information.
  
• Never order anything blind, get rentals or trials of everything, from the AAC device itself to the access system (switches, eye gaze device, morse code controller) to the mounting system and take data. The perfect AAC device is nothing if it is too heavy to carry for two hours at the mall or if the mount keeps slipping and it droops to the floor every 45 minutes.
  
• Make sure the batteries will last as long as you need them too and find out if a spare battery pack (or two or three) is an option or perhaps if it can run on a power chair batteries and if so what accessories you need.
  
• Make sure you are choosing the best means of access. If eye gaze is best, don't settle for scanning because the device the specialist knows the most about doesn't have a fire wire port, instead explore the 30+ links to the left for companies that sell a device with similar or the same software and a fire wire port. I promise you someone out there sells a device that can be matched with the software, access system and mount your child needs.
  
• Once you have the sample device set up the way your son or daughter will use it and try it out, have several conversations and see how it goes. Is the interface user friendly and intuitive? Is the access method simple, will it cause fatigue? Can you find or create important messages? Can you see the screen? Do you like using it? Is it meaningful? Is it fun?
• Keep reminding the team that you are willing to take the time to get this right, so long as they are doing their jobs (trying devices, taking data, teaching access and language skills, etc). Remind them that once your child has the device he or she is "stuck" with it for five years (the least amount of time it takes for another device to be funded)!
  

To paraphrase someone on a listserv I am also on: Don't just think outside the box, nail it shut and stand on it so you can see better!