15 y.o. with multiple disabilities. Looking to make sure I'm not missing something with assistive technology.

School OTR/L

1/22/2019 1:43 AM

School-based OT looking to ensure that I am not missing something with assistive technology for a 15-year old multiply disabled student who is home-schooled due to medical complexities. Cognitive disabilities, global deficits in all areas; spastic quad. CP, visually impaired/cortically (vision teacher says can see lights and some other things at about 10 inches), seizure disorder, GERD, G-tube (NPO), shunt for hydrocephalus, nonverbal, nonambulatory and no purposeful movement seen during OT sessions x10 years. Can turn head side to side if supported and once in a while will lift the right leg (extend knee) although it has not been consistent when trying to get a response. Switches were attempted in the past at school with the result being that she required hand-over-hand due to the lack of purposeful response on her own. Teachers/tutors go to the home for tutoring 2 hours a day. They do hand over hand (if Mom allows) and sensory activities (if Mom allows). Reading to her, lessons based on alternative assessment recommendations/curriculum, iPad activities (videos, letters, etc), music. No switch use or communication device used currently as speech sessions last year found data to be minimal to 0 responses. The responses that were seen were some sort of reaction to the stimulus (increased awake or verbalization "aaahh", smile, head movement--usually once or twice but never to "activate" anything). Please help. I want to ensure that everything that can be done is being done! Every student deserves this, but we have been working together with her for 2 years at home with minimal to no responses. Mom says something different and other agencies say we're not doing enough....what am missing?? Completed communication matrix below.

Facial expressions,Early sounds/vocalizations (not speech),Expresses comfort,Express discomfort,Expresses interest in other people,Occupational Therapist,Please Help!,Intervention Strategies,assistive technology

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• Hi all, this is definitely the place to be. So sorry that it's taken so long to get some type of response to you. Unfortunately, there isn't someone on the university team that is reading posts daily, and the grant that our implementation team is on has ended. We usually still get alerted by the PLEASE HELP button that you clicked, but that didn't send your message to me - so I will alert them back at the main website about that.
  
  So, to your awesome question....
  
  First, Hand-over-hand strategies that may be helpful in learning to manipulate items in our world or learning to do functional skills such as feeding or dressing, do not apply for communication. What we have learned from research is that many individuals react negatively through their sensory system to the touch or when using hand-over-hand with communication, they associate that the person doing the HOH has to always be a part of the communication, and it rarely fades.
  
  Secondly, some of the strategies for emergent communicators with a profile as the one that you are showing for your student, are Language Aided (Modeling) - so do some Communication Matrix Forum or internet searches on that; Partner Assisted Scanning (PAS). 

Information on Partner Assisted Scanning (search the Communication matrix community of Practice)

University of NC-Chapel Hill- Literacy & Disability Studies Project Handout on PAS

• See if you or a team member can get to a PODD training (Pragmatic Organization for Dynamic Displays) and a follow up session on PODD for Alternative Access (www.poddusa.com)PODD Information, Training, Trainers and Links
  
  SEE Jill Senner & the TALCenter Information http://www.talcaac.com/  (Click on the LINKS and DOWNLOAD Button)
  
  Communication Partner InstructionOvercoming Barriers to Communication
  
• Overcoming Barriers to Communication
• Communication Partner Instruction

well, I hope this is helpful and at least gets you started. If you have any questions, please contact me

ksfonner@gmail.com

Kelly Fonner - 2/4/2019