Two examples of how learners with CVI use AAC

Sylvia Mangan, Speech-Language Pathologist shares two different examples of what AAC looks like for her learners with CVI.

Girl with CVI sitting on mats during a PT session, holding her AAC device

There is so much to figure out when trying to find the best communication system for your child with complex communication needs. If you haven’t already, read more about the five essential steps to help find a communication system that is just right for your child. As parents, it’s helpful to hear about other children with CVI and what’s working for them. From this, we can get some inspiration to start thinking about how to best approach support and interventions for our child’s unique needs. 

Example A: Using what’s most motivating to develop a path forward from early communication to functional and social communication and beyond

When this learner joined my caseload, his functional visual skills were emerging, and he needed a lot of support to establish visual attention. On the Roman-Lantzy CVI Range, he was in early Phase II, integrating function with vision. His team was working on his visual-motor skills, trying to get him to reach for anything. He used total communication—his very expressive facial expressions—to show what he wanted and how he felt. 

We used his total communication to move forward with the skill to ask for more. He was generally doing a great job showing us with his body when he wanted more of something. As he started to learn to reach out more consistently, we wanted to pair reach of his upper limbs with a cause and effect task. He loved music and responded well to his iPad, so we put some of his favorite songs and simple, single color pictures related to those songs. 

We presented the iPad in his preferred visual field with a picture of a mouse on a plain background. When he reached to tap the picture, he got to hear his music therapist singing Five Little Mice. He loved it and clapped along with his hands. The iPad’s backlit screen supported his visual attention along with the highly saturated single color of the image. And he was motivated while engaging in a favorite activity—listening to music. We added more pictures that went along with his favorite songs. With consistency and repetition, he built up familiarity with those pictures. 

Now, we can use one picture at a time for choice-making. We do Partner-Assisted Auditory-Visual Scanning, where the educator puts up a photo on the iPad without any verbal prompts and allows the learner quiet wait time to look at the screen (so he uses his vision first). Once he establishes visual attention to the picture related to a favorite song, the educator asks, “Do you want Baby Shark?” After wait time, if the learner doesn’t move or react, the educator moves on to the next picture. Once the learner establishes visual attention, the educator asks, “Do you want You’re Happy, and You Know It?” The learner then reaches out to touch the picture on the screen, which prompts a simple recording, “I want Happy, and You Know It.” The educator then plays the song. 

It’s a systematic and collaborative process to integrate recommendations from the TVI (visual access, compensatory skills), OT (reaching, body mechanics), and from me, the SLP (cause and effect, choice making). The learner was mostly communicating with his body and facial expressions. Now he is at the point where he uses visual motor and visual attention skills to pick a highly familiar picture of some of his favorite songs.

The goal is to start with choice-making because it’s motivating and it’s exciting. And then we build a whole system that’s designed to have comprehensive functions of communication. This means not just requesting things or making choices but also learning to have a social element to greet people, say thank you, share feelings, and express wants and needs. 

Using the iPad with Partner-Assisted Auditory-Visual scanning, he can make choices with an organized system of pages and visuals. For example, the learner begins with a set of two options; for example, do you want to play with toys? Or do you want to chat? If he picks a chat, then we go into: Do you want to have some greetings? Or do you want to do some turn-taking? If the learner chooses greetings, he moves to the next level of choice: Do you want to say hello? Do you want to say see you later? 

Currently, the learner is on a path to become a diverse communicator. It’s important to start with what’s motivating as a hook, and then you diversify, helping him engage with his peers and family.

Example B: Building and expanding complex communication 

AAC is not only for students who are nonverbal. It can also be an important tool for building and expanding the complexity of language. For one learner, she is a verbal communicator, but she’s hard to understand. The articulation issues kept her in this space of using simple sentences only when communicating. This learner has functional vision skills, has greater visual regard, and can color-code well. We chose a high-tech AAC device for the learner to communicate with longer sentences and greater specificity. The device also is a consistent model of language. We color-coded the icons so that she could differentiate each icon from the other. 

There are two primary purposes for the AAC device. First, to mend communication breakdowns when she is hard to understand, so she can fully request her needs or share her feelings. Second, to use the visual supports on that screen to build sentences. Instead of saying a simple request, for example, “playdough,” she would expand her phrase to say, “I want the playdough, please.” With a familiar picture for every single word, she learns to sequence them appropriately and use these beautiful long sequences. 

When designing her AAC device, we looked at her motor skills to see if she could isolate pointer finger use and access the device reliably just by directly touching the iPad. We wanted to make sure she had the attention to sequence these longer sentences. We had to assess her visual attention and recognition skills when presented with a certain number of buttons on the page. How did she do with five icons? Do we need to go down to four? We tailored the device to her needs and abilities. 

This learner is now using longer sentences consistently, and she started to use her device when interacting with someone new who might not understand what she’s saying.  The long-term goal for this learner is efficient and independent communication to fully use her voice out in the community and any situation. 

Learn more about CVI and communication by watching the video of our Expert Q&A: CVI and AAC.

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