Computer augmented communication in the daily life of severely disabled speech impaired children
This study investigated the impact of Bliss based computer augmented communication (CAC) on the daily communication and daily activities of severely disabled speech impaired children from a Finnish school for disabled children from the point of view of the children, their discussion partners and therapists; it also investigated the value and meaning of the CAC devices for them. The school staff had considerable experience in the use of computers with disabled children, but only a few had any experience of CAC. In order to gain a rich understanding of the subject matter, a qualitative multiple case study approach was adopted. The longitudinal study investigated CAC in the real life environments of six severely disabled speech impaired children, aged 7 to 15 years, their parents, helpers, teachers, speech therapists and occupational therapists. All of the speech impaired children had cerebral palsy and their main mode of communication was Blissymbolics, used with the aid of a communication folder. The multiple methods of data collection used in the study included interviews, videotaped observations, the Assessment of Communication Skills Questionnaire, essays and data logs. The data gathering started before the participants received their CAC devices and continued 3,6 and 12 months after they received the devices: it involved studying participants in three different communicative environments. The data analysis was conducted by a narrative analysis of each individual case, which was followed up with a cross-case analysis. The process of CAC was highly individual and context dependent. During the study all the speech impaired participants learned to operate their CAC devices. Their initial enthusiasm begant o decreaseth ree to six months after the participants received their devices.A t the end of the study year, one of the participants used his CAC device nearly daily in two of his communicative environments, two of them used their devices regularly a couple of times a week, two of them hardly at all, and one not at all. The CAC devices were hardly used for face-to-face communication, they were mainly used for educational purposes, written communication, play and leisure. The children and their discussion partners perceived that the main reasons for not using CAC devices were the poor usability of devices, such as slow speed of CAC and insufficient vocabularies, and insufficient related services. During the CAC process the motivation to communicate of four participants increased, the communication folder use of three participants increased and vocalisations of two participants increased. V Despite of the perceived limitations of CAC, the speech impaired children considered the CAC devices important for them and helpful primarily in school work and play. Participants' discussion partners assessed that CAC enriched the children's communication and increased dialogue between themselves and the children. Discussion partners also considered as particularly important the participants' independence in being able to operate the CAC devices themselves and their possibility to use voice output. New opportunities provided by CAC devices were especially meaningful to the participants' parents. The study showed that CAC requires substantial highly specialised services and a number of recommendations were made on the basis of the study. CAC interventions should focus on not only the operative and communication skills of the users. Professionals conducting CAC interventions should evaluate more carefully what users need and subsequently evaluate whether the CAC devices meet these needs. They should also understand and support the motivational processes and psychosocial aspects of developing the use of CAC. The findings suggest that CAC devices should be introduced to severely disabled speech impaired children as an additional mode of communication for face-to-face and indirect communicative purposes and within the context of meaningful activities. This study has shown that CAC is an extremely complex phenomenon with a mixture of interrelated elements that affect the daily communication and daily activities of severely disabled speech impaired children.