Holly Cooper, Ph.D. TSBVI Outreach Texas Deafblind Project Communication Technology: Considerations for Students with Visual Impairment and Additional Disabilities or Deafblindness Holly Cooper, Ph.D. TSBVI Outreach Texas Deafblind Project

Multiple Disabilities 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. Multiple Disabilities H. COOPER Communication Tech and Vision

Multiple Disabilities 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 Multiple Disabilities H. COOPER Communication Tech and Vision

Vision Impairment 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) Vision Impairment H. COOPER Communication Tech and Vision

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 Vision Impairment H. COOPER Communication Tech and Vision

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 Vision Impairment H. COOPER Communication Tech and Vision

Cortical Visual Impairment 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. Cortical Visual Impairment H. COOPER Communication Tech and Vision

Cortical Visual Impairment 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) Cortical Visual Impairment H. COOPER Communication Tech and Vision

Cortical Visual Impairment 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 Cortical Visual Impairment H. COOPER Communication Tech and Vision

Cortical Visual Impairment 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 Cortical Visual Impairment H. COOPER Communication Tech and Vision

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 Vision Impairment H. COOPER Communication Tech and Vision

Intellectual development 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. Intellectual development H. COOPER Communication Tech and Vision

Intellectual development 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. Intellectual development H. COOPER Communication Tech and Vision

Intellectual development 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. Intellectual development H. COOPER Communication Tech and Vision

Symbols for Communication H. COOPER Communication Tech and Vision

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. Picture symbols H. COOPER Communication Tech and Vision

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 Picture Symbols H. COOPER Communication Tech and Vision

Picture symbols My house Mayer-Johnson symbol H. COOPER Communication Tech and Vision

Picture symbols My cat Mayer-Johnson symbol H. COOPER Communication Tech and Vision

Picture symbols My other cat Mayer-Johnson symbol H. COOPER Communication Tech and Vision

Enhancing Picture Symbols 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 Enhancing Picture Symbols H. COOPER Communication Tech and Vision

Enhancing Picture Symbols Background Mayer-Johnson picture symbols are available with a plain background. Some software will allow users to change the background color to enhance contrast. Enhancing Picture Symbols H. COOPER Communication Tech and Vision

Enhancing Picture Symbols 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. Enhancing Picture Symbols H. COOPER Communication Tech and Vision

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 Using Picture Symbols H. COOPER Communication Tech and Vision

Teaching Picture Symbols 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. Teaching Picture Symbols H. COOPER Communication Tech and Vision

Teaching Picture Symbols 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 Teaching Picture Symbols H. COOPER Communication Tech and Vision

Picture Symbols 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 Picture Symbols H. COOPER Communication Tech and Vision

Pre-symbolic learning H. COOPER Communication Tech and Vision

Teaching Object symbols 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. Teaching Object symbols H. COOPER Communication Tech and Vision

Teaching Object symbols 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. Teaching Object symbols H. COOPER Communication Tech and Vision

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. Hippotherapy? Object symbols H. COOPER Communication Tech and Vision

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. Tactile symbols H. COOPER Communication Tech and Vision

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. Tactile symbols H. COOPER Communication Tech and Vision

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. Tactile symbols H. COOPER Communication Tech and Vision

As individuals using tactile symbols advance in their understanding, We introduce more abstract concepts which can’t be represented by objects. Tactile symbols H. COOPER Communication Tech and Vision

Voice Output Devices H. COOPER Communication Tech and Vision

Use a diagnostic teaching approach, when working on voice output communication devices. Begin with simple systems with one or two messages. Voice Output Devices H. COOPER Communication Tech and Vision

Find motivating activities for your student, and prepare a device with objects, pictures or tactile symbols appropriate for the device. Voice Output Devices H. COOPER Communication Tech and Vision

Feature Matching H. COOPER Communication Tech and Vision

Selection of a communication device should match the student’s current level of symbolic understanding. Voice Output Devices H. COOPER Communication Tech and Vision

Try a low or medium tech system if recognition of picture symbols is not well established. Voice Output Devices H. COOPER Communication Tech and Vision

Is use of objects still necessary? Choose the device accordingly Voice Output Devices H. COOPER Communication Tech and Vision

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. Voice Output Devices H. COOPER Communication Tech and Vision

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. Vision abilities H. COOPER Communication Tech and Vision

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? Vision abilities H. COOPER Communication Tech and Vision

This medium-tech 7 Level Communicator can accommodate 4 different symbol sizes, Tactile symbols, and braille. Voice Output Devices H. COOPER Communication Tech and Vision

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? Hardware H. COOPER Communication Tech and Vision

Above all, expect that the communication device will change as the student changes and as the technology changes. H. COOPER Communication Tech and Vision