“My arms weren’t long enough anymore,” my friend said as she pulled reading glasses out of her purse during dinner…to my dismay.  Why was I dismayed?  This was a very concrete reminder of the aging process to which none of us is immune as much as we might try to be.  Her statement also made me smile, however, as I remembered myself as a young clinician placing therapy materials including AAC books, boards and devices at what I thought was the “appropriate” distance from my patients only to have them push them away about 12”.  

Changing position of the AAC device in relation to the user is an appropriate and easy strategy for those patients experiencing visual changes due to aging (presbyopia).  However, we know that neurological events such as stroke or brain injury can result in other types of visual perceptual issues that may impact an individual’s use of AAC.  

Note:  Consult your physician regarding diagnosis of visual issues following a neurological event.  Consult your medical/clinical supports (physician, speech-language pathologist and/or occupational therapist) to assist you in selecting compensatory strategies.   

Below, I have shared some visual characteristics which might be considered during the evaluation and implementation process for both light tech and high tech AAC when an individual demonstrates visual perception problems.  Modifications to these characteristics can be helpful in addressing visual issues as well as reducing the cognitive load on the augmented communicator.   I have noted how these considerations have already been addressed and/or how you can modify them in many DynaVox devices. 

• Type of symbol – Lasker, Garrett and Fox (2007) suggest that a more realistic symbol may be beneficial for some individuals. 
  • Options as to the type of symbol used to represent vocabulary are already available in DynaVox devices.  In the V/Vmax devices, pages containing photographs (digital images) are part of the page sets.   New, thin-line, more realistic PCS symbols have been used in the Xpress and can be downloaded for use in the V/Vmax.
  • Visual scenes, used in DynaVox devices to establish context and leverage use of other communication modalities, take advantage of the contextual/situational knowledge and experience of individuals with acquired communication impairment.
  • Photographs can easily be uploaded to many DynaVox devices.  Visit the DynaVox Knowledge Base, type in “photos” and select the device that you have to see how to do so.
• Number and size of symbols may decrease visual complexity of the display
  • Pages sets different in number and size of buttons are an integral (and existing) part of DynaVox dynamic screen devices.  Buttons can be hidden on dynamic display devices without removing them providing the option of showing them again in the future without having to reprogram.  Find information on this in the DynaVox Knowledge Base by typing in “hiding buttons” and selecting the device you have.
• Space between buttons may decrease visual complexity of the display
  • Page sets and templates for new pages already exist on DynaVox’s dynamic display devices.  Modifications to the space between buttons on each page can be made by decreasing the size of existing buttons. A new custom template can also be made.    It should be noted that this is beyond basic customization.  If this is necessary, discuss who will do it and how it will be done during the evaluation process.  The Knowledge Base will certainly be helpful in completing this customization.  Search for information on creating and using templates as well as pouring contents from one page to another. 
• Color of symbol background, color/width of symbol borders, font size and style may assist in increasing focus on symbol and readability of font.
  • All of these characteristics can be modified on DynaVox’s dynamic display devices.  Again, check the Knowledge Base for information on making these modifications. 

 Remember that modifications to these visual characteristics should be made intentionally based firmly on the needs of the augmented communicator. 

 In my next installment, I will highlight some of the specific visual issues which may affect use of AAC following a neurological event and a few strategies for addressing them.  

 Reference:

Lasker, J., Garrett, K., and Fox, L. (2007).  Severe Aphasia.  In Beukelman, D., Garrett, K. & Yorkston, K., Augmentative Communication Strategies for Adults with Acute or Chronic Medical Conditions. Baltimore: Brooks Publishing Co., pp. 163-206.