Gestural Development

SUSAN BASHINSKI:

Slide 1: Intro
Hello, My name is Susan Bashinski and I’m really excited that I’ve been offered an opportunity by the Kansas State Deaf-blind Project to talk with you about gestural development. The reason I’m so excited about this is, this really provides me with an opportunity to share with you some of my own personal research. For the last several years, I’ve been doing a lot of projects that involve learners with deaf-blindness as participants. And one of the particular targets that which we’ve been looking is how we can increase the gestural skills of kids with deaf-blindness and we’ve really had some exciting results. Several parents of learners with deaf-blindness who have participated so graciously in my research studies have allowed us to include photographs of their kids in this particular presentation. So I’m very excited to have this chance to share this work with you. We tried really really hard, even the technological wizards from the Kansas Deaf-blind Project tried to figure out how we could show you actual video clips, and we weren’t able to successfully support that technology. But we have several still shots that I think capture the essence of some of the gestures the children in the studies learned, and hopefully these will communicate what I’m trying to show you about, tell you about today. So let’s get started.

Slide 2: Natural Gestures
I think gestures are really central to promoting more sophisticated, more symbolic, more conventional communication for learners with deaf-blindness. As you can see from this image, pulled off the web, I don’t think any of us could look at these babies and say they are not communicating with each other. Makes the point that gestures develop in typically with kids when they’re very very young. Children who are typically developing, for the most part, don’t have to be taught gestures. Parents will try to teach them, maybe to blow a kiss or to wave hi or bye because those are the earliest gestures some kids will use in a meaningful way. But then so many gestures just emerge incidentally by those children being alive and being engaged in experiences and life with their families and friends. And for learners with deaf-blindness, gestures need to be directly taught in most situations. I love this, I wish I could talk with each of you because I think if we would go through and say - “what’s the baby on the left saying?”, “Oh, there’s your nose. Oh, you look different than I look”. The baby on the right: “I want to touch you, I want to touch your hair, I want to touch your nose” – When I showed this picture to one of my students, she said “I want to put my finger in your nose”, I think that’s a pretty funny application. But who knows what these babies are quote saying to each other, but none of us can doubt that they’re communicating, right? Gestures are powerful powerful powerful forms of communication. If you haven’t thought of teaching gestures, I really hope with all my heart that after this presentation you will at least give consideration to whether or not teaching gestures to some of your learners with deaf-blindness. Whether their young, whether their elementary school age, high school age, doesn’t matter, give it some consideration please.

Slide 3: What Are Natural Gestures?
What are natural gestures? Natural gestures. They are certainly elements of a culture’s nonverbal communication system. They’re non-symbolic elements for the most part; showing, pointing, giving things to someone else, shrugging your shoulders, extending your arm with your palm open, with your hand open with your palm up. Typically they’re learned incidentally, as I said previously, just by interacting with people as we go through our lives. Natural gestures remain in the communication system even after a native speaker learns to communicate with symbolic means. What that refers to is even after we learn to speak a language fluently, even after we learn to write a language fluently, as we interact with folks, we still continue to use gestures as we communicate.

Slide 4: Why Teach Natural Gestures?
Why should we teach natural gestures? We’ll talk about some theoretical reasons and then we’ll talk about the practical reasons. Theoretically, from a researcher’s point of view, so this is my research, I have to get that in there I guess. Developmentally, gestures emerge prior to symbolic communication. Gestures are thought, although it hasn’t been demonstrated beyond that shadow of a doubt yet. It’s believed that gestures pave the way for the emergence of symbolic communication. Now, if you’re a little unsure what I might be referring to when I say this, I would like to reference you to another recording that the Kansas Deafblind Project has available to you on the emergence of symbolization ability. And hopefully if you have a chance to take a listen to that, those two statements I just made will make more sense and be more meaningful. Finally, theoretical reason for teaching gestures to learners with deaf-blindness is they can provide incredible opportunities for linguistic input for that learner. If you think back, maybe not so far if some of you have very young children now. When kids first get mobile, typically developing kids first get mobile when they walk around your house with their little index finger stuck out pointing and their touching everything going (voice mimicking baby talk) “what’s that? what’s that? what’s that? what’s that? what’s that?”. They’re wanting, they’re yearning for linguistic input. Most of our kids with deaf-blindness don’t do that. But if we could teach them to point, wow, if we could teach them to hand us things. To either say - “what is this?”, “how does this dang thing work?”, “turn it on for me” – wow, think of the opportunities for providing input to build communication. They’re just astronautical.

Slide 5: Why Teach Natural Gestures?
Practically speaking, this is one of my little fellas, we teach natural gestures because they are readily understood by lots of other people. Gestures are culturally based, we’ve said that before, I’ll say it again, because that’s a critically important consideration. But for people in your own culture, a person doesn’t have to be familiar with your own child to understand a conventional gesture. If the child can learn to approximate a gesture the way you make it, then he or she will be understood by unfamiliar partners. Wow, you’ve just increased again, the number of opportunities for communication experiences, communication interactions, just exponentially. Another thing that’s wonderful about natural gestures, you don’t need equipment. All you need is your body, you don’t need extra stuff that has to be carried around in a bag, in a suitcase, a box. You have your body, you have what you need to make gestures. Gestures can be used across many different contexts, and the evidence base is emerging that gestures are easier to teach to a learner with deaf-blindness than some other forms of symbolic communication. And you probably have that figured out already, reason is, we can physically prompt, we can physically shape, we can physically move a learner’s hands, arms, head, through the movement of a gesture to help them learn, to make the gesture.

Slide 6: Natural Gestures
Natural gestures are very much influenced by the learner’s age. Some gestures that are appropriate for a three year old, sucking the thumb or pulling up and climbing on mom’s lap, a number of other things. They’re just not appropriate for a fifteen year old. Other things that are appropriate for a fifteen year old, how about giving a knuckle punch or something. Not quite as, not that it’s inappropriate, but it’s not as common a thing you would see a two year old do. Think about how old your child is, when you’re think about what gestures you might want to have the team at school teach. And look at your other children, look at the kids in the general ed classes of the same age as the learner. Take your gestures from them, but choose selectively because some gestures aren’t appropriate for us to teach. Culture, culture is big. In the African American culture, there are different gestures that are used commonly. In the Hispanic culture, in Eastern Asian cultures. Some things have different meanings, some things have contradictory meanings, some things are taboo. One of the worst mistakes I ever made in my life, I wasn’t thinking and I’m a very hands on kind of person. And I was working in a classroom with a student teacher, and I touched this one young boy on his head. He was from a different culture and he immediately burst into tears and ran out of the room because it’s not appropriate for a woman to touch a young man, in his culture, above the neck. And I didn’t know that, so we have to educate ourselves about the culture from which a learner and his or her family comes. And then the context, context of communication, very much influences what gestures are appropriate or not appropriate, when a gesture should be taught or should not be taught. Think of yourself, if you got a speeding ticket on the way home, how would you tell your spouse or significant other? How would you tell your children? How would you tell your mother? How would you tell a clergy person from your church? We use different words. So similarly, we use different gestures based on the context, based on who our partners are. You don’t go up and sucker punch the principle of your school, but you might sucker punch your brother when you’re having a fun interaction in the family room at home. So you have to think about context.

Slide 7: Categories of Gestures
This is an area, in terms of categories of gestures, where different researchers will say there are different numbers of categories. Some people will say their four, some people will say their three. I like to keep it simple, I think for the purposes of what we need to do, what we need to consider when we’re talking about teaching gestures to learners with deaf-blindness. The critical breaking point, in my professional opinion, is between what we call contact gestures and distal gestures. Again you’ll hear about proximal gestures, you’ll hear about proximodistal gestures, not that they’re unimportant, but I think the core of what we need is to look at these two categories on your screen right now because the shift from a learner using only contact gestures to using distal gestures, is a hugely significant achievement in communicative development. Research out there supports kids who use contact gestures are at a very different stage in communication development than learners who can use distal gestures as well. We don’t mean distal gestures only, we still use contact gestures sometimes. When I can’t think of the name of something, I’ll pick it up and say “what is this thing called”? So yes we can still use contact gestures, it’s not an exclusive use, but it’s the notion of does a learner use distal gestures? You might be thinking, well for kids who have very very poor vision, who are blind, distal gestures, are they even practical? Do they have meaning? And for the most part, it’s difficult to estimate and to really determine how useful distal gestures might be with those learners because they can’t see very far away. But as we define these, if we go back to the top of the slide, a contact gesture is actually making physical contact, touching the target. And to a distance as far away, up to six inches. So if you’re one inch away from a target when you’re pointing at it or reaching for it, it’s still a contact gesture, up to six inches. When you get six inches or more away from the target and you’re trying to stretch and reach it or you’re pointing to it or you’re putting your hand out, motioning with your fingers like “gimme gimme gimme”, if you’re six inches or further away, that’s considered a distal gesture. So even with kids who have very limited vision or limited visual fields, distal gestures can serve a purpose because it’s not, it doesn’t involve distances of two or three or four feet or more. If you want to read more about the categories of gestures, there’s a great article by the folks listed at the bottom of the slide (see Bruce, Mann, Jones, & Gavin (2007)-analysis of gestures expressed by children who experience deaf-blindness), the full reference is provided at the end of this slide show. That I think explains a variety of categories of gestures in wonderful detail. But I’m going to use the terms contact – less than six inches or distal gestures– six inches or greater. Hugely important, if nothing else after this little discussion, I hope that if you are watching learners with whom you interact your children in your own home, just watch, maybe you never noticed before when kids are gesturing; pointing, reaching, trying to grab something. What is the distance between them and the object? Maybe you’ve never paid attention to that before. Please take note of that, it’s really important. 

Slide 8: Brady & Bashinski (2008) Gestural Study
In our study, it was a study on adapted prelinguistic milieu teaching or adapted PMT or APMT. Big name, you don’t have to worry about it, I could care less if you ever think about that again. But I wanted to share with you the fact that what we were trying to investigate in this, what turned out to be six year research study that was funded by the federal government was, could we facilitate improved communication outcomes for children who have deaf-blindness? And in a word, the answer is yes we could. 

Slide 9: Adaptations To Basic PMT Strategies For Learners With DB
What we did, basic prelinguistic milieu teaching or that basic strategy had been used in many many many well respected research studies, at least 25-35 studies prior to what we tried to do. But none of those previous studies had involved any kids with sensory loss, none of the previous studies had involved learners who have severe motor challenges, none of those studies involved learners with significant cognitive or intellectual disability. So in our study, we wanted to see if we could adapt those strategies and all those studies, showed incredibly successful positive positive outcomes and skill gain on the part of the participants. So we wanted to try it, to see if we could adapt those strategies for learners with deaf-blindness. And the main kinds of things we did are listed on this slide, not that you need to know them to replicate this study but I think they reinforce for families, they reinforce for teachers. Strategies that are important to use as we teach learners with deaf-blindness. These are things you can use to help teach gestures to a learner; utilize predictable routines, incorporate augmented input, that means use touch cues, use object cues, utilize hand under hand strategies, all three of these topics are addressed in other webinar recordings that are available through your Kansas Deafblind Project. Take a listen maybe they’ll help you to build a way to teach communication gestures. Other things we did that are very useful is just, we haven’t developed anything for the Kansas Project yet on these topics, would be to emphasize tactile stimuli, emphasize vestibular stimuli throughout interaction, use movement, use touch, and encourage joint attention.

Slide 10: Adaptations To Basic PMT Strategies For Learners With DB
For kids who had extremely limited vision or learners who are totally blind, two of the kiddos that you’ll see pictured, of whom you’ll see pictures in a little bit, really were totally blind or had a light perception. So we used some indicator of directionality. The way they oriented their bodies, the way they turned their whole bodies not just their eyes, those were the ways in which they sometimes gestured.

Slide 11: Key Findings
So, I’m not going to bore you with the statistics and a lot of the numbers about our results. But the learners who participated in our study, all the kids in both the main study and the replication study group which took place in the state of Indiana, demonstrated both an increase number and greater diversity in communication forms. That’s the ways in which they communicated, the gestures they made, or the gestures and vocalizations they made. Later in this presentation you will hear me say, all the kids also demonstrated an increased number and diversity in communication functions that’s the reasons for which they gestured or made vocalizations. And all the kids demonstrated an increased communication rate and we will go through each of those. But all the kids improved in form of communication or the ways in which they made gestures, functions, or the reasons for which they made gestures, and the rate or the frequency with which they made those gestures. It’s pretty exciting stuff.

Slide 12: Key Findings (Participant nearest mean growth)
This is one learner’s example when we started our study. This is the fella who was closest to the average in our study. So again, I’m not trying to bore you with all the statistics. When we started the study, he had only three forms of communication gestures, they’re shown on the left. He’d push things away, he’d drop things if he didn’t want them anymore, and he cried. And you might say “what? Those are gestures? Pushing something away, dropping something?” Absolutely. The cries of vocalization. At the end of our intervention, he still did the three on the left, but he showed six additional new forms of gestures. Extending his hand with his palm up to say “I want it, give it to me”, taking a partner’s hand to something, giving an item to a partner and saying “help me with this thing”, high five greeting, he learned to point, he learned to clap his hands as a comment or celebration. So he started with three forms, he ended up with nine. 

Slide 13: Key Findings (continued…)
Here’s the slide about all the kids demonstrated increased function.

Slide 14: Key Findings (Participant nearest mean growth)
We’ll look at the same young man who was nearest the average of all the kids in the study. When we started, he communicated with gesture or vocalization from two reasons to either protest things or reject things. And if you think back, he dropped stuff, or pushed it away, or cried, right? So you can see how the only functions or the reasons for which he gestured or used vocalization were to protest something or reject something. At the conclusion of our study, he had added six additional functions. He was greeting people, he asked for turns, he asked for things or objects, he asked for attention, requesting attention from another person, he made choices, and he commented about things or tried to direct another person’s attention to something else. So we started with two reasons he communicated with gestures or vocalization, at the end of the study he had eight different functions that his gestures served. 

Slide 15: Gesture Dictionary
What we did through this study and at the conclusion, we made dictionaries of the learner’s gestures. And I would really encourage you, should you decide to undertake an effort to teach gestures to a learner in your class, families if you want to partner with your child’s education team to try and teach gestures, start putting stuff on paper. I have an example for you here in a minute. But write them down, write down what the gesture looks like and what the gesture means. If it’s a modification of a conventional gesture, like if the child can’t extend his arm and supinate his wrist that’s turn his hand over so the palm’s up, so that it’s exactly parallel to the floor, maybe he can only get it at a forty five degree angle, you might want to explain that. Lots of kids who have charge syndrome that’s the best they can do because their wrist won’t allow them to fully supinate their hand. Describe it, and describe how the child uses it. We created these for each of the learners in our study and what we started doing after the first couple, we also made video dictionaries. We captured on video, the learner herself making the gesture after she had learned it independently to do it independently and we burned those video clips to DVDs and we gave copies of those dictionaries, those video dictionaries to the classroom teacher and to the learner’s families. So again teachers, if you see success in teaching gestures to a learner with deaf-blindness with whom you work; I think a paper dictionary is great and particularly if the child is going to be moving on to a new classroom, transitioning to a new school building, if a family is going to be relocating to another city, please make a video copy of a dictionary of the child’s gestural, of the young adult’s gestural dictionary. Make a video copy, send it to the next school so that the receiving teacher can become immediately familiar with how this learner gestures and vocalizes for the purposes of communication.

Slide 16: Sample: Learner Dictionary
Here is an example of what one learner’s dictionary looked like. The form of what the gesture looked like is described on the left. The possible function, because again, we didn’t know for sure/positive, the kids couldn’t tell us in words the possible function of the gesture. Like the first one, raise your arm, hand open, ask for a high five, that was a greeting. Look at the fourth line, take partner’s hand and move it to an item, a switch or a location that serves a function of asking/requesting that item or requesting help with that item. Third from the bottom, push the object away, pretty clear that likely means rejection, “I don’t want this thing”. Bottom one, I just wanted to point it out, it is one example that we taught kids with very significant physical challenges, you’ll see one young man in the pictures in just a few minutes, he had some sight but very very limited movement. We taught him to close his eyes to say “I’m done with this, I’m finished, get out of my face”. And you say “what?” Yes, closing your eyes is purposefully/intentionally is a gesture. All these things are gestures, so you describe it, what it looks like, what the gesture looks like, what the vocalization sounds like, what the possible function is and if that all possible, create a video dictionary of these gestures.

Slide 17: Expressive Gestures: Extend Hand, Palm Up (Request)
So, let’s take a look at these guys and girls and see what some of these things look like. Again, I apologize I couldn’t get the movies to you, we tried and tried and tried. But we have pictures that I hope will capture the essence of the gestures. One gesture that every one of the participants learned in some form and/or another was to extend their hand, palm up to make a request. 

Slide 18: Extended Open Palm Request
Here’s one little fella who is totally blind, he is extending his right hand and I’m putting a vibrating bumble ball on a string into his hand. My left hand is under his hand just supporting it because as I’m placing the object of which he’s asking, into his hand, I place it in there pretty firmly to say “okay baby, I see you, you put your hand out there and now I’m giving you what you want” so I’m not vicious, but you put it in there pretty forcefully and I just put my left hand under his wrist to support it so I don’t bump his hand to the floor or hurt him in some way when I’m forcefully placing the object in his hand. As you might guess from looking at him, this is a learner who is totally blind. So what I had been doing with the bumble ball so he knew it was there, I stretched it out on the string and I touched it to his knee and I touched it to his left hand that’s lying in his lap so that he would know that it was there. And when it no longer was making contact with him, I would extend it again and bump 
it up against his arm, bump it up against his leg so he knew it was available, so he knew he could ask for it.

Slide 19: Extended Open Palm Request
Here’s a second version, this is a little fella who’s working on a light box with me and he has, as you see on the table, I have these translucent colored shapes and I wouldn’t just give them to him, he had to ask me for one. And you see how independently he has learned this gesture, it used to be that when I would pick up one of the shapes because I’d never put them in a container and make them available to him. I would pick one up and he would try to grab it from me or he would cry or he would protest and we shaped this gesture so that when he wanted one, he would put his little hand out, turn his little palm over and say “hey I want it”. As you look at him, you might say “well Susan this is not really a good communication interaction because he’s not looking at you” and what I would say to you and this is a very important consideration, he is looking at me. His visual field is not straight on central and he is looking at me, he has his head turned the way he does so he can see me. And that’s just what a second version of an open palm request might look like. This little guy does have CHARGE and as you can see, he can’t fully turn that wrist over but this is as far as he can get it, and it was good enough for me. The first time we did this independently, we had a major celebration.

Slide 20: Expressive Gestures: Tap Partner’s Hand (Request)
The second gesture that many of the kids learned was to tap the partner’s hand to make a request.

Slide 21: Tap Partner’s Hand(s)
This is a young lady who, there’s a couple of pictures here, what we’re trying to show - she absolutely loved to roll on this barrel. The graduate student who is working with her on the left, has his hand on the barrel. When he put it there, he slapped the barrel pretty hard. It’s a cardboard barrel, heavy cardboard. He slapped it pretty hard with his hand so the learner would know where the hand was located because she had to tap his hand to request that he would roll the barrel back and forth, roll it to the right, to the left so she would be rolling back and forth. You can see in this instant, with her right hand, it is raised, and she is searching with her right hand to tap his hand to say “where are you man? I want you to roll this barrel”. Because he had previously been on her right side no longer.

Slide 22: Tap Partner’s Hand(s)
Shortly after this happened, she does this. She raised up her right hand and she started searching with her left hand. She made contact with the adult’s hand and she tapped it. We didn’t count if she tapped it once or tapped it three times, as long as she tapped it, it was good enough. And you see the change in her facial expression is like “found it, got it, woohoo! I’m happy, now he’s going to start rolling this barrel”. That’s exactly what happened. She tapped his hand to say “give me some more of this rocking thing”.

Slide 23: Expressive Gestures: Take Partner’s Hand (Request)
A third gesture, many of the children in this study learned this gesture; was to take the partner’s hand to make a request. 

Slide 24: Tap Partner’s Hand(s)
So in this instance, this little guy, a game that we played with each other a lot. He loved for me to scratch his head and that’s why my hands are on his head or almost on his head in this picture. He absolutely loved to have his head scratched. He’s sitting on a “sit n spin” we’re not doing anything with that, he just liked to sit there. So that was okay by me, if you want to sit there, we can sit there, we can communicate with each other wherever you are. So the gesture has nothing to do with the “sit n spin” whatsoever but the gesture, and you can see it clearly in his left hand, he’s also doing the same thing with his right. This is a bimanual gesture. He’s taken hold of my hands as I’ve started to pull them away from his head. He’s taken hold of his hands and put them on his head saying “Susan, do it some more”. In the head line (of the slide), I made a mistake, I apologize, I try and try to check these things. This shouldn’t say “Tap Partner’s Hand” this should say “Take Partner’s Hand”, I apologize. And he’s grabbing hold of my fingers and putting them up on his head to say “Come on Susan, scratch my head”. It’s a great game. But you don’t scratch his head for free. Nothing is free. Favorite motto: nothing is free.

Slide 25: Expressive Gestures: Give For Help (Request Help)
This is a “give for help” gesture. It really is requesting help. But in our study, we call it “give for help” because I think it was more descriptive. If the child had a toy that was battery operated that had an off/on switch they couldn’t operate, the child had a container with something inside that she wanted but she couldn’t open the container. Anything like that where the child needed help to access something. We wouldn’t just automatically turn the toy on and give it to them. I wouldn’t just open the bottle if they wanted the smelly perfume. I wouldn’t just open the container if they wanted the squishy ball with which to play. They had to ask, they had to give and they asked by giving that bottle, giving that container, giving that toy to me as their communication partner to say “help me out, will you”? Nothing is free.

Slide 26: Give For Help
So in this instance, it’s a little hard to depict this one without the movie, and I apologize. But what he is holding is one of those lighted balls you can buy in a grocery store. When you throw it firmly to the ground, all of the lights inside will flash off and on for a given number of seconds but then the lights go out. Well he couldn’t activate the light by himself, but he loved this ball. This is very early in the intervention, we were just getting to know one another. So what he is doing, and you can see it, his left hand has gone to my hand. He’s taking my hand, he is going to raise my hand with his left hand and turn my hand over. Then using his right hand, he is going to put the ball in my hand to say “come on Susan, throw this thing on the ground and make the lights work again”. Okay let me go through that, it’s a little hard to explain. He with his left hand, picks up my hand, turns my hand over so it’s palm up, and then using his right hand, he places that ball into my hand. That’s the way he gives it to me to help him activate the lights. You might wonder, why are my hands all over his body? He’s a little guy and I have big hands. I put my hands there so he would know where to find them. As we worked with each other more, I faded my hands back, closer to my body, closer to his knees. And before we finished the intervention, I didn’t have my hands on him at all and he had to find my hands, he had to search for my hands to give me something. But as I say, this is very early on and I wanted to make my hands right there, readily available, all he had to do was touch it and pick it up.

Slide 27: Expressive Gestures: Point (Comment or Indicate Choice)
Other expressive gestures; pointing, pointing is powerful. Remember the example we discussed a little bit ago. Typical two year old running around your house going “what’s that? what’s that? what’s that?”, wow, pointing is powerful. You can use a point to make a comment or to indicate a choice of something you want. We’re going to have a couple of examples here. The first one is a contact gesture or a contact point, here the learner is making a comment to show me something. The second example is a distal point or a distal gesture where the young lady is pointing out the thing with which she wants to play. So let’s take a look.

Slide 28: Point, To Comment
This is a flash light that has the green color cap placed over the end of it. Lots of these flash lights are sold with differently colored caps. On the cap, on each cap is a firm black outline as a feature. This one has a bug on it and he loved bugs. So we used the bug. I helped shape the point, his point is not totally independent, in this particular picture. You can see with my right hand, I’m bending under his third, fourth, and fifth fingers to help him get an isolated index finger. But he is focused there and he is making the point and he touches the flashlight. He taps the green end of the flash light two or three times and its like “look at that bug Susan, look right here at that bug”. He doesn’t say that with his sign, he doesn’t say that with his voice, but he says it with the point; “look at that bug”.

Slide 29: Point, To Indicate Choice
This is great, I’m sure the grad student would love me putting this on the webinar. But he was a good guy. This young lady is pointing and she is much more than six inches away. He’s holding one thing that she could play with, but she wants the Ms. Liberty crown, so she’s pointing and she’s actually pointing with two hands. This is not necessary, but she is pointing distally to say “I want that thing, I want that crown on my head”. She is making a choice by using the point.

Slide 30: Expressive Gestures: Vocalization & Eye Contact (Request Continuation)
Expressive gestures for kids that were challenged by pretty significant physical disabilities. We used a lot of vocalization with eye contact to request continuation or we used eye gestures; we used eye pointing, eye closing. So these next couple of examples are with a young man, with whom we used this kind of intervention.

Slide 31: Vocalization & Eye Contact
I think you can see, you can’t hear him, but he is making a sound that we have practiced. He was doing it in a controlled manner to say “aah aah aah” and when he would do that, he was saying to me “I want you to do it some more”. Now if he’s saying “aah aah aah” and he isn’t making good eye contact with me, he did have some pretty good vision, then it didn’t count. It isn’t a communication if he doesn’t have the eye contact and looking at me. But again, if you’ll think back to that very first photo, with which we started this session, the two babies, could anybody look at the two babies pointing at each other and doubt that there’s communication? No. Well I challenge you, could you look at this picture with me and this young man and doubt that we’re communicating with each other? I don’t think so. So he’s making his vocalization and spot on target me right in the eye to say “I want you to bounce this bean bag up more and just shake my lunch out of me” because that’s what he’s saying. He wanted me to bounce the bean bag.

Slide 32: Expressive Gestures: Eye Gaze/Close Eyes (Terminate)
The same young man really was pretty significantly challenged by a lot of primitive reflexing. He still had an ATNR he couldn’t get a hold of. So gesturing with his upper extremities really was not a very practical way to go. So we taught him a few eye gestures.

Slide 33: Close Eyes To Indicate “Finished”
In this particular one, we taught him to close his eyes to indicate “I am through with this activity, I’m done, get out of my face, I don’t want to do it anymore”. We had been singing and he had been making choices, you’ll see a series of photos with him later on. I think it’s very clear that he is deliberately closing his eyes, they’re both closed, I’m right in his field of vision so he can see me. From the previous photo, you saw that when he wants to engage, he is with you one hundred percent. He’s smiling, his eyes are sparkling, he’s lighted up. But in this particular picture, his eyes are closed to say “I’m finished”. 

Slide 34: Close Eyes To Indicate “Finished”
This is what I did to signal him, “I see you, I understand” I would take my hand and very gently run it down in front of his closed eyes to say “I’ve received your signal, I’ve received your gesture, I see it”. When I did that, I verbalized “okay, you’re finished, we’re done”. This is the method. Some people would say how do you teach him to close his eyes to say he’s finished? This is how. I would block his eyes, I wouldn’t be mean, I didn’t put my hand firmly on his face, but I would rub my hand down across his eyes. If you try to do that to yourself, when you rub your hand down across your eyes, you close your eyes in most instances. Then I would get moved to where I could just put my hand on his forehead, partially shield his eyes, to just touch his forehead to the point he didn’t need that to close his eyes independently. But I always responded, gave him feedback with my hand to say “got it, message received, we’re done”.

Slide 35: Expressive Gestures: Greet
The next few examples I want to share, we can talk about the different forms of what the gestures look like. Some of them will be repeating the forms we’ve just reviewed. But these are to try to give you a picture of how the different gestures were used for different reasons or purposes or functions. So this was a greeting.

Slide 36: “High Five” Social Greeting
Remember in the dictionary we read, you put your hand up, you do a high five to say “hello, how are you doing today?” He put his hand up first, this is a grainy picture I apologize, then I put my hand up. But I wouldn’t take my hand to meet his hand. He had to reach up and slap my hand to say high five. What a great gesture to teach kids.

Slide 37: Expressive Gestures: Request Action/Turn
Another gesture is just simply to ask for a turn. “I want a turn, I want something to happen”.

Slide 38: Request Action/Turn
In this particular picture again, look at the eye contact, look at the smile. It’s the eye contact with the smile and with this young lady holding up these toys, and extending them to me, those are the forms of the gesture. What she’s saying is “let’s play with these instruments” and because you can see her left hand, the one holding the orange rain stick, she’s giving that one to me because she wants me to play with her. She’s going to do the shaker in her right hand, I’m going to do the shaker that you see me starting to reach for, the orange rain stick. She wants us to have an action band. So it’s the eye contact, that’s part of the form with the smile and facial expression and the extending the objects in my direction to say “let’s play together”.

Slide 39: Expressive Gestures: Request Object
One of the reasons we helped kids learn gestures is so they could request objects.

Slide 40: Request Object
I love this picture. You can see, again, this is the little fella with the sort of unusual or at least unconventional field of vision. And he wants this lighted ring placed on his finger. So he’s leaning forward, he’s trying to isolate his finger from his point. This is the same little fella we’re trying to teach the point. He’s trying to extend his finger to say “put that thing, put that lighted ring on my finger because I want to see it”.

Slide 41: Expressive Gestures: Comment (Request Attention)
Comments, request attention very very important to make a comment to say “hey somebody, look at this”.

Slide 42: Comment – Request Attention
This young lady again, I wish her smile were more visible behind this slinky. But what she’s showing me and that is a function in the communication literature, “show”. She’s been playing with this slinky and she’s holding it up and showing it to me to say “look at this thing Susan, can you believe this, is this awesome or what?” just to get me to pay attention to her, to interact with her. What a great gesture.

Slide 43: Expressive Gestures: Make Choice
Make a choice, making choices are very important. When I was showing you the distal point earlier and the young lady was pointing to choose the blue crown that was one form, or one type of gesture that could be used for making a choice.

Slide 44: Make Choice
Here’s a different one. This is our little fella with pretty significant motor challenges. And what you can see, in this series of shots, he’s looking and I’m showing him this frog. I squeeze it and the green eyes poke out. The green ball in my other hand is very textured, it has some light and it’s squishy. I’m asking him which one he wants me to help him play with. So he does a gaze shift, he looks at the frog, then he looks at the ball (slide 45: Make Choice), and then he looked right back at me (slide 46: Make Choice). You can see then, he smiles and the facial expressions supports it. But he actually did, we didn’t show you all the photos from the movie. He looked at the ball, then he looked at the frog, then he went back to the ball, and then looked at me. He has to settle on the one he wants, then look at me to say “this is the one Susan”. So let’s look at those one more quick time. Let’s see it in making a choice. It’s more like time lapse photography if I go through it quickly (scrolls through slides 47-50). Okay, make a choice, he’s already looked at the ball, now he’s looking at the frog, looking at the ball, and looking at me to say “that’s the one Susan, let’s play with that squishy ball”.

Slide 51: Expressive Gestures: Reject/Termination
Rejection/termination. I think all of us would recognize these particular gestures, but sometimes, I think we don’t consider teaching learners to do these things. To put something in front of a learner that we know they don’t like. We just don’t offer those things. But what I’m suggesting to you is often, the easiest gesture to teach, the easiest gesture with which to begin, is a rejection or termination gesture. What is one of the first words that typically develop when kids learn to speak? “No, no, no”. It’s very concrete, it’s very effective, it’s very powerful. “No, take it away”. So put things in front of the child, the child doesn’t want and teach them to push it away. It’s a powerful gesture.

Slide 52: Reject – Push Away
Does anybody have any doubt, by looking at this young lady, she does not want to play with tis bumble ball. She’s trying to push it off her tray. Her facial expression supports that, facial expression is a natural gesture, I didn’t teach her that. And she’s pushing it away. 

Slide 53: Terminate
This was even like “don’t you understand, get it away from me, I don’t want it”. She’s crossing her arms in front of her body and actually what she’s starting to do because she had learned a very modified sign for finished. She’s getting ready to throw her arms out to the side to say “get it away from me, I don’t want it”. This is a different object, but that’s what she’s saying. Powerful, terminate, leave me alone, get it away from me.

Slide 54: Summary/Discussion
So, as a summary of our research study, the adapted prelinguistic Milieu teaching, or in other words, the set of strategies we implemented with these children was very effective in helping learners with deaf-blindness learn the power of communication. Before they ever mastered symbolic communication; formal speaking, formal signing, formal tactile signing, no. Before that, they learned the power of communication through gesture. As I said previously, we were very effective in increasing the diversity of the kids forms, the diversity of the individual kids functions, or purposes, or reasons, for which they communicated. We had greater success with the kids with good motor skills. But that wasn’t the learners’ problem or fault, we weren’t creative, I wasn’t creative enough to figure out ways to teach them to gesture. And we also were very effective in increasing their communication rate. 

Slide 55: Communication Rate
So I want to just real quickly show you one slide about rate just because I think the numbers are powerful. We worked with the kids individually, I worked with the kids individually for 45 minutes, we did that four days a week. And when we started, we counted through videotaping, we counted the rates at which kids initiated communication or responded with communication. We did not count anything that was prompted. When we first began the study, kids communicated at rates of less than one communication act per minute. The average increase shown at the bottom of this particular slide is that our kids increased 1.31 more communication acts every single minute of a 45 minute intervention session by the conclusion of the study. Which, if you take that out and multiply it out, with 45 minute sessions, the average increase was 59 more self-initiated communication acts, not prompted communication acts, in a 45 minute session. Wow, that is amazing. If you jump back at the top, the increases range from 25 more communication acts in a 45 minutes session to as many as 77 more communication acts. A lot of communicating going on. 

Slide 56: Preview: Adapted – PMT Session
If you want to see more information about this particular study, on the National Center on Deaf-blindness site, which I’ve shown you there. If you click on the “Research to Practice”, then “Teaching Prelinguistic Communication”, there is a narrative, there is a small four page article about how we applied these particular strategies with one learner. It’s one of the guys you met in this slide show today. He’s pictured and named on pg. 3 of that article. And on the National Center on Deaf-blindness website, there are videos of me actually working with Lance that you can actually watch if you want to see him in action. The link for those videos is provided at the bottom of this slide.

Slide 57: References
I have provided references. The formal scholarly write up of this particular study, and then this is the full site for the article to which I referred earlier about the types and different categories or gestures. So those are there for your use if you choose to take advantage of them. Thank you, thank you for listening to me, thank you for giving me a chance to talk about this gesture study. I love it, I’m excited about it. I continue to work in gestural development with kids with deaf-blindness. I think it really holds the key to building more powerful more effective communication systems with learners with deaf-blindness. I sincerely hope you’ll give it a try. If you have questions, contact your Kansas Deafblind Project staff. And if they have questions, I’m sure they’ll be happy to get you in touch with me. Again, thanks so much, I like talking about this work. I appreciate your attention.