Our journey continues with Emma's AAC device. Here are some other posts I've talked about what we are doing with her talker if you want to get caught up. NOTE: Emma also has a Yes/No response and low tech ways of communicating but for the purpose of this post I'm only focusing on her use of the high tech eye gaze device.
Emma is now 100% eye gaze again with her device. She decided that her hands weren't helping her talk like she wanted and agreed to look at the device again. This is a big decision on her part because we can't make her look at the device and you can't navigate it with your eye gaze if you don't look at the device. I consider this a great milestone for Emma.
When we received her talker we had a long discussion and decided to set it up for 60 1-hit Unity. That basically means it could show up to 60 icons at a time on the screen. Emma had some success with it but not enough. I saw her struggle with it and it was frustrating to her and me but I didn't really know what to do about it. Then we met up with another little girl in our area who is about the same age as Emma and uses a device (a MyTobii) to talk. She was saying all kids of things with her talker and actively engaged in conversation. It took my breath away! After talking with her Mom for a while I decided to change Emma's device to 45 1-hit Unity so there would be up to 45 icons on the screen at one time and they would be larger than the 60. The less icons, the larger the size of them. Her device can do anywhere from 45 - 144 icons at a time on the screen. My plan was to dial the number of icons back and make the bigger and more easily accessible for Emma and see what happened.
The 45 set-up had things laid out a bit differently than the 60 set-up so I spent a Saturday night changing up the icons to more closely match the 60 set-up. Emma had a lot of the locations memorized and I didn't want to confuse her with having the screen look very different. Plus I figured I'd like them in similar spots because if she moves back to 60 Unity it would be an easier transition. The 45 set-up seems to definitely make a different for Emma. It seems easier for her to actually activate the icon she intends. You could see her try so hard to activate it on the 60 Unity and get frustrated because she would activate an adjacent icon.
With the 45 Unity, Emma seems more relaxed and happier to interact with the machine. It seems easier for her, she is having more success in telling us what she needs, and she is stringing more words together. She is also using it during working sessions with her SLP at school and has even initiated some interactions with people on her talker. This is huge since she typically wouldn't use her device at school no matter how much her team encouraged her.
Here are some things Emma has done since we changed the device, although she isn't very consistent about it. I think that will come in time and for now I'm happy to see her start to tell me more about what is going on in her mind.
- She has started to chat more. She will often use it for several back and forth conversations.
- She will use it to get our attention. If we walk away to do something or are in another room and she wants us she will say something. If she wants a drink and I'm preparing it she will select over and over and over again the same icon saying Drink Drink Drink Drink Drink similar from what you hear with impatient children! It's quite funny to me and always makes me smile :-)
- At dinner one night she leaned over to the table and tried to grab her bottle but couldn't reach it. She used her device to say the following in under 30 seconds without me modeling what to say first. It still blows me away that she said this so quickly and appropriately: "you help drink you get drink get". I got her message loud and clear - she wanted me to help her get her drink.
- Someone came up to her in the hallway at school to give her a marshmallow snowman treat. Her aide told the person Emma doesn't eat them and Emma immediately said on her talker "don't eat" and gave the person a smile before starting to drive herself away down the hall in her power chair to her Kindergarten classroom. Her aide was so happy to tell me about that and I was thrilled to hear it.
- Today when Emma came home from school I asked her how school was and she said "good". After she told me she wanted a drink I walked over to the fridge to get it and she thought I was taking too long so she said "I want my ". I returned around the time she said my so I finished her sentence with You want your drink? and Emma smiled big to indicate yes, that is exactly what she wanted.
Emma has a long way to go before I would consider her conversational in a social setting but I am convinced she will get there and I think it will be sooner rather than later. Especially since we're going to set up some play dates with her friend with the talker. Emma was VERY motivated to use her talker after her interaction with her friend. We are also hoping to send her to the summer session at a local school that specializes in augmentative communication devices and power mobility to help prepare her to hit the ground running in 1st grade.
Initially Emma's school team was unsure about moving her to the 45 Unity. They think (as do I!) that Emma is very smart and that 60 Unity will give her a lot more opportunities to speak with less effort. I was happy to hear they think she is capable of the 60 Unity cognitively but I brought up the observations I've made around her use of 45 vs. 60 and that she needs to get some early and consistent success with the device to help her engage more. Since Emma doesn't use the device as good at school it was important for them to know what changes I saw at home until she starts to demonstrate the same things at school. We also talked about her diagnosis of cortical vision impairment since she received the device and we had her vision therapist weigh in on 45 vs. 60 icons in light of her most recent Ophthalmologist report. Given all this we decided to keep her on 45 1-hit Unity.
The daily reports over the last two weeks have been really good. All her therapists report that she is more actively engaged and focused. She is making a lot of progress in all things and not just communication. She is doing well at Kid Writing which is something I thought would be super hard for her. She is doing well with simple addition and subtraction. She is distinguishing between singular and plural words with >90% accuracy - something that is VERY difficult for someone hearing with cochlear implants. She is walking longer distances in her KidWalk indoors (she loves to walk outdoors but not as much indoors) and driving longer distances in her power chair. Emma is just full on right now. I know from past experience that these periods of rapid progress are often followed by periods of sustaining before she kicks into another period of progress again.