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Write:Talk EPSRC Detailed Report |
DETAILED EPSRC REPORT
WriteTalk: An Investigation into the use of
Classroom Writing in a Communication Device by Children
Department of Applied Computing, Dundee University
Dr Annalu Waller (Dr Alistair Y Cairns left the department in
November 1997)
Speech and Language Therapy Service, Tayside University Hospitals NHS Trust
Mrs Hilary E Hood
Education Department, City of Dundee
Mrs Lynda Booth
Most augmentative and alternative communication (AAC) devices focus on either interactive conversation or writing, making it difficult to transfer information from one medium to the other. Although some individuals with severe communication disorders become effective communicators using AAC systems, many more remain passive observers. A contributing factor to this problem is that existing AAC systems do not provide an environment in which children can easily integrate their daily experiences into their every-day communication.
This report provides an overview of a two-year multi-disciplinary study which investigated the relationship between classroom writing and story telling with children who use AAC. The report is divided into three sections: The Aims of the Study; The Study; and Critical Assessment.
Four main objectives were specified in the original proposal.
i) To identify recording tools for assessment procedures.
ii) To develop training procedures.
iii) To select and train at least six children to use individualised Talk:Aboutä systems.
iv) To evaluate the children’s communication before, during and after implementation of Talk:Aboutä.
The overall aim of the study was to ascertain whether, given the opportunity, children with severe communication disorders would use pre-stored stories for interactive conversation. This led to the development of the following research questions:
Ø
Could AAC users
be encouraged to tell their own stories in a social way and if so how would
this affect their interactional skills?
Ø
Would a
story-based communication approach lead to a more natural form of conversation;
i.e. would the approach allow AAC users to share control of the conversation?
Ø
Given a
story-based communication system, would AAC users use their own pre-stored
stories in interactive conversation?
Ø Would the motivation to create written material which reflects AAC users’ own life have an effect on the quality, and quantity of their interactive language and formal writing skills (i.e. skills required to spell words and construct sentences)?
Research at the University of Dundee’s Applied Computing Department was instrumental in the development of Talk:About™, a story-based augmentative communication system. The first in a new generation of AAC devices, Talk:About™ offers a wide range of communicative opportunities – fast greetings, word and story-based communication. Talk:Aboutä was used in this study together with a word processor (Write:OutLoud™) and word prediction software (Co:Writer™). The combination of these three software packages will be referred to collectively as the “System” in this report.
Decisions surrounding the choice of measurement tools were made in relation to the research questions. The following tools were chosen to measure the participants’ language, functional communication and writing skills throughout the intervention period:
Profiles of the participants’ functional communication were compiled using language and functional communication assessments (see below), as well as a series of observations at school and home. Observations recorded with whom and how the participants interacted; the strategies used for successful interaction; and instances when communication was a problem. The profile also recorded information such as: names of family members, friends, teachers and pets; people with whom the participant interacted; their likes, dislikes and interests; and regular activities. This information was used to create basic individualised Talk:Aboutä systems. Observations continued throughout the study, providing a record of development over time.
The language and communication abilities of the subjects were measured at the beginning and end of the intervention period using the following tests: “T.R.O.G.” (Bishop, 1982), “Basic Language Concepts” (Engelmann et al, 1982) and “Profiles of Development” (Webster and Webster, 1990).
Two measurements were made to ascertain whether or not there was any change in the participants’ literacy skills. Spelling was assessed by asking the participants to type a list of words without Co:Writerä pre and post intervention. The participants’ story texts were also analysed using the organisation and syntactic features rating scales from the Crediton Language Development Project (Wilkinson et al, 1980).
Changes in the vocabulary within the participants’ systems were monitored by analysing the data within the system over the duration of the intervention period. This involved taking backups of the Talk:Aboutä data on a monthly basis and tracking the story files and their contents.
Questionnaires were developed for the participants’ parents and classroom teachers to provide information on the participants’ communication profiles pre-intervention. Repeated administration of the questionnaires at the end of the study provided subjective feedback on their progress. General feedback was also requested from the classroom teachers and the speech and language therapists (SLTs) post intervention. Comments from teachers and parents on an informal but regular basis were analysed for additional feedback.
A handbook was written for teachers, therapists and parents. The handbook introduced the reader to the concept behind using a story-based system and provided a step-by-step guide to using the System. Once the participants had been selected for the study, the research SLT and the research teacher visited each school on four occasions before the System was introduced to a participant. The class teacher and classroom assistants were introduced to the System, as was the regular SLT. However, the formal approach caused difficulties with the first two participants as the staff felt overloaded with information. The System was introduced more slowly in subsequent case studies, dealing with issues as they arose rather than attempting to cover too much information at once.
Staff were introduced to the concept of narrative-based communication and were encouraged to identify instances in participants’ activities in which they would have the opportunity to “tell” stories. The handbook was revised to provide a resource for troubleshooting while retaining the step-by-step instructions on how to use the System. Ongoing support was given when problems arose with computer use and the researchers could be contacted at any time.
The individual’s communication problems could stem from physical, language and/or cognitive disabilities. The selection of the participants depended on their potential to use an orthographic (text-based) augmentative communication system. A set of criteria for including participants was developed. This enabled teachers and SLTs to identify individuals on their caseload who they believed would benefit from such a system.
Six participants were initially selected to participate in the study, with five completing the study. The disabilities experienced by participants had different aetiologies, the common factor being severe problems with expressive communication - they were seldom understood by staff and parents reported some difficulties with intelligibility with unknown topics. Table 1 shows a summary description of the participants pre intervention.
|
Name1 |
Age2 |
Disability |
Communication |
Literacy |
|
Linda |
19 |
Quadruplegic Cerebral Palsy – wheelchair user |
Dysarthric – limited number of intelligible words.
Uses text-to-speech device to type words. |
Good literacy skills but poor spelling. |
|
Yvonne |
17 |
Quadruplegic Cerebral Palsy – powered wheelchair
user |
No intelligible speech. Uses text-to-speech device
to type words. |
Good literacy skills but inconsistent spelling
problems. Relies on computer for written work. |
|
George3 |
12 |
Downs Syndrome |
Articulatory dyspraxia and degree of non-fluency. Unintelligible telegrammatic speech. |
Reads some words. Can copy text. Writes name.
Beginning to write short words from memory. |
|
Anne |
10 |
Aetiology unknown – ambulant |
Dyspraxic. One/two word utterances, short
phrases/sentences are sometimes understood within context. |
Reads some words. Can copy text. Writes name.
Beginning to write words and phrases from memory. |
|
Colin |
11 |
Aetiology unknown – ambulant |
Dyspraxic. One/two word utterances, short
phrases/sentences are sometimes understood within context. |
Reads some words. Can copy text. Writes name.
Beginning to write three letter words from memory. |
|
Alan |
6 |
Aetiology unknown – ambulant |
Dyspraxic. One/two word utterances sometimes
understood within context. |
Pre-school level – writes name using keyboard –
beginning to copy letters. |
|
1All names have been changed. 2Age in years. 3George
withdrew from the project after 6 months. |
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Table 1: Summary description of the participants.
Each participant was provided with a system which was customised, e.g. personalised vocabulary was entered into Co:Writer™ and some personalised stories and topics were stored in Talk:About™.
The intervention stage of the single subject design was staggered so that the starting dates for subjects were different. The researchers worked with subjects on a one-to-one basis, both at home and school, and within the classroom situation. Two main types of intervention took place:
· Classroom support: Researchers facilitated the use of the system in interactive classroom work, e.g. contributing to news time, answering questions, completing worksheets. The researchers had advance knowledge from the teachers about project work and prepared appropriate texts with the subjects. This enabled researchers to identify the sorts of language and vocabulary which would be useful for classroom activities and helped the subjects to interact meaningfully within the sessions.
· Conversation Modelling: The goal here was to develop subjects’ story telling skills. This involved working with subjects on a one-to-one basis, assisting subjects in the creation of story texts. The appropriate use of these stories was modelled by researchers as most subjects had little or no understanding of the pragmatic use of story telling for social interaction.
Of the six participants, five completed the year long intervention period. George withdrew from the study six months into his intervention period.
The participants’ communication and language skills were monitored during the study using the assessment tools mentioned above. The language assessments clearly show that all five participants increased their functional communication and expressive language skills. However, their receptive language and underlying abilities remained stable. The data was also used to answer the four main research questions. Several additional issues were also identified.
Ø Could the AAC users be encouraged to tell their own stories in a social way and if so how would this affect their interactional skills?
The appropriate use of stories had to be modelled by researchers as the participants had little or no understanding of the pragmatic use of story telling for social interaction. Observations indicated that although participants with some oral ability did have pragmatic story telling skills prior to the intervention, they had learnt to communicate in telegrammatic utterances to ensure successful communication. Those participants with little or no intelligible speech used the system as their primary form of communication. However, those whose intelligibility decreased with utterance length tended to decrease their reliance on the system as their confidence grew. They then moved towards intentional use of it to back up poor intelligibility in specific circumstances.
It is not always the desire to create the story that is absent but the experience of how to tell the story. It is essential to develop story telling skills. It is also perhaps fundamentally important to encourage experience of imaginative narration.
Ø Would a story-based communication approach lead to a more natural form of conversation; i.e. would the approach allow the AAC users to share control of the conversation?
Analysis of videoed conversations showed that participants initially used the system to take full control of a conversation, ignoring the conversation partner. The System provided participants with the ability to take full control of an interaction, a new experience for all of them. Participants slowly began to react appropriately to their partners’ interactions and participants showed an ability to retrieve and use appropriate information towards the end of the study. The researchers believe that the ability to relate personal experiences, jokes and stories have enabled the participants to develop skills in initiating and controlling interactive communication.
The researchers observed that successful communication tended to occur in environments where an “open question ” approach was used, encouraging questioning from participants. Classroom activities, when teachers encouraged discussion and provided opportunities for students to direct activities – e.g. “News time” – revealed particular progress. However, the system was obsolete in situations where staff controlled the conversation.
Ø Given a story-based communication system, would AAC users use their own pre-stored stories in interactive conversation?
Weekly backups of the Systems allowed the contents of the stories to be tracked over time. The results show that most stories continued to be modified over the intervention period for all participants. Although specific circumstances surrounding the changes – e.g. who changed a story file and how the stories were used – could not be recorded, records confirmed that participants were usually present when the System was in operation. It can therefore be assumed that participants were involved when the System was used.
On-going observations and analysis of videoed conversation showed that participants were able to retrieve specific stories. Some participants, e.g. Anne, Linda and Colin, could retrieve appropriate information within conversation, despite the complexity of the interface. Yvonne and Alan needed prompting to do this. Yvonne elected to revert to typing individual words due to problems in remembering where stories were stored and the fact that she was used to doing this. Alan would indicate that he wanted to tell a certain story but still needed some help in retrieving these by the end of the intervention period.
The problems in retrieving stories highlighted the need for a simpler interface designed specifically for children with language and learning problems.
Ø Would the motivation to create written material which reflects AAC users’ own life have an effect on the quality, and quantity of their interactive language and formal writing skills (i.e. skills required to spell words and construct sentences)?
Results support previous research (Newell et al., 1992) in which the use of word-prediction has enabled individuals with language and spelling problems to produce improved written language structure and spelling. The participants’ written skills were analysed by comparing spelling errors on a spelling list, spelling errors on a dictated passage and sentence structure over the intervention period. The difference in errors made on the dictated passage and the spelling test were not significant. However, the participants’ therapists and teachers reported that their written language skills had benefited from the study. These observations were strengthened by the analysis of story texts using the Crediton ratings which showed a development of structure and syntax in unprompted stories.
Ø ISSUE 1: Creating Environments for Successful Story Telling
Some teachers and other staff tended to use a “closed question” communication approach to reduce the risk of communication breakdown. This had a negative effect on the participants’ ability to expand utterance length. There is a real issue that communication partners do not expect expanded utterance or narrative abilities from poor communicators and therefore the environment where these skills will be encouraged and developed is absent. This in turn may restrict the development of narrative skills.
Ø ISSUE 2: Integrating classroom activities and AAC
Teachers initially viewed the System as a means to use specific vocabulary to access the curriculum. The System was thus introduced as a wordprocessor, and was then gradually used in activities such as “News time”. Having an integrated system which can be used to develop formal classroom as well as conversational skills meant that speech and language therapy and education staff could use the same system. The system thus allows them the opportunity to satisfy specific goals as well as working towards common goals.
Used as a therapeutic aid, the use of the System should not be seen as an end in itself but as a means of encouraging interaction. As such, it could be used by the SLT during clinical sessions and in the class with and without support.
Ø ISSUE 3: Development of Self-esteem and Personality
Analysis of the questionnaires identified that the ability to express personality had developed in all five participants. Teachers, therapists and parents agree that all participants have developed their interactional skills because of the emphasis on story telling. Feedback has included statements such as: “I didn’t know she had a sense of humour”, "our relationship has changed" and “she is cheeky now”. These statements from those closest to the participants strongly suggest a development of a personal identity.
Ø ISSUE 4: The System as an AAC Device and a Therapeutic Tool
The system proved to be of therapeutic help to three of the participants who had oral speech with poor intelligibility. These young people developed more effective expressive communication, using longer and more complex communication. The communication system also proved to be an effective augmentative communication system for the remaining two participants who both use wheelchairs. These two young people have severe physical disabilities and are reliant on augmentative communication for all spoken communication.
Ø ISSUE 5: The System – Pros and Cons
The PowerBook was too cumbersome for ambulant participants to carry around. It also takes a few minutes to switch on and this caused some frustration. Participants also became frustrated when their peers were not always able to understand the synthetic speech, mainly due to its lack of volume. Despite this, participants were able to use the System in a structured setting, i.e. the classroom. Some participants also used the System to address larger audiences, e.g. when taking assembly or giving a talk, using external speakers.
The study also highlighted problems with the design of the interface to the System. This includes problems with using the three software packages together and the difficulty in retrieving stories.
The results of this research show that all five participants benefited from the introduction of a narrative-based approach to AAC. It is difficult to separate the natural confounding variable of the maturation process but the introduction of the narrative-based communication system does seem to be the most likely reason for the change in communication profiles. The success of the intervention can be attributed to the change in approach but the use of a literacy-based communication system within a personal computer has provided these young people with a wide range of communication modes and the use and development of pre-stored stories. The use of a literacy-based communication system provides a bridge between formal classroom work and interactive communication and allows teachers and speech and language therapists to use the same system to achieve a common communication and educational goal.
The study is seen to have been a success in the following ways:
1. A story-based communication approach has been shown to benefit the communication and language development of children with severe communication disorders.
2. The ability to relate personal story, tell jokes, and generally participate more fully in communication, gives a sense of personal identity to the individual, helping to develop self-esteem.
3. The System proved to be of therapeutic help as well as an augmentative communication system.
4. The publications from this study illustrate practical ways of implementing such an approach.
5. A research proposal to design a more appropriate story-based system for young children has been submitted to the EPSRC.
The multi-disciplinary nature of this study was essential to its success. The resignation of the full-time research speech and language therapist was unforeseen and problematic. The recruitment of a highly motivated psychology graduate resulted in a successful outcome for the project.
The four ambulant children were seen to be candidates for picture-based communication and their education had not focussed on literacy learning. It had been envisaged that the study would have problems selecting participants. However, experience gained during the study has made the researchers aware that more children should be introduced to a text-based system even when literacy skills are limited.
Problems associated with the robustness of the Talk:About™ software was possibly the major threat to this study. Early software problems meant that Anne had to disregard the use of the "Who's" when storing or retrieving a story. However, it had already become clear that the young people were not using the "Who's" to categorise stories. Further analysis raised the issue of whether the storage of stories in terms of topic (‘Whats’) and "Who's" is relevant to younger children as they did not mind to whom they told a story. The concept of keeping a story private only arises later on in development, e.g. with Yvonne and Linda.
The software problems and a change in school setting may have contributed to the withdrawal of George. It had been hoped that more participants could have been recruited to avoid this potential problem, but this proved impossible due to the problems raised in relation to recruitment. The researchers would also have found the additional workload difficult.
It was felt that the complexity of the screen and the way in which stories were accessed hindered the use of the system in the early stages of the study. Talk:About™ was designed for literate, linguistically intact users. The need to switch between Talk:About™, Co:Writer™ and sometimes Write:OutLoud™ posed additional problems for participants.
A total of 12 academic papers reporting the progress and results of the study have been presented at, or submitted to, national and international meetings, including the International Society for Augmentative and Alternative Communication (1998 & 2000); the European Association for the Advancement of Assistive Technology (1999), the British HCI Group Meeting (1999); and Communication Matters (2000). Dr Waller was also invited to give papers on story at the IEEE and the International Cerebral Palsy Society. One journal paper has been submitted for publication and three more are in preparation.
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