CD 485 Computer Applications in Communication Disorders and Sciences
MODULE 4
AUGMENTATIVE AND ALTERNATE COMMUNICATION (AAC) DEVICES FOR COMMUNICATIVELY
HANDICAPPED INDIVIDUALS
SECTION II
The Modality
Connection
AAC--A STORY OF
COMMUNICATION RESTORATION THROUGH THE USE OF MODALITIES
:
I. Communication and Modalities: It was Daniel
Webster who said, "...if all my possessions were taken
from me with one exception, I would choose to keep the power of communication,
for by it I would soon regain all the rest." This succinct and yet
profound statement encapsulates the purpose and the story of AAC (Augmentative
and Alternative Communication) ? giving back the power of communication to one
who has lost it.
and...ALSO PLEASE SEE. SCHUYLER'S
MONSTER below..
Please click here to see a video introduction to AAC.
Communication is
defined in the dictionary as a conveyance
of information. We can add that it is accomplished by the transmission via
some modality of an organized and
recognizable pattern of energy. A
Modality is a path or method, and among the domain of the living there
are two major modalities used for communication: signs and symbols. Semiology is the study of these
modalities, both individually and combined into systems. Hence, Semiology is
the study of the Òlife bloodÓ of the communication process. This becomes
critically important when one major segment or Sub Modality such as Speech is
lost to the communication process. Then modifications and or manipulations of
other Sub Modalities must be considered to recover as fully as possible the
ability to communicate. This is why a study of the Modalities of communication,
their links and junctions is important to the development a plan of
habilitation or rehabilitation for an individual with a severe speech
disability.
Symbols and Signs are transmitted by humans via a number of sub modalities, some of which are
Linguistic and some which are not. Examples of Linguistic modalities would be
speech, Sign Language, and Morse Code. These are symbolically based communication pathways that typically convey
very precise information. Non linguistic
symbols would include Art, Music and Rituals. Signs, all of which are Non
Linguistic in nature, would include facial grimaces, intensity of movement,
proximity and many others variables. Signs
typically provide a more general background for meaning. Frequently,
communicators take advantage of more than one modality at a time. Multi
modalities not only provide a richness
to the communication process, but also an element of redundancy so that if one
modality fails, there are others available to fill in the gap. These will be
discussed in more detail in the next Section. But for now, the question might
be, ÒHow do Signs as a modality differ from Symbols?Ó
II. Signs Typically Transmit
Information Necessary for Survival: What is the difference between a
symbol and a sign? If we were driving along the road and saw the following
image, what would we do?
Hopefully we would stop. This is a stimulus called a Sign and it is a call to
action -- to stop! Hence, it is typically a communication that is necessary
for our survival. Disregard it and
the results can sometimes be fatal! Signs can be events, motions or marks that
have meaning. They may be generated voluntarily or involuntarily in the realm
of the living. But even inanimate objects produce signs, although in this case
they are not always calls to action. Rocks, for example, omit signs that
indicate their age. Stars transmit signs which reveal how hot they are, how
fast they are rotating, how fast they are moving and in what direction, and
what gases are present in their atmosphere to mention a few. For animate
objects, however, there are three important features of Signs:
1. They are typically calls to action.
2. They are important for
our immediate survival; and
3. They are typically connected to their (referent)
meaning through an iconic
relationship or a cause-effect
relationship that can easily be recognized and learned.
A foot print in the sand, for example, has both iconic and cause & effect
significance. It both looks like a foot, and was caused by some one stepping
there. What is the call to action here? If you were Robinson Crusoe ostensibly
alone on an Island in a part of the world where there were cannibals, and that
was not your footprint, you would probably take great heed!
(A Sign that Someone was here)
It must be noted that the Signs we are referring to
here are not the same as the Signs used as the basis for Sign Language, but
more the signs used in the Pavlovian sense (i.e., a bell can be learned to be a
sign for the imminent arrival of food; or black clouds are a sign of the
possible arrival of rain). In the first case, the call to action is to
salivate; and in the second, to grab a rain jacket. The so calla Signs of Sign
Language on the other hand are not signs at all but in reality they are visual
symbols.
Many communicatively disabled persons with no speech are still capable of using
some natural and learned Signs. In a familiar environment, these signs may be
the most efficient form of communication being easy to produce and being
associated mostly with the communication of important needs. Hence, an AAC user
should not be discouraged from using these signs, even when they have a very
sophisticated and expensive speech communication device at their disposal. In
other situations, however, the speech modality is preferable because the
symbols covey messages with considerably greater preciseness. Einstein, for
example, would have had trouble explaining his Theory of Relativity by jumping
up and down, waiving his arms and yelling Òaarrgh. In fact I have seen the same
dialogue applied by some of my students who were commenting on the some
un-relevant facet of class final exam.
III. Symbols Typically Transmit
Information Necessary for Thought: If we see this, what do we do?
Probably we would do nothing. That is because it was NOT a call-to-action. And
it is certainly was NOT necessary to our survival. It was a call for a bit of
organized information, however, to be brought into consciousness from our
memory banks. For example, it may have brought to mind an idea -- about a man who is faster than a speeding
bullet; more powerful than a locomotive; and who loves to leap tall buildings
in a single bound. He often wears a blue leotard with a pink cape and boots;
and has a quirky habit of frequently changing his clothes in the nearest
telephone booth. He is employed by a newspaper company, and he has a girl
friend of questionable intelligence (she never recognizes him in his leotard
without his glasses). All these threads of interrelated information, which
we will call a concept, were brought to mind by the stimulus (in this case the
word) "Superman." That is what symbols in communication do. They
bring into our minds information (concepts) that we can then modify, enjoy,
discard or use to plan our day. But typically, they are not calls to action.
There are three important features of symbols:
1. They are calls for information to be brought into consciousness;
2. They can have a relatively arbitrary relationship to their
referent (that which they signify); and
3. They can act as surrogates in the thought process for the very concepts they
signify. For example we can and do think in words rather than images. Symbols,
then, not only transmit information but they also become a major part of the
thought processes.
One might easily think that the arbitrary connection of symbols to their
referents would create a major disadvantage, in comparison to signs, as a
currency for communication, especially for children. Signs with their iconicity
or apparent cause and effect relationship should be much easier to learn. But
this is where nature has provided humans with an awesome edge--the prodigious
ability to create and recall great numbers of arbitrary Concept--Symbol (Word)
associations. This is the "backbone" of language. And just as
it is no problem for a giraffe to reach nutritious leaves high up in a tree, or
birds to fly because of their special structures which are a product of
inheritance, it is no problem for humans to make these word„concept
associations. In fact many persons by the time they finish college have often
acquired over 100,000 concept-word associations in their lexicon! This capacity
is our genetic inheritance.
Indeed, for human communication, the arbitrary
nature of the concept--symbol association, has one major advantage: boundless POWER for communication!
Because there is no limit to the concepts that can be associated with symbols, there is nothing in the Universe that cannot
be communicated symbolically! Many concepts moreover, cannot be seen, heard
or touched, and can only be accessed mentally through their symbols. The words Òelectron
or democracyÓ would be two examples. Thus symbols open up to the mind
phenomenon and ideas in the Universe hitherto out of reach of the human senses.
In addition, these symbols with their surrogate function carry the power of
communication to the very mind itself. The potential and advantage for self
communication (which we call verbal thought or language) is awesome. Hence, for
severely sensory and/or motor impaired children, a goal for Assistive
Technology in general (AT) and Alternative and Augmentative Communication (AAC)
in particular is to open up the modalitis of communication so that they can
have access to this powerful instrument of thought and communication.
IV. Words, Art, Dance, Music, Ritual
are all Symbolic Modalities: Humans display many kinds of symbolic
behaviors. Probably, the earliest in history were Rituals, Music and Dance
and Pictures. They are still as important today as they were in
primitive times, nevertheless, because they have the capacity to communicate
visceral human thoughts and feelings that cannot always be fully expressed in
words. Although limited, AAC and AT (Assistive Technology) devices can provide ÒvirtualÓ
opportunities to communicate through rituals, music and dance.
Words as symbols, on the other hand, have five features in particular which set them
apart from the other symbol forms, and make them particularly suitable
for precise communication. These include:
1. There is a one-to-one relationship between a symbol (word)
and its referent (a thing or event in the world). For example,
the word "table" can be identified with a specific object. The body
of words which individuals store in their brain is referred to as a lexicon
(vocabulary). This provides the capacity for precision in communication.
2. The Symbol (word)--Referent relationship is arbitrary, and provides
the capacity to communicate almost anything.
3. Many symbols can exist for the same object. This, of course, provides the
bases for many languages. For example, ÒtableÓ (in English), ÒmesaÓ (in
Spanish), ÒstolÓ (in Russian {pardon my script}) all mean the same thing.
4. Symbols can serve as surrogates for concepts in the thought process!
This gives humans the ability to think in words about the past, the present and
the future, or to visit a world and a time that never was, through verbal make
believe, to mention a just few advantages. In fact, most adults typically think
in this modality, that is, verbally. It is this feature, moreover, that makes
this Modality so valuable. It is literally a passageway between the mind and
the universe of things beyond our immediate sight, sound and touch!!!
5. The symbols of language can be used to discuss language. This is referred to
as meta-language.
V. There are Two Kinds of Symbol Sub
Modalities: Presentational and Discursive:
1. Presentational Symbols are
perceived as complete units. This typically involves the right side of the
brain. Pictures and maps are some excellent examples. Many of the AAC devices
or systems, particularly for non literate and/or low cognitive users rely on
some form of pictures for encoding messages. These may be photographs, sketches
or two dimensional drawings. One non computer communication system called the Picture
Exchange Communication System (PECS) relies totally on picture symbols.
This system can stand alone for communication, or serve as a pre training
process for picture based AAC devices.
2. Discursive Symbols occur
over a period of time. This typically involves the left side of the brain.
Hence, it is not possible to perceive the whole unit except through the
cognitive process of short term memory. Many of the AAC devices provide
discursive stimuli, not only in the form of words but also in combinations of
words and/or pictures to form phrases and sentences. A major problem, as we
shall see, is the amount of time it takes to produce these strings of symbols
on an AAC device when the user is severely motor impaired. This, of course,
taxes the patience, if not the short term memory capacity of the communication
partner (the listener). Hence, the ÒHoly GrailÓ of the AAC world is always to
find techniques and strategies to speed up the communication process. To experience
a discursive communication, please checkout the following websiteƒ
VI. Signs and Symbols can be Communicated via Two
Modalities. These are Graded
and Combinative
signals.
1. Graded signals are stimuli that
vary along a continuum, for example, from more to less. If you change the
degree of the stimulus, you change the message. Imagine yelling at the top of
your voice versus mumbling softly as I often do in class. Students react
differently to each. To the latter they smile complacently as they finger their
Ipods. They know the lecture will continue benignly for hours. To the former
they frown complacently as they finger their Ipods. They know the lecture is
about to end in a furor of declarations. Pitch, tension, timing, space and
color are other examples of signals that can convey meaning when they are
changed from more to less along a graded continuum. These can be important
modalities for communication for a motor impaired individual. For example, an
increase in vocalization or body movement (albeit uncoordinated) may signify
distress, anticipation, frustration or happiness etc. Because of the lack of
precision of signs, the context of the situation may be necessary to decode the
message.
2. Combinative signals are stimuli
that occur in a sequence. If you change the order of the sequence, you change
the meaning of the message. Certainly, speech is a prime example of a
combinative stimulus.
VII. Three Basic Types of Messages:
Nominal, Expressive and Predicative, provide a total of SIX Modalities for Communication:
Using the two types of signals (Graded and Combinative) humans can
transmit three types of messages for a total of SIX possible modalities.
These messages types are: 1. Nominal, 2.
Expressive (sometimes called Emotional)
and 3. Predicative, (sometimes
called Propositional).
1. Nominal Graded Modality: This includes Messages that are transmitted by Signs.
If a change in the degree of the signal creates a change in the meaning it is a
graded signal as we mentioned above. They are Nominal if they are
relatively instinctive and typically generated by internal body processes.
Nevertheless, they can provide an important modality of communication for
severely cognitively and/or motor impaired individuals. Two examples of Nominal
Graded Communication are my rumbling stomach, and the early crying of an
infant.
a. My rumbling stomach, for example,
is one form of communication that generates a sign that may signify to a
listener that I am hungry, even if I say IÕm not. A stomach rumble is a Nominal
sign because it is an instinctive response arising from
internal body processes. I have no control over it, despite what my wife says!
If you are not familiar with stomach rumblings, check out the old classic
movie, ÒThe African QueenÓ with Humphrey Bogart. He (via special sound effects,
of course) gives an excellent demonstration early in the movie.
b. The Crying of an infant is
perhaps a more relevant example of Nominal Graded communication. No one
teaches a baby how to communicate so effectively. It is an instinctive reflex
generated automatically by internal body processes. This vocalization is a form
that generates a Sign, which is certainly a compelling call for action. The
degree of intensity (e.g., cooing versus screaming) determines the meaning of
the vocalization. Interestingly, humans appear to be neurologically wired to
respond to an infants cry. Hence, the baby's cry is more compelling and is more
difficult to ignore than one might expect, even for other babies. Put one
crying baby in a nursery of ten, and soon you will have eleven crying babies.
Besides crying, there are other body signs that are significant of personal
needs. These can include an increase in vocalization, or body
movements (agitation). These may be important signs and perhaps the
only modality of communication for a disabled individual, young or old.
Here is a POP Quiz for you...WHICH OF THE FOLLOWING BABIES IS TELLING US
THROUGH NOMINAL
GRADED COMMUNICATION THAT HE/SHE IS HAPPY WITH WHAT IS GOING ON? (Some verbal cues
will be provided for those students who are studying late at night and may be
experiencing mental myopia)
Please click HERE but PLEASE REMEMBER TO USE THE BACK ARROW ON YOUR BROWSER TO RETURN TO THE LESSON
and...
Please click HERE but PLEASE REMEMBER TO USE THE BACK ARROW ON YOUR BROWSER TO RETURN TO THE LESSON
and...
YOU CHOSE BABY NUMBER_____________.
Good for you.
As an interesting aside to the last Baby Picture, the
Dad had just received a rejection letter for a job and had ripped the letter up
which totally caught the attention of the Baby who relished in the continuation
of the process, and was great therapy for the Dad.
Now to continue.
Nominal
Combinative Modality: These messages are also transmitted by Signs
but their structure is sequential. Change the sequence
and the meaning changes. Two examples of Nominal Communication are the ÒTalkÓ
of Parrots, and the Babbling of a baby.
a. Parrots, like some Professors,
talk but they donÕt say anything. Their speech calls are clearly Combinative,
but unlike the baby's cry, they are not instinctive but are learned from other
birds. The propensity to learn the calls, however, is instinctive and hence,
they are still Nominal Signs. Because they are learned, baby parrots exposed
to human speech instead of other parrotsÕ calls, will pick up sequences
of speech sounds that they frequently hear. These sequences can get meaning in
a Pavlovian sense in that if every time I come home, I say to the Parrot, ÒEd
is Home,Ó the parrot may learn to say this sequence when Ed comes into the
room. It could be a call to action to be fed. This is not language, however,
because the phrase ÒEd is HomeÓ is in essence a Òbird songÓ uttered in its
totality with no individual words or grammatical rules distinguished or
intended by the Parrot. The parrot will not say, ÒEd is lazy,Ó unless of course
EdÕs wife has been frequently nearby. The peculiar aspect of Parrot talk is
that meaning is inferred on the sounds by humans that is not necessarily shared
by the bird. Patrick Parrot may look adoringly at another cute Polly Parrot and
sing, "Patrick wants a cracker." But food is probably not what is on
his mind. But these phrases can be useful. For the pre linguistic and/or low
cognitive adult AAC user, canned phrases that can be made by one stroke of a
key are very valuable. Like, ÒMy stomach hurtsÓ or ÒHow are you today,Ó or ÒPlease
call my doctor!Ó As with the Parrot, it is not necessary to know the individual
words or the grammatical rules involved. To experience a swearing parrot
incidence, please check out the following websiteƒ
c. Babies from 3 to 9 months do not
have language or speech, of course, but still communicate vocally using a form of Nominal Combinative
messages called Babbling. It is Nominal because it is instinctive. All humans,
regardless of race, culture or location begin to babble at around the same age
of development. (Even deaf children begin to babble but quickly give it up and
attend to a more rewarding, though analogous, activity using the hands). Initially,
Babbling may be an indication that the child is content. In time, it becomes
social and meaningful depending on the sequence. If dad comes in the room, the
baby may say dadada. If the child sees water, he may say wawawa.
3. Expressive (or emotional) Graded
Modality: Communications through the Expressive Modality are more
complex than Nominal, being mediated by higher centers of the brain dealing
with emotion. Hence, there is more room for decision making on the part of the
communicator. A very common example of an expressive graded signal is the
whimpering versus the snarling behaviors of animals, notably a dog. A snarl
from a dog is a warning to stay away. A less intense vocalization, such as a
whimper, is a sign of submission. The dog may choose his message based upon
past experiences and learning rather than instinct.
Here is a another POP Quiz for you...WHICH OF THE FOLLOWING PUPPIES IS TELLING
US THROUGH EXPRESSIVE
GRADED COMMUNICATION THAT HE/SHE WOULD LIKE TO BE PETTED? (As before, some
verbal cues will be provided for those students who are studying late at night
and may be experiencing mental myopia)
Please click HERE but PLEASE REMEMBER TO USE THE BACK ARROW ON YOUR BROWSER TO RETURN TO THE LESSON
and...
2. PUPPY TWO "CALLED "SNOOKY":
Please click HERE but PLEASE REMEMBER TO USE THE BACK ARROW ON YOUR BROWSER TO RETURN TO THE LESSON
and...
YOU CHOSE PUPPY NUMBER_____________. Good for you.
Now you may survive to continue.
Humans too, engage in a lot of
expressive graded communication. I whimper and my wife snarls. But the best
examples are provided in a popular book by Edward
T. Hall on Body Language.
I, of course, am Edward P. Hall and missed the Òboat of fameÓ perhaps by just one letter!
However, I would argue with Edward TÕs use of the word ÒLanguage.Ó Body Language, as important as it is, is a communication
system based on Expressive Graded Signs and consequently is NOT language. It is Graded in the
sense that messages are conveyed by changes in the degree of some variable,
like a change of voice pitch, intensity or modulation, the speed of movement,
the degree of body distance, or tension, etc. This is not to imply that body ÒlanguageÓ
is not important! To the contrary it is usually very important. If on my tenth
wedding anniversary, for example, when I took my wife out to see the Mike Tyson
heavy weight slugging match (instead of the Bolshoi Ballet as I had promised),
I should have deduced from a number of the communication modalities she
employed (viz., her clenched jaw, her
monotone voice, and the length of time (30 minutes) it took her to walk the 20
feet from the front door to the car) that she was not happy about my choice
of activities. These Signs are typically a prelude to my being locked out of
the house in favor of the chicken coup for the night. Where does the decision
part come in? If I resembled and had the demeanor of Robert Redford or Tom
Cruise, I suspect she might have decided to alter her body language in spite of
these same circumstances and react more like Marilyn Monroe than Koko the
Gorilla!
Now, here is an interesting example of Body Language used to communicate with a Horse. While
this appears to be effective, we do not advise using this in the home to
communicate with ones spouse!
:
For the
communicatively handicapped individual, body language can be a rich modality to
communicate many needs and feelings. These forms should be attended to and
encouraged even after the acquisition of an AAC device. The rubric below
summarizes were we are at this point in our discussion of Communication. ( In
the interest of brevity, and suspecting some of our female students hate bugs,
I deleted the discussion of the insects here.)
4.
Expressive (or emotional) Combinative Communications donÕt exist
according to many credible psycholinguists. But I believe I can point to one
example. You can judge for yourselves the voracity of this idea. The example I
would give is swearing. Although it is a speech
form it is NOT language. It is an Expressive communication. For
example, if you show me someone who is swearing, I will show you someone
(excluding anyone with Tourettes Syndrome) who is typically mad, surprised,
scared, happy, in love, or in pain, -- all emotional states. Hence, Swearing
is a Sign of an emotional state of mind. It is also a Combinative
communication. For example, if I hit my thumb with a hammer, it doesn't feel
like I have communicated my feelings if I say, "Oh green peas!"
Hence, changing the combination of phonemes from what I typically might say
(viz., ÒG@%$*^it!!!Ó) does change the meaning.
Incidentally, it is typically the Right Cerebral Hemisphere that swears. This
is because this hemisphere is for most folks a gestalt processor, which
organizes information in whole units. This includes such things as memories of
pictures, maps and even songs as well as swearing. There is also in the right
hemisphere lots of words and phases as they appear in over-learned clich?s and
expressive epithets. Speech Formulas, which are over used familiar phrases
(like, ÒHow are you todayÓ), Idioms (like, ÒThe Fat is in the FireÓ), and
Proverbs (like, ÒTwoÕs company and ThreeÕs a crowdÓ) are all stored in and
emanate from the right cerebral hemisphere. More like songs than language,
these expressions are pretty much units, fairly rigid in their order and tone.
They come as a whole or they donÕt come at all. This is the property that
places them in the Right Cerebral Hemisphere, which is, as I have
said, a Gestalt processor.
The Left
Cerebral Hemisphere on the other hand is a Segmental processor.
Hence, it carries the burden of language acquisition and use. So, for example,
if I should receive a severe injury to my left cerebral hemisphere, like
from a hard blow to the left side of the head with a heavy purse on my way to
the Mike Tyson Fight, I may find upon regaining consciousness that I am unable
to use words to describe my headache or anything else. I may have what is
called Expressive Aphasia. But in my attempt to speak, in
the
absence of expressive language, clear and fluent swear words may yet
stream out.
In other words, when I have lost my language ability, I may still be able to
say many of those phrases that are not language, such as swear words.
Ironically, this body of words that exists in the right hemisphere can be used
beneficially as a springboard to both speech and language rehabilitation. And,
with some reservations, for the teenage AAC user, some swear words or phrases
might often be included in an AAC device so he can fit in with his peer group,
and/or he may have some opportunities to learn the pragmatics of when to use
and not to use such phrases.
5. Predicative Graded Modality:
There are no examples available in the literature that I could find for this modality.
It is conceivable, however, that Sign
Language, one form of linguistic
communication, includes some of these propositional and graded qualities. For
example the Signs (really Visual Symbols) for ÒFarÓ and ÒVery
FarÓ appear to be distinguishable by the degree of motion of one hand relative
to the other.
6. Predicative Combinative Modality:
This Modality includes all sub modalities
of Language
based communications which use Symbols. These include speaking,
writing, Signing and Morse Code etc. This is in contrast to all the previous modalities of communication mentioned so
far, which are based on the use of Signs.
Language is Combinative because it relies on the order of phonemes,
morphemes and words to determine the meaning. It is Predicative because the
symbols bring to consciousness ideas or
concepts which can be communicated. It is this very process of
symbolization that in some cases breaks down and causes the communication
disability. This is referred to as Aphasia. Although this is not
basically a motor disorder, there are nevertheless AAC devices (e.g.,
Lingraphica) which are helpful in both rehabilitating language and restoring
the communication processes.
The Language modality for communication does exist in a variety of macro
modalities in the brain. It is important to the SLP to recognize these so that
when one modality (or more appropriately, a segment of a modality) becomes
disabled, the Speech Pathologist will know to determine where the break occurs
and to seek other combinations of modalities
to reestablish or improve communication competency. For this reason a full
discussion of these macro Modalities and their accessories will be the focus of
the next Section.
Suggestion--if the print in the charts above seem too small to be easily read,
use the Control & Plus keys (Command & Plus keys for MaC) to make them
larger.,