AACtual Therapy with Shareka Bentham: Navigating Eye Gaze for Beginning Communicators

Today, we welcome back Shareka Bentham, who has told us about her AAC adventures with the Harlem Shake, a field trip, and more. In this post, she shares her experiences in getting little ones started on the intentional use of eye gaze for communication.

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I think that most Speech & Language Therapists have those moments in therapy where they’re wondering “Am I doing the right thing here??” I have been feeling that way recently in my practice as I have been nudged into the world of using the head and eyes for communication.  I was (with extensive research) once able to use an eye gaze board quite successfully with an adult patient in the final stages of ALS, but I had never used such techniques in my paediatric clinic. However, I now have a few little ones on my caseload who have severe physical limitations, and are unable to use their limbs for switch access without considerable effort and physical manipulation, which really defeats the whole purpose of communication.  I believe as a therapist that communication should have minimal effort and that means of communication should be readily accessed for ease of interaction; therefore I have moved to body parts which can be moved more easily, which are the head and eyes.

In my AAC research and therapy observations, I have seen eye gaze used in older clients with higher levels of functioning, to quickly make choices or build sentences to engage in conversation. However my experience and readings have been quite limited in relation to using this type of communication for what I would consider the lower functioning emerging communicators. My dilemma was

“How do I begin to show these little ones that they can use their eyes to get a response from others, or to get what they want?”

I started to modify my therapy to draw from what I learnt about child language development and interaction, particularly from my training in the Hanen ‘It takes Two to Talk’ programme, and linked those to what I wanted to achieve in the AAC goals. I kept thinking about what I would have usually chosen for my children to do with their hands, and then replaced hands with head/eyes.

My first goal was to use play activities (song, people, and toy play) to show the children that they could use their head and/or eyes to get more of an object or interaction. Activities included:

• Looking over to mum in order to request more tickles/jiggles
• Looking to a symbol/object to request more of a song
• Looking to a side to find the puppet that’s hiding
• Looking to request more food

I found that all of the children needed initial practice in tracking, to be able follow the desired objects from side to side.  I used activities such as the “follow the snake” game below to help with this.

Another goal at a higher level was using eye gaze and/or head turn to discriminate between two objects/symbols.  Puppet play was usually the most fun activity to help elicit a response, but activities were generally tailored to the child’s interests.

For some little ones I have been able to move on to using head turn and eye gaze to respond to “Find the…” or “Where’s the…” instructions.  A favourite of mine for this goal has been to find the animals to put on the farm.

Progression with these goals has come with its share of obstacles as well. Getting a consistent head/eye response was quite difficult, initially, particularly with children with low tone who required more head support, or who favoured the stronger side as a result of hemiplegia. There was also the case where the head would come over but the eyes would still be looking in the opposite direction.  Furthermore, for each child there was always the difficulty that during each activity there might be some sudden distraction in the room that the child would reflexively orient towards (or away from),  and it was sometimes hard to regain that consistent gaze away from the distraction and back to the activity.

Progress has been positive thus far across activities and goals. However, this is still a work in progress, and I would welcome any feedback as I continue to navigate through this new area of AAC.