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App Review: ChatAble 1.3

The newly updated ChatAble 1.3 is now available from Therapy Box! I received a review copy of this AAC app, which offers communication through symbol-based grids as well as visual scene displays. Initially, I was quite taken with the combination of features provided (especially the Write Pad — more on that later!) and my mind ran away with the possibilities for using scenes and grids together. The timing of this review (end of school year) made it difficult for me to find many opportunities to use the app with kids or in classrooms, but afforded me ample time to explore, create, and play in the app. After using the app for a bit, I have dialed back my expectations for incorporating hotspots into my own photos and scenes, and created a bit of a wish list for future updates! 


A hotspot-embedded scene from ChatAble 1.3

THE WHAT: The features of ChatAble 1.3 are stellar, catering to several modes of nonverbal input, and showing creativity and innovation on the part of the developers. AAC apps for the iPad should be intuitive, easy to use and customize, and allow users to take full advantage of the internet and of their own photo and media libraries, and ChatAble 1.3 makes serious efforts towards all of these ends. ChatAble 1.3 allows communication using symbol-based grids, visual scene displays with embedded hotspots (think photos or drawings with embedded ‘buttons’), and pages with combined visual scenes and grid components (e.g. a hotspot-embedded scene with additional vocabulary or links to other pages below). Hotspots in the scenes can be associated with speech output or link to another page or to audio/visual media. Some really neat extras include the ability to set an alarm so that a message comes up taking you to a specific page at a set time, and being able to set a GPS location for a scene, so that the page is brought up automatically when the user is in the right location. 

The Keyboard function is pretty straightforward, allowing users to type a message which is spoken when the message window is tapped. I read in the downloadable User Guide about the ability to customize the placement of individual keys, but I crashed the app once while trying to figure out how to do it, and even when I followed the directions exactly, I never got it to work.

The WritePad feature from ChatAble 1.3

As I mentioned above, I love the WritePad feature! In this mode, you have a yellow pad on which you can write with your finger or stylus. The app interprets your writing, giving you additional options if it does not guess accurately, and eventually speaking your words. Great for short messages or closing a feedback loop for written language - “I can hear what I wrote!”

The quirky corner menu for editing and settings that ties the rest of the pages together doesn’t seem to fit as well on these alternate screens, in fact it is not even there for WritePad. Instead the user has a Back button in the upper left. The inconsistency makes it feel like this feature doesn’t quite belong with the rest of the app. 

Editing buttons in the bottom right of the screen

The feature that I most missed when exploring this app is the ability to lock the app down and limit editing by the user. There are lots of instances where it is great for the user to have easy access to editing. However, in working with young people with ASD in an educational environment, it is often desirable to be able to password protect or otherwise restrict access to settings and editing. When this is not built in to an app, I have sometimes been successful using the Guided Access option to restrict access to certain areas of the screen (i.e. where the Edit button is!), but I think that even if I left the navigation button accessible and created a guided access region that covered only the Edit and Settings buttons in the lower right corner, functionality of some pages might be impacted. 

The HOW: I’ve separated my thoughts on features and design from those on functionality because, although I love some of the features, they just don’t work as smoothly as I’d like them to. The real test of the functionality of an app like this is in creating your own grids, scenes, and pictures. As I was most excited about creating hotspots in my own pictures and visual scenes, I was most disappointed that this feature just doesn't seem ready for prime time. I'll describe my experience below, but the slow reaction times and the lag between actions make this an unsatisfying way to express yourself and inappropriate for true conversation. 

Having used other similar communication apps, I felt confident creating a variety of pages, and even customizing appearances and linking different forms of media. Though it may not have been necessary, I did read through the basic, but readable User's Guide, finding additional information on the Search function (It's in the Toggle menu!) and the GPS/alarm functions. I had the options and actions I expected to have in creating the pages I had in mind. Using my own pictures for grids and visual scenes was very straightforward, as was adding hotspots to a scene, and using images from the internet (you just have to save them to My Photos from outside the app… Would be cool to be able to do that from within the app, but the app’s Symbol Library is pretty thorough).

The frustrations I had were largely related to response times within the app. I should preface this all by saying that I installed the app on my old-school 64 GB iPad 2, running iOS 7.1.2, with 15 GB of available space. Not the newest hardware, but also still widely used in education. So, I’m used to things running slowly, but when I started the app, it took 10 seconds of a blank white screen before the logo began to appear, and then an additional 15 seconds before the home grid came up. If I had a student who used his iPad for other things, but wanted to be able to bring up the communication app when he needed it, this would not work. 25 seconds is interminable when you are waiting to say something. Once it was running, it usually came up as quickly as any other app, but even this was not consistently reliable. Sometimes (maybe after some period of not being used? maybe it crashed while I was doing other things?) it started back with the 25 second white screen process, even though I thought it would be already running. Because this was a review copy, I didn’t have the option to install it on a newer iPad, so I can't speak to how it might perform on a newer machine.

This wait time was also evident as I was working within the app. The hotspots were simple to create in my photos or visuals I found online, and I easily added text for the app to read or recorded my own audio. But there is an uncomfortable lag (1-3 seconds?) between touching a hotspot in a visual scene and hearing the message, whether the message uses the app’s voice or is a recorded message. I created a hybrid page (visual scene with grid buttons below) where one of the grid buttons was a link to another grid page. Though the audio label plays right away when I use that button, it takes a full 9 seconds for the linked page to open. The response time for hearing the message is much quicker when working within the grids, but even then if you touch a second cell too quickly after the first, the audio for the second does not play at all, though it will show up in the message window, so it could be played all together by tapping the window.

The BROAD VIEW: Overall, I love the ideas in this app. It’s probably most appropriate at this time for communicators working at the level of single words or just beginning to combine words. When using AAC apps like ChatAble on the iPad, my own clinical focus is school-age students with communication disorders including autism, with a range of verbal abilities. I love the collection of features because there are so many options that appeal to my students. Accessibility features like switch access and ‘touch anywhere’ scanning are easy to use. Visual scenes with hotspots provide context to abstract vocabulary and give structure for practice and more consistent use. Options for alarms and GPS triggers provide opportunities to fade cues and increase independence for users. The keyboard and WritePad provide for exploration, creativity, and play turning letters and words into voice. 

The delays in response times within the app make it hard for me to imagine using this with communicators who are combining ideas or who might need multiple layers of pages beyond the Home Page grid to provide them with adequate vocabulary. It’s also probably not a good option for the creative clinician or care provider who wants to create and link lots of pages. It isn't yet an option that allows for a lot of growth, and I’ll have to stick to other AAC systems for my students with higher needs. 

Right now, there’s enough potential that I plan to explore ChatAble with some of my emerging communicators. It will be fun to use the visual scenes and options like WritePad. I will definitely keep my eye out for updates, as I would love to use photographs of students’ own environments as visual scenes for communication. (Think: a photo of the front office with hotspots for appropriate greetings and interactions with office staff, a photo of the Play-Doh table with hotspots for all the different action words you can use, a photo of a student’s transition work site with hotspots allowing him to ask for help with different issues)

A funny post-script: In my experimentation with setting alarms and start time for pages, I typically set them for a time in the immediate future when I I knew I would be using the app. I guess I must have left one on because late last night a shocking train bell sound erupted from my iPad that I had never heard before! I opened it up in a panic only to discover a message that “Your scheduled ‘My Town’ scene is about to start now”! So, I guess I would add that iIt would be great to be able to see a list of set alarms/start times and GPS triggers!

¡Ecuador 2015! ¡Esperanza para Todos!

Give. It's one of our company Core Values, and something we try to weave into everything we do. There are the little bits of giving, like the chocolate left on the desk of a colleague after a yucky IEP meeting. There are the medium bits of giving, like our visits to Northwest Children's Outreach. And then there the are the BIG bits of giving that come in the form of our international service trips. First it was Costa Rica, then Bosnia and Herzegovina, and now, as announced last month, we will be going to Baños, Ecuador. Yes, that's right. We're going to "The Gateway to the Amazon." Because, go big or go home, right? 

Heather, a wonderful SLP and seasoned service-trip veteran, is heading up this project. She has been working on the groundwork for several months and has established a relationship with Esperanza para todos, whose mission is to provide education and therapy for families who have children with disabilities. Founded in 2008 by local parents, Esperanza para todos (which, incidentally, means "hope for all" in Spanish) provides daily, professional therapeutic care to 20-25 children with disabilities so that their parents can continue to hold jobs and provide a greater quality of life for their families. The Esperanza para todos team consists of 8 people: 1 physical therapist, 1 educational psychologist, 1 teacher, 1 preschool teacher, 1 occupational therapist, 1 cook, 1 master basic education teacher who helps a driver, and Yadira Escobar, the director. The students, who attend from 8am - 4pm each day, receive physical therapy, educational psychology, occupational therapy, special education, educational recovery, sensory stimulation, equine therapy nutrition services, transportation door to door, individual therapy, group therapy and recreational activities throughout the day like sports, dance, gymnastics, and puppet shows(!). 

Wait. Hold up a hot second. Did you catch that? Yeah, I bet you did. I bet you saw that speech and language services weren't listed there. It isn't listed because, unfortunately, there isn't anyone on staff at Esperanza para todos who is trained in providing communication interventions. This means that, while the staff do their very best for each child, they just don't have the support they need to help their students communicate. And this, of course, is where we come in. Our THF clinicians will be providing hands-on staff training through direct student services, as well as more "academic" trainings via lectures, with the goal of giving the staff a basic communication-intervention-skill-set that they can use well into the future. If we're lucky enough to have an OT on the team, we will also be able to support their services in that domain as well. 

As you might imagine, we're, like, rilly excited about all of this. Heather has just sent out the application to all of our THF clinicians, both SLPs and OTs, and will be announcing the team on September 1st. Monthly meetings will begin in September, and travel dates will be selected soon. This, my friends, is the good, good stuff, and we can't wait to share it all with you. Esperanza para todos . . . hope for all.  Exactly.

Research Tuesday - Narrative and Vocabulary Instruction in the Classroom

This whole Research Tuesday thing really works for me in the summer! I have the space to be a little more reflective and theoretical, without feeling like I need to implement my findings with Johnny in tomorrow's session. And the knowledge that fall is coming pushes me to think on a systems level, gathering evidence for anything new I'd like to try in the fall. 


With that in mind, I found this article on classroom-based instruction very interesting. There is not a lot of research on push-in support for students with language impairment from SLPs. Although it makes sense intuitively, the classroom is a complex environment and it is hard to isolate variables. This study is an "early-stage, non-randomized comparison study", and it ends with the all too familiar refrain (Spoiler alert!) of "more extensive research on this topic is warranted", but it is an important early step for SLPs collaborating with classroom teachers and administrators looking for more efficient and inclusive ways to support students with language impairment.

So, here we go, following Kelly Bawden's cut-to-the-chase organizational rubric: 

The Details: Sandra Laing Gillam, Abbie Olszewski, Jamison Fargo, Ronald B. Gillam; Classroom-Based Narrative and Vocabulary Instruction: Results of an Early-Stage, Nonrandomized Comparison Study. Lang Speech Hear Serv Sch 2014;45(3):204-219. doi: 10.1044/2014_LSHSS-13-0008.

The Question: Having developed an intervention program that teaches story grammar elements along with embedded vocabulary instruction, the team designed this study to assess the effects of the intervention. They wondered whether students who received this intervention would score differently on narrative and vocabulary measures from students who did not receive the intervention. As a part of the study, they examined the effects of the intervention on students both at high and low risk for academic failure. 

The Method: Researchers used students in two 1st-grade classrooms at a Title 1 elementary school. The classrooms were statistically similar in their make up, as well as pre-test scores for narrative and vocabulary. The students in each classroom were divided into high-risk (scores on the Test of Narrative Language below the 25th %ile) and low-risk groups. For 6 weeks, the students in one classroom participated in three 30-minute whole-class intervention sessions per week, led by an SLP. The narrative program taught story grammar elements, gave students students instruction in elaborating on a story, and provided opportunities for students to practice story-telling in a small group. Vocabulary instruction (8-10 tier 2 words/week) was embedded in the narrative intervention. The students in the other classroom received the traditional district curriculum throughout the 6 weeks. 

The Results: The students were assessed following the intervention period with a narrative probe, scored with the rubric Monitoring Indicators of Scholarly Language (MISL; Gillam & Gillam, 2013) and a vocabulary probe, also scored with a rubric. For both narrative and vocabulary measures, both high- and low-risk students in the experimental classroom had statistically greater gains than students from the comparison classroom. In both narrative and vocabulary skills, students in the high-risk subgroup had 2-3 times the gain than the high-risk subgroup, while students in the low-risk subgroup had 6-10 times the gain of their low-risk peers in the comparison classroom. 

The Take-Away: This feasibility study documents the potential value of SLP-led narrative intervention with embedded vocabulary instruction to both low- and high-risk students. As I plan for next fall in an elementary that is more data-driven and run by progress-monitoring and RTI, I am excited to be able to participate in the conversation! I hope to be able to add depth and detail to grade-level data team meetings with progress monitoring tools such as the MISL and the Test of Narrative Recall (TONR). I struggle to balance a focus on narrative with vocabulary instruction, especially when I'm talking to teachers about collaborating on whole-class instruction. It is exciting to see vocabulary instruction embedded into the narrative, and clear results in both areas! 

Here's to another 6 weeks or so to revel in the reflective theoretical realm, before tackling the daunting task of scheduling all of my plans into real life! 

Why SLPs Matter

If you're anything like me, you spend at least a little bit of time each summer reflecting on the year you just finished and wondering about the year to come. Because I'm slightly neurotic, my internal dialogue also usually includes a little bit of doubt about whether or not anything I do makes a difference. Sometimes that thought gets magnified by external sources. Cue the positive self-talk and Stuart Smalley clips

But the thing is, what SLPs do does make a difference. And just when I needed it, I was given a glimpse at proof. 

I offer up to you a letter, written to one of our Hello clinicians from an 11th grade student who was on her caseload this year. I don't know, really, what's most touching about the letter . . . the heartfelt words themselves, the sentence structure and grammar that are a little window into what kind of kiddo he might be, or the idea of a struggling student putting his gratitude down on paper in such a way that it is palpable to anyone who reads it. 

Sharon Soliday says that, while it is technically a letter to Mrs. Steele, it is really a letter to all of us. That this isn't just a reflection on this particular excellent clinician, but a reflection of who we strive to be as a company. I say that the letter says things that no amount of positive self-talk could ever say. It says that our hope against hope, our faith in kids that no one else has patience for, that those aren't romantic notions fueled by latent a Super(wo)man complex. No. Our trust and hope and faith are facts driven by the conviction that all kids matter. We aren't the doubters that this student wants to prove wrong. We are the BELIEVERS. 

What we do matters. It mattered to this young man, and it matters to the thousands of kids all SLPs see every year. Thank you, Mrs. Steele, for being a believer and changing the trajectory of this kiddo's life. Thank you also for sharing your letter and letting the rest of us bask in it's glow for a hot minute. I'll take this stuff over Stuart any day of the week. 

Boxes of Backpacks Project Update

Just in case you're wondering, "Hey, whatever happened with those backpacks you sent out?" I thought I'd share a couple of update highlights with you. 

One district followed up with a highly gracious thank you email with assurances the backpacks will go to families in need. Not only that, the office staff was so charmed, they've decided to fill them with school supplies so those kids will want for nothing come September! Talk about paying it forward! Love that.

Also, as you may remember, we included a SASE with each backpack that encouraged the recipient to drop us a line and let us know how school is going. Much to our surprise, we got one back! It is touching, and reminds us why our commitment to kids is so strong -- giving hope and helping students overcome their problems is what it is all about. 

So, we're writing back to Justin, and this is what we will say:

Dear Justin,
Thank you so much for the you note all the way from Wyoming! We live in Portland, Oregon. Do you know where that is on a map? We are all so glad you received one of our backpacks and really like it. It's very cool that you like school! And we're proud of you for working on your speech. We're sure you have an excellent speech teacher to help. Remember, you really can do anything.  We believe in you.
All the best,
Sharon and the Hello Team

That last part is the most important part. We believe in Justin, and we believe in all kids. It's why we do what we do, and why we love what we do.