Communication and Spelling

This table is only broadly illustrative, ignoring overlaps between adjacent domains. The point is that therapy for motor planning has value. That claim in itself is not disputed.

Neither is the use of therapist-specified targets in the early stages of therapy, such as demonstrating how to make specific sounds, how to hold a pencil and shape certain letters, or where to place one’s feet. The therapist establishes targets so that they can render professional judgments about the client’s accuracy and precision, and adjust therapy accordingly.

When a therapist models speech sounds, the client’s mirror neuron system helps them to figure out how to change their articulators to more closely match what the therapist is doing (if their mirror neuron system is intact, and their physiology is similar to that of the therapist). In S2C, the facilitator is not modeling the motion that the client should match, but rather they are moving the target and guiding the client with spoken prompts.

Now here’s an important part…

Over time, with known forms of effective therapy, as their skills develop in matching the therapist’s targets, the client can increasingly generalize the application of those skills their own selection of targets. Access to that autonomy is the moral imperative that drives the design of every valid approach to AAC. Every effort is made, explicitly and intently, to remove the influence of any partner on the meaning of the client’s intended message. If S2C really wants to be a valid form of AAC, then it must meet this standard.

So you can understand why S2C has such a big PR problem here, given the displayed influence of the facilitator during the training, and insufficiently persuasive demonstrations of the removal of facilitator residue.  In this very work, we are considering what might be done about that.

So let’s talk more about that influence, and its risk of harm.

S2C specifies a facilitator holding the edge of a letter board while remaining in the client’s field of vision, where the client then points to letters on that board to spell out sequences of words. In the initial stages, the facilitator moves the board (and sometimes the client’s arm), sometimes with verbal prompts, to help train the motor patterns.

As stated earlier, sharing target knowledge with the facilitator is necessary during certain steps of motor planning therapy. The facilitator knows which board to present in those cases where the alphabet has been distributed across multiple sub-boards. As a training stage, this would not be a problem, if prioritizing eventual access to autonomy were worked into the design at every stage.

But it is not.

Always look ahead to a time when the student will move along to a system where no one is holding the board. Too many demonstrations of the method make it plain that the facilitator is still moving the board enough to influence which letters the client is selecting. Some of this is due to the fact that the facilitator has spent so long moving the board that their own motor relationship is an entrenched reflex, and they might not even notice what they’re doing. The facilitator is also giving the client feedback with their facial expression, posture, and residual verbal prompts, and I quote, “getitgetitgetit.” S2C needs to getit all out of there. No microcueing. True independence.

S2C also needs to address those cases where a client is reported to create very long sentences when someone is holding the board in front of them, with the facilitator making little noises, and so on, but then the client is not able to select letters when those targets are presented on a touchscreen in front of them.

No, those form factors are not identical. Yes, that might make a difference. There might be effects of OCD and anxiety in regard to the changes. The touchscreen might be sensorily irritating. All of those things and more might well be true.

But none of them are reasons to leave a student dependent upon a facilitator.

Contention #4: Privacy of Meaning

Encourage the client to discuss topics that are so unfamiliar to the facilitator that they become a genuine partner.

The facilitator also knows the target in a stage that relies on the client producing answers to such closed questions as those used to measure reading comprehension. In this phase, correct answers are often wholly attributed to the client relying solely on their own knowledge even when facilitator prompting is still readily evident. Inaccurate answers are often attributed to deliberate ‘teasing’ or ‘joking’. This sort of pattern is not uncommon in AAC, where partners really want the client’s answers to signify intentionality. There are practices to help distinguish between the two. S2C should use them. 

What you want to establish is a privacy of meaning that wholly distinguishes between the client and the partner. Except for the possible case of telepathy (on which we take no stance in this essay), communication partners do not actually share the embodied part of their minds (although their extended cognition might overlap).

A good test is one where the topic is proven to be entirely unfamiliar to the facilitator, or better yet, one about which they have been deliberately misinformed. If the student still produces a correct answer, despite the facilitator either being ignorant or thinking that the client’s expression would represent a mistake, then that tends to support the assertion of agency on the client’s part.

As things stand, however. there are cases where the S2C client spells out what only the facilitator thinks is the right answer, even when the facilitator is wrong.

We are not saying that this is due to deliberate intent on the part of the facilitator. We are saying that without regard to intent, this facilitator influence does not promote the client’s access to autonomous expression.

Support for S2C often comes in the form of the claim that the student is providing their own answers to open-ended questions, which would be a wonderful step on the road to independence and autonomy. The assumption is that the answer must therefore be unknown to the facilitator. But this is a false premise, and was one of the distinct ways in which FC was roundly debunked. The client was only giving the answers that the facilitator expected. S2C needs to foster privacy of meaning if it wants to escape the shadow of FC.

Keep in mind that facilitators are sometimes said to be unaware of their influence. As alluded to earlier, the effect is worse when the facilitator has entrenched their own motor (and other) patterns because they have acted for so long as the trainer. 

Regardless of intent, this consequence still robs the client of their autonomy.

Contention #5: Evidence Base

If S2C were to address the these contentions, then it would be in a position to establish an evidence base.

And wouldn’t that be cool? It would be one less thing for people to fight about.

And if that evidence base were able to be established, then a very important improvement would ensue, namely…

Contention #6: Just the Facts

Stop presenting the fanciful S2C rationalizations that contradict firmly established science. They do not explain what is going on in S2C. Pseudoscience is a hallmark of quackery, and its use in support of S2C aligns S2C with FC. Instead, research the real explanations.

When that truth is available for you to tell, stop insisting that a client’s speech must be ignored during S2C training sessions. The fictional rationale for this abuse is that the motor planning system would be overwhelmed by trying to do two things at once, so the facilitator can only allow motor planning for pointing at the board. This story might sound like common sense to some people, but it is wrong. It disregards what the client’s neurological system is actually, factually doing, even if their motor planning is compromised.

Vosseller is adamant about this rule. So you can either stand by this person who adapted the technique from Rapid Prompting Method, or you can modify it. But if you modify it, then you can no longer call it S2C. It becomes your own made-up therapy, then… which is what we are suggesting that you do. Modify S2C to remove all vestiges of FC, including those inherited through RPM, and then subject that to research of quality.

Still not convinced? Then consider this…

The client is not required to lie down in order that gross motor planning won’t impoverish the resources needed for spelling. Neither are they directed to let their head freely loll about their neck, or let their jaw drop open. How does S2C explain this inconsistency? We don’t know. The S2C people have provided no answer for this flaw in their rationale. But look…

Even aside from the difference between superfine and fine motor planning, the client will be using speech that is conventionalized enough that it does not require the formulation of an entirely novel plan, so that speech would not impoverish the resources used to execute spelling. Not only that, there is a resource economy in the retrieval of multiple formal modes associated with a shared meaning. Plenty of solid therapy research recommends the promotion of multiple modes of expression.

S2C tells yet another story, one in which motor planning therapy works because it fosters “myelination.” That no doubt sounded like common sense to someone as well, but that’s simply not how myelin and myelination works.

So, to the degree that some people are interested in the development of S2C as a legitimate therapy with an evidence base, you have to drop the quackery. If you want to be different from FC, then you can’t keep stringing neurology buzzwords together to build up ad copy for some marketing ploy or other. That might sound harsh, but really, quit making stuff up.

If you want the respect of the community. then stop disrespecting all of their hard work. Stop making up these stories to pretend that you’re explaining what’s going on with S2C. You are only making it harder for any of us to figure out what there might be of value in the approach. Your appeal to pseudoscientific camouflage is preventing any benefit of S2C from being available to other people.

That is yet another way in which the facilitator’s needs (or those of the people selling S2C as a product) are being favored over those of anyone else.

So, when you find out what parts of S2C really work, and why, then you can use that knowledge to refine the therapy into a cleaner, more effective product.

And if the use of S2C really is about the needs of the client (about which we express no doubt), and not those of the facilitator (or those making money off of the product), then that improvement should be your goal. You should be striving to get rid of the portions that are quackery. 

Are you willing to do that?

Because if you are, then many more people could potentially be helped.

And if you’re not, then please understand that you are choosing to deliberately hurt other people.

This is your autonomous decision to make.

[2024-04]

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