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Comunique - Assessing Multi-Disabilities and Visual Impairment with a Computer Communication System

Focus: School Years

Topic: MDVI

Ana Helena Schreiber

Occupational Therapist

Coordinator of Low Vision Service 

Centro de Terapia Ocupacional do Rio de Janeiro

Av. das Américas, 700, Bloco 1, sala 108 – Barra da Tijuca

Rio de Janeiro – RJ – Brazil –

Cep: 22640-100

55 (21) 3803-7890


Comunique, a non-commercial software, meets the needs of a number of severely motor impaired individuals, who have been alternative communication consumers, for both oral and written communication. This software was developed by the occupational therapist Miryam Pelosi, and it has been used in the Occupational Therapy Center of Rio de Janeiro by nearly 80 children, and since 1994 by the public elementary schools of Rio de Janeiro as a tool for helping the inclusion of students with multi-disabilities in the regular educational system.  Devised in Windows format, this software integrates extremely simple multimedia and interactive elements, essential for its functionality. The software allows therapists, teachers, and parents to personalize the program for the user.


The main characteristic of Comunique is its versatility. The program presents a screen with several different cells, arranged in a regular lattice (see figure 1 below for an example). Each cell contains words or images. The cells are highlighted one at a time, at a speed that may be controlled by the user. The user selects a given cell by some voluntary movement coupled to a suitable switching device (examples are pull/push switches and infrared detection of blinking), at the very moment the cell is highlighted. Once the cell is selected by the user, the program may perform one of the following functions: write on the screen and/or speak a previously recorded message, magnify, delete or print the selected cell, generate a beep, play music, switch to a previously selected screen, and change direction of scanning. The software allows the user to select among several different configurations, including the number of cells displayed in a given screen (from 1 to 64 cells), the number of screens, the size and type of the fonts, the type of  highlighting (frame or bright spot), and the thickness and  color of frame.

Figure 1. Typical screen with four cells and an additional auxiliary image (the latter is not scanned) presented by Comunique

The switching device must be connected to the computer through the mouse, which needs a simple, homemade adaptation for this purpose. Alternatively, one may also employ mouse, joystick and standard or expanded keyboards. The preparation of the screens takes into account the consumer's needs and the content that is demanding evaluation or that is being learned. The images must be prepared in windows bitmap (.bmp) format.

The target clients presented significant differences in age, literacy, and presence of visual impairment. Comunique may be used by patients with severe and profound low vision, with visual acuity of less than 20/400. In this case, the screen presents few magnified cells. The software allows the user to choose the colors of the background and of the frames, thereby enhancing its applicability. Low vision patients are first submitted to a functional evaluation of vision, in order to define the best visual field, and the visual acuity.  During clinical sessions, these data are used to determine the optimal distance and position of the patient with respect to the computer’s screen. Furthermore, the size and number of cells are chosen according to the evaluation. The colors to be employed are also selected according to the contrast sensitivity of the patient. Finally, the monitor’s settings for brightness are adjusted as a function of the patient’s needs.

The software was used as a tool for oral communication by some clients and for written communication by others. In addition, some children used it as an utensil in the literacy process. The population attended present cerebral palsy, brain damage, medullary lesion and vascular cerebral accident. Our clinical experience shows that Comunique may be used with very young children. Two-years old children with cerebral palsy have successfully used Comunique to play games involving cause-effect connections, and to watch simple stories. In this case, we use a single cell, and the story unfolds as the child switches from one screen to the next (see figure 2). The goal at this point is to make the children understand the possibility of switching between the screens by voluntary act, and to enhance their visual and auditory attention. Once the child fully realizes that he or she is able to interfere, we start to scan two cells in the screen, allowing the child to choose between different possibilities. For instance, one may ask the child to find out a figure that represents a concrete object, with which he or she has a everyday experience (objects belonging to the daily life, as shown in figure 3).  This stage is far more complex than the previous one, because the child needs to understand the scanning procedure. Usually, the child manipulates the concrete object while trying to select its pictorial representation with Comunique.    

Figure 2. Typical screen with a single cell. The story continues as the user voluntarily switches to the next screen (image from PCS symbols)

Figure 3. Screen with two cells, containing photographs of daily life objects.

A slightly more complex activity is described in figure 4. The child is asked to select the picture identical to the model shown on the top of the screen (the model is not scanned). Previously recorded messages indicate whether he or she has succeeded.

Figure 4. Two cells, and an additional auxiliary image on the top of the screen (the latter is not scanned).

Finally, when the child is ready for the literacy process, Comunique is used as an useful auxiliary tool, of particular importance when he or she has a low motor performance and is unable to use pencil or keyboard. We may organize both reading (see figure 1) and writing activities. In figure 5, the child is asked to write the word corresponding to the displayed picture. He or she may delete a letter by selecting the eraser cell, and switch to next exercise by selecting the turning page cell.

Figure 5.  Writing exercise with Comunique (image from PCS symbols).

In spite of being very functional for both oral and written communication, the main use of Comunique was as an auxiliary tool to evaluate both visual and cognitive abilities of severely motor impaired individuals. This approach is extremely significant in Brazil, a country where both federal and state governments rarely make funds available for communicators. In this way, the ideal solution for both education and treatment should consider not only technical aspects but also financial ones. Comunique is a low-cost tool because it is made available for free by the Occupational Therapy Center of Rio de Janeiro for any potential user. Moreover, it relies on standard computer technology, which is usually already available in public elementary schools in Rio de Janeiro.

In conclusion, Comunique is a useful low-cost device for multiple purposes. Visually impaired children with multi-disabilities have successfully used it both as a communicator and as an educational tool.


·       Pelosi, M.B., A Comunicação Alternativa e Ampliada nas Escolas do Rio de Janeiro: Formação de Professores e Caracterização dos Alunos com Necessidades Educacionais Especiais, Programa de Pos graduação em educação, Uerj, Rio de Janeiro, 2000.

·       Galvin,J.C. e Scherer, M.J.,Evaluating, Selecting, and using Apropriate Assistive Tecnlogy,( An Aspen Publication, Maryland, 1996).

·       Ryan, S.E.,  The Certified Occupational Therapy Assistant, Principles, Concepts and Techniques,( Slack Inc, Thorofare, 1993).

·       International Classification of Diseases, 9th Revision – Clinical Modification (ICD-9-CM). First edition: Commission on Professional and Hospital Activities, Ann Arbor, 1978.

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