Tag Archives: Language

There’s a Person in There

My wife works as a speech and language pathologist for a local school district and her caseload is a mix of kids from ages 3 to 21. One of her most difficult cases involves a student with severe cerebral palsy who transferred into the district when he was 12-years-old. This student cannot speak or use his body to convey information and currently expresses himself primarily through eye contact and facial expressions. Because of this extremely limited range of abilities, his cognitive functioning is unknown.

The only real communication options involve interpretation of the student’s eye movements. Professionals can do this using a contraption called an eye gaze board, which is a simple frame to which you attach pictures or symbols. The professional sits face-to-face with the student, holds up the frame, and then prompts the student with a question. By observing where the student looks, the professional can make assumptions about their intended responses.

Needless to say, this approach has some limitations, particularly in this case. The student’s eye movements are hard for even professionals to interpret and the student himself tires very quickly. After careful consideration, my wife elected to see if the student could use an eye-tracking device in combination with a communication board or speech generating device (SGD) — a specialized computer that allows the user to build messages and relay them to others through a synthesized voice. (Dr. Stephen Hawking is a famous user of such a device.)

Users can access these devices directly using a keyboard or touch screen or they can manipulate them indirectly with a joystick, adapted mouse, optical pointer, eye tracking device, or other type of controller. The specific access method depends entirely on the abilities of the user and, in this case, there are not a lot of options. The student is quadriplegic and does not even have enough control over his head and neck movements to use switch access scanning, in which an indicator such as a cursor steps through selections automatically and the user hits a switch when the indicator lands on the desired choice. Blinking is also out for similar reasons.

A comparison of the two options shows some obvious advantages for the eye tracking option. Unfortunately, these devices are not cheap. While an eye gaze board can be assembled from five bucks’ worth of spare parts, a communication board and eye-tracking device cost about $8,000 apiece. No school district is going to spring for such a purchase these days so it became necessary for my wife to apply for a loaner and see if she could build a case for Medicaid.


Comparative Evaluation (Eye Gaze Board & Eye Tracking Device)

Eye Gaze Board Eye Tracking Device
Ease of Set-Up Easy Difficult
Ease of Listener Comprehension Difficult Easy
Y/N Response Accuracy 20-30% 80%
Number of Communication Functions 4 14
Size of Picture Field 4 pictures 12 pictures
Length of Time Before Fatigue 10 minutes 30-40 minutes
Maximum Length of Utterance 1 4+
Able to Fine-Tune Dwell Times No Yes
Able to Independently Introduce a Topic No Yes
Able to Communicate with Multiple Listeners No Yes
Able to Call for Attention No Yes
Able to Communicate with Non-Professionals No Yes
Able to Repair Communication Breakdown No Yes


1st Trial

The loaner — a Dynavox Vmax/EyeMax system — arrived in the last few weeks of the 2011 school year and came with some standard navigation screens or “boards” that are based on vocabulary and language ability levels. The user categories include — in order of ability — emergent communicators, context-dependent communicators, and independent communicators.

The primary choice for this case was between context-dependent, which means that the student’s ability to communicate depends on the environment, topic, or communication partner, and independent, which means that they are able to combine single words, spelling, and phrases together to create novel messages about a variety of subjects.


Examples of the Context-Dependent “Child 12” Navigation Page (left) and Scene (right)



Examples of the Independent Gateway “Child 12” Set-Up (left) and “Child 40” Set-Up (right)



These navigation boards make extensive use of picture communication symbols (PCS) and the Fitzgerald color coding system for language development. PCS are simply standard graphics whose meanings are easily understood while the Fitzgerald “key” system assigns colors to specific grammatical forms. The psuedo-3D appearance of the buttons looks a little dated to my eye but the perceived affordance may be necessary for some users. The program itself is highly customizable.

To create a message using the different boards, a user would navigate through the system and click on each component in turn until they were finished. For the purposes of measuring message complexity, each of these steps counted as one “navigational unit.”

A simple request for a sandwich might look like this in a context-driven environment (for an utterance of four navigational units):

The same request in a word-based environment would look like this (for an utterance of three navigational units):

My wife’s student’s communication level is context-dependent. However, the navigation boards available for context-driven communication were too complex for him to use and many of the topics simply weren’t relevant. (He would never use either of the above examples because he doesn’t eat solid food — all nutrients are provided through a gastro-intestinal tube.) To get around some of these issues, she programmed a customized board based on his particular abilities and interests.

Some of these modifications were fairly extensive. Since her student had no understanding of grammatical structure at this time, she simplified the color scheme so it only used three colors: orange for the “back” button, blue for any folder that could be opened, and gray for any item at the bottom of a decision tree. She also tightened up the button groupings to reduce difficult eye movements and eliminated any buttons that would appear “underneath” the back button to reduce navigation errors. Finally, she set the dwell time between 8.5 and 9 tenths of a second — the effective “window” for reading the student’s gaze accurately.


Customized Communication Board



The student was able to use the system for about 2 1/2 weeks in late Spring 2011 and for one week in Fall 2011. During the trial period, the student was able to use the twelve-button screen for several language functions, including basic greetings, requests, yes/no responses, exclamations, expressions of physical state, and even a few jokes (knock, knock jokes that my wife programmed into the computer). The range of communication partners included school faculty and several family members.

For casual observers, the student’s performance using the device was revelatory. One teacher who overheard the student working on a craft-related activity stated simply, “Wow, there’s a person in there.”

Although, it might seem obvious that such a tool would be beneficial for this particular student, the services were not deemed “medically necessary” and the initial request for Medicaid was denied. The evaluator felt that there just wasn’t enough evidence showing independent use of the system to create novel utterances. (Attempts to include some peer-appropriate language may have backfired when the evaluator dinged the student for overly frequent use of the phrase “smell ya later.”)

Another, longer trial was suggested.

2nd Trial

The next loaner arrived in April 2012 and my wife was determined to gather more quantitative data and provide as much documentation of the second trial as she could. Each of the student’s statements during the trial period were marked down and evaluated for complexity (number of navigational units or levels), conversational turns (the alternations or volleys between two speakers), and functions. Functions include descriptions (items, past events), requests (actions, information, objects), responses to requests, social devices (spontaneous calls, exclamations, greetings) and statements (emotions, future events, personal information, opinions). After four-weeks, there were 265 individual utterances available for analysis.

A few initial findings:

  • The student’s accuracy of responses to yes/no questions increased to 80% using the eye tracking device in conjunction with the SGD (compared to 20-30% on the eye gaze board).
  • The student’s ability to look at an item on command improved to 85%.
  • The student was able to comprehend all of the noun and verb phrases programmed into the device.
  • The student demonstrated comprehension of the following:  categories, colors, shapes, sizes, actions words, possessives, time words, words denoting quantity, pronouns and wh-questions.
  • The student spontaneously accessed the machine to call attention and participate in conversations with a variety of adults and peers.
  • The student combined multiple symbols to create a message and often used one symbol in novel ways. For example, he would use “bye” to indicate that he wanted to stop an activity.
  • The student demonstrated the ability to repair conversational breakdowns. After an unintended response, he would often use the method of multiple “clicks” on a word to emphasize his correctly intended response.

During the trial period, the student gradually shifted from single-level utterances to more complex navigational structures. By the second half of the trial, 61% of his utterances used a combination of symbols and the average length of utterance increased from about 1.6 navigational units during the first two weeks of the trial to over 1.8 navigational units in the second two weeks. A basic MS Excel t-test performed on this metric suggests that this change was significant.


Distribution of Utterances by Navigational Units (1 vs > 1)


Distribution of Utterances by Navigational Units


The mean score for Half 1 (M=1.605 SD= 0.727, N= 119) was significantly smaller than the mean score for Half 2 (M=1.836, SD=0.822, N= 146) using the two-sample t-test for unequal variances, t(261) = -2.42, p <= 0.016. This implies that the student has the attention, memory, and problem-solving skills to use a SGD to achieve his functional communication goals.

t-Test: Two-Sample Assuming Unequal Variances

Half 1 Half 2
Mean 1.605 1.836
Variance 0.529 0.676
Observations 119 146
Hypothesized Mean Difference 0
df 261
t Stat -2.42
P(T<=t) one-tail 0.008
t Critical one-tail 1.651
P(T<=t) two-tail 0.016
t Critical two-tail 1.969

Interestingly, many of the student’s more complex utterances were in conversations with peers — pre-teens with no training in speech and language communication. The student also increased the number of conversational turns per topic over time and, as with conversational complexity, his performance was better with his peers. He had longer conversational “volleys” and used many longer strings of symbols than his conversations with adults.


Navigational Units Comparison by Listener

Listener 1 2 3 4
Peer 45.6% 40.5% 8.9% 5.1%
Professional 46.2% 36.3% 16.5% 1.1%


Conversational Turns Comparison Over Time

Half 1 2 3 4 5 6
1 59.5% 25.0% 9.5% 4.3% 1.7% 0.0%
2 52.8% 27.1% 10.4% 5.6% 3.5% 0.7%


Conversational Turns Comparison by Listener

Listener 1 2 3 4 5 6
Peer 53.9% 23.7% 11.8% 6.6% 3.9% 0.0%
Professional 55.6% 27.8% 9.4% 4.4% 2.2% 0.6%


While there is no doubt that this technology would prove incredibly beneficial in this situation, the strict rules surrounding Medicaid requests makes the outcome difficult to predict. By carefully documenting the results of this second trial (and including some awesome tables and charts), my wife hopes to tip the scales in her student’s favor. The report was mailed yesterday so cross your fingers. As my wife’s student might say (through his technology-assisted communication device): “Let’s get this party started!”


  • June 22, 2012 – The request was approved. There is some hard work ahead but this is a big hurdle to clear. Congratulations and good luck to everyone involved!

Visualizing English Word Origins

I have been reading a book on the development of the English language recently and I’ve become fascinated with the idea of word etymology — the study of words and their origins. It’s no secret that English is a great borrower of foreign words but I’m not enough of an expert to really understand what that means for my day-to-day use of the language. Simply reading about word history didn’t help me, so I decided that I really needed to see some examples.

Using Douglas Harper’s online dictionary of etymology, I paired up words from various passages I found online with entries in the dictionary. For each word, I pulled out the first listed language of origin and then re-constructed the text with some additional HTML infrastructure. The HTML would allow me to associate each word (or word fragment) with a color, title, and hyperlink to a definition.

The results look like this:

The quick brown fox jumps over the lazy dog.

This simple sentence is constructed of eight distinct words and one word suffix. Six of the words are from Old English (colored in pink) while the others are from Gallo-Roman and Middle Low German (both colored in gray). Hovering over each word provides the exact source and clicking the word takes you to the full origin description.

A second example shows more variety:

Supreme executive power derives from a mandate from the masses, not from some farcical aquatic ceremony.

This is a surprisingly complex Monty Python quote where the colors represent Old English (pink), Middle English (red), Anglo-French (orange), Old French (light orange), Middle French (pale orange), and Classical and Medieval Latin (both yellow). I suspect that both the complexity and variety of word sources is intentional — standing in humorous contrast to the appearance of the speaker.

What follows are five excerpts taken from a spectrum of written sources. The intent was to investigate each passage and see if word origin varied significantly based on the intended purpose of the passage.

(This process was pretty involved and my initial dream of creating an app that would allow me to convert any paragraph to this format faded when I realized that much of the word matching process needed manual intervention. I definitely suggest digging in to the full etymology site to explore the full history of each word. I have probably made plenty of translation mistakes as I developed my paragraphs but I certainly had fun.)

Passage #1: American Literature

The first paragraph I looked at was an excerpt from Mark Twain’s The Adventures of Tom Sawyer. I chose this text because I thought it would have a good mix of English and American words.

Tom gave up the brush with reluctance in his face, but alacrity in his heart. And while the late steamer Big Missouri worked and sweated in the sun, the retired artist sat on a barrel in the shade close by, dangled his legs, munched his apple, and planned the slaughter of more innocents. There was no lack of material; boys happened along every little while; they came to jeer, but remained to whitewash. By the time Ben was fagged out, Tom had traded the next chance to Billy Fisher for a kite, in good repair; and when he played out, Johnny Miller bought in for a dead rat and a string to swing it withand so on, and so on, hour after hour. And when the middle of the afternoon came, from being a poor poverty-stricken boy in the morning, Tom was literally rolling in wealth. He had beside the things before mentioned, twelve marbles, part of a jews-harp, a piece of blue bottle-glass to look through, a spool cannon, a key that wouldn’t unlock anything, a fragment of chalk, a glass stopper of a decanter, a tin soldier, a couple of tadpoles, six fire-crackers, a kitten with only one eye, a brass door-knob, a dog-collar but no dog the handle of a knife, four pieces of orange-peel, and a dilapidated old window sash .


The passage has a solid base of Old English words mixed with a variety of French, Latin and Old Norse terms. Middle English makes an appearance in the form of a few words and suffixes while American English is found solely in the list of items Tom Sawyer collects from his friends. Two of these American terms (“fire-crackers” and “door-knob”) are hyphenated words built from Old English and Scandinavian components. (Several of Twain’s other hyphenated words apparently didn’t make it over the hump into full-fledged Americanisms. However, it should be noted that Twain was often the first author to record usage of U.S. slang of the era.)

I found it interesting that Middle English had such a poor showing in this text but it may be due to the fact that the defining elements of Middle English have more to do with sentence structure and grammatical elements than specific words. I was also surprised at the frequent use of longer, Latin-based words in an adventure novel, but the average word length comes in at about 4.4 characters — still fairly short and simple.

Although 73% of the word fragments are Old English, Twain uses words from over a dozen different sources in this short passage alone. Overall, the wide variety of word sources adds a pleasing “flavor” to the passage. The mix seems well-balanced and interesting.

Passage #2: British Literature

For my second test, I wanted to look at text from a non-American author. I chose a paragraph from Charles Dickens’ A Tale of Two Cities Great Expectations out of respect for my 7th-grade English teacher.

My sister had a trenchant way of cutting our bread-and-butter for us, that never varied. First, with her left hand she jammed the loaf hard and fast against her bib where it sometimes got a pin into it, and sometimes a needle, which we afterwards got into our mouths. Then she took some butter (not too much)on a knife and spread it on the loaf, in an apothecary kind of way as if she were making a plaister using both sides of the knife with a slapping dexterity, and trimming and moulding the butter off round the crust. Then, she gave the knife a final smart wipe on the edge of the plaister, and then sawed a very thick round off the loaf: which she finally, before separating from the loaf, hewed into two halves, of which Joe got one, and I the other.

The relative simplicity of this passage surprised me a little. The average word length is about 4.2 and over 84% of the word fragments are basic Old English. No other source comes in over 5% and the variety of sources is half that of the Twain passage. American English Hebrew makes an appearance in the form of the name “Joe” but most of the other borrowed words are French in origin. Still, I found the text appealing in a way — basic words for a basic task.

Passage #3: Legal

The third paragraph comes from a United Nations document on maritime territories. I selected this passage because it seemed to contain more jargon and I suspected that much of this jargon was borrowed. This hunch proved to be correct.

Where the coasts of two States are opposite or adjacent to each other, neither of the two States is entitled, failing agreement between them to the contrary, to extend its territorial sea beyond the median line every point of which is equidistant from the nearest points on the baselines from which the breadth of the territorial seas of each of the two States is measured. The above provision does not apply, however, where it is necessary by reason of historic title or other special circumstances to delimit the territorial seas of the two States in a way which is at variance therewith.

This text had a much higher ratio of French and Latin word fragments (16.9% and 9.3%) and a longer average word length — nearly 4.8 characters — than both previous passages. With 64.4% of the word fragments, Old English still serves as a major binding agent in this text but there is less variety overall. Middle English makes its appearance only as a suffix and there is only one word outside of the English/French/Latin triumvirate. After the visual and poetic excitement of the two literature entries, this paragraph seems very bland.

Passage #4: Medicine
Note: This passage has been revised (see thread)

My dad suggested that I take a look at a healthcare-related passage to see if the use of specific medical terminology would tilt the word usage even farther away from “native” English words. Boy, was he right.

The anatomic axis of the lower extremity is defined by the femorotibial angle, which averages 5° of valgus; the mechanical axis of the lower extremity is defined by a plumb line connecting the center of the femoral head to the mid ankle on a standing anteroposterior weight-bearing radiograph. The mechanical axis averages 1. 2° of varus, and it is more accurate than the anatomic axis in demonstrating load transmission across the knee joint, especially if femoral or tibial deformities contribute to limb malalignment. A study by Khan et al in patients with early symptomatic knee osteoarthritis showed a clear relationship between local knee alignment (as determined from short fluoroscopically guided standing anteroposterior knee radiographs)and the compartmental pattern and severity of knee osteoarthritis. In this study, each degree of increase in the local varus angle was associated with a significantly increased risk of having predominantly medial compartment osteoarthritis, and a similar association was found between the valgus angulation and lateral compartment osteoarthritis in 47 knees. osteoarthritis in 47 knees.

The medical paragraph has only 51.9% Old English word fragments and the average number of characters per word is 5.7 — much higher than even the legal text. French Latin, and Greek were used more frequently in this passage and, despite U.S. prowess in the healthcare field, there were no American English terms. This is a paragraph that is doing a lot of heavy lifting and it uses a lot of dense, muscular words to get the job done.

Passage #5: Sports

This last passage was an attempt to stack the deck in favor of some home grown words. It doesn’t get more American than baseball, but the only American word in this article about a spring training rainout between the Milwaukee Brewers and the Texas Rangers is the word “baseball” itself. Everything else is either Old English or borrowed. Still, I have to assume that phrases like “at-bats” and “suicide squeeze bunt” are not exactly common constructions and my guess is that the entire article would be a mystery to someone who didn’t know the game.

It was a wild, windy day at Maryvale Baseball Park before the rains came with the Brewers ahead, 6-4. The Brewers scored their runs on a throwing error, a delayed double steal, a wind-blown popup that fell in shallow center field, a fielding error on that same play, a wind-aided triple and a suicide squeeze bunt, all in three innings of at-bats.

The triple belonged to Caleb Gindl, who motored to third after Rangers center fielder Craig Gentry crashed into the wall, forcing open a large gate. Gentry and left fielder Conor Jackson worked together to close it so play could continue.

It was crazy out there, Gindl said. it was scary in the outfield. After a while we were all just playing deep, knowing the ball would either get to us or blow out.

Play didn’t last long after the Brewersfour-run third inning. Brewers reliever Manny Parra pitched a scoreless fourth, then the grounds crew covered the field before the bottom of the inning could begin.

After a delay of just 12 minutes, the game was called.

First of all, I absolutely LOVE the fact that Caleb Gindl uses two Old Norse words to describe the weather conditions during the game. It provides a certain primal, unhinged quality to the situation and adds a third element — nature — to the contest. I also like the use of the onomatopoeic terms “pop” and “crash” because they serve to underscore the action.

The passage itself is a little lighter on the French and Latin roots than some of the earlier paragraphs and many of the terms are fairly short — the average word length comes in at about 4.6 characters. Some of this may be due to the fact that it is an online article (and attention spans are short) but it may also related be to the simple concepts at the core of the game itself. Words like “bat” and “ball” are very similar to their proto Indo-European roots (*bhat- and *bhel- respectively), suggesting that any associated activities are pretty basic to the language. Also, the sheer number and variety of numeric references (e.g. “three”, “third”, and “triple”) bring in many simple terms.