Alternative Communication Program for a Child with Cerebral Palsy and His Communication Partners: a Multiple-Probe Design Study

MANZINI, Mariana Gurian; CRUZ, Daniel Marinho Cezar da; ALMEIDA, Maria Amélia; MARTINEZ, Claudia Maria Simões

doi:10.1590/s1413-65382519000400002

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Research Report • Rev. bras. educ. espec. 25 (4) • Oct-Dec 2019 • https://doi.org/10.1590/s1413-65382519000400002 copy

Alternative Communication Program for a Child with Cerebral Palsy and His Communication Partners: a Multiple-Probe Design Study² 2 All authors were responsible for the design, organization, and writing of the manuscript and approved its final version. Financial support: São Paulo State Research Support Foundation (FAPESP): Grant number: 2014/17741-6; and Coordination for the Improvement of Higher Education Personnel (CAPES) - Finance Code 001. The authors certify that there is no conflict of interest, whether financial, commercial, or of benefit, resulting from the direct applications of this research. Acknowledgements: PhD Dionísia Aparecida Cusin Lamônica for reviewing this paper.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Augmentative and Alternative Communication (AAC) for children with cerebral palsy is essential for their engagement in different contexts. Therefore, the purpose of this paper was to verify the effects of a program of AAC for a non-verbal child with cerebral palsy in three different contexts of daily life: school, home and rehabilitation settings. This study used a Multiple-probe Experimental Design. The participants were a child with cerebral palsy and three communication partners in their respective settings: teacher, mother and occupational therapist. The intervention consisted of the individualized process of theoretical and practical training directed at the communication partners and implementation of the AAC. After implementation of the intervention program, the results showed that the child and the communication partners successfully used AAC resources. The results indicate that the strategies adopted in the three contexts were effective and provided to the child and his communication partners an understanding of how to use the AAC effectively.

KEYWORDS:
Special Education; Alternative Communication; Cerebral Palsy; Occupational Therapy

Dyad participants	Month1	Month 2	Month 3	Month 4	Month 5	Month 6	Month 7
Dyad participants	NPS	NI	NPS	NI	NPS	NI	NPS
P 1 Mother and child	3	3	3	0	3	0	3
P 2 Occupational therapist and child	3	0	3	3	3	0	3
P3 Teacher and child	3	0	3	0	3	3	3

Stages	Procedures, resources and strategies
1. Learning of the initial repertoire of the communication partners and child	Description and documentation of the child's communication skills. Pre-intervention probing sessions: detecting the initial repertoire of the dyad.
2. Essential concepts of AAC through a theoretical training for the communication partners	Theoretical training started with mimic's activities performed by the communication partners in the three everyday life contexts (home, school, and rehabilitation settings). These activities had the aim of enabling the communication partners to feel how to transmit one piece of information without speaking. These activities had the steps: (1) Draw a theme for communication by the communication partners and (2) Transmit the information drawn using mimics. After this, the researcher discussed the difficulties found during the activity and their relation with the everyday life of the child. Training offered theoretical of AAC comprised assistive technology resources for children communicational skills. The theory was presented in a lecture with an hour duration.
3. Practical training: enabling the communication partners-child dyad to use AAC from an activity planned together by dyads and the researcher	(a) Guidance was provided to the communication partners to enable the child communication skills during play and (b) practical guidelines were offered for communication partners to enable them on how to offer objects or to present activities to the child using pictographic figures. The communication partners were trained to use one figure at a time. After selecting the activity, the communication partners removed the figure from the board and placed it in a sentence frame with Velcro^®. The communication partner should present a physical object to the child through using tactile, visual, auditory, and verbal cues; to compare the communication picture with the corresponding object; and to offer the activity through encouragement such as verbal, physical, and imitation. This procedure had the objectives: to elicit the child to take the picture of communication; to encourage motivation for the activity, and to provide timing for child's response. The child was trained to show interest in the picture related to the activity through a smile and/or grasping the picture from the board. The child should get the picture and give it to the communication partner. The child was taught to make the signal of shaking the head to express "no" if not motivated for the activity The AAC were offered only during the intervention in the three different settings to control the experimental variables of the research, avoiding bias.
4. Making an AAC board with each communication partner	A selection of pictures for the three AAC boards was done to be used at school, at home, and the rehabilitation setting with specific contents to each one. The communication partners were trained and encouraged to make an AAC board with contents of the routine of their own context using a laptop and the Boardmaker^® software. The categories selected for the board were self-care activities (clothes, food, bathing, hygiene), productivity (play), and leisure (recreation and socialization). The boards were made using low-tech assistive technology and printed pictures. All boards used in this research were given to the three communication partners after the conclusion of the research for continuous use in their contexts.
5. Assessment of the Communic_CP program: report of the communication partners and performance observation	Post-intervention probing sessions documented the skills learned; final repertoire of the communication partners and the child. Also, the qualitative perception of the communication partners of the use of the AAC was registered.

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[TFN2] *P = Participants, NPS = Number of probing sessions, NI = Number of interventions.