I gave a keynote on enabling communication rights through the use of mobile technologies, visual supports, and communication partner behaviours, at Aruma's national conference 2019 (Ballina, 10th December). These are abridged slides.

1. Whose Voice Is it? Finding
Enablers for Improved
Access to the Human Right
of Communication for
People With Disability
Bronwyn Hemsley, The University of Technology
Sydney
Presented at the Aruma Human Rights Conference,
10th December 2019, Ballina NSW

2. Acknowledgements
The Bandjalung
People as traditional
owners of this land
and custodians of
knowledge of this
land.
Colleagues and
participants in the
research informing
this presentation.
Aruma for the
invitation to present
and Judy Topper for
her support in
development of this
talk.
People with
communication
disability who have
informed
development of the
resources mentioned
in this talk.

3. Who am I?
• I am a speech pathologist with 31 years’ experience
• I work at the University of Technology Sydney
• I teach Master of Speech Pathology students about
Augmentative and Alternative Communication and
Visual Supports
• I am a champion of communication rights for people
with little or no speech
• My research looks at communication in health
interactions and the use of technology to support
effective communication

4. Some of my
areas of
research
HEALTH LITERACY E-HEALTH RECORDS 3D FOOD PRINTING FOR
PEOPLE WITH
SWALLOWING DISORDERS
SAFETY IN HOSPITAL THE USE OF TWITTER TO
COMMUNICATE
SOCIAL MEDIA

5. Free App
NHMRC funded research on
safety in hospital for people
with communication
disability

6. Free App
NHMRC funded research on
communication in hospital
for people with
communication disability

7. Using social media to communicate
Free articles here: https://www.tandfonline.com/toc/iasl20/20/1

8. 3D printing of food
• New research to look at
making puree foods more
attractive for people with
swallowing disorders
• 3D food printing – puts
puree food into a printer
• You design the shape, the
printer creates the food

9. Overview of this talk
• About communication needs and
communication aids
• HWNS / Aruma audit on
communication needs and
communication aids
• Aruma’s values and being BRAVE
in relation to communication
• Connecting, Communicating, and
Creating – aids to communication
• Just in Time communication
supports
• Visual scene displays
• Two steps to visual
communication using apps
• Concluding comments and
questions

10. Universal Declaration of Human Rights
Article 19

11. United Nations Convention on the Rights of Persons with Disabilities

12. Access to communication
is a human right.
Many of Aruma’s customers with disability have
communication difficulties, and most of those with little
or no speech do not have access to communication tools
and technologies that they need.
When a person with communication disability has little or
no speech, they need another way to communicate and
rely on the skills of other people to get their message
across.
It is the direct support workers, and family members,
who become the key communication advocates and
often the ones who gain considerable skills in helping the
person to communicate.
https://www.scopeaust.org.au/blog/communication-access

13. Types of
Communication
Aids
OTHER
AIDED
(low tech)
AIDED
(high tech)
VISUAL
SUPPORTS
Posters Topic books Mobile apps
Visual
Schedules
Book About
Me
Picture and
Word Boards
Speech
devices
Visual Scenes /
Social Stories

14. Key Word Sign and
‘Sign Bank’
https://www.youtube.com/watch?v=YLtoY8M0guk
http://www.auslan.org.au/dictionary/
https://www.scopeaust.org.au/services-for-individuals/specialised-communication-services/key-word-sign-australia/
UNAIDED AAC

15. Examples of aided AAC –
high tech (mobile devices)
Proloquo2Go
Scene and Heard
Pictello
GoTalk Now

16. Reasons given
for not using
communication
aids
Lack of clarity from staff in recognising
communication as a basic human right.
Staff already “know the customer’s
communication needs” and “what the
customer is communicating”
“Due to [the customer’s] severe intellectual
disability it is difficult to engage in any form of
communication.”
“Limited verbal communication, always
needing staff to interpret their needs.”

17. The person with disability is
often (mistakenly) viewed as
the barrier to communication
• Refusal: customer refuses to use routine.
• Frustration: from not being able to be
communicate their needs.
• Choice: [the customer] will often choose not to use
prompts or gestures; doesn’t want to use iPad app.
• Not using: [the customer] will often not use his
communication pictures to communicate.
• Damaging: The customer damaging the aids,
remove pictures from board.
• Difficult to sometimes engage [the customer] in
effective communication.

18. Aruma’s values inform the solutions

19. Relating
BRAVE to
communication
support needs
BOLD in our approach to address communication
support needs
RESPECT that everyone has the right to
communicate
AUTHENTIC in our support and recognizing that
everyone can communicate
VALUE teamwork and ensure a consistent approach
EXCELLENT in supporting all forms of communication
well

20. Connecting, communicating,
and creating
• Connecting relies on taking time to
communicate.
• Communicating relies on the
exchange of ideas, or the ‘joint
establishment of meaning’
• Creating makes use of new mobile
devices, touch screen devices, use a
wide range of technologies to help
support communication
It is easier than ever to
create communication
supports, and
communication aids,
using resources that are
freely available online and
often available at home.

21. Connecting, Communicating, and
Creating
“Just In Time” visual supports, including
pictures, videos, and gestures.
“Modelling” of accessible communication,
using videos and practice.
“Communication Partner Training”, making
sure that others know how to use the
communication support.

22. Where do you
get
communication
aids and
supports?
Requesting assessment
Design by a communication specialist /
speech pathologist
Creating content at home
Always advocating for the person to have
access to a communication aid or
communication supports

23. “Just in Time” Communication
Supports
• Just In Time = in the moment the activity is happening (here and now)
• Show me!
• Photo on the mobile phone, or the iPad, or it could be an actual
printed out picture. It could be a gesture.
• It could be a single word, that helps the person to understand what is
going to happen, or what they could do next.
• Just In Time supports need a little bit of planning, before the activity.
• In your next activity, take some photos and vids to create visual
supports to use ‘Just In Time’ the next time you do the activity.

24. Activity: Look through your
pics, find one that shows you in
a scene outside.
• People need to know how to quickly grab the iPad or
the mobile phone, take a photo or make a short video,
and insert that into an app that makes it easy to
retrieve.
• How many times have you tried to find a photo or a
video that you took some weeks ago?
• It’s important to store the photo or the video in a
communication app that becomes like a little ‘library’
of the pictures and videos.
• It can even use printed words, along with the picture
format. You can record your voice explaining
something, over the video.

25. Visual
Supports
(Visual Immersion System,
Shane et al 2015)
HIGH TECH (using iPad
video/audio, iWatch) or LOW
TECH (pictures, real objects).
Pictures, objects, and moving
images are all examples of visual
supports.
If you can look at it, and it means
something, then it could be
thought of as a ‘visual support’.

26. Visual supports
for
3 modes of
communication
Visual Expression Mode – Visual
Supports for the purposes of
communicative expression.
Visual Instruction Mode – Visual
Supports for the purposes of
learning and comprehension.
Visual Organization Mode – Visual
Supports for the purposes of
representing an organisational
script, routine, or sequence.

27. Principles
• Everyone communicates: Communication Can
Be Involuntary or Unintentional
• Communication Can Be Multimodal
• Communication Modalities Can Be Symbolic
or Nonsymbolic
!! Remember the modes:
Expression, Instruction, Organisation

28. Principles of
Intervention
using Visual
Supports
(Shane et al., 2015 p. 98)
Assessment drives
intervention
Intervention should be
ongoing and immersive
Intervention should be
focused on interests and
preferences of the person
Every single activity offers
potential for language
learning
Appointing one person to
co-ordinate all facets helps
Interventions aim to move
learners to symbolic
communication

29. Principles of Intervention using Visual Supports
(Shane et al., 2015 p. 98)
Interventions build on ‘procedural knowledge’ (of their world) to move them towards symbolic
understanding (function of objects within the environment)
Both table-top and the natural environment settings are good for intervention – table-top for
learning specific concepts, natural environment assists with generalization
Visual graphic symbols need to be understood by the person with disability
Visual symbols are intended to complement and not replace speech. You need to still TALK while
using the visual supports
Performance varies across environments (familiarity, fatigue, time of day, triggers)

30. Principles of
Intervention
using Visual
Supports
(Shane et al., 2015 p. 98)
Everyone who interacts with the learner should be
familiar with the visual supports developed for that
person (and how to program them, use them)
Communication replacements for negative behaviours
Positive results may emerge from attention alone (just
providing more attention and interaction may improve
performance)
Family should be involved in goal setting – they will
need to use it at home
Some skills affect achievement of other goals (eg joint
attention, staying on task, increase social engagement)

31. Communication
purposes: Why
do we
communicate?
1. Protesting (no, stop, go away, escape)
2. Organization and transitions (knowing what will happen,
changing)
3. Requesting (asking for things)
4. Directives (telling people to do things)
5. Commenting (opinions, thoughts, views)
6. Questions (asking for information, who what when where
how)
7. Social pragmatics (reading social cues, etiquette, politeness,
friends)

32. Visual Supports: Visual Scenes
Visual scenes are symbols that represent an entire event
or activity.
Visual scenes contain a lot of information about the
‘agents’ (people or things) ‘actions’ (events) and
interaction between agents and actions.
Visual scenes are either:
1) dynamic scenes: video clips showing the event
happening
2) static scenes: photos that represent a typical part
of the event

33. A static scene: making tea and toast

35. https://apps.apple.com/au/app/gotalk-now-lite/id953164338

36. UTS CRICOS 00099F
Content
creation about
apps on
YouTube
A useful resource for learning how to
program visual communication apps
https://www.youtube.com/watch?v=B6_k0eSQF-8

37. Advantages of visual scenes
• One photo or video can
capture the entire event.
• There is no need to understand
‘language’, as the meaning is in
the picture.
• Visual scenes are helpful for
supporting
• Organising and moving
between activities
• Requesting
• Directing others
• Making comments
“Children who can communicate their wants and
needs, who understand the organization of the
day and what is going to happen next, who
learn self- help skills, and who can give and
follow directives have the competence to handle
most of the routine communication needs that arise
during the course of a daily routine. These children
are less likely to exhibit behavior problems due to
frustration and aggression and can take more
personal control over their daily lives.”
(Shane et al., 2015).

38. Visual scenes can’t
communicate everything
• Visual scenes are not sufficient for supporting some
communication functions: protesting (feelings),
commenting (subjective opinions), questions (concepts of
who, what, where, or when), and social pragmatics.
• To help this, add pictures to the visual scene (embedded,
click on to expand, or hot spots) to expand the variety of
functions: (e.g., symbols for “no” or “take a break”
(protesting) and graphics to reflect a person’s point of view
(social pragmatics).

39. Barriers to visual scenes
• People need a lot of scenes/videos to reflect their daily lives!
• It is not easy to predict what a person needs to communicate
about.
• Videos and photos made in advance might become ‘out of date’ if
the scene changes.
• Visual scenes rely on ‘vision’ (not smells, sensations)
• Visual scenes cannot easily express abstract things (e.g., hope,
luck)
• Visual scenes can be time consuming to make - setting up the
scene, videoing parts, editing, and storing.
• Videos and pictures can be hard to locate in a person’s collection.
• Making the collection available across settings can be difficult.

40. Step 1: Create. How to create
and store a scene in an iPad app.
• Pick the activity you wish to create in a visual scene.
• Get all the equipment you need into the scene.
• Take a variety of PHOTOS (Visual Scene).
• Then, step through the activity and take some very
short VIDEO shots of each individual step of the activity
• It could be a drawer opening, a drawer closing, using the
tea towel to dry dishes, etc). Scene Cues (Videos attached
to hotspots in the scene).
• Store the photos and videos on your phone and transfer
import these into your iPad app.

41. Step 2: Connect – use the app
for “JUST IN TIME” Supports
• Have access to the app, keep it close by, have it at
every chance
• Do an activity (preferred)
• The things a person shows interest in, take that as
a cue to create a Visual Scene Display
• Program the hot spots
• Take the photos and video snippets you need
• Upload into the app
• Continue the activity

42. How can you
use visual
supports in
the future?
Are you an
enabler?
Are you comfortable with using pictures and videos to
support communication?
How often do you access and use mobile devices while
are you are supporting a person with disability?
Could the device also be used for a ‘just in time’
support to communication?
What apps would you need?
How will you learn to use the apps?
What are some barriers to using pictures and videos to
support communication?

43. Communication champions:
are they tech champions?
• Individuals can make a difference
• Being on hand to answer questions
• Knowing how to use the apps and the devices
• Being able to help create the visual scenes
• Thinking of using the communication aid ‘just
in time’
• Remembering the Purposes of Communication
(12)
• Remembering the Modalities for Visual
Supports (Expression, Instruction,
Organisation)
• Prioritising the human right of communication
• Training communication partners by modelling
good use
• Being BRAVE about communication supports