My name is Jane Remington-Gurney and I began my career in Augmentative and Alternative Communication (AAC) and Complex Communication Needs (CCN) at a time when low and high technologies were just emerging for people with little or no functional speech. Using iTech as AAC is very new to me. As an older generation person, it’s still scary to meet new technology and have new ways of doing things. So far, my teachers for the iTech have been my 20-year-old son, my clients and their families, and my colleagues in the US. I currently use an iPhone and an iPad. I have just started to get very anxious when I cannot find my iPad and have reached the stage of needing to register it for security with the MobileMe network.  This document was originally presented for an iPad discussion panel held with Disability Services Queensland in December 2010.

iPad

I would not describe the iPad as a communication aid. It was never designed to be such. It’s just another piece of very useful technology.

I consider it to be a tool in my toolbox of resources needed to do and enjoy my job.  Most people should be able to find an Education Department or similar facility that has listed the most useful apps for the population of people they serve. This can be helpful, but I would recommend taking time to search through the apps online regularly. I would also recommend downloading the iPad User’s Guide to your iPad. Personally, I love my iPad for being able to read novels and textbooks from iBooks. Some of my clients have great interactive books which they have downloaded for free from the state library. Here are some of the things I would recommend the iPad for:

1. An incredible teaching tool
2. A means for self expression
3. A social networking tool
4. A way for developing access
5. A tool for developing cognitive skills such as attention and memory

Let’s look at each of these areas in more detail.

• Teaching Tool – for language.  Really, what you have to do is work out what you want to teach or what you want to complement your teaching and then search for an application for it. For example, it took me a while to search for an emotional thermometer, but finally I found one under ‘anxiety.’ This app has a colour-coded and text scale of anxiety levels which link you to strategies to help manage your anxiety. The strategy you select then links you to information about how to go about this. If you just need a stress release, that’s not so ‘cognitive’; just use the Bubble Wrap app.  I have also used the Bubble Wrap app as a way of better exploring a person’s primary and secondary access area when I am designing a communication display for them.Other applications I use are in the areas of Rhyme, Word Associations, Syntax, Grammar, Voice Recognition, Phonics, Reading, Telling Time, and Pragmatics. Some apps I use are from the ABA sites and many are from the Kindergarten genre. The young children just love Talking Carl, Talking Tom, and especially Talking Larry. Just be sure to preview some of the interactive apps before you introduce them. It can be quite a shock to some children to see dinosaurs munching steaks or birds losing all their feathers before their eyes.

• Self Expression. Like many apps, the role of the communication partner, or the person knowledgeable when it comes to making equipment work and programming it, is vital. For self expression, I am using Proloquo2Go, Draw, Tap to Talk, Predictable and iSpeak.  I’ve just programmed Guy Talk as this could be a helpful start-up communication tool. As we all know, communication devices have to be taught and experienced, and a two-week trial of a communication device is close to useless if you don’t have any discourse or programming skills and you are also responsible for a family, a classroom, a job and a life of your own. There is a great app called PAGES which is very similar to a word processing program. This is worth looking into if you need to produce documents, posters and flyers.  I would always suggest downloading more than one app for self expression simply because there are times when we are able to use more or less complex language. We may be tired, sick or just not motivated. In these circumstances, we often use shortcuts, keywords and more gross- than fine-motor skills.

• Social networking.  On the home page, there is a file where you can store your photos and the communication displays you have made in the DRAW app. There is also the iPod and email. There are apps that you can download simply for playing games, i.e. Tic Tac Toe.  I have heard of many occasions in which family members, friends and support workers didn’t have the skills to use the dedicated communication device and couldn’t facilitate. Using the games, they were able to experience level 2 facilitated communications with the user, engage in non-test, non-judgmental games and simply have fun. It must beat sitting in front of the TV, going bowling or being silenced.

• Developing Access. This is probably the most exciting area I’ve seen to date. Looking at what may lie in store for us in the future, I am sure that we will see a lot more call for us to use our limbs to scroll, tap, swipe and keyboard.  Several years ago, I used a public washroom in New Zealand. What a scary experience. I swiped my hand over a touch pad to enter and lock the door behind me. I made the same action to make the toilet seat, flush and wash basin work. Essentially, I touched NOTHING.  You can probably think of lots more examples where touch access and sensors are being used rather than spoken interactions. Developing movement skills with the people we support has to be done with an eye on the future.The iPad has some great apps to motivate people to use access skills. If people cannot easily access the iPad, then you can get a plug-in keyboard. Children I would not initially have considered as potential users of an iPad have shown me how wrong I can be. Motivation and having access to a tool that non-disabled people use appear to be key factors in successful use of the iPad. The way you access the iPad is different from the way you access most devices you may have experienced so be sure to use the iPad yourself so that you can teach by experience. It’s no good telling someone to ‘go ahead and touch it/press it/tap it.” They may well be doing these actions, but still the screen doesn’t activate. Like everything, there’s a knack and like many things, you have to practice. You may like to look at the access skills needed for the following: the carry cases, Clicky-Sticky, Photos, iBooks, Talking Carl, and iPod.

• Cognitive, especially attention and memory.  The iPad is a tool that mainstream people use. It isn’t associated with disability. It is clear, user-friendly and ‘people’ know about it – there is shared knowledge and something to talk about rather than continually ‘learn and explain.’ The girls with Rett Syndrome who need music as the catalyst to free up and maintain movement can play their music while I do therapy on the same piece of equipment. The people who sign can access with me the sign dictionary as we need it. We don’t have to switch attention to where the book might be and then look it up. The people who have had an acquired brain injury or stroke can watch videos of the mouth postures, phrase-scenes or routines to help elicit and develop language. Most people can see visual information, schedules, choices, and feedback when I use the Draw app (which I can also save to Photos) and use again later. Those who are writing songs can put the beat or rhythm to their songs using apps like Piano, Xylophone, Easy Beat and Tone Pad. My clients who want to spell and share their iPad can use apps like Yes/No, Speak It, iSpeak, or just the Notes app.

The iPad has become a significant tool in my battery of assessment materials, but it is not a replacement for any… at this stage.

Switching from iTech to VOCA

I personally think that many would find a VOCA boring after using an iPad and that’s why I often suggest to the children that the iPad is Mummy’s and Daddy’s and they will use it with you. The VOCA is the child’s and it IS their voice. Each has a specific role or roles in the person’s life.  Although we may be tempted to try to compare the VOCAs with iTech, I don’t think we should. It’s like comparing apples and oranges…both fruit but both different in what they offer and how they are accessed/used.

Durability and Portability

Durability, portability and user -friendliness all depend on the user and common sense. iTech is made for the mainstream community. It’s made to fit into a bag and to be light and slim for portability. Its durability will be linked to cost and I suspect it will become a ‘disposable’ item in the near future and one from which we will quickly seek upgrades like we do for mobile phones and electrical goods. The screen is made of glass and that may be a barrier for some people.

Access

The two boys who introduced me to the iPad were aged three and eight and had cerebral palsy. They showed me that without facilitation, they could tap, scroll, expand-reduce and tap-drag. I would not have thought that they had the skills for this. One of the boys has also shown that when he wants to do something different and not what I want him to do, he makes a big ‘scroll’ movement in the air in front of me as if to tell me to ‘move on to something else!’  One of the best apps for people with access problems seems to be DRAW as you can draw up communication choice displays and save them as photographs.

Value For Money

One parent has suggested that she buy another iPad just for the Proloquo2Go software so that her son has a dedicated communication device (VOCA). This would still make her outlay $1500 for two iPads with the app.  If you are worried about the cost of the iPad, then I suggest waiting for prices to come down or paying the money and making good use of the Anxiety app yourself.

Security

Use the MobileMe network and secure the iPad so that if it is stolen, no one can access your material. Maybe one day I will have two iPads, one for therapy and one for running my business and presentations. The MobileMe is one form of security you can look at for the iPad and iTech.

Personalising Communication Software

Rarely is anyone going to pay or fund a private practitioner to personalise communication software. Reality check here. The people who need to do the programming and acquire or refine their programming skills are the parents or key people assisting the person with the communication impairment. Many of the parents I have met do have the skills to do this and have shown me what they have done. I feel it’s our job to empower parents and communication partners as programmers and make them feel more like valued team members.

Don’t try to compare the iTech with VOCAS or AAC devices. In mainstream, we have communication tools which include speech, gesture, pen, paper, keyboard, and iTech. In disability, they have these tools plus low- and high-tech communication equipment. Just like the VOCAs, the way you access the iPad can be tricky at first so you need to experiment and practice.

This paper was presented at the iPad panel discussion held with Disability Services Queensland in December 2010. I am happy for the paper to be circulated.

Jane Remington-Gurney, MSPA, MA, LCST
Director, Options Communication Therapy and Training Centre
2011