Another communication interaction skill that frequently arises is the issue of intentionality. While there are no prerequisites that a student needs to acquire before being considered for a communication system (Blackstone, 2006), some students may need to be taught skills and strategies that make communication meaningful such at pointing, gazing, turning towards a partner or vocalizing in response to stimuli. Sometimes our first “communication lesson” is to teach a student the connection between their actions and the response they get from the environment (including communication partners).

Access

Access refers to how the student will physically operate the system. This can range from a student selecting the desired message (direct selection) to using 1 or more switches to scan to the message and then selecting it (indirect selection). Direct selection can be achieved using a body part such as hand, finger, foot, head, eyes or by holding a “pointer”. Many students prefer to use a direct selection approach even when they have physical limitations. Keyguards can help students isolate messages/symbols/keys visually and physically. Many devices come with a variety of keyguards depending on the size or number of messages on the overlay or they can be customized for a student. School district tech classes are a great resource for making custom keyguards out of Plexiglas.

Eye gaze is a system where objects, pictures, words, letters or symbols are placed in such a way that the student can communicate by looking at the desired item. In low-tech eye gaze systems, the communication partner is positioned so they can see both the target and the student’s gaze. Depending on the student’s ability to visually track, scan, control head and/or eye movements and hold their gaze, the adult may have to make accommodations such as holding symbols/objects loosely by their face and moving them apart so the student can “follow their choice”. Another low-tech strategy is the 3-point eye gaze system in which the student looks at their partner to signal that they are ready to select a message, looks at their desired choice, then returns their gaze to the partner to indicate the final selection. Additional considerations are whether the student will be moving to a computer based eye gaze system where they need to learn to “dwell” or maintain their gaze on their choice, so need to keep a steady gaze on their selection. Regardless of the system, it is important to remember to: place frequently used messages in the same location every time (to increase motor automaticity); accept the student’s first response (don’t ask again just to confirm the message); as soon as possible give the student an option of saying they don’t want any of the choices (“something else”, “not here”); and to be flexible depending on “good days” and “bad days”.

Low-tech eye-gaze system (Burkhart, p 1993). Used with permission.

Computer-based eye gaze systems use a camera to “read” the student’s eye movements and select the message based on the length of time the student’s eyes dwell or stay on a message. A “head-mouse or Head Pointer” system is different from eye gaze. The student wears either a reflective dot on their head or glasses or some type of “head gear” affixed with an infrared transmitter. Using wireless technology, a head mouse translates the movements of the student’s head into movements of the computer mouse pointer or is recognized by the AAC system. The head mouse system integrates with “dwell” technology so that when the student maintains their “point” on a target for a specified length of time, it is interpreted as a mouse click or direct selection. It can help to train a student to “nose point” to their desired choice in anticipation of a head-mouse system.