Traditionally speaking, physical therapists could potentially play a role in helping to determine placement or accessibility of an AAC device for individuals who use a wheelchair. We may help play around with the placement of a switch (head control, arm control, leg control, etc.), or with an individual’s physical position in their wheelchair so they can best use their device while expending the least amount of effort. But what can we as PTs do for kids who are ambulatory who use AAC? If they can walk and carry their device, what else can we do for these kids? The answer is so much…
Jump! Run! Climb! Swing! Bounce! Oh, what fun! These activities tend to be favorites of all kids. If you think of a typical elementary recess yard, these are the things you see kids doing. As a pediatric physical therapist, these are some of the foundational skills we work on with our kiddos to build strength, balance and coordination. Because they are highly preferred activities, they also tend to be a lot of the words we see our clients use on their AAC devices during our treatment sessions. If you ask any of the 8 other PTs on my team, they could all say the word ‘swing’ on the LAMP app almost as fast as they could verbalize it. Because so many kids are highly motivated by gross motor and sensory activities found in the sensory-motor therapy gyms, it is a great place to integrate the use of their AAC devices. While ‘swing’ is a highly used word for me, as a PT, it may not be for everyone, especially for early communicators. But you know what words are? ‘Go, stop, up, down, more, help, again, all done.’ All words that are easy to target with an activity such as swinging (or jumping, or running, or climbing). I have been so fortunate to collaborate with several different speech therapists over the years who have taught me so much about AAC. Not necessarily where to find specific words, but the overall strategies and philosophies behind AAC and how to help make it successful for each student. For some students, that may be just having the device in the room with them. For others, it may be me modeling on the device for them. And for others, it is attached to them at all times and the expectation is that they will independently use the device.
While the therapy gym is often a highly preferred place, it can be quite the opposite for others. Depending on the severity of mobility impairments or diagnosis, movement activities (aka PT) can be very challenging or frustrating or even painful. It is equally if not more important for non-verbal individuals to be able to express their pain, discomfort or dislikes as it is their requests and joys.
I was first exposed to the world of AAC while I was working as a home health aide for a 3 year old boy with autism. He didn’t use his device much, but I went with him to speech 1x/week and watched his therapist model on his device and slowly grow his vocabulary. We worked it into his home programming and sure enough he started using it for one word requests, and then two word requests, and then protests, and so on. Simultaneously, he was also developing his verbal speech. Within a short while, his verbal speech surpassed his use of his device and he was able to pass his device on to his younger brother, who was also non verbal and also had an autism diagnosis. His younger brother is now a 13 year old teenager at Bridgeway Academy and he is still using a device (in addition to some verbal language) and they have both found their way onto my caseload, for physical therapy. I think because I was exposed to AAC prior to becoming a physical therapist, it was natural for me to want to incorporate it into my sessions. And now as the department manager, my expectation is that everyone on my team incorporates their student’s AAC devices.
At Bridgeway Academy, we are very fortunate to have developed a culture amongst our classrooms and therapists, where the use of AAC is so seamlessly woven into everything we do. All departments have unlimited access to the LAMP app on our department iPads (as this is the most widely used system). We have trainings to help teach new staff. We have a global respect for the diversity of AAC modalities and users. But mostly, we have really awesome students and clients who teach us every single day about AAC.
Whitney Williams, PT, DPT
Physical Therapy Department Manager