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ICEVI Conference
27 July – 2 August 2002 at The Leeuwenhorst Congress Centre, the Netherlands
Zoning and Intensive Interaction Interface
(A framework for improved communications techniques with people who have profound disabilities)
Transition: MDVI
Mark Gray
Training and Development Officer
RNIB Multiple Disability Services.
7, The Square
111 Broad Street
Edgbaston
Birmingham
B15 1AS
England
Tel: 44+121-643 9912
Email: Mark.gray@rnib.org.uk
Using case studies of two young people with profound learning disabilities the author will attempt to show how the twin theories of zoning and intensive interaction techniques can be applied to dramatically improve the communication potential of service users with profound disabilities.
Zoning was first developed as a concept by the author as part of the RNIB Certificate in Multiple Disability programme in 1993. It has since been re-launched in the UK and updated as part of the ‘Changing Lives’ series of courses. The theory works on the premise that individuals with profound disabilities occupy a zoned area of communication. Responses start from the person’s physical body and work outwards to the level of an individual sensory, physical and cognitive understanding and ability to interact with the wider stimuli within their immediate environment. This is indicated by the following slides.
Slide 1 – Zoning introduction
Slide 2 – Zoning I description
Slide 3 – Zoning 2 description
Slide 4 – Zoning 3 description
Slide 5 – Zoning 4 description
Slide 6 – Zoning 5 description
Slide 7 – Zoning 5 description
Intensive interaction is a technique first described in its current format by Dave Hewitt and Melanie Ninds in their book ‘Access to communication’ published by David Fulton Publications in 1995. Following on from previous work by the late Geraint Ephraim, a psychologist, who termed the concept as “Augmentative mothering”
The process of intensive interaction is based on the profile of mothers or main carers (it is not gender specific) with a young child pre-18 months and the description of interactions that take place that form the pre-requisites of language and concept development. Within its purist concept these are:
This process was applied to young people with severe and profound learning disabilities at a school at Harperbury Hospital in England during the seventies and eighties yielding dramatic results.
The drawback of the theory as it stood at that time and as it has currently been portrayed is that it has heavy emphasis on vision and auditory skills. It provides a start for communication to develop but does not lead on to recognised formal communications between the parties involved.
The author has revisited the theory using tactile responses instead of sight to develop routines and has achieved dramatic results with the two people described.
Lydia has since passed away but the author has permission from her foster family to pass on their remarkable story in her memory to assist others like her.
The author first met Lydia in 1981 but did not begin working with her on a regular basis until 1985 when she was twenty-one years of age. She had been in care for most of her early life. Lydia was born with cerebral palsy resulting in a spastic quadriplegia. She was totally blind from cortical damage and was profoundly deaf. Despite her severe physical restrictions she was found to have limited movement in her right elbow.
Lydia spent most of her time in a special wheelchair with a large tray on which her elbow would rest. She was considered as a person in zone one. This means because of her lack of sight and hearing, touch was to be her dominant communication method.
As her movement was restricted her elbow and her elbow contact with the chair’s tray was the communication zone that was identified and objects of reference relating to her sensory awareness were selected i.e. straw = drink, bent straw = hot drink etc.
By placing a straw to her lip and placing her flexible elbow on a straw on her tray she was able to ask for a drink independently. This skill was developed over a period of seventeen years until 1998 when she died. Lydia was able to recognise people, places and key activities by the use of tactile strips developed during that time.
Simon is twenty-seven years of age and has cerebral palsy. He is deafblind with profound learning disabilities. Simon is also quadriplegic but has no useful movement due to his muscle tone being hypertonic (floppy).
Again, he has been identified as being in zone one. However, because he had no useful movement the author was at first puzzled as how they could proceed.
In conversation with Simon’s mother she described how all he could do was to breathe and as the rule of interaction is you must be able to imitate to take turns breathing this was the method through which touch was developed.
By placing Simon’s arms across the chest of his mother and getting her to relax the author was able to get them to ‘centre’. This is a technique use in massage where the partners relax to share the same respiration rate. During the first session in a multi sensory room this was achieved within twenty minutes. The process was then carried out once a day for two weeks between Simon and his mother until the next session.
The result was such that the respiration rate was achieved in less than six minutes by instructing Simon’s mother to take a deep breath on the author’s command.
The author then placed a straw to Simon’s lips immediately her breath was exhaled and proceeded to get him to drink a sip of cold squash. This was repeated several time and again carried out at home.
The following session fourteen days later resulted in Simon independently taking a breath and this response was reinforced.
He has since learnt two drink responses and the author has rigged him to a ‘blow switch’ with a speech controller which allows him to speak to people in zone 6 ‘please get me a drink of squash’ etc., so that his breath responses are not misinterpreted as by pre-ventilation.
Simon’s mother is very pleased with the response he is making and within the last two years Simon has been able to make the following choices: hot drink, cold drink, toilet, hungry, coat (out) and hug (his mother’s favourite).
In both these cases the author has been able to identify the zone of communication, the methods available to the individual within that zone.
The method of interaction and turn taking leading to the development and generalisation of the skill so that it can be interpreted and reinforced correctly by enablers and carers of the individual concerned.
References:
Churchard M, Dawson C, Gray M, Watson D. ‘The development of advocacy and implications for services’ RNIB Changing Lives module coursebook 1, unit 3, 2001, RNIB Birmingham, UK.
Hewitt D, Nind M, ‘Access to communication’ David Fulton Publications 1995 London, UK.
Gray M, Golding R, ‘Implications of multiple disability’ RNIB Changing Lives module coursebook 4, unit 3, revised 2001, RNIB Birmingham, UK.
Ephraim G, ‘A brief introduction to augmented mothering’ 1986. Clinical Paper, Learsden Hospital unpublished.
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