by Margaret Edwards, MA, MEd, CCC-SLP (Speech-Language Pathologist); NWACS Contributor

If you are working with students that require use of AAC, then you are certain to one day get a student that has needs that are very complicated. It’s hard to know where to start with students that have little/few volitional motor movements, have vision and hearing that cannot be measured, and have no conventional way to communicate the most basic needs. These are the students that we want to help the most, but feel inadequate in providing services. Sometimes, these students are referred to as ‘low incidence’, which is exactly why they are so challenging.

I chose this topic a couple of months ago, not knowing that this very student would enroll in my school. To my surprise, the paperwork that followed did not include services in the area of communication. This, however, is not preventing me from providing support in the context of the classroom setting. So, where do I start with this student that has complex motor skills, complex communication needs, is medically fragile and new to the United States?

Here are my first four steps:

1.  Parent Interview/File Review: This first step is important for all students, but critical for students that have multiple disabilities. You will want to gather typical information around school history, past interventions, preferred language, sensory needs, and motor skills. You might want to use a form such as this one from the Kinosha Unified School District to gather specific information about communication likes and dislikes of the student. In the case of my new student, he has no history of attending school which leads to a host of other factors to consider.

2.  Observation: After all pertinent background information has been gathered, you’ll want to have a look at the student. An observation of the student in different positions (in wheelchair, on mat, in stander, etc.) is very important. The student may have volitional control of a body part in one position, but not in another. If you need a checklist to guide your observation, the Functional Communication Profile-R (LinquiSystems) might be helpful. Also, Charity Rowland’s Communication Matrix is a free tool that can guide a student observation.

3.  Make a Plan: Based on the data gathered from the parent interview and observation, start making some guesses about what the student can do. Can he use his foot to activate a switch? Will he turn his head to track music? Will he sustain attention to a screen on an iPad or computer? Can he demonstrate movement of any body part to request more of something he likes? Look at sites such as Paths To Literacy to get ideas about possible activities. 

4.  Multidisciplinary Approach: Enlist the help of your building Occupational, Physical, and Vision therapists when you first work on your plan. In the case of my new student, I also needed to find an interpreter. Luckily, there is a staff member that can speak the student’s language. Coordination of schedules is hard, but will ultimately give you the most information about the abilities of the student. Take good baseline data on each activity that you use and start to develop some early goals. It’s likely that the goals will overlap with motor skills, so developing goals with the OT and PT would be beneficial for the student.

Other challenges that can arise when working with this population of students include poor attendance, fatigue, working around feeding schedules, and slow progress. These are not roadblocks, just considerations that we must take into account. I encourage you to stay the course and work towards attainable goals. Opening the tiniest of doors for our students is worth the effort and should be celebrated! 

Please share your ‘first steps’ in the comments below. It’s great to learn from one another.