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The Principal,
Souls Primary School,
Orchards,
1200.

Dear Principal,
Thank you for your time, this letter is just a follow up to our last discussion over the phone
concerning Anna. I will like to bring to your attention the two barriers (Access and
Opportunity), that hinder Anna from participating in school as her peers.

Access barriers, are barriers that relate to the capabilities, attitudes and resource limitations of
individuals who use AAC, rather than to the limitations of their societies or support systems
(Beukelman & Mirenda, 2005).
Opportunity barriers are those barriers encountered by individuals with severe disabilities,
from people (parents, teachers, grandparents, and so on) within their immediate environment,
even though they have access to effective and efficient AAC devices or intervention
(Beukelman & Mirenda, 2005). I will briefly differentiate between both barriers in the
following paragraphs.

While access barriers are can be regarded as internal factors(coming solely from the AAC
user) placing constraints him, opportunity barriers can be said to be external in nature since
the influence comes from other people( in different contexts) in the users’
environment(Beukelman & Mirenda,2005).
Access barriers can be related to mobility, manoeuvring of objects, cognitive defects, literacy
problems, and inadequacies experienced from communication devices etc. Opportunity
barriers on the other hand are generated by people, and require a change of mindset to
overcome (Beukelman & Mirenda, 2005).
There are five types of Opportunity Barriers (Beukelman & Mirenda, 2005, p. 142), and these
are:
*Policy barriers, * Practice barriers, *Knowledge barriers, *Skills barrier, *Attitude barriers.
Policy barriers are those legislations or regulations coming from different establishments,
(e.g. Schools, Organizations, Government offices, Nursing homes, Hospitals, Care centres
etc) which affect the situations of AAC users negatively (Beukelman & Mirenda,2005). An
example is the case of the nearby public school whose principal feels that Anna is not suitable
for his school because as a matter of policy, only able-bodied pupils attend the school.

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Practice barriers are not in themselves policies but are conventions or norms practised by
institutions, organisations and schools etc and have become accepted ‘officially acceptable’
without any legislation backing it up (Beukelman & Mirenda,2005). An example is the
prohibited use of Anna’s GoTalk 9 device outside school, because the insurance company
will not cover the device outside the school premises.
Knowledge barriers refers to lack of sufficient knowledge about AAC(interventions,
technology, application) from people closest to the AAC user who deal with him from time to
time in different contexts(Beukelman & Mirenda, 2005).
Examples are Anna’s friends at school who only see her device as a toy to play with or her
grandmother who is illiterate, and not able to help Anna with her home work after school.
Skills barrier is very similar to knowledge barrier, except that skill barriers requires some
level of appropriate application of the knowledge gained to implement AAC
strategies(Beukelman & Mirenda, 2005).
Example can be cited about Anna’s teacher who despite repeated demonstrations from the
Speech therapist finds it difficult to program new vocabulary unto Anna’s SGD. The teacher
has definitely heard about AAC but she lacks the necessary skill to help Anna improve with
her communication and participation at school.
Attitude barriers are serious and can be expressed subtly, reservedly or unreservedly.
People around the person with disability bring their beliefs, limitations and negativism
interfering with a prescribed plan of AAC intervention. Close family members, care givers,
teachers are all not left out when it comes to this barrier (Beukelman & Mirenda, 2005). For
example, Anna’s teacher feels it is a waste of time to implement AAC strategies for Anna as
she has completely written Anna off in her mind as not being able to use any type of device
without taking Anna’s abilities into consideration. Overall, the teacher admits to not seeing
the importance of AAC in general.
My suggestions and recommendations to addressing the barriers above are as follows:

Policy barriers: while policies might not be easy to reverse, interest groups (made up of
parents, principals, teacher, therapists) supporting the cause of children with severe
disabilities using AAC can be birth. This group with a collective voice can help challenge
unfair policies (as seen from the Principal of the nearby school) within the community, and
also help clamour for public schools to be equipped for disabled children.

Practice barriers: practices which will limit or hinder participation outside the school
environment for AAC users should stop. Steps should be taken to raise funds for children so

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as to allow them lend simple devices, charts etc from school (Beukelman & Mirenda, 2005).
This will ensure continuity both at home and school. Otherwise, further negotiations can be
entered into by the insurance company and the school to allow the children the use of their
devices at home.

Knowledge barriers: this can be addressed by planning lots of workshops, symposiums,

lectures, displays and teachings on what AAC is about and its strategies. Everyone should be
involved, grandparents, teachers and siblings even other pupils in class. Workshops can be
given in the other languages (especially for Anna’s granny) apart from English just to make
sure some level of understanding is attained. Simplified version of talks can be organised for
pupils who are in class with Anna, so that they know that her speech device is not a toy.

Skills barriers: A lot of practical is needed to convert knowledge to skills. Anna’s teacher
would benefit from an in- depth training on AAC and not just loading vocabulary on Anna’s
device. This will give her more confidence and a better understanding of the device. More so,
the speech therapist should also not assume she can do it, but allow her repeat what she has
shown the teacher to determine understanding of the process.

Attitude barriers: a change of mind set, purposely being positive, and lots of support from
the school can help reduce this barrier. Organized counselling sessions can be made available
for this teacher to boost her mental and emotional well being. It will also help her see why
her negative attitude will affect Anna and perhaps other children in her care. Anna’s teacher
needs an appropriate channel to voice out her challenges and perhaps frustration within the
context of her work. Teaching able bodied children is quite overwhelming, how much more
children with some form of disability. Also the school must look at employing assistants who
will help take some burden off the teacher hands, thus enabling her perform her work more
efficiently.
In conclusion, I hope you find this letter relevant, and clearly see how these barriers (access
and opportunity) can be tackled to help Anna participate better at school.

Yours Faithfully,

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Question 2
The relational problems as stated in (Beukelman & Mirenda, 2005, p.112-113) affecting
Anna’s team are:

1. Lack of positive interdependence

2. A violation of social norms established by the team for interaction

3. Domination of meeting by a team member

4. Work Avoidance by some members

5. Lack of creative problem solving skill by a team member

6. Ignoring another team member’s suggestion

7. Feeling of insecurity whereby team members cannot express themselves openly

8. Inability to receive criticism.

Lack of positive interdependence: The teacher doesn’t really consider herself as part of the
team, otherwise she will not be blaming “ALL” the therapists for Anna’s lack of progress.
Anna’s case is such that everyone on the team must either swim together or sink. It will be
very difficult for any AAC team to forge ahead if her members will point accusing fingers at
one another.

A violation of social norms established by members for interaction: The physiotherapist

violated a social norm by storming out of a meeting attended by all team members due to a
remark made by the teacher. I believe she could have excused herself politely rather than
storming out, which is not socially acceptable especially in a meeting as crucial as this. Anna
is the main priority here and most times team members might not even remember that.

Domination of meeting by a member: The teacher was said to have dominated the meeting.
This means that the teacher did not give most of the team members’ time to voice out their
opinions. This type of attitude breeds contempt among team members and causes problems.

Work avoidance by a member: A child like Anna will spend about five to nine hours at
school everyday depending on whether she is enrolled for a half or full day. This means that
she spends more time with the teacher compared to all other members of the team apart from
her parents. However, it is sad that the teacher wants to pass the bulk by suggesting that

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someone else takes care of Anna’s speech device, when she is the best candidate to take care
of it because of its more frequent usage by Anna within the school environment.

Lack of creative problem solving skills: An example of this is the occupational therapist
who is finding it difficult to think of other ways of helping Anna and the speech therapist.
She ought to be more flexible in her approach and find time to work things out between
herself, Anna and the speech therapist.

Ignoring a team member’s suggestion: From the case study, the speech therapist had some
ideas to share but the rest of the team ignored her. The end result of this sort of attitude in a
team can leave it disoriented as was the case in this meeting called by Anna’s parents.

Feeling of insecurity and inability to express one’s opinions: although Anna’s parents had
concerns, they could not voice it out openly because they found the atmosphere shocking,
unfriendly, hateful, and dominated by the teacher. They left feeling isolated and frustrated at
the end of the meeting.

Inability to receive criticism: Although the teacher’s outburst is not right, the
physiotherapist could not accept the negative criticism coming from Anna’s teacher even
though she spoke collectively against “the therapists”. Offence is inevitable when people
come together for a common goal, above all, respect for others, maturity and a sense of
purpose is needed to accomplish those goals, otherwise there will be chaos within the team.

Importance of Collaboration

The aim of individuals in a collaborative team is to design and implement programs for
children with disabilities to achieve their educational goals, by maximizing every learning
opportunity the children are exposed to (Rainforth, York, & Macdonald,1997). Anna, her
parents and the rest of the team will also find collaboration important because it will help to;

 Define the roles of each member of the team from the beginning and what’s expected
from them, as Anna’s needs changes in different contexts.(Beukelman & Mirenda,
2005).

 Foster positive interdependence amongst team members. Everyone on the team will
respect one another and see themselves as a united force working towards a common
goal,(Anna’s progress) instead of exhibiting antisocial behaviours during team
meetings (Beukelman & Mirenda, 2005).

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  Develop mutual goals, as this process will involve all team members and in doing so,
conflict management, negotiating and listening skills will be developed and enhanced
among all members (Beukelman & Mirenda, 2005).

 Makes problem solving less challenging and fosters support among team members, as
stated in Johnson and Johnson, (1989) in Rainforth, et al.; 1993 ). This is lacking in
team members handling Anna’s case, because each specialist is doing her own thing
unitarily.

 Put into practice the most efficient and effective curricular and instructional practices
for students with severe disabilities. (Idol, Paloucci-Whitcomb, & Nevin., 1986) in
Rainforth ,et al., 1993 ).

Advantages of Collaboration

1. Collaboration will help other team members on Anna’s case have access to an in-
depth information of subsequent intervention processes and outcomes (Beukelman
&Mirenda, 2005).

2. Also, collaboration affords the team to solve problems as a group, and support one
another should the group imbibe the spirit of togetherness and cooperation( Rainforth,
et al,; 1993)

3. Collaboration allows each person on Anna’s team to use their skills, knowledge and
aptitudes to the very best in helping Anna in the various contexts of her daily living
e.g. school, home, and community (Rainforth, et al,; 1993). For example, Anna’s
parents, will also be able to contribute without feeling isolated and frustrated during
meetings as they are in a better position to tell the team how Anna copes in the home
context.

4. Collaboration will foster harmony and build a sense of belonging amongst team
members, team members are happy when they can listen to each other and
acknowledge contributions.

5. Collaboration empowers the team to learn from one another by developing an array of
other competencies not directly linked to their own profession. (Rainforth, et al,;
1993)

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 Question 3.1

The aim of a capability assessment is to identify the strengths and abilities, not weaknesses
and impairments of the person with severe disabilities. (Beukelman, & Mirenda, 2005)

Domains to be included in Anna’s capability assessments include:

*Positioning and seating/ motor skills, *Communication skills, * Cognitive skills

*Literacy skills, * Sensory skills, *Socio-emotional skills

Positioning and seating: Assessment of this domain is very crucial to individuals who have
challenges with motor impairments as most will spend considerable time every day in a
seated position, therefore, there is a need to make their seating and positioning comfortable in
order to enhance performance and ‘functional communicative effectiveness’(Beukelman
&Mirenda, 2005 p. 165). In Anna’s case, I would like to obtain information about any
neurological impairment, such as increased or decreased muscle tone, as these can bring
about problems in balance, posture, and make movements difficult.

Primitive reflexes (rooting, symmetrical tonic neck reflex and asymmetrical tonic reflex),
are triggered by certain ways which the body, head or neck are turned, raised or bent.
Information about these are needed to help a potential AAC user access adaptive devices and
switches which will require some degree of fine and gross motor movements. Information on
the presence of skeletal deformities (scoliosis, hip dislocation, pelvic rotation) is necessary
because a good upright posture and comfort is healthy while sitting (Beukelman & Mirenda,
2005).

Information on the presence of movement disorders if any is also important. Lack of control
over upper limbs can result in difficulty in writing, pointing for direct selection, and other
gross and fine motor movements (Beukelman & Mirenda, 2005).

Motor capability: focuses on motor strengths and not problems. Information will be needed
on the individuals muscle tone and postural control as these are necessary for manipulating
objects, devices or switches and to determine if an aided or unaided symbol system is
needed. Information about Anna’s hand function, upper limbs, foot and leg, as well as

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head and facial muscles is also crucial to know if she can learn some manual signs, as well
as help with direct selection or scanning, of symbols for communication purposes.

Information on the type of movements she can make in routine activities is also important, as
well as her current movement patterns, knowing this can help to determine her range of
motion and accuracy of movement, in getting her desired messages across to partners
without ambiguity. (Beukelman & Mirenda, 2005)

Communication Capability: in this domain it will be necessary to obtain information about

Anna’s desire to communicate, as this shows that she wants some interaction between
herself and others in the environment. Her ability to articulate and produce speech sounds
is also what I’d look out for (Beukelman & Mirenda, 2005).

Information about her communication functions is important. These will reveal her reasons
for wanting to communicate such as to gain attention, or initiate interaction. Also, her
current mode(s) of communication is important because information about how
intelligibility, ability to use facial expressions, natural gestures etc will be derived (Downing,
2005).

Information about her level of receptive language is needed because it can help me know if
can react to her name, understand simple instructions or complex ones etc. Another type of
information necessary has to do with Anna’s voice and fluency, its pitch, quality and
loudness. Also it is important to find out about her hearing ability, because if something is
wrong with her sense of hearing understanding what is said will be difficult (Downing, 2005).

Cognitive Capability: is about how the individual perceives the world. I will like to get
information about Anna’s concentration, awareness and attention according to Rowland
and Schweiger(2003) in Beukelman and Mirenda(2005), because all these are important to
participate in any activity, so also is her understanding of cause and effect which is prime to
communication. Her memory capacity is important to know as this will help determine how
she can retrieve and select messages should an aided or unaided set be introduced. Her
ability to make choices is an important piece of information I’d like to obtain as this will
show how much control Anna has over her environment.

Object permanence (ability to know something exists without seeing it), means-end
relationship (ability to use one thing to do something else) are necessary information to be
gotten from this domain. Another important information will be to know what level of

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representation (real objects, pictures, line drawing etc) Anna is on, and her understanding or
recognition of the symbols.(Beukelman & Mirenda, 2005)

Literacy Capability: Since she can request for a desired object by looking at it, then I will
love to find out if she recognizes familiar words, and logos (Beukelman & Mirenda, 2005)

It will also be important to know if she gets opportunities to be read to and how enriching
the school curriculum is (Beukelman & Mirenda, 2005 ).

I also want to know how best to support Anna to develop reading and writing skills, and if
the Go Talk 9 is an appropriate device for her presently.

Also, I would like information about her level of reading comprehension, and her spelling
ability (spelling letter by letter, initial consonants only, and so on).

Sensory Capability: I will like to know if Anna has any physical eye defects that can hinder
her vision and if it is paramount for her to see an Ophthalmologist (Beukelman & Mirenda,
2005 ) for further assessment.

If she doesn’t have any significant eye defects, it will be important to also know if Anna has a
good visual acuity which can help her notice fine distinctions or details in objects or symbols
(Beukelman & Mirenda, 2005 ). It can also help in deciding symbol size, and how far or close
it should be for her to see it.

Information about her visual field is important as it will help reveal if she has, blind spots or
decreased vision in her peripheral or central vision(Beukelman & Mirenda, 2005 ).

Also, information about her oculomotor functioning is needed as this will show if her eyes
move together in all directions as this can help her with locating a symbol or scanning later
on (Beukelman,& Mirenda, 2005 ).

It will be good to know if Anna is sensitive to light and glare as these could be bothersome
if she uses displays that are laminated. Colour perception is necessary information, as it is
needed for visual discrimination of contrast and detail, used on AAC displays. It is also
important to know if Anna’s visual stability is intact and not dependent on environmental
factors or physical status ( Beukelman & Mirenda , 2005).

Another important aspect of sensory capability is the sense of hearing. It will be good to
know that Anna has no hearing defects and if she does, making quick decisions about
remediating it is paramount.

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Determining if Anna can hear soft tones or loud ones will be important especially in the
classroom, because many electronic devices’ feedback are auditory and they come as beeps,
or a spoken echo(Beukelman, & Mirenda, 2005 p.217).

Knowing if she can comprehend a synthetic or digitized speech is also paramount as these
are used for auditory scanning (Beukelman & Mirenda, 2005).

Another useful information is if Anna reacts positively or negatively to textures ( i.e. rough,
smooth, soft, etc), and if she is able to just feel or touch objects and recognise them.

Socio-emotional Capability: Anna comes across as a sociable child who enjoys some form
of interaction with her friends, listening and laughing to funny comments. However, I still
want to find out if any she can turn taking skills, can she take balanced turns during
interaction, her response and pause time. All these are necessary for effective
communication.(Charliffue-smith & Rooke, 2008)

Observing if Anna can maintains eye contact during interactions is important as this can
reveal her level of interest or trust in the communication context.( AAK 702, study
guide ,2012).

Information about her attending skills (visual and physical) are important, as these are
needed for her to listen and respond likewise in communication exchanges.

Emotionally, it is important to see if there is any challenging negative behaviour as a result

of not being understood or from her needs not met adequately.

Question 3.2

Communication modes as explained by Downing, (2005) are forms or means of expressing

thoughts, needs and feelings. It also refers to multiple means of communicating (i.e.
vocalizations, facial expressions, gestures) such as verbal or nonverbal, aided and unaided
means.

From the case study, Anna uses a variety of communication modes such as her speech
generating device (Go talk 9) which helps her at school.

She also tries to talk, and is able to say a few words (such as, mom, dad, more).

She uses intense gaze (looking intently) and often does cries when she cannot be understood.

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Communication functions are simply the reasons or purposes for which one engages in
communication exchanges (Downing, J.E., 2005). It is also the use of linguistic and non
linguistic behaviour for social interaction, information transfer, and social closeness within
ones natural environment (Light, 1988).

Examples of Anna’s communication functions are (1) to gain attention by drawing attention
to herself in order to initiate a conversation (2) To request for desired objects when they are
out of reach, or by directing attention to it, (3) By requesting for actions, such as to turn on
her computer.

Receptive Language fundamentally deals with one’s understanding of language and showing
an appropriate response to what was said. According to Downing,( 2005), receptive
communication skills will be any behaviour indicating understanding of what was said to the
student. These responses can be in the form of acknowledging gestures, sounds, actions or
facial expressions.

From the case study, Anna is able to follow complex instructions and laughs at funny
comments made by her friends. She can also respond to questions using single words such as
yes or no.

Desire to communicate can be described as an intentional or deliberate pursuit of wanting to

communicate on the part of the severely disabled individual. If adults in the individual’s
environment do not allow him do some things by himself or learn to make requests, he will
eventually lack the desire to initiate communication and finally sinks to learnt helplessness
(AAK 702 course notes).

We can see examples of the desire to communicate from Anna as she tries to make her own
attempts to make her needs known outside school without her speech generating device.

Also, she uses gazing techniques to request for objects, and if she wants specific actions
performed such as switching on her computer. She even laughs at funny comments made by
her friends, and will draw attention to herself to initiate communication.

References

Beukelman, D.R., & Mirenda, P. (2005). Augmentative and Alternative Communication:

Management of Severe Communication Disorders in Children and Adults( 3rd ed.).
Baltimore: Paul H. Brookes.

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Charlifue-Smith, R & Rooke, C.C. (2008). Communication Development Domain. In
T.Linder, Transdisciplinary Play-Based Assessment(2nd ed) (pp 189-225) Baltimore : Paul H.
Brookes.

Downing, J.E., (2005). Teaching communicating skills to students with severe disabilities(2nd
ed). (pp.27-50) Baltimore: Paul H. Brookes.

Idol, L., Paolucci-Withcomb, P., & Nevin, A.(1986) Collaborative Consultation. In

Rainforth, B., York, J., & Macdonald, C.(1993). Collaborative teams for students with severe
disabilities: Integrating therapy and educational services.(pp 9-37) Baltimore: Paul H.
Brookes.

Johnson, D.W.; & Johnson, R.T.(1989). Cooperation and Competition: Theory and research.
In Rainforth, B., York, J., & Macdonald, C.(1993). Collaborative teams for students with
severe disabilities: Integrating therapy and educational services.(p 18) Baltimore: Paul H.
Brookes.

Light, J.(1988) Interaction involving individuals using augmentative and alternative

communication systems. In Beukelman, D.R., & Mirenda, P. (2005). Augmentative and
Alternative Communication: Management of Severe Communication Disorders in Children
and Adults( 3rd ed.). Baltimore: Paul H. Brookes.

Rainforth, B., York, J., & Macdonald, C.(1993). Collaborative teams for students with severe
disabilities: Integrating therapy and educational services. (pp 9-37) Baltimore: Paul H.
Brookes.

Rowland, C., & Schweigert, P.D (2003). Cognitive Skills and AAC. In Beukelman, D.R., &
Mirenda, P. (2005). Augmentative and Alternative Communication:
Management of Severe Communication Disorders in Children and Adults( 3rd ed.).
Baltimore: Paul H. Brookes.

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