IDEAS
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IMPLEMENTING STRATEGIES
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HELP CLARIFY SPEECH ATTEMPTS
INTRODUCTION “Many individuals who use residual natural speech as their primary mode of communication could enhance the intelligibility of their natural speech by 5% to 50% through the use of simple augmentative and alternative communication (AAC) strategies in conjunction with natural speech. Such strategies are not used to replace natural speech, but rather to supplement it, thus providing listeners with additional information to aid in understanding the speaker’s message.” In a recent study, Hustad and Gutmann report that using alphabetic cues was the one most powerful strategy to increase perceptions of communication effectiveness. Use of topic cues to indicate the topic of a message prior to speaking it also increased perceptions of communication effectiveness. Their findings state that using such AAC strategies will result in listener perceptions of effectiveness that are higher than if speakers do not use AAC strategies to supplement natural speech. “The data indicate that when speakers use mixed cues (both topic and alphabetic cues
simultaneously), listener perceptions of effectiveness are higher than when only one or no supplementation strategies were used.” Adapted from Hustad and Gutmann. Speech Supplemental Strategies: Effects on Listener Opinions of AAC Users. ISAAC 2000 Proceedings, pages 164 – 165.
SOME KEY PRINCIPLES: The individual often needs to be taught to become aware of his partner’s level of understanding or lack of understanding. This awareness does not always come automatically. Individuals are often unaware that someone is not understanding them and that they have a responsibility to try to help the partner understand. It’s important for partners to give very clear, constructive feedback so the individual knows when we understand him, when we don’t understand his words, when and how we understood his gestures, pointing, other cues… e.g., I really liked that you showed me the picture. That helped me understand you better.” The strategies need to be available at all times…alphabet displays, topic displays, remnant books, dictionaries, etc. We as partners need to become more systematic and aware of our questions. Ask questions, starting with general questions and moving to more specific topics e.g., use categories. Is it here? …somewhere else? Is it about home? … school? Is it something to play with?…to eat? … to…? Use of aided language stimulation consists of modeling strategies as well as verbalizing. This has been reported to be helpful as a teaching strategy for the use of AAC. When introducing displays, gesturing/ pantomime, books, dictionaries etc. as a way to clarify, the key is to model, model, model. Partners need to start changing their behaviour first and become good models. Once partners have become good at using these strategies, we can expect the individual and his friends to use them also. The idea is that the individual can see how it’s done and because his teacher, parents, attendants and all his friends are doing it, the individual gets the idea that it’s O.K. to use these strategies. If the individual is reluctant to use the display or book, have the communication partners take ownership of the book. Try using phrases such as “I’m having difficulty understanding you…I think I’ll get out my book to help me understand you better.”
Bloorview MacMillan Children’s Centre, Communication & Writing Aids Service - Adapted by Nora Rothschild Revised August 2001
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Do not use these books or displays for testing purposes. Phrases like “show me the dog” or “where is the apple” should never be used. Emphasize literacy skills. Even if individuals have only basic literacy skills, he will be able to supplement speech much more easily by using words or first letter cueing. Literacy allows novel messages to be communicated more easily. See also Speech Supplemental Strategies by Pat Dowden in Journal of Augmentative and Alternative Communication. Volume 13, March 1997. Pages 48 – 58.
FIRST LETTER CUEING First letter cueing appears to be the one most powerful strategy. By pointing to the first letter of every word as you say the word, it tends to slow down speech, isolate each word and provide a contextual cue. In a research study by M. Fried-Oken at Oregon Health Sciences University, this technique increased speech understanding by 95%. See further instructions –page 4 of this handout. Model how to use first letter spelling to give a clue about a misunderstood word. Play games to practice e.g., find the first letter of specific content words.
TOPIC
DISPLAYS
–
CONTEXT CUEING
The purpose of the topic display is to help clarify what is being said by giving the listener the main topic. For example if the individuals is talking about going for a walk, he could point to OUTSIDE and then repeat what he said. Use the topic or theme displays as an aided language stimulation strategy. Model context cueing. You need to teach categorization and classification so the individual can begin to use a context display. You can teach these through standardizing your questions. It is important to have structured teaching time specifically for this skill. When repeating what you heard the individual say, rephrase it giving the context first, while pointing to the appropriate symbol on the display. i.e., “Oh, at school today you played basketball”, pointing to SCHOOL and BASKETBALL pictures. Talk about vocabulary and scenarios that typically happen within specific contexts – as a type of rehearsal. If there are high frequency words that cause communication breakdown, add them to the display/book.
MIXED CUES
Using a mixture of topic setting cues and alphabetic cues together most significantly increases communication effectiveness.
GESTURES, PANTOMIME, “TOURIST TALK”, BODY LANGUAGE, (SIGN LANGUAGE)
Model using gestures, signs, pointing, pantomime. Be dramatic. Organize some group sessions where you talk about gestures and pantomime, Have the group play charades, “tell stories with no words”. When everyone does it, it teaches a very important attitude! When everyone does it, it also provides ideas and gives the other individuals some appreciation of what the individual has to go through. Talk about facial expression, have individuals demonstrate facial expressions/body language that show different feelings (play guess the feeling game).
Bloorview MacMillan Children’s Centre, Communication & Writing Aids Service - Adapted by Nora Rothschild Revised August 2001
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CALENDARS
One purpose of a weekly or monthly calendar is to let the school team and the family know about new topics that the individual may want to talk about. It also lets the individual comment on activities which he participates in regularly. Mark all special activities or out-of-routine events on a calendar. You need at least one month at a glance available but some individuals may like to keep 3 months so they can refer to the month recently past, the current month, as well as the month coming up next. Have the individual choose something from each day to put on the calendar. Model how to use the calendar.
PICTURE DICTIONARIES/PICTURE COMMUNICATION BOOKS
Model using pictures in conversation.
With young children especially, one needs to teach the use of dictionaries. This may be challenging to language or developmental levels. One needs to teach categorization skills and ensure that they are able to generalize use of these pictures. Have the whole class use picture dictionaries to tell their neighbors something they did, play “I’m thinking of…”, at circle or discussion time with different communication partners to talk about weather, choose songs, share news from home etc. The individual needs to see others using it – how they use it and to see he is not alone. With young children especially, choose dictionaries that are organized by category, themes. They have numerous, very detailed composite pictures, very rich in vocabulary.
REMNANT BOOK
A remnant book consists of photos or objects representing activities the individual has participated in. It allows the individual to initiate conversations – especially with less familiar partners. Alternatively, it gives those less familiar partners some topics to begin an interaction. Set up special news pages (from home/school) every day. The individual can draw pictures or paste remnants as a way of sharing. Have the individual add items from special places he/she goes (momentos e.g. bus tickets, receipt from movie, McDonalds’s place-mat etc.) Add symbols or magazine cut-outs from favorite movies or books that the individual likes to talk about. This will be another way for the individual to have a contextual cues readily available. Add in vocabulary from new units at school that the individual has difficulty saying e.g., dinosaurs, volcanoes, insects. Model using the remnant book.
CLARIFICATION STRATEGIES SUMMARY
FOR
BOTH INDIVIDUAL
AND
PARTNERS
Document the strategies that will be used by both the individual and the communication partner to make communication attempts more successful. Sit down with the entire team and talk about the steps that are required by both the communicator and the communication partner to ensure successful communication – including successful repair of potential breakdown. Break it down into simple steps. Review these steps with the individual and any new staff, caregivers, peers. Primary communication partners should model the partner strategies throughout the day so the individual’s peers will learn to use the strategies.
Bloorview MacMillan Children’s Centre, Communication & Writing Aids Service - Adapted by Nora Rothschild Revised August 2001
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Example: John will use the following steps when he is not understood:
1. 2. 3. 4.
Repeat what he said. Use different words. Use his alphabet board to cue with first letter. Use his board to show the topic.
Communication partners will follow these steps when John is not understood:
1. 2. 3. 4. 5.
FIRST
Let John know you do not understand. Repeat what you heard and understood. Ask John to look at you, using the predetermined gesture of touching your eyes. Ask John to spell it on his board. Ask John to show you (on his board or the item if it’s near-by).
LETTER POINTING WITH AN ALPHABET BOARD
1. Have alphabet boards readily available. If the student can attach it to himself, it is usually easier – does it fit in a pocket? Can you hang it from a necklace/shoelace around the student’s neck? Can you attach it to a belt that is always worn? Individuals have also found it helpful to have many alphabet boards placed throughout their home, in the car, wallet, coat pockets, walkers etc. The board can be any size, as long as it’s easy for the student to touch each letter and the partners can easily and accurately recognize the letter. 2. The student will point to the first letter of each word as the partner speaks it aloud. For example, if the student wanted to say, “would you like to walk with me?” he would point to letters as the partner said each word like this: W - WOULD Y - YOU L - LIKE T - TO W - WALK W - WITH M – ME
3.
If the communication partner is not familiar with the technique, it is the student’s responsibility to tell the partner that he will be pointing to first letters while speaking. Sometimes people expect the student to spell entire words and are waiting for more letters. If they don’t understand this first letter strategy, the student could spell out whole words. - adapted from M. Fried-Oken. Oregon Health Sciences University.
FIRST LETTER CUEING INSTRUCTION SHEET
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11.
My name is Sam. Sometimes it is difficult to understand my speech. If you don’t understand what I am trying to say – tell me. Repeat what you do understand. If you don’t understand, I will use my alphabet board. I will point to the first letter of each word I am saying. You can guess what I am saying after I point to a letter and say a word. Repeat every word after me so I am sure that you understand. When I am finished a word, I will touch the end word square. If I am going to spell the whole word, I will touch the spelling square. Please be patient.
Bloorview MacMillan Children’s Centre, Communication & Writing Aids Service - Adapted by Nora Rothschild Revised August 2001
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CLARIFICATION STRATEGY SUMMARY SHEET Date:
Name: will follow the following steps when he/she is not understood:
1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Partners communicating with understand his/her speech attempts:
will follow these steps when they do not
1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
Bloorview MacMillan Children’s Centre, Communication & Writing Aids Service - Adapted by Nora Rothschild Revised August 2001
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SOME FREQUENTLY USED CLARIFICATION STRATEGIES PARTNERS
FOR
COMMUNICATION
Say that you don’t understand. Don’t pretend that you do.
Repeat what you think you did understand.
Encourage the individuals to keep trying.
Ask them to start spelling it (first letter cueing).
Ask them to tell you the topic (by using a topic board or other quick technique).
Ask them to: Slow down Say it in a different way Tell you more Show you (by acting it out or pointing to something)
Try to understand the topic by asking questions. What is it about? Who is it about? Where did it happen? When did it happen?
Ask yes/no questions. Start with general questions and get more specific. Are you talking about something at home? Are you talking about a person? Are you talking about your mom, dad or sister? Is it your mom? Is it your dad?
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