Total Communication at Silver Creek Pre-School Part 3 of 3

by Maryann Bruni, OT Reg. (Ont.) & Sarah Strathy, M.H.Sc.SLP (C) Reg. CASLPO

This is the final article in a series on total communication at Silver Creek Pre-School. Silver Creek is an integrated pre-school, with 80% of the children exhibiting a special need. These include developmental, chromosomal, neurologic, orthopaedic, speech and language delays, sensory deficits (vision and hearing), sensory processing and other challenges.

In the two previous articles, we discussed the total communication environment, wherin all the communication participants have the opportunity to receive and express communication using a variety of possible means. The first article outlines how teachers and therapists help equip the childrn with a toolset of communication modes, which they may continue to build upon, or that they may abandon as their verbal communication skills develop. In the second article, we presented our use of Signed Exact English, and the use of visual modes (real objects, photos, and picture symbols), always used in combination with spoken language.

In this third and final article on the use of a total communication approach at Silver Creek Pre-School, we will discuss how and when we use technology to augment receptive and expressive communication in the classrooms and therapy programs.

At Silver Creek Pre-School, we use the following types of technology to support our total communication approach:

  • FM Soundfield systems
  • Voice Output devices
  • iPads

FM Soundfield Systems

FM Soundfield systems are used for group learning situations, such as circle time in the classroom. The adult wears a headset with a microphone, and the sound of his or her voice is transmitted through a speaker. The voice of the adult is amplified compared to background noises, providing clearer, more audible speech signals. This is particularly useful for children who have a hearing impairment, children who have fluctuating hearing due to ear and upper respiratory infections, as well as children who have more difficulty distinguishing between spoken language and environmental noise. We find that all children benefit from the soundfield system, as it helps reduce distractability, and improves auditory attention.

Voice Output Devices

Voice output devices include:

  • The BIGmack which can record a single voice message. The adult records an appropriate spoken message, which the child activates at the appropriate time by pressing and releasing the “button”. For example, as the teacher goes around the circle and each child says his or her name, one child participates by tapping the BIGmack, which has his or her name pre-recorded. Another example is to record a line or two of the favourite song of a child, so that the child can participate when the song is sung.
  • CheapTalk, and other voice output devices, onto which up to 4 verbal responses or requests can be pre-recorded. Typically, picture smbols are used to identify the choices. For example, snack item choices can be recorded onto the device, with picture symbols to indicate the choices. When the child presses his choice the device produces the spoken message.
  • Proliquo2go “app” for the iPad


iPads have been in use at Silver Creek Pre-School for approximately a year and a half. There is an ever-expanding array of apps designed for children with special needs. In addition to the general educational apps available.

Proloquo2Go is the app we have primarily used thus far the facilitate expressive communication for children who have difficulty communicating verbally and have the motor skill to touch the iPad screen to select an item. In our experience Proloquo2Go is most helpful for children who have good language understanding but have difficulty speaking. Motor skill difficulties can be minimized by customizing the set-up to include more space between grid items larger. Some children have found the iPad to be a communication possibility that they have not experienced using other approaches

At Silver Creek, we also use other apps to build a child’s understanding of how to use the touch screen, to build joint attention and interaction around an activity with adults and peers, and to prepare the child to use the iPad for its communication possibilities. The following video demonstrates early learning on an iPad for a young girl who has a dual diagnosis. Her interest in the activity, understanding of the expectations, verbal imitation of the animal names and sounds, and her seeking of joint attention with the adult were all skills not typically see in this child.

Video 5: Early Learning on the iPad

The advantages of using an iPad as a communication tool include:

  • Portability of the device
  • The customization potential for each child’s individual needs
  • The fact that it is “mainstream,” and used by many in the general population, which can be normalizing
  • It is engaging for most children, and peers and adults will likely be interested in its use as a communication device
  • It provides visual and auditory feedback
  • It gives the child a “voice”

Disadvantages of using this type of technology for communication include:

  • Expense
  • May be fragile: could be broken if misused
  • May be difficult to maintain face-to-face communication, as both parties will be looking at the device
  • The distractions of other apps on the device may take the child’s attention away from the communicative intent
  • Does not provide tactile feedback – the child may not realize she/he has activated a “button”

Throughout these articles, we have discussed and demonstrated the use of a total communication approach in an integrated preschool. Eye contact and eye gaze, facial expressions, natural gestures, signing, use of real objects, photos, pictures, pictures communication systems, single and multiple message voice output devices, FM soundfield systems, and iPads are all used in an integrated fashion to provide the best opportunities for each child to participate in communication with peers and adults.


Maryanne Bruni, OT Reg(Ont), has worked with children and families as an occupational therapist for over 30 years. Currently working at Silver Creek Pre-School in Toronto, she provides occupational therapy programs to children aged 2-6 years who have a variety of physical, developmental, and sensory needs. Maryanne lives in Toronto with her husband and 3 daughters. Sarah, who is now 22, has Down syndrome. In 2006, the second edition of Maryanne’s book “Fine Motor Skills For Children With Down Syndrome” was published by Woodbine House. Maryanne collaborated on a research project and subsequent article published in the Journal Physical and Occupational Therapy in Pediatrics on sensory processing in children who have Down syndrome.

Sarah Strathy, M.H.Sc. SLP(C), Reg. CASLPO, joined the staff at Silver Creek Pre-school as a speech-language pathologist in September, 2011. Prior to that, Sarah worked at The PREP Program, a resource centre dedicated to the inclusion of individuals with Down syndrome in home, school and community life, in Calgary, Alberta. At PREP Sarah worked with preschool and school aged children with Down syndrome to maximize their communication skills within a family-centered and participation-based model. Sarah also directed PREP clients and their friends and siblings without Down syndrome, in a production of the musical Annie Junior. Sarah is interested in international disability issues and has visited Tanzania and India in a professional capacity.

Published September 2013