ACE Centre

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• ACE Centre
• Rachel Moore Speech and Language Therapist
• Jackie Ayre Occupational Therapist

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Communication

• Communication is crucial. Communication is a
  fundamental human right. Communication is a key
  life skill. Communication is at the core of all
  social interaction.
• From "A Review of Services for Children and Young
  People (019) with Speech, Language and
  Communication Need" (Bercow July 2008).

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The ACE Centre

• Assessment of children with complex communication
  difficulties
• Multi-disciplinary team
• Training
• Information
• Research and Development

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But we were not seeing children early enough

• Communication starts with interaction and the
  earliest behaviours of children there are no
  prerequisites. Cress 2000
• What are we waiting for Kangas Lloyd 1988

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The political picture

• Early identification and intervention are
  essential.
• From "A Review of Services for Children and
  Young People (019) with Speech, Language and
  Communication Need" (Bercow July 2008).
• During this time we cannot afford to get things
  wrong.
• The early years are critical in childrens
  development. Children develop rapidly during this
  time
• physically, intellectually, emotionally and
  socially.
• From "Curriculum Guidance for the Foundation
  Stage" (Foreword by Margaret Hodge, Parliamentary
  Under Secretary of State for Employment and Equal
  Opportunities, 2000)

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So much happening

• It is well documented that from conception to
  first day of school development proceeds at a
  pace exceeding that of any other stage of life.
• Children are active participants in their own
  development, reflecting the intrinsic human drive
  to explore and master the environment Shnokoff
  Philips
• Human Development is shaped by a dynamic and
  continuous interaction between biology and
  experience Shnokoff Philips
• Play is a motivational tool

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Play!

• Through play children learn about the world
  around them. They learn to communicate, interact
  with others, develop their own identity and build
  on their social skills
• From Play Talks, SCOPE
• Children find out about the world around them
  through a process of observing, exploring,
  speculating and making discoveries. Mary D
  Sheridan (1999). Play in Early Childhood. From
  birth to 6 years.

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Play is !!

• Having fun
• Communicating
• Developing skills
• Taking control
• Physical difficulties can reduce opportunities
  for exploration and play
• A child with complex disabilities needs tools at
  every stage.
• Tool needs to be pitched at the right level.

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Toys2Talk Project

• Early Intervention (The youngest child we saw was
  11 months)
• Children with a wide range of diagnosis and
  difficulties
• Support for both families and professionals
• Information, strategies, equipment.

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Support for both families and professionals

• Parents are experts on their children.
• Experiences and expectations tend to be based on
  the normal developing child / no previous
  experience of a disabled child.
• Parents are looking for information, advice and
  support

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What did Toys2Talk involve?

• Referral
• Information collection
• Contact visit
• Loan of equipment and information provision

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Information Collected about the child

• Individual approach to all children referred
• Collect information from Parents and
  professionals,
• For example
• Communication
• Physical abilities and difficulties
• Level of play and interaction, sensory through to
  imaginative play.
• Attention
• Likes and dislikes

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Contact with the Child

• Sessions at ACE Centre
• Visits to children at home
• Visits to pre-school professionals

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Following a visit with a child

• Loan Boxes
• adapted toys, access devices for early computer
  play and communication resources
• whatever is necessary for the child to use the
  equipment, including advice and guidelines
• CD of photos and video clips

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Contents of a typical toy box
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How did we go about it?
Picture/video of child
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Identify appropriate tools for the
individual.Different types of play required
different tools

• Exploratory play
• Constructive play
• Pretend play
• Social interaction
• (types of play Sheridan 1999)
• Developing control skills
• Motivation

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• Exploratory Play (Edward)
• Constructive Play (Oscar)

Picture/video of child
Picture/video of child
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Pretend Play (Tamsin)
Picture/video of child
Cooperative play (Poppy)
Picture/video of child
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• Parents aware need for tools to enable children
  to play.
• Were often unaware of what tools were available.

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Tools

• Control devices
• Switches
• Touch screen
• Joystick

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Switch Control

• Switches
• Stick
• Latching box
• Activity- toy / Simple communication device/
  environmental control

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Introducing Switches

• Experience
• Show
• Offer (time) (respond to them)
• Opportunity
• A child learns to control using their body.
  (movement of whole body or specific parts eg the
  hand etc, sound production, eye movement)
• Learn to interact at different levels

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Why Switches

• Different reasons for introducing switches,
  strategies and techniques.

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Touch Screen

• Different reasons for introducing touch screens,
  strategies and techniques.

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Joystick

• Different reasons for introducing joysticks,
  strategies and techniques.

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• Communication starts with interaction and
  earliest behaviours of children there are no
  pre-requisites Cress 2000
• Communication is integral within a childs
  development and learning from the earliest stage
  ..
• An integral part of play.

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Communication Issues

• Young age of children
• Communication difficulties may not have been
  considered
• Some normally developing children may not yet be
  speaking
• Within Toys2Talk project, limited potential for
  long term support.

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Communication issues

• Sometimes there was no SLT involved
• Always liaised with a SLT if one was involved
• Sometimes keen for any suggestions
• Sometimes they asked for specific input
• E.g. Equipment,
• Discussion / introduction of ideas

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Parental approach

• Parents recognition of communication issues
  varied widely
• Required flexible approach
• Some parents are keen to support communication as
  early as possible
• Some parents concerned whether alternative
  communication methods will delay speech
  development?

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• Where an SLT was not yet involved, parents
  required advice and discussion
• Saarah. On a 6 month waiting list.
• Discussed strategies
• for encouraging sound
• production, loaned a
• signing dictionary and a
• LITTLEmack

Picture/video of child
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• Some parents required information and support
  with specific situations
• e.g. Morgan, had lost ability to communicate and
  his mother wanted to investigate a small,
  lightweight single message communication device

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Some parents were actively seeking support for
their childs communication, open and interested
in any ideas.
Sienna Discussed signing, loan of a signing
dictionary Discussed how to use core symbols,
provided these
Cameran Discussed eye pointing to symbols.
Provided core symbols and an E Tran frame. Eye
Gaze Folder discussed. Loan of Boardmaker
software
Picture/video of child
Picture/video of child
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• Poppy

• Thomas

Talked about eye pointing to symbols, lent E tran
frame with core symbols to support activities
provided. Already has a LITTLEmack
Eye points to either side for Yes/No.
Communication book is under development. Lent an
E tran frame, core Symbols, Loaned Boardmaker.
Already has a LITTLEmack
Picture/video of child
Picture/video of child
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Case Study Tiago

• Age 16 months
• Cognitively bright
• Cerebral palsy
• Physically complex
• Attends the Bobath, moves through a variety of
  positions through the day

Picture/video of child
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Tiago was placed in a variety of positions during
our initial visit
Picture/video of child
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..and more positions at home
Picture/video of child
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Tiago was interested in everything!
He particularly loved the computer
Picture/video of child
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Equipment loaned after initial visit

• 2 Jelly Bean switches
• Ruler with Velcro
• Maxess Wedge
• Mouser
• Powerlink
• Ablenet single switch latch and timer
• Range of simple cause and effect software
• Tape recorder
• List of books with repeated lines
• Guidelines on how to use equipment
• E tran frame
• Core Symbols
• A CD of photos and video clips taken during the
  visit will be included

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Communication Resources Provided

• Tiago produces a range of sounds, 2 syllable
  babble including some consonants, no words.
• Good eye pointing skills developing
• LITTLEmack already in place
• Toys2Talk provided E Tran frame, core symbols,
  yes/no symbols

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Alison provided feedback soon after initial
contact

• Request for further visit
• lots more symbols for meal times, nursery rhymes
  etc
• Mounting switch so that Tiago could play with the
  computer independently
• Trial of a joystick
• Further loan of toys

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Developed a bank of symbols in a short time, used
throughout the day
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Toys
Control
Choice
Picture/video of child
Picture/video of child
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Fun!
Picture/video of child
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Use of Computer
Picture/video of child
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Bercow considers that failure to intervene at an
early age has far reaching effects

• If a child does not benefit from early
  intervention,
• there are multiple risks, which may become
  apparent over a number of years of lower
  educational attainment, of behavioural problems,
  of emotional and psychological difficulties, of
  poorer employment prospects, challenges to mental
  health .
• From "A Review of Services for Children and
  Young People (019) with Speech, Language and
  Communication Need" (Bercow July 2008).

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• Rachel Moore - Speech and Language Therapist
• moore_at_ace-centre.org.uk
• Jackie Ayre Occupational Therapist
• ayre_at_ace-centre.org.uk