H. COOPER Communication Tech and Vision 2 Users of communication systems often have multiple disabilities. Many students with multiple disabilities have vision impairment as one of their disabilities. A vision impairment may not be clearly evident or easily diagnosed in individuals who have communication difficulties. A vision impairment my not be clearly evident in individuals who have motor impairment such as cerebral palsy.
H. COOPER Communication Tech and Vision 3 Vision impairment may occur for the same reason other disabilities occur: * Complications of prematurity (retinopathy of prematurity or ROP) * Complications of prematurity (brain hemorrhages causing damage in the visual processing area of the brain, or cortical visual impairment) * Viral infections in the first trimester of pregnancy such as CMV, rubella, herpes
Some types of Visual Impairment * Uncorrected acuity errors (blurry vision) * Visual field loss (blind spots or tunnel vision) * Ocular-motor difficulties (nystagmus, visual tracking problems, esotropia) * Cortical or neurological visual impairment (visual processing in the brain) H. COOPER Communication Tech and Vision 4
Students with visual impairment are served by a teacher of students with visual impairment. They have special evaluations related to their vision: * A Functional Vision Evaluation (FVE) * A Learning Media Assessment (LMA) * Most will have an Orientation and Mobility Evaluation H. COOPER Communication Tech and Vision 5
The FVE or LMA may have information about the student’s ability to identify pictures. This may include: * Picture size * Photograph vs. drawn picture * Crowding, recommendations for spacing * Visual scanning capability, ability to scan across midline H. COOPER Communication Tech and Vision 6
Some students who have had brain injuries or atypical brain development have cortical visual impairment (CVI). People with CVI have difficulty making sense of what their eyes see. H. COOPER Communication Tech and Vision 7
People with CVI have difficulty understanding what they are seeing. * Their vision may change or appear to be different from one time to another. This is affected by fatigue, medications, other sensory distractions * They may need longer time to look at something and understand what it is (latency) H. COOPER Communication Tech and Vision 8
People with CVI * May have trouble processing information coming from multiple sensory channels * May tend to look away when touching an item * May have difficulty with figure/ground discrimination * May get more meaningful information tactually than when using their vision H. COOPER Communication Tech and Vision 9
People with CVI * May appear to “see” mainly certain colors usually black and white along with red, or yellow * May have significant difficulties with visual memory * May not recognize even familiar people by looking at their faces * May not be able to make sense of two-dimensional representations H. COOPER Communication Tech and Vision 10
H. COOPER Communication Tech and Vision 11 Many of the difficulties people with CVI have, are also difficulties people with other visual impairments have. * Difficulties with visual memory * Difficulties seeing the resemblance between a picture and the “real thing” * Benefit from high contrast visuals: black and white, red, yellow * Have difficulty with figure/ground discrimination
Many of our students with visual impairment also have cognitive disabilities. These disabilities may exist for the same reason the vision impairment exists, such as complications of prematurity. The ability to recognize pictures (for individuals with typical vision) emerges at about the same point in development as expressive speech, 12 to 18 months. H. COOPER Communication Tech and Vision 12
It is difficult to obtain an accurate assessment of the intellectual development of a child with multiple disabilities. Many assessment instruments rely on speech, vision and motor functioning to ask questions or for the child to respond to questions. However, even allowing for the weaknesses of evaluation instruments, many of our students are significantly below the developmental level of 12 to 18 months, and therefor are pre-symbolic. H. COOPER Communication Tech and Vision 13
Before using picture symbols, object symbols are generally used with the following students: * Those below the 12 month developmental level, * Those who are new to symbol use. * Those who have a significant visual impairment (those who would not be able to see print well enough to read) are considered “functionally blind” and would use object symbols and later tactile symbols for communication. H. COOPER Communication Tech and Vision 14
H. COOPER Communication Tech and Vision 16 Developmental evaluations for infants through age 3 usually indicate an emergence of understanding the content of photographs and pictures around 12 months with additional development though 18 months for typically developing children. This symbolic development parallels early emergence of speech.
H. COOPER Communication Tech and Vision 17 Making an association between the “real thing” and a picture requires: * Vision * Visual memory * Experience with the “real thing” * Experience comparing the real with the symbol
H. COOPER Communication Tech and Vision 21 Things to do to make a picture communication board or display easier to see: * Make the picture symbols larger * Increase the space between the symbols * Minimize visual clutter, especially background clutter
H. COOPER Communication Tech and Vision 22 Background * Mayer-Johnson picture symbols are available with a plain background. * Some software will allow users to change the background color to enhance contrast.
H. COOPER Communication Tech and Vision 23 Contrast * Mayer-Johnson picture symbols are available in a high-contrast symbol set. * For many users with CVI, black is the best background color. * If the user seems to see red or yellow better, that color should be in the figure, NOT the background.
H. COOPER Communication Tech and Vision 24 Things to do to make a picture communication board or display easier to see: * Avoid changing the symbol system when you change devices * Pair a word with pictures * Use a photograph
H. COOPER Communication Tech and Vision 25 Things to do to help students learn to use a picture communication board: (not all of these will be useful for every student) * Start by using object symbols, be sure the student has a good understanding of objects as symbols for activities, people, etc.
H. COOPER Communication Tech and Vision 26 Things to do to help students learn to use a picture communication board: (not all of these will be useful for every student) * Pair a picture symbol with the “real object” * Post picture symbols around the classroom as labels for objects * Use quickie boards for specific activities
H. COOPER Communication Tech and Vision 27 Cautions when using picture symbol displays: * Don’t rely on memorizing picture locations, because visual memory is often a difficulty, and memory retention is often a difficulty * Don’t rely on motor memory or a comparison with sign language or “gestures” for multiple picture symbol use: the user could potentially use many different overlays * Using auditory scanning requires a good memory, good hearing, and minimal background noise
H. COOPER Communication Tech and Vision 29 Object symbols, or tangible symbols can be used for discussing a schedule for the day. A student who is already familiar with their daily routine can use this strategy to learn symbol use.
H. COOPER Communication Tech and Vision 30 The most basic calendar or schedule is the “next, finished” basket system. Object symbols can also be used for making choices about what to do next.
For an individual who is “functionally blind” we DO NOT USE Miniature versions of objects. The reason for this is the miniature does not tactually resemble the real object. H. COOPER Communication Tech and Vision 31
For an individual who is functionally blind (and significantly developmentally disabled) DO NOT USE Raised line versions of picture symbols. Understanding the meaning of raised line drawings is similar to reading a map, it is highly symbolic. H. COOPER Communication Tech and Vision 32
H. COOPER Communication Tech and Vision 33 A student who is able to understand the meaning of a raised line drawing could also probably read braille. Using braille is more efficient and universal than raised line symbols.
H. COOPER Communication Tech and Vision 34 For an individual who is “functionally blind” and advancing in symbol use we start to use whole objects or parts of objects attached to a card or surface.
H. COOPER Communication Tech and Vision 35 As individuals using tactile symbols advance in their understanding, We introduce more abstract concepts which can’t be represented by objects.
H. COOPER Communication Tech and Vision 40 Selection of a communication device should match the student’s current level of symbolic understanding.
H. COOPER Communication Tech and Vision 41 Try a low or medium tech system if recognition of picture symbols is not well established.
H. COOPER Communication Tech and Vision 42 Is use of objects still necessary? Choose the device accordingly
H. COOPER Communication Tech and Vision 43 Don’t try to provide a device which will “take her/him through the next 5 or 10 years”. Remember, it’s a computer and it’s useful life will generally be 3 to 5 years. Aug comm devices change and features including visibility and ease of use progress rapidly.
H. COOPER Communication Tech and Vision 44 * Match the device to the student’s current visual abilities. * Visual functioning can improve or get worse as a child or adolescent grows. * A student can learn to use their vision more efficiently, but we can’t “teach” them to see better.
H. COOPER Communication Tech and Vision 45 If a student’s visual potential is not known look for these features: * Does it accommodate object symbols? * Does it accommodate tactile symbols? * Does it accommodate symbols of large size? * Does it accommodate symbols of the type (M-J) your student has been using? * Does it accommodate increased space between rows and columns? Empty space?
H. COOPER Communication Tech and Vision 46 This medium-tech 7 Level Communicator can accommodate 4 different symbol sizes, Tactile symbols, and braille.
Consider the age, intellectual ability, hearing, and motor abilities of the student: * Is the device sturdy, or can a protective case be added? * Does it have forward-facing speakers so the voice can be heard above noise? * Portability versus picture size? * Mounting system? * Affordability? H. COOPER Communication Tech and Vision 47
H. COOPER Communication Tech and Vision 48 Above all, expect that the communication device will change as the student changes and as the technology changes.