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Alternative Communication Methods – Introduction

Alternative Communication Methods - Potential Pros and Cons when considering their use with people with Cerebral Visual Impairments (CVIs)

Many forms of alternative communication are available for use either with people who are nonverbal, or to support language development in those with limited verbal communication skills, this approach is most commonly applied in special schools.

If any of these methods are to be considered for use with children with CVIs, careful consideration must be given to whether they can be seen, interpreted and understood. For some children significant adaptation will need to be made even to make the most suitable system accessible and therefore meaningful. Other systems are not appropriate if their meaning is not apparent to the child.

Many alternative communication methods are not designed for use with people with low vision. In this series of articles, we will examine the commonly used communication methods, and will highlight when caution may be needed if such methods are being considered for people with CVIs.

We also have to bear in mind that in many individuals being considered for alternative communication methods, their CVIs may not have been identified. Even in those who have been diagnosed, the impact may have yet to be understood. Many non-verbal young people with disabilities are thought of as 'difficult to assess', and how well they can see has not been measured. This can mean that their apparent 'learning disabilities' may in fact be due their inability to see and/or understand the communication methods being used, or their impact exacerbated.

Vision

When deciding what communication methods to use, the first thing to do is to find out what can be seen.

The child's clarity of vision (visual acuity)is measured. The area over which the child can see (the visual field) is assessed, and the number of things that can be seen at once is ascertained.

These measures are then used to:

Ensure that the line thickness of every element of visual communication can easily be seen

Make all communication from within the intact visual field and...

Make sure that no communication is too cluttered, or against too patterned a background to be seen

If a person has blurred distance or near vision, this will impair their ability to respond to any communication method. If they have a visual field deficit, then presenting something in a 'blind' area means the person cannot respond. If only one or two items can be seen at once, additional items are invisible.

If one has had a visual condition from birth, one cannot know how others 'see' the world and so cannot tell anyone that one sees differently.

We know of many young people whose visual field deficits have been identified late in childhood yet were wrongly put down to being clumsy because they tripped, or bumped into or missed things. Some of these visual field deficits may not only involve the lower visual field, a relatively common problem, but some may have a hemianopia, as discussed by Kendall Cowle in her blog. Her CVIs were only identified at the age of 21! 'You can't know what you don't know'.

We know of many young people with multiple disabilities, including impaired visual fields, for whom it was assumed they could see things on their tray attached to their chair, when in fact they could only do this by using a combination of their senses of smell, sound, and touch. This can easily go unobserved in a busy classroom.

Spectacle Use

For young people with multiple disabilities, most learning takes place at 'near'. Hence the need to ensure they are properly assessed for spectacles to give as clear a picture for near as possible. Dynamic retinoscopy should be carried out as part of a vision assessment, as some children with CVIs may have poor accommodation (focus) and spectacles for near tasks may make a big difference to their ability to respond to visual stimuli. Imagine everything you 'see' is blurred. What incentive does this give you to look and engage with your environment. Yet we know of many young people who have come very late to spectacle wear.

We also know of many young people who have worn spectacles since infancy, some also wear hearing aids with no discomfort or problem. Yet we have also seen many whose spectacles sit in a bag at school and are never used, because no one is aware that they have been prescribed or they have been forgotten about, or the child appears not to enjoy wearing them.

Educating all concerned with the child about the reason for the spectacle prescription and giving information, (where it exists) about the child's vision is key.

Imagine how many children may be in education at present, unable to access learning of any sort by means of vision.

Children may have many professionals involved in their support and it is important that discussion takes place about what approaches and materials are appropriate and accessible for the child, taking into account the limitations of their vision impairment.

There are several possible reasons for a child being a reluctant spectacle wearer - but a positive outcome is usually achievable by carefully checking and acting on the following considerations:

First check the fit of the glasses.

Are the spectacle 'arms' the correct length?

Does the frame fit properly? For children who have a wide or a small bridge of the nose, there are companies that make spectacles designed to cater for this.

https://www.tomatoglassesuk.com and https://www.erinsworldframes.com/

The child may have hypersensitivity and not enjoy things on their face. This can be reduced by gently applying tapping pressure to the area the spectacles touch just before putting them on. This can reduce sensitivity in that area and allow the spectacles to be worn, even if only for a few seconds at first, then gradually built up. An occupational therapist may be able to initiate a programme to reduce facial sensitivity which is carried out as part of any intervention programme.

For some young people, seeing things clearly means that their brain is working harder to process visual information. Using spectacles when visual tasks are being undertaken and if necessary, giving the child 'spectacle breaks' can prove helpful.

In the following series of articles, we will highlight some of the issues that need to be addressed before implementing any communication system for someone with CVIs.

'Blanket' generic forms of communication are rarely successful for a variety of reasons that will become evident as each communication system is considered and discussed.

CVI Society

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