Eye Gaze Technology in AAC—Time for a Trial!

So now you have one of these amazing high-tech eye gaze devices in your hot little hands and 2-4 weeks to see if it’s a good fit for your child…now what?
During the trial, you want to set your student up for success. Remember, this is all brand new to her and eye gaze is very, very fatiguing while the eye and neck muscles build up strength. Your goals here are to see which device she is most successful in accessing, and to determine which language access method she prefers. It's really two separate goals rolled into one during the trial period.
CALIBRATING the device:
The device needs to be appropriately calibrated before you can assess how well your student can access the machine. Calibrating allows the device to recognize the nuances of a person’s eyes and eye movements.
Positioning is critical. Each device has specific preferences for placement, both its distance from the user, the height, and the angle. The User Guide and company representative for each device will lead you through these set-ups, but don’t hesitate to customize if you find positioning that is more successful. If your child tilts her head, be sure to adjust the machine to accommodate this.

For keeping her attention during the calibration exercises, you want something that is going to really catch her eye and her motivation. If she has a favorite cartoon character or singer or her own picture, you can incorporate those to make the trial time fun. Dynavox and Tobii allow you to bring in your own pictures for calibrating so that it becomes a game ("Follow SpongeBob with your eyes" is MUCH more fun than "follow the dot"). I don’t recall if PRC’s ECOPoint permits this or not…anyone?
If you have difficulty getting the machine calibrated to your student’s eyes, you can vary the parameters. Maybe a shorter session with fewer calibration points would hold her attention better. You may be able to step through the calibration manually with a keyboard, concentrating on the time she is focused on a calibration point rather than expecting her to follow the points as they move around the screen.
If all else fails, calibrate the device to someone else’s eyes. I’ve heard recommendations for having a parent or sibling calibrate, since the structure of the eyes is likely to be more similar than that of a non-family member.
TWEAKING for accuracy:
Change dwell time, button highlight, the transparency of the tracking “dot” or timer, and the visibility of cursor. Tracking training activities are very helpful in setting these for increased accuracy.
You can also change button sizes and colors and the page’s background.
Place buttons horizontally for more accurate hits. While it is important to explore the full screen to show you what potential the device has for access, for justification purposes, you might organize her choice buttons in a straight horizontal row rather than a 4-button grid, because horizontal eye movements are easier to master than vertical ones. I extend thanks to Judy LaRiviere at the Oakland Katie’s Clinic for this reminder.
Each device we trialed came loaded with fun activities created to develop eye gaze control, and these are effective for fine-tuning dwell features as well. These vary from one manufacturer to another, but they are all very helpful.
They all have a variation of a target practice activity, where the eyes chase a character around the screen. These can be highly motivating for a few tries (imagine being successful right off the bat when your whole life has been a series of discouraging attempts at things you can't do), and they teach YOU, the adult, a lot about ease or difficulty of accessing specific areas of the screen, as well as the button size that can work for your student. I recommend swapping out the built-in character for one you know to be motivating if that is possible with the software on the device.
PRACTICE activities:
Before you expect accurate responses from a child, he will need time to explore the device. I cannot stress this highly enough. Check out this post on a child’s needs for exploration. He needs to have had time to process the types and locations of choices before you can reasonably expect her to use them functionally.
In addition to undirected exploration, you will want to set up activities that are errorless. These are still learning activities and this is NOT a time for “testing!” Activities where your student directs action are a good thing for this. He might direct a bubble-blowing activity or a game like Simon Says or Red Light, Green Light. He might love books and prefer to comment and direct you to turn the page. He might enjoy exploring a tiny library of music clips. He may enjoy leafing through photographs of family and friends or enjoy activating video clips.
And don’t forget those target-practice activities you used to tweak the dwell features!
Also, most of the devices have a puzzle activity where you click to hide each key, unveiling a photo. If you swap out the original photo with one that has personal meaning to your student, this is a highly motivating game.
When you want him to practice indicating choices in a more directed activity, pull in those pictures of characters that he enjoys. "Where is Lightning McQueen?" is much more motivating than "Where is the fork?" Or try photos of family and friends.
Try to involve as many senses and motivational angles as you can. If music is motivating, set each key to play favorite music clip activated. He may enjoy sound clips of favorite people talking or of goofy sound effects. Maybe he would be highly motivated by video clips…your imagination is the limit.
Creating choice screens also gives you a feel for programming each device. Obviously, your ease of programming shouldn't impact the decision, but you will learn a LOT about how the machines function. You might start with just two choices per screen, then 4...simple is key for this.

Whatever activities you design, make them simple so you can duplicate them on each device. Unfortunately (or fortunately, since it teaches you the machines best), you can't transfer files between machines but must make the activities from scratch for each. That's why I recommend simple activities. What this does is let you see how each device handles the same expectations.

 OBSERVE LANGUAGE PREFERENCES:

I can't stress enough the
importance of letting kids explore without pressure.
This is especially true when it comes to navigating around the communication software to access language. Kids learn so much just by "playing around” without us talking or asking questions of them. As standby observers, we learn incredible amounts about their learning style and can probably determine just by watching them explore which of the language access methods is apt to fit each girl best.
Try to provide as much time during the trial for exploration of the device as possible. The quality of this extended time exploring the language access software is critical—the trial period is NOT the time to impose "interpretation" on those explorations. This gives a neutral environment--non-judgmental, not resulting in an outcome--for developing both motor skills and discovery of the meaning (especially since so many symbol keys are labeled with a single word yet will type/speak a phrase). We can learn so much from those explorations just from quiet observation (as opposed to interaction), noting which symbols get chosen repeatedly, what areas of the screen the child prefers, whether she explored alternate routes to the same content of a message (i.e.: the verb "drink," adjective "thirsty," and noun "juice" are all different ways to express desire for some juice to drink but, depending on the symbol set, may take VERY different routes to get to the message), how she figures out navigation strategies, etc. I don't want to call those "prerequisites" to communication, since communication has none, but they absolutely contribute the accuracy of an intended message.
For the purpose of funding justification, it is absolutely fine (perhaps best) to design a simple page that allows for a successful structured conversation, rather than relying on the built-in language access system.

However, you still need to observe how your student does during extended periods of exploring with the various language access software programs. There may be one she is far more highly motivated to "play with" than others, that holds her attention much longer. There may be one that inspires her to compose meaningful telegraphic statements with during her exploration (remember, we still aren't inserting ourselves yet!). Or she may gravitate to the full phrases or the keyboard…
Later, after the device has been purchased, the child will still require extended time to explore language access software. As the child begins to demonstrate the ability to activate keys with greater intention, there also comes a shift when we move from quietly observing in the background to engaging in conversation. At this point, key activations are credited as deliberate attempts at communication. This is when we move from fun, errorless exploration and activities to place where language takes on the power to make things happen.

So to summarize, the trial period is a time to find out which device the child demonstrates best access and for you to observe which language access system is a good fit. One may leap out as being a “best fit.” There may be another she doesn't even like--her body language and lack of attention will tell you. 

Eye Gaze Technology: Language access software

Language access software—now that is a very exciting topic! Seriously, it truly is…and I hope you get as excited about it as I do.

Once kids are able to access a computer through eye gaze, what is it they are going to say? How are they going to say it? THAT is what the language access software is all about, and it plays a HUGE role in successful communication.

Little nuances in fit make all the difference in comfort,
even within the same size!
Getting a good fit between child and language access can’t be stressed enough. It’s like fitting a shoe…even within the correct size, there are nuances to the fit of a shoe that make it successfully comfortable…or irritatingly painful. It’s got to fit right or it just plain isn’t a good match.

The key to selecting the appropriate software is your student—her learning and internal organizational style, what she wants to say, how complex her communication abilities are (or have the potential to be), even what level you hope her to achieve 20 years from now since what she does today can help lay the foundation.

Another consideration is how many hits it takes to create the message she wants, because even eye gaze is very fatiguing. And we know with Rett syndrome or any other disorder involving severe apraxia, motor planning of any kind is extremely exhausting.

Last week we talked about the devices made by Dynavox, Tobii, and Prentke-Romich. All three manufacturers use programs with different methods of organizing language and retrieving vocabulary. While there is a learning curve with each system, it could be that the language organization on one clearly stands out during the trial period as a better fit for your student.

In addition to the software packages traditionally associated with these devices, there are third-party packages that can be installed on most any of them. These open up even more options to the user, but I’m going to stick to the programs typically used by each of the manufacturers to simplify the discussion. The same evaluation principles apply when looking at third party software, such as WordPower or Picture WordPower or PODD.

So that leads us to language organization. I apologize in advance if I'm covering what you already know; I've learned it's best not to make assumptions (sheepish grin).

Language is stored as letters, words, or phrases.

1) When it is stored as letters, we have an onscreen keyboard, typically with each letter taking a single hit to spell out a word. The number of hits to create a message depends on word and message length.

The benefit of spelling is that it allows an infinite number of novel messages. There are also word prediction and abbreviation expansion options that can cut down keystrokes.

But even with these options, the high number of hits to spell is fatiguing. Spelling also tends to be frustratingly s-l-o-w with eye gaze, so that back-and-forth conversation requires excruciating patience.

2) When language is stored as words, it allows for as much novel message creation as most of us are likely to use in a lifetime, although unique words will have to be added.

Words can be accessed through one-key hits or through key combinations.
Creating complete sentences is still slow, but doable. Most AAC users who opt for words have very "telegraphic speech."  That is, they might say "cookie" "please" instead of "Will you please get me a cookie?" After all, the motor demands make words expensive in energy output. Kids can still be very effective in communicating a message that way, though.

Usually a person needs more vocabulary than can be stored on a single page. So pages are created to categorize the words. This is the most familiar language organization strategy.

For example, to reach the word "zebra," you might need to navigate from Nouns (or Things) > Animals  >  Zoo  >  more Zoo words > zebra, taking 5 hits to access the word “zebra.” Sometimes going through the organizational tree can take more hits than just typing out the spelling, unfortunately.

A challenge with this system is that memorizing the placement of the buttons can be very difficult. Each page offers a new array of buttons that must be visually scanned, which can be a tricky task for eye gazers, since eye movements are being tracked by the computer. The programmer must work hard to maintain consistent placement of buttons to support motor automaticity.

Let’s talk for a minute about motor automaticity and why it is essential for eye gaze users.

Motor automaticity is when your body moves the way you want without you having to think about it. It is the skill that lets you reach the stick shift or turn signal lever in your car without having to look. Touch typists use this skill as they fly over the keyboard, hitting all the right letters without peeking.

Your body knows where the shifter or turn lever or computer keys will be through repeated practice. Touching these things becomes automatic; you don’t have to look or even think about it. They are always located where your body expects them to be.

People who use eye gaze can—and should—develop motor automaticity with their eye movements. Their eyes come to expect certain keys to appear in the same position each time.

By contrast, scanning with the eyes can cause unintentional mis-hits when a child’s eyes dwell a little too long during the scanning process. The sooner a child can learn motor automaticity, the more accurate his communication becomes.

Single words can also be retrieved through a process called “semantic compaction,” which aids motor automaticity. Each stationary key represents a concept, and the concepts are combined to create a single word. For example, if you hit "apple," which represents food, and "verb," you get the word "eat." Similarly, "apple" + "feelings" = "hungry." A large vocabulary can be accessed in 2-3 hits. The keys are static and their layout can be committed to motor memory.

Semantic compaction tends to require more learning for the adults supporting a child than for the child herself. I'll share my bias--I was highly skeptical at first but forced myself to learn the system and found it to be VERY slick! I'm a believer now. Several summers ago, I had the opportunity to meet an amazing woman with severe CP who can speak at normal conversational rates using a head mouse with this system. Impressive, let me tell you.

3) A third system of vocabulary organization is phrase-based. In this, a person navigates to categories for various situations and hits a key to activate a pre-programmed phrase. This can make for fast conversation, but the person is limited to saying only what is programmed on the device. 

Imagine going up to a friend. In one hit, you can ask "How are things going at work?" That's quick access! And sometimes, it meets your needs well. 

But imagine this friend has just lost his job... Suddenly, "How are things going at work?" is completely inappropriate. The likelihood that "Sorry to hear about your job situation" is programmed onto the device is pretty slim.

To address this problem, some programs include partial phrases, like sentence starters, or “slot fillers” (fill in the blank). Some are more elegant in their capabilities to do this than others.

The software programs on each of the devices combine options of choosing from letters, words, and phrases, which is a GOOD thing. No one wants to be stuck with just the phrases someone else decides are important! All three include some keyboard for spelling, so I won't mention that again.



Dynavox’s Vmax runs Windows 7 and uses InterAACt.
This is a dynamic (meaning "changing" in this context, as opposed to static or stationary) page-based system for organizing single words and phrases. With it, you start with a page of broad categories and narrow down to smaller categories until you find the page with your word/phrase.

A plus to this is that it makes sense to the staff that programs the device. As an aside, the version of InterAACt I used six month ago desperately needed its programming design updated...taking many steps that should have been automated by now. It is possible that the newest version, 1.07, may have some improvements since that time.

Another plus to InterACCt is that it can hold a nearly infinite number of topic pages, which is nice for school.

The downside for the user is that chances for motor automaticity are very small--every page looks different. And every time a new vocabulary word is added, the page changes.

I find that it really doesn't lend itself to composing sentences--too many hits. For single words, it can be okay though. And for phrase-based conversation that will not change often, it works well.


PRC devices run Windows XP and use Unity
, which is based on semantic compaction. The core vocabulary is offered in several sizes, with each supporting motor automaticity and few hits to access a huge vocabulary.

It also incorporates a dynamic activity row which changes automatically with the categories as they are selected, including phrase-based conversations. From the "apple" key from the earlier example is hit, the activity row will show food-specific words that would be cumbersome to memorize with key combinations.

It also has sets of pages of one-hit topic vocabulary that can be built for school subjects.

I find Unity easy and quick to program, although you have to fully understand the language structure to locate new vocabulary wisely…or you can foul up the logic if you program into the Core set poorly.

On the downside, the software is less elegant for creating things like quizzes for class. The key sizes are pre-defined and sometimes you would like to have creative license on that.

The other drawback is that staffs tend to perceive Unity as being overwhelming to learn, which is unnecessary, but sadly often the case. PRC in our area offers excellent training that can help overcome that fear. The kids tend to look at it like a super-cool secret code, so I have yet to meet a child resistant to learning it.


Tobii C-12 uses Windows Vista and uses Communicator 4
as a base set. It functions much like InterAACt but with state-of-the-art programming.

Equally important, they have an add-on package (included as part of the device purchase) called Sono Lexis that combines some of the best of the other two navigation systems.

It has rows of one-hit high-frequency core words (such as I, you, want, like, not) that are always accessible. There are stationary category keys that open additional rows of vocabulary above these core rows. It also has a category for phrases.

It provides more motor automaticity than Dynavox's InterAACt but less than Unity on the PRC devices. It's pretty well thought-out, fairly customizable (and I have requests in to the company for features that would make is moreso), and easily programmed.

You can step outside of Sono Lexis to make pages that look however you want, which is nice for classroom activities.

To be honest, I wasn't in love with Sono Lexis at first but the more I play with it, the more smitten I become.

The major complaints I have are that I'd like to be able to customize the core vocabulary and to solve the problem of arranging new vocabulary added to the category rows so that it is logically organized (alphabetizing isn't always the most logical, and inserting a new word in ABC order throws off the motor memory). I’d also love to see a “replace all” feature, but then I want it all!

The new Tobii C-15 will run Windows 7 and the Communicator 4/Sono products.


 
There you have the basic run-down on the Major Three software programs for language access. Each has strengths and areas that could be improved. They all can be simplified for children who need to start at a basic level. But it is important for you to look at the capabilities of each to get a feel for what each can offer at higher levels.

Any comments you might make on these systems to help others?

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Here are some additional posts you might find helpful:

Eye Gaze Technology:  Looking at the hardware

Eye Gaze Technology:  Time for a trial! 


Eye Gaze Technology for AAC: Looking at the Hardware

We live in such an exciting time! Leaps in technology have opened doors for computer access in ways that we didn’t even know to dream about just a few years ago.
(Creepy picture...I couldn't find a copyright-free image
of a child using eye gaze on a device, sorry!)
Eye gaze technology can be a miracle for people with severe motor impairments who cannot touch a screen or control a mouse or joystick. When coupled with a voice output device, it may give “voice” to someone who is otherwise unable to speak.
Regularly, the question comes up in circles where I hang out about how to pair up a child with one of the eye gaze systems to access an AAC device. It’s such a big question; let’s look at it over the next few Thursdays in smaller parts.
Disclaimer:  I speak from personal experience and my own research. All children, even those sharing the same diagnosis, are unique individuals with specific strengths and needs that must be considered in evaluating the different systems available.
Please keep in mind that technology changes daily. Current specs that apply to today’s devices (3/10/2011) will be replaced by specs for new devices tomorrow.
Also, I am not affiliated with any manufacturer and receive no compensation for expressing my views.
Today let’s look at the eye gaze hardware used to access computerized voice output devices.
Eye gaze not the same as head tracking, where a camera watches a point on the head or other body part as the person moves. Instead, this technology watches eye movement independent of what the head does. This allows access for people who have no other movement, as well as people with uncontrolled movements in the rest of their bodies.
Experience by any number of clinicians working with girls with Rett syndrome have shown eye gaze to be an effective means of input for many of their clients. The same findings are true for children with other diagnoses who have severely limited motor output.
I personally recommend having the option of eye gaze on AAC devices for girls with Rett whenever possible, even if a child is currently capable of using touch to access a device. There is no way of knowing what skills will stay strong in Rett syndrome and which will decline. Unfortunately, touch skills tend to be one of the skills that are difficult to maintain in the long term. As well, when kids are sick, any access method is demanding and eye gaze is often easier than touch access  during that period. Since an AAC device is a 5-year commitment before insurance funding can be accessed again, if it is at all possible to include the eye gaze function (an additional option of about $7,000, unfortunately, and thereby requiring lots of justification for funding), I do suggest that. At this time, the eye gaze units can be disconnected so they don't need to travel with the device when not needed.

As far as which devices to evaluate, try to arrange trials with several manufacturers. Sometimes one will "click" with a student over the others in a very obvious way right from the initial exposure.
My experience is limited to three major manufacturers distributing in our area:  Dynavox, Tobii, and Prentke-Romich. Other companies also manufacture eye gaze devices, but I have no experience with these. If anyone can add their experience in the comments section with these other companies, we can all learn from you.
The eye gaze hardware and software is different between the three main devices (Dynavox’s Eyemax, Tobii's C-12 with CEye, and PRC's ECOpoint). Each one includes a touch screen and a removable eye gaze unit. Weights for the computers and their eye gaze units differ somewhat, with the Dynavox Eyemax being the heaviest at 9 lbs. 2 oz. The PRC ECOpoint combination is 7 lbs. 4 oz. Tobii lists only the base weight of the C12 as 6 lbs. 8 oz., with the CEye unit not specified (though I would guess it to be somewhere in the 7-8 oz range). Weight may not be an issue for a device that will be mounted on a wheelchair or carried by an assistant.

Prentke-Romich has one of the best descriptions of eye gaze range and tolerance for movement that I have read. They describe an imaginary "box" surrounding your head. So long as your head stays inside that "box," the unit can read your eyes. Move outside that "box" and your gaze will be lost. It is also possible that the calibration to the unit may be lost, depending on the device, and require that the child complete the calibration exercise again.
Each manufacturer's device has a uniquely sized and shaped box. One "box" may be preferable for your student than another (i.e.: if she rocks back and forth, then depth may be a more critical dimension than side-to-side or height). I'll share these with you as height (up and down motions) x width (side to side) x depth (back and forth).

On to the three eye gaze devices I have used with children, and my own daughter in particular:

a) Dynavox's Eyemax was an early arrival on the eye gaze market. It is the eye gaze accessory that combines with the VMax or Vmax+. I found it to be fairly particular about positioning. It's "box" is
6" high x  9.4" wide  x 11” deep for a person sitting 17-24" from the device.
While it stayed calibrated well for my daughter, the small "box" did not accommodate the large movements she makes. I would expect someone with much smaller head movements to have greater success.

b) Tobii has 2 different eye gaze units, each accompanying a specific device. The MyTobii P-10 has a built-in eye gaze function and, while portable, is mainly intended for stationary use in bed or at a desk. It is purported to have extremely exact eye reading capabilities (I haven't personally tried it, so I can't comment). It's tolerance for movement is
12” high x 16” wide x 8” deep at a distance of 20 to 28 inches The CEye is the eye gaze unit for their portable C-12 device and is very forgiving of movement. It allows movements 12” high x 16” wide x 8” deep at a distance of 18 to 26 inches. In our experience, it was the most accommodating of large head movements and of leaving/returning without requiring recalibration. Tobii’s new C-15 voice output device is due to be released to the public market any day; it appears to use the same CEye unit for eye gaze as the C-12 (I could be wrong; please check with your local rep if you are interested).
c) PRC's ECOpoint is an eye gaze unit manufactured by Tobii to be used with PRC's ECO2 or Essense PRO. Its "eyebox" measures 10" x 15" x 8" at a distance of 20-24". We personally had less success with it’s eye gaze than with the Tobii CEye unit. For us, it didn't accomodate large head movements as well and seemed to require recalibrating more often. However, some kids do better with the PRC eye gaze, which underscores the importance of trying many devices. One SLP I talked with said in her experience, mobile girls and those with large movements tend to have better success using the Tobii and girls in wheelchairs tend to have better success on the ECOpoint. 
At www.AACTechConnect.com, you can print off a comparison chart of the three devices with a greater number of specs, including computer and operating system specifications, touch screen size, battery performance, along with the types of drives and ports each has. These take on a bit more importance if the device will also be used in a computer capacity instead of just for communication.

I hope that gives you a start on thinking about hardware issues. The first step to using any AAC device is being able to access it. After all, the most wonderful language systems are only as useful as a child’s ability to access them. Your team’s occupational therapist can be GOLD in helping to determine the best unit for access for your child.
Next week, on to language access software!
What questions do you have about evaluating eye gaze technology with AAC? Please leave a comment below…I greatly appreciate comments!
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You might find these other posts useful:

When Your Plate Gets Too Full

In the USA, we celebrate Thanksgiving each Nov. 25th with an enormous meal. I’m sure every country has similar celebrations that involve heaps of food. Everyone reading, then, can probably relate to plates overfilled with delicious holiday fare.
We pile more enticing goodies onto our plates than any single human could possibly eat over three days (make that four days if my mom brings her Ambrosia salad). It’s no wonder we can’t eat all the food on our plates! There is simply too much.
But then Grandma comes out of the kitchen with her delectable warm apple pie and homemade vanilla ice cream and...oooo, yum!... We can’t say no (been waiting for this treat all year!). Oh no, we find a way to squeeze in a least a few bites of sheer bliss before we keel over in a euphoric state of overindulgence.
Parents have a tendency to heap more on our life’s “plate” than we can effectively manage. Unfortunately, this doesn’t end up in such a pleasant form of keeling over. It ends up in stress, poor health, damaged relationships, and a host of other nasties.
Much of what we heap on is by choice:  our careers, our homes, our church attendance, our hobbies and recreational activities, our pets, personal wellness, the extracurricular activities of our children, our fitness goals…the list is endless.
Some of what we deal with when our children have special needs is not what we would have chosen to add to the plate, but it is necessary for our kids’ well being:  medical routines, caregiving responsibilities, doctor and therapy appointments, IFSP/IEP/ISP meetings (don't you just love all that jargon?), 438 million phone calls to organize all these activities. Another endless list.
And then enters a plateful of “dessert” that we simply can’t walk away from—a crisis, an illness, some other unexpected circumstance that demands our immediate attention.
There are times all of this gets to be just too much. As difficult as it is, we must cope with our overfilled plates. Just how do we do that?
One way is to say no to anything that isn’t critical. If the candied yams with marshmallows aren’t your favorite side dish, pass them up for another that is.
You might decide that television viewing is a time luxury that you can’t afford. You might choose not to own pets (shhhh, don’t let our critters hear that one). You might limit the number of clubs and extracurricular activities that vie for your time. You might forego Twitter and Facebook.
Is there something you are doing right now that isn’t really necessary? If you stopped doing it, even temporarily during crisis, would your world really fall apart?
Another way is to scale back your portions. Take fewer bites of the things that matter. Maybe your hobby is what allows you to keep your sanity, but it may be necessary to cut down the amount of time you allow yourself to sew or sail or spelunk.
Scaling back is sometimes much more palatable than eliminating an activity all together.
Maybe your church’s home group is enough and all the extra women’s activities beyond that could be put on hold. Instead of visiting the library weekly, maybe a visit every other week is adequate.
What do you need to do or enjoy doing that you could do a little less of and still meet the need?
Streamlining your activities might be more of a cooking secret as we prepare that Thanksgiving feast than how we eat it, but it applies to managing all we have on our plate.
It’s become almost a game to me to figure out ways to save time or steps in my caregiving tasks. I save minutes by blending up a whole day’s batch of food for my daughter’s tube feedings instead of making single meals. By storing all her medications and tube feeding supplies in one cupboard, I save many steps in medication and meal prep. I use a quick checklist to send with my daughter to school each morning that takes only a couple minutes to complete and saves hours of phone calls later to clear up confusion.
Are there frequent tasks related to your child’s care that can be streamlined to save you time? Ask your friends who face similar issues how they approach the same task and learn from them (this strategy has helped me tremendously!).
Share what’s on your plate if you can. If you can’t eat it all, maybe someone else is willing to take several bites for you.
If you are fortunate enough to be able to afford to pay someone else to do some of your work, then hire it out. Maybe you would be better off hiring someone a few hours a week to do your housework or mow the lawn.
Maybe you can trade tasks with another family. Swapping babysitting is a tough one where we live, but I hear from other moms that it can work well.
And be sure to ask. When a friend or relative asks what she can do to help, let her. Maybe she could drop off a package at the post office you’ve been meaning to mail.
Instead of trying to do it all yourself, what could you pass along to someone else? What creative arrangements might you design to make this possible?
And then, give up the guilt over what you cannot finish. No one expects you to clean your plate on Thanksgiving. No one expects you to “do it all” in life. If you expect that of yourself, you’re being a harder on you than you need to be.
Are you beating yourself up for the things you can’t get done? If so, give yourself permission to stop. Guilt isn’t going to get you anywhere.
Special needs parents have a lot piled on our plates that we didn’t ask for and that may not be favorite dishes. But this is our reality and we do have to deal with them. We have control over many of the other things we add to that plate, and we can:
chose to eliminate some,
cut back on others,
streamline our routine tasks,
enlist the help of others,
and above all, let go of guilty feelings when we can’t get all of it done.

Crystal Paine at MoneySavingMom.com has a free ebook on time management that is the single best book I have ever read on the subject of managing your time (and I’m desperately disorganized, so I’ve read shelves full!). If you need help figuring out how to deal with an overfilled plate, I recommend it highly. It’s a fairly short book written from a Christian perspective and worth digesting s-l-o-w-l-y to get the most benefit. You can download it here.
This weekend our house was hit with a stomach bug. It’s a great time for me to re-read Crystal’s excellent book and get my priorities in order for the extra heap of helpings on my plate right now. I hope you will download your own copy and join me in managing our full plates!
Here's to a lighter plateload for us all in the week ahead!

Photo credits go to purpleslog and Emily C. at flickr.com

Quick and Easy Independent Practice for Low-Tech AAC

After last week's look at the importance of giving AAC users time to explore a device with NO pressure, are you convinced? What about kids who use manual (paper) boards or a PODD system, or those who need more time with their device’s home page?
Repeated exposure to these boards can benefit kids too. Here’s an idea for boosting time with low-tech paper boards. It takes just a little initial time on your part, after which kids can practice independently. It doesn’t allow for expressive output, but it DOES bump up exposure time and increase familiarity with the layout.
Flash cards can be a great help for some kinds of memory work, but what if a child doesn’t have the fine motor control to use them? And will a whole board fit on a little card and still be visible?
Enter “ceiling posters!” This was a strategy I used in college to memorize vast quantities of information. I wrote or drew out the facts I needed to memorize (like the infamous Kreb’s cycle…bleh) and posted them above the head of my bed. This information would be the first thing I’d see in the morning when I opened my eyes (and put on my glasses) and the last thing at night. It was like having a giant flashcard hovering over me…and it really helped boost my memory for these otherwise obscure bits of information. 
Kids can benefit from this strategy for gaining extra time to rehearse information as well.
We’ve used posters of all sizes to provide my daughter with independent rehearsal time. We’ve hung letter-sized sheets of spelling words on the back of the front passenger seat of the van for her to study while we drive (60 point Arial font works well). We posted classroom material on the bathroom wall across from the toilet for her to rehearse while otherwise, er, indisposed. Right now, there are posters over her bed to help her memorize a QWERTY page and a modified Sono Lexis home page for the Tobii.*
Eye gazing to a QWERTY board
She has a smaller poster of the Unity 60 Core page for the ECOPoint* and Unity QWERTY page on the bathroom wall…she’s learned Unity 45 and this core page is a bit different, requiring that she rehearse it.
Smaller wall posters of Unity 60 for the ECOPoint
and the QWERTY layout used on the ECOPoint.
*(Note: We are still working out which eye gaze device is a better fit for her. It may be confusing to practice both language access systems, but if we think of her as “bilingual,” I can justify it. Two different QWERTY setups is arguably conflicting, though)
Ceiling posters need to be large enough to read from the bed but not so huge that they involve large head movements to scan. These posters were made in BoardMaker with a board size of 41 x 16”. They print on eight horizontal letter-size sheets taped together. Each is just narrow enough to cover with a single width of clear Contact paper.
41 x 16" board size in Boardmaker
Posters of AAC boards hung on the ceiling or wall can offer additional practice time, even when kids are by themselves. If your children spend time at the changing table (not unattended please!) or on the toilet, lying in bed, entertaining themselves in the kitchen as you cook, or wherever else they may spend undistracted time, look for places you might post a sample board.
A poster won’t provide feedback to them. It’s nearly impossible to interpret eye gaze unless the pictures are spaced VERY far apart. Is it functional, then? In a sense, no.
But in another sense, offering a child more opportunities to practice on their own can have function. It may speed their memory of symbols and their locations. It can provide you with a way to incorporate the board into your expression, giving a powerful model. You can talk about categories on core pages for devices or PODD displays, demonstrating how you would navigate this main page to gain access to the vocabulary in question. It certainly can’t hurt…
What posters might you make today to support your AAC user?