Applying choices and possibilities

COVER STORY

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 20114

The increasing prevalence of tablet computers and mobile phones has led to an explosion in applications to support people with a variety of communication needs in the clinic, at home, in school or out and about. There are ‘apps’ for everything from counting stammering, modelling social skills and drilling speech sounds to practising prepositions. Here speech and language therapist Dot Reeves, an advocate for both the Makaton Language Programme and assistive technology, shares her experience of working with an entrepreneur, a software developer, The Makaton Charity and a host of users to create MyChoicePad as a flexible, quick and high quality application.

“Do you think it might be helpful for anyone to access, at an instant, the spoken words, signs and symbols

which are used with Makaton, via an app on an Apple iPad?”

When Zoe Peden asked me this question, I immediately said “yes!” The Makaton Lang-uage Programme is well-known to those of us who support people with learning or communication difficulties as an established and highly respected multi-modal programme, which makes use of speech, signs and symbols to support communication. Since it was established in the late 1970s, it has evidenced itself as a truly flexible and adaptable method. Many individuals who use Makaton are also familiar with - and enjoy the benefits of - assistive technology.

I am a devotee of Makaton, having experienced for myself the profound impact its application can have on those who use it. I have become heavily involved in the various training programmes on offer via The Makaton Charity, and thus get to meet an extraordinary number of extraordinary people using Mak-aton in a huge variety of ways. I have also been fortunate over the years to gain plenty of hands on experience bringing various aspects of technology into my work with people with learning and communication difficulties. My response to Zoe’s question was therefore not only enthusiastic but realistic.

Zoe, who had previously worked at The Makaton Charity, and Andrew Jackman, a software developer, took their creative thoughts around Makaton and the iPad to the organisation. The charity took a detailed look at the fledgling ideas and agreed this was a project worthy of support. The involvement of a wide range of experienced professionals was seen as an important element, and I felt very honoured to be invited to be part of the process.

We wanted to harness the possibilities that arose from the availability of a relatively affordable mass market device - the iPad - and produce something that would be a genuine support to the implementation of the Makaton Language Programme. The main challenges were:

• designing a simple interface• designing a positive user experience with

touch sensitivity• incorporating signs, symbols and speech

together• designing an approach which supported

and reflected the Makaton Language Programme.

We never aimed to produce a ‘com-munication aid’. The long-term philosophy was more around a dynamic application (commonly known as an ‘app’) on a portable device, the iPad. We wanted it to bring the

full breadth of the Makaton Vocabulary to the fingertips whether in the park, on the beach, in the classroom, or pretty well wherever the iPad could be taken.

The approach we used for evolving the software is called Feature Driven Development. This method was perfect for us as we wanted to start with a small, flexible piece of software that could be adapted and improved in quick iterations of development as we got feedback from users.

The starting prototype contained the bare bones of the MyChoicePad app – the ‘way in’ being via the cool, simple and famously well-designed Makaton Symbols. The display could be small, medium or large, so straightaway this offered a choice about how much to display on the iPad screen. The initial trial content was the entire Core Vocabulary of the Makaton Language Programme. Touch the symbol, and the concept depicted is clearly spoken by an English accented male or female voice. Long touch the symbol, and the line drawing and a video can be viewed, or the feature disabled.

The starting point of the app was quick-as-a-flash production of the vocabulary you might need to support communication. This was important because it could help the Makaton user and communication partner learn the vocabulary they need and would offer a direct reference point for a user wanting to join in the action. We built up the features by accepting or rejecting statements about functions which we could rank hierarchically in terms of priority. Through using this approach, we began to see the required development work ahead. Not only were we able to build an app full of features we knew people wanted, we could also prioritise the development of these and release a minimum viable product.

With this bare bones app available to test out, the next phase was to gauge its usefulness

READ THIS IF YOU WANT TO• DISCOVER YOUR

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• MAKE INTERACTION MORE DYNAMIC

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Dot

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SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 2011 5

with some target users. Within our profession we are only too aware that an intervention has to have a purpose, be evidence based, and demonstrate good practice. Objectives need to be set, outcomes measured and statistics logged. In theory it is all gloriously logical and measurable and, in the first instance, I became rather obsessively preoccupied with framing objectives for anyone who was keen to be involved in trying the app. I wanted to get the plans down on paper and then review whether the objectives had been achieved. The reality gradually dawned on me that testing out this intervention had to start with the truth that there was not one jot of evidence it would be of the slightest use to anyone.

The central philosophy when using Makaton is that it is personalised – we don’t have a rule book for application. My remit in the development process was to reflect on the ethos of the Makaton Language Programme and draw on my speech and language therapy wisdom regarding ways we could promote successful communication for and with people with learning or communication difficulties. As Makaton is all about meeting individual needs, I realised we needed to hand over the basic app and iPad to people who were keen to help us, then listen closely to their findings.

In short, we spent four months trialling the app and experimenting with approaches to its use that supported the Makaton Language Programme. We filmed the trials with schools, speech and language therapists and families. This provided case studies for us to learn from, but also gave us a way of showing other people the wide variety of uses and benefits MyChoicePad could deliver. These short films are available in the stories section of the MyChoicePad website.

If we had had any doubts about embarking on this project, the feedback from the trials put paid to them. Even within the first few weeks of having iPads out on loan with MyChoicePad installed it became clear the users were working

things out for themselves and providing us with some fabulous examples of innovative and entirely personalised use. This was good news, as having an iPad and downloading an app seems very much ‘of the people’.

Working resourceMyChoicePad was designed to be a working resource for users and their communication partners. While it can end up being an aid to communication, it is not designed to be a communication aid. Within the field of AAC there are awesomely experienced practitioners with a breadth of knowledge and wisdom about technological devices which can support communication, but I am fairly sure I’d struggle to find any who can nail a solution in one easy move. A huge part of the process is building up a picture of what a person can already do, or might be able to do. MyChoicePad can help develop a picture of what could be possible.

Charmaine (8) has a chromosome disorder. Her mum describes issues with:

• word recall• conversational skills• clarity of speech when she is tired• the need to know what happens next.After being involved in the development

of the app, her mum Eve said, “My daughter struggles with the world understanding her; with this app she has a voice in society. She can order her dinner in a restaurant, ask a

friend for tea, go shopping and make her feelings known. She is unable to use a PC, DS or any other computer device, but the touchscreen of an iPad, together with the very visual, familiar special needs-friendly concept that is MyChoicePad, really has opened up a whole new world in terms of freedom, independence and choice.”

Staff at Severndale Specialist School for Communcation and Interaction in Shrewsbury have been using the app with their secondary aged students to :

• improve social skills• help in making requests• aid independence• provide confidence to communicate.Assistant head teacher Judith Pilkington

commented, “We wanted an easy to use aid device that would help in lots of different settings that would not need specialist knowledge to be able to make grids... We found it very cost effective and versatile.”

Independent speech and language therapist Heather Grainger has been using the app as a therapy tool and for assessments with individuals, and for group sessions with young adults. She says, “Dashing between different pupils and students in different locations with differing needs and abilities can be a challenge on the best of days. I use MyChoicePad with young people with a broad range of speech abilities at key and functional word level, and it is a lifesaver when it comes to remembering and helping others with their signs.”

As speech and language therapists, we like functionally effective intervention strategies. We know when something looks impressive and is probably fun to doodle around with but does absolutely nothing of note to enhance communication. We do however have an open mind when a tool or approach adds positively to motivation or confidence to communicate. (Perhaps that’s why we all seemed to like The Kings Speech!) So, without harbouring delusions about its scope, I was

Makaton users have provided invaluable feed-back about MyChoicePad. Their responses have

driven design and development priorities.

Thank you to our models and Derwen Collegewww.stephenfordphotography.co.uk

SUPERVISIONInspiring Creative SupervisionCaroline Schuck & Jane WoodJessica KingsleyISBN 978-1-84905-0790-1 £16.99

Enthusiastic and practicalThis book is relevant to anyone who wants to get the most out of supervision, as supervisor or supervisee. It contains enough detail and example to guide the relative novice, but a large enough range of strategies to extend a more experienced supervisor’s repertoire.The clear, informative style draws on a wealth of experience. It gives a reader-friendly overview of theory while offering an enthusiastic and lively resource bursting with practical frameworks, ideas, activities and strategies for group and one-to-one supervision. The layout is easy to navigate and allows for dipping in and out.I will definitely enjoy revisiting this book and look forward to trying out some of the ideas within my own work, reflection and training sessions. It is an excellent buy for those interested in extending their supervision experience.Tamsin Crothers is a speech and language therapist specialising in AAC, and part of the supervision working party in the speech and language therapy department of Ashton, Leigh & Wigan Division of The Bridgewater Trust. She is also co-founder of 1Voice - Communicating Together, supporting children, young people and families who use AAC.

HEARING IMPAIRMENTChildren with Hearing Loss - Developing Listening and Talking, Birth to Six (2nd edn)Elizabeth B. Cole & Carol FlexerPluralISBN 978-1-59756-379-6 £41.00

Very readableThis detailed book looks at the skills and knowledge needed to promote the development of spoken language through listening in young children and babies with a hearing loss. Despite its length it is very readable. Each chapter’s ‘key points’ give a clear and concise explanation of the information to come. The comprehensive contents page makes it quick and easy to look up specific information.Early chapters provide a good overview of hearing loss, with information on terminology, technology, the structure and function of the ear, and causes. It includes data on good language learning environments and early language development. Later chapters look at intervention and are more practical, exploring strategies and activities for working

SLTP

COVER STORY / REVIEWS

SPEECH & LANGUAGE THERAPY IN PRACTICE WINTER 20116

reviews

REFLECTIONS• DO I KEEP ABREAST OF MASS

MARKET TECHNOLOGICAL INNOVATION THAT COULD BENEFIT MY CLIENTS?

• DO I THINK THROUGH THE ETHICAL DIMENSIONS OF WORKING ON PRODUCT DEVELOPMENT?

• DO I SET OBJECTIVES IN A WAY THAT IS APPROPRIATE TO THE TASK IN HAND?

with families. The appendices provide some interesting frameworks and checklists.Whilst the book refers to American terms and systems, the information is still useful. In places it is slightly repetitive (for example, the importance of good early hearing technology) and would benefit from more therapy suggestions, examples and sample sessions. However, I would recommend it as a detailed reference for students, a good resource for those new to the field and a refresher for more experienced clinicians, particularly with its discussion around recent research. I certainly enjoyed reading it and will dip into it again.Rachel Millward is a speech and language ther-apist working for the Durham Sensory Support Service with children who have a hearing loss.

COMMUNICATION SKILLSHelping Children to Improve their Communication Skills: Therapeutic Activities for Teachers, Parents and TherapistsDeborah M. PlummerJessica KingsleyISBN 978-1-84310-959-4 £18.99

Best for groupsThis book links research to clinical practice through the use of play. Five of the twelve chapters describe the theoretical background of play as an integral aspect of communication. There is not a lot of new information in these chapters, however they act as a useful reminder of the importance of play and the need to consider all processes involved in play when communicating with children. Parents felt these theory chapters were quite excessive, with information overload, however teachers appeared more aware and informed on completing them. The remaining seven chapters provide a wide range of activities split into different skills and communication outcomes and goals, which is extremely beneficial. A range of useful adaptations are also presented. The range of activities is excellent, but I feel they are a lot more suited to a classroom or group setting where you can include a larger number of children. They could be used with individual children but would require altering. Parents felt there was a lot to read and may be of increased benefit if directed to specific activities for their child rather than accessing the whole book.I feel this book would be of good value as a departmental resource, particularly if you work in group settings and can integrate therapy into classroom settings.Lynsey McDowell is a community speech & language therapist in Newry, Northern Ireland. She reviewed this book with the help of parents and teachers.

genuinely inspired by what came out of the trials of the MyChoicePad app, and could see it would be madness not to proceed with development work.

MyChoicePad has grown and evolved significantly since I was first asked for an opinion. One of the most recent developments is that people can download a free lite version as a taster, a ‘try before you buy’ option from iTunes. We also hope the app can be developed for other tablets and devices, but this depends on success with marketing the product and attracting new investment.

Marketing is probably the most alien of the activities I have had to think about recently. It is necessary not just so that people who might benefit from the app get the chance to hear about it, but so it can start paying its way and continue to be enhanced. Developing a product might feel very different to developing a service but, from my experience working with Zoe and Andrew, it doesn’t have to mean your professional integrity is going to take a battering. Quite the contrary – it has been great to offer a voice from a speech and language therapy perspective.

Dot Reeves is a speech and language therapist employed by Shropshire Community Health NHS Trust. She also works freelance as a consultant and trainer and is a Senior Tutor with The Makaton Charity, email dotreeves@gmail.com. You can find out more about MyChoicePad from chief juggler Zoe Peden, email zoe@mychoicepad.com, or see www.mychoicepad.com and www.makaton.org.

Resources• Feature Driven Development of software,

http://en.wikipedia.org/wiki/Feature_Driven_Development

• Minimum viable products, http://en.wikipedia.org/wiki/Minimum_viable_product

• The King’s Speech, www.kingsspeech.com/• Use of Makaton and assistive technology,

www.makaton.org/research/research.htm

How has this article changed your views? Let us know via Speech & Language Therapy in Practice’s Critical Friends, see www.speechmag.com/About/Friends.