IF YOU ARE USING OBJECTS OF REFERENCE AS A WAY TO COMMUNICATE, THINK ABOUT HOW A PARTICULAR OBJECT WILL MAKE SENSE TO THE PERSON YOU ARE USING IT WITH.

  • Often, we choose items because they have multisensory properties, such as scented soap to signify washing or a pair of riding gloves that smell of the horse to signify riding. An object may have a link to an activity, like a piece of seat belt/buckle to signify a trip in the car.
  • The object of reference must be relevant to the individual – two different people may have different objects of reference for the same toy or activity.
  • Avoid objects made of a material the person dislikes.
  • A child can build up a mental picture of an object of reference if they can handle it.
  • You can use a miniature version of an object, but be aware this choice may be more for your benefit than the person you are communicating with. If they have vision impairment, then a toy car bears little resemblance to the experience of going in a car – they cannot see that the toy car is a small version of a real car; it does not feel like one, sound like one, smell like one, or produce the sensation of riding in one.

VOCAS (VOICE OUTPUT COMMUNICATION AIDS) COME IN MANY SHAPES AND SIZES, WITH DIFFERENT SYNTHESISED VOICES, AND MAY HAVE THE ABILITY TO RECORD SPEECH.

Different kinds of VOCAs

Some VOCAs use paper or plastic sheets that have sets of words or symbols that represent recorded words or messages. These sets of words or symbols are static – they do not change. Other VOCAs display words or symbols on a computer-like screen. These displays are dynamic – they change according to what the AAC speaker selects. For example, if they select the “food” symbol, the display may change to a set of symbols of different things to eat.

Selecting a VOCA

Contact your local or regional AAC assessment service to find out more about using a VOCA. The service should be able to show you a range of equipment to try out as part of the assessment. Some centres lend equipment for up to three months to try out. They may charge a courier fee for this. Suppliers of communication aid equipment will often lend equipment as well.

Here are some of the things to consider when choosing the most suitable VOCA for an AAC speaker:

  • Will the AAC speaker walk and hold the device, or should it be mounted on their wheelchair?
  • How will they operate the device: by touching the screen, using switches, an alternative mouse or by eye gaze or head movement? Your local AAC assessment service can advise on the most suitable means of access for the AAC speaker.
  • Will they use spelling or symbols? If symbols, which ones are they already using? Will they be able to have the same symbols on their VOCA, or will they have to use a different but similar set?
  • What vocabulary will the AAC speaker need? What is their current level? If they are young, you will need to consider how their vocabulary may expand over the next three to five years. Computer-based VOCAs offer a wide range of pre-programmed vocabularies.

Single Message VOCAs

A very basic device with a switch that speaks a recorded message when pressed. You can record a new message over the old; for example, Mum can record a message for the child to take to school, and they can bring home a message recorded by a teacher.

These devices help an AAC user to participate. You can also use them to label items around the house or classroom, provide a talking lunch menu or introduce the user to speech output.

Little Mack

Personal Talker

Message Sequencer VOCAs

A message sequencer allows the user to have a series of messages. Each time they press the switch, the device speaks the next message in the sequence.

Some devices, such as the one shown here, enable messages to be spoken in random order.

Example:

Randomizer

Overlay VOCAs

You can buy a wide range of devices that use paper-based overlays, ranging from two to 128 keys. You place the overlays, which have pictures, symbols or words, over the keys to show which one will say which message.

Some overlay devices have several levels with different messages on each so they can be used in different situations with no need to re-record. The speaker may want to use different levels – for example for work, respite, going out, going to the pub, or shopping. Different levels are also useful when other people may use the device.  You make a separate overlay for each level.

Some devices allow the AAC speaker to change levels, but it may be difficult for some to manage this.

Examples:

Partner Four Plus


Go Talk 9+

Tech/Speak 32

Dynamic Screen VOCAs

Dynamic screen devices display symbols or graphics on a screen and can store multiple “pages”. The AAC speaker can navigate between pages by selecting the appropriate key.

You can set up the device in many different ways. For example, you could choose between one and 72 keys per page, or you could link pages together in simple or multi-branching ways. You could also programme the device to automatically open or close a page when the AAC speaker selects a particular vocabulary item.

On the dynamic screen devices illustrated below, the user can change which page to display. A page may contain any combination of symbols, pictures, words and phrases. These devices are equally suitable for someone who is highly literate and someone who doesn’t have reading and spelling skills. Some devices offer additional features such as SMS, playing music, viewing photographs, Skype, internet access and email.

Dynamic display devices cost several thousand pounds. They run on internal batteries that need to be charged overnight, every night, so they have enough power to be used for the whole of the next day.

Before purchasing any equipment it is important to assess an AAC speaker’s skills and needs carefully. But an assessment is essential if they will use equipment that is more complex than digitised VOCAs with paper displays.

Examples:

Tellus Mobi

Vantage Lite

USING SIGNING TO COMMUNICATE

LANGUAGE USES WORDS TO REPRESENT MEANINGS SO PEOPLE CAN COMMUNICATE THEIR THOUGHTS TO EACH OTHER. WE ALSO COMMUNICATE USING BODY LANGUAGE AND GESTURES.

  • Body Language

    means the way we stand, sit, or position our arms, for example. It is often unconscious but it can add a lot of important meaning to the words we use.

  • Gesture

    is a form of body language where we deliberately use movements to convey a specific message. Examples include nodding our head, beckoning, pointing, rolling our eyes, or wrinkling our nose.

We tend to use gestures more when we are in a situation where we find it hard to make ourselves understood with words. This might be a noisy pub, for example, or if we are in a country where we don’t speak the language. For people who find it difficult to communicate, non-verbal body language and gesture may be the only way they can express themselves.

We speak or write words, but we can also express words by gesturing or signing. British Sign Language, for example, is widely used by deaf communities in the UK. People who cannot speak may use signing to express their thoughts. We can also use signing as a visual prop to help someone who has difficulty understanding what is said to them. Signing, like speaking, needs no equipment – it is a very spontaneous, portable and reliable form of communication. The main difficulty with signing and gesture systems is that you need to know the system to understand what the signer is saying.

With AAC speakers, we recommend using speech alongside signing. Many people who use signing as part of how they communicate can hear at least some of what is said to them. Signing helps them to understand what is being said, rather than replacing speech. Signing can have benefits for both communication partners in a conversation.

Signing systems currently used in the UK

Makaton

Makaton is designed to support spoken language. Signing is used with speech and in the same order as the spoken word. The signs are based on British Sign Language. Makaton was originally designed to help people with learning disabilities to understand spoken language and to provide a means of basic self-expression. However, a wide range of people with complex communication needs now use Makaton.
The Makaton Charity | Email: info@makaton.org | Website: www.makaton.org

Signalong

This sign-supported system helps children and adults with communication difficulties, mostly linked to learning disabilities or autism. Signing is used alongside spoken English, following English word order, and provides support for everyday communication. Signalong signs are based on British Sign Language.
Signalong | Email: info@signalong.org.uk | Website: www.signalong.org.uk

Paget Gorman Signed Speech

This teaches English language and literacy to children who are deaf or have a specific language disorder. It is used alongside spoken English. Signers use every component of a spoken communication, in the exact same word order.
Paget Gorman | Website: www.pagetgorman.org

Amer-Ind

This set of signs is based on the hand shapes used by native Americans to communicate with other tribes, all speaking different languages. Amer-Ind signs need a little more guesswork than signs from natural sign languages used by deaf communities. The system uses key words only, and does not follow the word order of any spoken language. Adults with acquired difficulties find it particularly useful as an AAC system.
See also: Amer-Ind Gestural Code: Based on Universal American Indian Hand Talk; Reference: Skelly, M. et al 1974: ‘American Indian sign (Amer-Ind) as a facilitator of verbalization in the oral apraxic’, Journal of Speech and Hearing Disorders, 39, 445-456

Finger Spelling / Manual Alphabet

This uses hand positions to represent letters. People in the deaf community use the two-handed form. People who are both deaf and partially sighted may use a one-handed version. People with hemiplegia (one-sided paralysis) may also use a one-handed version.

Resources

British Deaf Association | Website: www.bda.org.uk

Action on Hearing Loss | Tel: 0808 808 0123 | Textphone: 0808 808 9000 | Email: informationline@hearingloss.org.uk

CHOOSING A VOCABULARY

When you speak, your words represent symbols for what you mean. For instance, if you say dog, you mean a furry animal that barks and has four legs and a tail.

For someone using an AAC system, “dog” might be conveyed by:

  • signing(e.g. by patting your leg)
  • spellingout the letters D, O, G on a keyboard
  • photographof a dog
  • a special symbolfor a dog
  • an objectto indicate a dog, such as a dog’s lead

If AAC speaker is able to spell, then they can spell out whatever they want to say, just like someone who is able to speak naturally can say what they want to. However, AAC speakers who are unable to spell must rely on their AAC system vocabulary to determine what they can say. It is very difficult to choose the vocabulary for someone. But here are some ideas of where to start.

Effective Vocabularies

Imagine that from now on you can talk as much as you like, but you can only use the same 100 words. To communicate effectively those 100 words must enable you to talk with the widest range of people, about the widest range of topics – both now and in the future. It is difficult to think which words you are most likely to need – but if you were designing an AAC system for someone who cannot talk, you would have to consider such things.

The vocabulary should be personalised, reflecting your personality, age, culture and gender.

And you want it to be flexible, with words to help you, for example:

  • Start, end and control conversations

    • “Can I ask you a question?”
    • “OK, I’m off now.”
    • “I’d like to talk to you about…”
  • Say what you want, what you need, and how you feel

    • “I want/don’t want to watch TV now.”
    • “I need to go to the bathroom.”
    • “I’m feeling a bit fed up just now.”
  • Clear up misunderstandings

    • “That’s not what I meant, I’ll say it another way.”
  • Say things that you have never said before in your life

    • “Will you marry me?”
  • Talk about your interests

    • “That photo has a good depth of field.”
  • Ask questions

    • “What did you do on holiday?”
  • Make positive and negative comments

    • “I really like that.”
    • “I think that class is boring.”
  • Say things angrily, politely, cheekily

    • “When are you going to make that cup of tea – I asked you 10 minutes ago!”
    • “Please can I have a cup of tea?”
    • “I’d die of thirst before you get round to making that cup of tea!”
  • Tell jokes

    • “Knock, knock. Who’s there?…”

Which words?

Our personal vocabulary is made up of a mixture of everyday words, personal words and special words:

  • Everyday words that crop up all day, every day

    Studies show that 100 everyday words account for 60% of everything we say.

  • Personal words that are a bit more unusual but are still used a lot

    Words that are important to a person include the names of places, people and activities. If you were an AAC speaker, you’d want to be involved in the choice of these words.

  • Special words for special topics and situations

    These might be jokes, compliments and insults, specific interests, words about a job, hobby or school work, event words for a holiday or sports day, for example. These words will need updating regularly: If you go on holiday, you want to be able to talk about it before you go, while you’re there and for a while afterwards. But you probably don’t want to be stuck talking about the same holiday two years later! And if you’re an adult, you don’t want to be stuck with the special words you used as a child.

Who chooses the vocabulary?

If you are the AAC speaker, you should have some input in choosing your vocabulary. People who know you well – your family, enablers and professionals – will probably all have ideas about what useful vocabulary to include. But you should be at the heart of such decisions.

Useful Resources

Some examples of core vocabulary

Some high tech vocabulary application programs

  • Hi-tech vocabulary application programs are improving all the time. Some of the companies on our Supplier page offer a wide range of vocabularies. You should also check out what apps are available for smartphones and tablets.

SYMBOLS

Symbols are used widely in everyday life as a kind of visual language. They convey information quickly and effectively. Good examples are road signs, care symbols on clothing, or direction symbols at an airport. Anyone can read a symbol, whatever their language or literacy skills. People with communication difficulties may benefit from using symbols to understand what other people are saying, as well as to express what they want to say.

Symbol Sets

Symbols are mostly available as collections or sets. There are several symbol sets that have been designed specifically for AAC. A symbol usually has the word or phrase it stands for printed above it, when the focus is on communication. Communication partners need to be able to see the words because they may not know what all the symbols mean. If the focus is on literacy, the symbol is printed above the word as the reader may need to see it to help decode the meaning. People who are learning to read often point to words as they read, so the symbol can be helpful.

The most frequently used symbol sets in the UK are Picture Communication Symbols (PCS)™, Widgit Symbols™, Symbolstix™ and Blissymbols™. See the section on Graphic symbol sets for more information. Graphic symbol systems such as Minsymbols™ and Dynasyms™ are associated with specific hi-tech communication aids.

Symbol Layouts

Ways of using symbols

Low-tech: communication books and charts are paper-based systems of symbols. The symbols are usually accompanied by text. The book or chart may be accessed by pointing, but other access methods also exist.

Some examples of low-tech ways to communicate

  • Communication books provide pages of symbols, usually organised by topic.
  • Communication charts are like communication books but the symbols are on a single board or sheet.
  • Communication cards are pages of symbols usually organised by topic.
  • Visual timetables and other visual supports can help someone understand a sequence of events.
  • Picture Exchange Communication System (PECS) lets an AAC speaker give a picture to someone else, who then gives them what the picture represents.
  • E-Tran Frames enable the user to use eye gaze to indicate a word or symbol on a plastic sheet.
  • Communication passports are booklets with key information that support a vulnerable person with communication difficulties.
  • Talking Mats are mats to which you can attach pictures. They are useful as a structured tool to thinking.

Hi-tech: symbols on mobile devices may be part of a communication app, and you may be able to choose a preferred symbol set. An app may have a pre-arranged layout and vocabulary that you may be able to edit. You may need to design the vocabulary from scratch. You may need to buy symbols separately. With a dedicated communication aid, you may be able to choose a preferred symbol set and to alter the layout. You can use symbols on a computer to access the internet, to support reading or to generate messages that you can print, email or upload.

Producing Symbol Supported Materials

You can make symbol-supported materials using software. These programs let you create a wide range of resources, such as communication books and charts, posters, labels, worksheets and timetables.

Communicate: In Print 3
This desktop publishing program creates symbol-supported resources for printing accessible materials. It contains the full Widgit Symbols set. It has templates and resources for signage, labels, posters, books, leaflets, flashcards, worksheets and timetables.
More information: www.widgit.com/products/inprint/index.htm

Communicate: Symwriter 2
This symbol-supported word processor uses Widgit Symbols to show the meaning of each word as it is typed. The program contains the full Widgit Symbol Set. It also offers text-to-speech and a spellchecker with symbol support. The student can write by selecting symbols from grids, using alternative access methods. Teachers can create their own activities.
More information:
www.widgit.com/products/symwriter/index.htm

Boardmaker (Plus and Studio)
These are design programs for creating visual materials using Picture Communication Symbols.
More information:
www.mayer-johnson.com

Matrix Maker
This design program is for creating visual materials with PCS, Widgit Symbols and Symbolstixs.
More information:
www.inclusive.co.uk/matrix-maker-p4837

Symbol Layout for AAC Communication

The layout should make it easy to find a particular symbol. This often means someone has several “pages” of symbols. Some symbol layouts are grouped by topic, for example symbols for clothes on one page, symbols for places on another. Some layouts group symbols by grammar – for example,  describing words such as “big”, “dirty, “hungry”, or action words like “go”, or “drive” are grouped together. Some symbol groups are organised around a topic or situation (bowling, or getting dressed) and are grouped on the same page.

Symbols need to be organised so that the user can see, reach and carry them as required. Some people have their symbols on display chart on their wheelchair tray, others use a book with the symbols grouped on the pages. The size of a book will have pros and cons. A small book is easy to carry around but will probably have fewer symbols than a large A4 folder. Some people use different books for different situations. Topic boards that don’t need to be carried are useful for specific activities or places. You can display them permanently in specific environments such as at the sand tray, in the bathroom, or at the supermarket.

Graphic symbol sets

The most frequently used in the UK are Picture Communication Symbols (PCS)™, Widgit Symbols™, Symbolstix™ and Blissymbols™.

Picture Communication Symbols (PCS)™
PCS has around 5,000 symbols in a core library and is available in 44 different languages. With add-on libraries, such as country-specific, the total number of symbols is approximately 12,000. The symbols are simple drawings that can be represented in black and white or colour. Some versions are high-contrast or have thin outlines.
More information: http://www.mayer-johnson.com/

Widgit Symbols™
The Widgit Symbol Set contains more than 12,000 symbols and is available in 17 different languages. The set is designed specifically for written information, so it contains some basic grammatical symbols.
More information: http://www.widgit.com/

Symbolstix™
SymbolStix has more than 12,000 symbols that are available on some voice output devices. The symbols were created to support a website with news and educational materials for people who can’t read text. The symbols are available through an online subscription.
More information: https://www.n2y.com/symbolstix-prime/

Blissymbols™
Originally devised as an international language, Blissymbols were adopted for use by people with complex communication difficulties in the 1970s. The symbols share visual elements that have consistent meanings.
More information: http://www.blissymbols.co.uk/

Choosing a symbol set for AAC Communication

Symbol sets vary in important ways such as how pictorial, how guessable, how flexible, how consistent and how visually complex. It is important to choose symbols to match the needs of both the individual and the communication environment. Your choice may be influenced by practical issues: is symbol software available to produce materials, or are certain symbols available for a particular AAC system?

  • How pictorial

    Some symbol systems are more pictorial than others. However, abstract concepts such as “through”, “tomorrow” or “want” are difficult to convey with a picture.

  • How guessable

    When symbols are easier to guess, the user might find the one they want by recognition rather than learning. Many guessable symbols represent objects, rather than abstract ideas, and may be represented in similar ways in different symbol sets. However, some symbol systems are not so easily guessable, and need to be learned.

  • How flexible

    Sets of highly pictorial symbols are easy to guess, but may be less suitable for referring to all the uses of a word. For example, a symbol for water probably won’t work well to express the message my eyes began to water”.

  • How consistent

    Symbol systems where the symbols share consistent visual elements may be easier to learn. Consistent systems allow the user to express things that aren’t included in their AAC system. They can do this by combining elements in different ways to convey new and subtle meanings.

  • How visually complex

    People with visual impairments may find it easier to process symbols with particular features, such as black and white, line drawing, or high contrast colour.

  • Selecting symbols for the communication environment

    Using symbols in an everyday setting is recognised as a very effective element of Total Communication. If a school or centre already uses symbols around the building, ideally the person attending can use the same set for their individual communication system.

  • Choosing a symbol set to match the needs of the individual

    The symbols must support the range of words and types of word a person will need. This is particularly important for people with good language skills – they may need numerous, very specific vocabulary items, or abstract words, or symbols for grammatical elements.

Points to consider for symbol systems

The purpose of a communication display is to arrange language in space so individuals can … say what they wish to say as quickly as possible, and can do so with a minimal amount of effort.

Blackstone, 1993

The selection of a functional and motivational vocabulary is critical for effective use of an augmentative communication device…..Vocabulary selection is an ongoing process.

DynaVox Systems Inc., 1999‘Selecting and Organising Vocabulary for AAC Users’

Things to consider when using a graphic system

  • Does the graphic symbol system contain all the vocabulary necessary for now and for future needs?
  • What is the relationship of the graphic system to spoken English? Are key words only used or does the AAC speaker need to use a fuller range of grammatical words?
  • There may be problems with symbols for abstract words eg. like, want, is, if.
  • A graphic symbol system will be built up slowly, so the user can see and understand how to use the symbols they have access to through utterances being modeled by the communication partner.
  • No recall is needed because the graphic symbol system is present as a reminder all the time.
  • Words must always be present with symbols or pictures on a chat or in a book so any communication partner who can read can have a conversation with the AAC speaker. It is better to have the words above the symbols for communication, but under symbols for literacy.
  • As only one reliable movement is needed to access graphic symbol systems it is possible for people with very limited physical skills to ideally suited to those with severe physical impairments.
  • Does the AAC speaker have any vision or visual perceptual difficulties? This may affect your choice of graphic symbol system.
  • Symbol systems (e.g. Blissymbols) are much more powerful than pictures (Picture Communication Symbols or Widgit Literacy Symbols), but they may be initially harder to understand and learn.
  • Pictographic systems (e.g.Picture Communication Symbols, Widgit Literacy Symbols) require more vocabulary to allow the user to say what they want, whereas a symbolic language like Bliss allows the user to create new words without having to increase the size of their charts or books beyond a manageable size.
  • Graphic symbols systems don’t break or need batteries, but can get lost! So it is important to keep a backup (paper and on computer).
  • Communication books and/or charts need to be carried around with the AAC speaker.
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