Case study family intervention, eye gaze-multimodal (summary)

Case study

A UK study looking at the relationship between communication partners and a child's communication strategies.

What was the aim of the study?

To see if therapy focussed on improving eye gaze between mother and child had an additional effect on the child’s range of communication strategies.

What did they do?

Background: This study was completed in England. It involved an 11 year old girl with cerebral palsy, her parents and a best friend. The study outlines all the case background data recommended by Pennington et al (2003) to enable replication of this work. The girl had experience of traditional therapy, focussing on speech production and AAC use. This was described by the parents as always looking at and working on things that she couldn’t do very well.

The study: In summary the girl was videoed four times at home, in a naturalistic way, communicating with her best friend, her mother or her father. These videoed sessions lasted approximately 20 minutes. They were called the starting point, i.e. an evaluation of what typical communication was like before the therapy aspect of the study started. It included the recording of a range of communication strategies, e.g. AAC communication, use of speech (intelligible and unintelligible), pointing, nodding and gesture. The intervention component involved a therapy technique called Video Interaction Guidance (VIG). This meant that all the videos were looked at for micro moments of successful interaction. This selection of moments was independently completed by the intervention guider and the parents.

The first ‘intervention session’ was sharing those moments with each other and discussing why they were regarded as successful. The mother completed a similar sharing intervention session with the girl and her best friend. The total amount of video time included in these sharing interventions was 5 minutes.

After this intervention phase 4 more video sessions were completed. The effects were independently evaluated from the parents’, girl’s and researcher’s perspectives. There was agreement across these perspectives.

What did they find out?

1. Focussing on what the girl had done well rather than what she was struggling with was a new slant for the parents to get used to in a ‘therapy session’. It changed their perceptions of how skilful their daughter was in using a range of communication strategies (referred to as multi modal communication).

2. Independent measurement of before and after videos demonstrated that there had been changes in eye gaze duration (showing perseverance) between girl and communication partners.

3. There were notable changes in the communication strategies used which included (i) an increase in use of AAC system, (ii) an increase in the use of pointing and nodding, (iii) a decrease in the number of unintelligible utterances. The authors comment on the evaluation of intelligibility/unintelligibility and acknowledge that this is by nature a subjective measure but intelligibility was measured in this study in terms of both partners agreed message transfer.

Conclusions: although each person with cerebral palsy is an individual with varying skills, strengths and needs; the authors believe that this intervention approach of not focussing on the tools, e.g. the AAC system, but rather the relationship between communication partners promoted a subtle increase in desirable communication strategies. Further research in this area would be beneficial.

Things you may want to look into: Video Interaction Guidance (VIG), communication partners, communication strategies, intelligible and unintelligible speech, multi modal communication

December 2012

Cited references: Pennington, L., Goldbart, J. & Marshall, J. (2003), Speech and language therapy to improve the communication skills of children with cerebral palsy. Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003466.