Cerebral Palsy, Communication and AAC

Cerebral Palsy, Communication and AAC

How can teachers include these students in the classroom?

Why is AAC beneficial?

What is Cerebral Palsy?

-Students with CP often have articulation disorders and impaired speech intelligibility (38%)

-Motor impairments may restrict student’s access to language-learning experiences and opportunities in the early years

-Speech problems associated with poor respiratory control as a result of muscular weakness, laryngeal and velopharyngeal dysfunction, and oral articulation difficulties that result from restricted movement in oral-facial muscles.

-Also, students with CP may have an intellectual disability that causes language delays (Beukelman & Mirenda, 2013)

Cerebral Palsy (CP) describes a group of disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, cognition, communication, perception, and/or behavior, and/or by a seizure disorder. (Bax et al., 2005)

-This is a proposed definition since up until recently there has not been a widely accepted medical definition for CP.

Three levels of participation in general education classrooms:

1.Competitive Educational Participation: Students with disabilities are encouraged to participate in the same educational activities as their peers in the general education classroom. They are also expected to meet the same academic standards, however they may not complete the same amount of work as their peers. AAC users may also require more time to finish assignments and tests.

2.Active Educational Participation: Students with disabilities are encouraged to participate in the same educational activities as their peers. However, the expected outcome is not the same as their peers. Their progress is evaluated according to individualized goals. Active students may receive supplementary instruction in specific skill areas. They usually benefit from adaptations or modifications to instruction.

3.Involved Educational Participation: Students with disabilities participate in the same educational activities as their peers, but they are expected to learn in cross-curricular areas such as communication, social, and motor skills. Their progress is evaluated according to individualized goals. Such students may require extensive adaptations in order to participate with their peers.

"Effortless communication is not an option for all people because some are unable to meet their daily communication needs through natural speech. Yet, effective communication is essential for learning and development, personal care, social engagement, education, and employment." (Beukelman & Mirenda, 2013)

ELLE

Strategies:

Augmentative and Alternative Communication devices allow students to express their wants and needs. These devices provide students with speaking and/or writing assistance that is needed due to their inability to effectively communicate using gestures, speech or written communication. When students are given access to AAC devices, they are able to communicate academically, and socially. They are able to form and keep relationships with peers and participate in the school setting. With more instruction and practice using AAC devices, students are able to generalize the skills and communicate in all settings in school and outside of school. As they grow older, and are able to transition to more advanced systems, they are able to use these devices with family, friends and on the job. The following video shares how Dynavox, a high-tech AAC device, has changed Elle's life for the better.

Risk factors for cerebral palsy in term or near-term children include intrauterine exposure to infection or inflammation and disorders of coagulation. Interruption of the oxygen supply during birth contributes approximately 6% of spastic cerebral palsy. Low Apgar score, need for resuscitation, and seizures are nonspecific indicators of neonatal illness that do not identify cause. Although not entirely consistent, current evidence suggests that inutero infection may predispose very preterm and more mature infants to cerebral palsy and that antenatal exposure to steroids may be somewhat protective. Recognition of a broader set of causal possibilities encourages hope for new strategies for the prevention of cerebral palsy.

Dynavox

-Determine communication needs of students AAC training for the teacher

-Whenever a child has an opportunity to communicate, make sure the child has access to AAC, and that appropriate vocabulary is available.

-Children are more likely to communicate and participate when activities are motivating. Children love books- shared reading activities are a great time to develop reading and communication skills.

-Respond to communication attempts- our responses to children’s communication attempts help them understand that communication is a powerful tool.

-Find ways to include student in all classroom activities

-Carefully match assistive technology to individual activity demands

-Maintain effective team collaboration (between special ed teacher, general ed teacher, speech language pathologists)

-Adapt the curriculum

-Prepare and maintain documentation

-Write goals and objectives individualized for AAC users

-Provide many opportunities to communicate

-Wait for a response- children who use AAC may require more wait time to prepare a response

-Determine the student’s motivation and attitudes toward AAC techniques

Types of Cerebral Palsy:

Ataxic (Ataxia) Dyskinetic (Dyskinesia) Spastic

Why is AAC beneficial?

How does it affect student communication?

*AAC includes many different strategies and methods, both aided and unaided that can assist individuals with CP to communicate through different forms.

Types of CP

• -It is common for children with Cerebral Palsy to have speech and language difficulties. It has been found that about 58% of children with CP have communication difficulties.

• -Areas of Speech production difficulties:

Respiration- rapid or shallow breathing, Phonation-inadequate airflow, Resonation-hypernasality and Articulation-difficulty controlling the tongue, lips or mouth

Resources

Cerebral Palsy Alliance:

Prentke Romich Company - AAC Devices

Unaided Communication:

Unaided communication relies on just the user's body in order to communicate. It doesn’t require any sort of external device or object.

-Unaided communication can include: Gestures, facial expression, sign language, eye pointing (looking hard at a desired object or person), body language

Aided Communication:

Aided communication is when a person uses a physical object to help them communicate. These can be both high tech (HT) and low tech(LT).

-Aided communication can include: Speech generating device (tech/talk, GoTalk), switches, paper communication boards(LT), iPad apps(HT), Boardmaker printouts(LT and HT), laser pointers (to point at a paper or non electronic communication board)

http://cerebralpalsy.org/

https://www.prentrom.com/

United Cerebral Palsy:

American Speech‐Language‐

Hearing Association (ASHA):

http://ucp.org/

Ataxic dysarthria- This is uncommon in Cerebral Palsy. The characteristics include imprecise consonants, irregular articulatory breakdown, distorted vowels, slow rate and harsh voice.

Spastic Dysarthria -

Consists of four major speech abnormalities of voluntart movement, which are spasticity, weakness, limited

range of motion and slowness of movement.

Spastic Children's Association:

http://www.asha.org/

http://scasft.org/about/speech-therapy/

Athetoid dysarthria-

Caused by a disruption of the internal sensory-motor feedback system for appropriate motor commands, leading to faulty movements. The disorder affects the regulation of breathing patterns and laryngeal dysfunction. It can also affect articulatory dysfunction, which are jaw movements and inappropriate position of the tongue.

Pinterest:

March of Dimes:

https://www.pinterest.com/

http://www.marchofdimes.org/baby/cerebral-palsy.aspx

The Family Center on Technology and Disability:

Ataxic CP (Ataxia) – The uncoordination seen with ataxia occurs when a person attempts to perform voluntary movements such as walking or picking up objects. Ataxia causes an interruption of muscle control in the arms and legs, resulting in a lack of balance and coordination.Ataxic movements are characterized by clumsiness, imprecision, or instability. Movements are not smooth and may appear disorganized or jerky.

People with ataxia may have:

• Unsteady, shaky movements or tremor
• Difficulties maintaining balance

People with ataxia appear very unsteady and shaky because their sense of balance and depth perception is affected.

Dyskinetic CP (Dyskinesia) – People with dyskinetic forms of cerebral palsy have variable movement that is involuntary (outside of their control). These involuntary movements are especially noticeable when a person attempts to move.

Dyskinetic movements can be:

• Twisting and repetitive movements – known as dystonia
• Slow, ‘stormy’ movements – known as athetosis
• Dance-like irregular, unpredictable movements – known as chorea.

Spastic CP - Spastic cerebral palsy is the most common type of cerebral palsy (70%-80% of individuals with CP). The muscles of people with spastic cerebral palsy appear stiff and their movements may look stiff and jerky.

Spasticity is a form of hypertonia, or increased muscle tone. When people without cerebral palsy perform a movement, some groups of muscles turn on and some groups of muscles turn off. In people with spastic cerebral palsy, both groups of muscles may become turned on at the same time. In some instances the wrong muscle groups may turn on. This makes movement difficult or even impossible.

http://www.fctd.info/

Website for browsing various Low-Tech/High-Tech AAC Devices:

http://www.mayer-johnson.com/category/assistive-technology/aac-low-tech

Low Tech:

Adapted writing utensils - pencil grips, or writing utensils that allow students to grasp and write without much fine motor control

Slanted boards - places wrist at a comfortable postition, while providing an open workspace for students

Button Communicators - buttons that allow for recorded speech, that talk when pressed

High Tech:

Vantage Light - portable communication aid with pre-set vocabulary uploaded that speaks when pushed

Wheelchairs - allows for mobility, accessbility and

is suited for students with low muscle tone.

-Differences in Early Development: Parents of children with Cerebral Palsy have been found to initiate most conversations with their children, introduce the topics, ask close ended questions and place commands. The result of these parental exchanges are:

-Children reply with short answers.

-They do not take as many conversational turns.

-They do not initiate as many exchanges.

-They do not use a complete range of pragmatic functions.

Learned Helplessness: Children with Cerebral Palsy have a higher risk than other children of learned helplessness. This means that they may not initiate communication with others. It is recommended that children with CP receive Early Intervention at a young age. Early Intervention services will encourage children with CP to use language to express their needs and wants and to help them make choices and decisions in their daily lives.

LOW TECH

Group 3

High Tech

http://www.especialneeds.com/writing-aids-handiwriter.html

https://www.prentrom.com/products

Emily Bieber

Skylar Luxon

Kayla Moran

Amy Nolan

Kristen Plachuta

www.ergocanada.com

http://invamedicalwarehouse.com/wordpress/wp-content/uploads/2013/06/CEREBRAL-PALSY-WHEELCHAIR1

Works Cited

About Cerebral Palsy. (2015, January 1). Retrieved March 19, 2015, from https://www.cerebralpalsy.org.au/about-cerebral-palsy/

Assistive Technology in Action - Meet Elle [Motion picture]. (2012). PACER Center.

Beukelman, D. R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs (4th Ed.). Baltimore, MD: Paul H. Brookes.

Kuder, S.J. (2013). Teaching students with language and communication disabilities. In Pearson Education Inc. (Eds.), Language and students with neuromotor disabilities and brain injury (pp 273-293). Upper Saddle River, NJ: Pearson Education Inc.

Kuder, S.J. (2013). Augmentative and alternative communication. Teaching students with language and communication disabilities (pp. 365-367). Upper Saddle River, NJ: Pearson Education, Inc.

Nelson, K. B., & Grether, J. K. (1999). Causes of cerebral palsy. Current opinion in pediatrics, 11(6), 487-491.

Spastic Children’s Association of Selangor & Federal Territory. (2010). Speech therapy. Retrieved from www.SCASFT.org/about/speech-therapy.

Worah, S., Douglas, S., McNaughton, D., & Kennedy, P. (2010). Augmentative and alternative communication resource guide for teachers.

Retrieved from http://aac-rerc.psu.edu/documents/aac_serc.pdf