Total Communication

This blog post contains extracts from a message that I posted to the CM-AAC-Forum in 2009, as one of many contributors to a lengthy discussion about "Icon V Text Based Communication Systems". This was was one of several branches of a discussion that was originally about word prediction software.

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The question, "How long does it take to learn to use a MinSpeak-based system?",  is just as valid for any other AAC system, but there is a particular reason why I am concerned about the MinSpeak question.  This is that I have been quoted as reporting in 1989 that it took 200 hours of direct therapy to teach a cognitively intact adult to use a MinSpeak system fully.  I was a bit baffled by this as I did not recall ever have said any such thing and could not imagine where this "fact" had come from. 

I was reminded of this issue when @SpeechReka recently tweeted a link to the marvellous SCOPE resource, "Supporting Communication through AAC", so I dug out the old CM-AAC-Forum email discussion.

So, to correct the facts. . .

Having Googled around a bit, the earliest citing of this misinformation I could find was in Module number 2 in the package “Supporting Communication through AAC” published by SCOPE:

http://www.scope.org.uk/help-and-information/communication/aac

There is an FAQ's section in Module 2 and the relevant Q and A are as follows:

The correct facts are found in a paper titled "Modified Word Strategy and Acquired Dysphasia" (Panton, 1989) in the Proceedings of the 1st UK MinSpeak Conference, 1989, UMIST (see link to copy on Scribd at the end of this post).

This presentation is about a young adult man (DF) who had a very severe stroke that left him without speech and with some significant cognitive and physical impairments. Although he had "full langage and was an experienced communicator" before his stroke (not "accident") he had very limited language after the stroke.

However, he retained better than average visual memory for some things (but not words or letters) and better than average mathematical skills (he had been about to start a PhD in robotics when he had his stroke).

My first contact with DF was about 6 months after his stroke, when I taught him AmerInd over a period of several months (American Indian Handtalk - not as daft as it sounds as it is meant to be "guessable" by people who have not come across the signs before). About three years later, I worked with him using MinSpeak for 20 hours (twenty - not 200) over 28 days. This involved me in 40 hours of preparation over that period and he also worked enthusiastically at home for several hours a day. This is the therapy referred to in the SCOPE AAC FAQs.

Therefore, this conclusion in the SCOPE FAQ paragraph is still true, even though the facts cited to support it are not:

" . . . we must accept that learning to use one of the symbol based VOCAs will be a lengthy business for any child, particularly those with additional disabilities. This has particular implications for service and support issues."

It seems likely that the reference to 200 hours and a cognitively intact adult should have been attributed to a presentation by Bruce Baker in 1988 at a Minspeak Seminar, in which he described the development of the Word Strategy Minspeak Application.

The outcome of my period of trial therapy with DF is also relevant to the "choice" question originally posed on the CM-AAC-Forum, ie. Icon-based verses Text-based AAC Systems.

DF had previously made very limited use of a nifty little QWERTY device called a Sharp Memowriter. He liked this because it looked good but he was dissatisfied with the fact that he could do so little with it. In the period of trial therapy described in the 1989 paper he learned to make far more use of the TouchTalker with modified Word Strategy. This success was still very limited, but a vast improvement on what he could manage without the TouchTalker. 

Use of a VOCA in therapy (not in "real life") also had a dramatic impact on his insight into his own language problems, on his strategies "in real life" to successfully compensate for them and on his increasingly sophisticated use of AmerInd.

The main benefits of the intensive therapy were NOT that he learned to use MinSpeak to communicate effectively but rather the impact of a form of communication and language therapy that used modified WordStrategy (MinSpeak) on a VOCA and "dialoguing" as therapy tools and methods. There was also a very unexpected down-side:  

"The trial was successful in that gains in functional communication were made and DF demonstrated that he could manipulate lexical items to produce appropriate, grammatical sentences in a highly structured therapy task. That this frightened and distressed him was unforseen and is an eventuality that is maybe specific to DF, perhaps analogous to the threat fluency presents to some long-term stammerers or maybe represents the challenge of coming to terms with an acquired disability."

In terms of other studies about the time needed to learn MinSpeak-based systems, there might be some among the electronic copies of the US MinSpeak Conference Proceedings here: http://www.minspeak.com/users/MinspeakAroundtheWorld.php

The UK/European Proceedings are listed on that page but have not been uploaded yet. Perhaps someone at Liberator could have a root around the Minspeak archives in the UK to see if there are any studies that could provide some data on this?

I have scanned my original paper, using Optical Character Recognition to produce a file of a manageable size, as the methods and findings might still be of use to others. This copy is on Scribd:

Modified Word Strategy and Acquired Dysphasia Liz Panton 1st Annual UK Minspeak Conference 1989