Thursday, January 30, 2014

AAC Update: Emma and her Eco2 with EcoPoint

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.  
All this has happened over the last month after a very long stretch of Emma refusing to use her device.  I'm hopeful that Emma will continue to grow and use her device consistently enough to tell us how she feels (especially important to me because when cries I don't know what's wrong or if she is hurting), what she needs, what she wants, how her day went, who she played with, etc.  

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.  

Wednesday, January 29, 2014

2014: Thank goodness you arrived!

I've been a bit quiet here lately and it's not for lack of things to write but rather that I've been focusing on other things at the current moment.

This year started off well - we spent New Year's Eve night at a hotel downtown.  Chris and Julia made a pit-stop at the lobby Starbucks to fuel up for the night and we wandered over to Reading Terminal Market to look around and see the Christmas train display.  Then we walked to Franklin Square Park for the family New Year's Eve celebration that started around 4pm with some light shows, a dance party and playground fun and culminated in a 6pm firework spectacular.  We were able to meet up with Julia's friend and her family there and the girls were thrilled to see each other over the "long" Christmas break.  Afterwards we went to the hotel, ate a very underwhelming take out meal and hit the indoor pool (which was colder than I would have liked!).  On the bright side our room was amazing and the beds were super comfy.

We were not thrilled with 2013 - it was a sad year for us with losing my Dad and Finnegan and were more than happy to say good riddance to 2013 and ring in 2014.  Speaking of New Year's Eve:  In true 2013 fashion it had to go out with a thud.  Our room was on the 19th floor of the hotel.  I stayed with the girls to try and get them to sleep because Emma is NOT a fan of sleeping in hotel rooms and Chris was hanging out at the lobby bar for a drink.  I finally got the girls off to sleep and started to doze off myself when the fire alarm sounded.  It kept going off for about 20 minutes.  Thankfully (?), both girls slept through it.  Chris was in the lobby and they wouldn't let him up to the room - obviously - considering every elevator has a sign posted on it not to be used in case of fire.  I was a bit panicked about the thought of carrying Emma down 19 flights of stairs in the middle of the frigid night with a scared Julia in tow.  I stayed in the room hoping it was a false alarm since it occurred too close to midnight for me to believe it wasn't a drunk partier pulling the alarm.  The talking, flashing hotel fire alarm said to stay put they were checking it out and then about 45 minutes later they said it was a false alarm.  Chris was keeping me posted (via text) of the fire department activity in the lobby and after everything was cleared Chris came back to the room just in case anything happened again he would be there to help.  Thankfully it all ended well and we had a good sleep after that.

On New Year's day we could see some of the Mummer's Parade outside our hotel room window so we decided to go and watch a bit before we left.  It was fun to be a part of the parade and Emma loved every minute of it while Julia was ready to go home almost immediately.   These two girls crack me up and couldn't be more opposites.  They balance each other out so well and make life so fun.  How blessed we are!

Here's to a Happy 2014!