526 Caring to Communicate

Study of raised symbolic communication systems for visually impaired people with additional learning difficulties

HELEN HENDRICKSON and MIKE McLlNDEN Premier Health NHS Trust, Lichfield, UK

ABSTRACT Individuals with a severe visual impairment will have difficulties in accessing con uen t ional pict u rdprin t-based symbols. They wi 11, therefore, be more reliant on tactildthree-dimensional symbols, for example, brailldobjects of refer- ence, as part of their everyday learning. This paper outlines the options currently available for the population of individuals with multiple disabilities and a visual impairment (MDVI) and reviews the main issues to be considered in developing an appropriate system to meet the communication needs of the population.

INTRODUCTION

The issues raised in this paper have evolved from preliminary research by the authors into the needs of a range of MDVI individuals who are unable to access conventional symbols and are reliant on tactile symbols for their learning.

It is well-documented that the proportion of MDVI children is increasing (Best, 1992). The New Directions report (RNIB, 1990) estimated that there were approxi- mately 6000 MDVI children of school age in the UK, and a recent survey by the Royal National Institute for the Blind (RNIB) highlighted the fact that 56% of children with a visual impairment were reported as having another permanent illness or disability, with 27% having three or more additional impairments (RNIB, 1992). The survey also re- vealed a tendency for those children who have poorer sight to be more likely to have additional impairments ‘in the areas of communication, physical integrity and mental functioning’ (p. 8). Within the population of children with additional disabilities, 42% required input by speech and language therapists.

USE OF SYMBOLS

Tactile symbols can help individuals with a visual impairment in a number of ways, including:

Enabling access to low- and high-technology communication aids. As an aid to mobility, for example, environmental markers and tactile maps, in both school and residential settings.

Hearing Difficulties a n d Special Needs 52 7

As part of daily living skills, for example, access to menus or timetables.

Whereas conventional symbols exist in a visual form, for example, a photograph or drawing of a cup, tactile symbols incorporate a third dimension allowing them to be felt by touch, for example, object of reference or raised pictures.

CLASSIFICATION OF SYMBOL SYSTEMS

Musselwhite et al. (1982) developed a decision process model for classification systems (Figure 1). Although the model offers a useful framework in which to consider symbolic systems, for the purposes of the population under discussion it may be desirable to consider possible modifications. These include:

Addition of conventional communication symbols commonly used in the field of Augmentative and Alternative Communication (AAC) in the UK, for example, Makaton symbols, objects of reference. A distinction between symbols designed for sighted individuals, i.e. uisual sym- bols, and symbols, and symbols for individuals with a visual impairment unable to access visual symbols, i.e. tactile symbols. A distinction between the relative iconicity of visual and tactile symbols.

Symbols

Two- dimensional

Three- dimensional

/\ /\ Representational Abstract Representational Abstract

I - Premack Moon Braille

I

1 object symbols - I Bliss photos - - - - -

pictures print tangible symbols

I

tangible symbols Makaton symbols

Cheyne raised Makaton symbols

FIGURE 1 : Symbol classification: examples of two- and three-dimensional symbol systems (adapted from Musselwhite et al., 1982).

528 Caring to Communicate

Symbols and iconicity 'Iconicity' is the term used to describe the nature of the relationship between a symbol and its referent (what the symbol is referring to). As an example, a line drawing of a cup may be used as a symbol to refer to a real cup.

When describing levels of iconicity within symbols, the term 'transparent' is com- monly used to describe those which bear an obvious perceptual relationship to a refer- ent. A photograph of a cup to represent a real cup, may be described as having a higher iconicity than a line drawing of a cup. The less obvious the perceptual relation- ship, the less transparent (and therefore the more translucent the symbol. Where there is no obvious relationship to a referent and an artificial association has been developed, for example, an abstract shape to represent a CUP, we might talk about the symbol being opaque. As an example, the written word CUP is a collection of three individual graphic symbols, each with low iconicity. These ideas are illustrated in Figure 2.

An important point, highlighted by Rowland and Schweigert (1989) is that 'iconicity is in the eyes (or hands) of the beholder' (p. 228). What may seem an obvious relation- ship between a symbol and a referent to one person may not be so obvious to another, particularly if the second person has limited vision and is more reliant on touch to process information.

Referent: CUP

High (Transparent) "'*..,

9

A *r '. *. 0.

-. t

-0. 0.

llmd4L lconicltv

'0.

**,* *. *. A '*, '.

0. 0.

'*. 0. Low: '.,

FIGURE 2: Example of different levels of iconicity: visual symbols.

REVIEW OF TACTILE COMMUNICATION SYMBOLS

A number of communication systems which utilise tactile symbols are currently in use by individuals with a visual impairment. A brief overview of these systems highlights their applicability for individuals with multiple disabilities. Examples of the systems are given in Figure 3.

Hearing D i f f i c u l t i e s a n d S p e c i a l N e e d s 529

... .-.- .... . . . D \ / N < Bnilb Moon

Drink DRINK (DRINK) (DRINK)

Premrk System

m (CUP)

O b W Symbol8

i (DRINK)

-1GURE 3: Examples of tactile symbols.

Braille/Moon Braille and Moon are the most commonly used tactile codes in the UK. As formal systems they require an advanced level of processing at both a tactual and cognitive level. It has been well-documented that a significant proportion of pupils considered educationally blind are either unable to use braille at all or are only able to use it inefficiently (Lorimer, 1978; Chapman & McCall, 1989). Braille makes ‘bigger cogni- tive and perceptual demands on the learner’ (RNIB, 1992, p. 21) than print and so for many children with MDVI learning braille will be an inappropriate goal.

Although there has been some investigation into the use of the Moon code as a means of developing early literacy skills in children with a visual impairment and addi- tional disabilities (McCall, McLinden & Stone, 1994), research in this area is still limited to a small number of case studies (Bell, Jordan & Westwood, 1993; McLinden, 1995).

Object symbols Objects of reference have been defined as ‘three dimensional iconic symbols that can be used to represent real objects or events’ (Bloom, 1990). Despite a growing aware- ness of objects of reference as a potential communication system for individuals with MDVl (Bloom, 1990; Ockleford, 1994) there is relatively little literature which is spe- cifically concerned with evaluation and use of object symbols (Park, 1995).

Rowland and Schweigert (1989) describe the use of tangible symbols, developed for use with individuals with multisensoty impairments. A distinction is made between:

Three-dimensional tangible symbols, for example, objects. Two-dimensional tangible symbols, for example, pictures.

530 Caring to Communicate

Three-dimensional tangible symbols are described as:

Permanent, i.e. requiring recognition rather than recall memory. Manipulable, i.e. can be held by the user. Requiring only a simple motor response, i.e. pointing or touching. Tactually discriminable. Iconic, i.e. bear an obvious perceptual relationship to a referent.

Three-dimensional tangible symbols bear a clear perceptual relationship to a refer- ent and can be used as part of an aided communication system. Research on the use of tangible symbols is limited, but has demonstrated that they may have a role in helping individuals with multisensory impairments develop a viable communication system (Rowland & Schweigert, 1989).

Cheyne system The Cheyne system is based on raised representations of pictorial symbols. It was devleoped for use with MDVI pupils at the Cheyne Centre in London (Jackson, 1984) as ‘an attempt to provide a simple form of expression coded by means of tactile picto- and ideographic symbolic’ (p. 13). As far as it is known, there has been no study which has evaluated the Cheyne system with the target population.

Premack The Premack system is based on a set of abstract tactile shapes. The successful use of the Premack system with aphasic children was reported by Hughes (1974/75, in Kiernan, Reid & Sony, 1982), although the scheme was not continued after the experiment (Kiernan, Reid & Jones, 1932). Although the Premack system has been used success- fully with apes (Premack, 1971) and sighted children with a learning disability (Deitch & Hodges, 1977) there has been no known research study which has evaluated the sys- tem with children with a visual impairment.

Raised visual symbols It is the experience of the authors that visual symbols, such as Makaton symbols, have been raised and used on a largely ad hoc basis by a number of professionals working with children with a visual impairment, with limited success (Madigon, 1995).

An example might be a black and white line drawing of a house to represent HOME. As a visual representation, the picture of the house bears a clear iconic relationship to the referent, for example, the house where the child lives. As a tactile representation, however, for example when the house is raised on to heat-sensitive paper, such a clear relationship may no longer be apparent and the individual may be confused by the tactile form. This can be readily illustrated by attempting to decode a clearly raised visual image, for example, a smiling face, through tactile exploration.

Because of the sequential nature of processing through tactile means, a number of researchers have emphasised the limitations of tactual when compared to visual process- ing (Heller & Schiff, 1991). It is clear from the literature relating to tactual and visual information processing that the preparation and use of tactile material requires ‘an appreciation of the process of tactile preparation and a knowledge of the principles of tactile design’ (Best, 1992, p. 121). This has clear implications when attempting to transfer information from a visual to a tactile form.

Hearing Di f f i cu l t i e s and Spec ia l Needs

RESEARCH ISSUES

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In developing appropriate tactile symbols for use in a communication system a number of important research questions remain unanswered. These include:

How appropriate is a standardised system of symbols for the population? (For example, use of a towel as a standard object symbol to represent the activity SWIMMING for a range of individuals with multiple disabilities.) What factors need to be considered in reducing individual symbols? (For ex- ample, which aspects of shape, texture or size make a tactile symbol more or less easy to decode?) What stages of progression can be used to provide a ‘bridge’ to a more symbolic tactile code? (For example, from objects of reference to Moon or Braille.) How can abstract concepts with no direct referent be represented in tactile symbols? (For example, ‘Thank you’, ‘Please’, etc.) How can different levels of information be represented within a tactile symbol? (Figure 4.) What tactual processing steps are most appropriate for accessing and utilising information from tactile symbols?

Clearly, symbols cannot be studied in isolation and consideration will need to be given to the use of the symbols within a formal communication system. Most commu- nication systems utilise a form of representation of nouns and verbs and it will be

(A)

(DRINK)

(B) -& (RIBENA)

FIGURE 4: Makaton (A) and Cheyne system (B) symbols which may also be raised.

necessary to investigate how a rule system can be developed (Kiernan, Reid & Jones, 1982).

In addition, there is continuing debate over the use of standardised symbols for the population. One might question, for example, how appropriate the use of a towel is as a standard object symbol to represent the activity SWIMMING for a wide range of children.

The authors are currently researching a number of these issues through a small- scale research project to examine the feasibility of developing a communication system utilising a range of prototype tactile symbols (or SYM-TACS). An example of how such a symbol may be developed is given in Figure 5.

532 Caring to Communicate

External Tenurc?

Intrrnal Texlurr?

Nature of Con Symbol?

FIGURE 5: How the different layers of information may be represented in developing a tactile symbol (SYM-TAC): Core symbol to represent the activity, e.g. SWIMMING; Internal shapehexture: to represent the place, e.g. SWIM- MING POOL; External shape/texture: to represent the day, e.g. MONDAY.

The study aims to investigate the factors that need to be considered in developing tactile symbols for MDVI individuals. In particular, it will consider:

Which physical and cognitive criteria need to be considered when devising three- dimensional symbols (for example, which aspects of shape, texture or size make a symbol more or less easy to decode tactually?) The haptic processing strategies used when decoding three-dimensional sym- bols by individuals with multiple disabilities and whether training can offer more effective strategies.

Based on these findings, a future project might examine the feasibility of develop- ing a communication system utilising the prototype three-dimensional symbols (SYM- TACS) .

CONCLUSION AND IMPLICATIONS

The development of communication can be viewed as being central to social, emo- tional and cognitive development. It has been demonstrated that pupils with multiple disabilities may become passive recipients in their environments if they fail to utilise the ability to make a request and informed choices (Bloom, 1990).

MDVI pupils present unique and challenging communication needs. The AAC sys- tems available to meet these needs are limited, severely restricting the options available to the teacher and practising clinician. It is envisaged that the outlined research project will extend the knowledge base relating to a significant population whose communica- tion needs have only recently been fully recognised.

Hearing Difficulties a n d Special Needs 533

NOTE

The authors are keen to liaise with others working in the development of appropriate tactile communication systems for MDVl children. Please contact them c/o the School of Education, University of Birmingham, Birmingham B15 2TT.

REFERENCES

Best AB (1992). Teaching Children with Visual Impairments. Milton Keynes: Open University Press. Bell J, Jordan J, Westwood I (1993). Moonshine. Special Children, October, 34-36. Bloom Y (1990). Objects of Reference. New South Wales: North Rocks Press. Chapman E, McCall S (1989). Visually handicapped children: current issues. In: N Jones (Ed.). Special Educational Needs Review, Volume 2. Lewes: The Falmer Press. Deitch R, Hodges P (1977). Language Without Speech. London: Souvenir Press. Heller M, Schiff W (1991). The Psychology of Touch. New Jersey: Lawrence Erlbaum. Hughes J (1974/5). Acquisition of non-verbal ‘language’ by aphasic children. Cognition, 41-55. Jackson M (1984). The Cheyne symbol system: a new approach to language through touch for the multihandicapped blind child. British Journal of Visual Impairment 11, 12-16. Kiernan C, Reid B, Jones L (1982). Signs and Symbols: Use of Non-vocal Communication Systems. London: Heinemann Educational. Lorimer J (1978). The Limitations of Braille as a Medium for Communication and the Possibility of Improuing Reading Standards. University of Birmingham: School of Education. Madigon F (1995). Exploring Alternative Methods of Tactile Communication with Specific Attention to the Possible Use of Makaton Symbols. Unpublished diploma dissertation in visual impairment. University of Birmingham: School of Education. McCall S, McLinden M, Stone J (1992). Literacy for blind children through Moon. British Journal of Visual Impairment 12, 1. McLinden M (1995). Touching the Moon. British Journal of Special Education 22. 64-69. Musselwhite C et al. (1982). Communication Programming for the Severely Handicapped. San Diego, CA: College Hill Press. Ockleford A (1994). Objects of Reference. London: RNIB. Park K (1995). Using objects of reference: a review of the literature. European Journal of Special Needs Education 10,40-46. Premack (1971). Language in chimpanzee? Science 172, 808-822. Royal National institute for the Blind (1990). New Directions: Towards a Better Future for Multi-handi- capped Visually Impaired Children and Young People. London: RNIB. Royal National institute for the Blind (1992). Blind and Partially Sighted Children in Britain: the RNIB Sur- vey. London: RNIB. Rowland C, Schweigert P (1989). Tangible symbols: symbolic communication for individuals with multisensoty impairments. Augmentative and Alternative Communication 6, 226-234.