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The ABC’s of Vision and AAC

Clinical News
Seeing is what seeing does

From birth, eye contact binds mother to child. Paralinguistic features (i.e., gesture, facial expressions, proxemics and eye contact) underlie the effectiveness of human interaction. According to Lea Hyvarubeb, M.D., "severely visually impaired children lose thousands of hours of incidental learning and visual communication and have to build numerous concepts on patched information with obvious holes in their knowledge." Individuals who also are unable to speak, particularly those who have motor impairments, lose many thousands more. Most people with VI need a sighted interpreter who can share the world and help them manage and learn. The fact is much incidental learning is precluded when you don't see well. It is essential that individuals with VI be able to ask questions and communicate feelings and thoughts.

Functional vision assessments and compensatory techniques and strategies for visual impairments are critical to AAC practice. An individual's body, eyes and mind affect what is seen. So does the position of the individual in the en vironment. Mobility factors, lighting level and the skills of communication partners also affect communication. Assessment of the visual system in persons with multiple handicaps, especially children, may include:

• eye examination by a developmental/behavioral optometrist.
• interviews with caregivers.
• observations of daily activities (e.g., watch for decreased body alignment, fatigue after working on visual tasks, and so on.)
• consultation with other members of AAC team.
• use of a assessment tools developed for persons with multiple handicaps or young children.

Dr. Hyvarinen, an ophthalmologist from Finland has developed materials to assist in the assessment of vision. Among the kits that are available are:

• a discrete symbol set (apple, circle, square, house—2 and 3 dimentional options) and protocols to train. Note: a variety of response modes are available.
• Functional acuity test.
• Binocular test.
• Color test.
• Preferred looking protocol.

Batstone and Harris presented assessment suggestions for use with children with severe communication and visual impairments. A protocol called "Assessing the functional vision of people with severe and multiple disabilities" considers the following areas:

• Body. Gross motor, independent mobility, arm/hand function and eyes (reflexes, refraction, acuity, symmetry, visual perception, visual noise tolerance, visual abstraction and use of vision.)
• Illumination. Position and type of light source in the environment, on materials and on a communication display.
• Contrast. Figure/ground characteristics are very important to functional vision. The size, color and complexity of information in the "figure" and in the background determine the degree of contrast.
• Size. Just making something larger does not necessarily make it easier to see. Size characteristics should depend upon the characteristics of the stimuli as well as the nature of a person's VI.
• Distance. The distance of a person from the visual target will affect acuity. Please note: Harris uses a simulator that allows him to get an idea about how a person sees things.
• Verbal formulas. The way you talk to a person is important. When providing choices, present the task in the same format, give the person time and be predictable. For example: It's time for a break.. Here is your cup. [Move it slowly across the person's visual field.] Here is your sweater. [Move it slowly across the visual field.] Now, I'm going to show them both to you. Look at/touch the one you want.

Another valuable assessment tool with an AAC perspective is the "SAAT—Systematic Assessment of Assistive Technology," which is available from Bristow & Pickering. See Resources.

Teaching individuals with VI will he more effective if you:

• involve their hands with communication media.
• pair symbols with sound.
• use familiar media in familiar activities so context cues may be used.
• base communication training within an individuals most familiar activities.

Please note: You may order a back issue of ACN Volume 7, # 5

containing all of the articles listed here by clicking here

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