PROVIDING THE CHILD WITH A MEANS TO INDICATE

Importance of selecting the right technique

Points to keep in mind when reviewing existing techniques

Scanning communication aids - a brief introduction

In less formal terminology, a technique is considered to be a scanning technique if the items in the child's vocabulary are presented to him one at a time so that he can let you know when the item he wants is presented. The simplest example of a scanning technique would be the familiar "yes/no" guessing technique (see Fig. 7a). With this technique, a second person would simply Present choices to the child such as "You're thirsty?" "You're hungry?" "Does something hurt?" "Do you have to go to the bathroom?" etc. When (and if) the second person reaches the desired message, the child will signal in some manner, such as smiling, looking up, or by using some other pre-arranged signal.

Another example of a simple scanning technique (see Fig. 7b) would be the use of a communication board with a second person pointing to the pictures, words, or letters one at a time while watching for a response from the child. Figure 7c shows this same technique, automated somewhat, so that a rotating arrow does the pointing for the second person. With this aid the child signals the aid directly when he wants to stop the arrow. To signal the aid he could use some kind of switch which is specially fitted to take advantage of some movement over which he has good control. For the child who can spell, this technique could be automated even further so that as he selects the letters, the aid would automatically print them out on a typewriter or other device. (Fig. 7d) If the child is completely non-vocal, it would be highly desirable to have a communication aid which could move around with him and function as his "voice," if you will, as he moves around in his environment, in school and at home. For this purpose a portable aid such as the one featured in Figure 7e could be used.

The most significant thing to notice about the scanning technique is that it is extremely powerful. By powerful I mean it can be used with individuals who have only minimal control. If you can recognize a child's "yes" (or an affirmative signal of any form), you can use any of the non-mechanical techniques, no matter how severe the child's handicap. By the same token, if the child has a reliable and recognizable signal, it can almost always be tapped, using a special switch of some sort, and used to control the mechanical or electronic types of scanning aids. Anything from a gross motor movement to a muscle twitch can be detected and used as a control signal. The price that is paid for this power, however, is speed. Because a lot of time is spent presenting unwanted choices before the correct choice is arrived at, communication with this technique can be quite slow. There are ways to speed up the selection process using the scanning technique and these will be described a little later.

Figure 7. Examples of techniques using the scanning approach: a) Yes/No guessing; b) manual scanning of communication board; c) rotating pointer communication; d) printing communication board using Row/Column scanning; e) portable printing communication aid.

Encoding techniques and aids - a brief introduction

The best way to clarify this definition is to look at some examples of encoding techniques. One very simple technique would be to arrange the letters of the alphabet in a matrix (see Fig. 8a). The child could indicate which letter he wanted, such as the "L," by pointing to the number 3 and then pointing to the number 2 to show that he wanted a letter in the third row, second letter across. An example of a simple encoding technique which could be used with a child who can only control his eyes is shown in Figure 8b. With this technique, the child would indicate which picture, word or letter he wanted on a vocabulary chart by using his eye gaze to indicate the numbers which are printed next to that picture, word or letter.

Once again, many of these encoding techniques could be automated. Let's say we have a spinal cord injured person who has fairly good control of his upper neck muscles. These muscles could very easily be monitored so that by simply tensing them he could send out Morse or some other code. This code could then be decoded by an aid and displayed so that the average person could see what letter he was trying to indicate. Figure 8c shows an aid which is controlled by shoulder shrugs. The message receiver would only have to watch the display to see which letters appeared, to determine what message the individual was trying to communicate. These techniques could also, of course, be fully automated so that the letters would print out directly onto a typewriter or other display. (Figure 8d)

Figure 8. Examples of techniques using the encoding approach. a) Two movement encoding with number line; b) two movement encoding using eye gaze; c) Morse code decoder/display being controlled with shoulder; d) Morse code decoder controlling typewriter.

The encoding technique is generally faster if the individual has some form of quick motion, or if the individual is able to point directly to a moderate number (eight or so) of different squares or switches. For the individual who can operate only a few switches and whose movements are slow and erratic, (as may be found in some severely athetoid or spastic cerebral palsied children) the encoding approach may be very slow, even slower than scanning. The specific abilities of the child must be taken into account before a comparison of the approaches can be made.

Two other aspects should be noted about techniques that use the encoding approach. First, this approach often requires more responses and thus more work from the child. This may be good or bad, depending upon how quickly the child fatigues and upon his physical abilities. Secondly, the encoding technique is more abstract than the scanning approach (where the choices are more directly presented to the child) and for very young children or children with cognitive handicaps this may present a problem. However, people who have implemented various encoding techniques have found that children pick them up much faster than originally anticipated, Later we will be discussing ways that can make the encoding technique fairly straightforward and easy to handle even for the child with limited cognitive ability.

Direct selection techniques and aids - a brief introduction

The Direct Selection Approach

Any kind of keyboard, including those that are expanded, guarded, or otherwise modified (Fig. 9c) would be examples of direct selection aids. Direct selection techniques can, of course, be used in portable, printing communication aids as well. (See Fig. 9d)

Figure 9. Examples of techniques using the direct selection approach. a) direct indication; b) pointing communication board; c) expanded, recessed keyboard; d) portable printing communication board.

Figure 10.

Unaided techniques

Fundamental aids

These techniques, however, do have a great advantage in that they are readily available to the teacher in the classroom. Most of the aids can be very easily fabricated by a teacher or by a local handyman. Their construction doesn't require any special kind of expertise as they generally don't incorporate any moving parts or electronics. It is only the amount of time and effort on the part of the second person to use these aids for communication that keeps these aids from being used on a more widespread basis and from fully meeting the communication needs of many of the children.

Simple electronic and mechanical aids

Because the child can (with the aid) directly indicate the letters, pictures, etc. which make up his message, very little knowledge of the system is required on the part of the second person. For this reason, the handicapped individual can generally communicate with a much greater number of people using this aid than he could using the simpler aids. Although the amount of work that has to be done by the message receiver is greatly reduced by using these methods, the undivided attention of this person is still required. This continues to be a problem if the child's message is more than a few words long or if he wants to partake in group conversation or do independent work.

Fully independent aids

Many of these aids have some sort of printer, typewriter, or television display. With these aids, the child is given not only a means of communication, but also a means of writing. This becomes very important if the child is placed in any kind of educational program. If the child is going to be held responsible for practicing his lessons, doing homework, independent work, and taking tests, it is necessary for him to have some means of writing without requiring the constant attention of a second person. This becomes even more evident when it is understood that a simple three-page book report can take between seven and twelve hours for someone to assemble, even if the child is using a letterboard (a relatively fast communication technique).

Fully independent and portable aids

IMPLICATIONS AND ADVANTAGES OF THE VARIOUS LEVELS OF IMPLEMENTATION

Another restriction, which hopefully is a temporary one, is that children are often not able to acquire the aid which is most appropriate for them due to financial restrictions. As you move down the chart the cost of the aids goes up rapidly. Aids in the fundamental category generally run from between $5 and $50 if you make them yourself, or from between $10 and $150 if you were to buy them as commercially available aids. The next level, simple electronic and mechanical aids, would generally run in cost from $50 - $100 up to about $1,000. Fully independent aids run anywhere from $1,000 - $7,000, depending upon how many accessories and different printouts you want with them. Fully independent portable aids cost about the same as the stationary aids. It generally costs more to make something portable, but then you don't have to cover the cost of adapting a typewriter. For those aids which are portable and can also be hooked to a typewriter the cost usually runs around $1,500 extra for a typewriter or TV display as an additional accessory.

Part of the reason for the high costs at the present time is the large amount of demonstration and information dissemination that must be done in connection with selling the aids. As these aids become more and more widely known and used, these "missionary" costs will decrease along with production costs, You can, therefore, eventually expect to see a decrease in the cost of the aids. Unfortunately, the number of aids that will be sold will never reach the scale of the pocket calculator and so you shouldn't expect the price drop you've seen in the calculator industry. Instead I think that we should be looking for a solution to the cost problem through either legislation or awareness activities at the school administration level. Although the cost of the aids seems high when looked at in isolation, what is not seen is that it would cost from $4,000 to $8,000 a year to provide a child with a dedicated "second person" to interpret his messages and allow him to do independent work so that he could participate in an interactive classroom situation. When compared to the $400 cost of even the more advanced aids ($3,000 divided by 10 years = $300 plus $100 maintenance = $400/year) the cost of the aids does not seem nearly so high. The cost of the aid can also be compared to the $1,500 to $2,500 per year (or even $25,000 per year in hospital school settings) that is already being spent to place many of these children in educational programs in which they cannot really effectively participate. Independent aids, therefore, seem to be not only necessary and appropriate for many of these children, but also cost effective. I'd like to restate here, though, that we should remember that the advanced aids are not going to be appropriate for all children and that it is often better to start the child out on simpler aids until his need for the more expensive and more advanced aids has been established.

The first approach we discussed was scanning. As stated earlier, when thinking about the scanning technique the thing that should first come to your mind is that it is the most powerful of the three approaches. By powerful we mean that it can be used by even the most severely physically handicapped individual. If there is even one movement or signal that the individual can make consistently, the individual has the physical capability of controlling a scanning aid. All that needs to be done is to develop or select a switch which can be used to recognize that movement or signal. To understand this point better, let's go over some examples of different kinds of switches that could be used. There are sight switches which attach to the frame of your glasses and will activate if you look at them. There are breath switches, both those that have paddles that you blow at and those which have a pipe stem which you sip and puff on. This method, by the way, does not require that you use your lungs; you sip and puff using your mouth in much the same way you would drink through a straw. There are pillow-like switches which can be activated either by heavy pounding or light pressure. Switches have been developed which can be used with almost any part of the body including the knee, thigh, elbow, head, tongue, and foot. In addition, switches have been developed which can operate off the electrical potential generated when you try to flex a muscle. As a result an individual does not necessarily have to even move. Simply by tensing a muscle slightly he can activate a switch. (For more information, see Masterchart in Appendix).

Although it has not been demonstrated in a practical manner at the present time, there is also research being done in the development of switches which run off brain waves. One experimenter developed a communication aid that could be operated using alpha wave output. The technique however, was extremely slow and took tremendous amounts of concentration. A more encouraging line of research has been conducted by specialists trying to develop a computer which can be controlled by thoughts. The aim is to have the operator "think" a word and have the computer be able to recognize his thought waves. If a small portable unit could be developed which could recognize even a small five word vocabulary (up, down, left, right, yes) a child would be able to direct a light to the word on a panel that he wanted to print out and then think "yes" to have it printed out. Theoretically this could be an extremely fast technique which would even approach the speed of normal speech. The feasibility of this type of approach, however, has not been explored in terms of these children. What the brainwave pattern of the athetoid cerebral palsied non-vocal child with limited language abilities is, I don't know. But if the brainwave patterns are regular enough to be used as a signal, they may be quick enough so that they could provide even the most physically handicapped child with a fairly efficient means of communication.

Overview of scanning techniques

The first technique is the simplest and is called a "linear scan."* In the linear scan various message elements are presented one at a time and the child simply responds when the aid gets to the one he wants. (Example in Fig. 11) This is the most straightforward and simplest type of scan and is probably the best one to use when starting out with a very young child or a child with limited cognitive ability. This approach, however, is the slowest approach and while it works well if you have ten pictures, it can become impractically slow if the child has a 50 or 100 word vocabulary. With a vocabulary of fifty words, for instance, it would take half a minute, on the average, just to get to a single correct letter or word (with a one second response time).

Figure 11. Example of linear scanning technique.

To help overcome this speed problem, some people have utilized a two-speed linear scan. With the two-speed approach, the individual has two switches. One causes the scan to go quite fast until it gets close to the desired letter. The child then releases this switch and lets the aid scan slowly up to the letter he wants. When it reaches the correct letter the child activates the second switch and the letter is printed out. This approach, you will notice, requires more ability on the part of the child. Not only does it require extra movements, but it also requires that the child be able to hold down the "fast" switch until the scanner has reached the vicinity of the desired letter. For some children, particularly athetoid children, this may not be within their capabilities and another approach may be more desirable.

Another technique which has been used to increase the speed of the scanning approach is the "row-column" scanning technique. With this technique the letters, words or pictures are arranged in a matrix or checkerboard fashion. Figure 12 shows an example of a 7 by 7 matrix which has 49 squares. To use the row column technique the aid (or person working with the child) first lights up (or points to) the rows to let the child select the proper row. Then the aid lights each square (or points to each square) in that row until the child signals again, indicating that that is the letter he wants. Now, with a 10 by 10 matrix, the maximum number of steps it could take would be 14, whereas with the linear scanning the maximum would be 49. The average time would be 7 versus 24. From these numbers you can see the savings in time that results from using the row-column technique; we have gone from an average of almost half a minute to less than ten seconds to get any one letter or word from the display. Once again you will note that in order to achieve the increased speed, the child must do more work in that he must signal twice as often.

Figure 12. Example of a row column scanning aid.

With either of the two techniques just discussed, one can increase the speed even further if the most frequently used letters, words, etc. are placed in the upper left hand corner where the scan begins. For instance, in the English language e, t, a, o, i, s, r, h, and l are the letters used most frequently. By putting these up in the corner where the scan starts each time, it is possible to reduce the average time needed to select the proper letter to about 2/3 the time it would have taken had the letters been arranged in alphabetical order.

If the child has enough control to use a joy stick (see Fig. 13), then another, more efficient scanning technique may be appropriate. This technique, called the directed scan, allows the child to control the direction that the indicator is scanning as well as to stop in on the correct choice. For the child who can use his eyes well, this technique can also be implemented on a manual basis where the child looks up, down, left, or right to direct the pointing of the second person. (See Fig. 14).

Figure 13. Example of a directed scanning aid with joy stick or ppushbutton control.

Figure 14. Example of directed scanning using eye gaze.

A pseudo-scanning technique is the "step-scan." With this technique the child hits a switch to move the light from each position to the next. Two or three switches are usually used for this technique; one to step downward, one to step across, and one to print the characters if a printing aid is used. (This is not a true scanning technique since the child actually moves the light himself - the aid does not actively present choices to the child and wait for his response to signal a correct presentation).

These are some of the different scanning techniques which have been developed. Each of them can be implemented in any of the levels, including: as a fundamental aid with a teacher doing the scanning, as a simple electronic aid, or as a fully independent or portable and independent aid. There is one final technique I would like to describe which would probably only be found in an independent communication aid. It was originally described by Rick Foulds, et. al., at the Biomedical Engineering Center of the Tufts - New England Medical Center. This technique, introduced as the "anticipatory scanning" technique, has also been called "predictive scanning" and the "computer-aided scanning" technique. The technique looks at the last letters that have been printed, and, based upon probability, tries to determine which letter the child will want next. For instance, if the last two letters were "t" and "h" the aid would know, (from probability tables), that the next most likely letters would be "e," "space," "a," "i," etc. The aid would then change the letters appearing in the scanning matrix so that the letters "e," "space," "a," "i," would appear in the upper left-hand corner of the display.* (See Fig. 15) These letters would then be the first letters presented to the child. Using this system the probability is 81.3% that the letter the child wants will be one of the first 6 letters presented by the aid. If the letters were presented in a fixed pattern (space, e, t, a, o, n, i, s, k, h) the aid would have to scan over 10 letters in order to achieve the same 81% probability of presenting the letter the child wanted, Studies are now being conducted to see whether or not the increase in speed which is achievable through the anticipatory scanning approach is sufficient to offset the increased cost of implementing this advanced technique.

Figure 15.

A partial survey of scanning aids

Figure 16. Roto Com shown with three interface switches; a pillow switch, a feather touch switch, and a slam switch.

The next aid shown is the VAPC Communicator. (Fig. 17) It is a battery operated message indicator that was developed by the Veterans' Administration. It is intended to display messages, such as "yes," it no," "I am hungry," "I am in pain," etc. Shown with the aid are three of its several interfaces, including a breath, push-button, and magnetic switch. The box to the right is a battery charger with timer for the aid.

Figure 17. VAPC Communicator shown with breath, push button, and magnetic switches. Battery charger at right has built-in shutoff timer.

The next aid is the View-Com developed by Fairchild Space and Electronics Company. (Fig. 18) This aid uses the direct scanning technique described earlier. The aid is controlled by means of the handheld switch in the bottom right-hand corner of the picture. Although this switch requires fairly fine motor control of the thumb, the aid could also be used with other types of switches. All the little squares containing messages can be removed or rearranged. In addition, blank squares are provided to allow individualization of the aid. There are two features which I'd like to bring to your attention concerning this particular aid. One is found on the bottom of the third column, the word "damn." Many parents and teachers feel that swear words such as this are necessary, but are reluctant to put them on indication boards for fear of endorsing them. Such words as "phooey," or simply an assortment of punctuation marks have been used with great success and provide children with a means of expressing frustration when they feel they need to. What is important is that some means of expressing frustration be provided. The other feature that I'd like to point out is in the bottom of the left-hand column. It is a square which controls a buzzer (which is built into the aid). Since many of these children do not have an effective means of calling the attention of those around them without going into complicated gyrations, this is an important feature. It is also important for calling the attention of people who may not be in the room.

Figure 18. The View-Com, a directed scanning aid.

The next aid is the SCRP "100 + 100" display. (Fig. 19) This aid, developed by the Ontario Crippled Children's Centre, Ontario, Canada, was designed specifically to be used with Bliss Symbols, although it could be used with words, letters, or pictures as well. Each of the squares on the aid has a small red light (LED) in the upper left-hand corner. The child indicates which symbol he wants by lighting the light in the appropriate square. This aid also uses a directed-scanning technique by which the child can control the direction of the jumping light and direct it to the square he desires. Using either the pillow switches (center), or the paddle switches (to the right), the child moves the dot up and down using one pillow (or one direction of the paddle switch), and moves the light dot to the left and right using the other pillow (or direction of the paddle switch). Alternately, the aid can be controlled with a joy stick (left) where the scanning direction is directly selected by the direction in which the joystick is pushed.

Figure 19. The SCRP 100 + 100 display (a directed scanning aid for use with Blissymbols), shown with three types of input switches; joystick, dual pillow and paddle switches.

All of the aids shown thus far have been examples of simple electronic communication aids. The Alphabet Message Scanner (Fig. 20) by Prentke-Romich Company is also a portable simple electronic communication aid. It, however, offers the option of having a typewriter controller plugged into it, thus becoming a stationary independent communication aid. The scanner uses the row- column scanning technique where the aid first scans across the top row until signaled by the switch, and then scans down the column until signaled again. Note that this aid also has a "buzzer" square (bottom right-hand corner).

Figure 20. The Alphabet Message Scanner, a row column scanning aid which can be used alone or in combination with a printer.

Centre Industries in Australia developed a linear scanning typewriter controller shown in Figure 21. This aid, called the Clock-Face Selector, would be an example of the linear scanning stationary independent communication aid.

Figure 21. The Clock-Face Selector - a linear scanning independent communication aid.

Another linear scanning aid was developed by Palmstiernas Mekaniska Verkstad AB in Stockholm, Sweden. (Fig. 22) The aid, called the PMV Printer, helps to alleviate the slower speed of the linear scanning process by introducing a two- speed scan. Two switches are then used by the individual, one which is held down to cause the aid to scan at the fast speed, and one which is hit when the correct letter is indicated.

Figure 22. The PMV Printer, a two-speed, linear scanning, independent communication aid.

One of the very early row-column independent communication aids was developed by Bush Electronics in California. Called the VISTA (Fig. 23), this aid was the only commercially available scanning aid in America for some time. The aid used an IBM typewriter which slid in from the back and could be removed for separate use.

Figure 23. The VISTA, an early row-column independent communication aid.

A more recent row-column scanning aid is the Whispertype^TM (Cyber Corp., Washington, D.C.) The Whispertype^TM has the capability of being controlled by a sound made into a microphone. It can also be controlled by a large variety of other interface switches which can be selected to best meet the needs of the handicapped individual. This Whispertype ^TM is part of a larger family of communication aids collectively known as Cybercoms ^R. All of the aids in the Cybercom^R family use a standard display format or code to facilitate movement from one aid to another as the child's physical skill development permits. In addition to their normal typewriter output, these aids have also been interfaced with a variety of other outputs including a voice synthesizer.

Another row-column scanning aid, the "System 8," was developed by Zambette Electronics, Ltd., in England (Fig. 24) The unique feature of the Zambette aid is the capacitance operated switch which requires only that the operator come near it to fine motor control. It thus requires no fine motor control.

Figure 24. The System 8, a row column scanning, independent aid featuring a capacitance operated proximity switch.

The final stationary communication aid in this survey is the Tufts Interactive Communicator (TIC) developed at Tufts University, Medford, Mass. (Fig. 25) This aid is available in several versions, one of which incorporates the "anticipatory scanning" technique described earlier. The anticipatory scanning model, which is in final development, will use a limited set of rules to look at the last three letters which have been printed when determining the next letters to be presented. A smaller, portable version of the TIC is also under development.

Figure 25. The TIC, a row-column scanning independent aid with electronic display and strip printer. Available with Anticipatory Scanning Option.

The first fully portable scanning aid to become available was the Portaprinter by Portacom, Incorporated, New York. (Fig. 26) This aid uses a row-column scanning technique which is different from any of the others which have been developed. Instead of returning to the upper right-hand corner after each selection, the aid continues its scanning pattern. The letters are arranged so that they form very commonly used patterns, and frequently used letters are repeated on the face of the display. The aid is normally battery-operated but can control two 110 volt outlets for environmental control when it is plugged into the wall. The output of the aid is on a 1/4"-wide thermal strip printer tape which is displayed at the very front edge of the aid. (A similar aid, using the conventional row-column scanning approach, has also been developed by Prentke-Romich, Shreve, Ohio).

Figure 26. The Portaprinter, a portable and independent aid which operates in a modified row-column scanning pattern, with strip-printer output.

A third portable scanning aid is the Versicom, developed by the Trace Center, University of Wisconsin-Madison. (Fig. 27) This aid is capable of operating in many different modes to best accommodate the specific abilities of different children. With its optional LED display (comparable to a calculator display), this aid represents the first portable scanning aid which is correctable. The aid is able to print out entire words, phrases, or messages with a single indication by the user. Thus, the aid can be used with children who are still learning to spell or, by coupling it with pictures or symbols, could be used by non-spelling and non-reading children.

Figure 27. The Versicom, a portable independent aid which can operate in many different scanning modes, with strip printer and electronic display outputs.

SCANNING AIDS - SUMMARY REMARKS

The disadvantages usually cited are that encoding approaches generally require finer control and more motions than the scanning technique. They also require the user to utilize some code or at least a two-step process in specifying his output. For very young children, or mentally retarded individuals, this may pose a problem. As we shall see, however, the encoding approach can be made fairly simple. Further, it is possible to develop some approaches so that neither the child nor the message receiver would even realize that a code was being used. Since there is often no visual display (as there is with the scanning technique), feedback can be a problem with the encoding approach unless care is taken to provide feedback information to the child while he is selecting the letter. Of course, feedback should also be provided to the child after he has selected the letter, both in the form of presenting the letter to the child and presenting him with his message to that point.

Response requirements for the encoding approach may be more or less demanding than the scanning approach, depending upon the specific techniques used. In general, the encoding approach requires more refined or more numerous responses than the scanning approach. The encoding approach, however, does not require that responses be given at a specific instant in time, as is required with scanning techniques. The encoding approach may therefore be easier for individuals who have difficulty in making very rapid responses. (It should be noted, however, that with the scanning approach the child is able to anticipate the instant at which he must respond, and it would be unfair to compare his reaction time under this kind of a task with his reaction time to a stimulus which was suddenly presented to him).

The number and complexity of the individual's responses are all dependent upon the number of switches required for a specific approach and the type of switches that are used. As we discussed under the scanning approach, there are a great many different types of aids that can be used with these children. Although specific aids usually come with one or another type of interface switch, it should be remembered that if the child is not able to operate a specific type of switch, any one of the many other types of switches described could be hooked up to control the aid.

The number and complexity of responses required by the user changes, depending upon the various approaches used. In general, the greater the number of switches or movements used in an encoding scheme, the simpler the code will be. However, an increased number of movements requires greater dexterity on the part of the operator. Thus, a compromise between the two factors, simplicity of code and number of movements or switches, must be worked out. Different researchers and clinicians have chosen different balances between these two factors in the design of their techniques. The specific needs of the individual determine which approach is best suited for him.

Overview of encoding techniques

The most common encoding techniques are all based upon a simple pairing of two items (two numbers, two letters, a letter and a number, a number and a color, etc.) with the various items in the selection chart or vocabulary. We saw an example of this earlier (see Fig. 28a) where a number-pair was used to specify the letters of the alphabet. In that instance, the alphabet was arranged in a matrix and the numbers were arranged along the top and sides, This same technique could have been realized in a slightly different manner by simply arranging the numberpairs along the letters in a list fashion (see Fig. 28b). This listing provides the same information as the first listing, but makes it easier for the user to pick out the two-number code which should be used with the specific letters. Both techniques, however, are equivalent, and both techniques could be used with pictures, words, or symbols instead of the alphabet as shown in Figure 23c. Since all these techniques require that the child make two pointing motions to indicate the letter, word, picture, symbol, etc. he wants, they have been termed "Two Movement Encoding Techniques." By using a larger number of encoding numerals, you are able to expand the system to account for larger numbers of vocabulary items. In very large vocabularies, three numerals may be used instead of the two numeral pair.

Figure 28.

When considering two movement encoding systems, there are two points which should be kept in mind. First, as we shall see in the subsequent discussion, the two encoding elements need not be numbers. For children who have trouble sequencing numbers, other techniques can and have been used. Secondly, when using two movement encoding systems, it is dangerous to use double numbers (e.g., 11, 22, 33, 44, 55... ). Using these double numbers usually leads to confusion on the part of the individual trying to decipher the child's message, and frustration on the part of the child. This confusion and frustration usually results in one of the following two situations. First the child may point to his first number, (say the number "2"). His pointing may be rather erratic, but the second person (whom we shall call the teacher for now) is able to guess the correct number and say it for the child, "two." The child then continues to try to point to the "2" to indicate that he wants a second "2." The teacher may then either say, "I already have that number," or she may think that she guessed the wrong number, and that the child is actually trying to point to the number right next to it. In this case, she may say, "I'm sorry, not 'two,' number 'three."' At this point the child may get very excited but there is little he can do to try to straighten out the confusion. Since continued pointing at a number is the technique that the child usually uses to let the teacher know she guessed the wrong number, there is no way for the teacher to tell whether or not the child simply wants a double number, or whether she has guessed the number wrong in the first place.

Or, suppose the child is pointing at the number two, and the teacher responds, "number two." The child then looks up at his chart to check the next number that he wants to use. Say it is a "4." During this delay, however, the teacher may think he is trying to indicate that he wants a second two, since he did not move off the square or point to any other square after she guessed the first number. She therefore guesses "2, 2" and again there is a problem. If there is a good rapport between the child and the person he is communicating with, and if good feedback is given after each and every number to confirm that it is a correct number, it is possible to use double numbers without difficulty. However, since the children will be communicating with a number of different people, some of whom may not interact often with them, it is usually best to avoid the use of double numbers.

We have talked about the two movement encoding system and have seen that, by using the listing, it is possible for an individual to specify a large number of vocabulary elements (pictures, words, etc.), even though he may only be able to physically point to a very limited number of squares. We have also seen that this system can be used by children who cannot spell but who rely on pictures or symbols to communicate. It can further be noted that number concepts or the ability to count are not necessary to use this technique. The child need only be able to find the picture or the symbol he wants, look at the numerals which are beside it, and then point to those numerals on the squares in front of him. In fact, he need not use the numerals at all, but could substitute any other arbitrary shapes in their place. The numerals are, however, convenient and familiar shapes to use for this purpose and can generally be used with a wide range of children. Still, there will be those children who are very young or who are severely mentally retarded so that they will find it difficult to use these number-pairing techniques. Other children will be able to use number-pairing techniques in the long run, but will have difficulty starting out with that task. Still others will have specific visual or other learning disabilities which cause them to reverse numbers or have difficulty in sequencing them correctly. For these children, other adaptations of the two-movement encoding approach have been developed.

An alternate technique makes use of color in place of one of the two numbers. With this approach, the child indicates which element of his message he wants by indicating first the color, and then a number. When this procedure is used, the vocabulary listing can be more easily constructed in one of the ways shown in Fig. 29. Each of the indication squares would contain both a number and a color. Using this technique it is possible to significantly reduce the problems associated with reversal. In addition, the child can now think of specifying his element as a two step process rather than being a compound process involving the sequencing of two indicators. In fact, the process can be reduced to one involving no sequencing at all except on the part of the message receiver. To do this, the message receiver would ask the child what color was around the picture (symbol, etc.) that he wanted and then ask the child what number was next to the picture he wanted. In this manner, all the child need do once he had indicated he wanted to express something would be to answer simple one-response questions concerning it. If the numerals presented a problem, they could be replaced by other shapes or perhaps even simple figures of people or animals so that the task became one of specifying the color wanted and the familiar objects or caricature printed next to the picture (in the same position where the number would have been printed). There is a possibility that this last technique may be too visually confusing and that one would be better off sticking with colors and numerals, even though the numerals may be simply abstract shapes to the child.

Figure 29.

For some children, this two movement encoding technique may be applicable except for the fact that they are physically unable to point to any number of squares, either with their hand or with a headstick of any kind. For these children, use of the eyes may be an appropriate signal source. One technique which has been developed for using eyes places the numbers and/or color squares around the very edges of the children's laptrays. The children then indicate appropriate numbers and colors by simply looking at them. When using this approach, it is important not to place too many of these number squares around the edge of the tray, or they will be too close together to easily tell which one the child is looking at. This technique may also be difficult for children who have poor head control or other problems which make it difficult to determine exactly where they are looking.

Figure 29.

One technique which can help to alleviate this problem is the use of an adapted ETRAN chart (here called the ETRAN-N). This adapted chart is a plexiglas sheet with a hole cut in the middle. The numbers are placed around the outside of the plexiglas sheet (see Fig. 30). In use, the ETRAN-N chart is placed so that the two people communicating are looking at each other through the window (hole) in the chart. The child looks at the numbers to indicate them in the same manner that the pointing child points to the numbers on his tray. Since the eyes are also used for just looking, it is important that a procedure be established to prevent the child's normal visual activity from being confused with the use of his eyes to indicate the correct numbers. To do that the following procedure is recommended:

The child will generally start out by looking down at his vocabulary listing which will usually be placed in front of him. He would then look up and stare at the first number of the plexiglas ETRAN-N chart. He would continue to stare at the number until the second person would say the correct number. If the second person says the wrong number, the child just continues to stare until the second person corrects himself and says the correct number. The child would then look up at the ceiling briefly to acknowledge that that is the correct number and then go on to the second number. When the second person had identified the second number correctly, the child would look up at the ceiling again. The second individual should then repeat the two numbers and the message element from the chart. To confirm that the item is correct, the child would again look at the ceiling. If there was a problem, the child would look down to make sure that he had picked the right numbers and the second person should read back the numbers one at a time to figure out if he'd gotten the first one right and the second one wrong. If there is any confusion, the second person should simply say, "Let's forget that, let's do it again."

As the child and the communicator become more experienced, this process can become quite swift and some of the confirmations can be dropped to streamline it even further. In the beginning, however, the full procedure is recommended to avoid initial frustrations with the technique. In addition, the full procedure is also recommended for general use with individuals who are not as familiar with the individual in using the technique. As with the pointing system, the ETRAN-N chart can be used with color and numerals as well as with the numerals alone.

Figure 30.

In the preceding discussion, we have been talking about the two movement encoding technique and how the original ETRAN chart has been adapted for use with the simple number encoding system. I'd now like to introduce the original ETRAN chart to you and describe its operation. Because the ETRAN chart and the ETRAN-N (the modified version) are similar in appearance and in some of their operational characteristics, there is a tendency to confuse the directions for using the two systems. The layout of the original ETRAN chart is shown in Figure 31. The ETRAN system uses no additional vocabulary listing and assumes the individual will spell out all his messages using the letters that are on the plexiglas sheet itself. The original ETRAN system is completely self-contained, and is a system for indicating the letters of the alphabet (and numbers) only!

Directions for using the chart are as follows:

You will note that there is no upper left-hand corner letter in the "A" grouping. This is because the handicapped individual would have the same "double indication" problem that we were talking about earlier with respect to the double numbers. That is, you have to look at the "A" grouping to show that you wanted a number from that grouping, and then would have to look from that grouping to the corner of the chart which is only an inch away. The second person would never be able to detect this small movement of the eyes. Thus you will notice that all four corner groupings are missing a letter which corresponds to their respective corners.

Because this approach requires spelling, it is, of course, a more advanced communication technique. It is convenient, however, in that it does not require either individual to look up items on a vocabulary listing. All the items are directly on the chart itself. On the other hand, it does require that the individual spell out everything he wants to say. Since the numbers are provided on the chart, however, it would still be possible to use them to encode words that would be on a vocabulary listing. Using this technique would require four motions of the eye to indicate the words since it would take two motions to indicate each number. It should be noted that Hugh C. Neale, for whom the aid was first developed, only used the ETRAN chart with his family for a limited time. After that time, he no longer used the chart but would simply look to the position in space where the letter groupings would be if he had a chart in front of him. His family had used it so much with him that they knew the position of the letters and they were all able to "use" the chart even though it wasn't present. Mr. Neale used the chart when communicating with strangers and others who were not as familiar with the system.

Figure 31.

The remainder of the encoding techniques which have been developed much more closely fit the picture which you probably originally formed when the term encoding was first mentioned. Techniques which utilize the Morse Code, as well as techniques which utilize a series of sips and puffs on a tube are examples of such techniques. The sip and puff techniques have been used extensively with individuals who have good control over their oral musculature (and are often able to speak), but who are unable to write. The sip and puff techniques are used to control typewriters to enable these individuals to have a means of writing.

There are also individuals who have good quick control over some very small movements, but are unable to operate a larger number of switches. For these persons, codes such as the Morse Code may be quite effective means of communication. The problem with these codes is that they are generally very restrictive because other individuals do not usually know the code well enough to use it for communication. For this reason, aids have been developed which can decode the Morse Code and display the letters either one at a time or on a printout. With such an aid, the handicapped individual is the only one who need know the code, since the letters are displayed directly for the message receiver. In addition, there is one technique which will allow the handicapped individual to use the Morse Code without even knowing the code himself. Figure 32 shows what this code looks like. With this aid the child starts with the light at the top of the "tree" lit. By indicating either a dot or a dash (perhaps by pushing a paddle to the left or right), the child causes the light to move down, either to the right or to the left. Thus, two steps to the right and one to the left would correspond to dot, dot, dash. The child would move the light down the tree until it reached the letter he wanted. He would then leave it there for the second person to view. If it were controlling a typewriter, the aid would wait for a delay, and, after the light had stayed in the same place for a set amount of time, it would print that letter and return the light to the top of the aid. If the child made a mistake, he could simply keep the light moving down any one of the tree branches until it ran off the bottom. He would then return to the top and come down again. To facilitate his use of the aid, it could be set up so that if the child held the paddle to the left or to the right, it would step down in that direction automatically. Thus, to signal dot, dot, dash (right, right, left), which stands for the letter "U," the child would simply hold the switch to the right for two steps and then push it to the left, let it make one step, and then release it. Using this technique, the child would be able to use the efficiency of the Morse Code without having to have to learn it himself or rely upon others learning it. [Editor's note: If one looks carefully at this tree technique, it will be apparent that it is not an encoding technique at all, but rather a directed scanning technique. It has been described at this point, however, because of its relation to other techniques which use the Morse Code].

Figure 32.

The final technique which I'd like to describe under the topic of encoding is "successive quartering." With this technique the child indicates which letter or word, etc. he wants by successively dividing the display into fourths and indicating which fourth he wants. For example, with the chart shown in Figure 33, the child would indicate that he wanted the letter "R" by: 1) indicating that it is in the upper lefthand quarter, 2) by indicating that it was then in the bottom left-hand quarter of that section, and then 3) by indicating that it was in the upper right-hand quarter of that piece. Thus, by making three pointing motions, the individual would be able to select from any one of 64 squares. By making four motions, he would be able to pick from any one of 256 squares. If the child has more ability on a joystick than he would pointing to squares, or if he is faster using a joystick, then the joystick may replace the four squares used for the successive quartering. This technique could be used manually or it could be used with an aid which would light up the display and extinguish the various sections as they were eliminated until a single square was left lighted.

Figure 33.

PARTIAL SURVEY OF ENCODING AIDS

Figure 34. Encoding Review - fundamental 2-movement encoding technique using colors and numbers.

Figure 35 shows Jack Eichler with the original ETRAN chart which was developed by him and by Hugh C. Neale, Ridgefield, Connecticut. Figure 36 shows a version of the ETRAN-N which was developed at the Trace Center. When not in use, the ETRAN chart folds flat, providing him with a plexiglas cover laptray. A piece of plexiglas is permanently screwed down to the tray both to fill the center hole in the ETRAN and to make a flat tray when it is folded down, and to act as a protective cover over the child's vocabulary.

Figure 35. The ETRAN eye gaze communication chart - a fundamental encoding aid.

Figure 36. The ETRAN-N - a 2-movement eye gaze encoding technique.

The communication aid shown in Figure 37 was developed at Rancho Los Amigos, Downey, CA, for a mentally retarded child. The aid consists of a commonly available beeper coupled with a specifically adapted switch. Depending upon the abilities of the children, the beeper could be used for either a very small set of messages, using one, two, or three beeps, etc., or the child would be able to pick from a number of lists and then signify by the number of beeps.

Figure 37. The Ranchos Beeper, a simple electronic encoding aid.

The Cybertype,^R (Cyber Corp., Washington, D.C.) is an example of both a row- column and a two-movement encoding aid. This aid is also part of the Cybercom^R family discussed under scanning aids. Two keys are used to print each letter in the fourteen key models of the Cybertype^R When only 7 keys are used, the same code applies except that the two keys are operated in succession. Many different interfaces have been developed for the Cybercom aids.

The Comhandi, developed by the National Resource Council of Canada, is one of the few aids designed to operate in a variety of operational modes. The Comhandi can be operated as a scanning aid, using the panel shown in the upper right-hand corner of Figure 38, as an encoding aid, using some of these switches also shown there, (in addition to a variety of other switches which have been developed for the aid) and as a direct selection aid, using the teletype keyboard with or without a keyboard.

Figure 38. The Comhandi, an independent aid which can operate as a scanning, encoding, or direct selection aid. Shown here with some of its different interfaces.

The MC6400 Communicator is a very compact electronic communication aid developed by Medicel, Incorporated, Burlington, Vermont. (Fig. 39) The aid, which is entirely enclosed within the small package to the right, can decode the Morse Code which can be input from a variety of switch forms, and display it on the screen of a television. The unit provides for high visibility and correctability and has a printer option if typewritten copy is desired. The Medicel unit is also able to take a keyboard for input and be used as a direct selection unit.

Figure 39. The MC6400, a Morse code based independent communication aid.

POSSUM Controls, Ltd., Aylesbury, England, has several encoding typewriter controllers. The one shown in Figure 40 is a unit originally developed by Hengrove, which uses a four-level sip and puff encoding system. Other models offered by POSSUM can be operated by chin and foot switches in addition to the sip and puff technique.

Figure 40. The Hengrove/Possum Sip and Puff Typewriter System, an independent encoding aid.

Both the Versicom (see Fig. 27) and the Auto-Com (Fig. 66), developed by the Trace Center, are capable of operating in a variety of encoding formats. Most encoding techniques which require a display can be implemented using the Versicom. Encoding techniques not requiring a display could be implemented on either the Versicom or the Auto-Com.

ENCODING AIDS SUMMARY REMARKS

A second very large advantage of the encoding system is the ability to access large vocabularies in an efficient manner. Using only the numbers from one to ten, and a three-movement encoding scheme, a child can access over 700 vocabulary elements in just a few seconds. This would require very fine motor control for direct pointing and would be very slow using the scanning techniques. Thus, encoding techniques may provide a faster means of communication and a means of accessing relatively large vocabularies, but they may also require greater physical control and usually require higher cognitive abilities than either the scanning or direct selection approaches.

As we shall see, however, there are techniques which can be used to overcome the range of motion problem, as well as techniques which can eliminate the need for fine motor control. There is a limit to these techniques and there are a great number of individuals who are unable to use the direct selection approach. For those who can develop the skills necessary to use one of the approaches, however, a quick, efficient, and straightforward communication system results.

Overview of the direct selection techniques

The first category is that of expanded and/or guarded keyboards. Because typewriters are both inexpensive and versatile output devices, many efforts have centered around trying to make the typewriter keyboard more usable to the severely handicapped. The simplest technique for doing this is simply to provide a keyboard guard or mask for the typewriter. This keyboard usually takes the form of a metal or plastic plate which has holes punched in it corresponding to the keys of the typewriter. The plate is then placed above the keyboard so that the individual must push a finger down through the hole in order to actuate a key. With such a guard in place, the handicapped individual is able to rest his hand over the keyboard and apply force on the plate to help steady himself. He can then slide his hand around on the plate without actuating any of the keys. When he wants to type a letter he simply pokes his finger, or perhaps a dowel which he is holding in his clenched fist, down through the hole to actuate the keys on the typewriter. Although this is a very simple technique, it surprisingly is not very widely well-known. This is truly unfortunate, because it is very inexpensive and can allow even some fairly severely involved individuals to have ready access to the typewriter for communication and/or writing. Keyguards for IBM and Smith-Corona typewriters are available directly from the companies although in some cases it is difficult to get hold of someone who knows about the policy. For more information on this, you can consult the Annotated Bibliography of Communication Aids distributed by the Trace Center.

In addition to providing keyguards, many researchers have also expanded their keyboards in order to make them accessible to even more severely handicapped individuals. With the exception of one or two experimenters who developed mechanical linkages to accomplish this, the researchers generally used solenoid banks positioned over the keyboards and remote keyboards which then controlled the typewriter electrically. This, unfortunately, raises the price of the aid quite rapidly above the cost of the typewriter alone. They are still among the less expensive independent communication aids, however.

The second category of direct selection aids that are of particular interest are the light-spot operated aids. With these aids, researchers have provided individuals who have good head control with a rapid and efficient means of pointing even though they may have limited control over the rest of their bodies. These aids usually consist of a fairly high powered light beam which is attached to the head (or occasionally to some other part of the body). The individual then directs the spot of light to an array of photodetectors which have the alphabet printed alongside of them. By training the lightspot on the photodetectors, the handicapped person is able to print out his message. The largest problem with the technique is the fact that high levels of ambient light interfere with the system. Some of the aids have to be used in darkened rooms and cannot be used in sunlight. Since most of the aids are stationary, however, it is usually possible to avoid situations where ambient light is a problem.

The third group of techniques I'd like to discuss are the range of motion expanding techniques. With these techniques, a very small movement is electronically expanded and displayed for the user, usually on a backlit display. A typical example would be an aid which provides the user with a very small joystick which he can either operate with small movement of a finger or with his mouth. (See Fig. 41) As he moves the stick, a lighted square on a panel moves around in correspondence. The position of the lighted square on the panel would directly correspond to the position of the joystick. In this manner, the individual who has a very small but well controlled range of motion would be able to directly "point" to a fairly large number of letters, words, etc. on the backlit display.

Figure 41. In ROM expanding techniques the position of the lit square is directly determined by the position of the joystick (or other signal).

An extreme example of range of motion expanding would be the technique developed by a research group in England. With this technique, the electrical signal generated by the flexing of a muscle (EKG) was used to control the position of a lighted square on a matrix. Two muscles, one from each arm, were used to control the square. The one arm would control the up and down motion of the square, while the other arm controlled the left and right motion. In this manner, the individual did not really have to move his arms at all, but only begin to tense or relax his muscles in order to direct the lighted square to the items on the display. This aid, called the GMMI, is further described in the survey of aids.

The fourth category is that of erratic pointing interpretation techniques. The most common mechanism for interpreting erratic pointing motions is the human himself. The second person functions as such an interpreter whenever he is working with a severely handicapped individual on a communication board. An automated technique which seeks to imitate this process has also been developed. This technique uses a combination of delayed activation proximity sensors, and a hard, smooth surface to produce an "auto-monitoring" effect which is very similar to the process used by a second individual when he is watching a handicapped individual on a communication board. Erratic pointing motions of severely athetoid cerebral palsied children have been used successfully with aids utilizing this technique.

PARTIAL SURVEY OF DIRECT SELECTION AIDS

Figure 42. Manual communication board, a fundamental, direct selection aid.

Figure 43. Picture/Word board - University of Iowa Hospital School Nonoral Communication Project.

Figure 44. Picture/Word board with alphabet - Iowa Project.

Figure 45. First formal communication board (second step program) for one boy using a headstick - Iowa Project.

Figure 46. Later communication board (fifth stage) for the same boy as in Figure 45 - Iowa Project.

Figure 47. Communication board with foldout pages - Iowa Project.

Figure 48. A communication board prepared on a typewriter - Iowa Project.

The communication board shown in Figure 49 is the thirteenth edition of a board designed by F. Hall Roe, a cerebral palsied individual who has been using communication boards since he was about twelve. This last board was designed by him when he was in his fifties. These premade boards are distributed as a service to the handicapped by the Ghora Khan Grotto (a Masonic organization), St. Paul, Minnesota.

Figure 49. The F. Hall Roe communication board (notches are for hanging board between wheelchair hand push handles).

The communication board shown in Figure 50 is one produced by the Ontario Crippled Children's Centre as part of its Symbol Communication Research Program. These Blissymbols will be discussed in greater detail later in the workshop.

Figure 50. A Blissymbol communication board - one of the available preprinted formats.

A rather interesting direct selection aid is the Slip 'n Slide communication board shown in Figure 51. This aid is of particular interest because it is one of the very few non-electric aids which allow a child to assemble a complete sentence by himself. With the Slip 'n Slide, little blocks containing pictures, symbols, words, or letters of the alphabet are placed in the track around the outer edge. The child can then select any block he chooses and move it around into the center slide where he can line the blocks up to form his message.

Figure 51. The Slip N Slide, a simple direct selection aid which can allow independent construction of sentences.

Moving to the independent aids, we have a picture of one of the IBM typewriters with keyguard, armrests, and paper roll. (Fig. 52) IBM makes all these items available at low cost (the keyguard costs $5). IBM also has a special program whereby it sells the used typewriters at the trade-in cost to handicapped individuals. With this procedure, handicapped individuals can secure the IBM typewriters for as little as $100 to $150, depending upon the condition of the machine.

Figure 52. IBM typewriter with standard modifications available - a direct selection independent aid.

Palmstiernas Mekaniska Verkstad, AB, in Stockholm, Sweden, has produced several expanded and miniaturized keyboards for controlling typewriters. Figure 53 shows a collage of four of their expanded keyboards being operated by different parts of the body. Figures 54 and 55 show two of their miniature keyboard arrangements as well as the typewriter fitted with a solenoid unit. PMV systems will also control IBM typewriters in addition to the Facit shown in the picture.

Figure 53. PMV expanded keyboards for typewriter control - direct selection independent aids.

Figure 54. PMV "minimum" keyboard.

Figure 55. PMV miniature modular keyboard shown with typewriter controller.

An expanded recessed keyboard is also available from Possum Controls in England. (Fig 56) This keyboard also has a built-in adjustable delay to further reduce accidental triggerings.

Figure 56. POSSUM expanded, recessed keyboard - a direct selection independent aid.

Two examples of light-spot operated typewriters are shown in Figures 57 and 58. The system shown in Figure 57 was developed at Delft University of Technology, Delft, The Netherlands, and is called the LOT (light-operated typewriter). The OCCUR, which is shown in Figure 58 was developed by the National Research Council, Radio and Electrical Engineering Division, Ottowa, Canada.

Figure 57. The LOT lightspot operated typewriter - an independent direct selection aid.

Figure 58. The OCCUR lightspot operated communication aid.

The aid shown in Figure 59 is the muscle potential range of motion expanding aid which was discussed earlier. By using the muscle potential in his two arms, the user is able to move the lighted square around on the display to choose the letters he wants typed. The aid can also be controlled using a joystick or other more conventional switches. This aid, called the GMMI, was developed at the Warm Springs Laboratory, Herts., England.

Figure 59. The GMMI - a range of motion expanding direct selection aid, shown here with the muscle potential (EMG) input.

Several aids which have been specifically designed for the deaf also have application for the severely physically handicapped. One of these is the TVphone shown in Figure 60. This aid is a typewriter keyboard base aid which prints out on a normal television screen. In addition, it can be used with a telephone to communicate with other TVphones or teletypes. This aid could, of course, be fitted with a keyguard to facilitate its use by the more severely physically handicapped.

Figure 60. The TVphone - telecommunications aid for the deaf which can be modified for the physically handicapped.

The first portable independent aid in this survey is the Lightwriter developed by Toby Churchill, Cambridge, England. (Fig. 61) The unit has a separate battery pack and the 32-character electronic display is removable so it can be placed conveniently for either or both user and the person with whom he is communicating.

Figure 61. The Lightwriter - a portable independent direct selection aid with removeable electronic display.

Another somewhat smaller fully portable communication aid has been developed for the deaf in the United States. This unit, called the MCM, is distributed by Micon Industries, in Oakland, California. (Fig. 62) The unit is completely self- contained and has a special low power 32 character display which was developed especially for it. In addition, the aid has a telephone cradle so it can be used to communicate to other similar aids over a phone line.

Figure 62. The MCM - a portable independent direct selection aid primarily designed as a telephone communication aid for the deaf. Modification for the physically handicapped available.

A rather unique approach has been taken by researchers at the University of Southampton, England. (Fig. 63) This aid, which was designed primarily for the mute, has a 5-character display which fits in the shirt pocket like a brooch and has a separate keyboard. The aid is able to get by with such a small display because it, unlike most alpha-numeric displays, floats the words across the display gradually rather than having them jump one whole letter position at a time. (Fig. 64) Because of the position of the read-out display, the aid has been named "The Talking Brooch."

Figure 63. The Talking Brooch - a portable direct selection aid originally designed for mute individuals.

Figure 64. Illustration of the walking display of the Talking Brooch.

Probably the most compact and portable of all of the independent communication aids to date is the Canon Communicator which was developed as a joint effort between Canon Incorporated in Japan and researchers in the Netherlands. (Fig. 65) The Canon Communicator is designed to strap to the wrist and has a small strip printer as its output form. To facilitate use with people having some muscular problems, special keyguards have been designed, which are shown in the background of the picture. Canon has also been experimenting with a slightly larger version which has built-in battery supply and a typewriter arrangement for the keyboard.

Figure 65. The Canon Communicator - a portable independent direct selection aid shown with one of its keyguards.

The Auto-Com (Fig. 66) is a portable communication aid which utilizes the auto- monitoring technique described earlier. The aid has an optional 32-character LED display, in addition to its standard strip printer output, which makes the aid completely correctable and portable. The aid is capable of printing single letters or whole words, phrases or sentences with a single pointing motion. The vocabulary as well as the arrangement of the words and letters on the surface of the aid can be selected and changed by the user to meet his specific needs. The Versicom described earlier (Fig. 27) is also capable of operating as a portable, range of motion expanding, direct selection aid.

Figure 66. The Auto-Com - a portable independent communication aid using auto-monitoring techniques.

DIRECT SELECTION APPROACH - SUMMARY REMARKS

The major limitation of the aids in this category is that they generally require a greater range of motion or finer motor skills on the part of the child. Thus, the direct selection approach provides a relatively fast, fairly simple and straightforward means of communication for the child who can develop the range of motion and/or control necessary to use a letterboard or keyboard.

Figure 67. Combination Scan-Encode Technique.

As another example, a combination approach might be necessary for a child who can point to 30 squares or so, but who is advanced, and would like to communicate faster than having to spell out every letter. For this child the combination approach shown in Figure 68 may be what he needs. In this approach, he is provided with the alphabet and a number line which he can use for encoding. In this manner, the child has access to a large number of words for speed in communication but, when he needs to spell out a word, he has direct access to the alphabet so that he can spell out the word more quickly. This same approach could, of course, be implemented in an independent aid, and is similar to the approach used in the Auto-Com.

Figure 68. Combination of Direct Selection and Encoding Techniques.

A large percentage of severely handicapped individuals, however, will not be able to use any of the direct selection approaches, particularly not in the beginning. For these individuals it is important to provide them with an appropriate communication system even if you are also working on developing pointing skills. Some communication system should be set up immediately with the child so that he has a viable means of interaction while work proceeds on the development of additional skills.

In reviewing the present literature in this area, it is also apparent that much more work is needed on the development of very simple techniques and in development of techniques for very young children. Through the techniques which have been discussed, however, we hope to have given you some ideas as to how you might provide a severely handicapped child with "a means to indicate" the pictures, words, or symbols which he can then use to express himself and respond to his environment. Once he has a means to indicate, we must work to provide him with a means of representing his thoughts: a symbol system which he can use to relay the elements of his thoughts to others. That will be the subject of the next speakers, Dr. Eugene McDonald and Ms. Shirley McNaughton, who will be discussing application of symbol systems with some of the techniques we have been discussing. While their discussions will be framed principally around the pointing communication board, it should be remembered that the symbol systems they will be discussing can be applied with other techniques if the child is unable to use a pointing board.