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Supporting Communication in Stressful Times

When researching ideas for how to explain complex issues in and around COVID-19 and other related stressful situations for our Winston Churchill Memorial Trust Action Fund project, there seemed to be very little guidance specific to those who struggle with communication. No matter how hard we try there is often limited amounts of time available to support someone who has speech and language difficulties during stressful times.

It is essential that both effective and calming conversations take place and when thinking how to develop communication charts that could be adapted and used in a wide range of environments, several concerns may arise…

  • How do those coping with social distancing i.e. 2 metres or around six feet) cope with small text or those working in visors and other types of personal protection equipment (PPE) manage?
  • How do the usual single word labels used with simple symbols support those for whom English is not their first language or where other disabilities have an impact on spoken conversations?

We have been collecting charts such as those offered by Widgit ‘To help patients communicate in hospital and critical care‘ or Patient Provider Communication with their ‘Adult General Needs‘ charts and many others. The symbols and words are clear, but what if one has a visual, hearing or cognitive impairment and more explanation is needed. How could anyone adapt the content or images? Their use with computerised text to speech or screen reading is possible, but what else would help?

AccessAbility 2: A Practical Handbook on Accessible Graphic Design‘ highlights some of the difficulties individuals may have, such as:

  • Distinguishing sounds from background noise.
  • Focusing or staying on task.
  • Memorizing and recalling information.
  • Understanding and following directions.
  • Understanding complex logic.
  • Understanding abstract ideas.
  • Understanding language usage.
  • Communicating in speech or wrltlng.
  • Working with numbers.
  • Keeping expected pace in any number of cognitive tasks.

This means that we need to be thinking how we can make communication in all its forms as easy as possible, not just depending on speech. Dr Rachael Grimaldi has worked with a team to develop an online app called CardMedic (that also works on tablets and phones) where she has used phrases and sentences for example in an assessment situation.

In discussion with colleagues the use of phrases and sentences is felt to be helpful, in particular when working with individuals where English is not their first language. This might apply to the professional as well as the client. ‘Easy-to-read‘ sentences with a symbol can provide context and can be read out exactly as written. We are adapting our present version of Boardbuilder to support this wider audience.

As a result of helping to support work on the W3C Web Content Accessibility Guidelines for cognitive impairment we have also been researching which font type would best suit the situation. A recently pulished article by Gareth Ford Williams (Head of UX Design from the BBC) further helped decision making on the subject. ‘A Guide to Understanding What Makes a Typeface Accessible, and How to Make Informed Decisions‘.

Meanwhile, Global Symbols now has many more freely available medical type symbols (that have beeen added to the original AAC symbol sets) that can be downloaded and adapted in line with their open licences. These new symbol sets include the UN OCHA Humanitarian Icons, the OpenMoji symbol set, and the Guemil icons which have a range of emergency images.Language  English French Croatian Serbian (Cyrillic) Serbian (Latin) 

Designing symbols that can work with other open licenced symbol sets.

voting criteriaWe have been having exciting times this summer setting up a series of AAC modules to introduce some of the ideas we have about making open AAC symbols accessible to all and to offer a voting system for localisation of some of the images that really do not fit some cultures and fail to represent AAC users’
home settings or personal needs.

We have written some voting survey instructions that we hope will help you to discover a way of making the symbol choices as democratic as possible.  You can upload a draft set of symbols that you feel need to be discussed with anyone interested in their use.  They can become part of an online survey with easy accesptance levels
on a scale of 1-5.   The process makes seeing where issues are arising easy with a chance to mark the look and feel of a symbol or whether it represents a chosen label, colour contrast is good and cultural concerns are highlighted. There is also a chance to gather general comments.

It is interesting to see that Carole Zangari discussed the idea of “Using Multiple AAC Symbol Sets and Systems with AAC Learners: Considerations for Thoughtful Interventionists” in August 2017.  She confirms that from a “learning perspective, it makes sense to have a consistent symbol type across the expressive tools that the client will use.”  However, we have found that many of the symbols in some of the main open symbol sets can be used in many different settings, such as everyday objects or some foodstuffs such as fruit.  So perhaps there is a case for learning which are the symbols that really need to be designed for local use and personalisation?

Designing for consistency and use of the same symbols across all devices, charts and keyring etc is important for a young user just starting out on the AAC journey.   So having chosen a particular symbol set, the task of developing new symbols is more about creating a similar look and feel with clear guidance about size, transparency and format  (download Word docx).
Then being comfortable that the new symbols will work alongside the symbols that cross cultures and finally to ensure that the symbol really is easy to learn – so guessability ratings are high wherever possible when thinking about early intervention.

Jellow, cBoard and Yuudee 2 update – more languages and evaluations.

In the last few months we have seen some very exciting updates appearing from the UNICEF Innovation Funded Jellow, cBoard and Yuudee teams. It has been so interesting acting as mentors and we have been working hard to connect up the Jellow and StraightStreet symbols to ConceptNet so they will soon be available on our site.

The Jellow Communicator on Google Play is now available in Bengali and it won the “#mbillionth South Asia award for Inclusion and Empowerment”

cBoard which is available on Github, has 33 languages on their app, but as the languages are using machine translation they require proofreading, The cBoard team have been asking for translation help  – you do not need to be a programmer!

Both these teams aim to use the The Psychosocial Impact of Assistive Devices Scales (PIADS) evaluation tool for their apps as it can be translated into any language and has a very easy to understand 26 questionnaire for assessing “the effects of an assistive device on functional independence, well-being, and quality of life”.

Yuudee2 have also been busy with evaluations and training – you might need to use Google Translate if you are not a Chinese linguist and if you select the image below you will also learn more about the interactive nature of their app with its hand drawn animated gifs to aid those with Autism.
Yuudee2

 

Classifying AAC symbols for ease of use

Low tech to high tech

With thanks to Techcess and the SCORE layout

There has been a long history and much debate about the way we classify AAC symbols for ease of use.  Do we make it easy for people to choose the symbols they want on a communication board from a label?  Should we try to provide categories and if so which ones?  Do we need to think about semantics and the meaning of words, phrases, or text in context as concepts and syntax (sequencing words into grammatically correct sentences) when we are searching?  What happens when people want to make visual displays based on different topics?

These questions become even more important when considering a range of languages which may have very few similarities in particular if they are not part of the European group of languages.  Issues around orthography as well as left to right and right to left placement if one is thinking about text to speech output on electronic devices and moving through a sentence or phrases with a minimal number of selections and distance to cover.

Once again we would like to use share our questions with others in the field in order to make decisions that suit as many AAC users, carers, families and professionals as possible.  Here are some key points in a set of slides available on SlideWiki

Celebrating Global Accessibility Awareness Day 2018

GAAD

We are celebrating Global Accessibility Awareness Day  with many others around the world! Companies and organisations are offering accessibility advice and support alongside exciting new ideas that have been filling our twitter feeds and @gbla11yday

The Australian Network on Disability has started the day by providing a useful collection of videos, articles and resources all linked to making things easier to use by those with disabilities.

In the UK the BBC have a theme of Access All Areas 2018 with talks about Accessible Gaming, Deaf awareness in the workplace, Voice assistants and spoken interfaces to name just a few of the subjects from well known experts.  The Accessible Gaming is linked to the work of Microsoft and they have launched an AI for Accessibility theme saying:

accessibility“We have started to see the impact AI can have in accelerating accessible technology. Microsoft Translator is today empowering people who are deaf or hard of hearing with real-time captioning of conversations. Helpicto, an application that turns voice commands into images, is enabling children in France with autism to better understand situations and communicate with others. And, Seeing AI and auto alt-text features are helping narrate the world for people who are blind or low vision.” (Microsoft, May 7th, 2018)

Abilitynet have blogged about their GAAD news and all the events they are involved with over the day including a fast talking video on Web site accessibility that highlights the fact cost of ignoring the ‘purple pound’.  “Disabled people represent a massive untapped market for business with a collective spending power estimated at £249 billion.” (Independent Living)

Each week Debra Ruh, Neil Milliken, and Antonio Santos host a Twitterchat providing practical advice given by experts in the field of inclusion and digital accessibility. You can find them on https://twitter.com/AXSChat. Neil will be hosting a day of talks at ATOS with live streaming of the speakers

The Paciello Group has a series of YouTube videos that cover topics from the use of screen readers to ‘The Future of Work: How Emerging Workplace Trends are Affecting People with Disabilities’. These will be streamed online in USA Eastern time from 0800.

communicationThinking about Global Symbols there is something else to look forward to The “2018 AAC In the Cloud Conference Schedule” June 26, 2018. All sessions are broadcasted live, and will be available on YouTube afterwards. You can see a link to uploaded resources/slides/handouts on the conference home page. http://aacconference.com/schedule-3/

Watch out for Coughdrop and their range of free communication boards, symbols and online support.

 

Arabic Speech Corpus shared by Dr. Nawar Halabi

respond symbol with audioIf you have been using our Arabic symbols page you will have noticed that we have made every phoneme for our lexical entries available as a sound file, so that you can hear how it is pronounced. You can see the audio links at the bottom of the symbol for ‘respond’ in the picture beside this text.   This can help those who have literacy skills difficulties as well as those wish to learn Arabic.

Nawar, who has been part of our Tawasol Symbols project from the beginning at the same time as successfully completing  his PhD, has made this possible with the development of an Arabic Speech Corpus with support from the University of Southampton and MicrolinkPC.

The synthesised speech output that results from this corpse is a very natural sounding voice, recorded using Levantine Arabic, as heard in and around Damascus.  Levantine Arabic is considered one of the three main Arabic dialects and differs from Gulf Arabic in some aspects of grammar and pronunciation although when phonemes are read aloud, they are often nearer Modern Standard Arabic and when combined there is less dialectal impact.

The corpus has been made available for download as a zip file and is released under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.  As the Arabic Speech Corpus website says the packages includes:

  • 1813 .wav files containing spoken utterances.
  • 1813 .lab files containing text utterances.
  • 1813 .TextGrid files containing the phoneme labels with time stamps of the boundaries where these occur in the .wav files. These files can be opened using Praat software.
  • phonetic-transcript.txt which has the form “[wav_filename]” “[Phoneme Sequence]” in every line.
  • orthographic-transcript.txt which has the form “[wav_filename]” “[Orthographic Transcript]” in every line. Orthography is in Buckwalter Format which is friendlier where there is software that does not read Arabic script. It can be easily converted back to Arabic.
  • There is an extra 18 minutes of fully annotated corpus (separate from above, but with the same structure as above) which was used to evaluate the corpus (see PhD thesis). Feel free to use this in your applications.

Please contact Nawar Halabi by email for further information.

Question words – Why are they so hard to design?

question

question

We have been having another look at our question words and it is really hard to design ones that make sense in all contexts.  If you are working in a European language such as English you will be used to the concept of the ‘wh’ words and there is a particular order in which they tend to appear as mentioned by Mira Shah  “what,” “where,” “why,” “how,” “when,” then “which.” “Where” is earlier in English and “who” is earlier in Italian.”

ARASAAC offer a collection of symbols for them

what

what

where

where

why

why

how

how

when

when

 

which

which

But then one has to think about the context and it might be time or an action.  So should one add more clues or just have what + Time as a separate question mark with a clock face?

 

 

The general consensus amongst the symbol sets  seems to be that ‘what’ is just a question mark and the other question words come with a clue but that can be difficult when the word in Arabic is combined and there needs to be a difference in the gender…

what

what

what is your name (F)?

what is your name (F)?

what is your name?

what is your name (M)?

where

where

why

why (F)

What time is it?

What time is it?

 

It seems that we need to have many more question words that are linked to relevant settings but they can cause confusion, such as ‘when?’ and ‘what is the time?’ or ‘what time is it?’

 

when

when

There do not seem to be any articles on this subject and as different languages have very different ways of asking questions we will go on developing more symbols so there is lots of choice!

Any ideas for ‘which’?

 

how are you

how are you?

Voting on symbols at Awsaj Academy

tablet with symbolIt has always been felt that it was essential that AAC users and those with communication difficulties should evaluate our symbols as part our research into symbol acceptance with real participation at all stages. We felt that this would ensure that the very people who would be using the symbols would provide us with feedback so we could tailor the symbols to their needs.

The team contacted the Speech Therapy team at Awsaj Academy for students with special needs to see if we could do a voting session with some of their students. Dr. Biji Philips arranged for 11 students to vote individually, with 15 minute time slots to complete the task. 2 students; a Tobii user with Cerebral Palsy and another with severe Autism required 30-45 minutes.

student votingThe students were given 20 of our symbols to vote on and a thumbs up and thumbs down symbol to communicate their like/dislike for the symbol. Some students preferred to use okay as an option as well. Based on the student’s capacity judged online, Nadine and I asked why they liked/disliked the symbols. Some of the older students were superb and gave us detailed feedback relating to the need for more detailed facial expressions, or adding context to the symbol rather than just characters. Others did not want to let us down and said they liked the majority of the symbols. Here are the results of the voting sessions:

 

 

 

Student comments

 

Good

Ok

Bad

Comments

Hello (Assalumu alaikum)

11

1

–   Not clear, waving or speaking

–   Saying hi and smiling

–   He tells how are you

–   Goodbye

–   Nice because he’s wearing Thobe

–   Nice clothes

–   Clear

–   Goodbye

Rice & Chicken

12 –   Only chicken

–   Doesn’t look like our food

–   Chicken

Children

10 2 –   Not nice hair

–   Put them in uniform

–   Boys

Dance

12 –   Very nice

–   Sing

–   Nice because he’s dancing properly

–   Nice design

Eat

9 2 1 –   Looks angry

–   I don’t see plate or water; I like that he’s opening his mouth and has spoon

–   Eat with hands

–   Don’t wear Thobe when you eat

–   Holding pen

First

11 1 –   Won

–   Appropriate for Qatar

Friends

10 2 –   Uniform

–   Like because it has 2nd and 3rd

–   Clear

–   Thobe are same

–   It’s nice how they hold each other

–   All the shoes black color

–   Shoes different

–   They shouldn’t hold their hands, it’s a shame

House

12 –   White + door white/gray; It’s big

–   White + smaller

–   Two thumbs up

–   Like our house

–   Qatari houses are different

Hug

12 –   Change clothes color

–   The girl is hugging her mother

–   Mom cuz wearing Abaya

I

10 1 1 –   Needs arrow on top of  head

–   Picture matches meaning

–   Full body

–   Not clear

Mother

10 2 –   Add rainbow color + lighten colors to look more happy

–   Child holding hand + smiling

–   Put Abaya

–   Should be in Abaya. I know non-Muslims don’t wear it. Should wear Abaya wherever you go

–   Black Abaya

Pray

11 1 –   I like he’s praying

–   Like him praying

–   Put him in the house. You don’t pray in the middle of the road

–   Clear

Nursery

12 –   Kids are playing and smiling

–   Good

–   School

–   The colors are nice

–   Nice colors

Please

5 2 5 –   Add text

–   She’s saying please and child should be angry

–   Open hands

–   Tilt head

–   Telling secrets

–   Not clear, I can’t see the two hands

–   Talk

–   Greeting

Souq Waqif

10 2 –   Add a lot of people

–   It has Thobe and Abaya

–   Looks like the old days

–   Didn’t know

–   Change the buildings

Pray

7 5 –   Needs more colors + full mosque

–   Not clear

–   Put someone praying + purple sky

–   There’s a bird

–   Didn’t know

–   It’s a mosque, not clear, maybe add colors.

–   I prefer the other praying symbol

–   Add colors

Thank you

8 1 3 –   Hand  gesture is more I love you ; handshake

–   Hold and shake hands

–   I do this for thank you

–   No hand on chest

–   He’s saying the national anthem

–   I don’t use this gesture for thank you

–   Hands greeting

Travel

10 2 –   More sky + men with yellow clothes

–   Need stairs or bus

–   Terminal

–   Dad looks like brother

–   Add airport

You

10 2 –   They should look at each other

–   Context. Add playground

–   Clothes are so different and shoes are different

–   Didn’t know

–   Not clear

–   Come

Bye

9 1 2 –   Show side profile + say bye to someone else

–   Sad face for saying bye

Boys on a stand as winners

Overall it was a great voting session with some valuable feedback obtained. Speech therapists reinforced the need for such a project, giving the example of one student who “could not look at” a picture card used for inferencing emotions due to the image of the boys not covering their arms (picture below). Teachers also reported that students felt empowered by giving their feedback, as they had always been accustomed to receiving help, but on this occasion they felt they were able to help others.

 

Symbols for different settings across the world.

map of countries for Tawasol Symbols downloads

World map where Tawasol Symbols have been downloaded

There have been many debates about localisation and globalisation or internationalisation and the different requirements to support these ideas – W3C have provided definitions that fit the web and in many ways localisation can support concepts used on web pages namely customisation related to:

  1. “Numeric, date and time formats
  2. Use of currency
  3. Keyboard usage
  4. Collation and sorting
  5. Symbols, icons and colors
  6. Text and graphics containing references to objects, actions or ideas which, in a given culture, may be subject to misinterpretation or viewed as insensitive.
  7. Varying legal requirements
  8. and many more things.”

We have acted on many of the W3C ideas over the last two and half years and noticed that while we have been developing our symbols for an audience based mainly in the MIddle East many of those who have requested use of the symbols and downloads have come from as far afield as Sweden, Australia and India.   We know some of these symbols have been for refugee groups and camps and others have been for religious symbols.  Both these requests have led to an increase in the number of symbols we have produced in these areas and many have been seen on our Facebook pages.

facebook sample symbols

But we are not the only ones making symbols for a wider audience and it is interesting to know that there have been requests that Apple should introduce emojis with women wearing the hijab with a petition gaining over 2,295 signatures seven months ago and headline news from the BBC and many others.

Many refugee organisations have booklets and charts with images to help those who do not speak the language of the country to which they are going. An example is the ICOON project which has many charts for download as PDF files.  These images tend to be in monochrome but cover a wide range of topics.

icoon symbols

Example of ICOON refugee charts freely available to download in PDF

Tawasol symbols are also available for download with charts in both Arabic and English and we have included religious settings and have an interactive version as a demonstration to illustrate the symbols in action thanks to The Open Voice Factory. 

sample prayer symbols

Sample prayer symbols from the interactive online communication chart

Tawasol at ISAAC

Dana and TullahI presented “Core Vocabularies: Same or different for Bilingual Language Learning and Literacy Skill building with Symbols?” and together with Dana; “Developing an Arabic Symbol Dictionary for AAC users: Bridging the Cultural, Social and Linguistic Gap”. We received a lot of great feedback about both presentations and many people showed interest in our project. One Speech and Language Pathologist (SLP) from Malta approached us having very similar issues with the analysis of core vocabulary. She mentioned that the issues I discussed in my presentation were almost identical to the issues in Maltese and was seeking advice on how to categorise pronouns given their attachment to nouns in the Maltese language.

A few SLPs from Israel approached us seeking advice about resources and access to our symbols as 20% of the population is Arabic speaking.  A team from Germany and a team from Sweden were very interested in using our symbols with refugees and the German team were interested in collaborating with us on a project that focused on a German/Arabic symbol dictionary.

Many attendees also found our second presentation very insightful as Dana and I discussed the criteria we used to adapt the symbols to be culturally appropriate. Several commented that they found the Arabic cultural and social norms as well as environmental considerations very different when compared to their personal experiences and were grateful for opening their eyes to things that would have never occurred to them as being offensive or unsuitable.

One of the highlights of this trip was the screening of our film at the ISAAC Film Festival which can now be seen on the Arabic and English home pages of the Tawasol Symbol website. Our film shared the story of Mohammed, an eye gaze user for whom we developed prayer symbols so that he could actively participate in prayer with his family. It was screened alongside approximately 10 other films from around the world and provided such a unique insight into the mix of films presented. Many people approached me after the screening and congratulated the Tawasol team on our “amazing work”, a “wonderful film” and a few took our details as they could see how the prayer symbols could benefit some of their clients.

film festivalFilm Mohammed

For the rest of the week, Dana and I went to sessions with a focus on core vocabularies and where possible in bi-lingual situations. It seemed that the issue of core vocabularies in other languages being quite different to English was a global linguistic challenge; whether it was Spanish, Maltese, Hebrew or German.

We visited the exhibition and saw some great new products and services. At the Boardmaker/TobiiDynavox stand we were shown some of their new apps including SnapScene and Pathways for Snap Scene. In these apps you are able to take pictures, add voice recordings, circle and highlight objects in images as well as label them. Pathways then gives you tips and tools on how to make these pictures an opportunity for communication, social interaction and learning. We also visited VocalID who customise your speech generated device to sound just like you. We topped off our ISAAC 2016 experience by attending the BUILD meeting whose members hope to bring together people working in AAC in developing countries. It was lovely to see/hear the work being done in South Africa, Taiwan, Singapore, Africa and Eastern European countries. It really made us think about creating an ISAAC Arabia or at least get the conversation going as to how we are collectively advancing the status of AAC users in the Arab region.

Quote ISAAC