Lisa

Lisa is an 18 year old student at a school for students with physical impairments. She lives in a group home near the school, but visits her family in another city every other week.

Due to cerebral palsy, Lisa has very little speech, but communicates through pointing to signs and letters on a Bliss board and through using a VOCA. It is easy to understand her when she says yes and no with her voice. Most of the time Lisa uses a low-tech Bliss board with 500+ Bliss signs arranged after grammatical groups+ letters and numbers. She points to this Bliss board with her hand, and her communication partner reads the text over each Bliss sign out loud, to confirm that he/she has interpreted her pointing correctly. It is also the job of the communication partner (or her assistant, if Lisa is not alone with her communication partner), to interpret Lisa’s hand movements and move the Bliss board sideways in the direction indicated by Lisa, so she can reach all parts of the Bliss board. Lisa likes the Bliss board better than her VOCA, because it is faster, but the VOCA is more useful when talking to strangers and friends and it makes her more independent.

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Lisa’s VOCA is a tablet computer with a touch screen and the software Mind Express.

The vocabulary is custom made for Lisa and contains a copy of her Bliss board, arranged on different pages with a taxonomic layout and with a number of grammatical functions that she can use together with the Bliss signs. It also contains an on-screen keyboard and around 40, mainly needs-oriented phrases on different pages.

At the start of Lisa’s participation, she completed an “activity schedule” during a week.

For every hour of the day she, or an assistant, checked which of her communication aids she had been using, and what kind of people she had been speaking to: family, friends, staff or assistants (figure 3.2).

Figure 3.2. Lisa’s activity schedule regarding her communication during a week 

It turned out that during that week Lisa only used her VOCA during the school hours and not at all during the weekend when she visited her family. It was also evident that she talked more often to teachers, assistants and other staff than to friends of her own age.

3.3.1 Interview with Lisa 

Lisa was interviewed by the occupational therapist in the project about her shopping habits. Before this interview took place, Lisa and the occupational therapist had never met. During the interview Lisa used her VOCA. Many of the questions Lisa got during this interview were open-ended and she answered by creating her message on the VOCA.

Here is an example from the interview. Lisa (L) has just told the interviewer (I) that she usually goes shopping in the company of an assistant.

I: var brukar du handla nånstans where do you usually shop

L: ((selects two bliss signs, then clicks her screen to get the on-screen keyboard, spells I (/) C (/) A , then looks up at the interviewer who is seated in front of her))

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I: ((leans forward too look at the screen to see what L has written))

L: ((presses the screen to speak the message)) MED ASSISTENT ICA WITH ASSISTANT ICA ((ICA is a well known supermarket))

I: Aha med assistent på ica (.) å då handlar ni mat på ica Ah with an assistant at ica (.) then you buy food at ica

L: aah ((= yes))

I: Mm (.) brukar du handla mer än mat Mm (.) du you usually buy more than food

L: aah ((= yes)) ((starts to create a message on the VOCA, selecting bliss signs to form the message))

DET (/) KAN (/) VARA (/) OLIKA (/) ((switches to writing)) V(/) A (/) R (/) O (/) R

IT (/) CAN (/) BE (/) DIFFERENT (/)     I (/) T (/) E (/) M (/) S  

((lets the VOCA speak the phrase)) DET KAN VARA OLIKA VAROR        IT CAN BE DIFFERENT ITEMS I: olika varor

different items  L: aah ((= yes))

The following pattern (with minor deviations) continues throughout the interview:

1. The interviewer asks Lisa an open-ended question.

2. Lisa creates a message on the VOCA by selecting Bliss signs combined with writing words she does not have a Bliss sign for. She then lets the speech synthesis speak the whole message.

3. The interviewer repeats parts of the message that Lisa has just said through the VOCA, often with an intonation that makes her statement a question.

4. Lisa confirms the interviewer’s interpretation with a yes/no answer.

5. The interviewer then confirms her interpretation with a yes (or “mm”)

6. She may then ask Lisa a couple of other questions that can be answered with yes and no, before giving her a new open-ended question.

It is hard to know if the interviewer’s repetition of what Lisa is saying is really needed in order to make sure that she has understood correctly. Although synthetic speech can sometimes be difficult to understand, this is rarely the case in this conversation. It could be a habit of the interviewer’s occupation, to expand messages created with Bliss signs to well formed grammatical sentences. With low-tech Bliss boards, confirmation of each sign and then the whole message is often necessary. In Lisa’s case, her expressions with

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yes or no, 5 requests for confirmation or clarification, used after utterances by L, 7 answers, of which only two were of the minimal type so frequently used by L. He also used 7 statements, 8 comments, one correction, 2 repetitions of utterances by L’s synthetic voice and 15 expansions of his own previous utterances. These expansions seemed like fillers, with the main function to keep up the conversation, especially towards the end when they seemed to run out of topics to talk about. A special pattern that emerged after the initial question by L, that she could create undisturbed for the whole minute it took, was that F was taking part during the creation of her utterances, and tried to follow along as the messages were formed. This reduced the need for L to let the synthetic speech say the utterances and to some extent speeded up the process. But it was still very time consuming for L to use the VOCA, and much of the concentration from both conversation partners was targeted at the device. After each such message

construction, L explicitly looked at her partner, indicating that the message was finished.

This was an important sign for the partner to take over the turn. It was also evident that there was a certain flow in the conversation, through F’s upholding the talking and L’s swift vocal answers.