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Annie

Annie learns to use a voice output communication aid in addition to her signing. This helps her to communicate with others at Nursery as well as at home.
Photo of young girl

Annie has had breathing difficulties since birth. At a very young age she required a tracheostomy and long term ventilation to help her to breathe. A tracheostomy is a surgical procedure where a tube is in inserted in a hole made in front of the wind pipe. Annie’s tracheostomy has affected her ability to speak and she has delayed motor development, which means she has been slower than her peers to learn to walk. As Annie has grown she has been able to come off her ventilator for longer periods of time. She is now walking independently and her fine and gross motor skills are developing well.

Annie has a portable ventilator and is spending longer amounts of time breathing naturally, but her tracheostomy still limits her ability to speak. Annie uses some sign language and blows kisses to gain attention. Her receptive language (her ability to understand spoken language) is appropriate for her age, but she doesn’t have the means to express herself at the same level.

Whilst Annie is not able to make any sounds, she enjoys pretending to speak. She will sign and mouth to her grandmother on the telephone, and play with her mother’s mobile phone as if she was talking.

Annie mimics talking on a mobile phone.
Girl pretends to talk into a mobile phone

Annie is very keen to communicate. A simple communication book was developed using symbols to give her quick access to a wider vocabulary. This included core vocabulary and category pages. Annie’s category pages relate to her favourite activities and topics of conversation. These included play activities, body parts, clothes, colours, shapes, numbers, people, places, weather, significant days, and favourite TV programmes. Annie was involved in choosing which symbols she wanted to represent the words she needed in her book. This meant that the symbols were meaningful and personal for Annie and she was motivated to use the book.

Annie’s First Communication Book
Communication Book Front Cover Categories in Communication Book
Core Vocabulary Favourite Stories in Communication Book

Annie had no previous experience of using Augmentative and Alternative Communication (AAC), so she was initially introduced to symbols when playing. Annie learnt the symbol meanings very quickly.

Annie is playing with Mr Potato Head.
Girl playing with Mr Potato Head toy

Annie is exploring a musical activity. The communication board is in a horseshoe shape with the activity in the middle.
Photo of girl using a communication tool

For a little while Annie used a TechTalk communication aid which has 8 buttons that each speaks a different pre-recorded message when pressed. Annie used this to join in with some of her favourite stories.

Annie is using the TechTalk to join in with her favourite story
Girl using a pointing device to communicate to another child

Simple messages and phrases can be recorded on to the TechTalk. Annie understood the pictures and symbols very well, so using the TechTalk to speak messages was easy for her.

Although Annie used the TechTalk for fun activities, she preferred to sign when at home. Everyone understood Annie very well, so she didn’t really need the voice output communication aid. However once Annie started Nursery, the other children were less familiar with her signing.

The 8 messages available on the TechTalk were not enough to match Annie’s potential to communicate. For this reason, Annie began to use a high tech Voice Output Communication Aid (VOCA), a Dynavox VMax. This is a dynamic display device, like a computer, which means she can have lots of pages with lots of messages.


Annie is introduced to using a high tech communication aid.

Some photographs of Annie and her family were put on the communication aid and Annie began to use the device to talk about familiar things. She was happy to explore the different pages and very quickly learnt where the messages were stored.

Snack time at Nursery.
Girl pointing to make a choice

Annie is sharing a book with her Mum.

Girl looking at a book and using pointing to communicate

More recently Annie does not need her ventilator as often. Her medical development has meant that she has been able to use a speaking valve and she is beginning to talk. At the moment she is speaking words and short phrases. She continues to use a range of different ways to help her communicate including sign, gesture and her VOCA when she needs it.

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