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JCPSLP
Volume 19, Number 3 2017
143
and interact, and perform sometimes physically and
cognitively challenging skills. They need to:
•
autonomously create their message;
•
recognise the symbols that represent it;
•
use working memory to hold the message;
•
initiate the interaction; use motor movements to indicate
that they have something to say;
•
filter extraneous auditory and visual stimuli;
•
wait and attend while the options are presented;
•
anticipate when the option they want is coming up;
•
attend to visual and/or verbal stimuli;
•
determine the item/s they need; and
•
perform a motor movement to signal when the item they
want is presented (Burkhart and Porter, 2006).
When PAS is used, the communication partner
is involved in co-constructing the message. The
communication partner needs knowledge and skills
to perform at least two roles during communicative
interactions: operating the scan; and participating in the
exchange in an interactive way (Burkhart & Porter, 2006).
When communication partners operate a scan, there are
several things they need to remember:
•
When the scan is auditory, the communication partner
needs to differentiate between their “scanning” voice
and their social interaction voice. The scanning voice
needs to be monotone and rhythmical, so that the
partner doesn’t lead the communicator, or provide
extraneous auditory information that needs processing
(Burkhart, 2016; Porter, 2012).
•
During PAS, items should be presented as a list rather
than a series of questions. This reduces the extra
language that may be difficult for the individual with
CPCSN to process and allows them to problem-solve
and initiate rather than become prompt dependent
(Burkhart, 2016).
•
The list of choices may be presented several times to
allow the individual with CPCSN to learn and anticipate
the item they want and organise their body to respond.
•
Each list needs to offer a “way out” or an option
for indicating “none of these”, “something else” or
“finished”. Individuals with CPCSN may not respond to
a list of options, either because they do not understand
the task, or because they may not want to select any of
the items offered (Burkhart, 2016).
•
The items for selection must be presented
systematically, in the same order each time, to allow
the individual with CPCSN to develop familiarity and
Reichle, 2008; Horn & Jones, 1996; White, Carney &
Reichle, 2010).
Scanning as a selection method requires the selection
set to be presented systematically. The communicator
waits until the desired item has been presented, and then
signals in some way to select it. Items are often selected
by activating a switch, particularly when the selection set
is presented electronically (e.g., speech generating device)
(Beukelman & Mirenda, 2013). Scanning can also occur
without technology using PAS. The focus for this paper
is on PAS, a non-electronic method for selecting and
interacting with AAC.
During PAS, the communication partner presents or
highlights items for the communicator to respond to, and
watches and/or listens for signals from the communicator.
PAS may be used with or without a physical AAC system.
In any environment, words or objects may be scanned to
support choice making and promote active participation
for the person with CPCSN (Burkhart, 2016). These words
or objects are presented to the individual as a list and the
individual waits until the item they want is presented, and
then they respond with a “yes” signal to select it. The items
may be offered visually (i.e., shown to the individual with no
auditory input), or as auditory cues (e.g., reading through
the alphabet), or the scanner may use auditory plus visual
cues (i.e., symbols are spoken aloud as they are pointed
to), depending on the skills and needs of the individual with
CPCSN. Visual symbols or objects are more concrete and
less transient than auditory symbols, and during PAS, a
communication partner may highlight, or show these for
longer if necessary. During auditory scanning, the order that
the items are presented is the arrangement or layout of the
AAC system (Porter, 2012).
Individuals who utilise PAS may use vocalisation, body
movement including eye gaze, facial expression, or change
in affect to signal acceptance or rejection of a presented
symbol. Some individuals may use a recognisable gesture,
such as a head nod or shake, to respond yes/accept or no/
reject to the scanned items. In other instances, movements
may be idiosyncratic and subtle (e.g., blinking, raising an
eyebrow or arm). The team supporting the individual with
CPCSN must look for at least one discrete and reliable
motor movement, which can be used immediately or
shaped over time, to signal acceptance during a scan
(Burkhart, 2016).
The communication of a message using PAS requires
skill on both sides of the communication dyad. The
individual with CPCSN needs to be motivated to engage
J is a 6-year-old boy who loves listening to Justin Bieber,
reading or listening to books, and playing with his dog
and his sister. He loves swimming and hanging out with
his friends and going to school and being outside.
J has spastic quadriplegic cerebral palsy, GMFCS level
5, and a severe vision impairment. He does not sit, stand,
walk, talk, eat, drink, dress, or do anything without
assistance. But J has a small amount of intentional control
over his right arm and uses it to communicate. J uses
PAS and a 20 cell per page PODD (Pragmatic Organised
Dynamic Display) communication book (Porter, 2012) to
tell his mother about school, to ask his friends to come
and play and to comment on his favourite singer.
When J has something to say, his communication
partner holds his PODD book in front of him and reads
through it, following PODD operational conventions,
column by column, then item by item, pointing at the
symbols they are speaking. J signals “yes” to the symbol
he wants by extending and raising his right arm. He tells
his communication partner to move to the next column
or item by holding his right arm down to indicate “no”. He
navigates through his book in this way until he indicates
that he has completed his message.
J accesses a robust vocabulary to express a variety of
communication functions. His communication partners
don’t know what he wants to say when he starts saying
it, but they work together to create his message. It is
autonomous communication, although it does not
happen independently and requires a competent
communication partner to co-construct the message.