Presentation at the More Than Gadgets Conference, Perth 2011

1. Visual Scene Displays Pretty Playthings or Powerful Pictures?

2. Jane Farrall Speech Pathologist AAC Support Services Manager Spectronics

3. Visual Scene Displays A visual scene display (VSD) is a picture, photograph, or virtual environment that depicts and represents a situation, place or experience. Individual elements such as people, actions and objects appear within the visual scene (Blackstone, 2004).

4. Visual Scene Displays Different from a traditional grid display The visual scene shows elements such as people, actions and objects in a visually integrated image. Messages can be accessed from the picture. Additional displays might also be triggered from the visual scene display

5. Visual Scene Displays Visual scene displays (VSDs) are meant primarily to address the needs of beginning communicators and individuals with significant cognitive and/or linguistic limitations. These groups are unserved or underserved by current AAC technologies. (Blackstone, 2004)

6. Let’s have a look....

7. Why so common recently? VSDs are much easier to do on dynamic display touch screens Dynamic display touch screens are now common and with a range of software options Dynamic display touch screens are more portable e.g. iPad, Maestro

8. Three main areas of research with VSDs People with aphasia Children with Autism Spectrum Disorder Young children with Complex Communication Needs Majority (but not all) of this research has been conducted by members of AAC RERC www.aac-rerc.com

9. VSDs and people with Aphasia Research primarily conducted by David Beukelman and colleagues. Summary webcast available at www.aac-rerc.com Looked at research which showed that AAC and Speech Generating Devices (SGDs) were most successful with people who retained literacy Wanted to look at ways of allowing people without literacy skills to retain social networks

10. VSDs and people with aphasia Beukelman et al (2003), Beukelman et al (2007) and AAC RERC (2009) VSDs have been very successful with people with chronic aphasia Need to be customised, real photos from their life. Higher uptake if individual is involved in selection of pictures and generation of utterances

11. VSDs and people with aphasia “After her stroke, our mother refused to attend (social) functions due to embarrassment of the challenges she faced when interacting with people outside of her immediate family . . . Her success (with a Visual Scenes Display AAC device) led to a renewed interest in attending family gatherings. Six weeks after the introduction of (the AAC device), she left her house for the first time (after her stroke), to engage socially – she went to a family holiday gathering’’ (Personal communication with the adult daughter of a woman with severe, chronic aphasia, Beukelman et al 2007)

12. VSDs and people with aphasia The most successful VSDs: Provide context (setting, people, objects and activities) Show Interaction with people or the environment Are personally relevant Are clear photos Have the ability to be used for personal story telling

13. Environment: Low Interaction: None Personal relevance: Medium Clarity: High

14. Environment: High Interaction: High Personal relevance: High Clarity: High

15. Environment: Low Interaction: Low Personal relevance: Low Clarity: High

16. Environment: High Interaction: High Personal relevance: High Clarity: High

17. VSDs and people with aphasia Lots of Publisher templates available with tested formats From aac.unl.edu/intervention.html Visual Scene Display – Adult (Aphasia/TBI) user in DynaVox Series 5 devices

18. VSDs and children with Autism Spectrum Disorder Research primarily conducted by Howard Shane and colleagues. Looked at VSDs as Visual Expressive Mode Visual Organizational Mode Visual Instructional Mode Called VSDs “Maps”

19. Visual Maps

20. Visual Organisational Mode Maps can be more successful than traditional schedules or charts because they convey more information Can convey not just that the individual will be going to McDonalds but also when, who will attend and what will happen.

21. Visual Instructional Mode Visual scenes compensated for the child’s comprehension or auditory processing difficulties (helped them to understand better what was being said by others) Built comprehension

22. Puddingstone Place This was created as an interactive virtual environment for children to learn language

23. Boston Children’s Hospital Now looking into use of iPads as visual supports throughout the day http://www.childrenshospital.org/clinicalservices/Site2016/Documents/Visualand%20tech%20to%20support%20language%20ASD%20Abramson&Laubscher.pdf

24. VSD Apps Lots of talking photo album options e.g. Click ‘nTalk. SceneSpeak Scene&Heard

25. Visual Expressive Mode Drager et al. (2005) repeated some of the studies done with children with developmental disabilites and found similar results in a study of preschoolers with autism (ages 3 – 5).

26. VSDs and young children Research primarily conducted by Janice Light and colleagues. Summary webcast available at www.aac-rerc.com Idea partly came from a AAC RERC meeting where the feedback from parents was that SGDs needed to: Decrease learning demands Increase appeal

27. Children and Symbols Drager et al (2008) asked typically developing children to draw pictures of 10 emerging language concepts. The children’s pictures were: Grounded in context Involved familiar experiences Used entire scenes This was mostly consistent across a variety of ethnic/cultural groups.

28. Generic VSD for young child

29. Hybrid VSD for young child

30. VSDs and young children Drager et al (2003) found that 2.5 year olds were most accurate locating vocabulary on VSDs even if displays were not customised for them Drager et al (2004) found that 3 year olds had trouble with all forms of vocabulary arrangement on initial exposure, but after just one session performed significantly better with the visual scenes than a grid format.

31. VSDs and young children Light et al (2004) found that by ages 4 and 5, the children were able to locate vocabulary within the visual scene displays and the grid layouts with similar levels of accuracy, but they had significant difficulty learning to use iconic encoding.

32. VSDs and Young Children Light and Drager (2008) reported on a study using VSDs with young children with developmental disabilities, aged 1 – 3. They concluded: .....

33. Young Children and VSDs All the children were able to use VSDs to participate in social interactions with only one session of modelling The children demonstrated significant increases in turn taking immediately The children sustained these turn taking and social communication gains Children tended to plateau, but improved again following introduction of hybrid scenes and then grid displays

34. VSDs and Young Children A lot of this research has had small sample sizes and in some studies children were only exposed to SGDs for short periods each time Focus has been on making AAC easier, acknowledging limited intervention many children receive

35. Case Study

36. Dynamic Display Devices Lucas received his first dynamic display device (Dynavox MT4) when he was 6 years old. At the time his multi-level communication book was organised by ‘semantic categories’ and so his device mirrored this.

39. Visual Scene Displays Advantages Lucas like the idea of them and was more motivated to use his device They look ‘pretty’ and so appealed to other people, making them more motivated to use the device Disadvantages It takes a long time to scan to parts of the visual scene It adds an extra cognitive step to the process (ie remembering where in the visual scene things are placed) particularly because of moving between PODD and VSDs It makes it difficult for other people to model the device as it is impossible/difficult to tell where things are placed on the visual scene At times the visual scene itself can be a distraction Using VSDs means that any multi-level communication book must be organised differently. For Lucas this meant learning and remembering two systems – VSDs and his PODD book.

40. PODD Due to the disadvantages Lucas now uses a PODD communication book and his device is programmed to reflect this book as closely as possible.

41. References AAC RERC. (2009). AAC for Aphasia: A Review of Visual Scenes Display Project. Retrieved April 27, 2009, from http://aac-rerc.psu.edu/index-21030.php.html AAC RERC. (2009). AAC Interventions to Maximize Language Development for Young Children. Retrieved April 27, 2009, from http://aac-rerc.psu.edu/index-16147.php.html ASHA. (2009). Children’s Representations of Early Language Concepts: Implications for AAC Symbols. Retrieved May 01, 2009 from http://convention.asha.org/handouts/1420_2072Drager_Kathryn_073157_Nov16_2008_Time_072254PM.pdf

42. References Beukelman, D., Fager, S., Ball, L. and Dietz, A. (2007). AAC for adults with acquired neurological conditions: A review. Augmentative and Alternative Communication, 23(3), 230 – 242 Beukelman, D., Fager, S., Ball, L., Prentice, C., Jakobs, T., & Caves, K. (2003). New AAC interfaces: Field test results. ASHA Leader, 8, 144. Blackstone, S. (2004). Clinical news: Visual scene displays. Augmentative Communication News, 16(2), 1-8.

43. References Drager, K., Light, J., Carlson, R., D’Silva, K., Larsson, B., Pitkin, L. (2004). Learning of Dynamic Display AAC Technologies by Typically Developing 3-Year-Olds: Journal of Speech, Language and Hearing Research, 47(5), 1133– 1149 Drager, K., Light, J., Curran-Speltz, J., Fallon, K., & Jeffries, L. (2003). The performance of typically developing 2 ½-year-olds on dynamic display AAC technologies with different system layouts and language organizations. Journal of Speech, Language and Hearing Research, 46, 298 – 312.

44. References Drager, K., Light, J., Angert, E., Finke, E., Johnson, J., Larson, H., et al. (2005). AAC & interactive play: Language learning in children with autism. Seminar presented at the annual conference of the American Speech Language Hearing Association, San Diego, CA HB Munroe Barkley AAC Centers. (2009). Visual Scene Resources. Retrieved April 28, 2009, from http://aac.unl.edu/intervention.html Light, J., & Drager, K. (2004). Re-thinking access to AAC technologies for young children: Simplifying the learning demands. Perspectives on Augmentative and Alternative Communication, 13, 5 – 12.

45. References Light, J. & Drager, K. (2008) Evidence-based AAC interventions to build language and communication skills with infants, toddlers and preschoolers. Paper presented at the ISAAC biennial conference, Montreal, Canada. Light, J., Drager, K., McCarthy, J., Mellott, S., Parrish, C., Parsons, A., et al. (2004). Performance of typically developing four and five year old children with AAC systems using different language organization techniques. Augmentative and Alternative Communication, 20, 63 – 88.

46. References Light, J. and Drager, K. (2007) AAC technologies for young children with complex communication needs: State of the science and future research directions, Augmentative and Alternative Communication,23(3), 204 – 216 Shane, H. C. (2006). Using visual scene displays to improve communication and communication instruction in persons with Autism Spectrum Disorders. Perspectives in Augmentative and Alternative Communication, 15(1), 8 – 13.