Physical-Medical and Communication Domain

    For my blog post I decided to focus on Cerebral Palsy (CP) a disability that falls under the Physical-Medical domain but also has major impacts on communication. Here in Central Bucks our students with more severe CP are typically placed in our MDS classrooms and my experience working with CP students has mostly been paired with a number of other disabilities including vision impairments, communication disabilities, etc. However, due to the complex nature of CP it can really cross multiple domains and lead to challenges beyond just the physical-medical. It is often primally categorized in that domain due to its primary issue of motor impairment. While there are numerous ways in the music classroom to work on physical and motor based IEP goals for the sake of this blog I wanted to dig into a communication and AAC goals that I have had some success with and would love to share/brainstorm additional applications for with you all. Before we get into that... lets start with

What Is Cerebral Palsy and how does it affect Physical and Communication domains. Cerebral Palsy is a neurological condition that is caused by damage to the brain before, during, or shortly after birth. This neurological damage leads to muscles receiving too much signal... Stiffness, too little signal... weakness, or mixed signals... Unrolled movement. "Cerebral palsy (CP) is the most common motor disorder in childhood (Koopmans et al., 2021). Children with CP may experience differences in sensation, perception, cognition, communication, and behavior, in addition to the hallmark feature of motor impairment" (Koopmans et al., 2021). This often leaves students with CP to rely on AAC devices due to the body's inability to control the motor functions required for communication. 

In researching about CP I found an article titled "Functional Communication in Children and Adolescents with Cerebral Palsy" published in Developmental Neurorehabilitation Journal. This article investigated communication abilities and goals of 35 students with CP. The article found that students with CP often rely on Augmentative and Alternative Communication (AAC) including single switch devices, tablets, and Yes/No systems. The article is linked below and goes into some detail on how they assess a students growth and usage of their AAC Devices and what some of the challenges in the study were to isolate IEP goals. 

HERE IS A LINK to the article referenced above it is a nice read if you are looking for some background on AAC devices and students with CP. 

Now, let's talk about activities!! One major IEP goal my students had was to learn to use their AAC devices. Most of the class (all but 1) used "Yes/No" switches which mounted on their wheel chair and were placed near the part of their body that had the most control (head, knee, lap, etc) what I noticed about the devices was they were essentially just a switch connected to an 1/8in jack. Using a Makey-Makey which is based on creating a circuit to follow a coded event in "Scratch" I was able to connect their devices to my computer and use them to trigger more than just "Yes or No" we were able to play notes, drum sounds, guitar chords, etc. We used their AAC devices and started with questions... Do you want to play the drums, (yes) do you want to play the Bass drum, (no)... Do you want to play the snare drum (yes). Then once they made their choice, I would hook their buttons up to the Makey Makey, program a Scratch Codes ... "When Space Bar Pressed.... play Snare Drum Sound" etc. then just connect their devices to the "Space Bar" clip on the Makey, and BOOM! Instant snare drum. I would then use my student who had a Tablet AAC with a bunch on song choices on it to choose the song we would play along too. It was super fun and really got the kids to engage with their AAC devices. In addition to working on communication goals this also worked on their physical IEP goals as well controlling their head, arm, or leg etc to trigger their buttons. Beyond just working on IEP goals this tech also allowed them to come in and "Play" with our band too. The band would play, and they would trigger drum sounds or Aux Percussion sounds throughout the piece and it allowed them to be part of the ensemble when they came to visit class. It was a super rewarding lesson because it allowed the students not just to work on IEP goals but it helped form a greater connection to our school community. Our MDS students were able to perform music, trigger sounds, and be part of an ensemble for the first time. 

Unfortunately the pandemic hit and shut down my MDS classes, and a few year later I moved schools so I haven't done this lesson in a while but now that I am up at the HS more recently I have had a chance to work with our MDS class and get them to engage in music in different ways. I don't have the Makey Makey any more... but I'd love to get one set back up and see if they remember how to use it!!! I'll keep you all updated on if we're able to try it again any time soon!

You can see a video of my students in action below (parent consent to record and share these videos was received at the time of filming). 

Below is a video of HOW I made the devices connect to the Makey Makey if you are interested in trying this in your classroom!

And here is a video of how the final setup came out. I 3d printed a case for the Makey Makey because my students kept knocking it off the computer stand. I also built nicer Alligator to 1/8 cable adapters so it was quick and easy to setup each class.