Using AAC to support Physiotherapy Exercise Programme

Assistive technology for communication, known as Alternative and Augmentative and Communication, or AAC, isn’t always about using technology to express oneself. It can also be helpful to support understanding and to help with remembering something, or the steps involved in an activity.

I have been working with a young man who has difficulty doing his physiotherapy exercise programme at home. He has Cortical Vision Impairment and finds it difficult to retain and recall information when it is presented by demonstration. In addition, he has a receptive language delay and finds it difficult to read a long description of the exercise and then translate into a body movement.

Due to COVID-19, more students are now doing programmes at home which might previously have been done in a clinic environment with a therapist there to prompt and assist. However, aside from the increased need for improved access to therapy from home in the current climate, it is also important for this student to be able to do his exercise programme by himself, without needing an adult to assist. He is now 12 years of age and is starting to take more responsibility for the activities in his daily routine.

I need to know what this student’s needs are first, then match the right technology to fit those needs.

Step 1: How does information need to be presented in order to work for this person?

We considered together how he finds it easiest to follow information. These are his key ingredients:

  • Clear pictures on an uncluttered background
  • Short description, using just a few words
  • Every step of the task is broken down, even the parts that might seem obvious
  • A clear start and end point
  • The same information presented in multiple ways different; for example, a picture, a word and audio feedback. On different days and at different times, some methods of receiving information are easier to process than others, and sometimes, he needs to hear the same thing in multiple ways to retain it

Step 2: What technology is the best match for this person’s needs?   

To make the programme quick and easy to access, without the need to spend ages setting up technology, we used the technology he already has and is familiar – Snap + Core First on his iPad Pro.

snap and Core app logo

He uses this as an interactive visual timetable already, so we added Physio as a folder there. This made sense because exercises are a normal part of this child’s routine at home and school.

We added a visual timer to the folder indicate how long he should spend on exercises, as a reminder to keep going until the time is up! This is set to start when he clicks the ‘exercises’ folder and we chose 10 minutes to start with. More information about how to set up a custom timer is available here:

AAC software page

Step 3: Setting it up – the technical bit!

By sharing his user details with me, I was able to log in to his Snap + Core profile from my computer, make changes and then the student can import the changes onto his device. This means that we were able to set this up completely remotely, which is essential in the current climate.

We used Microsoft Teams video calls to chat about the content, and we could share our screens to edit the software live during the call. This worked really well as I could demonstrate suggestions, and we could play around with the wording and layout to find what worked best.  

For this student, Physio can take place at different times, so we created a folder and then copied this to different pages, for example, it appears in ‘Home’ and also in ‘School’.

To do this, click on an empty button a page and ‘link to existing page’, which in this case was called ‘exercises’. More information is available here:–core-first–7-link-to-an-existing-page/?redirect=true

With linked pages, when content is changed in one place, it is changed everywhere; so when his exercises are updated in the ‘home’ folder, the same changes are seen in ‘school’. This makes editing and adding new things faster.

There a few different ways to add a sequence on Snap + Core. In this case, because there are a number of exercises and each exercise has multiple steps, I created a button for each exercise, then added an action to create ascript. (A ‘script’ action allows me to add as many steps as I like).        

I read the description of each exercise on the Physio handout and reduced and simplified the description. We discussed how to word each step of the activity in a way that makes sense to this student, bearing in mind that what makes sense to me might not work for someone else! We used just the important key words in each step, to avoid cluttering the screen with lots of sentences.

After adding the button label and then the description, I searched the picture library to find an image to demonstrate each part of the action. I found some pictures I needed by searching by the name of the body part e.g. ‘feet’ and also quite a few under ‘yoga’.

When there wasn’t a suitable picture, I searched on the internet, saved a picture as a photo on the desktop and then used the ‘search’ icon in the picture dictionary to import it into Snap + Core. This is an example where the first image is from the internet as there wasn’t one in the picture library, and the second is from the picture library built into Snap + Core First.

I could have also taken a photo with the camera of this student doing the exercise himself, but a picture of high colour contrast and clear outlines is easier for him to visually process. Comparatively, photos often have a cluttered background and are not as clearly defined.

The Good:

Key points to consider here were:

  • Considering the way this child understands things best
  • Using the technology he already has and is familiar with
  • Reducing and uncomplicating the description of activities
  • Checking the content as we went along to ensure that the descriptions that I was using made sense to him
  • Breaking down the steps of the task, as if it was always being read for the first time by someone with no prior knowledge of the programme (simulating what it is like for someone who has difficulty recalling visual information).

I like the flexibility to customise supports in Snap + Core, which offers lots of options to create unique content to suit different needs. The sky is the limit, but here are some other ideas for using sequences or scripts in Snap + Core, or other similar software:

  • Shopping list
  • What to pack in my bag
  • Morning routine
  • After school routine
  • Recipe or meal preparation
  • What will happen during a medical appointment

The not so good:

It would be enhanced with more options in the picture library for specific body movements and exercises – feedback sent to Tobii Dynavox who are continually updating the library.

The verdict:

Personalising assistive technology systems is essential to making AAC work for real people, in real life. Having options within the software to customise content is an important consideration for anyone choosing AAC, I believe.

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