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.
- 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.
- Single message VOCAs speak a recorded message
- Message Sequencer VOCAs allow the user to use a series of messages
- Overlay VOCAs allow the user to select from a number of messages; you place overlays with pictures, symbols or words over a keyboard to show which one will say which message
- Dynamic Screen VOCAs display symbols or graphics on a screen
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.
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.
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.
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.
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.
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
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.
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:
Our personal vocabulary is made up of a mixture of everyday words, personal words and special words:
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.
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.
Ways of using symbols
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
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/
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 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/
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/
Makaton symbols are simple black and white pictographic drawings that form part of a multi modal language communication programme, which uses speech, signs and symbols. The symbols are available on ICT systems; in addition, their simple style means that they can also be drawn by hand. There is a symbol match for the 450 sign concepts in the core Makaton vocabulary in addition to more than 11,000 concepts in the resource vocabulary. The symbols have been designed to reflect language themes to encourage and support the development of language structure.
More information: https://makaton.org/
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?
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.
The selection of a functional and motivational vocabulary is critical for effective use of an augmentative communication device…..Vocabulary selection is an ongoing process.