Multi-Sensory Referencing and Objects Of Reference

Multi-Sensory Referencing and Objects of Reference

"While they were saying among themselves it cannot be done, it was done."
Helen Keller

"I do not want the peace which passeth understanding, I want the understanding
which bringeth peace."
Helen Keller

"Reduced vision and hearing can deprive children of the means to be aware of anything beyond their own bodies, which, in turn, can mean they have little chance of understanding people, objects or places. Such children may have no way of anticipating people or objects
and so they cannot know that the world contains anything stable."
Rosalind Wyman (2000)

"The child is unable to anticipate what is going to occur when he/she does not see or hear stimulus cues. Without this anticipation the child has no basis for calling upon previously learned schemes to respond appropriately. As external information fails to become organized and useful, the Young child who is deafblind may turn more and more inward to stimulation provided internally which to him is controllable and predictable." (MacFarland and Nelson 1998)

"To live on a day-to-day basis is insufficient for human beings; we need to transcend, transport, escape; we need meaning; understanding and explanation; We need to see overall patterns in our lives. We need hope, a sense of a future."
(Oliver Sacks, 2012, page 90)

Multi-Sensory Referencing is a didactic system that seeks to develop awareness of self in time and space in order to raise cognition and understanding of the world as it is experienced. It is not a single approach but comprises a range of techniques that are used together to form a holistic system. The techniques include Spatial and Temporal Sensory Referencing, Sensory Cueing (often confused with Objects Of Reference), Environmental Engineering, creating a responsive environment, Tangible Symbol development, and Objects Of Reference.

If you don't want to read through the items on this page or are finding it perplexing, why not book a day's course from TalkSense and let someone else explain it all to you! Use the form at the end of this page to get in touch.

"These results suggest that from a mental age level of 2 months children are equipped to detect cause and effect relationships and build up a picture of their world based on expectancies about such relationships; and that violations of these expectancies can lead to negative effects."

(O'Brien, Y., Glenn, S., & Cunningham, C. 1994)

"I realised that these pupils were at the simplest levels of development and needed an education that gave them the opportunity to reach out and sense the world around. A more formal education had to wait patiently until they were ready"
Flo Longhorn (2010) PMLD Link, Vol. 22, 2 issue 66, page 2

"The intervention, which took place over a 7-month period, addressed the use of tangible symbols in the context of a structured
protocol for implementing the daily schedule. These educators reported that students learned the meaning of symbols, exhibited
improved behavior, and learned part or all of the daily routine, among other benefits."
(Bruce, Trief, & Cascella, and 2011)

"The results suggest that even children with the most severe impairments were able to identify the use of many of the tangible symbols."
(Trief, Cascella, and Bruce 2013)

This is not the end ...

Winston Churchill once said, "This is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning." Likewise, Talksense would wish to point out that this page detailing Multi-Sensory Referencing will never be complete (it is not the end). Indeed, it does not even begin to approach an end (not even the beginning of the end) but perhaps it is a good starting point (the end of the beginning). Talksense will revisit and update this page regularly adding new material and relevant research as it is discovered. Some research findings may force amendments to the thinking and philosophy outlined below. Indeed, a small number of the suggested approaches are not supported by every person working in this field: indeed, Talksense may be alone in advocating specific techniques. However, when Talksense advocates any approach that it knows or believes is contrary to that of others, it will say so and quote at least one of those others. Talksense will argue its side of the issue but will always respect the final judgement of the reader. In other words, you must make up your own mind. In reality, In one sense, Talksense agrees with some aspects of these contradictory points of view: that is in the sense of working in an ideal world. In an ideal world certain standpoints can be justified, however we do not live in an ideal world.

As new items are added (or amendments made) to this page, Talksense will update the date counter here:

9th February 2015

such that you will be able to tell if things have been added or amended since your last visit. Thus, the last time Talksense updated this page was on the date printed in bold above.

A nightmare scenario:

Imagine that you are having a bad dream. In the dream you find that you are wandering around in an alien building. The building is a maze of corridors, each one seemingly identical to the last. There are doors off the corridors but they too are identical and, when opened, lead into rooms that are very similar in design. You wander around this building trying to get out. You have no idea of time. You have no idea where you are and, indeed, if you have travelled along the present corridor before. There are no clocks. The are no maps. Occasionally a person passes by and speaks to you. Well, their mouths move and strange sounds come out but you do not understand what they mean.

After a while a person comes up to you. She takes you by the hand and leads you down a corridor and into a room. You do not understand the noises she is making. She shows you to a chair at a table and seems to want you to sit down. You sit down. She then gets out a piece of strange equipment and places it on the table before you. She makes more sounds. Her arms move around the equipment. She appears to want you to do something.

How do you think you are feeling in the dream? List a few emotions that you think are running through your mind. My guess is that they are
all negative emotions: frightened, anxious, confused, angry ...

How does your mental state affect your ability to perform the task the woman is demanding of you?

What do you think would help you in such circumstances?

People experiencing Profound and Multiple Learning Difficulties

It is my belief that the above nightmare situation is often the world of those people who are experiencing Profound and Multiple Learning Difficulties. I often find myself losing my way while visiting Educational establishments: a maze of corridors with doors that all look alike. However, I can stop and ask for assistance but, if I couldn't, then the whole experience would seem very perplexing. Staff become very familiar with their environment and begin to take it for granted. They could probably get around blindfolded after a while and have a good idea of where they are. Not so those experiencing PMLD. By definition, their cognitive capacity to cope with such circumstances is significantly impaired.

What would help in the nightmare outlined above?:

A language that I could understand;
Familiar surroundings;
Corridors and doorways that were distinct from each other in some way;
Signs and symbols that I could read;
Friendly faces of people using gestures that I could interpret;
People that understood my 'fears' and tried to help;

People experiencing Profound and Multiple Learning Difficulties are likely to have some difficulty with the sense of space and time: they may not know where they are in space or where they are going next and they may also not understand what part or the day it is and what is happening in the future.

Multi-Sensory Rooms and Multi-Sensory Environments

What is a Multi-Sensory Rooms? A Multi-Sensory Room is:

An environment that can offer stimulation of each of the senses;
Each sense can be stimulated individually or together;
Learners can be given control over the stimuli;
That is purposefully crafted for this specific purpose;

Such purposeful Multi-Sensory Environments (MSE) are typically called Multi-Sensory Rooms, Light & Sound Rooms, White Rooms or Snoezelen Rooms. In some instances, they are smaller spaces crafted for single or a limited number of individuals (little rooms , cozy rooms). However, while an Multi-Sensory Rooms is an MSE not all MSEs are Multi-Sensory Rooms! A MSE could be anywhere: the supermarket, in the park, or even the classroom. There is a problem with using these places as MSEs. If we look at the criteria for Multi-Sensory Rooms above there is a definite element of control involved: the stimulation of the different sense can be individually selected and controlled; control can be given to the Learner such that items can be turned off and on as desired. Not so in the park or in the supermarket, there is no control over what happens or when it happens or even what senses will be stimulated and it is likely to be a different experience each time they are visited. This means that the focus of such sensory work usually takes place in a Multi-Sensory Room. However, why should the benefits of a MSE be confined to the Multi-Sensory Room? They shouldn't!

Multi Sensory Referencing attempts to take some of the benefits of a Multi-Sensory Room and spread them across the establishment and across the curriculum creating a MSE for the benefit of all.

What is Multi-Sensory Referencing

MSR is:

part of a Total Communication Environment (it does not function as well in isolation);
an approach that assists individual awareness of self in space and time;
not a single technique but, rather, comprises a range of techniques;
used to address POLEs (People, Objects, Locations, Events).

"Learning is about searching out meaning and imposing structure"
Prof Carol McGuinness, Queens University, Belfast.

MSR turns this statement around because it seeks to impose a structure to enable Learners to search out meaning. the techniques utilised impose a consistent structure on a Learner's world such that the Learner can more easily get a fix on their position within it even as it changes. This does not happen overnight but over a period of time. The techniques involved all obey the thirty (30) second rule which states that 'any new action asked of staff within a special needs environment that takes longer than thirty seconds is NOT likely to be implemented'. This is not because staff are unwilling or lazy. Rather, it's because staff are generally under great demands on their time and simply cannot add an extra few minutes into the mix. It is asking too much. Thus, MSR techniques (once the structure has been put in place) are all capable of being undertaken in 30 seconds or less.

"...unless the environment is shaped in certain ways to be supportive, the child will have great difficulty in making sense of the world.” Pagliano P. 2001

MSR is an approach that shapes environments to be supportive. While Pagliano talks of the child, the same is true of people of all ages experiencing PMLD or loss of cognitive function.

When MSR is properly implemented it can have several benefits:

reduction in confusion and apprehension (increase in personal feelings of security);
inclusion for people experiencing PMLD;
anticipation is raised;
development of early communication skills;
development of early cognitive and thinking skills;
aids the development of sensory integration.

Prerequisites for MSR and OOR

" Although we don't believe that there are any prerequisites for communication intervention, we do believe their is a logical sequence of intervention that builds steadily on current levels of communication. Building on current abilities with clear intervention targets and objectives will bring success more rapidly."
Rowland & Schweigert (2000 page 9)

Although many works on the use of Objects Of Reference state certain pre-conditions that learners on such a scheme must possess, Talksense believes that any such prerequisite is a barrier to entry to the scheme. Indeed, it is through the scheme that such skills may be learnt! To possess such skills would perhaps indicate that the Learner does not need to be on the scheme! Therefore, when reading any work on Objects Of Reference please treat any statement concerning the need for a specific ability with a great deal of scepticism. There are only two prerequisites:

the Learner is breathing;
the Learner is conscious.

Any other prerequisite may disbar the Learner from entering the scheme which is a nonsense. Treat anything which looks, feels, smells, tastes, or sounds like a condition for entry into this club with great caution. The Learner need NOT:

have sufficient physical skills to manipulate objects;
have tactile discrimination;
understand cause and effect;
be able to recognise objects;
link object to activity;
...

all these things can be addressed as part of the scheme.

"For receptive communication purposes (as a means to provide information to an individual), you may start using tangible symbols prior to the emergence of intentional pre-symbolic communication skills. using these symbols receptively increases the likelihood tht your communication to the individual will be understood. It also helps to reinforce the association between symbols and referents so that when the individual is ready to use them expressively, the correspondence has already been established."
(Rowland & Schweigert 2000 page 10)

POLE to POLE

The word POLE is used frequently throughout this page and therefore it is important that the reader understands its meaning. Actually POLE is an acronym that stands for four 'areas' that the MSR scheme addresses.

POLE is an acronym for Person, Object, Location, or Event. These are the things which MSR techniques are used to signify. For example, the use of Objects Of Reference (see below this page) can be use to signify that a Learner is about to move to a different Location or change an Event.

BEST is an acronym for Best Ever Stimulating Thing: that is, the thing or things that a particular Learner finds the most motivating.

While all Learners may interact with similar POLEs in any establishment they will each have their own particular idea of which is BEST. For one particular Learner, a BEST POLE might be a walk around the sensory garden while another might find dancing with a particular staff member highly motivating.

Sometimes it is not easy to discover what motivates a particular Learner. Some staff might be tempted to state that 'Nothing motivates James' (for example) but this is not good practice. It would be far wiser to state, "We haven't yet discover what motivates James but we will continue to search".

In terms of operating an MSR system, it is not necessary to have identified a Learner's BEST POLE(s) as MSR is designed to work with POLEs in general. Learners typically move from POLE to POLE throughout any day in any environment. IF POLEs are set by Significant Others (which is the norm) then Learners may not be aware of what is happening to them at the times when the POLE is set to change. In some, this may cause:

abnegation of new POLE;
behaviours staff may find challenging;
confusion;
distress.

If we can use techniques to make Learners more aware of a forthcoming POLE then we can build Learner anticipation and help alleviate such issues.

Transitions

We all spend a lot of time in transit: much more than we realise. Transitions form a significant part of a school day, as Learners change to different POLES. It has been shown up to a quarter of a school day may be engaged in such transition routines: moving between classrooms; going to and coming from the playground; moving to a dining area; sorting items in cloakrooms or putting things in cupboards or lockers; as well as collecting the things that are needed to begin work in any session (See Sainato, Strain, Lefebvre, & Rapp, 1987). Such transitional requirements are not confined to school but can also be found in home activities as well as in the workplace, as people switch tasks,attend meetings, take a break, go for lunch, etc. It has been shown, for example, that Individuals with autism spectrum disorders may have more difficulty in shifting attention from one task to another or in such changes of routine. This may be due to a greater need for predictability (Flannery & Horner,1994), challenges in understanding what activity will be coming next (Mesibov, Shea, & Schopler, 2005), or difficulty in coping when there is a disruption to a particular pattern of behavior.

Helping a Learner to anticipate, understand, and cope with such transitions is therefore important. There are a number of techniques that have been developed to assist a Learner with this process some which were developed with specific types of disability in mind (autism for example). If suitable, such techniques might be adopted and adapted for other populations in schools, colleges and centres. The goals of using these approaches include:

reducing the time taken by transitioning;
decreasing behaviours that staff may find challenging;
increasing awareness and anticipation;
greater inclusion in all events;
developing emergent communication skills (moving from receptive to expressive);
increasing independence (less reliance on adult prompts).

As will be outlined in the sections to follow, Multi-Sensory Referencing is a technique that has been developed to facilitate the achievement of such goals at times of transition (POLE to POLE) by:

increasing awareness;
improving anticipation;
reducing uncertainty and apprehension;
improving inclusion for those experiencing PMLD;
fostering independence skills;
furthering communication.

Pre-requisites for MSR

There are NO prerequisites for MSR!

If there were prerequisites, the very people for whom the system
was designed would be denied access to it.
Providing the Learner is awake and conscious anyone can benefit.
The list of prerequisites on the left is a fiction ...
There are NO prerequisites!

Some people might justifiably argue that you cannot simply 'jump in' with the use of Object Of Reference (for example) claiming that you have to prepare the individual for the experience. Those with the most profound intellectual impairments may be totally unaware of an object placed in their personal space even if that object were to touch their skin. However, while this is undoubtedly true, individual targets at Stage One (see below) are directly concerned with the identification, assessment and development of such skills within the MSR scheme. Thus, it is not a matter of 'jumping in' but assessing a starting point and progressing through stages of development which, at the initial level, do not have any pre-requisites.

Some individual Learners may need to develop the sense of touch (see, for example Hewett D. [2007], Do Touch, Support for Learning, 22, 3, 116) or other sensory area, some may need to develop their awareness of (and interactions with) others. If such developments are necessary, they should be being addressed in almost every (if not all) area of the curriculum and not just MSR.

It might be assumed that MSR seems to suggest a single pathway through the development of awareness. That is not the case. Every person is an individual and will take their own pathway and will, therefore, need their own objectives (see for example the Routes To Learning documents). Thus, the first stage, not only assesses and develops the skills necessary to benefit form the scheme but also allows for individuals to progress at their own pace, in their own way and on their own pathway. This means that we might need to employ one of Penny Lacey's 'scruffy targets'. Scruffy Targets are not the opposite of SMART targets but, rather complementary and, in my opinion, should work alongside. They are ‘Student-led, Creative, Relevant Unspecified Fun For Youngsters' and, possibly, more appropriate for Learners experiencing Profound Intellectual Impairments. Even with very small steps, it can take a very long time to reach the next SMART target so, perhaps, we should incorporate a few Scruffy ones into the mix. Scruffy Targets can suggest a range of things that the staff can try in order to assist an individual reach the next target. Scruffy Targets are also good for staff moral as staff can become a little discouraged when individual learners do no appear to be making anticipated progress. Noticing and recording the 'little things' that happen in playing games and having fun in interacting can also build into a statement of individual achievement.

While you may want to wait until an individual is 'ready' to take the first steps on the Multi-Sensory journey and might suggest preparatory practices that will help to ensure that s/he can gain maximum benefit from the program, it may be that they will never reach a stage when they put a metaphorical foot on the metaphorical ladder! As Multi-Sensory References is all about providing appropriate sensory experiences, why not incorporate those 'preparatory practices' into the scheme so that it is tailored to the needs of each individual Learner? If the Learner spends a very long time working through Stage One ... so be it ... at least s/he reached Stage One!

Beware those who quote prerequisites for MSR, Objects of Reference or Sensory Cueing. There are no prerequisites other than the person is breathing and conscious. All other things are addressed by the MSR scheme itself. Indeed, the MSR scheme is designed to build such skills. For example, some would cite the following as necessary START up prerequisites:

Some awareness of cause and Effect;
Tactile defensiveness has been addresses;
Aware of objects and ability to link object to activity;
Requirement for specific level of physical control;
Tactile discrimination.

Talksense says this is misguided: the MSR scheme itself is a tool to address such things. The Learner will build such skills in the implementation of the course as staff address such issues via their practice. The requirement for such prerequisites will only serve to delay the onset of such a scheme and some Learners may never reach the stage where they can begin the scheme because it is felt that they do not yet have the necessary skills! We should use such a scheme as a tool to teach these skills! That is, we should build the teaching of necessary skills into the design of our approach such that all staff are empowered to address these issues throughout their practice.

Some might argue that specific Learners might respond better to music or to speech and therefore such a scheme is not appropriate for their needs. This assumes that neither speech nor music should play any part in this approach! Again, this is misguided. Talksense would want to argue that, by definition, an Individual Experiencing PMLD is unlikely to be cognisant of the meaning of the speech of Significant Others even though they might perform certain actions as though they are aware of it. Assumptions of Learner understanding are dangerous and assumptions of Learner understanding of speech more so. Staff need to provide evidence of cognisance shown in changes in behaviour of the Learner which cannot be explained in other ways (for example by mere accident alone). A Learner's smile is not evidence of understanding!

We cannot simply claim intelligence, we have to demonstrate it. However, claims of intelligence through use of such techniques as the use of the closed question format are fraught with danger. Please see the page on fundamental issues on this website for further information.

MSR and TCE

It is best practice if any MSR scheme forms part of a Total Communication Environment (TCE). In the picture to the left (click on it to enlarge it) the MSR is shown as comprising all of a TCE. However, this is just to allow enough space to illustrate the component parts of a MSR scheme. In reality, it would occupy a smaller but relevant proportion of the TCE.

MSR is made up of two separate components: SR-S (Sensory Referencing - Spatial) and SR-T (Sensory Referencing - Temporal). The spatial component addresses the questions: 'Where am I?' and 'Where am I going?'. The temporal component addresses the questions: 'What am I going to do next?' and 'How is my day/time being ordered?'.

The two components are themselves addressed by a range of techniques which include Sensory Cuing the use of Objects of Referencing, Tangible Symbol work, and Environmental Engineering as well as several others. These techniques, when implemented correctly and consistently, help to build awareness of self in space and time and anticipation of future events.

What is a Total Communication Environment? This is covered on two other pages of this website: Creating Active Environments and Fifteen Fundamentals of AAC. It is recommended that you visit these pages after studying this section.

Inclusive Learning

"If a lion could talk, we could not understand him."
Ludwig Wittgenstein (Philosophical Investigations, first published in 1953, page 223)

What?! That's crazy! If a lion could speak English then surely we would be able to understand what he was saying. Even if it could only speak lionese, if we had a translator then we would comprehend his message: wouldn't we? Wittgenstein was not specifically talking about lions of course, he could just as easily be talking about dinosaurs or any animal and many humans.

So what did Wittgenstein mean and how does it relate to the Multi-Sensory Referencing approach? Wittgenstein is often rather difficult to understand but I take him to mean that if a lion could speak, the language games he would use would be very unfamiliar to us because a lion's experience of the world and a human's experience are alien entities. In order to understand a lion we would have to approach the lion from a lion's perspective. Had we walked a mile in the lion's (metaphorical) shoes then we might begin something resembling a dialogue.

How does this apply to Learners experiencing profound communication difficulties? Well, if we approach using just our language, there might be an issue because Learners with such difficulties will, by definition, have significant problems with language. We cannot just expect such a Learner to comprehend all that we are saying via the medium of speech alone: we have to approach at the 'lion's level of experience and understanding'. In other words, we have to approach the Learner from the current experience and level of the Learner. That is, we need to be inclusive!
"If children don’t learn the way we teach,
We must strive to teach the way they learn."
Ignacio Estrada

In 2001, the Special Educational Needs and Disability Act changed the 1995 Disability Discrimination Act to be inclusive of schools and colleges. Thus, it became unlawful to discriminate against a Learner experiencing a disability in all aspects of school life without proper justification. Thus, the potential for real inclusion took a step forward. However, it should be understood that Inclusiveness is not the same thing as integration:

“We seem to use integration and inclusion as synonymous. This is not helpful and it would be useful is we could agree what we
mean by each of these.”
(http://www.diseed.org.uk)

Indeed, integration can mean further segregation: the child integrated into a place where s/he is not accepted or included can feel more segregated than the child who was not integrated. While we might be integrated into a whole series of lectures by Stephen Hawking, the authors would undoubted feel lost with the level of knowledge required to participate; therefore, we would be integrated but not included. To be included, the tutor, and the rest of the class would have to change their practice. Simply providing an additional (part-time) member of staff to work alongside the authors in the series of lectures and ‘translate’ Stephen’s language into the ‘English’ that we might understand is insufficient and not inclusion.

Integration + Translation ≠ Inclusion

Including a Learner (who is experiencing profound learning and communication difficulties) may be daunting for many staff. Even in ‘specialist’ establishments, staff may find such a Learner very challenging: they may find that s/he:

is at a completely different level to the rest of the class;
does not understand staff communication;
uses equipment with which they are unfamiliar;
requires additional help from other specialist staff which means that they miss significant parts of lessons;
is too slow and holds up the progression of the others in the class;
finds the level of work inappropriate and is constantly failing to achieve;
cannot use his/her simple communication system to answer class questions;
begins to behave in a challenging fashion after a short period of time within the group;
needs to be segregated into specialist provision within the special;

On the other hand, staff might naively claim that the Learner is understanding and following all that is happening within the class when in fact most it is flying over the Learner’s head at an incredible rate! The supporting member of staff (LSA) is the one who might be (maybe unwittingly), in fact, completing most of the work on the Learner’s part, for which the Learner is being credited.

All scenarios are clearly unacceptable and none is inclusive.

Generally speaking, educational staff at all levels are already fully tasked with work. Contrary to popular misconception (lots of holidays and short working day), educational staff work very long hours and put in a great deal of effort during and beyond the school day to deliver the school curriculum. Therefore, the majority of the suggestions on this webpage and on this website generally obey the ‘30 Second Rule’ (Caroline Musselwhite); that is, they can be delivered in thirty seconds or less by almost any member of staff. While some may take a little longer to prepare, once preparation is complete – the implementation should be possible in 30 seconds or less and the prepared materials can be saved and used again and again.

Generally, teachers find the inclusion of Learners with severe and profound disabilities in the ‘academic’ curriculum much more challenging (Heller, 2001). The authors’ classroom experience reinforces this notion. Staff are often unable to articulate why Learners are using special equipment in a particular way or why a Learner is performing a specific task with a simple SGD (Speech Generating Device) (And you are doing this because...?) or why a particular technique is being practiced.

What does all of this mean with reference to Multi-Sensory Referencing? Talksense would want to suggest the following:

All staff:

are trained in Multi-Sensory Referencing and understand why and how it is applicable to the Learners;
can explain the approach to an outsider who asks, "and you are doing this because... ?";
approach the Learner at the Learner's level of understanding;
do not simply assume Learner understanding rather they look for evidence of understanding;
record evidence of understanding.

Sensory Cueing

Sensory Cueing is a technique used within MSR to provide referential clues to an immediate POLE (Person Object Location Event). They are are often confused with Objects Of Reference (OOR) but are usually distinct: The main difference being that, whereas OOR are presented in the session immediately prior to moving to a POLE or indicating a change in focus, the Sensory Cue is encountered on reaching the POLE and is featured as a unique part of that particular experience.

Whereas there is a single OOR presented on moving to a new POLE, there can be several Sensory Cues provided by the POLE itself. Each cue will address a different sense and will depend on the number of Learners attending the POLE and their particular sensory needs and awareness. Indeed, there may need to be specific Sensory Cue provision for an individual whose needs are very special. Thus, Sensory Cues could make use of the senses touch, sound, sight, smell, and taste or any combination of them or any other sense.

As an example, consider a visit to a supermarket to go shopping. The staff might provide an OOR to each Learner at school prior to travelling to the supermarket. However, on reaching the supermarket, staff make a point of assisting the Learners to feel the bars of a supermarket trolley. Why a supermarket trolley? While this does NOT have to be the sensory cue for supermarket, it is a good choice as:

the trolleys are normally only present at supermarkets and similar large stores (unique to the experience);
the staff don't have to search for them. They are always there waiting (obeys the 30 second rule);
the trolley provides a visual, auditory and haptic sensory experience that can benefit the majority of Learners.

Staff assist Learners to move their hands gently over the surface of the trolley before entering the supermarket and beginning the experience. This is repeated every time the Learners go to the supermarket. Over a period of time (which will differ for each Learner), it is hoped that Learners will come to associate the haptic experience (feeling the trolley) with the POLE event (shopping in a supermarket) and begin to anticipate what is forthcoming. That is, it is hoped that the Learner's thought process will make a connection between a sensory experience and a following event: 'last time I had this experience, this happened ... I wonder if it will happen again' ...

It should not be assumed that this process will happen overnight. Very little learning happens in such a short time frame in this field of education: it can take many weeks or many months of repetition before progress is made. By definition, MSR is one tool that may be used to address the needs of individuals experiencing Profound Intellectuals Impairments. Such individuals typically do not make rapid progression when compared to peers. In some instances, progression may be so slow as to seem that an individual is not responding. Tis can become demoralizing for staff. The use of Penny Lacey's SCRUFFY targets (see above) can assist both individuals and staff in this matter.

It should not be assumed that the only sensory cue for a supermarket is a trolley! While the trolley has been suggested and appears fairly logical, there may be a need to provide a different cue for an individual. The very word 'individual' suggests that we are not all built the same and that what works for Paula might not work for Paul. There is not one defined pathway to the goal but, rather, random rough routes... the important thing is 'to get there!'

It should not be assumed that a sensory cue must involve touch; it may not. Use can be made of any of the senses or any combination of the senses. Some examples of the use of other senses (for example smell) follow. Once again, these are examples, it is up to the staff in each individual establishment to decide if and what sensory cues should be utilised.

Sensory Cueing: Personal Care

One of the most invasive things that staff have to do with Learners is provide personal care services (toileting). This typically involves entering a Learner's personal space, hoisting, undressing, intimate bodily contact, etc. Personal Care areas are not always the most fragrant of places. However, there is no reason why they shouldn't be so. It's more pleasant for the Learner and for the staff involved. Suppose we make the Personal Care Areas (PCA) in an establishment always smell in the same way? For example, let's choose the smell of pine. Every time Learners enter the PCA, they will smell pine before the staff assist with their personal care. Over a period of time, the Learner begins to associate the smell of pine with the necessary actions of the staff in a PCA. Learners begin to anticipate such actions and are therefore better prepared for what follows.

In the example above, the smell of pine is an olfactory Sensory Cue provided at the POLE for the benefit of the Learner. Is it possible to use any fragrance or perfume? No! We could nip down to the local store and buy a fragrance called 'Summer Lawns'. Providing it was strong enough to pervade the PCA it would still be unsuitable. Work with Sensory Cues is always time dependent: that is, it can take weeks, months or even years for a Learner to make a connection between a Cue and a POLE. If the provision of the Cue is governed by fashion (fragrances come and fragrances go) then we may not be able to purchased more of it when our present purchase runs out. By definition, it is essential that we will be able to replenish our stock of the Cue over a long period of time: we cannot keep swapping the Cue because that defeats the whole purpose of our action. Summer Lawns may well be in vogue now but may be unavailable in six months time. It will not do for this purpose therefore. If we are using fragrances they must be basic fragrances (such as pine or lavender or banana) that it is possible to keep using almost indefinitely.

Sensory Cues: here, now, and beyond.

Sensory cues address the here and now, the immediate, what is just about to happen. They answer the questions: 'Where am I' (but not 'where am I going?') and 'What is going to happen now?' (but not 'what is happening later today?'). As such sensory cues cannot easily be positioned outside of the POLE itself although they could form part of an entrance to a room providing that they are not experienced by the Learner on leaving the room (it would have to be a one way system or the cue would have to be removed).

Sensory Cues, as all aspects of a MSR scheme, should obey the 30 second rule. In both the examples cited staff do not have to 'chase the cue', the cues are present and waiting for them and require the minimum of effort on their part. Indeed, with the pine fragrance, in the example above, staff have only to enter the pole area and the cue is unaviodable.

Isn't the sight of the supermarket itself a Sensory Cue?
No, you can see supermarkets without actually going inside!

What if we are going out - the PCAs outside our environment may not smell of pine?
That is true. However, it is possible to take some pine fragrance spray with you to provide personal access to the Cue.

What if the Learner encounters the smell of pine in areas other than PCAs?
There is always a chance that this might happen which is why it is important that the choice of the Cue for any POLE is as unique as is possible. We generally don't encounter the smell of pine as an everyday event but, if the school/college/other were built in a pine forest, the smell of pine would NOT be a good choice as a Sensory Cue.

Can Sensory Cues be used at home?
Yes, the greater the consistency, the more chance of the Learner making a connection. However, parents must understand that this is a long term process and they cannot get fed up with the smell of pine and decide to swap for lemon!

Can a Sensory Cue become an Object Of Reference?
Yes it can. We can find something that feels like the bars of a supermarket trolley and present that before travelling to the supermarket. We could fragrance the OOR for personal care with the scent of pine ...

What is the Learner has no sense of smell?
It may still work for other Learners on the scheme. However, that particular Learner's needs have to be met by another additional Sensory Cue. Likewise, if the Learner has a visual impairment, don't use visual cues, focus on other sensory areas.

When does a Sensory Cue become an Object of Reference?
The answer is it doesn't! Even if you a lone teacher working with a group of learners in a single room and while the focus of the session changes (for example: from numeracy to literacy), the use of an stimulus to represent a change in focus here is clearly an OOR and not a Sensory Cue. However, if in addition to the presentation of an OOR the group where to change orientation in the room (such that they were facing a particular direction for numeracy and another for literacy type practices) in addition to the presentation of an OOR, then this would be classed as a Sensory Cue. Admittedly, Cues and Object boundaries can become blurred in certain situation but no one should become concerned about this as the focus is on Learner understanding and not on whether a particular item is a Cue or an Object - the semantics is lost on the Learner!

Sensory Switch Caps

Some Learners may require switch access to interact with their environment. It is possible to create Sensory Switch Caps easily and cheaply using spray glue and or Velcro This aspect is covered fully on the BIGmack page. It involves coating the surface of the switch cap with glue and attaching a sensory surface (such as sand or fur) that the Learner will feel every time s/he interacts with a particular POLE.

Learners should ideally have their own set of switch caps so that staff do not have to search out a particular cap (breaking the 30 second rule) and can easily locate and use the cap on every appropriate occasion. If the Learner uses both big and small switches (although it is recommended that you remain with one size) then two sets of sensory switch caps will need to be constructed.

The sensory surface used should ideally be related to the POLE in some way. However, it does not necessarily have to be a direct relationship: providing the switch cap is used both frequently and consistently then there is every chance a Learner will come to make the association between the surface and the POLE over a period of time.

Do not be tempted to make hundreds of sensory switch caps, one for every eventuality. Start with a small number only (1 to 4). Choose those POLEs that the Learner frequently encounters and gradually increase the available caps as both staff and Learner become accustomed to their use.

Social Greetings and Sensory Cues

As social greetings as commonplace daily activities and therefore can be reinforced often they are ideal for working with Individuals Experiencing PMLD (IEPMLD). However, as social greetings are abstract concepts (What the heck is an 'hello'?!) they are also less than ideal! If we are going to work with greetings with IEPMLD then we need to make the experience easy to understand. One idea for doing this is the furry glove approach. By fur, I mean faux (fake) fur: no animal should be hurt to use this idea.

You will need to obtain a pair of faux fur gloves. You can purchase these new or look in charity shops. If you are right handed, keep the right hand glove whole. If you are left handed reverse this procedure. Using the other glove, cut out a section of fur that will fit on the surface of the switch cap for a BIGmack (or LITTLEmack). Attach the fur to the cap using velcro, so that it can be taken off for cleaning from time to time. The BIGmack now has a furry surface. This surface should ONLY be used for greetings such as 'Hello', 'Good Morning'. 'Good Afternoon'.

Before saying 'good morning' to your group in the classroom, put on the remaining furry glove and hold the BIGmack (with the furry switch cap) in your other hand. Go around the group saying and signing 'Good Morning' to each group member. As you do so, either:

shake their hand with your furry gloved hand OR,
stroke the surface of an exposed part of their skin with your furry gloved hand.

Present the BIGmack so that each Learner can also say 'Good Morning' to you and to the rest of the group. As the Learner does so, s/he is once again coming into contact with the furry sensation (fur is soft and friendly). Hopefully, over a period of time, the Learners will come to associate the furry sensation with that of greetings.

Note that after each ' Good Morning' response from an individual to the staff member and to the rest of the group, the rest of the group should all reply 'Good Morning' back to the individual: 'Good Morning Sarah' ... 'Good Morning Sam'... In this way, no single individual is sat waiting for their turn for long periods of time: the process is individual and the group, individual and group, individual and then group... That would seem to suggest that we should have as many BIGmacks available as there are Learners In the group and, not only that but, every BIGmack should also be covered in fur! In an ideal world, this is indeed what would happen but, as we all know, we live in a less than ideal world. If there are a limited supply of BIGmacks or alternatives to go around the the group then, at least, the supporting staff should assist all the Learners to say or sign or indicate in any way possible, a returned 'good morning' to the Learner whose turn it is.

Using the BIGmack (or an alternative) in this way is not turning it (actually the fur covering) into an Object Of Reference (see section on OOR below) but, rather, creating a Sensory Cue; the fur giving information about what is going to happen albeit immediately.

What if the Learner has a pair of furry gloves they actually use? Won't that confuse them?
That is a possibility sure. However, the fur tends to be on the outside of gloves and, as such, the Learner will not be feeling it even when wearing them. Of course, others may wear furry gloves and may touch Learners outside the classroom. Who would be doing this and why? A casual acquaintance on the street is likely to be saying hello and thus reinforcing the concept. Significant Others can be informed about this technique and warned not to wear furry gloves or at least, if they do, only use touch the Learner with them when they are giving a social greeting. Of course, if you believe the suggested technique is going to be problematic then do not use it!

Does it have to be fur?
No, it does not really matter as long as whatever sensory surface is used it is used consistently. Fur is soft and warm and friendly which sort of reminds me of a social greeting but so might another fabric.

Yes, but the Learners Teddy Bear is furry and that will provide them with the same Sensory Cue. Isn't that going to be confusing?
Hopefully there will be some distinction between the fur of the teddy bear and the fur used for the technique. However, discriminating between the two for a Learner at this level of ability may indeed be problematic. What might this mean? Teddy might begin to represent a social greeting or the Learner might take the fur to mean that s/he is going to get their teddy. As the Learner will not be given a teddy bear after this technique it is very unlikely any Learner will form this association. When playing with their teddy they will get additional and very different cues to that of accessing the surface of a BIGmack. This should help them to make a distinction. Again, if you believe the technique to be problematic adapt it or reject it.

Could the BIGmack be made to sing 'Good Morning to you'?
Yes it could but it may be a little too long if the whole song was recorded. If the first four words only were recorded (good morning to you)
then that issue is avoided. Certainly, if a Learner was being tasked to sing the 'good morning' song to the group then the furry surface would be used.

That's all very well but it wouldn't be consistent. Others would be interacting with the Learner outside of the school and giving social greetings without wearing furry gloves and I couldn't expect Mum to put on furry gloves to wake the Learner in the morning; that's taking it a little too far!
Yes, you are correct we cannot ensure that every single person interacting with the Learner does so in this way when giving a social greeting. However, the vast majority of such greetings are going to be either in school/college or at home by family members. In school we can either decide to implement the idea or not. At home, we can inform the family of the idea but we cannot make them apply it. If they do not, what damage are they doing? As the Learner receives nothing very concrete from a social greeting (it is an abstract concept after all), a family member saying hello without using the fur is unlikely to cause too much upset.

That's a crazy idea! Staff are going to be saying hello to Learners when passing in corridors for example and they are not going to be walking around carrying furry gloves! The head says 'good morning' in assembly. She is not going to be wearing furry gloves and even if she were she would not have time to go around all the school and shake their hands!
As I said, if you don't like the idea, do not use it! It's an idea and it will not work for everyone. You are correct; there will be times when it is impractical to assume that staff will have furry gloves available and yet still want to say 'hello'. C'est la vie! As with family members doing the same is it likely to cause a major problem? If you believe that it will then do not implement the idea.

I want to use fur as the surface of an Object Of Reference to be used for toys. Can I also use it in the way that you describe?
No, I would not recommend doing that. It is likely to be confusing for the Learner and counterproductive for you. Use fur for one or the other and decide on another sensory surface for the one remaining.

Sensory Cues: Handle With Care

"A particularly imaginative use of smell was shown by the residential boarding school who used a different smelling soap for each day of the week to inform the students what the day was."
(Virginia Moffat 1996 page 34)

While the above quote might seem like a really good idea, it should be viewed with a little caution: the use of smells to represent POLEs is not infinite and if a smell is used for one thing, it cannot be used for another (all Sensory cues, as all Objects Of Reference, have to be unique). The use of a different smell for each day of the week uses up at least five if not seven smells. As such smells not only have to be unique but also have to be continually available (you cannot keep changing them because it may take months if not longer for a Learner to make the association from the smell to the POLE) they are very valuable commodities and should be used wisely. Try to list distinct smells that:

are recognisable,
can be purchased;
will not go out of fashion and thus become unavailable for future use.

they will be natural everyday smells such as pine, lavender, lemon, apple, strawberry ... the list is a finite one. Therefore be wary of using them without really good reason.

So what's wrong with using five different smells for days of the week?
In theory nothing; indeed, it sounds like an example of good practice, does it not? However, those that need the use of Sensory Cues (Individual Experiencing Very Significant Learning Difficulties) are really unlikely to be aware of things that are happening this afternoon let alone what is happening next Tuesday morning and are not cognitively ready to make that leap of understanding. Those that are ready to understand the concepts of 'days' are, by definition, at a higher cognitive level and are not in need of the use of smells in this way. At the cognitive level that can recognise and understand the concept of a 'day of the week' there is no need to make use of smells (which are needed for more significant learning disabilities): why not use symbols instead? If you can understand that today is a Tuesday and we have sport every Tuesday afternoon then (if you can see) will be cognisant of symbols (if you have an issue with visual acuity then tactile symbols).

Are you saying that Learners experiencing PMLD cannot recognise individual days of the week?
Yes! If a person can understand the concept of a 'Tuesday' then s/he is not experiencing PMLD. The same holds true of language: if a person can speak and hold a conversation, that person is not experiencing PMLD. There are certain things that characterise a person experiencing PMLD and certain things that do not. While the boundaries may be a little fuzzy at the edges and PMLD is a continuum there are still certain abilities, aptitudes, characteristics and traits that are representative of those experiencing PMLD. It does not follow however, that an inability to recognise specific days of the week alone defines a person as experiencing PMLD: it could be that some subtle neurological damage to a specific area of the brain (after an accident or a stroke for example) has removed this function from a person's repertoire. It is known that some people have lost the ability to recognise faces (for example) but are in the majority of other ways intact (see the works of Oliver Sacks for examples of this and many other such cases).

So is it wrong to use smells for days of the week?
No, of course not. There is usually no single right answer. However, I would want to reserve such resources for those with the most need.

Memory Books

A Memory Book is a form of diary that can assist the Learner with the concept of time. If an item is pasted into the Memory Book to represent each session, then it becomes possible to look back at what happened this morning or yesterday. The ‘item’ should be some meaningful thing from the session (a piece of the artwork produced, a ticket from a bus or a train journey, the logo from a bag of the shop visited, a digital image of the Learner engaged in the activity, a small flat piece of dried food that was used in cooking, …) and not a written report on how much ‘Jenny enjoyed this session’ (note: Learners with limited visual acuity will need 3 dimensional cues in their Memory Books). Furthermore, the Learner must be actively involved in the completion of the Memory Book, perhaps using switch adapted electric scissors to cut out, assisting with the application of paste, and helping to position the item on the page. Schools and parents can collaborate on this process to produce a Learner accessible, historic record of the events that have occurred in the Learner’s day, the Learner's week and, over time, the Learner's life. As ‘Memory Book Time’ should be fixed to the last few minutes (10 minutes?) of a session, it also acts as a ‘sensory cue’ about the timeline indicating that the session is about to end.

Parents can explore the Memory Book's recorded events of the day with the Learner each evening. The items contained on the pages should be a rich source of sensory stimulation for the Learner and promote a theme for communication between parents and their children. Of course, the Memory Book is not a one way system (school to home), it can also be used for parents to record evening and weekend activities and, thus, it becomes a sensory record of of a Learner's day, week, and life.

Memory Books can also be used to prepare a Learner for a forthcoming event by placing a cue to that event on the appropriate page in the Memory Book and then counting down to it by showing the reducing number of empty pages as time progresses. Not all Learners will understand the concept but, unless we attempt such things, they never will.

There are certain rules that govern the creation and use of Memory Books so that they do not become something else such as a home school diary (which are different things entirely).

Entries should be relevant to the Learner and the session;
Entries should be made in the last (ten) minutes of any session or period;
Entries should NOT simply be a symbol for the session otherwise the Memory book will become a copy of the timetable;
The Learner should be immersed in the entry. Not an observer but actually involved.
Staff must not write in the Memory Book other than a very brief explanation of the attached entry/item for the benefit of Significant Others if the entry is not self evident;
Representations of Objects Of Reference should NOT be used in Memory Books.
The Memory Book itself should become familiar to the Learner ... a sensory experience.
The Memory Book is the property of the Learner but the Learner may be assisted by any Significant Other (Staff, Parent, carer ...) to complete entries each day, evening and weekend.
Memory Books must be used, reviewed, talked about etc where appropriate by Significant Others and not simply put in a bag and forgotten.

More on the use of Memory Books can be found on the Memory Book page of the website.

Objects Of Reference

What is an Object Of Reference? An OOR is a (typically) tangible, multi-dimensional, multi-sensory 'symbol' that is used to represent a POLE. Ockelford described them as 'Objects that have special meanings' (Ockleford A. 1993 Objects Of Reference: RNIB London). They were first described, in the mid 1960s, by Jan Van Dijk of the Instituut voor Doven, in Sint-Michielgestel, in the Netherlands as a means of communication for people who were congenitally deaf-blind. However, their use has been extended and now they can be found in use in a variety of settings for anyone experiencing a severe/profound learning difficulty. Even though the use of OOR was first described in the mid 1960s, they were not in popular use even twenty years later; for example the book 'A Complete Guide to Communication with Deaf-Blind Persons' by Linda Kates and Jerome Schein (1980 Deafness Research and Training Centre, New York University School of Education) does not make mention of them at all!

Objects Of Reference have been and, in some countries, are still known by other names and labels. These include (in alphabetical order):

anticipation cues (Joffee & Rikhye, 1991);
object cues (Lancioni, O’Reilly, & Oliva, 2002; Westling & Fox, 2004);
object symbols (Bloom, 1990);
tactile symbols (Lund & Troha, 2008);
tangible cues (Vicker, 1996);
tangible symbols (Rowland and Schweigert,1989, 2000).

In the symbol depicted to the left above, the Sensory Cue for the supermarket (see earlier this page) has been developed into an Object Of Reference that can be presented to the Learner in the session immediately prior to the supermarket visit. In this instance, a piece of crossed wire mesh has been attached to a backboard shaped like a building to give further reference to the Learner that the object is a place. The colour red has also been used to indicate a place (any colour could be used so long as it is used consistently)(red was used in this instance because it was felt that it was the colour of many brick built buildings). However, Objects Of Reference (OOR) do not have to be designed and built in this way. We could borrow a supermarket trolley from Tesco (I'm sure they would agree to this!) and present this to the Learner in the classroom. There are a couple of problems with this approach: first, the local supermarket would probably not agree to the venture and, second, the trolley is a little too big and heavy. When I created such an OOR, I found a metal 'cooling tray' (a surface on which you place hot food to allow it to cool) in a local Wilkinson's store that was made of a thick wire mesh that looked and felt very much like the bars of a supermarket trolley. This was of a size (about 200 mm square) that I could present to a Learner without any alteration and it was relatively inexpensive.

Who, Why, When and Where?

Who:     OOR are used to address specific needs for people who are experiencing
profound learning difficulties. Such people can be of any age from toddlers to
senior citizens - all can benefit from their use.

Why:     OOR are used to help Learners to:

             -     anticipate;
             -     comprehend;
            -     remember;
            -     communicate;
            -     make choices...

Landesman-Dwyer and Sackett (1978) noted that Individuals Experiencing PMLD (IEPMLD) spend only five percent of their time actively engaged with their environment and ten percent of their time demonstrating overt movement. While this data is now over thirty years old and modern education practice may have improved matters somewhat, it nevertheless remains of vital importance that we encourage the active involvement of IEPMLD in their daily routine. As Jones, Favell, Lattimore and Risley (1984) have pointed out that active engagement with objects in the environment is a precondition to several aspects of development, the use of OOR can have a contributory effect in personal development.

"Broadly speaking, the results of this project suggest three major clinical implications. First, participants demonstrating a wide range of abilities learned to use tangible symbol systems as an effective means of communication, supporting the first of our initial hypotheses. Second, a number of students were able to use tangible symbols as a stepping stone to more abstract symbol systems, supporting our second initial hypothesis. Third, we have gained some insight into the relationship between presymbolic intentional communication and the acquisition of symbolic behavior." (NOTE: for Tangible Symbol please read Objects Of Reference)
(Rowland and Schweigert, 2000, page 72)

When:
OOR must be presented immediately prior to a change of POLE either by a staff member to a Learner (means to goal) or by a Learner to a staff member (Goal). Staff must 'buy in' to the OOR scheme and not declare UDI (Unilateral Declaration of Independence). That is they should not decide (on their own without consulting the OOR team) that a particular Learner does not need the OOR (for what ever reason) and proceed to the POLE without presenting it. However, it is my experience that, there will always be at least one member of staff demonstrating UDI! Staff should be:

involved in the setup of any scheme;
understand why they are undertaking these actions;
given a channel to vent any frustrations they might be feeling that may otherwise lead to UDI.

Where:
Everywhere is preferable but not always practicable. I have found that sending OOR sets home with Learners is fraught with problems! Either they don't get used or get used incorrectly but, more typically, they get lost and don't always return. It then becomes a costly exercise in continually replacing missing OOR. The ideal procedure (sending the OOR home with the Learners) is, thus, not always the best way to implement such a scheme. The rules and suggestions below will cover the ideal but give practical ways of implementing. Some may disagree with such an approach. That is fine. Where I am aware there is disagreement over an approach, I will present both cases so that you may decide for yourself which is 'right' for you.

When and Where:
Consistently, all day in every situation and in every place! However, even with restrictions, good results are possible.

"Ideally, an aided symbol system should be made available to the child in every context 24 hours a day so that the child can communicate at will. We were not able to manipulate the total environment of our participants; indeed, we were only present for 15 to 20 minutes a day, on average, and only on school days. In most cases, the documented successes of our intervention efforts had the desired effect of encouraging aging teachers and speech-language pathologists to pursue the use of tangible symbols in other contexts of the school day, and in some cases to encourage their use at home. We can only speculate as to how much more dramatic the improvements in the participants’ communication skills might have been had they been given 24-hour access to tangible symbol systems." (Rowland and Schweigert, 2000, page 75)

What makes a good OOR?

The symbol on the left represents a pale blue plastic plate onto which has been attached a laminated symbol (for meal). Such an object could readily be used as an OOR for mealtimes. It is lightweight, durable, and represents its POLE (going for a meal) directly. Why is a symbol attached? The intent is not to remain with OOR for ever but, hopefully, to move through them to a future symbol stage (more on this aspect later). Thus, while the focus is on the plate and not the symbol, each time it is presented, (if the Learner can see) the Learner is also seeing and experiencing the symbol.

Some things do not make good OOR. For example, they might be sharp or otherwise present a danger to the Learner. They might be expensive and be too costly to replace if lost, damaged or stolen. They might be too big or too small or too heavy to be of any use. Typically the criteria for good OOR include (in no particular order):

safe (should be safe for unsupervised use);
hygienic (should be able to be easily cleaned);
size (not to big or too small) Portable;
weight (not too heavy to hold/carry);
unique (Learner should not be encountering item in other situations);
durable (they have a tough life and need to last so durable is better);
available (they go missing and have to be replaced);
inexpensive (if they cost a lot to replace it becomes very expensive);
multisensory (as is practicable and possible but don't have to cover every sense);
iconic (ideally should directly represent the POLE: Concrete rather than abstract. However, consistency is more important);
saliency (has the OOR a direct link to what is meaningful in/from the POLE in the mind of the Learner?);
meaningful (to the Learner. Ideally, this is true. However, it does not necessarily have to be thus. See below);
adaptable (explained in sections below);
property of the Learner (ideally the set should belong to the Learner and move establishments with him/her);

Furthermore, the OOR that are the most commonly/ frequently encountered are likely to be those that will be the most successful: those that will be encountered at least once a day (or even more frequently):

"The student that I had the most progress with, was the student that I had every day, was seeing the symbols every day, over and over and over again." (Quoted in Bruce, Trief, and Cascella, 2011)

While iconicity is important, it is not necessary for all OOR to be iconic:

" where an association has been created between a tangible symbol and a referent (because there is no logical symbol available), a perceptual association exists for the user because the created symbol has been repeatedly associated with the referent through
receptive exposure prior to its introduction as a symbol for expressive communication." (Rowland & Schweigert, 2000b page 63)

In other words, it is possible for staff to create a link between an object and a referent (POLE) in a Learner's mind via the use of a number of techniques (covered elsewhere on this webpage) coupled with continuing consistency of approach.

It's in the Bag

Where should you keep your OOR and why? What is the best approach? There is not one 'right' answer to these questions but there are responses that may be not as effective as others.

There are, at least, two possibilities to housing a set of OOR;

a room-based approach with OOR hanging on a wall or in some other prominent position;
a bag-based approach with OOR contained inside a draw string bag of some form or other.

The room based approach tends to be used when individual Learners do not have their own set of objects and the objects in use are shared between those in the class on the scheme with each class having its own set. This type of approach tends to be used when Learners do not move between classrooms for different lessons but rather stay in the same room with the same staff while the topic changes focus (maths changes to literacy, for example).

The bag-based approach tends to be used for Learner that have their own personal set (not shared with others) of OOR which travel around with them and which will eventually transition with the Learner to any new establishment (for example, when the Learner leaves school). The type of approach also lends itself better to Learners who move between classrooms when the lesson changes. However, it does not follow that a bag-based system is the incorrect approach for use within a single classroom when the lesson changes but the Learner does not move.

It is my experience that a bag-based system is better than a room-based system. However, this may not be the right approach for your situation and you must decide based upon the constraints and conditions that you face. It is my opinion that a bag-based system more effective because it:

is easier to manage;
is less expensive over time as less Objects go 'astray';
makes it easier for the Learner to understand the system;
makes it easier for the Learner to cope with the system;
makes it easier for staff to locate Objects when out of the classroom;
helps staff to makes less 'mistakes';
permits more developmental work;
...

In a room-based approach the Objects must be located on view at all times. They may be on an accessible shelf or on hooks (or otherwise attached) on a wall. It is important that the Learner knows where the objects are located because, at Stage Five (see later section), s/he will need to be able to give an Object to a member of staff to make an expressive statement that 'I want to go here / do this / see this person'. The Objects need to be visible because all Learners will not be able to manage the retrieval physically. If this is the case then they can look at a desired Object to make a request (but would not be able to do this if they were kept in a drawer although they could look at the drawer itself).

What about those who cannot see?
For those that have additional problems of visual acuity, this option may be impractical but they can be taught another way to request the Object set from which they can make a selection.

Are you saying that individual Learner s should have their own set of OOR which belong to them and moves on with them when they finally leave school or college?
Yes!

Should there be an OOR in the bag for every curriculum activity?
No, not initially and maybe not ever: it depends on the Learners ability and how they cope with the scheme. Initially you might begin with just a few OOR, for example:

mealtime
break/drink;
personal care (toileting);
hoisting (if the Learner is hoisted).

Does that mean that there will be different OOR in every individuals bag?
Yes, most probably. Some will progress faster than other Learners and these individuals may have more OOR introduced. Some will have been on the scheme for longer and, thus, may have more OOR. Some will be following a different curriculum and therefore have different OOR. Some will require hoisting and therefore need as OOR to indicate that this is about to happen.

How on earth are we supposed to keep track of what is in everyone's bag?
That's not a problem! First, one person should have the responsibility for keeping a track of every person on the scheme and may have a spreadsheet (for example) detailing their (growing) set of OOR. Second, it is good practice to put a laminated itemised list of all the things that should be in an Individual's OOR bag. This list can be checked every morning by a member of staff designated to do this job (not the person who is keeping a record of all the Learners). If an item has gone astray then it wil be that member of staff's responsibility to go to the OOR store (or store keeper) to replace the item such that no member of staff has to go searching for a missing OOR during the working day.

What if an Object does not fit in the bag?
Then it is probably too big for use as an OOR. An object should not be too small as to present a choke hazard and not too big such that it does not fit into the bag. Too big an Object may be more difficult for a Learner to manipulate and experience. Thus all Objects in use on the scheme should fit into the bag.

Stages Of Development

Click on the image (left) to enlarge the picture to view.

According to Jones, there are five stages of development (Jones A. 1995) which move from being a passive recipient of communication to an active and expressive communicator. Development through the stages can take many months or years and some may never reach stage five.

Stage One:   at Stage One, Learners are intolerant of the OOR. They will either not look at it, refuse to hold it, throw it away, ignore it completely, or be completely unaware of its presence or existence. Such Learners are dependent on others. That is, they will not use OOR expressively but will wait passively while another presents the OOR to them. As such, they are dependent on others while working with OOR. The meaning of the OOR at this stage is extraneous; that is, for the Learner, the OOR has little or no meaning and is perhaps perceived as a plaything if, indeed, the Learner has any awareness of it at all.

No claim is made of Learner cognition during Stage One. The purpose of the stage is to start the process of developing and building such understanding. By definition, Learners operating at this stage are difficult to reach. They may be completely passive or uncooperative with what you are trying to do. They will not understand why an OOR is being presented and, indeed, may be giving little (if any) attention to its presence.

Note: Stage One necessarily includes the assessment and development of the skills that enable a person to benefit from the scheme. It is not expected that the individual Learner will be simply 'plunged' into the basic OOR scheme from day one but, rather, that the OOR scheme will include practices that will lead to the development of sensory awareness, tolerance, and person to person interaction skills. Thus, for example, the stage might include more time spent on reducing tactile defensiveness and improving haptic awareness.

Stage Two:    During stage two Learners become a little more tolerant of the OORs being presented. That does not mean they grasp them with open arms but don't tend to push them away as much or perhaps throw them away less. Staff typically report the task as becoming a little easier and 'feel' that they 'might be getting through'. In all other aspects stage two is identical to stage one although, perhaps, the Learner is not as difficult to reach but has become just 'hard to reach'. Many Learners will jump straight in at stage two. They will hold and tolerate a presented OOR although they are still dependent on others for its presentation and still have no understanding what the OOR represents.

Stage Three:   By stage three, Learners are becoming receptive to the idea of OOR. While they may not demonstrate complete awareness and understanding of their meaning they may, nevertheless, get up and start moving towards the door after presentation (if ambulant) or otherwise indicate some form of partial understanding if only awareness that there is going to be some sort of change. If a Learner does move to the door, staff should open it and allow the Learner to lead the way with the staff following (ensuring safety). If the Learner goes straight to the POLE ... celebrate! That is a momentous occasion for both the Learner and the staff. However, this isn't likely on the first attempt. If the Learner goes completely in the wrong direction, staff should re-direct the Learner by barring the way. If the Learner goes in the right direction but doesn't quite reach the POLE staff should provide as much assistance as is required (from each according to their ability. to each according to their need) in order that the Learner achieves success. Other Learners may be helped to progress in this stage by taking them to the POLE door and then allowing the Learner to enter the room unaccompanied. On a subsequent occasion, staff can guide the Learner to a metre further from the POLE door and hope that s/he makes the little extra distance on his/her own. Backward chaining in this fashion, the staff and the Learner keep 'parting company' a little further from the POLE on each subsequent occasion (although the staff member is never too far away). The Learner takes on a more active role and the staff member become very slightly more passive (supportive).

Stage Four:   During Stage Four, the Learner is assisted to become more expressive; that is s/he moves from being a passive receiver of the OOR to one who begins to understand that s/he can exercise control over others by using the objects expressively. This is very unlikely to happen out of the blue (although it has been known) but, typically, requires a catalyst; that is, staff promote the expressive phase through their interactions with the Learner. The catalyst comes in the manner the OOR are presented. Before this stage, it is important that OOR are presented individually:- one object for one POLE. When the object is presented, the Learner should move immediately to the POLE. However, at Stage Four, the Learner can be encouraged to select the appropriate OOR from the place where the OOR are stored. From personal experience, I prefer a bag-based approach with each individual Learner on the scheme having their own bag and objects. Thus, at Stage Four, the Learner can be presented with a choice of two objects in the mouth of the bag, although the 'incorrect' object should be placed behind the appropriate choice, such that the Learner is 'assisted' to make the correct choice of object for the POLE. However, if, by accident, the Learner manages to get the incorrect object, accompany the Learner to the place indicated by the (incorrect) OOR then, immediately present the correct OOR (without choice!) and proceed to the correct POLE. The process of encouraging the Learner to take / retrieve a desired OOR from a bag (or other) is an essential precursor to Stage Five in which a Learner independently selects an OOR and presents it to a member of staff.

Stage Five:    It is rare for Learners experiencing PMLD to reach stage five though common for Learners to make progress through some of the stages. If Learners are working with several OOR they do not typically reach stage five with all of them at the same time. It is usual for just one to be used in this way. At stage five, a Learner will independently retrieve an OOR and present it to a staff member. This should be seen as an expressive act of communication and acted upon as such (even if it were actually an accidental event). It is a momentous moment in the life of any Learner: it is also a momentous moment for staff. I often joke. on the training courses I deliver. that the school or college or centre should organize a party and celebrate the achievement: it is of that order of magnitude.

Some Learners never reach stage five with OOR because they have moved on to other augmentative communication systems such as the use of a symbol set. This is typically the route taken by Learners experiencing an ASD. Such Learners benefit from the consistency and predictability of an OOR scheme and use it as a foundation in order to move on to a another augmentative communication system such as working with symbols. Some Learners never reach stage five because they have not started on the path towards communication early in life and reach the end of their time at school or at college and move to a place where the scheme is not supported. If they had started while they were toddlers who knows what would have been possible. It is never too early or too late to start but it is better to start early. Some Learners never reach stage five because of the severity of their learning difficulty and physical disability. Staff should never assume that a Learner is incapable of making progress: while it is undoubtedly true that some find it more difficult than others, all can benefit to some degree.

Note that a Learner may enter the scheme at any stage depending on ability.

Objectives: Stage One

Each stage is accompanied by a number of objectives that should be met before proceeding to the next level. To download these objectives as a Word document please click on the blue link in this sentence. When all objectives have been met then (and only then) a movement to the next stage can be considered. The objectives for Stage One are set out below. Stage One includes the necessary prerequisites for progression through the following stages. It may take some time to achieve these objectives with some Learners depending on their level of awareness etc. The Objectives below have been written as factual observable objective statements: either a person can do it or they can't. Objectives should not be written in a subjective manner; 'Johnny understands that ...' how does a member of staff know that Johnny understands? It is subjective and not objective. 'Demonstrates a memory for an object' is another problematic objective: how are staff to know whether an individual has 'demonstrated'? It really is too woolly. We might ask them to record exactly how the Learner 'demonstrated' a memory and then, review the observations of several staff to make a decision as to whether it is believed that the observations fulfill the objective set. The use of video (particularly at this stage) can help clarify if an objective is being met and is also very useful as a baseline to measure the progression made by a specific Learner.

Penny Lacey's 'Scruffy Targets' (see earlier) can assist staff in finding paths to explore ways to reaching objectives. Therefore, you may wish to amend the following, not only to suit the needs of your Learners and your establishment but also, to include some scruffier objectives!

Objectives for other stages follow below.

Stage One Objectives.

The Individual will be able to:

     1.       respond in any way to (varying) external stimuli (change in the environment)(record stimuli, record response);
     2.       respond to a particular sensory modality (light, sound, feel, smell, vibration, etc)(record modality);
     3.       respond in any way to presence of another person (record response);
             -         outside personal space;
             -         edge of personal space;
             -         inside personal space;
             -         close contact;
     4.       notice object placed in personal space (include rejection of object);
     5.       respond to object touching skin;
     6.       demonstrate a fondness for a particular object (repeatedly selects object from a group, for example);
     7.       tolerate object placed in personal space;
     8.       tolerate object touching skin for short period (record object, record location, record period);
     9.       tolerate presence of another in personal space (record specific person[s]);
   10.       tolerate touch of another;
   11.       tolerate close contact from another;
   11.   reduce rejection of object(s) placed in personal space;
   12.       interact in any way with an object (record interaction, record positive and negative objects);
   13.    explore object in personal space
             -         with eyes;
             -         with hands;
             -         with mouth;
             -         with other (record).

Please note that a response is an observable change in Learner behaviour. A Learner may be rocking back and forth and, when the OOR is brought near to him/her may rock in a different direction so as to avoid contact with the OOR. While not an ideal response, it still demonstrates that the Learner is aware of the object.

Stage One of the OOR scheme is about assessing, developing, and recording awareness, sensory, tolerance, and person to person interaction skills. As these skills form the basis for all areas of development they will not just be addressed as a means to the MSR scheme but in all subject areas. Staff should seek ways of fostering such skills in the pursuit of meeting the objectives in a caring and fun manner.

Stage One focus is primarily on developing sensory awareness of the OBJECT and of other people. Stage One may therefore take a considerable amount of time to achieve for some. It is not a race to the finishing post ... it need not be rushed.

Please Note:

Not all the above objectives with be relevant for some individuals and may have to be adapted. It is left to your best judgement which to adopt, adapt, or reject.
Although the numbered arrangement suggests a particular sequential arrangement, there may be times when one objective is met before another (earlier numbered) one.
Linear routes may be easier to depict on a website but rarely does life follow text: individuals will progress in different ways by different routes and therefore some flexibility should be built into any system.

Objectives: Stage Two

Stage Two should only be attempted when the objectives from Stage One have been met to the satisfaction of the staff members with responsibility for overseeing the implementation of the OOR system. It may be that a particular Learner begins at stage two (or above) and skips an earlier stage because it is felt that s/he is already operating beyond the level indicated by the objectives that have been specified.

Stage two Objectives are probably not really objectives at all! An objective, by definition has to be quantifiable and many of the items listed below are not: they are more 'feelings' or 'instincts'. A staff member 'feels' that a particular Learner is improving, becoming more tolerant, or less difficulty to work with. Perhaps the individual is now throwing the OOR on the floor a little less often or is exploring the presented OORs for a little longer and appears to be a little less tactile defensive than previously.

In stage Two, we begin to notice not just increased acceptance and interactions with object but also increased acceptance and interaction with 'others' particularly staff. The Learner will demonstrate an awareness of the presence of another person by altering their behaviour in some way (it does not have to be positive: if the Learner starts to scream when another person approaches, they are indicating an awareness. During stage Two there will be a movement towards greater tolerance and acceptance of both Objects and People. The movement will be from behaviour that staff may find difficult in the direction of behaviour that staff find more acceptable.

Also, during Stage Two, there is an increasing focus on developing awareness of the POLE event (Stage One focused on the OOR event). This will be greatly assisted by the use of Door Markers which are identical to the OORs in use and mounted such that they are easily seen and explored by all individuals following the OOR scheme. It may be that the OOR used has some direct connection to the POLE ( a paintbrush for art for example) which, in itself, assists the individual to understand that the OOR represents the POLE. However, while such connections are desirable, they are not essential; even abstract OOR can be successful providing they are used consistently and staff create an environment (environmental engineering) which fosters the development of understanding.

Stage Two focus begins to move to linking Object to POLE

Stage Two Objectives:

The individual will be able to:

1.     demonstrate increased tolerance of OOR;
2.      hold or otherwise explore the OOR for increased period of time;
3.      interact in any way with a.n.other;
4.      interact positively with a.n.other;
5.      demonstrate longer or increased frequency of interactions with a.n.other;
6.      demonstrate a preference for specific other(s);
7.      demonstrate some awareness of marker OOR at POLE;
         -      look at marker;
         -      reach out and touch/ explore marker;

Staff should begin to direct the Learner's attention to POLE markers and try to demonstrate that the OOR and the marker are the identical items. Staff may:

Remove the marker from the door and place it alongside the OOR in the Learner's field of vision;
Encourage the Learner to explore the marker together with the OOR;
Use words like 'same' and point out similar attributes (both are blue, both are round, both are soft ...)

It is NOT expected that the Learner will understand that the OOR and the marker share identical characteristics and therefore the OOR relates directly to the marker. However, staff are creating the environment which will (hopefully) foster this development.

Please Note:

Not all the above objectives with be relevant for some individuals and may have to be adapted. It is left to your best judgement which to adopt, adapt, or reject.
Although the numbered arrangement suggests a particular sequential arrangement, there may be times when one objective is met before another (earlier numbered) one.
Linear routes may be easier to depict on a website but rarely does life follow text: individuals will progress in different ways by different routes and therefore some flexibility should be built into any system.

Objectives: Stage Three

At Stage Three the Learner is taking on more responsibility and beginning to actively participate rather than being a passive recipient of the actions of others. Staff should do all they can to foster and nurture this behaviour and praise the Learner for particular behaviours when it is appropriate so to do. The Learner, by his or her actions, will demonstrate increased awareness of the process. Interactions with both objects and people will generally be positive (it does not follow that ALL interactions will be positive: we all have our 'off' days!).

A Learner may begin to show signs of anticipation and awareness of the POLE event. The Learner may (if this is possible):
-      get up and move to the door on being presented with an OOR;
-      move towards the POLE area independently;
-      choose the correct direction to the POLE when alternatives arise;
- move into the POLE area without being led or prompted;

It should be noted that a Learner choosing or indicating the correct direction towards a POLE from a choice of two is NOT evidence of understanding! It simply may be a chance occurrence However, if this behaviour was to be repeated consistently then this would strongly suggest an understanding of a relationship between the OOR and the POLE. If the Learner is not ambulant then how can staff ascertain a Learner's awareness of the POLE? They will need to be particularly creative. For example, a staff member could deliberately select the wrong direction in which to go to get to the POLE represented by the OOR. This must be after repeated trips to the POLE using the OOR has had the chance to establish a connection (Stages One and Two) over a period of time. Does the Learner in any way indicate that something is amiss?

Staff will also be expecting the Learner to take the OOR from the OOR bag when the bag is presented. Many Learners will need assistance to do this. The Bag is presented with the correct OOR protruding from its top. This process serves, at least, two functions:

it shows the Learner that the OOR 'lives' inside the bag;
it prepares the Learner for independent retrieval of an OOR at a later stage.

Likewise, staff will expect the Learner to replace the OOR in the bag on reaching the POLE.

It should be noted that the bag is an integral part of the process throughout all stages. While it is not required for staff to present OOR within the jaws of the bag at stage one or two, they should, nevertheless, be taking the OOR from the bag (and, later, replacing it in the bag) in view of the Learner.

Staff should encourage the Learner to begin to make a link between an OOR an it's POLE. For example, on the way to the POLE staff can allow the Learner to lead the way with the minimal amount of assistance possible. It may be that staff allow the Learner to enter the POLE area on their own after seeing them to the room and then just standing back to ensure that they enter. On subsequent trips to this POLE area the staff member may allow the Learner to move unaided to into the room from a greater distance away. In this manner, the staff member is backward chaining learning by gradually increasing the distance the Learner travels independently to the POLE.

Stage Three Objectives
The individual will be able to:

1. take any object from (presented) OOR bag;
2. replace the OOR in to the OOR bag on reaching the POLE;
3. recognize that the presentation of an OOR represents a change in activity by one or more of the following actions:
- ceasing interacting with prior activity;
- getting up and moving towards the door;
- indicating (pointing, eye pointing, vocalizing, ...) an awareness of a change;
4. hold/carry/interact with OOR on route to POLE;
5. choose or indicate the correct direction to follow on route to the POLE on more than one occasion;
6. respond to a staff strategy to test awareness of relationship between OOR and POLE
7. move into a POLE area from a short distance before the area without staff guidance.
8. show an awareness of POLE event represented by the OOR by moving towards or into the POLE area independently;
9. demonstrate increasingly consistent positive interactions with a.n.other;

Stage Three focus begins to move to building awareness of process.

Please Note:

Not all the above objectives with be relevant for some individuals and may have to be adapted. It is left to your best judgement which to adopt, adapt, or reject.
Although the numbered arrangement suggests a particular sequential arrangement, there may be times when one objective is met before another (earlier numbered) one.
Linear routes may be easier to depict on a website but rarely does life follow text: individuals will progress in different ways by different routes and therefore some flexibility should be built into any system.
Staff can be encouraged to suggest ways in which they can assist Learners to make more explicit links between OOR and POLE.
As has been suggested, staff can make use of the backward chaining technique to allow Learners to make their way to the POLE area with the minimum of guidance and support. What other methodologies might they also use?

Objectives: Stage Four

During Stage Four, the Learner is assisted to become more expressive; that is s/he moves from being a passive receiver of the OOR to one who begins to understand s/he can exercise control over others by using the objects expressively. This is very unlikely to happen out of the blue (although it has been known). Typically, the process requires a catalyst; that is, staff promote the expressive phase through their interactions with the Learner. The catalyst comes in the manner in which the OOR are presented.

Prior to Stage Four, it is important that OOR are presented individually; one object for one POLE. When the object is presented, the Learner should move immediately to the POLE. At Stage Four, the Learner can be encouraged and assisted to select the appropriate OOR from the place where the OOR are stored from a choice of two. From personal experience, I prefer a bag-based approach with each individual Learner on the scheme having their own bag and objects.

Thus, at Stage Four, you might begin to present the Learner with a choice of two objects in the mouth of the bag. This should be somewhat 'staged' to ensure that the Learner virtually always chooses the correct OOR. For example, the 'incorrect' object might be placed behind the appropriate choice, such that the Learner is 'assisted' to make the correct choice of object for the POLE. However, if, by accident, the Learner manages to get hold of the incorrect object, don't panic! Simply, accompany the Learner to the place indicated by the (incorrect) OOR then, immediately, present the correct OOR (without choice!) and proceed to the correct POLE. In this way, the Learner's choice of OOR was fulfilled even though it was not the OOR for the next time-tabled item on the curriculum.

Another technique which can be introduced at stage four is to take all OOR from a Learner's bag leaving only one OOR . The OOR remaining should be the correct OOR for the next POLE. The Learner is encouraged to take the OOR from the bag (rather than from the mouth of the bag). The OOR, thus 'selected', is, of course, the correct OOR for the next item on the Learner's timetable.

A further technique, that does not involve the use of the bag but can be used at this stage to promote the concept of choice, is the use of an adapted FOPA system (Free Operant Preference Assessment). This technique is explained in detail on the 'Choice Pickings' page on this website. It may be adapted such that the Learner can make free choices of the OOR used in the scheme. See the FOPA section lower on this page for further details.

During all stages, when the bag is used, it is important that the Learner comes to understand where the bag lives. If it lives on a peg on the wall, then the Learner should be able to see the staff member getting the bag from the peg. If it lives on the back of a Learner's Wheelchair, it is equally as important that the Learner knows that it is kept there. How can a Learner see behind him/herself? Using a mirror is one option. Allowing a Learner to see that other people (who use wheelchairs for mobility) have their bags hanging from the handlebars is another. However it is achieved, it is important that the Learner comes to understand that the bag is where the OOR live and the bag is always kept in the same place.

The process of encouraging the Learner to take / retrieve a desired OOR from a bag (or alternative) is an essential precursor to Stage Five in which a Learner independently selects an OOR and presents it to a member of staff.

At any stage a Learner may indicate an understanding of a particular object. That 'understanding' should be recorded. Understanding can be shown in a number of ways:

action (Learner raises a cup OOR to mouth for example);
name (Learner names OOR using other AAC system: points to a symbol for example);
vocalisation (identifies OOR through sound association);
movement (Learner moves to correct POLE area);
other (?).

It is at Stage Four when we expect a Learner to be beginning to make the connection between an OOR and a POLE independently (without staff assistance). Thus, it is always gratifying when a Learner indicates an awareness of the connection by any means whether direct or indirect.

Stage Four Objectives
The individual will be able to:

1.       select an 'appropriate' OOR from two on request when the OOR are positioned to 'assist' the process;
2.       indicate a knowledge of the location of OOR bag;
3.       take OOR from bag (errorless - 1 item in bag);
4.       move more independently (than Stage Three) to new POLE on presentation of OOR;
5.       identify OOR by gesture (raise cup to mouth);
6.       identify OOR by sign or symbol;
7.       identify OOR by vocalisation or other;

Stage Four Focus is on 'helping' the Learner to move from passive communication to expressive.

Please Note:

Not all the above objectives with be relevant for some individuals and may have to be adapted. It is left to your best judgement which to adopt, adapt, or reject.
Although the numbered arrangement suggests a particular sequential arrangement, there may be times when one objective is met before another (earlier numbered) one.
Linear routes may be easier to depict on a website but rarely does life follow text: individuals will progress in different ways by different routes and therefore some flexibility should be built into any system.

Objectives: Stage Five

During Stage Five, the Learner is beginning to use the OOR expressively for him/herself. That is a Learner may take an object from its storage position (for example the OOR bag) and present it to a staff member to request a particular event.

Stage five may not be reached by all who follow an OOR scheme. Some may move onto another scheme before they ever reach this stage. For example, they may begin working with symbols and the OOR scheme gradually is phased out. Some Learners may never use the OOR expressively although, if the scheme is followed, and all Significant Others play their part, there is no reason why, given sufficient time, that any Learner should not reach this milestone.

It is my experience that Learners do not reach stage five with all OOR simultaneously: there is usually one or two objects which have the honour of being used in this way. I am not aware of any research which states why this should be the case but I hypothesize that those OOR that are more motivational and are used most frequently (and regularly) are the ones with which the Learner may one day surprise you!

When an OOR is presented in this Stage Five manner, in other words, when the Learner gives a Significant Other an Object, what should the SO do? First of all, they should not get too excited and rush around telling all the other SOs what has just happened. It is really important that the SO acts upon the request such that the Learner can see the power of expressive communication. To do anything else is to negate all the work completed in all the other stages leading to this point! If the Learner presents an OOR to a SO it must be treated as a request by the Learner for the POLE and, thus, the POLE should be provided immediately.

What if the Significant Other believes it to be an accident or a 'fluke'? It does not matter! The SO must act upon the request an create an active environment (see Jean Ware's work 'Creating and Active Environment'). The SO must not be tempted to get the Learner to 'do it again' to prove that it was a genuine request. If an OOR has been presented by a Learner the POLE should be provided.

What if the Learner is supposed to be at some other place and the request is for a different POLE? You go with the Learner to the requested POLE. Find some way of sending a message to the other location to say that the Learner will be late. When the requested POE is reached or presented and the Learner has had time to see that his/her request has come to fruition then it is possible to present the OOR for the 'other place'. How long is enough time? How long is a piece of string?! There is no good answer I can give to that question, the SO will have to ascertain if the Learner's request has been fulfilled from the Learner's viewpoint. If the request was to go to the toilet then it should be fairly easy to figure out when the request has been fulfilled!

What if I have to be someplace else and a request is made of me? It is more important to fulfill the Learner's request. Do NOT pass the responsibility to another member of staff, the request was made of you so you must enable the Learner to fulfill it. However, it would be apt to get a message to the place where you should be to let them know the current situation.

What if the Learner continues to ask for the POLE in the middle of other sessions? For the first (let's say) thirty times (with a single OOR in a single session) fulfill the Learner's request. It is vitally important that the Learner understands that s/he can control his/her environment through communication with others. After this, then it begins to enter the realm of pragmatics. People first learn to communicate and then they learn when it is appropriate to communicate and when it is not. Each case must be considered on its merits and any decision made should be by a consensus of a team rather than the decision of one team member. Thus, the first time the multiple request situation occurs, try to fulfill ALL the requests but take the issue back to team to discuss the future strategy. Do not take it upon yourself to make the decision to refuse to fulfill a request because you have already fulfilled the request four times in the last 20 minutes! Rejoice, this is a fabulous problem! The Learner is demonstrating expressive communication for the first time ever. The strategy has worked and the team should be praised for a job well done. It may seem a small step forward for Significant Others but, for the Learner, it is a giant stride with profound implications for that individual's future.

It may be that the request is to go to the toilet repeatedly in one session. While, on the second occasion nothing may occur, that is no reason for refusing to go on the next request. Significant Others must understand that the fulfillment of the request is reinforcing the concept of expressive communication in the Learner's mind. To deny the request is to negate that process and not good practice. So what if the Learner does not want to go to the toilet when you get there? It does not matter; play the game! Try to put yourself in the Learner's shoes. If you suddenly discovered a new power within you, wouldn't you want to do it over and over again? However, remember to take this issue back to the team to discuss.

It may be that the request is for a particular item (for example a drink or a favourite toy). If the Learner already has been given a drink (and, thus, the request has been fulfilled) and another request is made before the drink is finished then take the drink away and top it up. If it has not been touched, treat the request as a sort of a game and keep taking it away and bringing it back (or bring another drink!). The Learner might find this amusing but will also come to understand that s/he has the power to control the actions of others. Again, after that first session when you have been running around fulfilling a Learner's POLE requests over and over, take it back to the team to decide on the next strategy. Please remember that you are all winners! This should not be seen as a problem but rather a cause for celebration.

I do have ideas for what to do in such circumstances but I will not present them here. Please contact me if you wish to discuss options!

What if the Learner requests a POLE that simply cannot be provided? Suppose there is an OOR for swimming and the Learner loves to go swimming but swimming takes place out of school in a local facility which is only made available once per week. This is not untypical. Now, suppose that a Learner makes a request for swimming at a time when it is not available! It defeats the goal of the system to refuse the request. Such a request should NOT be possible (See rules below). If there are such OOR contained in any Learner's set they must be removed and only made available when a request can be fulfilled. While this is not the optimum situation it is probably a necessary action to avoid the possibility of such an event. If any one has a better idea for such an event please let Talksense know and we will add it to this page.

In Stage Five Learners begin to use OOR expressively. Learners are encouraged (and assisted) to present OOR to Significant Others to make a request for a POLE to the point at which a Learner begins to understand that s/he is able to do this for him/herself. It is important that Significant Others immediately respond to a Learner's request so as not to negate all the work that has been involved in reaching this important milestone.

Stage Five Objectives
The individual will be able to:

1. select appropriate OOR from a range placed in front of user;
2. select appropriate OOR from presented bag (choice of two);
3. indicate a need for OOR bag;
4. select appropriate OOR from presented bag (choice of >2);
5. initiate communication using OOR;
6. repeat the use of an OOR to initiate communication on more than one occasion.

Stage Five Focus is on 'helping' the Learner to become an expressive communicator.

Please Note:

Not all the above objectives with be relevant for some individuals and may have to be adapted. It is left to your best judgement which to adopt, adapt, or reject.
Although the numbered arrangement suggests a particular sequential arrangement, there may be times when one objective is met before another (earlier numbered) one.
Linear routes may be easier to depict on a website but rarely does life follow text: individuals will progress in different ways by different routes and therefore some flexibility should be built into any system.

Stepping Stones: Transitioning Between Stages

While some Learner may be able to move between stages as a result of interacting with objects on a daily basis it is likely that these will number only in the minority; most Learners will need assistance to 'move on up' - a set of stepping stones to assist them to cross the stream.

While the techniques utilised in the delivery of any OOR and MSR scheme should directly assist a Learner to progress, it will be necessary to provide additional support to guide the Learner gently forward.

Each stage differs to the previous in only small details. However, as we know, what seem small things to us can be mountainous to those experiencing PMLD. The following ideas may help you understand what may be necessary to transition between stages. Each transition is detailed separately below.

GENERIC (ALL STAGES)

Take your time: be patient;
Ensure a sensory experience for the Learner on presentation of OOR;
Ensure that staff are familiar with and following the OOR rules set out in the section on rules later on this page;
Ensure that the Learner is encouraged to navigate between POLES: Staff should not lead the way rather they should encourage and facilitate the Learner's navigation to the destination. While this is important for all Learners, it is especially important for those Learner who are non-ambulant (and who do not self propel their wheelchairs or use an electric wheelchair).Staff typically whisk such Learners between POLEs with minimal Learner (cognitive) involvement.

STAGE ONE TO STAGE TWO
The main difference between Stage One and Stage Two is the Learner's tolerance of the OOR. While this might naturally arise over time staff should nevertheless do what they can to assist this progression. The following are some ideas that may help (the list is not intended to be completely comprehensive):

Persevere: over time the Learner should become accustomed to the practice.
Be consistent: on every change of POLES present the OOR;
Take your time. In the hurly burly that may be the special education curriculum that Learners may have to move between POLES in limited amounts of time and staff may feel pressurised to undertake a particular practice quickly. This should be avoided. The development of cognitive awareness through the use of MSR/OOR is of great value to all and thus should be accorded the necessary time to give the scheme a real chance of success.
Never force an OOR on a Learner. The process should always be pleasurable and fun. It should never be coerced and distressing.
Praise the Learner for carrying the OOR between POLES. Let other Learners see and hear you praise Learners for this behaviour.
Make a reward contingent on handling and holding an object. For example, if a staff member picks up a textured ball and puts it into a nearby clear plastic box give her a sweet/candy (or other suitable small reward). This behaviour is modelled for the Learner by staff. If the reward is something that the Learner particular desires, will the Learner imitate? Please note that OOR should NOT be used for this purpose as it breaks the OOR Rule #1. Use an object that will not be used in the OOR scheme but is similar in size and texture to the ones that the Learner is currently rejecting. While the object concerned my begin proximal to the box, once the Learner does this, move the objects and the box further and further apart and make the task more
Consult your therapy team on issues of Tactile or Sensory Defensiveness.

A Learner who is uncomfortable with interacting with objects may signify an issue of 'Tactile Defensiveness'. If such a condition is identified, your therapy team will be able to advise you on means of addressing the issue.

STAGE TWO TO STAGE THREE
The most important difference between Stage Two and Stage Three is the Learner's growing awareness that the OOR have meaning. An indication of this is Learner movement following presentation of an OOR. Staff may take several actions in order to assist the development of such awareness. The following list is not intended to be comprehensive, you may be able to add other ideas:

Use door markers;
Ensure that door markers are noticed by Learners: point them out, talk about them;
Ensure that the OOR being transported between POLES is matched to the door marker;
Ensure that the OOR is always presented from the bag (or that the Learner is aware of where they are situated in the room if an alternate approach is being used);
On presentation of the OOR always:

- sign and say or otherwise signify the new POLE;
- give and go (Rule One);
- give and take (Rule Two);

Ensure that Staff understand that the 'Goal is Control' (Learner Control) and thus, the Learner should lead the way to the POLE with the staff member simply acting as a facilitator.
Use backward chaining to empower the Learner to do more of the change of POLE for her/himself;
Make transition between POLEs fun.

STAGE THREE TO STAGE FOUR
From Stage Three through to Stage Five there is a growing awareness of the Objects as means of empowerment. The Learner should begin to realise that s/he can choose to effect control over others through the use of the Objects. Again, staff should not simply sit back and expect this is happen by itself without any assistance from themselves other than delivering the OOR scheme consistently. What can they do to help? All staff need to scaffold learning to be supportive. The following are some ideas that may help. The list is not intended to be comprehensive:

ask the Learner to indicate where s/he is going (what s/he is going to do) on presentation of OOR:
get the Learner to take the object 'out' of the bag. To ensure the correct object is taken, remove all other objects but the one that is required for the new POLE.
Continue empowering the Learner to make decisions over the direction to the new POLE;
Use Pole Positioning (see section later on this page) to enhance the knowledge that Objects create empowerment;
Use Co-Active Objects (see section later on this page) for Learner control.

STAGE FOUR TO STAGE FIVE
The development of expressive skills will move the Learner from Stage Four to Stage Five. Experience tells me that all Learners will not reach Stage Five (however we must still make the attempt) and those that do will not reach it with all objects (although by reaching it with one object the potential must exist for the use of all objects). There are a number of ways to assist a Learner to make the transition. The following list is not intended to be comprehensive:

Ensure the Learner knows where the OOR 'live'. If it is in the bag, ensure the Learner always has access to the bag or has a means or indicating a request for the bag;
Play 'Can you find it in the bag?'; see section below for details
If a Learner accidentally gets hold of an OOR then staff should treat it as though it were an intentional behaviour an move to the new POLE if only for a few minutes (prior to presenting another OOR for the 'correct' POLE);
get the Learner to choose between two objects proffered at the mouth of the OOR bag. If the Learner selects the 'wrong' object then go to the 'wrong' POLE - at least, initially!
Use Free Operant Preference Assessment (FOPA) (see section later on this page) to enhance the notion that the choice of an object leads to the choice of a location or an event;
Continue the use Co-Active Objects (see section later on this page) for Learner control.

MOVING BEYOND STAGE FIVE
Once on an OOR scheme many Learners stay there or the scheme fades into non-existence and no progress is made. Neither of these should be our goal. Our goal is to view the OOR scheme itself as a means of transition to other forms of communication such as the use of sign and or symbols. In order to facilitate this, staff might:

ensure that the symbol for the POLE is attached to the OOR. It is not that the focus is on the symbol (it is not, it is on the OOR) but rather that as the OOR is presented the symbol is also presented such that the Learner may come to associate symbol and POLE over time.
ensure that the symbol for the POLE is alongside the door marker object at the entrance to the room/location.
ensure that they give a clear sign while stating the new POLE on presentation of the OOR;
introduce a symbolic timetable if one is not already in place. Do not be tempted to work with symbol timetables too early. For most Individual Learners Experiencing PMLD the concept of what is happening on next Thursday afternoon is too demanding: they need to understand what is happening now or what is going to happening in the next couple of minutes. MSR and OOR address these issues.

Can you find this in your bag?

Playing 'Can you find this in your bag?' is a means of helping the Learner to know where the objects are located and that the objects can be used to control others. A staff member shows an object to a Learner BUT does NOT give it to him or her. The staff member says, "Can you find this in your bag?".

At first the bag is provided containing just one item: the item that is required! Once the Learner has taken the object from the bag and given it to the staff member, the staff member should provide lots of praise and then together they should move to the POLE indicated by the object if only for a few minutes of work there.

Once successful with one item, a further SINGLE item can be used in the same way. It is important not to move to two items until both of them have been successfully removed from the bag by the Learner. The new item should be selected so it as distinct from the first item as possible: if the first object was hard the new object should be soft, If the first object was smooth then the second object should be textured in some way.

Once the first two items have been established in this way then we can put both objects in the bag and ask the Learner to find a particular one. Hopefully, s/he will locate and give you the object you have shown but, if the Learner gives you the other object, respond as though it were intentionally ... "oh you want to go to X" and both of you should go off to X together for at least a few minutes.

If the Learner takes the correct object from the bag then provide lots of praise and move off to the particular POLE represented. Do not assume that the Learner has understood the nature of any part of the process at this point though. Selecting the correct object from a choice of two is a fifty fifty chance. However, if the Learner can get it correct on several occasions without error then we can start to believe that there is some understanding.

Free Operant Preference Assessment (FOPA)

A 'free operant preference assessment' is a short period of assessment of approximately five minutes in which a Learner is provided with free access to a variety of items believed to be stimulating (See, for example, Roane et al.; 1998). Several such items are placed within the Learner's reach and the Learner is free to explore or work/play with any s/he chooses. Staff record the amount of time the Learner engages with each item. The more time a Learner spends with any single item is seen as indicative of Learner preference. The set of items provided can, thus, be ranked in order. Free operant assessments therefore provides a simple and speedy means of evaluating Learner preference.

While there are some issues with this technique, these are addressed on the Choice Pickings page.

This technique may be adapted for use with Objects Of Reference ONLY when a Learner reaches and has progressed through most of Stage Four.

The Learner is sat at a table;
Several OOR are placed around him/her in easy reach;
If the Learner takes an Object that is treated as a conscious choice (we create a Responsive Environment);
The other objects are removed and the Learner gets to do ten minutes of the OOR activity in the POLE position;
In the new location, the Chosen OOR is removed from the set and the others are replaced around the Learner;
If the Learner takes an Object that is treated as a conscious choice;
The other objects are removed and the Learner gets to do ten minutes of the OOR activity in the new POLE position;
The Chosen OOR is removed from the set and the others (including the first OOR chosen) are replaced around the Learner;
... Continue until end of session.

Such an approach obviously requires significant preparation and flexibility. If five OOR are positioned from which the Learner may make a free choice, there must be five sets of materials available with which the Learner can work and five areas must allow a Learner and a member of staff to enter and work separate from others that may be already occupying it.

The objective of this approach is to show the Learner that s/he can take control of the OOR scheme and by making a choice of OOR can select what they s/he wants to do in what order. This technique does not involve the bag but the Learner should have had lots of other OOR experiences with the bag and be beginning to realise that the OOR are located there.

What if the Learner chooses the OOR for personal care from the table top set? They may not want to go to the toilet!
There are at least two possible ways to deal with that issue. The first is NOT to put out those OOR (including personal care) would be inappropriate for this session. The second is to treat the choice as a request to go to the toilet and actually go.

What if the Learner cannot physically reach out and take an OOR?
Then you must adapt the technique in such a way to make it more inclusive. For example, staff could monitor the Learner to see at which OOR the Learner is looking and take that as a conscious choice.

What if the Learner does not reach out and take an OOR even though he can do so?
You could take this as though the Learner had made a choice not to participate in this activity at this time and move on to do something else for twenty minutes or more and then try again a little later.

What if the Learner always takes the same OOR?
That is impossible as each time the Learner chooses an OOR that Object is NOT provided in the next selection set. The worse that could happen is the Learner chooses the same two activities over and over again. There are at least two schools of thought on this:

if the Objects are placed in random order and the Learner always chooses the same two then this would seem to indicate real choices (maybe, the learner is just attracted to a particular colour or attribute).
The OOR should not be replaced in the set until three or more choices have been made.

What if the Learner is selecting by colour and not really understanding the link to the POLE?
We could test for colour preference in a different activity to see if colour is really a deciding factor. However, the Learner is still learning that what is chosen determines what will happen. Of course, if you move to a factor of three or more removals, then the Learner cannot keep selecting on the basis of a preferred colour unless the Learner has a preferred colour hierarchy which may be an alternative explanation for the choices made. However, again, the Learner is still receiving consistent experiences contingent upon the choices s/he is making.

Whoah! We cannot take the Learner to another classroom as it will disturb others that might be using it.
There needs to be considerable preparation and flexibility for this technique to work. Each potential area requires a set of materials available that the staff member can utilise with the Learner which does not involve making demands of the incumbent staff. The whole procedure must be set up to be as non-disruptive as possible and make no demands on others. If this is a problem then do not introduce the technique. Others will need to be informed in advance of the use of this technique so that they are not surprised by a potential visit from a Learner and another member of staff. The visit is only potential because the choice is in the control of the Learner and s/he may opt not to go to a particular location for a particular activity on a particular day and at a particular time. Thus, everyone has to be flexible and patient for it to work!

We haven't got sufficient staff to do this. We cannot lose a member of staff for ten or minutes at a time from the room as s/he may be required for other duties.
If you cannot staff it, don't do it. Do it wen you can staff it. Remember, all of the group will not be at stage four at the same time and therefore it may only involve one Learner and one staff member.

Shouldn't we have an OOR for the FOPA choice making activity?
You already have one: it is the OOR bag!

Approaches to Objects Of Reference

There are at least three approaches to OOR that have different strengths and weaknesses. Some people prefer one over the others and I favour and recommend one that is typically NOT favoured by many others! The approaches are SDI which stands for:

            Shared
            Differentiated
            Individualised

In a shared approach all Learners use the same things for each POLE. So for example, for break, they may all have a blue plastic cup.
In a differentiated approach, while all Learners use essentially the same object each may have a different type and colour of cup.
In an individualised approach each Learner can have a unique OOR that is special to them. One may have a cup, another a beaker, another a straw, and another something completely different such as a place mat. There are strengths and weaknesses in each. I personally favour the shared approach BUT most books on the subject recommend an individualised approach. Indeed, in 'Objects Of Reference in practice' (Birmingham University 2003) Professor Liz Hodges wrote (page 26);

"I have real concerns about the use of all-purpose sets of Objects Of Reference (or all purpose anything in this complex field of education). For reasons already outlined, children’s first Object Of Reference need to emerge from their own experience of objects within activities and only when a child is a confident user can Objects of Reference be introduced in isolation."

With great respect, although I understand why Prof Hodges would champion such a statement, I disagree for a number of reasons:

First, language is NOT individualised, it is shared. For you to read this article on the web, you must share the same language with me. For signers to sign to each other with meaning they have to share the same system of signs and in schools do we adopt a different set of symbols one for each and every symbol user? No. Why then should we differ with OOR?
Second, and on a practical note, it is much more difficult to keep track of individualised OOR for a number of Learners when they may have several each. It makes the staff's role more difficult and I make no apologies for being staff centred.
Third, and on a financial note, it is more difficult and much more expensive to replace individualised items when they go missing than it is shared items which may be purchased in bulk.
Fourth, it is the very nature of the scheme itself that creates a inter-connection between the object and POLE. The Learner learns through frequent repetition that a specific object is associated with a particular POLE. The object could be totally abstract although I would not deliberately seek out abstract objects and would use ones with an established connection (plate and meal, cup and break, ...) where such a connection exists.
Fifth, the statement sets a prerequisite and I have great mistrust of pre-requisites! For me, 'Only when a child is a confident user' is a prerequisite. I would argue that the child becomes a confident user through involvement in the scheme and dedication, persistence, and consistency of the staff and their approach.
Sixth, with any other approach than shared, door markers cannot be utilised. (see below)
Finally, I know, because I have implemented such shared schemes, that it can work to great effect. I have no doubt that the individualized approach also works well too but, it is my personal belief that it can hold a number of problems.

I may well be wrong. However, having made my case and stated Professor Hodges' opinion, I leave it to the reader to make up his/her own mind on the matter. While we may disagree on one or two aspects of OOR, however, we agree on more than we disagree!

There is one other statement with which I disagree, in part at least, with Professor Hodges. It is to be found on page 27 of the work already cited:

"OOR are not a panacea – the introduction of OOR can be a very useful strategy but it is not a universal one. Some children do not have sufficient physical control or tactile discrimination; some are not developmentally ready to link object to activity; some simply respond better to other types of cues such as speech or music. Giving every child a set of OOR is as much a nonsense as expecting all children to speak or sign."

While I agree with the underlying philosophy behind this statement, there are a number of points with which I will present a differing viewpoint, once again, with great respect to the Professor. I will explain why I believe the way I do in each case and, again, allow readers to decide for themselves:

"Some children do not have sufficient physical control". For me, that is not a reason to exclude them from an OOR scheme. If they cannot hold an OOR, assist them to explore it, rub it gently on their skin, move it in front of their eyes to allow visual exploration of its surface, allow them to smell, to hear, and to experience.
" or tactile discrimination". I would want to argue that we become more proficient in any skill by practicing it. If we bar a Learner because s/he has insufficient tactile discrimination how then are they ever going to learn haptic discrimination? Would not almost any other approach we take also preclude such Learners for the same reason! Why can't OOR be a means of assisting an individual Learner develop tactile discrimination?
"some are not developmentally ready to link an object to activity" Do not neonates begin to form links from the moment they open their eyes and experience the world? Isn't it, indeed, one way in which we learn? How do we make this judgement? Based on what evidence? Who is to decide who can benefit from such a scheme and who can't. Who would want that responsibility?
"some respond better to other types of cues such as speech or music". First, no one ever said that we could not combine speech or music with an OOR scheme. For me, one does not preclude the other. Second, if a learner could respond appropriately to speech alone, I would argue that they are no longer experiencing PMLD but have moved beyond this stage. It is more likely that they are responding to all the other contextual cues that accompany speech and, for me, that is a demonstration that they will be more likely to benefit from a structured and consistent OOR scheme.
Giving every child a set of OOR ... " Again, who is to make this decision? On what basis? Doesn't every child have a right to participation in an OOR scheme if there is any possibility that it will help them progress? Who is excluded and who is allowed? Learners at such a level are notoriously difficult to assess formally. We can never prove they are incapable of an action or a thought BUT we can prove, beyond all reasonable doubt, that they are capable of such things. We can never say with absolute certainty that 'Johnny will never' but we can say with absolute certainty that 'Johnny can ...' Of course, if you take this argument to its logical conclusion then we would have to allow all Learners to follow every scheme and that is, obviously, a nonsense. We do have to make judgements about who does what and when based on ability. However, I still have a funny feeling about the preclusion of some Learners from such a scheme. You must decide for yourself.

The RNIB in their on-line document (search for Objects Of Reference RNIB) state the following:

"It is sometimes argued that objects of reference should be standardised throughout a school. It is very strongly recommended here that each object of reference is child-specific; for Afzal the webbing was the correct object of reference for "car" because she held onto her seatbelt whilst in the car. Thus she could readily associate the webbing with the experience of going in the car. However, as soon as Robert got in the car he stretched out his hand to feel the drop-down table on the back of the front seat. He showed no interest in the seatbelt, so he would have been unlikely to attach the special meaning "car" to a piece of webbing; instead, his object of reference was an identical drop-down table donated by the local garage.

Another factor to bear in mind is what will happen when the child moves to another school, or leaves school and goes to college. If child-specific objects of reference have been used, these can readily transfer to the new setting with the child. However, if a standard set has been used in school one, and another, different, set in school two, communication will break down and the child is likely to become very bewildered and frustrated."

Once again, I find myself slightly at odds with this item in a particular part of the document (although not with the document as a whole):

Having every object of reference child specific (individualised approach) makes it very complicated for staff to remember what goes with what if lots of Learners are on the scheme. It's difficult enough for staff to be consistent when a shared set is used, it is much more difficult when an individualised set is in place. A shared set that is used consistently is better than an individualised set that isn't. In an ideal world, I would concur with the RNIB; unfortunately we do not live in an ideal world and I would recommend a practical approach. The very nature of the task demands a consistent approach. Anything less is doomed to failure. An individualised approach makes consistency that much more unlikely. If you believe that the staff in your establishment will cope with hundreds of different OOR then the individualised approach should be the system that you use. However, I have found that staff already have more than enough on their shoulders in every special education establishment in which I have worked, adding more is unlikely to promote consistency.
The thirty second rule is a good recommendation for new requirements in special educational establishments. That is, if it takes staff longer than thirty seconds to do something additional they are unlikely to do it - not because they are lazy but because they are already up to their necks in work and simply cannot cope with more and more loading. Thus, if I am asking staff to do something new, I try to figure out how it can be done in thirty seconds or less. If I can reduce the need to think about the task then it is more likely to achieve automaticity and become routine. Ask yourself, would a different object for every Learner on the OOR scheme for every POLE be more or less likely to become routine for staff than the shared approach for your staff?
Having individualised OOR pushes up the cost of the scheme a large amount. Trying to replace individualised OOR when they get lost or broken is a much greater and more demanding task. Once again, in an ideal world, the individualised system is philosophically the better approach but in a less than ideal world which is the more practical?
Language is NOT individualised, it is shared. For you to read this article on the web, you must share the same language with me. For signers to sign to each other with meaning they have to share the same system of signs and, in schools, do we adopt a different set of symbols one for each and every symbol user? No! Why then should we differ with OOR?
For Afzal, we cannot state a single 'correct' OOR. Te document says that Aftzal had to be taught to associate the webbing with the car over 'several days'. Was another OOR tried? Would this not also have had the same effect if presented consistently over the same period prior to movement into the POLE? The document states that Afzal has no functional vision. Not every person experiencing PMLD has such problems with visual acuity and thus movement to ,the car and the car itself would become a sensory cue to a repeated experience. Even with such additional handicaps, I would want to make the case for a consistently applied shared system.
The RNIB document claims that Robert would be unlikely to attach a special meaning to any other than the drop down table. Although I do not know Robert, I doubt this very much. All children are capable of learning. For some, it is a much more difficult and time consuming process than for others but, with patience and consistency, we can engineer the situation such that a specific object becomes associated with a specific POLE. How do the RNIB paper authors know that Robert would not attach meaning to such an object? Did they try it or did they just assume it? Isn't what they are saying akin to inferring that Robert is incapable of such learning? Surely, as educators our purpose is to help enable children to make such connections. Isn't that what learning is?
For me, Robert's drop down table acts as a sensory cue to his current location (L) and therefore should not be used as an OOR but should remain as one of the main sensory cues to this POLE..Furthermore, a drop down table would seem to me to me to be a little on the large size to be an OOR. Normally OOR are portable and can be carried to the POLE by the Learner as the indication of the coming POLE.
It is true that child specific objects of reference can transfer to another establishment but then so can a set of shared OOR if the new establishment is willing to work with individualised. If it isn't then it doesn't matter what set is used.
For me, an OOR is another tool used in emergent communication with the goal of promoting expressive communication. Could a drop down table be used expressively? Maybe. However, if this is a favoured activity what if it was used during class when the car was not available? "No Robert, you cannot do that now"! So, do we deny Learner access to some OOR and use them only receptively? Isn't that somewhat defeating the goal of the exercise? Doesn't that also make the whole scheme a little more complex for staff to manage?

All three approaches will work if executed correctly. However, which is the more likely to be executed routinely and consistently? I am not against the individualised approach; indeed, I believe that, philosophically, this approach is the better. It is just that pragmatically I believe the opposite to be the case! You must consider my arguments above and make a judgement for yourself. I always present both sides of the debate when giving presentations and state the reasons for my approach and allow the audience to make up their own minds.

While there is almost certainly no single correct approach to the use of OOR there are definitely incorrect approaches and methodologies. Inconsistency is such an incorrect methodology. If an individualised approach can be be maintained (financially, pragmatically, and consistently) then I would advise its adoption. However, if you do adopt this approach, please continue to ensure that it is happening as it ought (as it is written in your policy document) because the individualised approach, by definition, is that much harder to operate.

Readers should also note that a shared approach does not entirely rule out some differentiated exceptions. For example, a particular Learner may already be working with a couple of OOR that have been established by family (or other body) which can be accommodated into the scheme. The odd differentiated OOR in an otherwise shared scheme is not going to cause significant problems.

In 2005, in her book on teaching communication, Professor June Downing (Professor Emerita of Special Education at California State University, Northridge, USA) suggested that while a highly idiosyncratic experience of a particular referent is perhaps best represented by an individualized OOR (tangible symbols), standardized OOR can be used when a referent is experienced in a similar way across individuals especially when a dominant feature of the referent is a part of the object.

"I mean, in the beginning, I wasn’t sure about the whole thing. Because when you think about communication systems, you think about what’s the most relevant to each student individually. So, having this universal system, well, it seemed like a great idea. It kind of
seemed like, how are these kids going to understand this if they don’t have any relationship to the symbol? But having gone through it, you know, and seeing some real progress, you know, I think it, for me, it seems like it is about the consistency." (Teacher quoted in Bruce, Trief, Cascella, 2011)

Consistency and Human Error

"I really like the way it [the intervention] went. I think the only issue I had was getting
everyone on board. Getting related services to actually take the cues out and probe the
kids. That was a little difficult, to get everybody on the same page. It had nothing really to
do with the kids themselves." (Quoted in Bruce, Trief, Cascella, 2011)

In an ideal world, we would want to build a system in which there was consistency right across the curriculum for the implementation of an Multi-Sensory Referencing and an Objects of Reference Scheme. However, we do not live in an ideal world and, experience tells us that, things are likely to go wrong!

In order to build a consistent Objects Of Reference system, it is wise to try to eliminate any possible errors or, at least, reduce them to a level where they have a minimal effect on Learning.

What are the possible errors? There are errors which are caused by the design of the system itself and those which are related to the human factor (although, it could be argued that, the system errors are originally design faults caused by human error). In the Technique for Human Error Rate Prediction Methodology (see - Swain, A.D. & Guttmann, H.E., Handbook of Human Reliability Analysis with Emphasis on Nuclear Power Plant Applications. 1983, NUREG/CR-1278, USNRC.) the possibility for error is analysed. There are:

Errors of Omission

leaving out a step of the task;
leaving out the whole task itself.

and;
2. Errors of Commission:

Errors of Selection – error in use of equipment or in issuing of commands.
Errors of Sequence – actions are undertaken in an incorrect order.
Errors of Timing – action is undertaken before or after when required
Errors of Quantity – inadequate amount or excess amount

What factors contribute to a greater possibility of error? These include:

More actors more likelihood of erroneous actions;
Increase in equipment involved;
Stages in task (number of);
Training quality and Time since Training;
Amount of complexity in task;
Knowledge and understanding of task;
Equipment and Environmental failure;
Stressors (External).

Let's take each of these factors in turn:

M is for More: The more people (that includes both staff and Learners) in any scheme then the more likelihood that an error will occur: the two are directly proportional. That does not mean that in a scheme with only one learner there will be no errors, it just means that it is statistically more likely that if you are operating with tens of individuals. This is an argument for restricting the number of staff involved but as some staff may act as mentors, police other staff, act as substitutes when particular staff are unavailable, and promote good practice there may be advantages to having a whole team involved. Scheme with only a single Learner should follow the individualised approach to OOR by definition. However, as the number of Learners rise a move to a shared scheme has its advantages. As the earlier quote in this section suggests, 'getting everyone on board' is not an easy task. Even wen they are on board keeping them on board and maintaining their involvement is equally as important and as difficult.

Increase in Equipment. An increase in the number of Learners requires more equipment. Individualised approaches means that this range of equipment has to be multiplied by the number of Learners. With such a large range of equipment the possibility of error, chance of loss (without immediate replacement), and the cost increases significantly.

Stages in Task. The number of stages in any task increases it's demands of staff. It follows that there is more opportunity for staff to forget a stage (or decide to skip a stage) the more stages there are. When time is pressing (see Stressors to follow) the temptation to curtail a particular practice (It won't matter if I do not do this. Who will know? I haven't got time today but I'll do it properly tomorrow ...) is increased.

Training is vital and good initial training, such that all staff are aware of the system and the reasons for its implementation, is vital. However, over time, staff tend to forget the fine details of their training and develop idiosyncratic means of doing things. Ask yourself if you still drive your car in the same way as you were originally taught? I doubt it! The longer it is since the last training on MSR/OOR the more likely it is that staff will vary practice or develop bad habits. It is therefore important that regular training top ups are scheduled to ensure awareness and consistency of approach.

Amount of Complexity: the amount of complexity in any task is directly proportional to the number of errors and inconsistencies in the future unsupervised performance of the task. In some cases, Thus, keeping any task relatively simple is a positive step in maintaining consistency. Sharing work load among staff can reduce complexity. Reducing the amount of equipment. Decreasing the cognitive loading. Supplying check lists. Introducing regular training top ups.An individualised approach for all but a single Learner is, by definition, more complex than a shared approach. Therefore the chances of error are also increased.

Knowledge and Understanding: Training has already been discussed. However, some training informs staff what to do but does not tell them why they are doing it! Staff need to have the knowledge of the theory behind the process such that they are more aware of why they are doing a particular action in a particular way and it's benefits for Learners. They need to understand, for example, that such schemes can take a significant period of time to have any effect and therefore they should not expect results in a matter of days. They need to understand why consistency is important and they need to feel that they have a voice in the process (ownership).

Equipment and Environmental Failure: If your flying a plane and an engine fails there is an immediate need to know what to do and any mistake or error of omission can be very costly (indeed, life threatening). Of course, it is not the same on an OOR course: it is not life threatening or is it? Isn't poor education threatening to the quality of life faced by any child? OK a bit dramatic so let's leave that argument aside for the present. If it is seen as not life threatening then the chance that a staff member will think that it will not matter if I do not do it this once (error of omission) is increased. If an object is missing, broken or unavailable then the staff member is highly unlikely to go searching for a new one (s/he will probably not have the time). If the weather turns nasty a pilot might become concerned about passenger safety. At such times, the demands on the pilot increases and the chances of error are raised. Likewise, environmental factors plays some role in increased errors in staff operation of any scheme. If the schedule is tight, if the Learner is having problems, if another person is causing an issue, then these might have an effect on staff behaviours at that time (see also stressors to follow) and errors might result. Also if the environment fails both the staff member and the Learner (for example the scheme is not set up to cover missing OOR and so the environment does not support recovery) then staff are likely to skip a stage and Learners are unlikely to complain or to report them! However, such a lack of consistency can have disastrous consequences for Learner understanding for, it is likely that, only with a consistent approach the Learner begins to understand a connection between OOR and POLE.

Stress. We all know that stress contributes to unclear thinking and increasing the chance of error. In almost every educational establishment I have visited staff report a considerable workload. When workloads are high, stress can increase and the chances of mistakes rises. What can we do to reduce the staff stress? We can address the issues raised above!

Presenting and Removing OOR

There are strategies that should be typically be employed when presenting OOR to a Learner and, equally, other strategies that should be used when they are removed. Some of these are listed below:

On Presentation:
01.     Ensure that you are in the best position to present the OOR. Do not obscure the light
          source such that the OOR is shaded and cannot be easily seen. Do not tower over
the Learner but rather, squat down to a level where you are on a face- to-face level.
02.     Do not undertake any action suddenly.
          Allow the Learner time to 'see' what you are going to do.
03.     Ensure that the Learner attends to the OOR. This might be by placing it directly in
their known field of vision, or watching where they are attending, or gently rubbing
it on their skin or by illuminating it with laser light, for example. Do not simply pop it
on their lap and then go to the POLE. Learner awareness of the OOR is central to
the success of the system.
04.     Some Learners may be distracted by the sound of your voice and their attention may be focused on you rather than the OOR.
If this is the case, present in silence, otherwise you can state the name of the POLE that is to follow.
         Stating the name of the POLE once the OOR has been presented and explored, however, will not distract the Learner.
05. If you are going to sing a song while presenting an OOR as an accompaniment ensure that the song selected is not used for
other purposes or is sung without the POLE occurring. For example, singing 'The wheels on the bus' while presenting an OOR
for a bus journey is not a good idea as the Learner may encounter this song and then not get to go on a bus. Better to create
another bus song especially for use with the OOR or not sing at all at this time.
06.     If a Learner pushes the OOR away or throws it on the floor, pick it up and re-present. Do this three times. After the third time,
          move with the Learner to the POLE holding the OOR yourself. On the way, if there is an opportunity, show the Learner the OOR.
07.     Facilitate and encourage Learner interaction with the OOR.
08.     Try and involve the storage location of the OOR in the presentation when possible after Stage Two.
          This may involve the OOR bag if such a system is employed. If a Learner is physically capable of taking an OOR then
present the OOR from the top of the storage bag.
09.     If possible try and incorporate the symbol for the POLE into the OOR. It may not always be possible.
10.     Do not pass a single OOR around a group of Learners (see the rules section on waiting below).
11.     Do not present more than one OOR at any one time (before Stage Four and then only present two OOR with great caution!)
12.     Once presented ... go to the POLE immediately. The rules are 'GIVE and GO' (Rule One) and GIVE and Take (Rule Two). (See
the section on Rules lower on this page).

"Although it has been found that under four months of age can associate their movements with a consequent event, if there is a delay of more than three seconds between the infant's movement and the event even infants as old as nine months fail to link the two." Barber, M. 1994 page 51)(see also Millar 1972)

On Removal:

1.     Ensure that you are in the best position to remove the OOR. Do not tower over the Learner but, rather, squat down to a level where
you are on a face- to-face level.
2.     Do not undertake any action suddenly. Allow the Learner time to 'see' what you are going to do.
3.     Try and involve the storage location of the OOR in the removal when possible after Stage Two. This may involve the OOR bag if
such a system is employed. If a Learner is physically capable of putting an OOR back into the bag then present the open bag
or assist the the Learner to replace into the bag.
4.     Always remember to remove the OOR when the POLE is reached. Do not allow the Learner to move FROM the POLE area
clutching the OOR that means 'I am going TO the POLE'.

D-OOR-ways: Door Markers

D-OOR-ways Door Markers can only be used with a shared approach to OOR. Doorways are drop-in slots that permit OOR mounted on hardboard (or equivalent) squares to be displayed to indicate the POLE is within the room. The Learner can be encouraged to match the OOR to the door marker each time s/he enters the room.

The drop in slots are a sort of three sided photo frame that can be screwed to the door. The OOR may need to be adapted (cut in half, for example) so that it can be mounted on a board backing that is the right size to drop into the slot on the door and thus provide an OOR marker for the room. If the room changes focus during the day (because it is used for different subjects) the slider portion can simply be removed and replaced in seconds. If rooms change focus in this way, the set of ready mounted OOR for each subject should be kept in a box inside the door so that staff do not have to search for them.

If you don't want to make your own D-OOR-ways, then you may purchase them from Ability-World. DOORways come complete with slide holder, screw fixings, and slider plate. Please note: the OOR themselves are not provided.

The RNIB document (cited earlier) has this to say about what I term 'Doorways':

"In some schools, objects are employed to mark specific locations. For example, a spoon is provided at the entrance to the dining hall, a piece of mat outside the gym. Objects used in this way obviously have to be standardised for all children. However, rather than calling them objects of reference, it may be preferable to refer to them as 'location markers'."

Location Markers? What does what we call them matter to the Learners? What we now have is a set of 'location markers' which are not the same as the OOR for that particular POLE in use. Surely, it is preferable if they are the same such that children are helped to make the connection. Thus, according to the RNIB document, sometimes it is OK to standardise objects/markers and sometimes it is not (see the section on 'approaches to OOR')? Isn't there some inconsistency here?!

As was stated in an earlier section, philosophically I believe that the individualised approach to be the better however, pragmatically, I believe that the shared approach is correct. If your establishment can see no problems with an individualised approach pragmatically (or believes it can overcome such issues) then you should choose it. In an ideal world I too would support this approach but schools and colleges are not ideal worlds!

OOR for People

For example, characterizing the teacher by a ring is possible if the teacher constantly wears the same one, or characterizing horseback riding by a leather strips with a knot representing reins is possible if the learner is taken horseback riding often. Characterizing activities
are especially important for the development of symbolic language. Gradually, the
communicative referent may be changed to more of an abstract form (distancing principle) based upon the child's progress in generalizing its use across environments. For example, the teacher's ring could eventually become a raised circle on a referent card that the learner uses in his grouping of people he knows. (MacFarland and Nelson 1998)

As the P in POLE would indicate, OOR can be used to indicate and request People; that is, to indicate:

a visit to a specific Person;
a need for a specific Person.

If the OOR is used expressively (Stage Five) therefore the Individual is communicating a desire to:

have a particular Person come to him/her;
go and see a particular Person

However, if staff are presenting the OOR then it would be indicative of a visit to a particular Person. There is another alternative; a staff member is teaching his/her own OOR to a Learner. Typically, such an OOR represents a salient characteristic of the Significant Other. For example, a staff member may always wear a particular wrist band such that an identical wrist band could be used as the OOR to indicate this Person when this person is not around or for a Learner to request assistance from this person if given a choice of who should help from all staff available in the session at that time.

OOR for People must follow the OOR rules (see below) for other POLEs. Therefore, they must be unique: if a wrist band is used for one member of staff, it cannot be used to identify yet another. That would be confusing not only for the Learner but for staff as well! For local use (inside a particular session) it is possible to display the OOR together with the staff pictures prominently on a wall as both a means of teaching and for later Learner use expressively (for example, a Learner could indicate a particular picture/OOR).

In the examples above; Mrs Adams always wears a bangle, Mr. best uses a walking stick, Ms.Carter is especially fond of a certain brand of confectionary and often gives them out in sessions, and Mrs Davis wears a butterfly brooch. Thus, a bangle, a smaller version of a walking stick, an empty bag of sweets, and a butterfly shape are used to represent each of the members of staff. These items cannot now be used for any other Person; staff member or significant other within the OOR scheme. It should be noted that the (Makaton or other) sign for the Person should reflect the object choice or visa versa the object choice should reflect an already established sign whenever possible.

I have seen staff using jewellery in such a manner, this is usually fine but there are one or two areas of concerns:

Dangly earrings (as an example) (with pierced ears) can be grasped by a Learner and may be pulled causing serious injury. Any such item which when grasped by a Learner could cause injury to the staff member or the Learner is problematic and needs careful consideration before use.
items must be unique otherwise confusion could result when the Learner encounters similar items worn bu another staff member.

Are you saying we should have separate OOR for People in addition to OOR for Events and Locations?
No! I am saying it is a possibility but certainly, at the start of any scheme, you should keep the system simple. Do not be tempted to introduce too many OOR at any one time. You should build up to a more complex scheme on the success of previous work.

We have lots of staff and they might be working in any of our rooms at a particular time. We cannot put pictures up of them all!
That is not necessary. You might have all the staff pictures and OOR mounted on a set of boards in a box in each room. When staff present in the room they find their own board and hang it on a hook on the wall such that the staff on view are the staff in the room. In the majority of establishments, there is also a master display of all staff usually in the reception area, this could also be amended to include OOR for all to see.

We are not allowed to wear bangles and other jewellery in and around our school.
The select something else! It doesn't have to be a real characteristic of the Person, they can each make up something for themselves that could be taught to Learners. Ms Carter may not actually like those sweets for example!

What if the person is always in the same location?
If a person is always associated with the same Location, for example a Physiotherapist with the Physio room then it might be possible to use the same OOR to represent both Location and Person. However, typically there is more than one Person working in the department and, even though they are primarily associated with this particular room they might still be involved in other areas (for example, the Physio might work in the classrooms from time to time and may also be found in the hydrotherapy area). If your OOR scheme has a backing board (see this page on the use of backing boards) then you might use one shaped top to represent the Person and another to represent the Location with the same OOR.

What if an Individual is continually requesting the same member of staff and this is causing a problem?
First, let's look at the positives in this question: the Individual is using the OOR systems to express a desire! Wow! That is a big step in the right direction. Let's celebrate that achievement. OK, so this Individual wants to work with this particular member of staff all the time? There are strategies that you can employ to manage the situation:

Employ limiting factors. See the fundamental page for details.
Step up the level of difficulty of the request. For example, make working with this Person contingent on the use of a symbol board.
Make the request a reward contingent upon the Learner performing some piece of work.
Other?

The above scheme only relates to the people in the room, therefore if the Person is not working in the room, the Learner should not be able to use the system to make the request. If the person is timetable to be in the room, use one of the above strategies.

Can a Person have a Sensory Cue?
Yes. Indeed, as the Sensory Cue is supplied at the Location and the Location in this instance is the Person themselves then the Sensory Cue must be something about the person that is sensory and unique. I always remember a college nurse with whom I used to work offering to walk around smelling of disinfectant (the sort used in her surgery) so that would be a cue as to her identity and function. The four people represented on the cards depicted earlier each have an OOR such that, when they are not present, a Learner could request them. However, when they are present, Mrs. Adams' bangle on her wrist is a Sensory Cue, as is Mr. Best's walking stick (indeed the click as he walks might be an additional Sensory Cue, and also Mrs Davis' brooch (but she must always wear it). What about Ms Carter? Well, if she always carried her bag of sweets with her, it might be Sensory Cue especially if the bag rustled as she moved around but, as it is unlikely that any member of staff is going to do that, the sweet bag is not really a very good Sensory Cue.

Pole Position: OOR for Objects and personal Events

As has been detailed earlier on this page, POLE stands for Person Object Location or Event. If a Learner has a particular BEST POLE (see earlier this page) then we can use a technique devised by Jones (2000) called POLE Positioning. To illustrate this technique let's assume a particular Learner loves rocking with a particular member of staff and another loves going out for a walk around the school garden and yet another loves a particular game involving rolling balls and getting them into holes. An object (one which the Learner can manage) is used as a form of Object Of Reference and each time the Event (the E of the POLE) occurs or the Object (The O of POLE) is requested, the staff member concerned goes with the Learner to a particular place/position in the room to collect the object before beginning the Event or providing the Object. After the Event/Object is completed, the staff member goes with the Learner to return to object to the place where it is kept. This might have to happen a hundred or more times before a Learner makes the association between the object and the POLE. Furthermore, it may have to occur many more times before a Learner takes the initiative to present the object to a member of staff to request the POLE.

In order to assist the Learner to move from Staff initiated behaviours to Learner initiated behaviours, it may be necessary to introduce an intermediary step: after the staff member has accompanied the Learner to get the object on lots of occasions (How many is lots I hear you ask? Some big number is my response!), then the staff member can ask the Learner to go and get the object on his or her own and bring it back before they start the POLE. If the Learner looks confused, the staff member can point to the object or in the general direction of the object. Thus, the Staff member, is scaffolding the learning experience for the Learner in order to move him/her forward to an independent action; the use of an object to make a request.

A further assisting technique is the use of a 'pause'; the staff member must eventually allow a portion of time (How much is a portion of time I hear you ask? Something more than a bit of time is my response!) in which the Learner has to wait before the Staff member initiates the activity. In this time, the Learner is afforded the opportunity to act independently. As days go by, the staff member can delay the start of the activity by a few seconds such that it takes that bit longer each day before the E/O begins or the Learner is prompted to go and get the object in order for the E/O to begin.

I like the idea BUT my Learner is not independently mobile and could not pick up an object and return with it even if he were.
Yes, that is an issue but one which can be overcome by encouraging the look. We adapt the idea for the specific requirements of each individual Learner. Thus, in this case, we might say the name of the Event/Object and encourage joint looking at were the EO object is located. To facilitate this further we could make the EO object big and bold and bright and, rather than placing it in a drawer or a cupboard, hang it on a wall where it can be easily seen. We still travel together to get the object off the wall before we begin the EO and, after the Event, we go together to put it back. However, the Learner initiated EO is simply a look at the object in its location.

OK. What if the Learner is not ambulant, cannot manipulate the object and has a severe problem with visual acuity?
Well, that makes it even more difficult to work with this idea: if not impossible. If you can figure a way around the obstacles or modify the technique in some way all the better. The focus must always be with the Learner: what can s/he do? If s/he can discriminate by touch perhaps a sensory surface on the arm of a wheelchair could be used to make such a request. That would be fine when only one thing is being requested but should it ever reach a position where several things are involved then the arm of the wheelchair might become rather crowded! To cope with this a sensory board might be developed with the arm of the wheelchair surface being used to request the board from which a choice can be made. This system would build very slowly over possibly many years.

So I could have OOR all over the room in specific places and Learners could express a desire by going, getting and presenting or simply by looking?
Yes, exactly but a word of warning, if you have lots of objects around the place you might be inundated with requests!

Suppose a Learner asks for something at an inappropropriate time?
There are several aspects to the answer to that question:

If a Learner has never done that sort of thing before, drop everything and do the activity with the Learner. It's a must!
If a Learner is always doing it (and, wow, that is great!) and you cannot supply the EO, remove the object until you can.
If the event is something like swimming which requires a trip out of the building, do not have an OOR on display in POLE position!

Suppose the Event is an Object such as a game?
That is not a problem. The technique is the same but the Object must not be on display in the room otherwise the Learner may just as well cut out the middle man and go straight for the Object (game) and not the object (of reference). Thus, an object is used to reference another Object (in this example a board game).

Suppose the Learner keeps asking for the Event or Object over and over. What then?
Well, first congratulations, you have succeeded! The Learner is using an object expressively which, we assume, s/he was not able or willing to do prior to your intervention. If the Learner now is asking for the event all the time 'step it up'! That is, you make the task a little more difficult. How? There are several things you can try:

Move the object to a new position in the room but do not tell the Learner. Does the Learner locate it and learn its new location and then continue with his/her expressive use? Wow!
Add in an element of choice. Put a second object that relates to another event right by the first. If the Learner can get the object him/herself then make the two objects very similar perhaps only differing in colour (for example). Can the Learner discriminate (or learn to discriminate) between them? If the Learner cannot get the object him or herself then we can use 'creative asininity' to make the Learner work that little bit harder: we act as if we do not know which the Learner wants and hold the two objects up (one in each hand) and ask the Learner to indicate which s/he wants. If the Learner easily discriminates (wow!) then we narrow the distinction between them (identical but for colour for example). In this way we can assess a Learner's level of understanding and even build upon it adding to his/her discriminatory skills. From two objects we can go to three ... what if the Learner chooses the 'wrong' object? Then that must lead to another event, something that the Learner can do but not a BEST item, something perhaps that you'd like the Learner to do but the Learner generally takes some persuading to do. The Learner has to understand that once this small piece of work is complete then s/he can choose what s/he wants to do again. At first, this second task should be kept small such that the Learner is not deprived of their desire for too long. However, each time this object is chosen, the task should become a little longer. In this way the Learner will learn that on completion of this work there is a reward.
Take the object down and replace it with a symbol on the wall. Now the Learner is using a symbol to make the request. Once this is established, change the symbol to two symbols, one for the EO and one for another POLE. Keep adding symbols until the learner is discriminating between several of them. Once you have achieved this you can begin to believe that this Learner is no longer experiencing PMLD!!

What if the Learner does not go and get the object independently or look at the object independently?
Then you continue with teaching the system in the hope that one day s/he will. Remember, that if the Learner does not make a request then control is in your hands. Thus, you may perform this activity once or twice during the session but, at other times, get on with other things.

What if the Event is not finite and the Learner is distressed by it being taken away?
By a non-finite Event, I assume you mean providing the Learner with something like a ball game which, after one request, s/he could be playing for the rest of the session. In this situation you need to think creatively of ways to make the POLE finite. There may also be a means of ensuring the Learner makes addition requests during such play. For example:

If the balls get used up during the game, the Learner may have to ask for replacements or for assistance to release them.
If the game has a release mechanism which feeds the balls back to Learner automatically, disable it.

Of course, you can also make use of a timing system (kitchen timer?) which allows the Learner a set time to play with the requested POLE after which it is returned to its storage space (out of sight). Any Learner distress should be alleviated in the knowledge that s/he can simply request the POLE again using the original object. Multiple requests for a particular POLE can be addressed as described in an earlier section above.

Objections to using Objects for Objects!

The O in POLE stands for Object and, thus, as is explained in the section immediately above, an Object Of Reference could be used to request another object (for example a particular favoured game). However, we could imagine a scenario in which an OOR was used to request a treat such as a chocolate button. Although this would be a highly unusual method of employment, it is not completely out of the question. Let's assume (for the sake of exploring the issue) that an OOR is to be used to stand for a chocolate button. We will imagine the use of a brown circle of plastic about 100 mm in diameter as the OOR in question.

The Learner has to be taught that the OOR can be used to request. We are therefore literally jumping in at Stage Five which already seems a little problematic! However, we are not quite at stage five (the Learner is not yet using the OOR expressively) but pre-stage five in that we would have to teach the Learner a requesting relationship between the OOR and the POLE.

Once established, the Learner is likely to settle for a single chocolate button and may make repeated requests. Of course, in order to do this, s/he would have to give a staff member the OOR each time. Each time the OOR is used expressively, staff would have to provide a chocolate button and returned the OOR to its storage place. Isn't this great? Isn't the Learner now using Objects expressively? It's not only a momentous moment for the Learner it's also a momentous moment for the staff too (often overlooked).

While the OOR for the object (chocolate button) would normally reside in the OOR bag or with the collection of other OOR stored within the classroom, let's imagine removing it from its normal home and not just permanently attaching it somewhere else in the room (as suggested in the section above) but affixing it to the Learner's wheelchair tray (We'll assume that this Learner has a wheelchair and it is fitted with a tray)! Thus, each time the Learner touches the bag attached to the tray, staff present a chocolate button. You can probably foresee several issues with this technique! You now have objections to using an object to stand for and object! What might some of these 'concerns' be?

If the Learner really likes chocolate buttons then s/he might make themselves sick (they will certainly put on some weight) from an endless supply.
You nor your school or college is not in a position to provide an endless supply of chocolate on demand.
What if the Learner touches the bag by accident?
What if the Learner touches the bag when staff are not looking?

It would seem attaching a bag to a tray as an OOR for chocolate is not the best of ideas! However, we could formulate strategies to deal with each of these concerns. For example, perhaps an empty chocolate bag could be attached to a BIGmack (or equivalent device) which is only presented occasionally when staff have a supply of buttons and are able to observe the Learner. The BIGmack could be programmed to say, "Chocolate please". We could set up 'limiting factors' to respond to repeated requests. As setting limits has been covered on other pages on this site, it will not be repeated here (see the page on Fundamentals of AAC for explanation of 'limiting factors').

Of course, now we are operating with a plastic bag on top of a BIGmack, we could rightly ask if we are we still operating with an OOR or are we moving into the use of simple AAC with symbols (or to some form of alternate PECS system)? We are certainly trespassing on that territory and the distinction is not all that clear!

While it is not common for OOR to be used in this way, it cannot be ruled out. Indeed, you may decide that it is to be the starting point for the introduction of OOR into your establishment.

As was suggested in the previous section, OOR can be used to represent a favourite game. I used to work with a young man who loved playing with a a bagatelle type game with large balls. We used one of the balls as an OOR for the game and we taught the Learner that when the ball was presented the game would immediately be taken out of the cupboard for him to play for a short period of time. The ball was kept on display in the room and, as this was his favourite activity, it as hardly surprising that, in a very short space of time, he was using the ball expressively (stage five) to request the game. This was great, here was a young man who was using a tangible symbol (See Rowland, C., & Schweigert, P. (1996) expressively, which was one of our primary goals. However, it soon became an issue because that is all that the young man in question wanted to do! Thus, we had to set strategies for both:

limiting the use of this particular OOR once it had become well established (See fundamentals page for setting limits)
stepping up the level of difficulty involved in requesting the POLE (see previous section for details).

Co-active Objects

In Jan Van Dijk's approach to working with Learner's experiencing deaf/blindness he speaks of the use of a co-active approach (For example: See MacFarland and Nelson 1998). This is very similar to the approaches used within Intensive Interaction (Nind and Hewett 2006). In coactive approaches, staff members join in with the activity of the Learner:

Co-active movement sequence strategies are an extension of resonance strategies. The major difference is that the learner is showing signals to request continuation of the turn-taking interaction with another individual. This partner follows the child's movements in a reciprocating fashion. In addition, the child may follow a partner initiated movement. The learner soon discovers that "When I do this, she does it too'" Rapport continues to be strengthened and the learner gains more understanding and control of his world as schemes of integrated information develop. (MacFarland and Nelson 1998)

OOR can be introduced into such an approach to provide a means of enabling the Learner to:

control the event as it occurs;
request the event at some future point

For example, take the scenario in which a staff members rocks a child back and fort while some music plays on a BIGmack or similar device. The child appears to enjoy this activity as s/he laughs and smiles while it is occurring. Attached to the top of the BIGmack is an OOR such that pressing down on the object causes the BIGmack to play the music. In a staged approach, at first the staff member activates the OOR her/himself each time the music stops and begins the activity once again. The Object is in reach of both the staff member and the Learner. After a few times, the staff member pauses before activating the object again to allow time for the Learner to take the initiative. The staff member may look at the Learner and then look at the object in an attempt to cue the Learner into the appropriate action. The staff member does not use language to tell the Learner what to do but, at first, models and then cues the action. If the Learner does not respond to the cueing, the staff member may gently and carefully guide the Learner's hand to the object (hand under hand is the better approach) physically cueing the Learner. It may take sometime before the Learner does this for him or herself especially if the Learner is not yet cognisant of the concept of cause and effect.

Once a motor patterned sequence is learned, change must be planned to add variety, continued complexity and
distancing, and anticipation. (MacFarland and Nelson 1998)

When the activity is over, both staff member and Learner must remove the object from the BIGmack and then (together) put it in a position in the room where it can be accessed by the Learner at any time to request the event. Within each session, before the activity begins, both staff member and Learner must go (together) to retrieve the object from the location in the room to place it on the BIGmack before commencing the co-active movement sequence.
Hopefully, at some future point, the Learner will go alone to get the object to make a request of the staff to provide the activity. Indeed, staff may facilitate this by:

asking the Learner to go and get the object (can s/he do this?)
waiting (providing an opportunity for the Learner to act) for a short period before going together to get the object.

That's all very well but my Learner cannot physically activate an Object on a BIGmack.
It is not a necessary requirement for a Learner to be able to active the object only to indicate a need for the object to be activated. Thus, if the Learner where to look at the object once the activity had stopped then this would be indicative of the Learner's desire to continue with the action.

My Learner is not ambulant and therefore could not go and get the object even if he wanted.
Providing the object is placed in a position where it is accessible then the Learner can indicate a desire for it by simply looking at it.

My Learner is not ambulant and cannot see.
Then looking at a special position is not a realistic option. The focus must always be with the Learner: what can s/he do? If s/he can discriminate by touch perhaps a sensory surface on the arm of a wheelchair could be used to make such a request. That would be fine when only one thing is being requested but should it ever reach a position where several things are involved then the arm of the wheelchair might become rather crowded! To cope with this a sensory board might be developed with the arm of the wheelchair surface being used to request the board from which a choice can be made. This system would build very slowly over possibly many years.

What if the Learner does not activate the object simply because s/he does not like the activity?
That is a possibility or perhaps the Learner has had enough and wants to stop. We cannot peer inside a Learner's mind and see what they are thinking. All we can do is to observe their behaviour to see if there are obvious signs of enjoyment during the initial stages of the activity. If the Learner shows no such signs or signs of distress then this should be taken as indicative of a displeasure and the activity should cease. Staff should always try to choose an activity with which the Learner has previously shown a pleasurable response if possible.

ASD and MSR and OOR

While the cause of Autism still remains something of a mystery there are a few cases of people who have experienced ASD and are able to tell the tale. Such people typically report a brain that is wired in a different way to the norm: a form of extreme synesthesia resulting in complete sensory overload that creates an individual need to shut down to shut out the overwhelming sensations. Such synesthetic cognitive connectivity may also go some way to explaining the ability of the savant (as depicted by Dustin Hoffman's character Raymond Babbit in the film 'Rain man'). The video clip below of an ABC news report on Carly Fleischmann. In it carly talks briefly about her autism and the strategies she uses to block out some of the sensory overload. For example, she says that she sees a thousand images when she looks at a face which is why she avoids eye contact. If this report is factual (I have no reason to believe that it is not) and if Carly is typical of all people experiencing ASD then we should be aiming to reduce sensory input and not increase it. Keeping sensory input simple and consistent over time may help the individual Learner to make sense of the world.

Backing Boards: Mounting OOR

There are (at least) two schools of thought: OOR should not be mounted and OOR should be mounted onto some form of backing board. Those who argue for the former (no baking board) state that the backing actually diminishes the handling of the the OOR and reduces its sensory aspect. Those who argue for the backing board state that it can add additional dimensions (in particular - shape and colour) such that a particular shape and or colour can represent a particular POLE. They also rightly state that small OOR ruled out because of safety measures can be made safe by attaching them securely to a backing board.

Backing Boards can be card, wood, or plastic. It is generally easier to provide a colour aspect with either card or plastic although wood can be stained to provide colour if desired.

Different colours and different shapes can represent POLEs. For example:

COLOUR SHAPE

Person: pink /brown domed top

Object: orange square top

Location: red pointed top

Event/Action: green octagonal top

There is no hard and fast rule as to what shape or what colour should represent whatever aspect of the POLE; it is entirely the decision of the organising team. The board can also contain the text accompaniment as well as Braille or symbol form accompaniment. Below the shapes and colours have been used with the same OOR to represent differing aspects: a person (the sports teacher?), an object (a ball or the concept of sport itself?), a location or building (the gym or other sporting venue), and an event (a particular match) or an action. Again, this is suggestive rather than definitive - it is entirely up to you how shapes and colours are used. What is important however is, whatever decision is reached on this matter, it must be approached completely consistently when in use with Learners.

Note: To attach an OOR to a back board, the object may need to be cut in half (as, for example, the tennis ball in the illustrations below). If objects pose a choking hazard they must be attached in such a way that even if they were to come loose they could not be swallowed (or in such a way that they could not come loose).

Backing Boards can be used in conjunction with Doorways (see section above) such that they slide perfectly into the door holders to mark a particular location. Backing Boards can also be drilled with a small hole at the top edge such that they can be hung up (for example, if a room-based system rather than a bag-based system is being employed).

Recently, on a trip to Wilkinson's (A UK low cost store) I came across a set of plastic chopping boards in a pack of five. The boards were only small and were made of durable plastic which was easy to cut and to work and the set was quite inexpensive. I purchased a couple of packs and made backing boards out of them as examples for my MSR training course. I hard but to cut and shape the tops and devise a method of attaching specific OOR. I note that Argos are marketing a similar set (link active at time of writing). Amazon also have a similar set. While such products come and go (and thus the links provided may no longer be active at the time you are reading this) a simple search on Google for coloured plastic cutting boards might yield positive results! Depending on the size of the cutting boards in question it may be possible to construct several backing boards out of a single sheet. Another advantage of using cutting boards for this purpose is that they are designed to be hygienic and are easily cleaned. Some sets of cutting boards are described as 'flexible'. these may not be suitable for the intended purpose depending on their level of flexibility.

Which do you prefer: mounted or unmounted?
As you are asking, I prefer the unmounted OOR system. However, I can see some benefits to the mounted approach. However, I always encourage schools and colleges to make up their own mind.

Can I use a different colour scheme?
Sure. Of course you can. As long as it is used consistently then there should not be a problem. Remember, if you are already using a colour scheme for another Augmentative Communication system (for example: the Fitzgerald Key for work with symbols) then the mounting colour scheme should be in accord with this. I would advise you to adopt the Fitzgerald colour approach as it is more widely used across special education and special care at all levels and all ages and is therefore less likely to cause a conflict at some later time. However, the choice is yours to make.

Stages Not Ages? Preference Not Deference!

As Objects Of Reference are likely to be in long term use for any individual and have to be consistent if of any use, then it is possible that a teenager might still be working with an OOR that was assigned as a young child. We then get into the thorny area of age appropriateness. There are those who are very concerned about age appropriateness and those who are less concerned and are likely to cite 'stages not not ages'. However, I would imagine that none of us really wants to see a thirty something old Learner working with a child's rattle. It would seem to support the view of someone experiencing PMLD as a child and to be treated as a child and, I hope we would all agree, that is an undesirable state of affairs. While I have no issue with using an individual's favourite item as a way in; a stepping stone to promote further learning: the goal is to take the Learner beyond that. Therefore, while I might use such an item as a starting point, my goal would be to wean the Learner off its need and to move towards more age appropriate items eventually.

Thus, when selecting an OOR, it must be remembered that its use might continue into the distant future and, as such, we should consider the age appropriateness of the choice and try to select items that will still be appropriate in ten and twenty years time.

Thus, it is my view that, age inappropriate items should only be used when the initiative is coming from the Learner (Preference): that is the Learner has chosen such an item. However, when others are selecting items with which to work with the Learner (Deference: the Learner is deferring to your judgement) then the (and in this instance, continuing) age appropriateness of the item should be also be considered.

Preparation for OOR (Priming the Pump)

Best Practice would dictate that, in order that the potential Learning is maximised, we should prepare all Learners working with Objects Of Reference for their use (priming the pump/increasing the objects saliency). To do this involves the use of the OOR in situ by the staff members to whom the OOR refers. For example: Let us assume that we want to make a red, softly-spiked ball the OOR for astrophysics (a silly example of course!). We would give the ball to the astrophysics team and ask them to include and use it in some memorable way in at least three sessions (for all Learners on the scheme) prior to the commencement of its use as an OOR on the scheme. The astrophysics staff team would then decide on some memorable use of the object in their sessions, when the Learners were present, to increase its saliency. They might play a game with the object involving both staff and students. They might prominently wear the object during these sessions. As we are more likely to remember the funny, the rude (legally so!), or the unusual they might do something using the object that is more likely to remain happily in the memory of the Learners: something that might prime a Learner to associate the particular object with that group of People, in that Location or with that Event.

Ideally, the Learner should be involved in any preparatory work such that s/he gets to experience the Object within the POLE via the staff's usage. Such experiences will need to be tailored for the specific needs of individual Learners: for example, a Learner with issues of visual acuity may not see an object worn by staff (as in the cartoon!) and. thus. would need to experience it in other ways. While staff may wear an OOR for the period of these sessions they may also play a game with the (another identical) object such that the Learner gets to handle, see, feel, sense, smell, and even taste it.

How do we know that a Learner Experiencing PMLD has been primed in such a way? We don't! We hope that when the OOR comes into use in the general timetable that the Learners make the connection after fewer uses than might be the case had we not primed them in such a fashion.

What if some staff are associated with more than one subject?
If staff are associated with more than one POLE then it may be better if they did not wear the OOR but, rather, used it in some way to fix it to the location and or event.

You are joking! I am not going to wear an OOR on my head. That's stupid.
No, I am not joking and it's not stupid if it creates a link in the Learner's mind between the OOR and the Person, the location, or the Event. Of course, if you are uncomfortable with wearing it on your head then do not wear it on your head, wear it somewhere else instead but try to make it memorable for the Learner. Your task is to figure out what is going to make a lasting impression on Learners such that when the OOR goes into use, they will more likely immediately associate it with a particular POLE.

Nah, that will not work with my Learners.
How do you know if you have not tried? Even if it doesn't work, what have you lost by trying?

We are going to use a wooden spoon as the OOR for cookery sessions. Isn't this already associated with cookery for the Learner?
Yes, it may be. However, it certainly won't hurt to do some additional preparatory work with the spoon in addition to the association that you believe to be already established.

Are you saying we should do this for such events as personal care too?
Why not? You could go to the personal care area and play a simple game with the Learner(s) using the intended OOR. It need not take very long and then the Learner(s) could return to their normal session.

Problematic POLEs: Conflict and Confusion

There is a problem with the use of OOR to represent People, Objects, Locations, or Events (POLE) which manifests itself in a variety of ways:

Some OOR represent People, others for Locations, and yet others Events. A few even are used to represent other Objects.
A room is used for multi purposes: for example the main hall is used for lunch, break, physical activities, dance, and drama. Should there be one object for 'hall' (location) or several (one for each Event)?
A subject (Event) occurs in more than one Location during the curriculum;
(combining the two above) Subjects not only occur in more than one location but some of those locations house more than one event. For example, the main hall houses dance, drama, and music at various times during the week BUT each of these subjects has it's own base room which is normally used except when another class is in occupancy.

How is an Individual Experiencing PMLD supposed to figure all this out let alone cope with it? How is s/he to know to what an objects refers?

For those Individuals experiencing PMLD and those experiencing ASD consistency is a vital component of learning to understand and to cope with their world. Thus, the best case scenario is:

P = O = L = E

That is, that each subject (E) takes place in a distinct location (L) with its own staff (P) and its own materials (O) and there is no conflict between subjects. In such a scenario, the Learner would 'understand' that music (for example) (E) took place in one classroom (L) with selected members of staff (P) and specific items of equipment (O). However, in most educational establishments this would be something of a logistical nightmare. Locations get double booked and therefore classes have to move to other available locations. Staff are involved across subject boundaries. While some subjects might have distinctive materials (for example the art room) there is no guarantee that the Learner will not be tasked to do some painting in another subject and or in another location.

Planning the annual curriculum in any setting is typically a somewhat difficult task. As the jigsaw starts to build suddenly it can be realised that a few pieces will simply not fit and even some are missing! Compromise is often the key to it's solution with some classes be moved to other locations and some areas being called into service that otherwise would be remain for a specific purpose. To ensure P = O = L = E or even getting some where near to it is thus somewhat problematic.

This situation can be eased somewhat if it is approached with an emphasis on the most needy. A process of 'qualitative easing' can be put into position such that the curriculum for the most needy is addressed with a view to consistency and thus an elimination of potential conflict and confusion. Who are the most needy? Those Individuals experiencing PMLD and many of those on the Autistic Spectrum for whom any change can be troubling. In any educational establishment there are likely to be some operating at a higher cognitive level than others. There will be some for whom a change in venue for a session will not be as problematic as it might be for others. If we address the requirements of those with the greater need first it does not follow that the needs of those remaining will NOT be met: indeed, it could be argued that they are being better prepared for the world beyond education where change would appear to be the one constant. Thus when preparing the curriculum for the new academic year, try to ensure that those with the greater need (IEPMLD and ASD) have the greater consistency when it comes to subjects in fixed locations and consistent staffing.

If P=O=L=E then an OOR will equally represent both a subject and a location and maybe even a specific member of staff. Of course, if the OOR is presented with a backing board (see section above on this page) then the board itself can give a cue to which POLE it refers. However, Talksense does not recommend the use of backing boards with IEPMLD.

If specific events take place in the hall and only in the hall then each event can be referenced by an individual OOR as and when needed. However, if the subject/event only takes place in the hall some small part of the time then presenting the OOR is likely to lead the Learner to believe that s/he is heading for the primary location for the event. Obviously this is confusing and is best avoided. Having a separate referent for the hall tells the learner where s/he is going but not what they are going to do when they get there However, this can be addressed by the use of good quality Sensory Cues at the hall location to represent the activity.

While there is no easy answer to these issues it is best to design the curriculum to avoid them (prevention is better than cure). Having an OOR for the hall (the hall is being used as an example here) might be the solution when the the subject is generally taught in another location (L) whereas, if the subject is only ever taught in the hall then an OOR for the subject can be used.

Ambulant and Non-Ambulant Learners and OOR

In 2013, Trief et al found that the best predictor of Learner success in the implementation of a tangible symbol system (OOR system) was the ability to walk:

"The only variable that yielded a statistically significant difference was mobility. The participants who ambulated independently acquired more knowledge and use of symbols than did those who were nonambulatory or ambulatory with assistance. Children who ambulate have a greater opportunity to explore their environment purposefully than do those who are nonambulatory. Purposeful exposure to environmental stimuli may help this group to understand the symbols more readily than the nonambulatory group."
(Trief, E., Cascella, P.W., & Bruce, S.M. 2013 page 189)

Does this mean that we should refrain from the use of OOR with nonambulatory Learners? Of course not! However, it does mean that we have to work extra hard to ensure that nonambulatory learners have as much chance of gaining from the system as their ambulant peers. As ambulatory Learners have a greater opportunity to explore their environment, they have more opportunities become more aware of locations within their environment. It would be interesting if the findings of Trief et al discriminated between those non-ambulant Learners who could move independently (self-propel their wheelchairs or used an electric wheelchair) and those that needed staff assistance (the study does not do this). I would hypothesise that the independent movers would be in advance of the non-independent ones on the acquisition of OOR skills. This being the case (or not!), what can we do to assist those non-independent non-ambulatory Learners in the acquisition of OOR skills?

Passive Pushing vs Active Assistance
I am fond of using the phrase 'the goal is control' in my presentations. Staff need to provide an environment in which as much control as possible is given at every moment of every day to each Learner. What tends to happen in special establishments when a time for a transition to another location occurs is staff will take control push those Learners who require the use of wheelchairs to their next place of study or recreation. Typically this does not involve the Learner in controlling the direction travelled: while staff may say, 'we are going to X now - are you ready?', they will not ask the Learner to guide them to the destination. Many staff will be engaged in chatting to and with the Learner as they are travelling but active cognitive engagement of the Learner and the destination is rarely a feature of that conversation.

As the 'goal is control', what is required is a change in the manner in which (those who are non-ambulatory and cannot self-propel their wheelchairs) Learners are actively engaged in controlling the direction of travel and making choices about which way to proceed. There will be questions about the feasibility of such an approach with those Learners experiencing profound Learning difficulties. However, it does not follow that simply because a task is hard does not mean we should not attempt it at all. It may be that an hidden effect of the use of a manual wheelchair (by someone who cannot self propel) might contribute to a cognitive difficulty because of the measures we use to deal with the issue.

Moving in the right direction: Engaging Environments
It would seem fairly obvious that all Learners are not going to be able to direct staff during transition times to new POLE locations: Learner Louise is not simply going to be able to tell Staff Sally how to take her from art to cookery especially as Louise:

has never done such a thing before;
has never been expected to do such a thing before;
cannot speak;
is experiencing Profound and Multiple Learning Difficulties.

Staff cannot simply go from passive pushing to active assistance overnight. Movement from one to the other will require:

Strategy
Time
Environmental engineering
Patience and Practice

Our Strategy necessarily includes a teaching plan as well as some fundamental changes in some of the ways we approach working with Learners. In order to direct an enabler, a Learner will have to indicate by some means or another 'go right', 'go left', 'go forward', 'go straight on', 'stop', and 'turn around'. For the Learner experiencing PMLD, speaking these words is going to be problematic; even the use of signs and symbols may be not an option for someone at such an early stage of cognition. However, they may be able to indicate a particular manoeuvre through body language: for example, by turning their head or looking to the right to indicate that staff should go right. While even this may seem too advanced for some Learners,Staff should:

ask the Learner which way to go using as little spoken language as possible.
talk about, signal, and make concrete the directions taken while moving to a new POLE
point out landmarks along the route;
on arriving at the POLE, indicate the unique aspects that identify the room

Thus, staff might attempt to indicate a choice of direction through gently touching a Learner on the right or left side of his/her body before turning and moving in the direction while clearing pointing to the right and saying 'going right'. Note that, all staff should use the same words to describe the direction taken such that the words have a chance of becoming associated with the movement over time. It might be that the staff decide to say 'move right' or 'turn right' or 'right turn'; it really does not matter that much as long as it is kept both simple and consistent. Do not just use the word 'right' (or left). Why? Because, unfortunately, in English right has multiple meanings and staff will be saying 'right' in classrooms often (when they mean 'correct') for other things. Such a diverse use of the same word will be completely confusing to many Learners. If staff can learn to always use 'correct' when they want to say 'right' and 'right' only when they mean a direction then it would be OK. However, it is unlikely that staff will be able to curtail their use of language in such a way and therefore we need to use a further word to make our meaning clearing (go right, move right, turn right, right turn ...)

This will require Time. Transitional times between lessons and locations are usually limited by convention and timetabling. However, for some Learners, it will be necessary to change the way in which we think about such periods of time. I would suggest that every moment in a specialist educational establishment should be considered as one of Learning unless the Learner or the timetable calls for a period of relaxation and or fun (and, even then, learning may occur). Thus, transitions between sessions could be seen as teaching areas in and of themselves and the necessary time allowed to enable Learners to better understand the route between differing locations. By definition, that will make smooth operation of a timetable more difficult to implement. However, is the timetable in control? Who should be in control if the 'goal is control'? The Learner!

If the timetable calls for 'passive pushing' then we will never get 'active assistance'. There is at least one possible exception to that claim: if 'transitions' was made a subject and became a session on the timetable (such that a period was given over to the teaching of navigation of the corridors) then between timetable transitions might remain (for a while at least) as passive pushing.

We can assist Learners to have a better chance of knowing their way around through Environmental Engineering. This means that we have to find ways to make all corridors and doorways to classroom look and feel different. If we have the time and the money, we could rebuild and/or redesign them to ensure differentiation but that is an unlikely scenario. However, we can change a corridor's style and we can add symbols, coloured strips of card or paper and even 3-D objects to doors.

In order for Learners to figure out the way to a particular location within a building they have to know where they are currently located. This means that locations need to be distinctive to assist in their identification. As Learners travel around an establishment (be it School, College, Centre, or other) they will begin understand the spatial relationship between one room and another if the rooms are clearly marked in some way and each is unique. The use of an interchangeable d-oor-way system (as outlined on this web page) is one means of achieving this end.

A problem with this approach is in the use of different rooms for the same subject. If the class on 'self-awareness' (for example) was timetabled in one room on a Tuesday and another on a

Wednesday it would make it much more difficult for a Learner to associate a particular OOR with a particular location. To overcome this problem such room changes should be avoided for PMLD classes (such room changes may only be for those with higher cognitive abilities). If not possible, then the OOR for this particular subject area must be held back until other OOR are established.

When working with Learners who are Experiencing PMLD repetition of learning is necessary. Thus, it is very unlikely that a Learner will be able to navigate his or way to a new location without plenty of tuition, help, Patience, and Practice . Staff must hold the belief that one day the Learner will be able to complete such a task and do what they can to help the Learner achieve the goal. As the 'goal is control', Staff should always be seeking out new ways of handing control of the situation to the Learner.

'Blind' Facilitation
The true test of a Learner's ability to navigate the rooms and corridors of any establishment is to task them to do it without assistance. As the Learners in question cannot self-propel their wheelchairs it follows that staff must be involved in such a task. However, to ensure that the staff are not consciously or unconsciously assisting the Learners staff must perform 'blind': that is, they must not know where they are going. Isn't this a case of the blind leading the blind? Only if the Learner in question has no real understanding of the required destination and or how to get there. Of course, the task may also be unsuccessful if the Learner has misunderstood what s/he has to do or does not want to co-operate or is having a joke or ... While we can never prove a Learner incapable, we can prove the opposite: a Learner who successfully completes such a task, on more than one occasion, demonstrates an ability, an understanding, and a cognitive engagement with the demands of the situation.

Get real! Staff cannot push a Learner in a wheelchair while they are blindfolded.
No you misunderstand: staff are not blindfolded - they simply are not told where they are going. Only the Learner is given that knowledge such that s/he is control and s/he has to direct the member of staff concerned who is acting only as a facilitator.

Get real! Are you suggesting that Johnny who is rocking back and forth in his wheelchair can direct others? You are crazy!
Crazy I may be but unless we try Johnny will never be able to do it for himself. If he cannot presently and we never provide the tuition and the structure to enable him to take control then, by definition, he will never get there: literally, he will never reach that goal. I never claimed it would be easy or that it might not take a great deal of time and effort but why is Johnny in a special education establishment in the first place? Is it solely for care?

For many, the act of pretending to drive is obviously a fun thing; why else would there be toy steering wheels in the shops? Maybe this is but one methodology for teaching directionality: get the Learner to pretend they are driving and to steer (or indicate) in the right direction. I haven't yet trialled the idea of using a light source as a means of indicating a direction (staff member shines a light on the arm of the wheelchair to indicate the path - right or left - to be taken) but I am exploring it's potential and trying to figure out how it might be best implemented. It would be fairly easy to switch adapt a battery operated light source such that a Learner (or a staff member while training) could indicate by operating one of two switch (right or left).

Furthermore, we can teach directionality in a number of fun ways: we could use switches and play online games which involve moving around (for example mouse club). Too difficult? OK, how if we hide a special treat on the left or on the right of a Learner? Too difficult? OK! Let's just put a BEST item on the left or on the right and try and get the Learner to look there. Too difficult? OK! What about signing some song (the Hokey Cokey) while moving the Learner around the room? Too difficult? No, I don't believe you! Also here. And here. And here. And here. And here. And here. And here. And here.

Also, we can set up a trail with left and right signposts that lead us back to where we began. On the trail, the Learner gets to notice the signs (feel tactile signs for those who are visually impaired) and turn to move in the correct direction.

Object Banking

I have been asked on more than one occasion about the preparation of Individuals having a degenerative condition where it is expected that at some point in the future they will 'acquire' Profound and Multiple Learning Difficulties. While Multi-Sensory Referencing was not designed specifically for such a population it may nevertheless meet some of their future needs. As 'Voice Banking' is a technique in which a person 'stores' (banks) his or her voice (for example a number of sentences and other items of vocabulary may be recorded) for a future time when it is expected they (for whatever reason) will no longer have the use of their voice so 'Object Banking' is a means of preparing people in advance for a time when they may need to use objects as a simple form of awareness and communication.

One of the main issues with Object Banking is the acceptance of the Individual of the need to prepare for a possible future time when communication via objects might be necessary. We all live in hope and no one likes to believe that things will actually deteriorate to such a level. If the Individual does understand that this is one possible outcome and that such an approach might improve his/her quality of life then the preparation is made all the easier. However, what do you do if the person refuses to accept that this is a possible outcome and therefore rejects an preparatory undertakings? S/he has made a choice. Are we to disrespect that choice? That moral dilemma is one for which I have no answer. It is further compounded if the Individual does deteriorate and had made clear that s/he does not want to be working with objects but now could really benefit from them.

The following may appear to some to be unethical (you must decide for yourself) however, if an individual is in denial of a any possible need for 'object banking' then one possible pathway is to work with a very close Significant Other (Spouse, parent, or other family member) to analyse the Individual's daily life 'patterns' to try and ascertain what objects and or sensory cues a/he already uses or recognises as attached to a single POLE (Person, Object, Location, or Event). Indeed, it may be possible for a Significant Other to 'engineer' the environment to create such recognition. For example, the toilet could be made to smell of a particular everyday substance (lemon, pine, lavender, etc) such that every time the Individual uses the toilet the smell is present and, as such, s/he begins to associate the smell with the location. Likewise a Significant Other could introduce a particular colour and shape and style of sponge into the bathroom for bath time and ensure that the Individual has to use it every time. The sponge is never changed (if it gets old and worn out it is replaced with an identical sponge). Thus the Significant other introduces and promotes a consistent routine into everyday events with the hope that certain objects will take on specific meaning for the Individual which will be retained should the Individual's cognitive condition deteriorate to a level where the use of MSR proves to be necessary. Is such a practice ethical? I am not in a position to answer that question. You must decide. However, it is one possible approach to the Individual who is in denial of this possible future.

Where the Individual concerned is prepared to work with us then the process is made somewhat easier and the ethical issues disappear. Together we would need to decide on a number of future 'referents' for which we must select Sensory Cues and or Objects Of Reference. Once again, each item selected must be built into the daily route of the Individual such that s/he begins to associate that particular cue or object with a specific POLE. If we wanted to create a cue or an object for a Person (for example - a male Individual's wife), we could ask the wife to always wear a particular perfume and to choose a particular song which she must play a lot when he is around. An object to represent a wife could be a bangle that she always wears or a brooch. The point is the wife must consistently wear the perfume and the object from that point on such that these become specifically associated with her in the husband's mind and can then be used to represent her (if needed) at some future time. The wife must understand that she cannot change bangles when around her husband because then the item may not become fully associated. It would be best for the wife to select an item that was purchased for her by her husband such that there are already established memories. If no such item exists then the husband and wife together can go out an choose one to create the memory. As we tend to remember the unusual, the rude, the larger than life things, etc, it would be wise for the couple to select something out of the ordinary and do something unusual or rude with it together! I will not make any suggestions here; I am sure that you can come up with your own ideas!! The point is to make all the cues and objects selected:

a part of the everyday routine for the individual;
as memorable as possible;
associated with only ONE specific Person, Object, Location, or Event (POLE);
available for potential future use.

One way of making objects memorable as a specific location is to make then a part of that location. For example, we could hang the object on the back of the toilet door as a part of the decor such that it is always in view every time the toilet is used. If the toilet is also 'engineered' to smell of lemon (for example) then the object could be soaked in lemon fragrance if it is brought into use in the future such that the object and the fragrance give multiple cues to an up coming event.

The Individual, Significant Others and the Coordinator will need to be as creative as possible to prepare for any potential future. While they will all be hoping for a better outcome being prepared is a wise move to make.

OOR Rules OK?

The section below covers a set of 'rules' governing the use of OOR.

If you believe there are other rules that I have not covered please contact me and let me know.

If you can think of occasions or situations, in which the rules do not apply, that I have not mentioned, please contact me at TalkSense. I will add them to the site for the benefit of everyone.

Although the term 'rules' has been used, perhaps 'guidelines' might have been a better choice of word. However, telling staff that these are 'guidelines' for use gives them carte blanche to do their own thing! That is a recipe for disaster! Talksense does not pretend that one size fits all and that one approach is correct. Thus, we encourage you to think about your own situation and decide whether what we propose would work for you and the people that you serve. You are free to adopt, adapt or abandon any section of this page as you see fit. It would be good practice for all staff to understand why particular rules have been adopted, adapted or abandoned in relation to your particular situation.

Of course, rules are meant to be broken but please break them with care and for reasons that are specific to your methodology for the use of OOR.

Rule One

Give and Go

When the Object Of Reference has been presented it is imperative that staff assist
the Learner to go directly to the POLE with the OOR.

The only exception to this rule is if an emergency situation arises in which the assisting staff member has to go elsewhere. In which case, s/he should take the OOR from the Learner and deal with the emergency and re-present the OOR on returning. In all my years of experience with implementing OOR I can only recall this ever happening once. In this instance, the staff member was alone in a room with two Learners. She had just presented an OOR to one Learner and was about to leave the room with him when the other Learner had a seizure. She could not simply leave, she had to help. She removed the OOR and went to assist the other Learner.

What if the Learner refuses to carry the OOR or throws it away or simply drops it? See the section on 'Give and Take'.

Rule Two

Give and Take

The Learner should travel to the POLE with the OOR. The Learner should
preferably be carrying the OOR although this may be problematic.

To maximise the potential for the Learner to make an eventual connection between the OOR and the POLE, the Learner should be encouraged to carry the OOR to the POLE or, at least, tolerate it in his/her personal space.

Some Learners, especially in the earlier stages of development with the use of OOR, will not wish to have any sensory interaction with the object and may refuse to interact (especially if tactile defensive), push it away, throw it across the room or simply drop it. This can develop into a 'present and collect' game in which staff are continually chasing discarded objects and returning them to Learners!

Establishments should set standards as part of their OOR policy and procedure documentation which are guidelines for staff. For example: if a Learner throws the OOR away when it is presented, staff might pick it up and re-present the object a limited number of times. As the rule is 'give and go', it is important not to spend a significant period of time playing the 'throw and retrieve' game with a Learner. After one or two re-presentations, the staff Member and the Learner should go to the POLE. The staff member can carry the OOR him/herself. If possible, it should be carried in a position where it can be seen by the Learner (if the Learner does not have issues of visual acuity).

If the staff member involved is able to catch a discarded OOR, this could be used to create a 'responsive environment' (see the work of Jean Ware). The 'catch' could be treated as though the Learner had intentionally given the staff member the OOR! "Oh, you want to go to <POLE>? OK, Let's go!". In this fashion, the staff are encouraging expressive use of OOR (Stage Five) by manipulating the situation to model the required behaviour.

Staff should not be too concerned if a Learner discards, throws or pushes an OOR away. At least the Learner has interacted with the OOR, albeit briefly. Hopefully, over time, the Learner will become more tolerant of the use of OOR.

Shouldn't a rejection of the object be respected?
There are several aspects to that question which must be considered. First, is the Learner really rejecting the object in the way that we would understand rejection? Isn't this an assumption on your part? Second, dropping an object is no the same as rejecting a POLE. Thus, as in the cartoon above, dropping the dice cannot be assumed to mean 'I do not want to go to maths'. Third, in schools and colleges at least, we have a duty to provide an education for the Learner and, thus, if we were to take any perceived rejecting action as indicative of an individual's preference not to take part in some event or activity we would not only be failing in that duty (of education and development) but also reinforcing negative behaviour. While, good practice dictates that we put control into the hands of the Learner (preference not deference), it does not follow that assumptions of understanding of a (negative) Learner behaviour should dictate practice in this way. Furthermore, in society, people cannot always do as they want or as they do not want: A bus driver cannot simply decide that s/he is bored with the same route each day and thus decide to go another way today! A child cannot simply decide that s/he is not going to go on the holiday with her/his parents that they have booked and on which are about to depart. A person cannot decide not to obey the law simply because they have other preferences: if they do, there will be certain consequences. Thus, while I support totally the notion of providing both choice and control for all Learners, in any society (or microcosm of society) there have to be limits of which we must make the Learner aware. To do otherwise is not to educate and may even be not in the Learner's best interests.

Rule Three

Present Concerns

On presenting the OOR, ensure the learner interacts with it

"Because many children's oculomotor control will be more efficient in a centred forward gaze, raising the height of the task presentation will also be helpful. This will also eliminate the dropping forward of the head that may occur with the effort to look down at the tray, and the child will maintain better head control." Fieber, N.M. (1977 page 51)

It is thus important to assess an Individual's perceptual motor control and abilities and to work within the Learner's current capabilities. For example, It is of no use presenting an OOR out of the field of vision of the Learner and expecting him/her to make any connection between Object and POLE. Even placing an Object in a Learner's hand may be problematic if the Learner has difficulty in seeing it and being able to move it so as to be able to see it. Where the Individual Learner has an impairment of one of the senses (for example, the Learner has a severe visual impairment) there is a need to adapt presentation of Objects such that the focus is on the Learner's use of the other senses.

It is important that any object is not simply presented to the Learner in a manner in which there is no cognitive engagement with it (or any staff expectation of Learner cognitive engagement with the object). If such engagement is not typically forthcoming then staff must seek out and provide means to foster such engagement:

"Waiting for the child to respond is a critical feature of a responsive environment. Unfortunately, because a child with PMLD may reposnd very slowly, or not at all, or in an unexpected way, there is a tendency for adults to behave as if they are not expecting a response. MacDonald and Gillette (1984) say that caregivers and teachers are often surprised when they do wait for a child to take a turn, at what he or she is able to do. They also point out the need to wait in a way that suggests that a response is expected. In the Contingency-Sensitive Environments Project, we found that children are more likely to respond when the adult is looking attentively at the child while she waited." (Ware 2003 page 12)

Rule Four

Size Matters

As we require the Learner to interact with the OOR and to carry it to the POLE,
the OORs in use should be portable. Therefore its size and weight are important
factors.

Ideally an OOR should be of a size that an individual Learner can manipulate (sensory exploration) and could carry to the POLE unassisted. Therefore, it should not be too large or too heavy and should ideally fit within an OOR bag (if one is being used) but not be too small as to pose a safety hazard (see rule on safety).

Rule Five

Safety

An OOR should always be safe for unsupervised use.

Some things that could be selected as Objects Of Reference might be too small and pose a choke hazard if a Learner was to put it in his/her mouth. Some objects may be easily breakable and portions of it might be sharp and could cut. Some objects might have protruding parts that could hurt a Learner or a Learner's peer if they were ht against an unprotected body part. It is extremely important that all OOR are safe. My criteria has always been, "Is this object safe for unsupervised use"? In other words would I be happy about leaving the Learner alone with the object while I was across the other side of the room for a brief period. If the answer to that was 'no' then I would look for a different object to represent the POLE.

If the object is too small and poses a choke hazard it can be made safer by securely mounting it onto a backing board.

Rule Six

One to Go

Only ever present one OOR at any time.

For example, do not decide that the Learner will be calling in at the toilet on the way to lunch and therefore it is necessary to present both the OOR for toilet and the OOR for lunch at one and the same time. Multiple presentations of OOR are, at the very least, confusing to the Learner: consistent presentation of one OOR has the possibility of becoming associated with its POLE, whereas multiple presentations do not.

It is natural for all Significant Others to want to see positive results in a short space of time. However, by definition, people experiencing Profound Cognitive Impairments do not move at the same speed as their more cognitively able peers and progress may not occur in hours, or days, or weeks, or even months: it may take years of work to make significant steps.

As it is natural for Significant Others to want positive results, some may be tempted to jump forward a stage or two too quickly believing (on very scant evidence) that a particular Learner has demonstrated the necessary skills to warrant such a move. Talksense urges caution! The presentation of more that one OOR is in some circumstances and at later stages of the scheme acceptable. However, this represents an advanced stage and its introduction too early is counter-productive and should be avoided.

Talksense has also experienced staff using OOR to try to teach the meaning of all the individual OOR out of context in a single session! OOR can and should not be mastered by such a technique. It is completely confusing for an individual Learner to be presented with an OOR and then not acquire the POLE. Such a methodology is not in accord with Rule One (see above). However, well intentioned the member of staff concerned it is a flawed approach which should be avoided. OOR are learnt in USE; as they are presented they become associated with their specific POLE in context. They cannot and should not be presented/taught out of context.

Note that this rule is broken at stage four. However, it is only broken with great care. It is broken to encourage the Learner to begin to demonstrate an awareness of links between OOR and POLE and to develop the expressive use of the system.

Rule Seven

Letting Learners Lead

Allow Learners to lead the way to the POLE

When Learners start to show recognition of an OOR by beginning to move (towards the door), let them lead the way. If they are going towards the POLE do not interfere, if they are going away from the POLE block their route so that they turn around and move towards the POLE. Then, once again, let the Learner lead. If the Learner reaches the door to the POLE and shows no sign of entering then assist him/her to match the OOR to the door marker such that the Learner is aided to make a connection between the marker an the OOR.

The use of backward chaining techniques has been recommended. In this approach, the Learner is assisted to reach the POLE door and then allowed to enter the POLE area unassisted. The next time that the same POLE is encountered, the Learner is assisted to reach a few steps away from the door and allowed to enter the POLE area unassisted. On each subsequent occasion, Learners are allowed to do more and more for themselves unassisted.

Don't be silly, John is not ambulant and therefore he will not be able to lead the way to a POLE.
That is certainly a truism but there might be an alternative; perhaps John can be ask to indicate the direction that the assisting staff member should take. For example could John:

turn his head to indicate the direction?
move an arm or another body part to indicate the direction?
make a sound to indicate a choice between left and right?
eye point in the direction to go?
make a 'no' response if the staff member deliberately takes the wrong path?

While, at first, the attendant staff member might sign and say '(we are going to) Physio' for example when presenting the OOR and then allow the Learner to provide the necessary directions, eventually the staff member might just present the OOR and say 'We are going here' and see where the Learner decides to go! Of course, ending up at Physio in this situation does not prove that the Learner is cognisant of the OOR for Physio as the Learner may always go to physio during this particular session and would go there without the OOR! To prove beyond doubt that the Learner understands the OOR it would have to be presented in a place and at a time at which the Learner does not normally make such a journey. If the Learner goes to Physio in such circumstances then we could be fairly certain that s/he has made a connection between the OOR and this specific POLE.

You're crazy! Many of my pupils just sit and rock and couldn't give me directions to any location within the school.
I assume you are saying that some of your pupils are currently at a stage prior to one in which they would be able to perform such a task rather than making any statement of ineducability. There will be those who are not yet at the correct cognitive level to perform such tasks. It is our job to develop the individual's cognitive skills such that, one day, s/he will be ready to work in this way. If the Individual lacks the physical skills then alternatives (as outline above) must be found to pass control to the Learner. So the job is to take the rockers and turn them into rollers!

Rule Eight

Reach, Reinforce, Remove

On reaching the POLE the connection between the OOR and the POLE should be
reinforced and the OOR returned to its home location.

When the Learner reaches the POLE (staff should treat movement to POLE as a skill in itself and not lead the Learner), staff should reinforce the connection between the OOR and the POLE (see, for example, dOORways this page) and then, remove the OOR. The OOR should not be left with the Learner nor should the Learner be allowed to leave the POLE still with the OOR in his/her possession.

Reinforcement can be enabling a comparison between the OOR being carried and the Door Marker system (if one is in use and the OOR matches the door marker). If no Door Marker scheme is in place then staff can simply refer to the object and the POLE to reinforce the objects's meaning. Of course, if the Learner has made his/her own way (even with a little staff prompting) to the POLE then staff should praise the achievement. If the Learner has located the POLE without any staff assistance for the first time then this should be recorded as a momentous occasion.

The removal of the OOR should be done as soon as possible after reaching the POLE. It should involve the Learner returning the OOR into the system bag (if a bag is being used) or to the place where the OOR are kept him/herself if possible. If not, the Learner should be involved in the returning of the OOR to its home as much as is possible. The Learner needs to know the home location of the OORs such that, at a later date, the Learner can locate and use the OOR expressively.

Rule Nine

Let Learners Learn Location

Learners need to know where the OOR are located
in order to begin to use them expressively.

Typically OOR are presented to the Learner by staff. Then, together, they move to the POLE. However, this is not the ultimate goal. The desired goal is the Learner presents an OOR to a Significant Other thus making a request for a particular Person, Object, Location or Event. In order to facilitate this future possibility, Learners need to know where the OOR are located so that they may easily locate, choose and present an OOR to a member of staff.

There are at least two methods of housing OOR: room-based and bag-based. In a room based approach, the OOR are located in a specific area of a room either mounted on a wall or board or kept in a drawer or on a shelf. In a bag based approach, Learners have a personal set of OOR that are kept in a draw string bag that accompanies their movements around the building. In either approach, Learners need to know where the OOR are located in order to progress to Stage 5 (See stages above) and use OOR expressively. A Learner will never be able to use an OOR expressively if s/he does not know where to go or what to do in order to locate the desired object. Thus, Rule five states that:

Significant Others should include location awareness into OOR presentation

Such inclusion should be gradually built into the presentation technique so that all Learners become aware of the location of the OOR set. Furthermore, on reaching the POLE, the Learner will be required to give up the OOR. This is a further opportunity for staff to reinforce the positioning of the OOR. For example, in a bag-based approach, the Learner should not just hand the OOR to a member of staff but should be assisted to put the OOR back into the bag.

Rule Ten

More or Less: Less is More
Don't try to do too much too soon. Keep it a simple start.

Talksense is often asked should an establishment begin with an OOR for absolutely every item on the curriculum or for every event in a Learner's life. The response is NO: there is no need. While it may be good practice to plan ahead and decide on possible OOR for items on a timetable it is neither necessary, practical or desirable to introduce them to a Learner all at the same time.

Some might argue that such an arrangement is not logical because the Learner is now travelling to most POLEs without an OOR (at least in the beginning) and that they could be starting to make connections with the other OOR. However, if this is to be maintained then surely the Learner must have OOR for every event in his/her day/week!

'Less is More' (Robert Browning,1855, The Faultless Painter) in this instance is very apt. Talksense would want to argue that starting from small beginnings is better for:

the Learner (There is less likely to be Learner confusion)
the Staff (They can more easily control and evaluate the system)
the pocket (Finance is typically an issue)

If this is the case then how many OOR should be introduced initially and how is it to be decided which to introduce and which to leave to later? If we attempt to answer the latter question first it may also suggest the answer to the first. There is more likelihood that a Learner will form a cognitive association between a regularly encountered object and a POLE than one which is encountered less frequently. Which events happen both frequently and regularly in a Learner's life (a birthday can be said to be regular but it is not frequent!)? If an event (POLE) occurs more than once daily then it is prime a candidate for association with an OOR. However, there may be some POLEs that occur with such frequency but with which the Learner is unmotivated (or actively dislikes!). Attaching OOR to such POLEs early in any OOR scheme is probably best avoided! There are a few obvious candidates for early introductions of OOR that may occur more than once each and every day:

Personal Care (toileting);
Food (meals);
Drinks;
Hoisting (only applicable for those who require hoisting);
Travel (to and from a particular place or event);
Favourite Fun motivating items (be careful! Only provide Learner access to OOR for items when they can be presented at any time.)

Talksense recommends beginning with a minimum of three and a maximum of six OOR for individuals starting on any OOR scheme. You should always include at least one OOR that represents a highly motivating fun thing for the Learner to do. However, be careful! If the motivating thing to do is horse riding or swimming (or some other such event) that cannot be provided on demand from a Learner (as swimming requires a trip across town and a booking at the local pool!) then access to such OOR may be problematic and may need to be restricted. You may disagree on the 3 - 6 number of OOR and argue otherwise and there is no hard or fast rule which would make you incorrect in so doing. However, if you have considered the above issues and come to a decision which best represents the Learner's needs within your establishment and for your staff then Talksense would support that wholeheartedly.

Rule Eleven

Policy and Procedure

Create your own accessible policy and procedure document on the deployment of OOR.

All establishments must have written Policy and Procedure documents on the use of MSR/OOR to which all staff should have access that is reviewed at least annually. All staff members working within the OOR scheme should have read and understood these documents. Generally speaking it is better that Policy and Procedure documents are separate entities rather than a combined document. Policies reflect the 'rules' governing the implementation of the establishment's processes. Procedures, on the other hand, represent the implementation of policy and should evolve over time as new ideas, philosophies or 'tools' emerge, new processes are designed, and the environmental changes. (In fact, there should be an expectation that staff members will 'challenge' outdated procedures and a recorded means/channel (within the Procedure itself) that informs staff how they may seek the amendment of an aspect of Policy or Procedure.

Policy statements outline the rules. Procedure statements outline how to implement the rules as set out in the Policy Statement.

The Policy and Procedure documents on OOR should:

detail the establishment's policy and procedures for the use of OOR both inside and outside of the establishment.

Staff may not know what is important.

detail individual responsibilities (who is accountable) within the scheme by staff position or name or both. For example: 'The SLT assistant is responsible for replacing lost or missing OOR.' Staff should know who they are to approach if they have questions about procedure.
be up-to-date. An up-to-date, on-line system will permit those who use or are directly affected by policies and procedures to have the access they need.
be the responsibility of a designated member of staff who countersigns the document.
be reviewed annually.
be readily available: Staff cannot always find the documents they need to make informed decisions. When staff members are unsure about any aspect of procedure they should first consult the P&P document. On-line P&P documents can make them accessible to all.
be written using plain English so as to be accessible by all staff.
be practical. For example; a procedure document that outlines a procedure that staff find impossible to follow is worthless.
both lead and reflect what is actually happening.
use a paragraph numbering system that permits them to be cited easily.
refer to other applicable policies and or procedures if relevant.

A sample policy and procedure document for OOR is included below. This may be adapted, adopted or abandoned as you deem fit. To download the document click on the document. (updated 16/09/2013).

A further Policy and Procedure document is also available for download. Click on the blue wording to download the Policy and Procedure document for Sensory Cueing.

Rule Twelve

Why Wait

Do not pass a single OOR around a group of Learners and make each Learner wait until the whole group has been served by the process before moving to the POLE.

Learners can spend a great deal of time waiting in this manner. For the initial Learner (to whom the OOR was presented) the wait probably means that s/he has forgotten the OOR and will not make an association with the POLE.

If an individual OOR cannot be provided then, as the OOR is moved around the group, each Learner in turn should move to the POLE and not have to wait.

It is recommend practice that each Learner on the OOR scheme have their own OOR which they are able to carry with them to the POLE to reinforce the association between OOR and POLE.

Learner queuing refers to the still common practice, in special education classrooms, of rows or circles of Learners waiting their turn as the the focus progressively passes down the line.

In a Learner Queuing system the group of Learners are typically arranged in a row, a semi-circle or in a circle and an 'activity' is passed around the group one Learner at a time. For example, each member of the group is encouraged to say 'good morning' or interact with an SSS as a staff member moves along the line. The last member of the group has to wait until all the others have had their individual turn and the first group member (once the interaction with the activity is complete to the satisfaction of the controlling staff member) has to wait until all others have completed the task and the focus moves back to the group dynamic once again. All group members are on task for a short period of time but play the waiting game for a much longer period of time: the more group members the longer the period of waiting. In a Learner Queuing approach only one Learner is active at any one time:

L1 L2 L3 L4 L5 L6 L7 L8

each Learner becomes active as the focus passes around the group. Even though:

staff may be very well intentioned;
and the the activity itself may be worthwhile;
and very well done...

Learner Queuing is poor practice because of the 'hidden curriculum' aspect; that is, in reality the individuals involved are actually being taught to ... wait. Individual Learners , especially those with special needs, simply cannot spend so much time off task. Some may go to sleep, some may withdraw into themselves, some may focus on other behaviours that they find personally more stimulating (though staff may find such behaviours challenging). Just how much time during a typical day an individual Learner spends waiting is somewhat difficult to ascertain unless there is a time and motion study within the establishment which, by definition, itself affects the outcome (staff may behave differently when they are being observed). If a Learner's IEP has a target that states '<Learner> will learn how to wait appropriately', I am always concerned! It is likely that <Learner> will already be spending a great deal of time waiting!!

The purpose of this website is not just to point out poor practice but to suggest practical alternatives. There are, at least, three possible alternatives to Learner Queuing. These are outlined below. The first is the preferred methodology by Talksense. You may know of others. If you are willing to share alternative methodologies, please get in touch so that I may add other approaches to this section of the C.A.N. page. You may also want to raise issues with the whole of this section. Again, please feel free to get in touch.

Alternative 1: The LAG Approach
The first alternative to Learner Queuing is what may be called the LAG approach where LAG stands for Learner And Group. In this classroom technique a staff member's interactions with a group of Learners (individually) is interspersed with a short whole group activity. Thus, instead of the L1, L2, L3, ... arrangement as seen above, what we now have is:

L1 G L2 G L3 G L4 G L5 G...

where G = Group

Here, as you can see, the focus passes from Learner to Learner as before but, in between, there is a short group-based dynamic which maintains cognitive engagement for all participants with the given task. For example, if the session in question was a morning greeting. Learner One would be enabled to say 'good morning' to the group. Following this, and before Learner two was enabled to say 'good morning', the whole group would be enabled/required to say 'good morning' to Learner One. This may be by signing (Makaton, Signalong or other) or through the use of SGDs or some other methodology (indeed, some members of the group may not require AAC). The session dynamic changes: no longer are individual Learners sitting awaiting their turn and, again, waiting after their turn but, rather, only inactive for the time it takes a single Learner to say 'Good Morning' to the group before they are called into action again to respond to each group member's greeting.

Alternative 2: One on One
In the second alternative, individual Learners have one-on-one staff support. The staff member's task is to maintain Learner cognitive engagement while the focus progresses. However, this is easier said than done: how is a staff member to cognitively engage a Learner during a good morning activity, for example, in a meaningful manner while awaiting the Learner's turn and, even if they can do it, how do they do it without disturbing/distracting any other member of the group?

If the Learners are getting on with individual work while the good morning greeting is progressing it is not really true to this alternative but creates a third alternative ...

Alternative 3: Individual work
In this alternative, Learners are actually working on some activity as a group or as individuals. While they are working, they are interrupted to allow a staff member to present a new focus to them one by one. While the Learners are not waiting, interrupting one period of cognitive engagement with another, only to expect the Learner to return to the first cognitive activity is probably not the best of practices!

However, if the shared activity in question is the use of a group Object Of Reference passed around the group then, as each individual is handed the OOR, s/he moves to the new POLE. Thus, there is no waiting post activity. While each Learner takes it in turn to receive the OOR, they can still be working with their one-on-one staff member until the OOR is presented. Personally, I do not favour this approach to the use of OOR.

The above Russian video is from YouTube. I assume they posted it because they were proud of their practice but, for me, it illustrates a deviance from at least three of the fundamentals cited on this website (see Fundamentals of AAC page):

The Learners are spending a lot of the time waiting for involvement,
The Learners appear to be fly-swatting;
The use of technology here does not seem to be providing an optimal solution maybe because I believe it is being using in a manner that does not show best practice.

Of course, I have not seen the rest of the session , do not know the children or the circumstances and am therefore being a little unfair. However, watch the young man in red seated on the sofa: what is his involvement in the session so far? None. He is spending all the time waiting. This is not good practice.

Rule Thirteen

Staff Say Strategy
It is imperative that the staff (Significant Others) supporting the OOR scheme must be aware that they have a channel to have their say. If they believe that a particular Learner is not benefiting from the OOR system or has not progressed sufficiently and, therefore, no longer needs to be part of the scheme then they should not declare unilaterally that they will no longer include the Learner (by moving to the next session without the use of an OOR). Instead, staff should have their say at a (weekly?) meeting at which any OOR scheme should be a regular part of the agenda.

The policy and procedure document should contain reference to the official channel for staff suggestions and questions about issues concerning the OOR scheme so that all are in no doubt about the establishment policy or the procedure to follow.

Rule Fourteen

Express Train

Act upon expressive acts of communication by Learners.
Treat all Learner uses of OOR as though they were expressive.

If the Learner uses an OOR expressively then, it is a necessary condition of training that staff act upon this communicative act without hesitation (especially if it is the first time ever that a particular Learner has ever done such a thing). No matter what is being requested, even if it is not believed to be intentional on the part of the Learner, staff must go with the Learner to that particular POLE (and, if practical, even if that POLE is out of school).

If the provision of positive reinforcement in this manner is completely impossible because of staffing, or establishment policy, then prevent it from happening: Remove the OORs whose POLEs cannot be provided to a secure place until they are needed. This will mean that the Learner cannot make an expressive request for such POLEs until an appropriate moment.

All staff must understand that expressive acts from Learners experiencing PMLD are rare and therefore, extremely important. They should act upon them as though they were commands from the highest authority in the establishment. Staff should record such momentous moments and let all other staff know what has happened. It may not happen again for some time but, if it happens just once, staff belief in the system is elevated enormously and motivation levels are raised. Everyone deserves a pat on the back for their efforts because it is the team effort that helped make it a possibility. The Learners reward is to get to go to the place s/he has requested as well as taking one giant leap forward cognitively.

If the Learner just happens to get hold of an OOR by mistake or for some other reason (than a member of staff giving it to the Learner) then staff should treat the occurrence as though it were an expressive act - a request by the Learner to for a particular POLE. Thus the staff member should say something like:

"Oh Jane, you want to go to the dining hall? OK let's go together."

If Jane is supposed to be somewhere else then the staff member should take the OOR for that POLE with him/her and, when Jane has had a little time in the dining room, the new OOR can be presented and Jane and the staff member can move on to the correct location. If Jane is simply going back to the place from which she came, the procedure is the same: the staff member takes the OOR for this POLE with him or her to the dining hall and, after a short period of time, presents it to Jane so that she can now go back to her session.

Creating a responsive environment (see the work of Jean Ware) in this manner is good practice.

Rule Fifteen

Not Really

OOR should NOT be used as real indicators of a time-line.
They are NOT a time-tabling system.
They are not a work box system.

OOR are not to be used as a time-tabling system. That is they can be presented together at the beginning of the day to say, '"This is what you are doing first and then this and then this and then it is dinner time and then you will be doing this followed by this and then you will be going home". This approach would break the Give and Go' and the 'One to Go' rules that we encountered earlier and be extremely confusing for the Learner: sometimes OOR are used indicate the thing that is happening immediately and sometimes OOR are used to indicate something that is happening later in the day. NO! OOR must not be used in this way.

OOR must NOT be used as a:

timetable or as timetable items for Learners;
task or work box system or in any form of visual scheduling or visual countdown system;
choice of activity system until (at least) stage four and then only with great care and consideration.

It should also be noted that it is better practice not to use the OOR for real life events. For example, if you are using a plastic cup as an OOR to represent drink time, it is better not to use that cup for the Learner to drink for real. This is because, after use, it will get put into the washing up system and will not be available the next time you need it. Of course, if you are using a swimming costume as the OOR for going swimming then it perfectly acceptable for it to be used for real as there is time for it to be washed dried and return for use on the next occasion!

Rule Sixteen

No I in team but there is in inconsistency

Share responsibilities.
Create strategies to support consistency

The problem with people is that they are fallible! The bigger the team the more likely there are to be errors and inconsistencies. The more complex the task the more likely it is that those inconsistencies will be compounded. Indeed, research in other fields (for example in errors in surgical outcomes in hospitals) point to the following factors:

1 excessive workload;
2 fatigue;
3 poor technology;
4 insufficient training and supervision;
5   inadequate systems;
6 poor communication among staff;
7 time of day;
8   administrative failures.

See   Gawande, A., Zinner, M, David M., Studdert, D, and Brennan, T. (2003)  "Analysis of errors reported by surgeons at three teaching hospitals"; Surgery, Volume 133, Number 6).

Do not the majority of the above seem familiar?! Could they not equally apply to some (if not all) special education settings? Inconsistencies and errors are more likely where systems:

are more complex;
involve large numbers of staff;
are not properly detailed, explained, and reinforced;
have not got staff approval/backing;
invoke large workloads, stress and fatigue.

"Accepting the inevitability of error and the importance of reliable data on error and its management will allow systematic
efforts to reduce the frequency and severity of adverse events" (Helmreich, R.L. 2000)

How can we help to reduce errors, omissions, and inconsistencies? We can:

break the task into smaller components and ascribe responsibilities to several staff such that no one member is overloaded and all understand their duties;
ensure regular training updates;
ensure their is a clear policy and procedure document easily available to all staff;
provide checklists for staff to follow such that nothing can be missed;
involve the staff in the process;
provide an official channel for staff to make their opinions known;
provide a more staff centred approach (as opposed to Learner centred!) reducing complexity where possible.

In terms of which is more beneficial to the Learner, Talksense would want to argue that, from experience, a consistent staff centred approach is better than an inconsistent Learner centred system. Of course, if you are able to provide a consistent Learner centre system then this is the best of all. However, what is good when written on paper is not always good when applied in practice and the problem with people is that they are fallible!

Breaking The Rules: and you're doing this because ...

"Ask an impertinent question, and you are on the way to a pertinent answer"
Jacob Bronowski (1973 The Ascent of Man.New York, Little,Brown and Company)

We would all do well to ask ourselves this phrase everyday; not just with MSR and OOR but in all we attempt to do with and for Learners. Rules were meant to be broken; indeed, your establishment may decide not to follow one or more of the rules and add others of its own. That is fine providing staff can justify why they are doing so.

Of course, not everything we do with emergent AAC has to have a sound educational motivation ... just the majority of the things! Having fun is a legitimate reason, although we can have fun AND have sound educational reasons underlying what we are attempting to do. In some instances, what staff might consider to be 'having fun' might actually be detracting from the Learner's current objectives and actually causing confusion. Staff should be encouraged to question what they think the Learner is understanding from any action; that is ... ask themselves 'and I am doing this because ...?'

If we are working within any area in Special Education we should be asking 'and I am doing this because' and relating our response to the Primary Purpose (see Fifteen Functions of AAC on this web site) which is Independence. All staff should be able to answer these questions:

I am doing this because ...
It helps develops the Learner's Independence because ...

and the answer cannot be because 'I have been told to do it' or because 'the curriculum says I must do it'. Those are not answers they are excuses. Staff need to understand and be able to state the what, why, and how they are doing something. Staff also require a belief in what they are doing.

Towards the DOORWAY

Is there a definitive OOR set? The answer is no, not yet although some have tried: see below). Some would argue that OOR should be individualised and therefore there cannot be a Definitive OOR WAY. However, as I have a foot firmly in the shared camp, it would be useful if all establishments were 'talking the same language' and there was a definitive list that establishments could reference. To this end, I have prepared the document below. It is NOT definitive nor is it intended to be. What is is, however, is a starting point from which we can move forward. If readers will let me know what they are using as the OOR for the POLEs listed below, together with any other OOR and POLE combination, then I will start to compile an international survey and update the table below regularly with the most numerous choice occupying position one, etc. Please use the contact form at the bottom of this webpage for this purpose.

There are benefits to having a definitive (and desirable) way forward: First, it is a resource from which we all may benefit, second, a manufacturer might be tempted to produce the set of items if enough people want to use the same OOR, and third, if a Learner moves school or transitions to a new establishment, there is a greater likelihood of consistency of approach. However, as has already been pointed out there is a majority of opinion for whom a definitive set would be a folly.

Below is the listing - it can be DOWNLOADED (Word Document) by clicking on the link.

In 2009, Ellen Trief, Susan Bruce, Paul Cascella, and Sarah Ivy conducted a survey in New York City schools on the the use of and requirement for Objects as symbols. The survey resulted in a listing of 55 'universal' object symbols which I have outlined below:

Activity
Dismissal
Bathroom
Gym
Speech
Classroom
Literacy
Circle time
Outside
Music
Occupational therapy
Physical therapy
Snack
Biscuit/Cookie
Computer
Art
Sensory
Rest time
Nurse's office
Toothbrush
Cooking
Orientation and mobility
Arrival
Mathematics
Science
Vision
Centre time
Drink
Lunchroom
Break
No
Community
Stander
Orthotics
Calendar
Walk
Light box
More
Games
Food
Finished
Juice
Bubbles
Milk
Yes
"Itsy Bitsy Spider"
"Twinkle, Twinkle"
"Wheels on the Bus"
"Alphabet Song"
Bedtime
Park
Church or temple
Bath time
Set the table
Do the dishes
Car ride

Object
Strap with a buckle
White tile with a black edge
Tennis Ball
Mouth or lips
Doorknob
Small, thick book
Wooden circle
Three stones
Bells
Three beads
Squishy ball
Small, empty snack bag
Biscuit/Cookie
Floppy disc
Paintbrush
Small tube of lotion
Small square of a blanket
Large Band-Aid
Toothbrush
Measuring spoons
Tip of a long cane
Plastic hands
Unifix cube
Magnet
Small eyeglasses
Clothes pin
Cup
Spoon
Timer
Raised "X"
Piece of a tactile map
Vinyl square
A half-cup measuring cup with a Velcro strip
Piece of a calendar for the Blind
Shoe or sneaker
Plastic piece from a light-box kit
Piece of red velvet
Spinner
Small plate
Spool on a cord
Juice box
Bubble wand
Milk box
Raised "O"
Plastic spider
Raised, shiny star
School bus
Raised letters "A," "B," and "C"
Piece of a comforter
Metal chain
Smooth moulding in the shape of a roof
Small bar of soap
Piece of a placemat
Small dish
Car keys or house keys

While I wholeheartedly applaud and support this team's effort and ambition, I would raise a few points:

the list cannot claim to be universal as they only surveyed New York City schools and some of the things in the list might be seen as typically American.
No reference is made to intrusion on personal space through such things as 'hoisting'. For me, an object for hoisting should be a must-have in such a list.
a few of the things on the list might be encountered at some other time and not result in movement to POLE. For example, a spoon might be encountered at Breakfast and therefore might not be the best thing to use for lunchroom unless all meals are taken in this place and that is highly unlikely as Learners will probably eat out at some point and may be using a spoon. This objection might be overcome if the spoon was unique in some way (colour and texture and size and material?)
Using a biscuit/cookie as an OOR for biscuit/cookie seems a little strange! Surely the Learner would just eat the OOR! As such, it would not be an Object Of Reference as it did not lead to a movement/transfer to a POLE. It could be a Sensory cue but then, by definition, all items could be seen as sensory cues for themselves. This would appear to defeat the objective of the exercise but I may be misunderstanding the listing in some way. If there was such a need, I would probably use a small packet of biscuits/cookies (the type that you get in hotel rooms) as an OOR. However, as such a thing would not last nor be too hygienic after a couple of days, I would probably create plastic biscuits/cookies and wrap them in plastic such that they looked liked the real thing but would be more durable.
A 'universal' listing is, by definition, the very opposite of an individualised approach which is what is recommended by the majority of those writing on the subject (although I do not share that opinion!) and, as such, as is stated elsewhere on this webpage, one must weigh up the pros and cons of each approach and come to a conclusion which you feel is the best for your place of work and the Learners and Staff within it.

The above points are not meant as a criticism of the list as I approve of any team trying to forward this area of Learning rather they are meant as addendums to the list to provide other points that should be considered.

Healthy OOR

How does a person experiencing PMLD let you know that they are in pain or not feeling well? That's not an easy question to answer. Of course, you can (and should) look for tell tale signs such as:

Crying;
Changes in behaviour;
Facial expressions;
Changes in appetite.

However, the individual is not telling you, it is you that are observing and even with such observations there is a possibility that pain can be missed. The Learner may be in some distress and thus it would be obvious that something is amiss but what if the Learner is not showing signs of distress? It would be great if we could develop an OOR for pain such that the Learner might pass it to a member of staff when s/he is not felling well or is in some pain. If a person could understand that a doctor is responsible for patient health care then that might be a means to developing an OOR system for health: every time you visit the doctor you always take a particular OOR and thus an association might be formed between seeing the doctor and the OOR such that, in time, the person might request to see the doctor by presenting the OOR to a staff member. However, there is a big problem with this idea! How does the individual make the link between the doctor and pain relief? The doctor and health care? As far as the individual is concerned, the doctor is just another individual coming into his or her personal space. If, every time the individual saw the doctor, all pain stopped immediately then such a link might be formed but we know that this is not what happens. Thus, an OOR for 'doctor' is not really useful. The same might hold true of visits to the nurse although a nurse might change dressings and apply medications etc which might make an individual feel more comfortable and thus an association between seeing the nurse and feeling more comfortable might be formed. Thus an OOR for visits to the nurse is a more practical idea. Typical OOR for 'nurse' are empty (plastic) medicine bottles or disinfectant bottles maybe with a few dried peas inside so that they rattle. The tops should be glued shut.

What other ideas are there? One idea is to provide an OOR during all periods of illness consistently. That is, when it is obvious that the Learner is ill with a cold, flu, or some other infection then a particular item is placed nearby in plain view throughout the period of illness. Over several periods of illness, the Learner might come to associate the object with the times that s/he is ill and could, at some future point (reaching stage five expressive use of OOR), locate the OOR and pass it to a member of staff to indicate that s/he is not feeling very well. What object could we use here? Perhaps the person gets to wear a badge with a red cross every time s/he is ill. The badge uses a safety pin so there it is safe for use. The person then might associate the badge with illness and if one was added to the OOR set (with no pin) then it could be used as a way of communicating a poorly feeling. The association would have to be built over some period of time of course but as a red cross is a standard symbol for health care, the Learner may also notice it on any trips to hospitals, etc. An alternative to the badge idea could be a first aid box but the OOR would have to be a smaller version.

Changing POLEs with no Learner Movement

As we have seen, the first rule of the use of OOR is 'Give and Go'. That is once the OOR has been presented, it is important that staff and Learner go to the POLE straight away. However, In some situations individual Learners do not move to a separate area to change POLE: they may, for example, stay within the same room and simply change the session topic... maths may give way to literacy and literacy to self-awareness. Thus the OOR is not followed by a change of environment rather a change of focus. In this situation, it may be more difficult for a Learner to grasp the meaning of the OOR as in changing rooms you are changing both Location and Event and usually also Person (staff change). Indeed, the objects in use in the new location may also be significantly distinct and, thus, every aspect of the POLE is addressed by the OOR. In remaining in the same room, you are not changing Location and probably not changing the Person but you are changing the Event and maybe the Objects. However, we might employ a technique to enhance the strength of the change on presentation of the OOR: we might also change Location! How can we change Location while remaining in the same room? We don't actually change location, what we actually change is position and orientation.

This technique suggests that all encounters with a new Event (while remaining in the same Location) should ideally be in the same orientation and position whenever practical and possible. Thus, if the Learners are staying within the same room and are changing topic perhaps we can change orientation or position within the room so as there is a distinct change before the start of the new subject area. Moving from a carpeted area of a room to an area covered with linoleum for a particular topic might become associated with that specific topic. Changing from North facing to South facing could have a similar effect. Thus, the Learners are moved to a new position and are now facing in a new direction. If Learners are facing a new direction then, by definition, they are facing a new wall of the room: that wall could hold the display for the topic in question. It is as though the Learners have moved to another classroom for the new topic even though they have remained in the very same room.

You are crazy: you think we have time to do that?
I think you should make time. It actually doesn't take that long once you get all the available staff organised. It may also be beneficial in that now the Learners can be facing a wall devoted to the topic in question.

But my whiteboard is at the front of the classroom!
Do you have to use the whiteboard for all topics? Could you procure a mobile whiteboard? Could you not project onto a blank area of the new wall? If you like the idea - you'll find a way to be creative to overcome any issues. However, I did say 'if practical' in the text above. If it's not practical then don't do it!

Transitional Objects, Self-Stimulatory Systems, Objects of Reference and IEPMLD

While 'Transitional Objects' may also be 'Self-Stimulatory Systems' and 'Self-Stimulatory Systems' may also be 'Transitional Objects' neither can or should be used as an Object Of Reference.

As there are a couple of new terms in the above statement, we must begin this section with their definition.

There is a well-known cartoon 'Charles Schulz' character called Linus. Linus is almost always to be seen carry around an old blanket. He takes it wherever he goes, chewing on its corner or curling up with it when things get tough. Such a comfort or security object (as blankets and teddy bears, etc.) is seemingly a part of a system of emotional support for almost every child. It assists the child to get to sleep, it provides extra comfort when Primary Others are not around, and it's reassuring when things are a little scary. Such special items are known as Transitional Objects because they help the child to make an emotional transition from dependence to independence. They tend to be soft and easy to snuggle up to and may also smell of home or a loved one. They remind the child of home, of safety, and are comforting. Children can become very distressed if a Transitional Object is mislaid. The term 'Transitional Object' was introduced by the paediatrician and psychoanalyst Donald Woods Winnicott (1971) in the early 1970s.

A Self-Stimulatory System is, as its name implies, a system of self-stimulation that has been 'developed' by an Individual Experiencing Profound and Multiple Learning Difficulties (IEPMLD) over a number of years in response to a sensory deficient environment. It is typically a repetitive behaviour that the individual perceives as stimulating such as rocking back and forth, twirling or flapping an object near to the face, eye poking, face slapping and even more injurious behaviours such as lip biting or arm scratching. LaGrow and Repp (1984) identified over 50 variants of such behavior. Some of the behaviours may be additionally reinforced by others who may find them concerning and therefore show the individual greater attention. However, the withdrawal of attention will not serve to reduce the behaviour (Lovaas, Newsom, & Hickman 1987) because the behaviour is not initially shaped by social events.

"Significantly, self-stimulatory behaviors do not extinguish with the removal of social reinforcers. When subjects are left
unattended, the rate of their self-stimulatory behavior remains high. This independence of social reinforcement is
documented in studies with both retarded and autistic subjects, showing that self-stimulatory behavior gives no evidence
of extinction in settings that are devoid of social reinforcement." (Lovaas, Newsom, & Hickman 1987 page 54)

Although not typically the case, it is possible for a Self-Stimulatory Object to also be a Transitional Object and, visa-versa, for a Transitional Object to also act as a Self-Stimulatory Object. Not all Self-Stimulatory actions involve objects. Those that do may involve flapping or twirling the object close to one's face for visual stimulation (or the object acting like a fan). It may also be that the repetitive motions of body parts are also adding to the overall effect.

The use of a Self-Stimulatory Object (SSO) is one type of a Self-Stimulatory System (SSS). There are other SSS which do not involve SSOs, for example, poking oneself in the eye with your finger (unless one considers a finger an object). SSSs will act to distract an Individual from learning (Lovaas, Newsom, & Hickman 1987); if you are poking yourself in the eye, it is hard to focus on other information from the world around you. We might look at that another way and suggest that the individual is poking him/herself in the eye because there is insufficient stimulation from the environment. That should lead us to question whether all the individual's sensory mechanisms are functioning as they should. Indeed, we are nearly all aware that Individuals Experiencing PMLD often have one or more impaired sensory functions such as a problem with visual acuity of a particular form of hearing loss. Transitional Objects, on the other hand, do not normally impair learning. Indeed they may act to diminish an anxiety which otherwise would have interfered with concentration and, thus, they may assist learning. However, when an SSO becomes a TO (or a TO becomes an SSO) then the two do not cancel each other out (SSO + TO ≠ 0); the SSO still acts as a distraction and, therefore, we should seek to extinguish Self Stimulatory Behaviours (See, for example, Rincover, A. 1978).

"when engaged in these behaviors, the children were particularly hard to 'reach' socially and difficult to teach.Their
attention seemed to focus exclusively on their own behaviors, making them oblivious to all but the strongest
external stimuli." (Lovaas, Newsom, & Hickman 1987 page 46)

In some circumstances, the removal of the SSO may result in:

an increased awareness of the individual's environment (SSB - SSO = attention to others).
adoptions of alternative forms of Self Stimulatory Behaviours (SSB). For example, an Individual who flaps a piece of card may change to hand flapping (SSB - SSO = alternate SSB) if the card is removed.
behaviours that staff may find challenging. This is especially true if the SSO is also a TO.

We should take some comfort in the recognition that SSBs are learned; children are not born with these forms of behaviour but acquire them at some later point, perhaps as a result of accidentally performing a particular body movement and finding it to be in some way satisfying and thus reinforcing. If an Individual can learn such a behaviour then, by definition, they are capable of learning other behaviors too (and are thus NOT ineducable) although the former learned behaviour, as we have seen, may interfere with the acquisition of other subsequent learning.

As an SSB's etiology may lie in a mismatch between need for, and outside provision of, sensory stimulation, they may be reduced by provision of more acceptable alternatives. For example, an Individual who is eye poking will require the provision of something that is equally (if not more) stimulating than poking oneself in the eye. However, establishments often resort to 'prevention rather than cure' and may splint, strap or otherwise restrain an Individual's arms in an attempt to prevent (or at least reduce the frequency of) such self injurious behaviors. While this undoubtedly has the required effect it also imposes an infringement of the Individual's liberties and also results in a lack of arm function with which the individual could otherwise interact with his/her environment. Thus, the 'solution', which seeks to enhance learning, has a side effect of diminishing the possibility of learning! In 1978, Rincover (op.cit) was able to show a reduction and even an extinction of SSBs by preventing the Learner's perceptual feedback (that is by removing the auditory, visual, or proprioceptive feedback reinforcing the behaviors) from such behaviours. For example, by carpeting a table, and thereby removing the auditory perceptual feedback, a child stopped the tabletop object spinning behaviour which he had previously exhibited. Where such inhibitory interventions were used the SSBs decreased dramatically. However, they returned to full strength when such interventions were removed.

The provision of an alternate super-stimulatory activity (one that is subject to external educational manipulation) may reduce the level of an Individual's SSB in favour of the alternative:

"Such data support a reinforcement interpretation of self-stimulatory behaviors because behaviors that are controlled by a
strong reinforcer tend to dominate behaviors based on a weak reinforcer." (Lovaas, Newsom, & Hickman 1987 page 55)

For example, if a child who is eye poking is given access to something that provides greater perceptual reinforcement, then the child will tend to seek the alternative. What is more perceptually reinforcing than eye-poking? One could provide the direct equivalent: by placing a fan near to the child's face such that the fan (when activated) will blow directly into the eyes. This might offer an acceptable (and less physically damaging alternative). Furthermore, the fan could be controlled through a switch via a Powerlink system (or equivalent). Seemingly, that would require that the individual to be cognisant of and able to activate the switch. However, if a string switch was attached to the child's wrist (if the child is eye poking s/he can move their arm by definition) via a wrist band (attached to a strong elastic band attached to the string of the switch), such that a movement in any direction of a certain magnitude will cause the switch to activate, the child can learn by accident a contingent relationship between a specific movement and a desired perceptual stimulation (primary circular reactions become secondary circular reactions). Furthermore, the new PowerLink system can record the number of switch activations made by the Learner in any given period such that the frequency of the behaviour can be monitored over time. It may well be that another, different form of perceptual reinforcement may have equal effect in reducing the undesirable behaviour. For example, a switch activated vibrating cushion or mat (especially if the frequency of vibration is adjustable) may provide greater returns for the individual and thus the unwanted behaviour will extinguish. If this interventional procedure is successful then a subsequent step might be to replace the string switch with a more conventional jelly bean type of switch with a specific visual or tactile label. The Learner has therefore to learn to target the new switch to receive the desired reinforcement. What might the next step be? Simply stepping up the difficulty of the task a little at a time is an educational process. Thus, we might provide two switches: one which operates the desired reinforcement and one which does something other than the Learner is directly seeking. Each is labelled (visual or tactile). Does the individual discriminate between the switches? What does that tell us? What can we do now?

As we are advocating the Local Engineering of Sensory Stimulation (LESS) as an alternative to SSBs (especially those that are harmful) for educational purposes such techniques relate more to MSR than OOR. As LESS are under the control of other than the Individual, they can be manipulated to:

provide an alternative to undesirable SSBs;
reduce harmful behaviours;
enhance specific skills;
scaffold cognitive growth.
support a reduction in their requirement.

SSOs and a TOs should not be used as an OOR. They serve different purposes for the Individual. However, the Learner may accept both a SSO and or a TO being placed in a OOR bag providing the Learner comes to understand that these will be returned to them on request. As they are not being confiscated but merely being stored in a place where the Learner has access then the likelihood of behaviours that staff may find challenging occurring are reduced. While safely in the OOR bag, any SSO will not act as a distraction.

Using the LESS approach, eye poking may be replaced by switched eye blowing (using a fan operated via a switch) to provide the stimulation. Over time, the fan may be moved (gradually) away from the Learner such that the Learner's dependence on the stimulation strength is slowly reduced. However, as the Learner developed such behaviours as a result of a lack of stimulation it is imperative that acceptable replacements are provided otherwise the original behaviour might re-emerge.

That's crazy! While it might work in the classroom the behaviour is just going to be displaced to other location such as during breaks or out of school.
If it works in the classroom then why don't you extend it to other locations? Presumably, this person is not running around at break (if they were they would not be eye poking) and Local Engineering of Sensory Stimulation can equally be put into place.

From Objects to Symbols or Sign ...

Fading and shaping procedures are used to transform natural symbols to drawings, written words, finger spelled words, formal sign, and/or speech that is of the language of the child's culture. The teacher or caregiver must consider all the child's potential learning modalities: visual (e.g., drawing), auditory (e.g., listening to directions), tactual (e.g., signing or Braille), and visual-auditory (e.g., written word after speech). Symbolic communication strategies help the child use problem solving behavior in regard to the constructs of language. Gradually, the child's existing vocabulary is expanded upon through dialogues about the topic at hand. For example, a father and a young child feed their new puppy. During the experience, they refer to a card which has a small Beginnings 12 bagged sample of the food attached with a Braille label underneath. Gradually, the card is presented before the activity begins to symbolize something that is not currently present and eventually the Braille alone comes to represent the activity. (MacFarland and Nelson 1998)

It is likely that those Learners needing the use of an approach involving MSR may be involved with the scheme for a long period of time probably measured in years. However, there should come a time when a transitional move is made from such object and sensory symbols into other symbolic forms such as symbols and or signing (it could be both). This does not mean that symbols not signing or other forms of communication cannot be used in conjunction with MSR: indeed, their use is to be encouraged. However, the initial staff focus is on the objects rather than the sign and or symbol.

To facilitate a transition from one communication medium to another a number of strategies might be employed. Some ideas for such strategies are given below. The list is not exhaustive.

Symbols might be added to Objects such that, when the object is presented the symbol is always present. Staff focus is not on the symbol at this time but on the object. However, as the symbol is always present, the Learner is prepared for future transitions. The image attached to this section depicts the use of a plate as the OOR for meals. Attached is the symbol for 'meals' such that, when the plate is presented, the symbol is omnipresent. However, the focus is on the plate and not on the symbol.
Staff sign the POLE as the object is presented. Staff signing should be consistent. However, while Learners may attempt to sign on occasion, Learner signs should be accepted even if they are only approximations of the actual sign.
Objects can be 'faded and shaped' into new forms. For example, an object could begin as a whole but, over time, be gradually cut down and down, until its is almost an outline of the original. This outline might then be produced as a card with a raised line form (using hot glue from a glue gun for example).
The symbol for the POLE can mark the entrance to the room (if the POLE is associated with a room or rooms) along with the door-marker object system.

Zones Of Awareness

This section is in development: apologies

According to an unpublished article by Jones (2000), there are five 'zones of awareness':

Zone 1a     Self Awareness: Body Proprioception
Zone 1b     Self Awareness: Knowledge

Zone 2:     Personal Space
Based on the work of Heine Hediger involving animal proxemics, the importance of personal space for humans was probably first outlined by Edward T. Hall in his book 'The Hidden Dimension' (1966 Anchor Books), although the notion of 'propinquity' was previously explored by Festinger et al in the early1950s (Festinger, L. Schachter, S. and Back, K. W., 1950, Social Pressures in Informal Groups: A Study of Human Factors in Housing, New York: Harper). Hall (1966 op. cit.) described four distinct areas of personal space associated with social interaction: intimate space (0-1.5 feet), casual personal space (1.5-4 feet), social consultant space (4-12 feet), and public space (12 feet and beyond).

Personal space has been defined as "an area with invisible boundaries surrounding a person's body into which intruders may not come" (Sommer 1979, Personal space. Englewood Cliffs: Prentice-Hall). Personal space may extend to the limits of zone three and, for some, may even go beyond. Personal space may extend forward from some feet but is likely not to extend to the same distance in reverse: i.e. behind the individual (although a person walking alone at night might feel threatened by footsteps at the rear even at some distance). Thus, although shown as perfect circles in the diagram, zones of awareness may be quite irregular in shape and may actually change form in different contexts and at different times of the day.

Personal space has an interpersonal and interobjectional (as in a relationship to objects) aspect: it is not a fixed boundary for everyone and everything. There may be some people that evoke strong emotions and whose presence cannot be tolerated even in zone 4 when, normallly, the individual's personal space is set at zone 2. It may also be that you cannot tolerate spiders (or even the knowledge of spiders) in zone 4 but are perfectly happy with a cockroach (and likewise for some particular inanimate object). However, there is a postive side to such reactions: as you have to be aware to react, a reactions lets observers know that an individual is aware of (at least some) items in zone four.

In the Special Education Environment, staff may be required to enter individual personal space much more frequently than would be typical in a state school for example. However, no matter how many times a staff member has to enter an individual's personal space in the course of his/her work, s/he must never take the siutaion for granted. It should always be assumed that the individual Learner has the right to refuse a staff member entry into their space. Thus, staff should always enter with this in mind and look for cues that an indivdual is permitting the 'entry' and, equally, cues that suggest the individual is unhappy with their presence. To this end, it is important that staff members enter personal space within the individual's immeadite sensory zone of awareness. Creeping up from behind is not an acceptable approach. If a staff member is going to push an individual in a wheelchair, for example, s/he should approach from the front and 'seek permission' before moving to the rear. No staff member should approach from behind, take hold on the handles of a wheechair and begin to move forward. This should be viewed as personal abuse. Likewise, reaching over from behind a Learner while pushing a wheelchair is not an acceptable strategy even if he individual has given staff' 'permission' to push. If something needs to be sorted, apply the brakes and move to the Learner's Primary Zone of Sensory Awareness and 'seek permission' before performing some necessary task.

By definition, the presentation of an OOR should always be within an individual's Primary Zone of Sensory Awareness.

Zone 3a:   Immediate Exploratory Zone
Zone 3b:   Orientational Exploratory Zone

Zone 4:      Bounded Environment - Level One (Sensory Impairment and Boundaries)
Zone 4b:    Bounded Environment - Level Two
Zone 5:     Beyond the Bounded Environment (awareness of the world) The role of language
                   a) spatial
                   b) temporal

The greater the level of cognitive impairment the more the need to work within the lower numbered zones

Personal Learning Space

Dimensions of Personal space (it is not 2D but 3D)

APOLOGIES : IN DEVELOPMENT

Not a Miracle ...

In the film of the story of the life of Helen Keller 'The Miracle Worker' (1962)(Note there have been three such films 1962, 1979, and 2000 but I believe that the original is still the best!) Anne Bancroft plays Johanna "Anne" Mansfield Sullivan Macy (better known as Anne Sullivan), a 20-year-old graduate of the Perkins School for the Blind (Anne was herself visually impaired), who is employed as a personal tutor for Helen Keller by Helen's Parents in 1886. At this time, Helen was an almost feral, seven-year-old, deaf blind, young lady with a near complete lack of language. Under Anne Sullivan's tutelage Helen goes on eventually, at the age of 24 (in 1904), to graduate with a Bachelor of Arts degree; the first deaf blind person ever to do so.

While we know that Helen was an intelligent young lady (she goes on to gain a degree), it still takes Anne Sullivan weeks of work working one to one with Helen for her to make the first connection between the tactile finger spelling system employed and the world around (it was for the word 'water'). If it took weeks of work for Anne working 24/7, one on one, with an intelligent young lady, to make a breakthrough then none of us (no matter how gifted tutors we consider ourselves to be) are going to make such a breakthrough in less time with any Individual Experiencing Profound and Multiple Learning Difficulties. In reality, it is going to take much much longer. All staff need to understand this concept: nothing will happen overnight. It may take many months (or even years) of work for an individual to make any progress. Staff must not believe otherwise or else they may become disillusioned with the approach.

Not only did Helen have Anne as a personal tutor but also, as the film graphically portrays, several other factors contributed to Helen's 'eureka moment' - it was not a miracle but rather:

one to one tutelage
working all day and every day (Anne lived with Helen);
the eventual exclusion of all outside interference (even Helen's parents!);
Anne sets standards and will not compromise;
Anne's belief in Helen's potential
Anne's passion, enthusiasm, and determination;

While we may not be able to match Anne's 24/7 approach we have the advantage of working in teams: The MSR approach does not just involve one staff member doing everything but the whole team working with a common goal (if they are not then the system is more likely to fail). However, we too must have the passion, the enthusiasm, the determination and the belief in both the Learner and the system: limited commitment is not sufficient - indeed, it is likely to produce very disappointing results.

Download the Talksense Training Course PowerPoint Presentation

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New Version uploaded: 18th August 2016

Bibliography and References

Dr. Jan Van Dijk has a website: http://www.drjanvandijk.org/

The following is a list of references for Objects Of Reference and other related areas such as haptic communication. It is not intended to be comprehensive but Talksense likes to be thorough! If you are aware of other sources of information in print please contact Talksense and let us know so that we can add it to the list for the benefit of all.

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