Teachers and speech-language pathologists serving children who have dual sensory impairments combined with severe orthopedic impairments are often at a loss as to how to provide effective communication instruction. No systematic approach has been available to guide teachers through the intricacies of what is necessarily a difficult process. This paper describes the results of a 3-year investigation of the use of microtechnology to enable children with dual sensory impairments and severe orthopedic impairments to communicate. We present here an instructional sequence that applies across the wide variety of children who participated in the investigation. Some of these children initially appeared to have no voluntary behavior at all: others were able to produce some intentional motor behaviors, but these were not under any clear stimulus control; while others had some primitive but unreliable means of signalling, such as gross vocalizations. By the end of the project, all of these children had shown an ability to learn and had acquired new communication skills, ranging from signalling for attention to indicating a choice. Three case studies are provided to illustrate the use of the instructional sequence.
KEY WORDS: aided communication, dual sensory impairment, instructional techniques, multiple disabilities, physical impairment, single subject design, technologyThis paper summarizes the major findings of a 3-year investigation into the use of microtechnology to allow children with severe and multiple disabilities to communicate. The population targeted by the investigation was children who had dual sensory impairments as well as severe orthopedic impairments and nonexistent or extremely limited intentional communication skills. Communication in children with such severe and multiple disabilities is an area of the utmost concern for educators. However, clear and comprehensive procedures have not been available to date at either the preservice or inservice level to address the communication needs of this population. This problem becomes even more acute in light of the progress that has been made recently in integrating low-incidence populations into general education settings. A teacher may not have the specialized instructional skills (e.g., how to collect unambiguous data, how to design an alternating treatment approach) necessary to probe and analyze the behavior of the target population, leaving the teacher uncertain whether a child has succeeded at an instructional objective. Once success has been achieved, the teacher may not know what to do next in order to bring the child closer to functional communication. The instructional sequence presented in this paper was designed to provide clear guidance for teachers. It is based on the establishment of social contingency awareness as a stepping stone to intentional communicative behavior.
BACKGROUND AND RATIONALE FOR THE INSTRUCTIONAL SEQUENCE