[UW Augcomm Home]

[AAC Glossary]

[AAC Vendors]

[AAC References]

[AAC Links]

[Contact Info]

[Disclaimer]

Home > Continuum of Communication Independence > Emerging Communication > Case Example

Case Example: Emerging Communication

The examples that I will present here will be people who were originally "emerging" communicators, but eventually became successful AAC users. The reason for this is to highlight some of the reasons that an individual may be "emerging"....it can be due as much to our methods as to the individual's capabilities.

David K.: Young child with emerging communication

This young man was only 4 when I met him. He had (and still has, of course) severe spastic-athetoid cerebral palsy with essentially no volitional control [G] over his hands, arms, head, legs, feet and eyes, any part of the body. His communication was limited to facial expressions and body postures, but even those movements were full of non-volitional movements. His family was able to read a smile for "acceptance" and a frown for "rejection" but the rest of the team could not distinguish these signals from non-volitional grimaces of the face.

David was an "emerging" communicator, because he had only non-symbolic methods of communication and had no reliable method of symbolic language.

But he didn't remain an emerging communicator, and that is the story that gives us perspective on our task with emerging communicators:

Our first steps with him were to:

1) Evaluate his hearing and vision: His parents, who spoke a dialect of Chinese at home, were quite certain that he had good hearing and vision and had stories to tell that substantiated their claims. We insisted on verifying his sensory abilities, however, because it is important to rule out even a subtle loss. The audiologist used special "passive" testing methods that will be discussed elsewhere in this course. It turned out that David had a significant hearing loss in the high frequencies, and he required hearing aids. (Interestingly, his family's native language uses fewer high frequency sounds than English. We were later able to establish that the loss affected his comprehension of English more than his comprehension of their Chinese dialect.)

2) Maximize his non-symbolic methods of communication: We attempted to shape David's signals for acceptance and rejection, but found that we could not improve upon them.

3) Identify the first reliable signal for symbolic communication: There was a large team of individuals working with David for a number of months, including OT, PT, SLP, physiatrist [G], etc. We examined a large number of sites on his body for possible switches or even just as signals to the partner, but every site and every attempt failed: he simply did not have volitional control over those muscles or he had involuntary spasms that interfered with what little control he had. For example, he could turn his head from side-to-side and often did so to watch people. However, he also had a very strong involuntary reflex (the Tonic Neck Reflex [G]) that was set off by turning his head about one-third of the time. We could not find any movement that could be used.....until we thought of his VOICE as a signal.

David was able to vocalize on demand. It was faint at first, and it was often hard to sort out from the involuntary sounds he made when he was working hard (which was most of the time...fighting all his involuntary movements). But, over time, we were able to shape his phonation. We were not trying to shape speech, but to make it a rapid and dependable signal for him. Once he was able to produce a sound we could recognize within 7-8 seconds of our command, we then began to associate it with symbolic communication. We conducted trials with Partner Assisted Auditory Scanning [G]. We spoke the options and when we got to the item to select, he phonated. We began doing this with vocabulary related to needs and wants but quickly progressed to communication that was verifiable (e.g. who lived with them at home, family members names, etc.) and then to academic tasks (e.g. spelling his first name, recognizing words.) He excelled with this method, and was later able to run a computer and communication device using a voice-activated switch [G].

The most important part of this story is that once WE had identified his hearing loss and WE had found a signal and then WE taught him partner assisted scanning, David was no longer an emerging communicator. We had provided him with a "reliable method of expressing symbolic language" so he could move on.

Max Whitman: 67year old with re-emerging communication

Mr. Whitman suffered a severe Cerebrovascular accident (CVA) last year, resulting in severe aphasia and apraxia of speech. When the SLP first met him, he had very garbled speech and confused yes and no in his replies to questions. He also had significant right side hemiplegia. Mr. Whitman had no reliable method of communicating beyond the here and now, no symbolic communication. But his communication was RE-emerging.

Our first steps with him were to:

1) Evaluate his hear and vision as input modalities: Testing showed that Mr. Whitman did not have any peripheral hearing or vision impairments. He did, however, have significant perceptual impairments in both input modalities.

Mr. Whitman had a significant visual field cut that made it difficult for him to use visual information, at least initially. His therapists were able to teach him to compensate for his visual impairment, permitting him to use print material. This led to the finding that he was still able to read highly familiar single words and short phrases reliably.

Mr. Whitman also had a severe impairment in auditory comprehension. The fact that he could read single words meant that written words could be used to enhance his understanding of speech. One of the goals of intervention was to teach his wife how to utilize writing and drawing to supplement her speech to him, a technique called aided input [G].

2) Identifying the first reliable method of symbolic language: Once his team provided him with print materials that he could see clearly, and with "aided input" to improve his comprehension, Mr. Whitman was able to demonstrate his true expressive communication abilities. The team quickly learned that he could utilize pages of printed words and line drawings for alternative communication. This was the beginning of his reliable symbolic expression.

In Summary:

What do we KNOW about Emerging (or "re-emerging) Communicators?

We only know that Emerging Communicators do not have the tools to communicate beyond the "here and now". They do not have a method of expressing symbolic communication reliably.

Do we know WHY they are only Emerging Communicators?

Not yet. We cannot know why they don't have symbolic language until we succeed in developing it. In David's case it was because of his hearing loss (worse for English than his native language) and the fact that he did not have a reliable motor movement for signaling. In Mr. Whitman's case, it was due to visual impairments (initially hidden to us) and his limited auditory comprehension. Only when we compensated for these impairments could we reveal their ability to use alternative communication methods.

There is a tendency to assume that someone limited to only "emerging" communication has significant cognitive impairments or developmental delays. Unfortunately, those assumptions do not help eliminate obstacles and they are often used to justify a decrease in effort by the team. Keep in mind at all times that it is impossible to test cognitive and receptive language abilities in emerging communicators with hidden vision impairments and/or severe motor impairments. That type of assumption actually keeps people like David and Mr. Whitman (and countless others) from success with AAC.

Let's go on and read about communication once someone is no longer an "Emerging Communicator".

Continue on with the model: Context-Dependent Communication