AAC and Multiple Disabilities
Melanie Conaster OTR/L
Brenda Del Monte MA CCC-SLP
Video Disclaimer
A special “thank you” to all the children and
their families for letting us show these
beautiful children for educational purposes.
The videos don’t lie. They show children
doing amazing things…sometimes because
of the therapist facilitation and sometimes in
spite of the therapist. Nobody is perfect but
we are willing to show the do’s and the
don’ts. 
How are we defining “Multiple Disabilities”?
 (h) Multiple disabilities means concomitant
impairments, the combination of which
causes such severe educational needs that
they cannot be accommodated in special
education programs solely for one of the
impairments. The term, multiple disabilities
does not include deaf-blindness.
(Washington
State) WAC 392-172A-01035
Areas of Concern
 Vision
 Hearing
 Motor
 Sensory
 Cognitive
 Communication
Sometimes the answer is:
All of the Above
Not a Straight Road to
Communication
Let’s
break it
down!
Vision
 Blind – no vision at all
 “Functional” Blindness - A person is functionally blind
when he or she has to use so many alternative
techniques to perform tasks that are ordinarily
performed with sight that his/her pattern of daily living is
substantially altered. Such alternative techniques
might include reading a newspaper by listening to it
over the telephone or using Braille to read a book.
Cortical Visual Impairment
 Neurological vision disorder rather than ocular
(although they can co-exist)
 Disturbed or reduced vision due to various brain
abnormalities
 Symptoms include variable vision, a limited field of
vision and depth perceptive challenges
Stimuli needs to address:
Color
Contrast
Simplified symbol set
Lighting
Auditory Support
High Contrast
AAC Considerations:
Apps to check out:
E
v
e
r
e
t
t
Everett
 Age 5
 Down Syndrome
 Functionally Blind (can see some light)
 Attending Foundation for the Blind for Preschool
 Splits time in Special and General Education
 Hearing is normal, not crawling yet, non verbal
AT Options
http://www.ablenetinc.com/AssistiveTechnology/Communication
https://enablingdevice
s.com/catalog/assisti
ve_technology_devic
es_used_in_educatio
n/take-talk-series
Hearing Impairment
http://ada.ky.gov/hearing_imp_def.htm
 A hearing impairment is a hearing loss that prevents a person from
totally receiving sounds through the ear. If the loss is mild, the person
has difficulty hearing faint or distant speech. A person with this degree
of hearing impairment may use a hearing aid to amplify sounds. If the
hearing loss is severe, the person may not be able to distinguish any
sounds. There are four types of hearing loss:
 Conductive: caused by diseases or obstructions in the outer or middle ear
that usually affect all frequencies of hearing. A hearing aid generally helps
a person with a conductive hearing loss.
 Sensorineural: results from damage to the inner ear. This loss can range
from mild to profound and often affects certain frequencies more than
others. Sounds are often distorted, even with a hearing aid.
 Mixed: occurs in both the inner and outer or middle ear.
 Central: results from damage to the central nervous system.
K
y
a
n
d
e
r
Kyander
 Age: 3 ½ years old
 Hearing Loss – Severe to profound
 30% Sensory Neural Hearing Loss; 70% Conductive
Hearing loss
 Due to a rare genetic disorder – no known cases
 Functioning at a 9-13 month level with splintered skills
 Tube fed, beginning to crawl, vision in normal, non
verbal
AAC for Kyander
http://saltillo.com/products/nova-chat-10
• Visual Feedback
• Tactile Feedback
Motor Limitations
Motor impairment is a limitation of muscle control or
movement of the body. This may result in weakness, poor
stamina, lack of muscle control, or total paralysis. Motor
impairment can be a result of neurological conditions,
cerebral palsy, stroke, or indicative of other diagnosis.
Access Methods
 Direct Selection:
 Touch
or
 Mouse or Eye-gaze control with dwell
 Indirect Selection:
 Alternative input method with scanning
(such as use of switches)
Motor:
Access Sites & Movements
head eye, chin, mouth
finger, hand, forearm elbow,
knee, thigh, foot.
(www.customsolutions.us)
Switches- Size and Sensitivity
 Micro Switch
 Big Mac Switch
Pressure Switches
Spec Switch
Buddy Button
Pal Pad Switch
Gooshy Switch
Switch
String
Grip Switch
Wobble Switch
Ultimate Switch
Ribbon Switch
Motor: Access Considerations




Voluntary and repeatable movement
Excursion of movement
Timing Involved
Stabilization of non moving parts
(www.customsolutions.us)
Switch Training Software &
Apps
Repetition with Variety
http://helpkidzlearn.com/
https://www.judylynn.com/
http://www.janefarrall.com/html/ipad.html
Mounts
Mount’n Mover
RJ Cooper
Magic Arm
www.rjcooper.com/tablet-mounts/index.html
Daessy – Lite Mount
http://www.daessy.com/
ModularHose
www.modularhose.com
Snake clamp
http://snakeclamp.com/
Rehadapt
Custom Mounting Solutions
www.rehadapt.de/products.php
Communication
Strategy
Assistive Technology
Repetition
The strategy was reinforced by
via social interaction and by
using switches and single
message devices which
would say :”Yes” and “No”
when action/
and consistent practice help the
student pair physical actions
with
Yes and No.
Yes: Chin Tuck
No: Head turns away
movement was
Initiated.
Communication through Choice Boards &
Partner Assisted Auditory Scanning
AAC Devices
 High Contrast (VI)
 Visual Input upon selection (Multiple
Disability)
 Auditory Preview (VI)
 Text, sign, video (HI)
S
a
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t
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a
Santana
 Age 8
 Dx: Near Drown at 18 months
 Hearing: Mild loss
 Vision: CVI
 Motor: Right wrist movement, right head movement
emerging
 Cognition: ?
 Communication: Cause and Effect, Choice Making
Santana’s Functional Needs
 Communicate needs/ health and comfort issues
 Participation in school activities
 Choice making
 Body awareness
 Interaction with peers
www.lburkhart.com/handcvi.htm
Santana’s 2014 Goals
 When presented 2-4 choices, Santana will use his aid
com to make reliable choices on 8/10 opportunities.
 More and all done / yes and no
 Santana will demonstrate 1-to-1 correspondence with
numbers 1-4 on 8/10 opportunities.
 Santana will improve interaction skills by participating in
greeting friends on 8/10 opportunities
 Santana will express an emotion from a field of 3 on 8/10
opportunities
iPad, Apps, Mounting Solution
Wobble Switch
Super Switch Interface
CJT Mounting

http://cjtmounting.com/index.php
Go Talk Now – Home Page
Go Talk Now
Sensory
Choices
Songs
Videos
TV
Toys
Academics
“Go Talk Now”
Other Ideas
Scanning Scene
Displays
Songs & Audio
Books
Adaptive Accomplishments
 Santana now responds “Yes” with a wrist movement within 3
seconds of an auditory choice.
 He activates the switch to make choices on the iPad from a
field of 4 choices and to activate apps.
 He participates in social interaction and activities with peers
via the Go Talk app.
 He is beginning to work on basic academic skills such as
numbers 1-5 and colors using simple academic apps.
S
e
t
h
Seth
 Age 6
 Vision: Ocular and Neurological Impairment from birth as a
result from Congenital Human Cytomegalovirus
 Hearing Profound loss in Right ear, Moderate loss in Left
(Progressive)
 Motor: variable, has crawled in the past, whole hand direct
select with keyguard
 Communication: some vocalizations, non verbal
 Cognition: ? - Cause and Effect, Choice Making, Core
Words Emerging
AT for Seth
•Motion Table
•Cause and Effect
•Cause and Effect
•Sensory Light Box App
•NovaChat
•Actual Objects
•Visual Feedback
•Tactile Feedback
•Auditory Feedback
B
e
l
l
a
Bella
 Prader Willi Syndrome
 Hearing: Normal
 Vision: Farsighted with corrective lenses
 Communication: some vocalizations, non verbal
 Cognition: ? Choice making, navigation skiils
 Motor: Scoots, crawling, direct select with keyguard, now
eating by mouth
Bella Games
 ENGAGING GAMES




So Big
Airplane
Crash!!
Peek a boo
L
i
l
y
Lilyanna
 Age 11
 Dx: Atypical Rhett’s
 Vision: CVI
 Hearing: Normal
 Motor: No voluntary movement; EyeGaze
 Cognition: ? – Choice Making, Core Words
 Communication: Tobii I-Series
C
a
m
d
e
n
Camden
 Age 3
 Dx: Pelizaeus-Merzbacher Disease
(Rarest form of Leukodystrophy)
 Vision: CVI
 Hearing: Normal
 Motor: spastic CP
 Cognition: ?
 Communication: Tobii I-Series
Eye Gaze
 Tobii I-Series 15” www.tobii.com/assistive-technology/global/products/hardware/tobii-i-series/
 Sensory Guru
www.sensoryguru.com/products/i-series/
 Flopper Stopper
www.rjcooper.com/flopper-stopper/
No Shortcut to Ongoing
Evaluation
1.
Know diagnosis and then challenge each aspect
2.
Know preferences so you have a “hook” (Likes and Dislikes
Checklist)
3.
Provide Multiple opportunities to succeed
4.
Use a Team Approach
Critical Considerations:
 Outcome
 Trial usage
 Continually monitoring progress
 All environments
Gathering Data Form
Tools Selection and Trials
Tools and Trials Con’t
Learning Software & Supports
 Boardmaker
http://www.mayer-johnson.com/
 Unique Learning Systems & News2You
http://www.mayer-johnson.com/
 Classroom Suite
http://www.cambiumlearningtechnologies.com/
 Life Skills Software and Apps by Attainment Company
http://www.attainmentcompany.com/
Resources for AAC Data
Collections
 Beukelman, D. R., & Mirenda, P. (2005). Augmentative
alternative communication: Supporting children & adults with
complex communication needs (3rd ed). Baltimore: Paul H.
Brookes Publishing Co., Inc.
 Burkhart, Linda J. & Musselwhite, Caroline (2001) Can We
Chat? Scaffolding Conversations for Struggling AAC Users
L http://www.lburkhart.com/canwecha2p.pdf
 iCAN. (2000). Why is choice-making important? Retrieved
January 2011, from: http://www.autismnetwork.org/
 Kintsch, A., & DePaula, R. (2002). A framework for the
adoption of assistive technology. Retrieved from:
citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.124.372
6&rep=rep1&type=pdf
References
 Wisconsin Assistive Technology Initiative
http://wati.org/
 The Magical BoxResources: CVI and Complex Communication Needs
www.curlewapps.com/Blog.html
 Linda Burkhart and John Castell0
www.lburkhart.com/lindaJohnCVIhandout.pdf
 American Printing House for the Blind
http://www.aph.org/cvi/define.html
 Simplified Technology by Linda J. Burkhart
http://www.lburkhart.com/index.html
Additional Resources
 Family Center on Technology and Disability- Instruction Technology in
Early Childhood: A New Way for a New Day
www.fctd.info/assets/newsletters/pdfs/307/FCTDTechVoicesmar13.pdf?1372995063
 Integrating Technology in the Classroom: a Teacher’s perspective
www.fctd.info/assets/newsletters/pdfs/306/FCTD-TechVoices135.pdf?1369774667
 iPad and Apps: Learning tools for Young Children with Multiple
Disabilities
http://idahotc.com/Portals/0/docs/2013webinars