 All right, we are now officially recording and it is now officially 3.30. So welcome everyone. I am really pleased to see so many folks here tonight today. I hope you are all staying warm on this terribly frigid day. I am really, really pleased to introduce Kim Elliott, who is a Canadian, which I should have known from reading your bio. As I said, all the really good people are Canadian, and Kim is an SLP, and Kerry Luce is that right? Is the OT on this team of the dynamic duo, we'll call them for the next couple of months. I had the great privilege and kind of was a lovely little happenstance that I saw Kim and Kerry present at the Portland AT conference last February, so just about a year ago, on this complex of access and communication. And I went into this thinking, you know, I know this blah, blah, blah, blah. And then as I watched them, I thought, oh, this is really good. I really, really appreciated their three-part approach for emerging communicators. And some of you might know that I've been speaking about it sort of ever since. So it's really, I'm really, really happy to have it from as the word, from the horse's mouths, as they say. I think you'll all be in for not only a treat, but also a really lovely, systematic approach to what probably many of us might try and do in our work. But it's always nice to put some systematicity to it and some real, some real thought. And it also, from my point of view, really helps those teams who are working with SLPs and OTs, PT's teaming to come together around some of our most challenging kids, but also can be our most rewarding kids. So I'm going to keep talking for now. I'm going to, at the end, I've got an announcement. So stay to the end for the announcement. But with that, I'm going to say that I will monitor the chat. And I'm going to turn my webcam off right now. And I will hand it over, I guess, first to Kim. So welcome to Cold Alberta in the virtual domain. All right. Thank you so much, Kathy. And welcome, everyone. I'm excited to talk to you today about this approach. And as I was talking to Kathy, the benefits of Zoom are that here we are in various parts of Alberta or otherwise, and also we're meeting here for the comfort of our own office in Portland, Oregon. And so Zoom is a really amazing interface for that. But the payoff is that I don't have you all in a room with me live. So I can't see if you have questions, et cetera. So we do want this to be as interactive as possible. So please, just if you have any questions or comments, write in the chat. And Kathy will moderate that for me and highlight that. So OK. So first of all, I just want to introduce myself. As Kathy said, I'm a speech language pathologist and a certified assistant technology professional and a co-directed assistant technology lab. We have a nonprofit here in Portland, Oregon called Community Vision. This is a picture of our building. It's brand new. We've just been in it for 18 months, and it's lovely. We feel very blessed to be in such an open and accessible space. They co-direct this lab with Kerry Luce, who is an OT and also a certified assistant technology professional, and she's going to be joining us a little later into the presentation. So I just wanted to frame today's session. We're going to do just a brief overview of what communicative competence with AAC is, and then I'm going to explain the components and the rationale behind our three-part approach, which we call the PAL approach, and discuss the importance of participation in the developmental process, and then the best way we found to elaborate on the components of PAL is to go through case studies, and then there'll be time for some questions at the end. And I just wanted to note, since this is a two-part series, this is mostly about just establishing what the PAL approach is. Next session, we're going to dig in a little more specifically around the tools and strategies in each of the areas. So you can feel free to ask questions, but know that there is a part two as well. And one of the reasons, as Kathy alluded to, that we sort of systematized this or operationalized it is because there can be so many tools and strategies that we're working on, it can get a little overwhelming for teams. And so we found this session is also a really nice way to organize those tools. So in part two, we'll also talk about the sort of organizing of the tools. So communicative competence for everyone, not just around AAC, is the knowledge of the language, right? The grammar and the vocabulary and the rules around the language. But also to be a competent communicator, we need to be able to use it in real life. So it's really those two parts that make any of us a competent communicator. But for AAC, we have these extra demands because it's an external tool, whether it's a high tech tool or a light tech tool, but it's still external. And so because of that, we still need those first two things, the knowledge of the language and the ability to use it in real life that serves those social skills. But now we also have the visual motor operation of that device. And some of you might be aware of the work that Janice Light has done around communicative competence for AAC. I'm not really addressing the strategic piece of that, but these are kind of the basic sort of linguistic, social, and the operational. So we're going to talk about these three areas. And so what is POW? It's participation, access, and language. And really, we can relate these to communicative competence in that participation really is sort of getting a child ready for that social use of language, right? Using it in real life, participating in the world around us, looking at the access, which is that visual motor operation of any tools that the child might be using. And then of course language and learning the words and the grammar and meaning, etc. And so these are the three parts to our three-part approach and all really to help a child start off and be successful in their journey towards communicative competence. And as I'm sure most of you know for all of us, really the journey for communicative competence is it's a lifelong journey, right? As adults, we learned language much as young children, but if you think about maybe the way you were, what kind of a communicator you were when you were 16 versus how you are now, right? We still grow and learn and become more competent through our life experiences. So why do we use the approach? As some of you know, access can be really challenging. And the more sort of physical or visual sensory challenges a child has to overcome, right? The longer that access can take to sort of figure out and fine tune. And so in the meantime, while we're trying to figure out those access challenges, we need to start the road for developing those communication skills. So we don't want to wait for access to sort of begin the language journey. But also participation is so essential for all of us, right? We don't, you know, that's what gives us engagement and meaning in our lives is just to be able to participate in the world around us. And so we also don't want to wait for language acquisition and access to begin with participation. And really that participation lays that foundation for those language and social skills. And it also gives you a topic to talk about and engages you with the people around you. So that's why we start with the P first, because no matter what the child's challenges are or how old they are, we have found the first time we meet a child, we can think of tools to do that increased participation immediately. So we always start there. And then we've got kind of a foundation to begin our language and access journey as well. So I just want to talk a little bit about the developmental process because in AAC best practices are to follow, you know, what we understand about typical development. So you think about a baby who's born into the world and they have, you know, they start with participation, right? They explore the world around them. They have experiences. So they, we begin our lives with participating and interacting with people in the environment. And through that, we begin to communicate, right? We know infants communicate long before they have linguistic skills. So through that participation, grow into communication, we hear language in context as we're having all these interactions and then that language starts to become part of the way we communicate. And then, you know, we talk about that as, you know, our language acquisition or learning language. Unfortunately, some of the history of AAC, we kind of turned that upside down because sometimes we start a little bit later with kids and we might focus on them learning the symbol first, which is really trying to sort of teach them the linguistic code first. And then we teach them how to use that in context of communicating. And then once they've reached a sort of level of competence, then we say, okay, let's go out in the world and use it. And really that is opposite of what a sort of a natural developmental process is. Fortunately, that isn't happening as much as it used to in AAC. I think this is kind of an older school approach, but just kind of rooting us in participation as the basis and into communication and then language. Because participation is engaging, right? And we communicate when we are engaged. I also like this visual. This was a presentation I went to. And it was a mother that was presenting about her son. And she didn't have any formal training on AAC or communication, but she came up with this really beautiful graphic. And I just loved it. So she had her son's communication house. And she has these different parts of the house, the walls and the roof. He has different modalities. He's got some sign language and some spoken word. He uses body language. And he also had some formal AAC tools through an iPad and some pictures. And so she did this beautiful, multimodal AAC, you know, kind of just understanding that intuitively, her communication house. But then she said, the way to enter my son's communication house is through engagement. That is the door. And so I asked her if I could use her lovely illustration. Because I really think this is just a lovely way to think about it. So just establishing that we're going to start with communication and then look at access and language. We can talk more in depth about the theory behind these three areas of this approach. But we found that really the best way to explore it is through these case studies, seeing it in action. So I am going to introduce you to Stella. Carrie and a former colleague of mine started seeing Stella when she was about two or three. She has cerebral palsy and pretty significant cortical vision impairment. And this is a video, not so much when she was, she's a little bit older here. I think she's probably in about second grade. But what she has on her lap is a tool called a step-by-step. And some of you might know with that, it's just a small communicator that has a single button. But you can record sequential messages. It's called, it's through AbleNet that you buy it, but it's called the step-by-step communicator. It looks very similar to another device called a one step, which is just a single message. But this one, Stella started using a step-by-step where she was really, we, we, we. Little one, I can sing songs, et cetera, but her mom is really great. And she loved, as she got older, she loved to give news, tell stories. But her mom is super creative and is always trying to find ways for Stella to be able to participate easily. And so she just sent us this little video of Stella getting ready to go out for Halloween. And that was it. It was just, I think it said happy Halloween and then trick or treat. So a super simple toy, or not toy, sorry, device tool for Stella to be able to go out on Halloween. It's not a robust communication system. It's not a lot of language, but her access is easy. And she's just able to participate using this step-by-step. Another way to participate that her mom got it, she got this idea from another parent actually, just a simple thing being able to blow out her own candles at her birthday. So she had a power link. There's a little picture of that. It's just an environmental control unit that is switch accessible. She plugged in the fan and Stella was able to blow out her own candles for her birthday. And we just thought that was a great fun idea to increase participation. And then for Stella in those early years, Carrie and my colleague were trying to figure out her best mode of access and switch seemed like it was going to be her easiest access. So she just started with doing a switch, adapted switch games on an iPad. You can see she's got one up on her head and they were sort of figuring out her hand use in these early years, doing an interface with the iPad and all game and playing. So she would have songs that she could sing. I think she probably had some of the big bang patterns that she could activate the iPad with just to work on her vision and just having those really nice CBI vision games on the iPad. So trying to figure out that access in those early years. And then also in those early years as they're trying to figure out, why is she going to do two head switches ahead in a hand? They started shaping just scanning through a yes, no. So the no would be no, not that one, no, not that one. And then she would turn her head to the right to indicate, yes, that's the one. So there's a little bit of language in this, obviously. But it's not a language system. It really is just basic choice making. So picking the toy she wanted to play with or the game she wanted or if they were singing, she might scan through and indicate what song she wanted to sing. So very and very errorless in the sense that all of it was her favorite and she loved and it was very engaging. So as she's trying to figure out this access if she didn't quite get the one that maybe she would have wanted to get, it's still going to be enjoyable. So there's not really any bad answer for her. In the meantime, though, we didn't want to just give her choices, right? We wanted to start on that language development. So just a partner assisted auditory scanning book was created for her. And this is just an example of two pages out of that book. So the top kind of panel is just the front page. It kind of just identified, I wanted to activities. I need something, let's do something that's more action-oriented. I think something's wrong, et cetera. And then for an example, for page two, if it had been I want to do an activity, then you would turn to page two and see what some of those choices for activities are. And so when the book was first introduced, it was just modeled for her. So somebody might say, still I have something to say. And as an example might be, I want, turn to page two, books. Let's read a book. And so it would just be modeled for her. And then you can ease her into sort of a partial scan. It might be, still I have something to say. I want, you go to the activity and then maybe she would scan and pick what the activity was. Or if you knew you were already singing and you modeled that, she might then scan through what song she would like, just through those yes and no's. So it's, yeah. This is a question from me. This looks kind of pod-esque. Did you use pod to kind of start to think this through? Yeah, yeah, yeah, it was, before we knew about pod, we had some basic just auditory scanning books that were kind of like this. And then I think at this point, we'd been influenced by pod. And so we kind of had a little more of some of the pod content in there. But yeah, yeah, exactly. Yes, because what you'll see that she then moved to after that very early book is this is actually an auditory scanning pod book. I got the template for this through the five day advanced pod workshop that I did. And I think it's available now in the UK. I think we're all waiting in the US still for this. Well, Australia has it. I don't know if there's any way. Yes, we're waiting with faded breath. Yes, we are. Yeah, I think I'd heard the UK might have it. But anyways, you know, we had this. So this is what she kind of transitioned into is this more formal, actual auditory scanning pod book. And again, there were more things to say in this book. So there was a lot of modeling and then she was given opportunities. But in the meantime, because she had started quite young and she'd been working on that sort of yes, no, she was getting really good at her auditory scanning. And pretty quickly moved into being able to use this book pretty robustly. So she's now has and she's still continuing to use switches. You'll see in these mid years, we actually set up an iPad through GoTalk now. But again, some we did some things that were just very mildly language influenced. Like she still she loved to tell jokes, but a lot of it was still just very fun based. So she Stella was somebody who really loved funny sounds. And so as just something fun access practice is she would be able to use. She was using at this point to switch step scanning to just go and like make funny animal sounds or I think she had a few other just like really entertaining things programmed on this GoTalk now iPad. And then she actually then started to shift from doing the two switch step scanning to actually doing really well with auto scan, which quite honestly, we haven't had a whole lot of kids who do great with auto scan, but that ended up being really good for Stella. She got really good at her timing and, you know, just wait for it. And then she used that right head turn to make her selection. So she started with this. And then today what she has is she continues to have a an auditory scanning pod book. She has her switch always mounted. She still uses the step by step a ton. She loves fun social interactions. We just saw her at camp and she used the step by step a lot with fellow campers. But she also went through device trials and she a PRC device was identified. She's actually working with a different speech therapist right now, but they were in contact. So they kept us posted that they identified a PRC device with the auto scan and it is ordered and hopefully on its way. I think there's insurance that slows things down here in the United States. I'm not sure if you guys have many issues up there as we do down here, but it's hopefully on its way. And she also now has a power share through all of this with her with head access. She's got, I think, proximity switches on a head array and she's able to drive her power chair and it is got all the components it will need to talk directly to her speech generating device. So that's where Stella is. And that's how those pieces all came together. She is now nine. So, you know, it's been a long journey for her. But through the whole time, her her parents and a lot of the people surrounding her were really great at making sure she always had opportunities to participate. She's had access to a good solid partner assisted language book for a long time. And then she's had a lot of time just to work her way through that access. And now we're at this place where she can be really successful with all these pieces coming together. All right. So another example is our friend, Weston. He also he has quadriplegic cerebral palsy. This is a little picture of him in the the bottom left with he and his twin brother. He has glasses, but vision is pretty good. We started seeing Weston when he was just about five and he is currently almost 12. And so he also like Stella loves to use the step by step. There was an app called Tap Speak Sequence that, unfortunately, is no longer supported in iOS. It does. I think developers doesn't exist anymore. But he loved to tell jokes and tease his dad, et cetera. But he also used this app that his school team found. It's called Teligami and it's an avatar app. And this was just an example of him being able to participate at school doing a presentation. So I'll play you a little clip of this. I'm talking for Weston. My report is about Hammerhead sharks. I picked Hammerheads because of the weird shape. They can get up to 20 feet long and weigh 500 pounds. Their skin feels bumpy and rough. They are gray on top and white under. So I'm going to play the whole thing, although I'm sure you're very curious to find out what Weston was telling you about Hammerheads. Anyways, this was a really cute idea. I thought of having this avatar so he could co-plan the presentation with his aide at school. And then it was a text-to-speech. They were able to get all the information he wanted in there. And one of the things I love about a tool like this, say in a school setting, is all the other kids thought it was really cool. So it wasn't the thing like, oh, this, you know, he uses that and that's strange. But like they loved doing it. And I think to normalize that technology as well, I think a lot of the other kids in the class were given opportunities to do presentations also with their own avatar. I mean, you know, not for every presentation, but once in a while. And so this, I thought, was a really great tool for some participation at school. I'm so for access for Weston, we were hoping for a little while that he might be able to do eye gaze. And so we weren't sure again, we started those eye gaze trials. And he tried so hard. He worked really hard, but it was just hard. I think he didn't it just didn't work out. And he told us eventually that he preferred the switches. I just think the ocular motor control was just not quite their head mouse was also not super great for him. And at this point, as he was going through these sort of, you know, different access sort of practice, and these were all again, game based. So we didn't have him, even with the eye gaze trials, we didn't put them on a communication device right away. But it was all just a lot of those great eye gaze games that now come with the on the SGDs. So he worked on them. They were fun, but it just ended up being really hard. And he was, you know, six, getting onto seven as he was going through this access practice. And as you know, with a lot of six and seven year olds, they are not terribly patient. So, you know, he was it was just too hard. And so he eventually said he really wanted to just stick with switches. So we got him set up on some switch games through inclusive technology that help kids learn. They have a lot of nice games, not as many for two switches, I would like, but it was a place to start. And so in this picture, we're just demonstrating, we were trying to figure out which switch access points were the best for him. And at the time he did really well with a left hand move and then his right hand to select. And at the beginning, right, just so that he wouldn't get frustrated, we held the switches so they were optimal. And if he just sort of initiated a movement, we would just make sure he was successful. And then once we kind of he got warmed up, we found that switch placement. We were able then to mount one switch. So Kerry's in the picture over on the right, where she's still holding the scanning head switch. But we were able to mount the select switch and then eventually got so we could mount both. And so one of the things we like to say for kids, if they're still, you know, if things are hard, we want to keep the access as easy as possible. Yes, it's not ideal to be holding switches. And we wouldn't want to do that for a very long time. But really given his age and the fact that he was at a point in his development where frustration, you know, he'd go from zero to 60 pretty quickly. We only wanted him to have really positive experiences with technology because that is another really important part is if we make things really hard or there's too many barriers and it gets frustrating. We do that video too long. Then the instead of seeing the technology as a tool that will empower him, he will see it as work and sort of a source of frustration. And we really didn't want to have him burn out on that technology. So we just made it as successful as possible. He had lots of fun game practice with this. Kim, can I ask this against me? My question is, so, excuse me, did he come in to do this with you for a certain amount of time? Did other people hold the switches for him or was it only you guys that how did how did this work? Yeah, and just to clarify, it's not that we had to hold them for very long. This was sort of like this was like a new activity. We were trying to find the position and he actually lived about an hour and a half outside of Portland. So he would come into us for consultations. We do like maybe little intensives, but then we would really talk to his school team and kind of then they would kind of do it on a more regular basis. So this was really just to kind of get him set up or sometimes let's say, you know, success. Yeah, and maybe school was on break for a while and they have to like get the ball rolling again. They might just start in this successful way, but it did not stay there for very long. Okay, cool. Not a potential thing to do. Yeah, thank you. So in the meantime, Weston has had a lot of language in his brain and so we made him a 20 cell pod book, just a traditional visual pod and he, you know, he learned it really quickly and was, he's a really great scanner with partner assisted scanning. Just using a yes, no, you'll actually see that coming down the pretty soon in one of the videos. But so he had his pod book through all of this and really we did not wait on the language, but he still had all those participation tools. But the access is what sort of took a little while for us to figure out. And then those pieces with that practice came together and he a few years ago got a smart box grid pad 12. I don't know if smart boxes in Canada are not. But they the grid software is. Yeah, good. People have access to good software here. So yeah, so he's got a grid pad 12 uses to switch steps can he has a power chair and he ended up not using the head in hand but ended up through access and then some of his driving practice to switch heads scanning using a left and right head switch ended up working well for him. He continues to have his pod book he also uses a lot of other apps and he loves the step by step again that one app tap speak sequence isn't supported anymore but and he uses a lot of just spontaneous auditory scanning with his verbal yes and no, and he does have words as well. So can I so you said he continues to have his pod book is that the case for the other little girl to that, along with the electronic system does she continue to have the pod system. Yeah, because as, as you know, there's times, you know, like, if you're a switch scanner and you're not your chair, right, you know, have access to switches. You still need access to your words, or, you know, things you run out of battery power, there's a glitch, or sometimes, even just having like your fatigue, and you just, you know, using the switch is so much harder than just having a partner, I'm going to be able to support you with the scan. In fact, I'm going to show you this video. This is Weston and his mom and brother at home, and he they have his speech generating device, but I'm not sure exactly why if he's just fatigued or there's some reason he's not hooked up to his switches, because access is still he has a lot of tone and it can still be challenging. So it's good to remember that it's not an all or nothing like once you get your SGD it always has to be independent on switches. They're actually using partner assisted scanning, but using his device. So here you can watch that video. Do you have something to say? Yeah. Yeah. Okay, chat. Is it chat words? Greetings or manners? Yeah. Greetings or manners? No. No. Chat words? Yeah. Okay, let's go back. No, I put on chat words. Okay, is it in this row? Yeah. Me, you? Uh oh. No. No. No. Hello, hurry up. Wait a minute, stop. Yeah, hurry up. Yeah. Is it back in towers? Are you telling me to hurry up? Yeah. Yeah. So I love that video because, you know, his mom is, they're thinking so much about the skin and, you know, she's got the video and then it dawns on her. So anyways, so Westa has his speech-generating device, but also because access can be difficult or fatiguing at times, or it could be at the end of the day, you can also use the speech-generating device in a partner-assisted scanning way. And then he does have some word approximations. You can hear he's got some pretty significant dysarthria, but he definitely has some words, and he's a fabulous scanner. Yeah, and just has a really nice multimodal system right now. That was what I was just gonna say. He's a true example of total communication, right? Exactly. Okay, so now Carrie is going to introduce you to Julie. She's known Julie since she was about two years old for most of her life, and she's 20 now. So I will let Carrie step in and talk to you about Julie. Okay, so here's Miss Julie, cute as a button. So very early on, like Kim said, when she was two years old, we started right away with participation. And so she used that step-by-step right away, singing songs, making funny sounds. She had some gestures. She had a really nice high hand. When someone come in, she could wave her hand. So early on, we just wanted to make sure that she was participating and kind of being part of the world. So Julie has the diagnosis of schismcephaly, which is a brain disorder. She also has cortical vision impairment. So we knew early on that access is gonna be challenging. And it wasn't clear if she was gonna be a direct selector using her finger to point to symbols or on a device, or if she would need to be a switch scanner. It really wasn't clear and access was challenging. So in the beginning, we just tried different switch games, just kind of getting her used to the idea of indirect selection using switches. She continued to work on her fine motor and visual motor skills and occupational therapy using her hands and eyes together. In the beginning, we didn't know. So we just kind of worked on these different access activities, but just very fun. And we weren't laying on much language really while she was practicing her access. And then if we had had the iPad, this was pre-iPad and pre-tablets, this would have been a fantastic app for us to try. And we use this a lot now. So some of you might know CanTunes. It's made by the University of Victoria. It's a free app to access music. You can set it up here. We have it set up with four different music CDs that pull from your iTunes account. You could set it up with six. You could set it up with two. And you just tap the circle and then the music starts playing from your iTunes account. And it's a really great way for someone, a child to practice using their finger for targeting, getting that idea of, you know, if I touch this, something happens. You can also overlay it with a key guard and have a custom key guard made for, you know, again, two, four, six. I think it goes up to 12. So this would have been great if we had it at the time. We didn't, we're gonna kind of practice that visual motor tapping in a fun low pressure activity. So for her language, we knew access was really hard, but we worked with the school team a lot. We wanted to make sure that really early on, Julie had access to learning about symbolic language. The school made her picture symbol book with just tons of pictures in there. And because of her cortical vision impairment, she would pull off a symbol and hold it really close to her eyes and study it. And then she'd throw it, but she was learning, again, that this symbol means something. And she was learning a lot of these words. And she had this huge book and she loved to study all these pictures. And over time, she started to learn a peck system. So picture exchange system where she would pull one off and then she was learning to hand it over to somebody. Sometimes it would still go flying, but she was learning that system. And in the meantime, she was kind of building her repertoire of signs and gestures. She didn't have a lot, but she had some and she had some verbal approximations. So as she got a little older, her visual motor skills started to improve. Her vision got much better where she could actually look at something a little bit more of a distance and she didn't need to pull it up to her eyes. And when she was young, if she went to use her hand to touch something or activate a toy, she often looked away with her eyes. It was just too much to use eyes and hands together. So as she got older, she was able to use her hands and keep her eye focused on something. So at school, she was going through trials with a Dynabox and eventually was able to get a Dynabox system. Six Cells was the most that she was able to access and it had a key guard on it. So mom came up with a great idea of making a light tech book that was the same as her Dynabox with the same pages. And she cut out a foam board key guard overlay on every single page because her access was so hard. She still had her pull-off symbols that she could study, but as you can imagine, those symbols go flying. So really over time, the goal is to have not pull-off symbols, but just a solid page. And so mom came up with this idea of making a key guard for each page so Julie could feel where the border is and then she could point to what she wanted. She was still using her step-by-step all the time to participate. Once the iPad came out, she started getting some fun apps where she could practice swiping and tapping and really getting that visual motor practice. She still had some gestures, her vocalizations. She had a few vocalizations over time that got harder. And then here she is at 15 years old and things are starting to come together. She's got a real multimodal system here. She's got her book with the key guard, the foam key guard mom made. She's got a Dynabox speech generating device as Kim mentioned, the Tap Speak Sequence app isn't supported anymore, but it's essentially a step-by-step on the iPad. She used that a lot. She had call buttons around her house that were next to the bathroom that says I need to go to the bathroom or one by the back door that says I'm gonna go outside. And when she was around 13 or 14 years old, we were able to start to work more on this auditory scanning using her yes-no. It really took that long. She had some yes-no up until then where she would tap a yes-or-no symbol, but she just didn't get the idea of scanning through a list until she was about 13 or 14. And now she can do it. She can scan through a list of things. You know, what do you wanna do today? We could go outside. We could play with toys. We could read a story or something else. And for each one she can say yes or no and actually scan through a list. She still primarily uses her Dynabox or her communication book, but sometimes if there's something that's not in the book or in her device, mom can scan through a list with her or her teacher can scan through a list. So, Carrie, I'm just gonna ask you. To me, this says don't stop before the magic happens, right? Like it takes some of our kids a long time to get there. And that's a really great example. So, thank you. Yeah, absolutely. We always say, you know, we're in it for the long game and you're laying that foundation sometimes for years, but you're not waiting for access. You're exposing to language right away. And first and foremost, participation, starting right away to be part of your world. But yeah, for it all to come together, it can take a long time and that's okay. I'm glad you pointed that out. And she also had a seizure disorder. And so far, Julie, you know, there would be times where she would kind of lose some skills and we'd work back. So, you know, our kids, they have lots of things going on. Take a little break. So today, she still has access to the book that mom made with the foam key guard on the pages, but now she also has a more robust pod style book where mom really wanted her to stick with this six cell layout, moving maybe towards a nine cell layout, but instead of having the key guard, she now can have a flat piece of paper. She has tons of pages in her pod book and she can use this quite well. She's got her Dynavox with her key guard on it. She's got her call buttons. She can do her auditory scan. So, like you said, true total communication here. And then for her Dynavox, mom is great at programming pages, keeping them up to date. They are out in the community all the time and at school. And so she's really got a nice multi-motive system here. So, we'll kind of pull it all together and do a quick recap here. Panel approach, as Kim said, with the communication house, engagement is the key into building communication and starting with that engagement. Start with participation immediately day one. What's a way that your student can start participating in activities in the classroom or at home? So, start with participation immediately. And then when writing your goals and thinking about your goals, oftentimes we wanna pack a lot of things into a goal, but really thinking about what is the focus of that goal and keeping the access and language goals separate in the beginning. Sometimes we'll layer those on together and we recommend keeping those separate in the beginning, working on your access over here, fun activities, and then having your language all over here. And when you're working on access in the beginning, just like with Weston, keep it fun, errorless so you're having positive experiences with technology and can't wait for language. Gotta start that language right away. So, I'm gonna hand it over to Kim for questions, discussion, there she is. All right, so yeah, so that's the basic framework. Like I said, next session, we'll actually dig into some of those tools and get a little deeper with them, but any comments, discussions? There are a couple of questions that I'm gonna open it up again so people can do this, but, and this is kind of a question that I had when people have a DynaVox, does it mirror their pod book? I saw you using kind of multiple systems, the pod plus a lamp, although that wasn't, or not lamp, it was unity. Yeah. Yeah, so talk about that and how do you feel about whether these things need to be, how much the same do they have to be before kids can really navigate across? I know I have my thoughts, but I want, you're the top, you're the speakers, so what do you think about that? Yeah, so as an example, like Weston, he was very used to his pod book and so one of the reasons we went for the grid pad was because it did have the pod software, so he could really transition, he knew the organization of it, so that was really very seamless. Julie is an example, she actually, when some of her systems were developed, it was before we knew about pod, before pod was in the US, so she kind of has gone through a little bit of a, a piebald morph of a few things, but she amazingly can switch between her modalities and she knows, you know, with my device, it looks like this, with my book, it looks like that, it's really amazing how she's pretty flexible about that. I feel torn because I would say a couple of years ago, I felt more of the mind that they really should be like close to the same or, you know, the same and I still think that is obviously, there's less to learn, right? If you know the organization, et cetera. That being said, I think once you get to a certain level of maybe having some stronger linguistic skills and you might actually be able to access those core words a little more, that you might be able to change your organization either through your light text, so it's tricky because pod has a robust amount of templates for a light text system that can kind of grow and change. Electronic devices are, you know, there's the pod 15 cell that's very much like those sort of earlier pragmatic books, but then you jump the next, if you get to the more linguistic, you get to 60 cells. So from an electronic pod standpoint, it's really hard to, you know, especially if you're a scanner, it's hard to find, you know, some of those bridge user areas. And so really it's sort of working between the school team and the family and the child. And when you do, as their access is getting ready for a speech generating device, it's really kind of looking at all of them and seeing what ends up being the best next step. I don't know if that really answers- I think that's brilliant. And I guess I will just sort of say that, you know, kind of like you, I kind of see the pod on the iPad or the pod, yeah, not quite there, it's not quite there. However, I wonder if your approach about focusing on language and what you said about these kids that have more linguistic language capabilities can switch because we can switch because we have language capabilities, right? So I think that that privileging of language through the low tech system or I, oh, you know what? I told people that I was going to pinch myself every time I said low tech and non-electronically, I'm not going to pinch myself right now. It's important to recognize, as you guys do, I believe the power of a non-electronic system and what that can do for kids. Yeah, anyway, so any other questions? Oh, can I just say one thing, continuing this conversation, an example is another boy who actually, we could probably talk about like a gazillion case studies, but there's one little guy where we should probably get his up here because he's a little bit different. He ended up being an eye gaze user and he did the same process with us, the PAL approach, but he, because his access and his sort of linguistic knowledge was like everything was much more fast-tracked, and the whole thing was like it happened over a much shorter amount of time and he is like now in second grade, I think, and he's already like doing great with spelling, so he's probably going to be a text-to-speech communicator. And he definitely, from an electronic standpoint, outgrew the sort of pod layout and absolutely is a core kind of word communicator now on his electronic system. Yeah. And then Julie is somebody, she took a much longer time and she is just the kind of young woman who if her mother had not been as dedicated to sort of doing the long haul, she's just the kind of a kid who somebody would absolutely underestimate what the possibilities are. And even with lots of challenges, she is an amazingly flexible communicator going from system to system, like really phenomenal. So one of the comments here is so very impressed how your examples truly emphasize how many different ways we can communicate truly multimodal. And I think that's clearly shown in your examples. And again, I'm just gonna say how, and this is just sort of self reflection is how I start, you know, step by steps, blah, blah, we don't really need those anymore. Yes, we do because kids need to have that participation while they're developing language and getting their access. So all of the things that you guys are talking about is so important. And again, that you can focus on them separately while bringing them back together. So I continue to be a fan of your systematic approach to doing that. So I'm gonna say one more time to folks. Any other questions that you have before we let these ladies go for this month and then we will bring them back to learn more and hear more next month. So questions, comments, thoughts? I'll wait if you're looking at the chat there. I'm just gonna make one comment about an adult we know who's now 30 with Syrup and Palsy, actually switch scanner on a PRC device, uses a lot of partner assisted auditory scanning. He has very, very difficult access to this day. And when Tap Speak Sequence worked, he absolutely wanted to use it as an adult. He would want to like, I think he had a volunteer job where he wanted to be able to just go in and ask a couple of like volunteer related questions. He and it was never foisted on him. It was something that he requested. So I think just honoring as our, children turn into adults is really just honoring what their own preferences are within that multimodal system. And different partners in different environments and contexts will make some tools sort of more efficient and powerful than others. And just sort of keeping an open mind about that I think is really important. Lovely. So here's a couple more things that have come in on the chat. I love the systematic approach that you take. Thank you very much. Great session. Anyone have a favorite, a single switch call button cheaper than AbleNet products? Okay. So it depends what the use is for. If it's like a, like a, you know, a call button like by the back door, like I want to go outside if it's kind of thing. They're, I don't know if they still have them, but we used to like these ones called talk blocks. And they're these square, big square blocks in different colors. Put a symbol in them. You know, I looked recently, I feel like they were hard to find online more recently. I agree. Yeah. A lot of the things that used to be happening from in our world, Radio Shack and some of those things just don't exist anymore. Right, right. Is there another one you've got there, Carrie? Talk blocks. I'm just looking. I'm just looking by them. Oh yeah. Yeah, you can buy them. Oh, they're still available. Okay, maybe it was just at a stock, but the talk blocks are still, what's a hundred bucks, a five pack? Right, right. So this is, they're a hundred, but you get five of them. Okay. So there could be other ones. Yeah, yeah. I wanted to say, yeah, and then there's other ones through attainment company, but they just, depending on which one you get, they can be a little more tricky for access. Sometimes you need like, they're a little bit stiff and you need like more of a finger or, but those ones are cheap, but yeah, I think their access is not quite as good. And Diane Hall from Calgary says talking bricks. Yeah, those are also able net, the talking bricks, but those are a little, I think you pulled it down. Yeah, yeah. And they're great too, but they're not super cheap though. The only thing that's different though, say versus the step by step, I'm not sure if this is, is none of those ones can be sequential. So it's just a single message. Right, one message, single message, yeah. I have a dream to work with just like some young engineer makers and see if they can't do a cheap version of a step by step for us. I'll keep you posted if we're ever successful with that. All right, you got you. We got that recorded. Okay, so I'm gonna say thank you very much. And Wendy's reminding me to not forget my announcement, which I won't forget. These are these wonderful folks here. And I'm assuming that you will be happy to have questions, but we have them back in a month. So please come back because I think this has been great. And I hear from lots of you that you think so as well. My announcement is, we've talked a little bit about POD tonight and the POD-S kind of sessions is that we're going to be doing in Edmont, well, POD in two places. POD training with Laura Stevens in Calgary in March. And in Calgary, I'm looking at my calendar. Laura's going to be doing sessions on the 14th and 15th of March. And then she's going to be coming to Edmonton on the 17th, 18th to do a two-day POD and then the third day, which will be extended access. So I will send that out to everyone, but I think basically, based on what we've talked about tonight, lots of people might be interested in that in terms of thinking about building language while we're thinking about participation, while we're trying to figure out access. And so I'll send that out, as I said, as an email, but I thought it kind of worked with tonight. So what I'm going to also say as we close is thank you very much, Kim and Carrie. This has been a great session. People are very appreciative. It's always really positive to hear those real cases and those real kids. And it's also, I think, continued, I continue to think as I did when I say last month that, or last year, sorry, that it's important for us to be systematic in how we think about these different areas and your approach really helps us to do that. So thank you so much. And I look forward to seeing you in February. Great, thank you, everyone. Good night. Good night.