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Jeanette’s Story

Posted by on Jun 1, 2013 in Uncategorized | 0 comments

adult-services_1Jeanette is a strong-willed woman, diagnosed with cerebral palsy, epilepsy and profound mental retardation. She grew up in a state-run institution and at age 40 moved into a community-based residential program. I was introduced to Jeanette when she was 57. Determined and thoughtful, nonverbal and non-ambulatory, Jeanette had many barriers and limited opportunities.

Jeanette demonstrated skills at a pre-symbolic level; she would not be able to successfully use the ‘standard’ Boardmaker line drawings or even colored photographs but rather needed ‘vocabulary’ that would be more concrete to represent her thoughts, ideas, and words. Following a comprehensive assessment, a program was established for her, consisting of training staff on how to teach Jeanette Object-Symbol vocabulary, how to assess Jeanette’s ability to understand and use her new tangible ‘words’ and what to do with the vocabulary once she acquired it. The following targets were identified for training. No one ever thought it would take just two weeks for Jeanette to communicate her first word!

OBJECT-SYMBOL

Metal Spoon

Clear Plastic Cup

Wooden puzzle piece

(reinforced) Toilet Paper Roll

Keys

Small ball

Bath sponge

Blanket square (4×4)

Portion of magazine (4×4)

Tylenol Bottle

Remote control

Blue Acrylic Choice Board

MEANING

Eat

Drink

Puzzle

Toilet

Ride

Play Ball

Shower

Nap/Sleep

Flip Through Magazine

Pain

TV

Activity Choice

Staff at Jeanette’s home did a great job teaching Object-Symbols; prior to the activity represented staff would verbally label the upcoming activity as they showed and encourage Jeanette to feel and manipulate the Object-Symbol.  Once they arrived at the activity location they again directed Jeanette attention’s to the Object-Symbol, pairing the activity with the Object-Symbol.  Then again, during the activity they paired the Object-Symbol with the activity again, making the connection. They did this with all the Object-Symbols listed, each time Jeanette participated in one of the listed activities.  Obviously some Object-Symbol had more training than others, ‘Toilet’ obviously had a lot of training, every two hours Jeanette was handed the TP roll, told she was going to go to go sit on the toilet and was then wheeled to the toilet, where she sat on the toilet, had her wet Attends changed and was cleaned up.

One day, a short two weeks into the training, staff noted Jeanette was ‘fussy’, not wanting to participate in any activity staff tried to engage her and seemingly very discontent.  In a last ditch effort, a staff member placed the basket containing the Object-Symbol staff used for training on Jeanette’s lap and asked her, “What do you want?” Jeanette then looked up at staff and began rummaging through the basket of Object-Symbols; she then  lifted her hand to staff and handed them the TP Roll!  Astonished, the staff immediately took Jeanette to the toilet, where she successfully urinated in the toilet FOR THE FIRST TIME IN HER LIFE! To this day, Jeanette is content, she no longer requires Attends during the day and she has dignity.  She also has a lot to say, with over 20 known Object-Symbols used on her Communication and Choice Boards, Jeanette is now an active participate in her care and her life, indicating preference, choices and basic needs utilizing a growing repertoire of Object-Symbols!

Click here to see Jeanette and what successful communication looks like!

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Dan’s Story

Posted by on Mar 7, 2013 in Uncategorized | 0 comments

Adult ServicesOne of my favorite stories is that of a staff person named Dan and the lesson he learned by playing ‘dumb’. Dan had attended one of my trainings in rural Eastern Oregon, entitled Developing Communication Skills with Adults with Developmental Disabilities.  Dan had sat through the whole training, without saying much but listening intently.

The next day Dan approached me with a big beam on his face.  He had tried one of the strategies we had discussed the day before and he couldn’t wait to share his success!

Here’s Dan’s story:

“When I got to work on Friday it was Pizza Night, just like every Friday; however, this Pizza Night I did something different with Stevie, the individual I support, and boy did he notice! 

Stevie and I went into the kitchen together, and like always, I turned on the stove, showing Stevie that I set the temperature to 425 degrees Fahrenheit.  I then turned to the refrigerator but rather than taking out the pizza I simply looked at it on the shelf and shut the refrigerator door.  I then opened the oven and closed the oven door and set the timer for 12 minutes.  Stevie looked at me and I smiled, as I walked away.  Stevie, perplexed, followed and we sat in the living room until we heard the timer ring. 

Stevie and I hurried back to the kitchen to see our cooked pizza.  I looked at Stevie as I opened the oven, “Is it done?” I asked.  Stevie looked in the empty oven, then back to me, puzzled. 

“Nope?” I questioned, and set the time for another 12 minutes.  Stevie was now getting hungry – me too! – and I could see he was mentally questioning my skills, but he followed me out of the kitchen, again, and we went back to hang out in the living room. 

Once again, when the timer rang, Stevie and I went to see our piping hot pizza.  And once again when I opened the over and looked at Stevie, I asked “Is it done now?”

Stevie had a very puzzled look on his face, took hold of my hand and led me to the refrigerator. He opened the refrigerator and pointed to the pizza, sitting cold and uncooked on the shelf.  I looked shocked!  “What? I forgot the pizza?” I shouted. 

Stevie smiled and then did something he had never done before.  He carefully lifted the pizza from the refrigerator, placed it on the counter, slowly and methodically  unwrapped it, and then, turned and opened the oven door for me!  Stevie knew I was not getting this pizza cooking thing and had now become the expert, showing me how to get dinner done!  Twelve minutes later both Stevie and I enjoyed this pizza and his success more than any other night!”

We are so often the expert in our communication exchanges we rarely provide our emerging communicators the chance to show us what they can do and be successful at.  To see what your budding communicator can do try one of the following in your next interaction.

  • Place a favorite thing within view but out of reach and be immediately available to assist the person, once requested. Use Tupper Ware or semi-high shelves.
  •  Play ‘Dumb’. Forget how to turn on the bath, use your keys to unlock a door or open the snack cupboard, or…make a pizza.
  • Offer things in small amounts.  Portion out snack, Legos, beads, drinks, etc.
  •  Give everything needed, minus one piece. Forget the straw, spoon, or their socks.
  • Provide toys or items with missing parts or seemingly “broken” pieces. ‘Hide’ a puzzle piece on your head or in your sleeve, forget to help them with their belt.
  • Let them be the expert: Within a familiar routine, don’t do the expected and WAIT PATIENTLY.  Put their shoe on their hand, put their coat on with the zipper in the back, start to pour their drink in a cup that is upside down!
  • Use LESS words and MORE gestures.
  • Once engaged in an interaction (for example, swinging, feeding, tickling, rocking, playing a game, getting in the car to go some place) ABRUPTLY STOP what you’re doing and wait for more to be requested.
  • Offer toys, games and items that require assistance or an interaction. Bubbles, wind-up toys or put items in bins that require assistance to open.

* Ideas Adapted from A. Weatherby & B. Prezant (1989) and F. Sussman (1999)

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