1.1 Outline of the Problem
Communication is a basic human need that happens in all circumstances. It does not only include exchanges of information but also the process of perception, thinking, and motivation. It is significant for interaction with our environment, which is why nonverbal and verbal communication tools are to be learned from an early age and are absolute prerequisite to integrate into our society. (Baeumer et al., 2010)
There are distinct individual alterations of communication, language and speaking in children with Down syndrome (DS). Amongst other things, these changes include motor-function skills, cognitive and social requirements, as well as motivation, and the desire to communicate. The delayed development of speech is not only noticeable in comparison to regular children but also within the intraindividual development of motor, cognitive and social skills. The linguistic abilities of children with DS are significantly affected by their individually pronounced cognitive impairment, but their general skills are often more developed than their linguistic behavior might indicate. Children with DS are often undervalued in their cognition, which changes the expectations of their caregivers and leads to the child being subchallenged. These reasons interfere with their motivation and willingness to communicate. (Wilken, 2014)
There are many different ways to interact with children besides verbal communication. These options allow the child to understand and to be more easily understood. As a result of this, socializing and memorizing leads to a positive outcome.
Almost every therapeutic intervention is introduced or explained verbally. If the verbal communication is impeded because the interlocutor does not offer the same language requirements or does not speak the same language, other tools are included or translation services are used. (Baeumer et al., 2010)
In children with DS the storage and processing of information are characterized by reduced short-term memory and prolonged latency. Hearing impressions are processed especially slower by children with DS which is why verbal content should be repeated often and supported visually. (Wilken, 2014)
Augmentative and alternative communication (AAC) offers numerous options such as gestures, symbols, or electronic communication aid. (Castañeda, 2016)
Gestures and sign language for example are a common and important way to support communication in therapy for children with special needs. Camenisch et al. (2016) showed that gestures visualize language and therefore complement the auditory perception in children with special needs. This is decisive to help them understand.
1.2 Central Research Question
What role does Augmentative and Alternative communication (AAC) play in physiotherapy for children with trisomy 21?
1.3 Physiotherapeutic Relevance
As mentioned in chapter 1.1., children with trisomy 21 need alternatives to conventional spoken language to understand main contents, likewise learned in physiotherapy. Not being able to communicate or making them feel undervalued due to lack of language skills can be counterproductive for their motivation and therefore their learning process.
Language is a foundation for cognitive processing and saving of experiences. This function of language is not bound to verbal communication. (Wilken, 2014)
Therapy for children and especially for children with special needs is holistic and interdisciplinary. AAC is known to be a logopaedic concept. The aim of this thesis is to show, what kind of role AAC plays in physiotherapy with children with trisomy 21.