CDS 485 Computer Applications in Communication Disorders and Sciences
MODULE 4
AUGMENTATIVE AND ALTERNATE COMMUNICATION (AAC) DEVICES FOR COMMUNICATIVELY
HANDICAPPED INDIVIDUALS
SECTION III
AAC and the
Manipulation of Modalities
I. What is a Modality? Augmentative and Alternative Communication
is a story about Modalities and how whole or sub modalities may be
switched when one becomes hopelessly disabled. But what is a Modality?
The word for example, Modality, like the word Spouse, can mean
different things depending upon who is using it. To some the word Spouse means
a companion, a friend and an object of affection. To others it may mean a
monster, a liar or a jailor. Likewise, many disciplines find a different use
for the word _Modality._
To the Theologian, the word Modality is used in Christianity to refer to
the structure and organization of the local church. The Universal Catholic
Church is the modality as described in Catholic Theology.
To the Lawyer Modality refers to the basis of legal argumentation in
United States constitutional law.
To the Musician it is a subject concerning certain diatonic scales known
as musical modes. It_s also why I never learned to play the piano!
To the Sociologist, it is a concept in structural theory.
To the Philosopher it is the qualification in a proposition that
indicates that what is affirmed or denied is possible, impossible, necessary,
contingent and some other things. So much for these notions, and there are
others. But let_s look at some that are more relevant to a discussion of AAC.
II. A MODALITY IS A SENSORY SYSTEM AND MORE.
To the Medical Profession a Modality may be the faculty through which
the external world is apprehended. Hence, it can refer to a sense-organ
or a specific sensory channel (system), such as in vision or hearing.
Seeing and hearing, of course, are not just functions of the transducers (i.e.,
the eyes and ears which convert stimuli from the environment into analogous
patters of electro chemical impulses in the brain). They involve a complex
neurological infra structure that exists beyond the transducer to organize and
interpret the stimuli. This infra structure can be portrayed adequately for our
purpose by Mysak_s Model, an _oldie but a goodie,_ with a few adaptations.
A. Transduction -- The first four green boxes in Mysak's Model,
which he calls the Receptor Unit, (green boxes 1-4) are the Receptive
Transducers such as the eyes, the ears, touch and kinesthetic
feedback. These transducers put us in touch with the environment by
changing external stimuli into internal electro chemical impulses. But at this
point, there is no meaning involved in the stimulation. Nevertheless, damage to
these transducers can imperil cognition, speech and language development and
communication simply by the isolation it creates. Assistive Technologies,
like hearing aides, glasses, and structures to facilitate standing or walking
etc., can help to breach this isolation and enable the development of
cognition, language and communication.
B. Perception -- The next two boxes beyond the transducers, (blue
boxes 1 and 2) represent neural networks that organize the inflow of
electro-chemical impulses from the transducers to efficiently and quickly
achieve meaning. This is the process of Perception and is represented in
Mysak's Model by the Integrator Unit. But why are there two boxes in
this unit?
There are two boxes because perception has two processes which contribute to
the organization function. The first (blue box 1) represents the contribution
of that Innate Genetic Inheritance which creates the specific neural
infra-structure we possess because we are human. Our neural structure is
different than that, say, of a cat and we perceive the environment differently
than does a cat. The other (blue box2) refers to the influence that stored
past experiences and learning have on the way we organize and interpret
incoming stimuli.
Disruption to the former (blue box 1), the innate perceptual networks, can
create severe processing problems that result in a major lack of effectiveness
in achieving organization and understanding of what is being transduced. Poor
figure-ground discrimination, and spatial and temporal confusions can be a few
of the consequences.
A dearth of good, or a plethora of bad experiences or training, (which pertains
to blue box 2,) can create or exacerbate a perceptual problem. A child, for
example, who because of a severe motor impairment has had little or no
experiences in touching square, round or rectangular objects may have
difficulty later in perceiving drawings including them, such as are found in
printed letters. In this case, providing AT early in life, such as specially
constructed body supports which free a child_s hands to physically explore
objects in the environment, is one key to rehabilitation.
C. Memory _ the next red box represents the Storage Unit of
Mysak's Model. By all rights, this box should be ten times as large as it is,
because this is where humans are the World Masters. Our ability to develop and
maintain in memory thousands upon thousands of concepts, symbols, recollections
of the past and a plethora of motor patterns is unparalleled on this planet.
Memory, of course, is a bundle of processes, including short term memory (and
all its mechanisms), long term memory (and all its mechanisms), and the
conversion process from one to the other. Included here also are a number of
forgetting processes.
Severe memory disorders due to retardation or brain trauma may inhibit not only
communication but the ability to cope with daily living routines. AT can be
very useful here in providing systems and/or mechanisms to bridge the gap.
Picture schedules, generated by a computer, for example can allow a child or
adult with a severe memory deficit to participate and even take responsibility
for some daily activities.
D. Concepts, Language and the Seat of Consciousness _ the next brown box
in Mysak's Model is the Governor, which represents the process of consciousness,
decision making and ultimately the formulation of an idea to be communicated
symbolically. Descartes said, "Because I think, therefore I
am!" This threatens my very existence, so I don't want to go into
that too deeply.
But Language is a Process of going from an un-symbolized idea or concept in the
Governor (Deep Structure) to a symbolic expression (Surface Structure).
This involves the application of phonemic, morphologic, syntactic, semantic and
pragmatic rules, which may be expressed eventually through speech, Signing,
writing or some other form. A lack of opportunities to socialize early in life
before the emergence of language (i.e., to communicate with others), which is
characteristic in the life of severely motor impaired, autistic, deaf and other
disadvantaged children, can in itself retard or forestall the development of
these language skills. AT and AAC which enable social interaction, if provided
early can ameliorate significantly this lack of development.
E. Movement -- The Black Box which holds the secret of most motor
behaviors including Speech is the Mixer in Mysak_s Model. It answers a
riddle that many of us may have pondered in an idle moment (before, of course,
we took a course in Phonetics) -- How do we talk? We do it
effortlessly, and copiously (if you are a professor), and yet we have little
awareness of the specific movements we make to do it. Indeed if we did, speech
would cease, because the number of movements and the speed and precision
required are almost incomprehensible, unless you make a study of it (and why
would anyone be crazy enough to do that!!!). Speech movements exceed by far in
timing and number, the finest of ballet routines you can imagine.
In reality, the Mixer is like a neural _Juke Box_ (for the ancient
generation) or an IPod (for today_s younger students) which stores records
(thousands upon thousands) of all the motor behaviors we have learned throughout
life. This includes, walking, eating, brushing our teeth, tying our shoe
laces, dressing, playing a musical instrument, performing sports and, of
course, speech etc., etc., etc. The Mixer, like an old fashioned juke box
brings up a motor pattern upon request. If we wish to say something, the
message is sent from the Governor to the Mixer which selects the proper motor
pattern and sends it to the appropriate muscles designated to do the work.
If the Mixer fails to work, movement becomes totally uncoordinated and
ineffective. This is called Apraxia. It can be mild or so severe that an
individual can make no voluntary movements. It can effect an arm (hence no
Signing or writing), the vocal mechanism (hence, no speech) and/or the whole
body (hence, almost total isolation). To have a simulated experience like this,
stand in the middle of the room. Then raise the toe of the right foot (keep the
heel down), then raise the heel of the right fool (keep the toes down). This is
a simple rocking motion. Then do the same thing with the left foot. Alternate
this rocking movement between the right and left feet, and then increase the
speed. You may find that this simple motion becomes all confused because the
Mixer is not yet trained to handle it. (After this exercise, it is best that
you remain seated for three hours to avoid appearing intoxicated as you walk
across the room. You can avoid a lot of work too.)
If that demonstration was a little too wild for you, here is another one I
learned at my PAGE Club (Professors And Geriatrics Exercise Club) as
demonstrated personally here in the 3 pictures below by their 95 year old Class
Instructor, Madam Celia.
Cross your hands at the wrists, right on top of
left, rotate the wrists clock wise so that the palms face each other, clasp the
hands with alternating fingers (figure 1 above), and then draw them toward you
and up (Figure 2 above). When the clasped hands are up, have someone point to a
finger which you are to then move (figure 3 above). You may find it difficult
(at least for a short moment) to find the proper motor pattern to move the
designated finger. Other fingers may move instead. This is what it is like to
have Apraxia except for those who have a real and severe case of verbal
apraxia or more, this is the rule rather than the exception. But AAC devices
can fill the gap where the motor patterns have failed to go. Hence, verbal
communication through a computer with speech output can make a huge difference
in the life of a person with severe verbal apraxia and no speech!
F. Speech -- The EFFECTOR UNIT of Mysak's Model is the Speech
Mechanism which receives the messages from the Mixer. It consists of three
parts (represented by three gray boxes):
The Motor, which is the muscle system that serves as the source
of energy for speech (e.g., the Diaphragm and others); the
Generator, which is a mechanism for creating the sound for speech
(e,g the Larynx); and the...
Modulator, which is a system of resonating air chambers that
shape the air waves from the larynx to make them sound, among other things,
human and recognizable as phonemes.
Damage to these mechanisms can disable speech partially or totally. The speech structure
may be impaired or missing (like a laryngectomy or a glossectomy) or the motor
function may be compromised (like in ALS or Cerebral Palsy). The job of the
SLP in these cases is to assess the total person and find the best match in
terms of assistive/alternative devices or strategies. This is not as simple as
it may sound because there are many variables that must be considered. This
will be the focus of the next module.
It must be noted that the Effecter Unit in Mysak_s model relates to only
one form of communication_speech. There are, of course, many
others forms which depend mainly on the functional integrity of the first box
(the motor). On a linguistic level, there is Sign Language, Braille and Morse
Code. On a non linguistic level, there are the forms of communication we
discussed in the previous discussion of Graded and Combinative Nominal and
Expressive Communication. These can include gesturing, raising an eyebrow,
eye-gaze, body proximity and even coughing to name a few. Typically, Speech is
the dominant form of communication and is supported simultaneously by the other
forms. When speech becomes disabled, the other forms may be able carry an
increased role in transmitting a message. A lot depends, of coursed, on the
integrity and capability of the motor system
G. The Channels
of Communication in Mysak_s Model relate to speech production. They are
the routes in the environment for the propagation of the speech sounds. For the
speaker only, as far as the sound waves are concerned, there are two channels
of propagation.
Channel 1 is the air through which sound waves
travel. Everyone hears those sounds including the speaker.
Channel 2 (for the speaker only) are the bones of
the skull through which his/her own speech sounds travel. That is why when we
speak, we hear ourselves slightly differently than the rest of humanity
The two Channels have a medical significance to Audiologists who compare them
to differentiate a Conductive from a Sensory Neural Hearing loss by measuring
and comparing the Air-Bone hearing thresholds_the so called
_Air-Bone Gap._
In AAC, where oral speech is not the output source, these channels can have a
different meaning. For example, in Computer Technology, a Modality
is a path of communication between the human and the computer.
Hence, these channels may represent modalities by which a patient may
communicate with a computer, such as by touch (direct selection)
or by a mouse (Proportional control), or through a switch
in conjunction with a scanning system. This extends the concept of a
modality beyond the limits of the body Sensory System to an AAC device that now
becomes part of the communication pathway. In fact, this notion is embodied in
the etymology of the word _Modality,_ which involves the employment of any
therapeutic agent. The number of different kinds of devices in the
world of AAC that are available to fit into this pathway, of course, is quite
large. This provides a plethora of options for the SLP to consider in planning
a program of rehabilitation.
H. Feedback -- The four green Sensor boxes in Mysak_s Model are
the Receptive Transducers again, used this time to monitor the signals produced
by the Expressive Transducer. That includes the sounds that are being produced,
the sensations of touch from the tongue and lips, and kinesthetic feedback from
the jaw movements, to mention a few. This is part of the essential feedback
process.
For the AAC user, however, these transducers can carry an even greater role.
The selection of a particular communication device or strategy for a
communicatively handicapped person, for example, may depend on the integrity of
these Sensor Units. Vision, for example, must be assessed to determine its
functionality. Some individuals cannot focus, while others can_t see the entire
visual field. For those with poor vision, a device may be modified or it may
have auditory cues available (as in the use of auditory feedback during
scanning). For patients both Deaf and Blind, tactile devices (featuring Braille
or Morse Code or mechanical hands for Touch Signing) may be considered.
I. Repair -- The Comparator in Mysak's Model (the yellow box)
uses the feedback from the Sensor Units to monitor and repair the movement
produced by the Expressive Transducer. The name of the game is FEEDBACK. It is
virtually impossible to learn or maintain any motor behavior without feedback.
Before any movement ever actually takes place, there is a flurry of activity in
the brain.
Expectancies of what is to be accomplished by the movement is set up in the
Comparator, which is probably a number of locations in the brain--such as the
frontal lobe, the cerebellum, and the brainstem to mention a few. If the
feedback from the Sensors does not match the expectancies, error messages are
sent to the Mixer to correct the movement, and to the Governor so that we are
aware of the process. This process applies to all motor movements, whether
making a sentence or pointing our finger at a picture, letter or word on an AAC
device.
Some individuals with motor impairments, like cerebral palsy, may have less
than accurate repair processes. In these cases adaptations to keyboards that
access a computer may be indicated. This may take the form of special software
to modify the response of the keyboard, or devices to help channel the user_s
movement to the right location.
III. LEARNING MODALITIES
To Some Education Theorists, Modalities are Learning Systems
which can be reduced to channels such as the visual, auditory and motor
modality. Visual children tend to learn by watching and
looking at pictures and may be easily distracted by movement and action in the
classroom. Auditory children tend to learn by being told, respond
to verbal instructions, and may be easily distracted by noise. Those who
respond to motor/kinesthetic stimuli tend to be involved and
active, and would rather do than watch, and prefer 'hands on' projects.
Language skills have also been similarly classified by modality. The Illinois
Test of Psycholinguistic Ability is a case in point. It makes an assessment
of the Auditory and Visual modalities to determine which is functioning the
best for learning and communication, and which may be significantly impaired,
and if so, where the breakdown in the pathway may have occurred.
The concept of Learning Modalities is useful in AAC. It provides a framework
for understanding the redundancy of language in the pathways of the brain. We
will review three Learning Modalities for this purpose. These are the Auditory,
Visual and Haptic Modalities. Of course I am hedging to
save paper, as professors love to do, because the Haptic Modality itself is
really a composite of three separate Modalities: Tactile, Kinesthetic
and Vestibular. So there are really five! Well, there is more
than that if we consider gustatory and olfactory tracks, but we won_t at least
for now. Each modality, with the possible exception of the Vestibular (the
sense of balance), can support language and the communication processes. When
communication breaks down (or fails to develop), it is necessary to examine
each modality in detail to determine where the break may have occurred and what
alternate routes may be possible without and/or with the aid of technology.
This is referred to as Task Analysis. Failure to do this
can have tragic consequences! Take for example, the story of Julia.
Julia was a young woman who was afflicted with a stroke which left her almost
totally paralyzed from head to toe. All she could do finally was make a kind of
a guttural sound, but no speech. The doctors, nurses and family assumed she had
no language, and hence everyone talked in front of her. Frequently they
referred to her as a vegetable, and made jokes or other unkind statements,
assuming she could not understand. In truth, Julia had considerable language
capacity. Only her expressive language was impaired. In terms of receptive and
inner language, she was quite normal. Hence, she understood and endured with
anguish all that was being said. In addition, she suffered from the terrible
isolation that occurs when the language bridge is broken. It was six years
before someone became suspicious that she was not a "vegetable," and
began to explore her actual language abilities. Finally she was freed from her
body prison through AAC. Had some one analyzed her language processes more
thoroughly in the beginning, she would not have had to suffer so severely so
long!
Please
click here to see the complete Julia file.
(PLEASE NOTE THAT TO GET BACK TO THE LESSON, SIMPLY CLOSE THE PAGE. That is because if you use the return link at the bottom of the Julia page, you may get hopelessly sucked into cyberspace and never find your way back!!! The good news is that we've only lost one student this way from Cohort I and she finally showed up in Cohort XI.)
History is full of similar cases. The well known term "deaf and dumb" is testimony to the old notion that deaf individuals who cannot speak have little language capacity. To the contrary, they are lacking in only one area of language processing (the receptive transducer for the Auditory Modality). The classic example, of course, to repudiate this idea, is the life of Helen Keller. She was, of course, both Deaf and Blind and still learned to communicate by speaking!
Helen Keller |
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And here is a fascenating film
strip of Helen Keller and her teacher Anne Sullivan taken in 1930.
Please click HERE, and then on the Arrow in the
Center of the Picture, to see the Helen Keller Video, THEN USE THE BROWSER RETURN
BUTTON TO GET BACK TO THE LESSON.
A. What is a Task Analysis of
Language?</B
We have discussed the processes that occur
in the Sensory System, and we are still talking about these processes but now
we will be discussing the Auditory,
Visual and Haptic Modalities.
The Auditory, Visual and Haptic Neural Systems
For each of the modalities, these processes
may be distributed among the Receptive,
Inner, or Expressive
components of Language. It is important to analyze these components
individually when we are assessing the language abilities of a child, or an
adult. This would have saved Julia a lot of grief by identifying both her
language weaknesses and strengths.
A. Receptive and Expressive Language Skills: What identifies a
Receptive (or Inner) Task as opposed to an Expressive Task. A Test of Receptive
and Inner functioning relies on minimal
voluntary responses, using forms such as pointing, nodding, grunting,
blinking, twitching and other similar behaviors, which I often see in the back
row of my AAC class on campus. The emphasis is on the timing, not the efficiency
of the movements. Gestures could also fall under this category.
Expressive tests, on the other hand, focus in on the efficiency and competency
of the response. Hence, tests that require a complex response are expressive
tests. Speaking, writing, drawing, Signing, and pantomime are some examples of
a complicated response that we might observe for an expressive task.
B. The Auditory Modality consists of the neural system that extends
between the receptive transducer (the ear) and the expressive transducer, the
mechanisms for speech. Phonemes, of course, are the basic unit for social
communication in this modality. Hence, speech is the most typical form of
encoding involved. Morse Code would be another possibility. These, as we
discussed are based on a system of symbols.
Because in Semiotics the manner in which information is encoded
is considered a modality, both the stimuli and any motor responses to the
stimuli could be considered as additional segments of the modality structure. Other
modality segments for the Auditory modality then would include messages that
are encoded as signs. Examples, as we discussed earlier, are nominal graded
signs (viz., stomach rumbling, burping etc.); nominal combinative signs
(echolalia); expressive graded signs (viz., moans, shouts, crying and laughing,
etc.); and expressive combinative signs (viz., swearing, singing, social speech
forms such as, _How are you today,_ idioms, and proverbs, etc.) These provide
many possible options for variation in the Auditory Modality, some of which can
and do operate simultaneously. These options also provide a redundancy
in communication for alternative routing when a segment of the
modality is disabled. If speech fails, for example, communication may still be
possible through Morse Code. Yes, it is true that friends of a disabled patient
may not be able or willing to learn Morse Code, but a computer will, and can
even convert the code into speech!
At this point, then, our Auditory Modality Structure may look
something like this:
C. The Visual Modality includes those neural systems that extend
between the receptive transducer (the eye) and the expressive transducers (the
motor mechanisms required for writing, and/or Sign Language, Pantomime and
gestures.) Writing and Sign Language are based on symbols such as graphemes
(written letters) and visual patters
of space and movement (the Signs of Sign Language). But there are many
other communications based on signs. Examples of these are nominal graded
(viz., thrashing and crying); nominal combinative (viz., pointing, gesturing
etc.); expressive graded (viz., body _language_) and expressive combinative
(viz., swearing gestures, and social routines like opening a door and letting
someone else go first).
At this point, then, our Visual Modality
Structure may look something like this:
D. The Haptic Modality is yet another channel within the brain
that can support the processes of language. This modality, however, is a
composite of two more basic modalities--the Tactile and the Proprioceptive
Modalities.
1. The Tactile Modality is the sense of touch and, of course, is
very familiar to us. Its receptive transducer is the system of nerve endings
just under the skin. The role of the Tactile Modality in our cognitive
development may be underestimated by most of us. Tactile modality plays a
major role in the child_s exploration of the environment. It helps a baby to
develop an awareness of the body's limits, of which the new born baby is
unaware. It helps us to keep tabs of where we are in space. We can gage much
about our body position from what we feel through our feet on the floor and
from our seat and back against a chair. Knowing where we are in space is
paramount to the development of many language concepts (e.g., prepositional
phrases) and language skills (e.g., discriminating "b" from
"d" from "q" from "p." Hence, as you observe a
baby, you may notice that they spend much time touching and rubbing against
things with their hands, feet, legs, lips and tongue. This is as much a process
of serious study and exploration as is the busy bustling of a scientist about
his laboratory.
2. The Proprioceptive Modality is also two sub modalities
experienced as one: The Kinesthetic
and Vestibular Modalities.
3. The Kinesthetic Modality is tantamount our "eyes"
looking inward to our own body. The transducer for the Kinesthetic modality is
the system of nerve endings in the joints of the body, and in the muscles. Like
the sense of touch, it is very important to the development of body awareness.
In fact in cases where this process fails, a person can totally loose the
awareness of a body part! To the baby, the kinesthetic sense is also a basic
ruler for exploring and understanding the environment. Initially, visual (or
auditory) images provide no real information to the baby about the properties
of referents (things) such as angles, sizes, shapes, distances or mass. This is
information is obtained first hand (no pun intended) as the baby comes into
physical contact with and manipulates the referents in their environment. The
baby's hands, feet or mouth are constantly probing objects that are within
their grasp--rattles, blocks, rails on the crib, balls, table legs, fingers,
etc. These objects' properties are measured by the kinesthetic sensory system,
which calculates and stores body angle, tension and fatigue etc. This
information is cross referenced with the Visual and Auditory Modalities to give
them a bases for meaning. The Vestibular
Modality also plays a role in this exploration by providing a reference
in space around which positions of up
and down can be determined.
Symbolically, the Kinesthetic Modality alone can support language in the form
of Braille, writing, typing and touch Signing to name a few forms.
One goal of early education is to provide young children with as many
opportunities as possible to examine many different referents. The ultimate
goal is to develop concepts upon which language can be mapped. The story of
Montessori is a grand example of using the Haptic modality for this purpose.
The Montessori approach stresses a hands-on exploration at an early age. But it
is just this modality and these types of experiences that are denied to the
severely motor disabled child. This child because of his/her impairment is
unable to interact with and explore the environment. The consequence is a lack
of information upon which to develop basic concepts about the world and around
which language can be developed. Later in life, the motor impaired child may
not have as much to communicate about because of this dearth of concepts.
Hence, language and communication are impaired two times over_because of a
language delay, and because of the motor impairment. .
At this point, then, our Haptic Modality Structure may look
something like this:
E. Cross Modality Processing: When a person listens and then
speaks, the communication process is confined to a single modality. But
frequently the action may involve two or all of the modalities in consort. For
example in the Peabody Picture Vocabulary Test, the Stimuli are words
(auditory) and Pictures (visual). Hence, an additional process of cross modality conversion becomes
involved.
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In this manner all modalities may be involved simultaneously. For example, in a
teaching of reading strategy called the _Writing Road to Reading,_ a pupil
writes the word (viz., in the sand) for Haptic processing, and says it aloud
for Auditory processing and looks at it for Visual processing all at the same
time.
F. Modality Extensions: To a medical Doctor, a Modality may refer to the employment of, or the method of employment of, a therapeutic agent.
Hence, in the world of AAC, for a patient who cannot speak, the therapeutic agent may be a Communication
Board, Pictures used in a particular manner, or a Computer with
speech output among others. This extends the reach of a modality
structure beyond the limits of the body to incorporate an external technology,
like a computer.
1. In Computer Technology, a Modality is also a path of communication between the human and
the computer. Hence, a patient may communicate with a computer by touch (direct selection) or by a mouse (Proportional control), or
through a switch in conjunction with a
scanning system. And of course, there are many different kinds of
computers to be considered that can be used as part of this path. Now our
Modality Structure may look like this on the Expressive side:
Ironically, when the expressive modality is impaired to the extent that there
is only a minimal motor response available for communication, and an AAC device
is deemed to be an appropriate rehabilitative strategy, the role of the Receptive segment of the Modality
System takes on a new importance. In order to use an AAC device, a patient must
be able to discriminately see, hear and/or touch it. This in itself may require
Assistive Technology, like glasses or a hearing aid. But then, the question
becomes, _What is the patient able to decode?_ That is, what should there be on
the device for the patient to choose from_words, letters, pictures, photos?
2. In Computer Science, especially Computer Imaging, the type of input is considered to be a
modality. For example, Black and White
would be one modality, and Color
would be another. This is equally true for input from an AAC device like a
computer which a patient might be using for communication. But there is more.
The input may be linguistically
symbolic, like phrases, words, and letters; or it may have graphic symbols like pictures or
Bliss Symbols; or it might use signs
like Happy, Sad, Yes, No or Stop. The pictures may have abstract
meaning or iconic meaning or both. A picture of an Apple, for example may mean
_apple,_ but in combination with a picture of a truck, it may mean _red._ Bliss
Symbols are another example of a symbol system that has a high degree of
iconicity (i.e., it looks like what it signifies.) Then again, pictures may be photographs,
colored drawings, two dimensional black and white sketch or stick figures. Each
in its own right would be considered a modality segment available for plugging
in or out of our communication modality structure. So our extended modality
structure may look like this on the Receptive
side:
When we combine ALL the modalities into one picture and take into consideration
the wide variety of computers, low tech devices, and no tech strategies that
are available, it becomes apparent that there is a vast array of options
for the SLP to choose from in modifying these modalities to meet the needs of a patient. And of
course, there is a plethora of issues
associated with each which will help determine the choice that the SLP will
make. Many of these will be examined in the next Section. For now here are
several examples of multimodality communication using speech, gestures, body
language, and an AAC Device among others:
Please
click HERE, and then on the Arrow in
the Center of the Picture, to see the FIRST Video, THEN USE THE BROWSER RETURN BUTTON TO GET BACK TO
THE LESSON.
Please
click HERE, and then on the Arrow in the Center of the Picture, to see the
SECOND Video, THEN USE THE BROWSER RETURN BUTTON TO GET BACK TO THE LESSON.
Please
click HERE, and then on the Arrow in the Center of the Picture, to see the
THIRD Video, THEN USE THE BROWSER RETURN BUTTON TO GET BACK TO THE LESSON.
Please
click HERE, and then on the Arrow in the Center of the Picture, to see the
FOURTH Video, THEN USE THE BROWSER RETURN BUTTON TO GET BACK TO THE LESSON.
Please
click HERE, and then on the Arrow in the Center of the Picture, to see the
FIFTH Video, THEN USE THE BROWSER RETURN BUTTON TO GET BACK TO THE LESSON.