Every Move Counts,
Clicks and Chats
Jane Korsten
www.everymovecounts.net
[email protected]
Everyone communicates in
some way. It is our challenge to
recognize that communication
and respond to it!
Every Move Counts is the result of
a three year innovative research
grant funded through the
National Institute for the
Neurologically and
Communicatively Disordered.
(NIH)
It represents a synthesis of the
research in the areas of:
Communication
Learning theory
Sensory integration
Vision
Every Move Counts was ‘no tech’.
Every Move Counts, Clicks and
Chats is an expansion of the
original work and addresses
switch use and voice output.
It includes:

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Relevant research
Assessment strategies
Implementation strategies
Flow charts to support implementation
Goals and objectives
Evaluation of effectiveness formats
Positioning suggestions
Parent guide - English and Spanish versions
Glossary of terms
Resource list
Relevant Research
“Sometimes the problem ain’t so much
what we don’t know as what we know
that just ain’t so”
Will Rogers
Piaget’s Sensory
Motor Stages
 Parallel development
 Significance of behaviors
primary circular reactions - finger flicking
secondary circular reactions - banging,
shaking, hitting objects
tertiary circular reactions - dropping objects
Piaget continued:
 Communication begins to emerge
around stage 4
 Meaningful expressive language
occurs in stage 6
VanDijk & Sternberg
communication vs. language
“Communication” is the message.
“Language” is the symbol system used
to communicate the message.
Language prerequisites:
 Eye contact
 Attention to task
 Receptive vocabulary
Musselwhite & St.Louis
Communication prerequisites:
Able to:
 separate self from the environment
 understand that there is something
to do to exchange information with
someone
Communication prerequisites continued:
 understand that there are things
about which to communicate
 understand that there are people
with whom to communicate
Contingency Intervention
Project
 infants quickly lose interest in an
environment they can never hope to
control
 maternal stimulation is un-related to
IQ; responsiveness is significantly
related
Contingency Intervention continued:
 Co-occurrence is essential in developing the
concept that the world is controllable;
those with physical/ sensory/motor
differences seldom, if ever, experience cooccurrences; 100,000 co-occurrences need
to be detected, associated and
remembered
Contingency Intervention
continued:
 Infants under 4 months of age learn to
associate their movements with a
consequent even
 A delay of more than 2 seconds between
movement and consequence and infants
as old as 9 months do not learn
 3 month old infants remember response
consequence associations for at least 1
week and learning can be reactivated for
up to 3 weeks
Baby Brains
Baby brains get bored too! Infants
learned switch use by exploration and
then quit using the switch when they
got tired of the consequence.
Changing the consequence resulted in
renewed switch use.
Sensory Integration
 Improvement in MLU and
receptive vocabulary have been
documented as a result of
vestibular stimulation
Sensory Integration continued:
 Reduction in self-stimulatory and
self-injurious behaviors have been
documented as a result of vestibular
and tactile stimulation
 Behavior modification programs often
result in a high rate of replacement
behavior and a high rate of recidivism
Sensory Integration continued:
 Less than 1% of seizure prone
individuals are adversely affected by
vestibular stimulation
 Vestibular stimulation is the kind of
stimulation that kids enjoy
Assessment
inherent weaknesses of formal
assessment for the target population
 language based
 commensurate scores don’t reflect
commensurate abilities
 identify disabilities rather than abilities
 focus on “typical” development
 result in teaching to test
 do not detect small increments of growth
 are static
Every Move Counts, Clicks and
Chats Assessment:
 communication based
 not developmental
 identifies abilities rather than
disabilities
 focuses on skills relevant to building a
functional communication system




motivating targets
current communication
appropriate symbol system
response modes
 detects small increments of growth
 is dynamic and ongoing
Every Move Counts, Clicks and
Chats Assessment includes:





Sensory Assessment
on-going probes
Communication Survey
Clicks / switch use evaluation
Chats / voice output strategies
Imagine
Sensory Assessment continued:
scoring and interpretation
 sensory preferences
 motor abilities
 current communication
General guidelines:
 Two can play
 Play the table as it’s laid
 Video if possible
 No talking, just the facts
 No arguing, just problem solving
We tend to be uncomfortable with
silence. We are a culture of clutter
and clatter. If the television is not
on, we are lonely. If the other person
is not talking, he or she must not like
us. If the radio goes silent for more
than ten seconds, we are convinced
that it’s gone dead. Silence is a
decision to keep one’s mouth shut and
to listen with the heart.
Ron Wooten Green
Sensory Assessment
 steady state
 no social interaction
 scoring
 0 = no response
 1 = reactive / reflex
 2 = proactive / purposeful
 age-appropriate? - customized
Sensory Assessment continued:
Items:
 vestibular
 proprioceptive
 tactile
 visual
 olfactory
 gustatory
 auditory
Insert 3 tastes of one gustatory item
when the symbol (spoon) appears.
Enter score on #7.
1. vestibular – Provide movement for the time indicated for the activity
and then pause for 5 seconds. Record response.
Note: Disconti nue if blanching, gagging or seizure activity is observed.
position:______ ________ _____
stimulus
side to side
(10 seconds)
front to ba ck
(10 seconds)
rota ry
(5 seconds)
up and down
(5 seconds)
pre-task condition: _____________ ________ __
response levels
trial 0 1 2 response description
1
2
3
1
2
3
1
2
3
1
2
3
score:
_____ of _____ = _____%
2. proprioceptive Ğ provide stimulus for 10 seconds and then pause for 5 seconds.
Record response.
position:______ ________ _____
pre-task condition: ________________
response levels
stimulus
trial 0 1 2 response description
1
2
3
1
2
3
score:
_____ of _____ = _____%
3. tactile ĞProvide stimulus for 10 seconds and then pause for 5 seconds. Record
response.
Note: Do not apply stimulus to skin with a bruise, wound or rash.
position:______ ________ _____
pre-task condition: _____________ ___
response levels
stimulus
trial 0 1 2 response description
1
2
3
1
2
3
score:
_____ of _____ = _____%
4. visual ĞMove stimulus through central visual field and all four quadrants (2-3 seconds
per quadrant) and then withdraw from sight for 5 seconds. Record response and
describe any differences across visual field quadrants under the corresponding column.
Note: It is impo rtant that sound not accompany the visual presentation. Do not use stro be
or flashing lights.
position:______ ________ _____
response levels
stimulus
pre-task condition: _____________ ___
quadrants
trial 0 1 2 UL UR LL LR C
1
2
3
1
2
3
score:
_____ of _____ = _____%
response description
5. auditory ĞDuring each trial , present sound at midline, behind and slightly above the
head. Allow 10 seconds for music and 3 seconds for noise makers. Pause for 5 seconds.
Note: It is impo rtant that movement within the visual field not accompany the sound.
position:______ ________ _____
pre-task condition: _____________ ___
response levels
stimulus
trial 0 1 2 response description
1
2
3
1
2
3
score:
_____ of _____ = _____%
6. olfactory ĞTo differentiate between reflexive and purposeful responses, pass an
unscented item under the nose for 3 seconds. If response to scented and unscented items
is the same, the response is most likely reflexive (level 1). Score response made within 3
seconds of presentation or removal while allowing 20 seconds between presentations.
Note: Consider allergies and fragrance sensitivity.
position:______ ________ _____
pre-task condition: _____________ ___
response levels
stimulus
famili ar
novel
trial 0 1 2 response description
1
2
3
1
2
3
score:
_____ of _____ = _____%
7. gustatory – Provide taste of food. Score response made within 5
seconds and then allow additional time necessary for food to be
consumed.
Note: This item should not be admin istered if individual is NPO (nothing by mouth).
Consider suckers for individuals who can taste but do not have the oral motor c ontro l
needed to eat. Allow self-feeders to set own interval. Do not force consumption of
food that is rejected.
position:______ ________ _____
pre-task condition: _____________ ___
response levels
stimulus
sweet
sour
salty
bitter
pungent
astringent
trial 0 1 2 response description
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
1
2
3
score:
_____ of _____ = _____%
Summary:
Sensory: Enter the % of points scored in each category and indicate
whether ‘2’ responses communicated pleasure (+) or displeasure (-).
Modality
Subscore
vestibular
tactile
proprioceptive
visual
olfactory
auditory
gustatory
Preferences: Enter the most preferred sensory and most non-preferred
sensory categories and corresponding physical responses:
preferred
sensory
1
2
3
A
(voice, affect,
eye gaze)
B
(head)
C
(extremities)
D
(mobility)
non-preferred
sensory
1
2
3
A
B
C
D
(voice, affect,
eye gaze)
(head)
(extremities)
(mobility)
questions
 What does she like? What was the ‘AHA!’?
 How did she communicate that?
 What was the motor ability she
demonstrated in the context of her
favorite activity?
 What are your questions?
 What don’t you like?
 What differences of opinion do you have?
probes
 gather more information
 answer questions
 settle disagreements
Probes:
date: _____
stimulus
comments:
position:____________ ____
response levels
trial 0 1 2
1
2
3
4
5
pretask condition: _________ _______
response description
Communication assessment
EVERYONE communicates in some way.
Recognize how the individual
communicates NOW in order to
respond to, expand and refine the
current system!
name: _________________________
date:_____________
completed by: _____________ relationship to individual: _________
Directions: This checklist may be completed based
on the examiner’s knowledge of the communicator
or by interviewing the parent or primary care
giver. Circle the number that best describes the
means by which the individual communicated. Give
examples of gestures, signs, symbols or words
under ‘comments’.
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
1. protests through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
2. demonstrates disco mfort or pain throug h:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
4. spontaneous use of any of the above
comme nts:
8
13
18
6
5
12
16
4
2
10
15
2
never
rarely
sometimes
almost
always
3. indicates hunger or thirst throug h:
0
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
4. responds to removal of reinforcer throu gh:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
5. indicates desire for more through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
6. indicates wants and needs (other than those
listed above) through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
7. indicates “yes” a nd “no” through:
0
0
0
sometimes
rarely
never
with sha ping or physical prompting
when presente d verbally and accompanied by a sign
or gesture
3. when presente d verbally only with no repeti tion
comme nts:
1.
2.
3
6
2
4
1
2
0
0
11
9
7
0
almost
always
8. responds to requests through:
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
9. demonstrates attention to people throu gh:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
10. demonstrates attention to activity through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
11. responds to social interaction through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
12. initiates social interaction through:
0
0
0
1. change in affect, vocalizations or eye gaze
2. gestures
3. symbols, signs or words
comme nts:
8
13
18
5
12
16
2
10
15
never
rarely
sometimes
almost
always
13. seeks attention through:
0
0
0
Enter sum using only the highest score on items 1,2, and 4-13 (item #3
may have two scores)
Communication summar y: Refer to each item and indicate below with a tally
the means by which the individual communi cated on each item.
affect
vocal
motor
Comm unication Method(s)
gesture
sign
word
symbol
other
Level
I
Moto r
Response
Level
II
Asso ciation
Level
III
Anticipation
Level
IV
Choice
Level
V
Expansion
Level
Comm unication Levels
1. inconsisten t motor responses;
2. rarely appears to respond to anything in the environment;
3. may respond to things that are invasive/come in contact with the
body; generally scores 5 or below on most, or all, ite ms
 consiste nt motor responses;
 rarely appears to respond to anything in the environment;
 may respond to things that are invasive/come in contact with the
body; generally scores 5 or below on most, or all, ite ms
 appears to anti cipate familiar activities or events indicate d by
changes in responses;
 generally scores 8 -12 on most, or all, items
 with co ntextual cues, uses symbol to: request mor e of pleasurable
activities; initiate familiar activities; and decline non-pleasurable
activities;
 generally scores 13-15 on most, or all, ite ms
 witho ut conte xtual cues, , uses symbol to: request more of
pleasurable activiti es; initiate familiar activiti es; and decline nonpleasurable activiti es;
 generally scores 16 or above on mo st, or all, items
Select a communic ation level based on the information gathered: ______
symbols
symbol thought process
What if…?
One is not better than another.
The one that works is the best.
Symbol considerations:
 Motor abilities
 Environmental awareness
 Vision
 Hearing
Symbol hierarchy
object - exact duplicate
object - tangible activity remnant
object - miniature
photograph
line drawing (color vs. black & white)
gestures (touch cue)
sign
printed word
spoken word
symbol assessment
Vision concerns: yes / no
Hearing concerns:
yes / no
spoken word
touch cue
sign
printed word
line drawing
With which symbol(s) did individual
demo nstrate :
 no response
 symbol awareness
 anticipation of the activity
 initiation of the activity
object
Activity 1: _______ ________ ____
photograph
symbol assessment (continued)
spoken word
touch cue
sign
printed word
line drawing
photograph
With which symbol(s) did individual
demo nstrate :
 no response
 symbol awareness
 anticipation of the activity
 initiation of the activity
object
Symbol summary: Transfer tally marks
from all three activities to this grid.
Symbol system to which individual was
most responsive: _______________
message
Consider:
 How communication partners will
perceive the interaction
 Print rich environment
 Verbal message
assessment summary
How can assessment information be
reported in such a way that it
guides educational decisions?
what’s so vs. so what!
21 Gun Salute!
The Assessment Summary is intended to
guide organization of information gathered
during assessment so that it can be
reported in a manner that supports
development of an appropriate
individualized implementation program. It
is designed to be a ‘worksheet’ or working
document completed by a ‘team’. Use
results of assessment strategies combined
with team input to complete items.
counts
1. Indicate below preferred (+) and non-preferred (-) sensory
modalities and regularly occurri ng activities involving that sensory
modality:
modality
vestibular
+/proprioceptive
+/tactile
+/visual
+/olfactory
+/auditory
+/gustatory
+/-
possible related activiti es
(refer to modality charts)
comme nts
2. Indicate below what was communi cated and how:
MESSAGE:
like
MANNER:
eyes
affect
voice
head
extremi ty
mo bility
do
not
like
stop
more
comme nts
3. Circle and describe motor abilities observed:
motor ability observed
eye gaze
affect
voice
head position
trunk
extremi ty
mo bility
description
4. Circle symbol system(s) t o be used and why:
symbol(s)
objects
photogr aph
line drawing
printe d word
sign
spoken word
why
5. What are the opportunities for choice within daily activities?
activity
choices
6. Refer to Communication Summary. Select COUNTS level and describe
below the strategy to be used:
Levels:
Methods:
A
(voice, affect,
eye gaze)
B
(head)
C
(extremtites)
D
(mobili ty)
I
Motor Response
Level
II
Associ ation
Level
III
Anti cipation
Level
IV
Choice
Level
V
Expansion
Level
7. Select the goal(s) that best address the student’s needs:
Establish a consistent moto r pattern
Develop an association between a symbol and event
Request more of a preferred activity
Decline a non-preferred activity
Communicate to control activities / make a choice from a field of 2 / choose between
symbol for preferred and symbol for stop
Communicate wants / needs from a field of ___
comme nts:
8. How will progress be documented? What cha nge is expected ?







identified motor patt erns will become consiste nt and predictable when the activity
is starte d or interrupted
consiste nt and predictable anticipatory behavior will be demonstrated when symbol
is presented
symbol will be accessed consisten tly and predictably to initiate the activity
symbol will not be accessed consisten tly and predictably to decline the activity
foil will be accessed consisten tly and predictably to decline the activity
wants and needs will be commu nicated consisten tly and predictably from a field of _
othe r – describe:
9. Who will implement and when ?
activity
person responsible
when
When the information for COUNTS has been gathered, the summary items
#1-9 have been completed, and an appropriate program to address functional
communication has been developed, consider progressing on to CLICKS for
switch use strategies.
clicks
What would it take to convince
you that the individual has
purposeful switch use?
Refer to the Sensory Assessment and
enter the most preferred sensory
and most non-preferred sensory
categories and describe
corresponding physical responses
below.
sensory/motor grid
preferred
sensory
1
2
3
A
(affect,
vocalizations,
eye gaze)
B
(head)
C
(extremity)
D
(mobility)
non-preferred
sensory
1
2
3
A
(affect,
vocalizations,
eye gaze)
B
(head)
C
(extremity)
D
(mobility)
1. Select one preferr ed and one non-preferred sensory activity that can
be provided thru s witch use.
preferred: _______________
non-preferred: ________________
2. Select one discreet mo vement that may be used to activate a switch.
discreet mo vement: _______________________________________
A
B
C
D
affect, vocalizations,
eye gaze
Up, down, left, right
Shoulder, arm , hand,
finger, let, foot, toe
mo bility
1. Select a s witch that can be activated by the discreet movement.
(Consult the table belo w.)
Switch: ______________________
eye
*
eyebrow
*
*
*
*
*
*
tongue
*
*
*
*
head
*
*
*
*
*
shoulder
*
*
*
*
*
arm
*
*
*
*
*
hand
*
*
*
*
*
finger
*
*
*
*
*
torso
*
*
*
*
*
leg
*
*
*
*
*
foot
*
*
*
*
*
toe
*
*
*
*
*
*
*
*
other
*
*
mo uth
other
*
tongue
*
bite
*
pneumatic
*
voice
voice
biofeedback
tilt
infa-red
twitch
lever/leaf
touch
switch/motor grid:
4. Combine the preferr ed activity, the discreet movem ent and the switch
to assess purpos eful switch use.
(sensory) + (discreet movement) + (switch) = (purposeful switch use)
Remember, this is an ‘assessment’ and not an ‘instructional’ activity
therefore it is critical to present as follows:
a. the switch and it’s activity be modeled and explained only once;
b. there is no interaction after the explanation has been given;
 there is no verbal or physical prompting or shaping…ever!
5. Select one of the methods on the following pages to document purposeful
switch use. (See Notes to You to determin e when use of these techniqu es is
appropriate.)
1. Variance
2. Mohs system
documentation method: ___ ________________
VARIANCE
position:
pre-task condition:_____________________
____________________________________________
switch: _________________ location: ___________________________
discreet movemen t:
NR = no observable response across conditions
NC = no change in frequency of identified response across conditions
C = change in frequency of identified response across conditions
materials:
activity:
NR
NC
(switch and activities)
disconnected switch
preferred activity
non-preferred activity
comments
C
MOHS SYSTEM (timely activation)
position: _________________ pre-task condition:
____________________
discreet movemen t: ___________________________________________
switch: ________________
location: _____________________
interrupted
on
Less than 5
seconds
More th an 5
seconds
21 Gun Salute
clicks
Consider CLICKS after the information for
COUNTS has been gathered, the summary
items #1-9 have been completed, and an
appropriate program to address functional
communication has been developed.
10. Describe switch, switch location, manner of activation and consequence
or activity used to determine CLICKS abili ty:
switch
Comments:
switch location
movement
activity
preferred:
str ategy
variance
non-preferred:
Mohs
11. Describe switch use patterns:
random:
control led:
12.
Indicate switch goal(s) below:
o will control a sensory event in the environment
using a switch
o will participate in general curriculum
 Comments:
13. Indicate environmental control opportu nities associated with switch use.
sensory category
environmental opportu nity
(setting)
event
14. How will effectiveness be evaluated ?
1.
variance
5. Mohs
2.
speed
3.
frequency
4.
late ncy
6.
accuracy
7.
spontaneity
8.
duration
15. Who will implement and when:
activity
person responsible
when
chats
When the information for COUNTS and
CLICKS has been gathered, the summary
items #1-15 have been completed, and an
appropriate program to address functional
communication and purposeful switch use
has been developed, consider progressing
on to CHATS to enhance COUNTS and
CLICKS with voice output.
16. Indicate CHATS level below:
c/e not
documented
c/e
documented
0 symbols
single
symbols
t
a
l
k
symbol & foil
muli ti ple
symbol array
2 symbol
combi nations
i
n
g
16. Indicate below the opportunities during the day to use voice output:
opportunity
Comments:
message
symbol
18. Select voice outp ut goal(s):
will participate in a social event using a voca switch
will demonstrate association between spoken symbol and corresponding event
will participate in the general curriculum
19. Describe features of current communication system and then refer to
product information to select device( s) that best match these features.
commu nication system
symbol system
ability to device feature match
features
potential device matches
symbol size
number of symbols in array
number of arrays (levels)
manner of activation
portability
voice quality
Voca selected to support light tech system: ________________________
20. Select below the variable by which changes will be documented:
speed
frequency
late ncy
accuracy
spontaneity
duration
21. Who will implement and when ?
activity
person responsible
when
When the assessment process is
complete, continue to gather
information and modify the program
through the use of probes and data.
Consider the Activity Curriculum to
further expand COUNTS, CLICKS
AND CHATS in accordance with state
and local guidelines
test
and
tape
EMC,C & C part two
implementation
January 23, 2006