Episode 317: Elisa Wern: The Importance of Including OTs During AAC Consideration & Implementation
This week, we share Rachel’s interview with the amazing Occupational Therapist (OT) Elisa Wern! Along with being a school-based OT, Elisa speaks and writes about issues related to AAC and OT, including that OTs can have a critical role in the AAC consideration and implementation process! Elisa shares ideas for supporting students with sensory processing issues, the need for OTs to get involved earlier to support writing at an early age, the importance of teaching AAC Users how to type, and more!
Key ideas this week:
🔑 OTs are skilled with body and device positioning, environmental control, supporting executive function skills, and teaching students when and how to advocate for themselves. These are all skills that apply to AAC Users. OTs involved in the AAC process can provide greater perspective on many topics that are not as familiar to SLPs. There are things, like the glare from overhead lights, that SLPs may not consider, but OTs are often good at analyzing and making adjustments to positioning of the device and/or the student to reduce glare.
🔑 We need to think more about sensory processing concerns when we’re setting up and positioning an AAC device. Some sounds that come from an AAC device can cause sensory dysregulation for people with sensory processing issues, and if they don’t have the language to share their dysregulation, the situation is even more difficult to navigate. If possible, try and teach AAC Users (when they are ready to learn) how to navigate to a page where they can share these dysregulated feelings for themselves.
🔑 OTs should make sure they’re involved on the team when they are discussing writing at early IEP meetings. Providing acess to letters and literacy enables students have the ability to create any utterance, not just being forced to choose symbols and words that are not preferred by the AAC User, and it can take a lot of practice to develop alternative pencil or keyboard skills.
Links from This Week’s Episode:
Elisa Wern's AT & OT Coaching & Consulting Website
Fundamentals of AAC: A Case-Based Approach to Enhancing Communication
Transcript of the Episode
Please Note: This transcript was generated using speech recognition & AI tools; it may contain some grammatical and/or spelling errors.
00:00:08 Rachel Madel
Welcome to Talking with Tech. I'm your host, Rachel Madel, joined as always by Chris Bugaj. Hey, Chris.
00:00:13 Chris Bugaj
Hey, Rachel. All right, so I got something kind of interesting now. Again, I want to be very cautious that this talking with tech podcast does not become the talking with tech about generative AI podcast. Right. And keep it AAC focused, but something I used generative AI in a way that I hadn't used before. And about a year ago, I tried to use it this way, and I got really frustrated, but I spent pretty much an entire day wrestling with chat GPT to use it in a new way. And let me explain what this is all about. So I think you might know that I participate as one of the committee members for the Joy Zibala Fellowship. So just to real quick recap, what's the Joy Zabala Fellowship? Joy Zabala, legend in the field of assistive technology, developed the set framework which we've talked about on this podcast many times, and we use as a consideration process for all assistive technology, including AAC school environment tasks. And then think about the tool. So Joy developed this and was a great mentor in my life and so many. And when she passed away, a bunch of her friends and colleagues said, how do we keep Joy's legacy going? We're going to create a fellowship all around mentors and mentees. Right? Is that a good, quick summary?
00:01:34 Rachel Madel
It was perfect.
00:01:35 Chris Bugaj
Okay, so what that means is every year, people apply to be either a mentor or a mentee. And sometimes they've already found themselves as pairs and they apply together, and those come to us in a Google form, and then we screen them and we look for matches between abilities like, oh, this mentor is really good at. For instance, there was someone in there that sort of was a champion for AAC and said they specifically work with AAC. And yes, they dabble in other assistive technology, but they'd be most comfortable being a mentor for someone who is specifically looking for AAC support. And then we go look for mentees that have submitted and be like, hey, I'm really interested in building a program that in my school district, in my state, or wherever that is around AAC. Right? So, oh, those are a great match. So the screeners look at the results of the Google form and look for people who are really passionate, really dedicated, really kind of have a vision and focus for a project that they'd like to work on or where they'd like to take their work in assistive technology, accessible educational materials, and take that to the next level and then try and pair them. So what that means is there's a bunch of screeners, I'm one of them, and there's a handful of others that all get these Google forms. And what we do is we look at them separately and try and make matches. Okay, I read this one. I read this one and read them all and kind of give feedback. And we have sort of a loose way that we do that collectively, like, what happens next? And we haven't done it yet for this year, but we've done it for previous years. At the time of this recording is we get together and we then say, okay, what did you think? Well, I thought this mentor and this mentee might be a good match. And usually there's more people that apply than we can actually support. So, like, who can actually be awarded the fellowship for the entire year. So, so there's a little bit of a selection process that goes in play. So here was my sort of dissertation question, if you will, and that is, could I take the criteria that we use in the screening process, which is specifically the quality indicators for assistive technology, which is this rubric that all these legends in the field of assistive technology got together, made these, this, this rubric of good practice, and you can reflect on this rubric to score yourself or your school district on your practices around assistive technology. So I took that rubric and I put it in chat GPT, and then I said, okay, here, I'm going to feed you chat GPT, I'm going to feed you the mentees. You tell me how you'd rank them in a score from one to five in these different criteria. And I don't want to spoil with the criterias because I don't want to necessarily taint it for future generations. But there were certain things I was specifically looking for. These were not criteria that we developed together for the joys of Allah fellowship. This was the Chris Bugaj criteria. Okay, so I put that into chat GPT, say, rate each mentee on a scale from one to five, and then here's the mentor applications. Do that for mentors. And then after you do that, come up with your matches. Chat GPT and so that took me in what I just described to you, in two minutes or less. That took me, I don't know, 6 hours to do in GPT, like wrestling with how fast it could go and how many files it could upload and questions that I asked it to clarify. I wanted it to ask me clarifying questions, so I had to answer those questions. There was all this work that I did to try and get the best possible results I could. And certainly enough it gave me five matches at the end. I had five matches. I didn't really look or analyze those. I just put them to the side, copy paste it into Google Doc, put it to the side, and then I did all that same work again on my own. All right, I'm going to read each one, I'm going to rank each one. I've had a google sheet where I gave numbers for each thing, and I came up with my own algorithm in my own brain for each one going, oh, I really like this person. They really mentioned this and this person. Oh, well, they would have been so good if they mentioned this. Oh, I see where they were going with that. So I had this little thing that I kind of, you know, figured out how how I thought the matches could work. And then here was the dissertation question. Would it match? Would chat GPT match my results?
00:06:24 Rachel Madel
So dun dun.
00:06:28 Chris Bugaj
First, let's take your guess. What do you think? Cause I'll let everyone listening continue to take a guess. Do you think chat GPT and Chris Bugaj and chat GPT fed by Chris Bugaj, like, I gave it the information, do you think it matched what I came up with, or do you think it had separate matches than what I came up with?
00:06:48 Rachel Madel
I'm gonna say that it matched, maybe not perfectly, but like very close.
00:06:55 Chris Bugaj
Yeah. Turns out vastly different.
00:06:59 Rachel Madel
Really?
00:07:00 Chris Bugaj
Yes, vastly different. And I think maybe I started to do it. I started to make some revisions when I realized that. And I thought, okay, this will be another six to eight that I'll spend making these revisions because all I told it to do was to look at the quiet indicators. I didn't ask it to look at universal design for learning and the different principles of universal design for learning. I didn't ask it to look at it from some of the principles with AAC. And certainly people were submitting things that were AAC related, you know, like, you know, when we do our presentations, we say there's these six basic things. Like, I could have fed that to it and I didn't, right? And so all of that sort of stuff is in my mind that I did not spend the time feeding it into chat GPT. And then there's other stuff too that, you know, like there's, I don't know, just a way people word things that were like, oh, that was appealing because I get the impression this person is, is wording things in a very inclusive way, you know, where I don't know if that chat, maybe it would pick out those subtleties, maybe it is. I don't know. I don't know how it's analyzing it, but they're just the way it was currently done with just the quality indicators that ended up being vastly different suggestions. So I'm going to keep it to the side. At the time of this recording, we will have already met and we will already have come up with who those pairs will be. But my plan of action is to not tell them I did that. Just mean, when I say them, I mean my other committee members. Just give them the Chris Bugaj suggestions and compare that with all the other members who are, who are screeners and come up with our pairs and then afterwards say, hey, now I want to show you what I did with chat GPT, just to see does it match with any of your matches? Like did it match? So it didn't match with me, but did it match with you? Or you, or you. I'll be very curious how that all works out. So I don't know, a couple big takeaways from that was just how much time it took to do. It wasn't just, oh, generative AI was solution for all or it wasn't cheap cheating. Second thing is, it didn't actually produce the results that I maybe anticipated. My hypothesis would that it probably would, but it didn't. And then third is how much more time would it take to, to get similar results? And then one last thing. Thinking about Rachel is something we hear about, or at least I'm on a bunch, I'm on committees and in conversations about generative AI all the time, something that comes up is the inherent bias in it because it's built on, you know, language that's on the Internet for years and years and years, right? So there's biases in there, but I think we also have our own biases. And I thought, hmm, a certain bias that might happen in any sort of selection process. Screeners who are looking for people that are going to college, for instance, and they're going to be reading us college essays or anything like that. I looked at a number of these and I had spent hours doing it. Reading, reading, reading. Did I fatigue over time? Did I start to weigh someone differently in comparison to the first ones I read versus the last ones that I read? If I had read them in a different order, would the numbers be different because of my human bias? All questions rattling around in my head where that sort of bias wouldn't exist in Chachi PT, right? It would be like I read the first one and I read the 50th one in the same vein. Right. It wouldn't have this fatigue, it wouldn't have a time delay. So that was something else that I was kind of curious about, or just, I should say, I thought it was interesting.
00:10:49 Rachel Madel
I love this, Chris, you are just pioneering all the different ways that we can use chat GPT, and I really appreciate you sharing. You know, it leads me to, you know, think about all the different ways that we could potentially use this tool. And I'm happy that you kind of did it as an experiment, because I feel like I've also kind of experimented with these, this tool and figured out, like, where are its limitations? Where can we outsource, and where do we have to make sure that we're, like, checking our work? And I just. It's interesting to think about, you know, how we can feed it to create the algorithm or whatever formula it uses. That's the most important thing. And I think those types of iterations are necessary to get the optimal outcome, and that doesn't come easily. It's like training a tool, and you have to truly train it in very precise ways in order to get the desired outcome.
00:11:57 Chris Bugaj
All right, let's talk about that just a little bit deeper for a second, because another experiment that I ran and spent multiple hours doing was. Hmm, okay, we use a consideration process to select AAC, right? We have a committee get together, you know, the parent, the speech therapist, the teacher, a facilitator, and we ask a bunch of questions that eventually, again, using the set framework that Joyce Zabala said framework and do a feature match, I thought, could I create a GPT, a specialized version of chat GPT, where you could ask it questions and. Or it could ask you questions, you know, tell me about the student's fine motor abilities, right? Tell me about the student's visual abilities, right. Those sorts of things. Could I create a GPT that would guide somebody or guide a team of people through a consideration process or related to that? You could answer it on your own, and it would give you a suggestion. What you might consider is, and then insert AAC tool here with a certain setup, with a certain vocabulary on a certain device, certain hardware. I spent many hours doing that. I haven't perfected it yet because I don't know that I'll ever be able to perfect it. Based on what I just learned here about the Joy Zabala fellowship and my own, I still think, yes, generative AI could maybe help you wrestle with some of this stuff, but it still needs the human element to make the final decision. It might get you close, but then the human humans have to really make the final decision.
00:13:38 Rachel Madel
Chris, I'm not sure if this, if you know the answer to this. I feel like if anybody would, it would be you. Because one of my challenges, like I want to, it's like I want to export this into different formats, meaning I wanted to put it in a spreadsheet. I wanted to put it in a PowerPoint. And I know there are specific tools where you can create slide decks as an example. I know that that exists. But is that like because you have the premium version of Chatsupt? Is that possible? Because I feel like one of the values of generative AI is the organization elements of scrolling through text and then organizing it according to certain criterion. Is that something that's possible?
00:14:22 Chris Bugaj
Give me an example.
00:14:24 Rachel Madel
Like if I needed it to organize information, I'm trying to think of an example, like a specific example, but basically scrolling through. Let's use this as an example, obviously de identifying this, but taking a 30 page neuropsych report. And then obviously you can ask it specific questions, like, you know, what are the top three biggest challenges of this student or whatever, but then, like organizing it in an information. What if I had to go through like six different reports and I'm trying to like organize in a spreadsheet?
00:15:03 Chris Bugaj
You absolutely could.
00:15:04 Rachel Madel
You could, yes.
00:15:06 Chris Bugaj
I think the takeaway, though, from this joy Zabala experiment is it might take you longer than you think it would take you. You know what I mean? So, yes, and I think that's actually a really good use of it. You take out the names, put it into, in there, and ask for comparisons, ask for outlying information, ask for stuff you find in common. Yes, yes, totally. I think it would give you, again, get you close, right. And give you certainly things to think about. Some of the things that I wanted to do. One of the reasons it took me so long to organize this and get, get the results I wanted was I was trying to put everything into a spreadsheet. So I would often try and copy and paste it back to a spreadsheet and the format wasn't right. And then it would give me things in a, with a label and an answer, like, you know, let's say it was like name or location, and then it would give me a city and state. It's like, well, I just, I'm going to copy all the whole column in and you're giving me all that. So can you do that again? And so I'd have to ask it again, because it really didn't know what I wanted until I told what I wanted. So there's some formatting things that might be frustrating from that lens. It certainly was, you know, time consuming, but from a synthesis and analysis standpoint, yeah, I think that's absolutely doable.
00:16:27 Rachel Madel
Yeah, I think that that's the formatting piece is what becomes tricky, because it's like I'm like copying and pasting and it doesn't. And then I'm like, not so many emojis. I don't know, it just a little cumbersome at times.
00:16:40 Chris Bugaj
But, yeah, what's also cumbersome is I've mentioned chat GPT, and, you know, I pay the fee for chat GPT a month because I'm very curious and I use it for these sorts of things. But now there's Gemini. Bard evolved into Gemini for Google. There's Microsoft copilot. And every time I open up my news feeds, it's like, this is now the best one. This is not the best one. So I wonder, like, well, I'm trying to use a Google sheet. Would Gemini be able to do that? And then do I want to spend more time trying to figure that out? So all of that becomes a wrestling match, which is maybe why people listen to the podcast. A little bit here is like, okay, just tell us which one. So right now, I'm still going to use chat GPT because I'm most familiar with it. But I bet you someone who started with Gemini would be like, no, that's the one. Because I'm more familiar with it. You know who else I think plays with generative AI? And also someone who is very intimately involved with the joys of all the fellowship? Our good friend Alyssa Wern. So just before we recorded this banter, I said, rachel, gotta pause for a second. And I ran and did a costume change. Check out my cool shirt. I know people can't see it, but see how it says the joys of owl of fellowship? I have this shirt, and then you can kind of see on the back there this awesome logo. I know it got quieter because I moved away from my mic, but I had to show you my back of my shirt. This shirt was designed by the one.
00:18:04 Rachel Madel
The only, Alyssa Wern.
00:18:06 Chris Bugaj
It was. She was, and she was one of the mentors for the first round of the joy Zabala fellowship. And Alyssa and I have known each other for many, many years. In fact, back in the think back in the early days of our podcast, when the AAC agreements, we did that episode and we were working on the AC agreements, Alyssa used her graphic design skills, one of the early adopters of canva, I think, and built. So took the AAC agreements and put them in canva to make them a little bit more visually appealing and for parents and for other people who are consuming them. And so, for years, you know, Alyssa and I have known each other through Atia, and so that makes me even more bummed that the scheduling didn't work out for the interview, because I wasn't there. It was just you and Alyssa that got to me for this interview, so I can't wait to listen to it.
00:18:57 Rachel Madel
If you guys aren't aware, Alyssa Wern is an occupational therapist who does a lot of work and presenting in the world of AAC. She's also a good friend of ours, and we have been talking about Alyssa. We've definitely mentioned Alyssa multiple times on this podcast, and it's been on our running to do list, like, get Alyssa Wern on the podcast, I'm happy to say, finally did an amazing conversation. We dive into literacy. We dive into kind of the OT angle, because I feel like oftentimes we're talking. Talking to slps and, you know, having a really strong multidisciplinary team when you're working with a student who uses AAC, especially when we're thinking about our students with complex bodies that can really be invaluable. And so we. I had lots of questions prepared. We had a lot of fun, and I'm really excited to share the interview that I did with Alyssa Wernher.
00:19:59 Chris Bugaj
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00:20:34 Rachel Madel
Welcome to talking on tech. I'm your host, Rachel Mado, joined today by Alyssa Warren. Alyssa, this interview has been a long time in the making.
00:20:42 Elias Wern
Absolutely. I'm thrilled to finally be on the talking with tech podcast.
00:20:48 Rachel Madel
I know we've been, you know, friends for years at this point, and I. I am always like talking to you when I see you. I'm like, you need to come on the podcast. We need to have Alyssa on the podcast. We've literally talked about it. Chris and I on the podcast multiple times. So, anyway, Elissa, I'm excited to have you here. Start off by just telling our listeners who aren't familiar with who you are or what you do.
00:21:12 Elias Wern
Okay. So, as she said, my name is Alyssa Learn. I am an occupational therapist by trade. That's really my tried and background, and I work full time for a school system in Florida. I'm licensed in both Florida and Texas because I do some work there, and then I do lots of private work and consulting and training, probably, if you've heard my name in the last couple of years, it's somewhere connected to the comprehensive literacy for all Facebook group, which I'm sure we'll touch on a little bit here. And really, I work in the intersection of our OT's and physical therapists and our students who need assistive technology in any, including AAC.
00:21:56 Rachel Madel
Yes, we're definitely going to dive into the literacy piece because I feel like there's so many things to talk about. I'm really curious because you're an occupational therapist, and we have the opportunity oftentimes to collaborate with occupational therapists when we're thinking through assistive technology. I'm curious for our listeners who are out there thinking, like, my OT doesn't know about AAC. Like, what are ways that we can start kind of looping in occupational therapists in the work that we do? Just because I myself have even thought, like, I don't know if this OT will, like, know how to help me, and then it kind of prevents me from even reaching out, and I feel like that's not the move because you guys have such a, you know, handle on, you know, motor and visual processing and all these kind of skill sets that, you know, us slps don't have. Um, so you kind of speak to that a little bit.
00:22:52 Elias Wern
Absolutely. I think sometimes OT's are afraid to claim their knowledge in the space of AAC, but there are tons of things within our scope of practice that align really perfectly with AAC. When we talk about positioning, when we talk about environmental control, which sometimes is, it seems techy and scary to people, but it's really, how do our AAC users claim control of their universe? Right? Turn lights on and off, prank their siblings? Like, how do we help them control that universe? And then, I think, aligned really nicely is things like, how do we support their executive functioning skills to know strategically. Like, how do I ask for help, and when do I self advocate? I think all of those things are 100% within our realm. And again, a lot of times OT's are hesitant to step into the AAC space or to claim it as a piece that they could help with. And really as an SLP, I would encourage you to ask them, hey, I've got this AAC user who I really don't know that I've got the device positioned well, or it's not the best it could be. Could you come and take a look at that? It seems a little bit less scary to have a very specific task that you've been asked to do as an OT, and you're like, oh, yeah, I do positioning. I can look at how they're positioned, how the things positioned versus just, hey, what could you do for my AAC user?
00:24:23 Rachel Madel
Yeah, I completely agree. I feel like having a specific ask helps kind of all parties involved be like, okay, this is a thing that I need help with. And I think also what happens when you kind of loop in an occupational therapist is we have opportunities to kind of teach from the speech language pathology side, the language side of things. And also, you know, that ot starts becoming familiarized with AAC so that when they do have that student on their caseload, you know, they know a little bit more about AAC than they did prior.
00:24:58 Elias Wern
I am a huge advocate of co treatment. I know sometimes in private practice spaces, billing doesn't always support it well. And in school system work, there's not always time for good collaboration. But I think even if you were to find at the beginning of a school year or beginning of your working with a client one time, one session where either that school based therapist comes and supports the SLP, or I go to sessions privately with the student, because I think that teaming approach is just super critical not only for our users, but our families to see we're all on the same page, we're all supporting. And sometimes it starts with building that relationship. I think a lot of times both of us in SLP world and OT world are very good at working in our silos. We go, we work with our student, and then that student goes back into class magically, and the teacher doesn't know this SLP doesn't know. What did OT do in that time? How are they approaching writing? You know, did the OT identify a really great alternative pencil that that student could use? Well, if you don't tell anybody and you only keep it in your magic little closet of OT, it makes it really hard for there to be carryover in a way that supports, ultimately, that learner.
00:26:12 Rachel Madel
Totally. Alyssa, I'm curious, in the work that you do what's kind of some of the things that you, as an OT and thinking through that OT lens. See, that could be, you know, changed or done differently. I'm thinking specifically about positioning and midline and all of those things that, again, slps don't have a lot of training on. But. But myself, I've done quite a bit of co treatment with occupational therapists, and I've learned so much. So are there some things that you're like, yes, there's a few things that as an OT, I see and like, please do this different.
00:26:50 Elias Wern
Well, I think when it comes to positioning, first and foremost, the student needs to be positioned well. Right. And we know some of our students are very active. Right. They're not students that use a wheelchair even part of their day, but we need to make sure whatever chair they're sitting in, their feet aren't dangling. Right. It's really hard. I don't know if you've tried to sit in a chair yourself without your feet touching the floor, your core just screams at you after a little bit. And our users, our learners can't always say, hey, my feet are dangling. I need my feet in a better position. Right. But first, making sure they're positioned well, however that is, and if they are using a wheelchair or an adaptive chair of some sort, that they're positioned well, then we can look at how do we position the device? I think the number one thing I see that is wrong. I'm using air quotes wrong is that we position a device without thinking about the lighting glare because we're not sitting where that user is sitting. So we can't always tell that really what they're seeing is glare and not a device. And then we think, oh, well, they don't want to activate their device. Well, sometimes it's really hard. I don't. Have you ever been out in sunlight and seen glare? And it's really hard to know where you're touching. So if their accuracy is off, I would want to know, is it sitting flat or can we raise it up even if that's sitting it on a three ring binder?
00:28:11 Rachel Madel
Right.
00:28:12 Elias Wern
On a two inch, three inch, three ring binder. Can we at least try to change its position a little bit if it doesn't have a great stand built in? That's a really good point, number one. And number two, any of our users who have any sensory processing concerns, we need to take that into consideration when we're positioning and working with that device. That could be tactilely how they're activating it. That could be the voice, the options that are there, or the extra sounds that come with activating a device. And it could be something relatively, I say simple, but that they don't have the right words in their device to discuss or advocate their sensory processing needs. I was very fortunate to co author a chapter with Sarah Gregory on this specific topic about sensory processing. Naac. And I know she's been on the podcast before, but I don't think she hit on that because I don't know that the chapter existed at that time.
00:29:11 Rachel Madel
No, I don't think so.
00:29:12 Elias Wern
But I think when it comes to positioning and access, that's a really huge space. We're seeing a ton more learners across the board just have sensory process, dysregulation post Covid, or whatever stage of COVID we're in now. And I think. I think the more that we can do to align what we know about their sensory processing needs, how they need to access their device, and then the words they need in their device to talk about their dysregulation or regulation needs.
00:29:42 Rachel Madel
And I think that that's a really good goal for SLPs and Ot's to be tagged on is like, this idea of advocating for my sensory needs. Um, you know, Ot's come in and like, here are the sensory needs, and then slps come in and say, here's the language we could use to help students learn how to communicate about that.
00:30:00 Elias Wern
I think it's huge. You know, Ot's we do, a lot of our background knowledge is very neurodevelopmental in nature in terms of what's causing some of those sensory dysfunctions or dysregulations. And then, like, a lot of what we do to figure out what's going to work is going to be very individualized to that learner. And what works to help regulate me. That might be herbal tea on a good day is very different than when somebody who needs coffee or needs to go run a mile. And the same is true for our younger learners and our adult learners. What's going to work for that one person? We might have a bucket of things we think might work, but we will eventually end up with a toolbox for that specific learner that they know they need. We did a look when we wrote that chapter. Very few of those words are in any of our most popularly used AAC. See devices or apps. It's just not a space where they do a lot of. A lot of work, even. Even like a blanket, you know, kind of uncustomized set of vocabulary.
00:31:05 Rachel Madel
Yeah, and it's one of the most important things. Like, so many of my students have sensory challenges and regulation challenges. And it's like if we are working with students that aren't regulated, like, they're not in a place that, where they're ready to learn. And it's just this vicious cycle where it's like they don't have the language yet to be able to communicate they need and how they feel. And then, like, we're just in this vicious loop where we, like, can't get out of it. And I think that the first step is us teaching kids how to advocate for what they need. And, well, I back you up there.
00:31:38 Elias Wern
Like, the first step is we got to figure out what they need. And often that's a, that's a great time for teaming, like you said, because it needs to be that learner, the SLP, the parent, because they see them, you know, twenty four seven at home and other related service providers that are supporting them. And once we know what they do need, then making sure that those words are there and we've taught them how to self advocate. And self advocacy doesn't happen just in a speech language session or just when they're an OT. Right? Like, I've got to advocate for what I need twenty four seven and know how to do that when there isn't another adult around who's taught me how to do that so that I can do that as independently as possible. And sometimes that means you're co constructing that message and you're saying, you know, I'm noticing, you know, Johnny, I don't know why my people examples are always Johnny, but I'm noticing, Johnny, you know, you're moving a lot more in your chair. Last time that happened, you told me you needed a movement break. Tell me what's happening. You know, and it may be that that's how we start drawing out that message from them. And then eventually they're in the space where, oh, I noticed my body's moving a little bit. Let me find those words in my device. It's not something that happens overnight.
00:32:53 Rachel Madel
Yeah, we actually had Chloe Rothschild on the podcast, and Chloe talked about this whole journey that she went down on kind of that interoception piece, understanding what was happening in her body. And in fact, AAC was the kind of, kind of gateway that unlocked a lot of that for her language wise. And so I share that because, well, first of all, if you haven't listened to Chloe Rothschild, go listen to that episode. It's a really good one. But also it's like a process, and we can't expect it to be immediate for our students, and we need to make sure that we are supporting them and scaffolding that learning for them. And I think the other thing that always comes up for me, too, is that we only tend to kind of pull these folder up in our AAC system when a student is incredibly dysregulated, and it's like they're not in a place where they're able to learn at this point. Right? Like, yes, like, we can model language in those moments, but, like, we also have to take the extra time and effort to, you know, create opportunities for learning when students are regulated so that when they are in the situation where dysregulation has, you know, come, they're more likely to be successful in using that language.
00:34:04 Elias Wern
Absolutely. And that's role playing. That is in ot space, we would call that kind of a therapeutic use of self. I can walk in and be like, man, I am really tired today. You know, let me see, what could we. What can we do that would help me wake up before. Before we start our work together? And then it's. Then it's on me, right? Then it's not this other thing, this other person, but they get to kind of help me co create and experience. I think that learning outside of dysregulation because when you are sick, when you do not feel well and. Or you're having seizures, and these are daily experiences for a lot of RAC learners and users, it's really hard to learn a new thing. It's really hard to be like, what should I do? You're just trying to make your way through the day. And in that space, things like interoception are very relatively new in our world. Some of our most common sensory processing measures in terms of more standardized tests, don't even really include intraoception. And there is. Kelly Miler is doing some great work for interoception and doing those separate assessments, but things like, what is it like to be hungry? What is it like to be thirsty? What is it like to feel like I need to go to the bathroom? What is it like when I feel sick? All of those things are really, like, hard to externally describe, but have huge effects on what's happening on our learners daily. And to try to get them in a space where we can help them know what it is that they need and know how to advocate. It can make a huge difference in them just being available to learn. Right. It's really hard to concentrate on emergent literacy or any literacy activity if you just feel like crap and being able to kind of help them get in a better space where they are as available as possible to participate in their learning.
00:36:01 Rachel Madel
That was a beautiful segue. Alyssa, we aren't going to talk about literacy because I'm so excited to have you on here. So for people who don't know, Alyssa has started an amazing Facebook group. Comprehensive literacy for all is the framework, the. The bible for us, you know, individuals who are teaching our students literacy, who are complex communicators. And I just want to talk a little bit through the literacy lens. You and I, Alyssa, kind of talked offline about this idea of writing, and I really want to kind of help our listeners kind of dive in a little bit. We've talked about literacy on the podcast, but I'd love to kind of take the opportunity to pick your brain and learn from an OT lens. What are the things that we should be considering when we're thinking about, you know, literacy in general? But I also kind of want to take. Take the path of writing because I think that that can be challenging for a lot of practitioners.
00:37:00 Elias Wern
Absolutely. So, yeah, this Facebook group, such a surprise came out of COVID Thought it was going to be very, very small group of people kind of working through this book when it came out in 2020. We are now right on the edge of 7000 people internationally that are in this group. I just checked before we jumped on to. To record, and it's still mind boggling to me. And really the hope is that it's a safe space for people to ask questions. We don't have it all figured out how to do literacy with kids who have complex needs, and no one in this group would purport to be the expert. So I feel like it's just a great community. And when it comes to writing, and when I think specifically as an OT, I think the number one thing we could do as OT's to help our learners is be on that team when they are helping to identify their alternative pencil. And if you're not familiar with what I'm saying, alternative pencil. Okay. We know not every learner is going to be able to pick up a typical number two pencil and put it to paper and give us writing, whatever format of writing that is. And so it's about how do we find other means? Everything from typing on a keyboard using their AAC device. Sometimes it's adapting the pencil itself, sometimes it's. Sometimes in the day they use this version of a pencil, and sometimes in the day they use this version of the pencil, but giving them access to those 26 letters is incredibly powerful. And at least once a week, somebody is asking a question about that in the group or posting an example of why it's important we have young AAC users whose parents post videos of them being able to search for something when they were super frustrated and couldn't find it and couldn't explain it in their device. And to me, that's the power of us being able to identify a means for them to have access to those letters, to be able to produce something that isn't in their device. There's no way, no matter how sophisticated the device and no matter how much programming has been done, that you could put every spontaneous and novel utterance we would ever want to make in a device. And so giving them access to that, those is kind of opening the door for them for literacy activities in ways other than just tied to what someone else thinks they might want to say in a device.
00:39:23 Rachel Madel
Yeah, exactly. It's really so cool to see students who are merging with literacy skills, especially writing, start learning how to independently navigate to a keyboard and start trying, you know, their best attempts at spelling. And I think that that. But like you said, that skill is so important because we don't have all the words on these devices that we can't possibly program everything that a student will want to say or need to say in, you know, their experience. And I love when I start seeing kids start spelling because it shows that, like, their brain is really thinking, like, through the lens of literacy. And these are skills that we need to teach students. You know, we need to prioritize this. And, and I know that it can feel really daunting when you're working with a student that might have limited language skills and is emerging. And even just using AAC, we can teach literacy to students alongside of language and AAC with a lot of success and early and often. And I think that it's something that we as educators really need to prioritize. And I think that that part of the challenge is people don't know what to do. Yeah.
00:40:40 Elias Wern
And I think sometimes there's the wait and see mentality, right. They started in a pre k or kindergarten classroom, and they're having trouble holding a typical pencil, and they think, oh, well, they just need their hand to get a little bit bigger. They just need to whatever the fill in the blank is. And to me, it's. That is a perfect space for occupational therapists and other professionals to be pushing in to those pre k and kindergarten classrooms and as early as possible, you know, there is no reason why a student should be trouble. Like, the barrier should not be. I can't hold a thing in my hand totally. And especially post Covid, we have lots of kids who just didn't get that practice, who, for whatever reason, didn't develop those skills and putting alternative means in magnetic letters stickers. Like, there are tons of ways at a very developmentally appropriate way we can do that that helps us. And sometimes it's a kid that doesn't necessarily have some outward, very visible disability. We know developmentally from OT PT perspective that kids that skip the crawling phase, that all four hands quadruped or commando crawling phase tend to have less development of their intrinsic, their little hand muscles. And those are the muscles you need to control a writing tool. So even if it's just that they skip that calling phase and they may develop a little bit later, we don't want them to think of themselves as unable to write while we're still building those independent, stronger hand muscles. And so for some of our kids, that holding that tool will never come, and that's not going to be the way that they show us what they know. And for everybody in between, providing options is the way, right? Like, that is the truest form of UDL. Let's put a whole tray of writing options out on a table. I have kids that love to use label makers. I have kids that are still using intellikeys, blue keyboards, as touch keyboards. They use their devices. They use magnetic letters. They use apps that have those magnetic letters within them. There's tons of ways to provide the Alphabet to them that are not paper, pencil. And doing that early and often sets the stage for them to be able to put those letters together in meaningful ways, to, again, write for purpose.
00:42:56 Rachel Madel
I want to kind of dive in a little bit more with this because I feel like the thing that I oftentimes see when I'm working alongside of teachers and I'm in classrooms is a really big push for handwriting. And for our students who are really struggling with the handwriting process, you know, it's like, oh, well, we'll just have them trace, we'll have them trace their name. We'll have them, you know, we'll do hand over hand and help their hand move. And it's just like this huge emphasis on handwriting. So I want you to just speak to that a little bit, you know, from your experience, like, and to be fair, it's like, I think you're right. It's kind of this, like, wait and see, we'll wait and see as their motor skills develop. And, you know, I sit in these IEP meetings every year here, the Ot talk about how handwriting has improved, you know, and sometimes not by that much. Um, and then the question becomes like, well, should I give up on handwriting? Should I move to keyboard? What should we do? So can you just speak to that a little bit? Because I feel like that's what I'm seeing in my clinical experience is like tracing, basically.
00:44:00 Elias Wern
I will do my best. Um, so I will say declaratively, tracing is not handwriting. Tracing is not handwriting instruction. I know that there are some programs that incorporate elements of tracing into their handwriting instruction, but sometimes it's the only handwritten instruction I see in classrooms. And that really worries me because they're not doing it with an educator sitting really right next to them. What they're learning to do is draw their letters. They're not learning to write their letters. So that's how we develop all these funky patterns of letters, starting in really weird places and then their motor coordination to get it to form a letter that looks somewhat near what it should is really often funky. So I tend to very early talk in our goals as OT's about written work production, right. Or work production instead of they're going to complete handwriting, should we give up on handwriting? Well, I don't know that give up is the right term to me. It's shifting the emphasis to them doing a specific method to complete a task to how are we going to complete the task? Right. It is fundamental task analysis. We got to finish this thing and how are we going to finish it? And sometimes for some students, that is as early as second grade, first grade, even going, let's give them access in other ways. Let's put them on the computer to type most of the time now, when our kids transition to middle school, so some places, that's fifth grade, 6th grade, 7th grade, that body of space. Very rarely is there an emphasis where they need to hand write something. Right? A lot of places are one to one devices. So if that's true for our kids leaving elementary school, going to middle school, that is a skill all of our learners need to have. And we know for learners who have complex bodies, they need longer times and more repetition to gain a skill. So why aren't we starting that early? And can it be in combination with, I'm still going to learn how to form the letters. Absolutely. But that doesn't mean that you have to pick up a paper and a pencil to form the letters, right? You can form them out of big letter pieces. You can form them out of clay. You can form them with big markers and on a whiteboard, but not on a tiny, tiny writing space. Like, there's lots of ways to focus on the mechanics of. I know what this letter looks like. Right. How it's graphically represented, which is really important for literacy, but them physically being able to make it, when we get to them, be putting letters together to form words and sentences, I feel like it's less important. Right. They need the right tool for that task in that moment.
00:46:45 Rachel Madel
Yeah. And so kind of to reiterate, what I'm hearing you say, which I completely agree with, which is, you know, the key is helping students kind of complete a task. And I feel like the caveat is complete it with letter formation and spelling.
00:47:01 Elias Wern
Right.
00:47:01 Rachel Madel
Or eventually spelling. And I think that that's where, you know, I'm seeing kids complete task. But it's like, it'll take letters completely out of the equation. It's like, oh, we'll just have them circle a picture, or we'll just have them, you know, stamp with a stamp marker. And I think the key is, how can we help our students become more independent with. With literacy and letters? And it. It can look like, you know, using some other means or alternative pencils. And I think that that's where, you know, the emphasis should be. And I'm not always seeing that, unfortunately. But I think that the key here is just, like, giving opportunities for kids to practice forming letters and having access to letters.
00:47:48 Elias Wern
Right. I think it comes down to that. And I think you and I are aligned in our views on hand over hand. I. To me, what I. How I tell adults who are in that space is I do that activity with that adult, and I'm providing hand over hand assistance to that adult, and I ask them what they see, because what they see is my hand doing the task, which it doesn't then equate to my hand and my body are learning how to do this task as a learner. And I think it's somewhere along the way, it became, this is a way that we can help them produce a thing. And I don't think that we're actually doing the thing that we intended initially by doing that. So sometimes a soft transition from that is to support them by hand underhand. Ideally, I want to get as little physical contact happening to initiate a task, but a lot of our learners are so used to having somebody support them physically that they have to. We have to make a shift somehow. Right. And the beginning shift is, is, can I support that person by putting my hand under their hand so they see themselves doing the action, then we pull back that support even more to maybe they just give a little initiation at the. And these are kids who have complex motor planning needs, right. These are not kids that can do this independently. And eventually you get to the space where you don't need to provide physical assistance, and that's ultimately the goal. Right. We want them to be able to do a task without us, us having to intervene to the maximum extent possible. And the places that they do need physical support to do something. Hopefully it's in the setup of something, right. So it's, oh, I got to get your keyboard out because it's all the way up on top of the other computer and you can't get there. To me, that's an appropriate kind of task completion task for assistance for an adult to give. I need setup assistance. I need closing this up, putting this away assistance. But the actual task, we want it to be as independent as possible. And it's one of those things that is a pendulum shift that I hope we're starting to move the pendulum in the right direction so that what we see is learners understanding. They have autonomous control over their body to do a thing, and they have the ability to request their help, an adult's help, as much or as little as possible as they need. And that's a lot of people teaming together to make that happen. That doesn't just happen with a snap of the fingers and a magic wand that sometimes is years in the making of helping to support them with language to make those asks, understanding what it means to have somebody help you and then understanding what your role as the learner is in the task.
00:50:32 Rachel Madel
So just to clarify, because I love this, you actually will do, like, hand over hand with an adult to kind of showcase this to them?
00:50:40 Elias Wern
Absolutely. Well, because I think a lot of times we're in the. In the go mode, right. As adults in a classroom, our job is to facilitate that activity. We know we've got centers, rotation, and we have this much time to do it, and so we just do things, some kind of unconsciously not thinking about what's happening or that learner's experience. So, yes, I have been. I will ask their permission first, but I have been known to see, like, can I just show you what that experience is like? You know, what. What Joey is experiencing? And then I say, what do you notice? I'm not like, did you notice how I did this? This, like, what did you notice. And 90% of the time they're like, either I don't like the way that feels, I didn't have control, or it's all I saw was my hand. And I think those are really good. Guard our arguments or discussion points for us to then ask some deeper questions, to say, is there a way you could think of that you could support this learner differently? And I'm not denying we have kids who have very complex bodies that don't have a ton of control over arms or legs, and we need to help them in some ways, I think it's about the way that we do that, that respects who that person is. Ultimately, that is most important. And asking adults to experience a little piece of that, I think is super part of OT's roles as education. Like just walking into a classroom and trying to make little changes. I'm a huge proponent for push in or in classroom therapy because of that. Because we notice things happening in a classroom that don't happen when we pull a small group or a single student to work with them and we can ask those curious questions. Right. And I think if you've developed relationship and rapport with the staff members that you're working with, which has to come first, they're open to those questions.
00:52:29 Rachel Madel
I love that. I also think that, you know, when we provide super high levels of support for students, they become used to those super high levels of support. And it's, you know, oftentimes, especially when we're thinking about kids with complex bodies, you know, motor is so challenging. So if we. If I know that if I wait long enough, someone will just kind of grab my hand and do it all for me, then great.
00:52:54 Elias Wern
What's their motivation? What's their motivation to try to attempt a hard thing, right, exactly. And I think, you know, it's. I say us. It's globally this education slash therapeutic system that's done this, right. Like we've at some point in the pendulum process, we thought, hey, you know, providing them physical support is the way to go. So it's on the onus is on us, us globally, all of us to then swing the pendulum in the back in the right way so that we, as from my school system work, we produce 21, 22 year olds, 26, depending on your state, people that leave us who have as much control over their world as possible. And I think literacy goes a long way for that. I have some learners that my goal is that they are accessing keyboard plus word prediction, enough to produce a novel message when they leave us. Right. And that's a multi year goal for some of our learners. But it's so critical because a huge piece of who OT's are is that self advocacy space. And there's nothing more important than giving a voice to self advocate to an AAC user. And so when I think about that connection, like why do I, why do I care so much about this comprehensive literacy thing? I think that's why I think the OT part of myself will never disappear. And it's such a huge part of the work I do now because I see adult users who've graduated either from school systems I'm in or other places I know. And I think, dang, if only they had had access to the Alphabet earlier. And so I think it's let's do everything we can now for our current adult and transition users, but we dang sure better be putting some emphasis on pre k kindergarten one and making sure that our youngest users have access as much as possible. And do we do that to the greatest extent we could even in the school system or who are. No, we don't. This is a, we've got to do better and so we got to do better by people. It's not, you know, us doing better because we like our jobs and we want a paycheck. It's like there's a real human element to this and, and that's, you know, one day in all my spare time, I'm going to do an overlay of the OT practice framework and things like the communicative competencies, because I think everything lines up very beautifully for OT's to be in the AAC space. So I guess my encouragement would be like, please invite other people into that AAC space. If you as an SLP, do a lot of AAC work there, invite other people in, because I think not only do ot's have a lot of knowledge, physical therapists, which you didn't really, we didn't have a chance much to talk about yet, you know, and other related service providers, itinerant, deaf, hard of hearing teachers, our teachers, the visually impaired. We have tons of related service providers that bring a wealth of knowledge in other spaces than the knowledge you all have as slps.
00:56:01 Rachel Madel
Totally. I actually just had a call with a teacher at the visually impaired and I was like mind blown so many times. It's like this super tricky case. I was like, there's visual things going on and so I'm like, okay, like, I need to just like go to the source. And I did a co treat and I was like, wow, like, this is crazy. And so I completely agree. I feel like when we bring in, you know, the whole team and all the different elements of this student that's right in front of us, we start learning so much about where some of these roadblocks are and the origin of them, and it. And it just better helps support our ability to move the needle and continue down the path of progress, because I know a lot of people listening right now have students on their caseload that that student's not really making progress or the progress that we would hope for. And there's tweaks that we can start making based on all of the amazing information from, you know, a multidisciplinary team. And I think that that can really move the needle for kids, especially kids that aren't making the progress that we want, but just in general, kind of this idea of team based approaches, and.
00:57:08 Elias Wern
I think it starts with goals. Right. You know, if we don't have a direction to move in. So a few years back, AshA APTA for the physical therapist and AOTA for the OT's, very rarely do they get together collaboratively and say anything, a statement about anything. And they did, and they wrote an entire statement on the importance of writing goals together. And it's something that I think everybody who's working in one of those three disciplines needs to be aware of. And I can give the link that you can put in the show notes, because I think it's really. Are we going to change that overnight? No, but sometimes it's really hard to say, oh, well, we need to find time to collaborate. Well, if your goals lend themselves to you needing to collaborate, it's another measure for you to be like, oh, yeah, that's right, we're supposed to be working on this, this or this together. So how about next week? I come when you're seeing that student, you know? So I think it starts from, how are we setting a direction? And in the school system, often in private practice, that's the goals we set. So I did want to make sure that people knew about that collaborative goal writing document, because I think, is it the magic wand? No, but I think when we're talking about us working together as collaborative teams, school system or private practice, we have to set the stage with, what is our intention for this learner, for this next year, for this next six months? And how can we work together for that learner?
00:58:35 Rachel Madel
I love it. It. Alyssa, what's, like, on the horizon for you? I'm curious, like, what's your next passion project? Things that you're really interested in?
00:58:45 Elias Wern
Oh, I don't know. Definitely there's still more work to do in comprehensive literacy. We have nowhere near saturated everyone who needs to know everything in that space.
00:58:56 Rachel Madel
Yeah.
00:58:56 Elias Wern
So we are, at the time of this recording, in round six of going through the book, there will be around seven. So that's a piece of it. And I think to me, it's about little change and big change. So continuing to do the work that I do in the school system, but then also spaces that I have the opportunity to share more broadly about this. I think there's absolutely still people who have not heard that every kid should have access to literacy, and there are absolutely Ot's and pts who have not heard that they have a space and a place in working with AAC. So I think those two very much align with what I still want to do.
00:59:42 Rachel Madel
You're doing amazing work in the field, Alyssa. I'd highly encourage, if you guys ever have the opportunity to hear Alissa speak or present at a conference, take it. I've had the pleasure of presenting with you, which was so fun. I'm like, what do we present on? We presented on screen recording tools.
00:59:59 Elias Wern
Screen recording as a tool for. Yep, yep.
01:00:02 Rachel Madel
Oh, I love it. But yeah. Alyssa, I'm really excited to share all of your wisdom that you've acquired over the years, and I'm really excited to share this episode. So thank you for taking the time to come chat with me and to record for the podcast. Finally, we did it.
01:00:20 Elias Wern
I'm excited we finally did it. Hopefully it's got some good pieces of knowledge to help somebody out, and I'm always welcome to have a conversation if somebody has questions. As a follow up, I'll be sure to make sure you have the right contact info.
01:00:32 Rachel Madel
Yes. What is your contact information for people who are like, oh, I need Alyssa in my life. I need to reach out to her?
01:00:38 Elias Wern
Well, I'm pretty easy to find on Facebook. I am the sole admin of this comprehensive literacy group, so that's probably the quickest and best way to get me is Facebook messenger. But I'll make sure you have my website and my email that you can link in the show notes. Perfect in case anybody has questions and wants to reach out.
01:00:57 Rachel Madel
Alyssa, thank you so much again for being here. I really appreciate all of your wisdom, and I'm really excited to share this episode. Thank you for having me for talking with tech. I'm Rachel Madel, joined by Alyssa Wern. Thank you guys so much for listening, and we'll talk to you next week.