The authors would like to thank the Conseil Scolaire Public du Grand Nord de l&#8217;Ontario (CSPGNO) for the partnership in this project. This research was made possible through a partial financial contribution from Health Canada. The views expressed here do not necessarily represent the official views of Health Canada. Thank you to the students who participated in the data collection and preparation of the manuscript: M&#233;lissa Therrien, Melissa Lariviere, France Rainville, Sylvie Rondeau and Alexandra Albert.

This study was approved by the Laurentian University Research Ethics Board. Only participants for whom informed parents signed the consent form participated.
1. Setting
<ol>
	<li>Assess participants in a private room if possible.</li>
	<li>In order to reduce the impact of possible fatigue on the cognitive and navigational scores, it is not recommended to administer all of the tests at one time, instead, assess the participants over two to four sessions that vary from 30 min to 2 hr each.</li>
	<li>When using this procedure for research purposes, to control for the element of test practice on subtests that were last given, randomly determine the order in which the navigational task and cognitive subtests are administered, and ensure that they are not the same for all participants.</li>
</ol>
2. Procedure
<ol>
	<li>Navigational Task
	<ol>
		<li>Materials: Use a computerized tablet and an augmentative and alternative communication application with a 16-location grid and taxonomic categorization. Use the symbols that come preloaded with the augmentative and alternative communication application. Use the navigational task that involves the retrieval of 25 words (see Table 1) and 5 practice words before beginning the formal assessment. Use a booklet that contains the symbols for each of the target words. Note: Each symbol is present alone on one page.
		<table border="0" cellpadding="0" cellspacing="0">
			<tbody>
				<tr>
					<td fo:width="3.4in">Words From the Practice Portion&#160;</td>
				</tr>
				<tr>
					<td>1. foot&#160;</td>
				</tr>
				<tr>
					<td>2. banana</td>
				</tr>
				<tr>
					<td>3. cat</td>
				</tr>
				<tr>
					<td>4. boat</td>
				</tr>
				<tr>
					<td>5. fork</td>
				</tr>
				<tr>
					<td>Words From the Formal Navigational Task</td>
				</tr>
				<tr>
					<td>1. dog</td>
				</tr>
				<tr>
					<td>2. hand</td>
				</tr>
				<tr>
					<td>3. apple</td>
				</tr>
				<tr>
					<td>4. car</td>
				</tr>
				<tr>
					<td>5. spoon</td>
				</tr>
				<tr>
					<td>6. frog</td>
				</tr>
				<tr>
					<td>7. shoes</td>
				</tr>
				<tr>
					<td>8. mouth</td>
				</tr>
				<tr>
					<td>9. fish</td>
				</tr>
				<tr>
					<td>10. carrot</td>
				</tr>
				<tr>
					<td>11. chair&#160;</td>
				</tr>
				<tr>
					<td>12. flower</td>
				</tr>
				<tr>
					<td>13. duck&#160;</td>
				</tr>
				<tr>
					<td>14. table</td>
				</tr>
				<tr>
					<td>15. boy</td>
				</tr>
				<tr>
					<td>16. airplane</td>
				</tr>
				<tr>
					<td>17. turtle&#160;</td>
				</tr>
				<tr>
					<td>18. cookie&#160;</td>
				</tr>
				<tr>
					<td>19. baby</td>
				</tr>
				<tr>
					<td>20. belt&#160;</td>
				</tr>
				<tr>
					<td>21. tree</td>
				</tr>
				<tr>
					<td>22. bus&#160;</td>
				</tr>
				<tr>
					<td>23. pencil&#160;</td>
				</tr>
				<tr>
					<td>24. farmer&#160;</td>
				</tr>
				<tr>
					<td>25. bicycle</td>
				</tr>
			</tbody>
		</table>
		Table 1: Words from the Navigational Task.</li>
		<li>Sit/stand at an angle, across from the participant in order to observe if they can select the appropriate symbols on the computerized tablet, and to facilitate turning the pages of the booklet. Place the computerized tablet directly in front of the participant, flat on the table or at a 45&#176; angle to control the reflection from the lighting in the room. Place the booklet upright using an easel with the symbols between yourself and the participant.</li>
		<li>Ask the participant if they have previously used a smartphone or a computerized tablet. Note: This variable is only important if this method is being used for research.</li>
		<li>Explain that symbols can be found under folders representing categories, that the home button links to the first level and that the back button links to the previous level. State: &#8220;The symbols can be found in each of the different folders that represent different categories (point to the different folders). This button over here (touch the home button) links to this level (demonstrate for the participant) and this button over here (touch the back button) links to the previous level. See?&#8221;</li>
		<li>Present in a booklet, alone on one page, the symbols that need to be found in the tablet. Say the words that represent the symbols aloud.</li>
		<li>Keep the booklet open while the participant navigates within the levels of the computerized tablet to find the symbols.</li>
		<li>Give as many verbal and physical prompts as needed during the practice portion, for example: &#8220;What category does this word belong to?&#8221;</li>
		<li>Begin the formal navigational task after the 5 practice words have been successfully retrieved.</li>
		<li>Touch the home button on the application between trials in order to consistently start from the first level.</li>
		<li>Ask the participant to retrieve all 25 words within the levels of the computerized tablet using the same procedure as the practice portion, with the exception that prompts are not given.</li>
		<li>If a symbol cannot be retrieved, tell the participant that by turning the page of the image booklet, the item can be skipped.</li>
		<li>Score items as correct if the participant correctly selects the symbol that matches the target in the booklet.</li>
		<li>Give a score of zero when a symbol is incorrectly retrieved.</li>
		<li>When the participant does not make a selection within 5 minutes, remind the participant that by turning the page of the symbol booklet, that item can be skipped.</li>
		<li>End the test once all of the 25 items are presented or after the participant reaches the ceiling of failing to retrieve 8 consecutive symbols.</li>
	</ol>
	</li>
	<li>Cognitive Tests
	<ol>
		<li>Administer the following subtests of the Leiter International Performance Scale-Revised (Leiter-R)3 according to the instruction manual. For each subtest, after providing the non-verbal instructions, monitor the participant and record the number of correct responses. Note: The Leiter-R is a non-verbal test that requires the participant and clinician to communicate only with non-verbal cues such as pantomime, gestures, pointing and a questioning manner. The tasks on the Leiter-R generally involve a pointing or matching response. Materials include stimulus easels, cards, and foam shapes.
		<ol>
			<li>Administer the Attention Sustained subtest.
			<ol>
				<li>Point back and forth between the target picture and one correct answer on the page and simulate a crossing out motion to indicate to the participant the need to find and cross out as many items as possible that are identical to the target within an array of geometric shapes, within a time limit of 30 to 60 sec3.</li>
			</ol>
			</li>
			<li>Administer the Picture Context subtest.
			<ol>
				<li>Use pantomime to indicate to the participant that the stimulus card relates to an empty box on the easel illustration3. Gesture back and forth to indicate the need to identify a pictured object that has been removed from a large display by using contextual cues3.</li>
			</ol>
			</li>
			<li>Administer the Figure Ground subtest.
			<ol>
				<li>Point back and forth between stimuli material and the easel and shrug in a questioning manner to indicate to the participant the need to identify embedded figures or designs presented on a card within a complex stimulus3.</li>
			</ol>
			</li>
			<li>Administer the Sequential Order subtest.
			<ol>
				<li>Gesture back and forth between stimuli material and tray slots to indicate to the participant the need to select a related stimuli that progresses in a corresponding order. For example, place shapes or cards in the wrong order and shake head &#8220;no&#8221;3.</li>
			</ol>
			</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>

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T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Leiter International Performance Scale Revised (Leiter-R). , (1997).</li><li>Wallace, S., Hux, K., Beukelman, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Navigation+of+a+Dynamic+Screen+AAC+Interface+by+Survivors+of+Severe+Traumatic+Brain+Injury.">Navigation of a Dynamic Screen AAC Interface by Survivors of Severe Traumatic Brain Injury.</a> Augmentative and Alternative Communication. 26 (4), 242-254 (2010).</li><li>Lloyd, L. L., Fuller, D. R., Arvidson, H. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Augmentative and Alternative Communication: A Handbook of Principles and Practices. , (1997).</li><li>Reichle, J., Drager, K. D. 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C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Designing+dynamic+display+AAC+systems+for+young+children+with+complex+communication+needs.">Designing dynamic display AAC systems for young children with complex communication needs.</a> Perspectives on Augmentative and Alternative Communication. 15 (1), 3-7 (2006).</li><li>Robillard, M., Mayer-Crittenden, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Benefits+of+Assessing+Linguistic+Skills+within+the+Evaluation+of+Navigational+Skills.">Benefits of Assessing Linguistic Skills within the Evaluation of Navigational Skills.</a> The International Journal of Assessment and Evaluation. , (Submitted).</li><li>Archibald, L. M. D., Joanisse, M. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=On+the+Sensitivity+of+Nonword+Repetition+and+Sentence+Recall+to+Language+and+Memory+Impairments+in+Children.">On the Sensitivity of Nonword Repetition and Sentence Recall to Language and Memory Impairments in Children.</a> Journal of Speech, Language and Hearing Research. 52 (4), 899-914 (2009).</li><li>Conti-Ramsden, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Processing+and+Linguistic+Markers+in+Young+Children+with+Specific+Language+Impairment.">Processing and Linguistic Markers in Young Children with Specific Language Impairment.</a> Journal of Speech, Language and Hearing Research. 46 (5), 1029-1037 (2003).</li><li>Conti-Ramsden, G., Botting, N., Faragher, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Psycholinguistic+Markers+for+Specific+Language+Impairment+(SLI).">Psycholinguistic Markers for Specific Language Impairment (SLI).</a> Journal of Child Psychiatry. 42 (6), 741-748 (2001).</li><li>Dollaghan, C., Campbell, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nonword+Repetition+and+Child+Language+Impairment.">Nonword Repetition and Child Language Impairment.</a> Journal of Speech, Language and Hearing Research. 41, 1136-1146 (1998).</li><li>Thordardottir, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sensitivity+and+Specificity+of+French+Language+and+Processing+Measures+for+the+Identification+of+Primary+Language+Impairment+at+Age+5.">Sensitivity and Specificity of French Language and Processing Measures for the Identification of Primary Language Impairment at Age 5.</a> Journal of Speech, Language, and Hearing Research. 54 (2), 580-597 (2011).</li><li>Mayer-Crittenden, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Les Comp&#233;tences Linguistiques et Cognitives des Enfants Bilingues en Situation Linguistique Minoritaire. , (2013).</li><li>Mayer-Crittenden, C., Robillard, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Importance+of+Assessing+Non-Linguistic+Cognitive+Skills+in+Bilingual+Children+with+Primary+Language+Impairment.">Importance of Assessing Non-Linguistic Cognitive Skills in Bilingual Children with Primary Language Impairment.</a> The International Journal of Assessment and Evaluation. 20 (2), 25-55 (2014).</li><li>Waddington, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Three+Children+with+Autism+Spectrum+Disorder+Learn+to+Perform+a+Three-Step+Communication+Sequence+Using+an+iPad(&#174;)+&#8211;+Based+Speech-Generating+Device.">Three Children with Autism Spectrum Disorder Learn to Perform a Three-Step Communication Sequence Using an iPad(&#174;) &#8211; Based Speech-Generating Device.</a> International Journal of Developmental Neuroscience. 39, 59-67 (2014).</li><li>Kagohara, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Using+iPods(&#174;)+and+iPads(&#174;)+in+Teaching+Programs+for+Individuals+with+Developmental+Disabilities:+A+Systematic+Review.">Using iPods(&#174;) and iPads(&#174;) in Teaching Programs for Individuals with Developmental Disabilities: A Systematic Review.</a> Research in Developmental Disabilities. 34 (1), 147-156 (2013).</li><li>Drager, K. D. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Learning+of+Dynamic+Display+AAC+Technologies+by+Typically+Developing+3-Year-Olds:+Effect+of+Different+Layouts+and+Menu+Approaches.">Learning of Dynamic Display AAC Technologies by Typically Developing 3-Year-Olds: Effect of Different Layouts and Menu Approaches.</a> Journal of Speech, Language, and Hearing Research. 47 (5), 1133-1148 (2004).</li><li>Higginbotham, J. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Use+of+Nondisabled+Subjects+in+AAC+Research:+Confessions+of+a+Research+Infidel.">Use of Nondisabled Subjects in AAC Research: Confessions of a Research Infidel.</a> Augmentative and Alternative Communication. 11 (1), 2-5 (1995).</li><li>Light, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Performance+of+Typically+Developing+Four-+and+Five-Year-Old+Children+with+AAC+Systems+Using+Different+Language+Organization+Techniques.">Performance of Typically Developing Four- and Five-Year-Old Children with AAC Systems Using Different Language Organization Techniques.</a> Augmentative and Alternative Communication. 20 (2), 63-88 (2004).</li><li>AssistiveWare. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Proloquo2go+[Mobile+application+software.">Proloquo2go [Mobile application software.</a> Proloquo2go [Mobile application software]. , (2015).</li><li>Dunn, L. M., Dunn, D. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Peabody Picture Vocabulary Test. , (2007).</li><li>Dunn, L. M., Th&#233;riault-Whalen, C. M., Dunn, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=&#201;chelle+de+Vocabulaire+en+Images+Peabody.+Adaptation+francaise+du+Peabody+Picture+Vocabulary+Test-Revised.">&#201;chelle de Vocabulaire en Images Peabody. Adaptation francaise du Peabody Picture Vocabulary Test-Revised.</a> Manuel pour les formes A et B. , (1993).</li><li>Roid, G. H., Miller, L. J., Pomplun, M., Koch, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Leiter International Performance, Third Edition (Leiter-3). , (2013).</li></ol>

This research was initially performed as part of the first author&#8217;s doctoral dissertation.

The aim of this video was to outline the methodology used to explore the cognitive factors that impact a child&#8217;s ability to navigate an SGD. Since the study by Robillard and colleagues1 was the first of its kind with children, there was no pre-established protocol.
The decision to include children with typical development was made to obtain information on basic learning strategies and difficulties that relate to the use of this technology18-20. The symbols were presented in a booklet (on one page) at the same time as the word for the symbol was said aloud to control for the participant&#8217;s ability to correspond the symbol to the referent and to ensure that only navigation was being measured. A pilot test determined that a 16-location grid was required. When more than 16 symbols per level were used, the complexity of the navigational task was greatly increased because of the need to scan more items per level to locate the symbols. Using less than 16 symbols per grid would have led to a greater need to change pages and may have increased the complexity of the navigational task. The number of words to identify for the navigational task (25) was also determined through pilot testing and was based on the number of items that the children could reasonably complete within a single session without needing a break.
SymbolStix23 symbols were used because they came preloaded with Proloquo2Go21. Other types of symbols could also be used. The words selected were chosen from the younger stages of receptive vocabulary tests such as the Peabody Picture Vocabulary Test &#8211; Fourth Edition (PPVT-4)22 and the &#201;chelle du vocabulaire en images Peabody (&#201;VIP)24. The words chosen were judged to be familiar for most children aged 4 to 6 years. The words chosen included concrete nouns that represented objects, animals or people. The order of presentation of the words was also determined through pilot testing. The words that had the highest success rate from the pilot group were placed at the beginning, while those with the lowest success rate were placed towards the end. Items were also placed in an order that would ensure that two successive symbols were not located under the same category. Some symbols could be found at the third level and others at the fourth level. Throughout the experimental navigational task, there was a progression in the level of difficulty. At first, the targeted words were under the same categories used in the practice portion. As the task progressed, new categories were introduced. In order to not discourage the participants, the most difficult words to retrieve were placed at the end of the task and were not administered to the children having reached a ceiling of eight consecutive errors, as this prompted the termination of the task. The participants were given a score of 0 for the items that were not administered.
As for the cognitive measures, the Leiter-R was selected because all subtests are non-verbal and could therefore be administered to children who have complex communication needs. Attention Sustained was selected to measure the ability to sustain attention. Picture Context was selected to measure categorization. Figure Ground was selected as a measure of cognitive flexibility. Sequential Order was selected to measure fluid reasoning. A new version of the Leiter-R3, the Leiter-325 would also be a good measure of cognition.
The results by Robillard and colleagues1 showed that cognitive skills have an impact on the navigational skills of typically developing children who are new to AAC use. Sustained attention (Attention Sustained, Leiter-R), categorization (Picture Context and Classification, Leiter-R), fluid reasoning (Form Completion, Sequential Order and Repeated Patterns, Leiter-R), were all correlated with navigation1. A more detailed discussion of the results can be found in Robillard and collaborators1. Cognitive flexibility (Figure Ground, Leiter-R) was correlated with navigation in children and adolescents with a diagnosis of Autism Spectrum Disorder (ASD)2, but was not correlated with navigation for young children with typical development. Among the factors correlated with navigation, the subsets that best predicted typically developing children&#8217;s navigational skills with a taxonomic organization included sustained attention, categorization, and fluid reasoning. Due to the small number of participants in the study on ASD, linear regressions were not possible. However, the correlation results open the possibility that cognitive flexibility could be an important factor for the prediction of navigational skills of children with ASD. New studies are needed with a larger number of participants. The speed of selecting symbols was not a variable in the previous studies, but could be added as a measure of processing speed.
Procedural limitations are present in this method. The administration of the assessment tools was carried out in multiple settings (i.e. private room, school with background noise, clinic). This could have impacted the participants&#8217; performance. Visual acuity could have been assessed to rule out difficulties with vision. Some participants could have difficulty understanding the representations of the words even though symbols were presented in a booklet during the navigational task. The navigational task does not represent real communication and was in fact the first use of an AAC device after minimal training only. Navigational skills could be aided by personalizing the device, which could reduce the cognitive demands. This procedure was outlined for assessing children and was not examined for an adult population. Also, the validity of the cognitive factors could be questioned because they are difficult to isolate.
In order to reduce the limitations described above, all participants should be assessed in a private room with no distractions or background noise. When this is not possible, distractions should be limited in order to not impact the participants&#8217; performance. When hearing and vision testing is not possible, difficulties could be ruled out by asking the participants&#8217; families about hearing and vision acuity.
Other applications than Proloquo2Go21,25 could be used. Other non-verbal cognitive tests could also be used to measure cognition, as long as they include numerous subtests that isolate the different cognitive components. Caution is needed when modifying the procedure outlined in this paper or when using alternative approached to assessing cognition, such as non-standardized cognitive tests, as the results could differ from the expected outcome.
It is important to understand how cognitive factors contribute to navigational abilities. The improper selection of an SGD could cause children and their caregivers to become frustrated and abandon the use of a device for communicative purposes. When choosing an SGD for young children, attention, categorization, and reasoning skills can be assessed to help predict their success with dynamic paging using a taxonomic organization1. For children and adolescents with ASD, cognitive flexibility may offer the best prediction of navigational skills2. More studies with other, larger clinical populations using the described method are required in order to determine the impact of cognition on navigation in children who require and use augmentative and alternative communication strategies.

The methodology used to assess cognitive and navigational skills can vary widely. Few studies have been published regarding cognitive and navigational skills. Previously, Wallace, Hux, and Beukelman (2010) studied the impact of cognition on navigation with adults who experienced a traumatic brain injury4. They found that cognitive flexibility impacted navigational skills for this population. The method described in this paper conducted by Robillard, Mayer-Crittenden, Roy-Charland, Minor-Corriveau and B&#233;langer has been published in 20131. Rondeau, Robillard and Roy-Charland also used this method in a similar study2. For the purpose of this paper, step-by-step instructions with visual supports will demonstrate the methodology used in order to encourage duplication of this technique with other populations for research purposes, and to support clinicians who want to assess navigational and cognitive skills for clients who have complex communication needs.
Speech-generating devices (SGD) produce an electronic voice using a synthesizer and can have dynamic levels with links that allow the user to access new words by changing levels (i.e. to change from a page of symbols to another)5,6. The ability to navigate between these levels is required in order to find symbols within the multiple levels of an SGD6,7. The importance of cognitive skills in the ability to navigate the levels of an SGD has been demonstrated1,2,4. Results of a study that analyzed the impact of language abilities on navigational skills revealed that language skills were not a good predictor of navigational skills among children8. By having a better understanding of the cognitive factors that can impact navigation, clinicians can offer a more reliable assessment of children with complex communication needs. The cognitive factors that will be addressed in this study are: sustained attention, categorization, cognitive flexibility and fluid reasoning. See Robillard and collaborators for a description of these cognitive factors1.
Since very few studies have looked at the impact of cognitive factors on navigation, an assessment protocol has not yet been put into practice. Over the years, other fields in speech-language pathology have established assessment batteries in order to better identify children in need of those services. For example, it is a well-known fact that non-word repetition and sentence imitation, two tasks that rely heavily on verbal working memory, along with select language assessment tools, can successfully identify children with language impairments9-14. However, in the field of augmentative and alternative communication (AAC), very little attention has been given to the relation between cognition and the ability to navigate an AAC device. Even less attention has been given to the development of a systematic method to follow. Very few tools exist for the assessment of navigation skills in children. Since there exist a variety of assessment tools that can be used to assess nonlinguistic cognitive skills, it is understandable that determining which tools or tasks to use could be very overwhelming for a clinician15. Clinicians commonly use feature matching with individuals who use AAC. It involves matching the person&#39;s abilities to the design features of the SGD. It is therefore important that clinicians are best able to match the cognitive skill levels and the person&#39;s navigation abilities to the appropriate device.
Until recently, very few studies have been conducted using an electronic tablet. Waddington and collaborators16 suggested that functional communication skills could be taught using an intervention approach that includes the use of a computerized tablet to children with ASD who have limited or no speech. Moreover, a systemic review by Kagohara and collaborators17 suggested that children with a developmental disability could be taught to use technology such as a tablet for a variety of communication purposes. The method described in this paper will provide researchers and clinicians with a detailed guide to use when assessing cognitive and navigational skills.

<table><tbody><tr><td>iPad</td><td>Apple, 2015</td><td>MD786C/A</td><td>tablet with dynamic screen</td></tr><tr><td>Proloquo2Go</td><td>AssistiveWare, 2015</td><td>available on iTunes</td><td>applicaiton for augmentative and alternative communication</td></tr><tr><td>SymbolStix</td><td>N2Y inc, 2015</td><td>https://www.n2y.com/products/symbolstix/</td><td>Symbols used with Proloquo2Go (preloaded)</td></tr><tr><td>Leiter International Performance Scale - Revised, Roid &amp;amp; Miller), 1997</td><td>Stoelting</td><td>37050M</td><td>cognitive non-verbal test</td></tr></tbody></table>

practical methodology of cognitive tasks within a navigational assessment

This paper describes an approach for measuring navigation accuracy relative to cognitive skills. The methodology behind the assessment will thus be clearly outlined in a step-by-step manner. Navigational skills are important when trying to find symbols within a speech-generating device (SGD) that has a dynamic screen and taxonomical organization. The following skills have been found to impact children&#8217;s ability to find symbols when navigating within the levels of an SGD: sustained attention, categorization, cognitive flexibility, and fluid reasoning1,2. According to past studies, working memory was not correlated with navigation1,2.
The materials needed for this method include a computerized tablet, an augmentative and alternative communication application, a booklet of symbols, and the Leiter International Performance Scale-Revised (Leiter-R)3. This method has been used in two previous studies. Robillard, Mayer-Crittenden, Roy-Charland, Minor-Corriveau and B&#233;langer1 assessed typically developing children, while Rondeau, Robillard and Roy-Charland2 assessed children and adolescents with a diagnosis of Autism Spectrum Disorder. The direct observation of this method will facilitate the replication of this study for researchers. It will also help clinicians that work with children who have complex communication needs to determine the children&#8217;s ability to navigate an SGD with taxonomical categorization.

For both studies that used this methodology1,2, cognition was correlated to navigational scores. The higher the cognitive scores were, the higher were the navigational scores1,2. Positive correlation coefficients were obtained for cognitive flexibility and navigation in the study with the ASD population. These results were more similar to those of Wallace et al.4 whose participants included adults who experienced a traumatic brain injury than to those obtained by the study with typically developing children. In fact, in the later, cognitive flexibility was not correlated with navigation. However, certain cognitive skills were able to predict the navigational ability of a typically developing population1. For these children, sustained attention, categorization and reasoning skills permitted the ability to predict navigational skills1. Age was not an important factor for the prediction of navigational skills. The results are depicted in Table 2. Complete details on the results of these studies can be found in the results section of the above-mentioned papers. It is evident that cognitive skills were an important factor in the ability to navigate an SGD. However, since the predicting factors varied from one author to the next, further studies are needed with different clinical subpopulations and age groups in order to more clearly determine the underlying role of cognitive factors on navigational skills. Studies with larger populations, as well as with children and adults who have complex communication needs and use SGDs to communicate are also needed.
<table border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td fo:width="2in" style="width:300px">Population</td>
			<td fo:width="2in">Cognitive Factors Correlated with Navigational Skills</td>
		</tr>
		<tr>
			<td rowspan="3">Children with typical development&#160;</td>
			<td>Sustained attention</td>
		</tr>
		<tr>
			<td>Categorization</td>
		</tr>
		<tr>
			<td>Fluid reasoning</td>
		</tr>
		<tr>
			<td rowspan="4">Children and adolescents with a diagnosis of Autism Spectrum Disorders</td>
			<td>Cognitive flexibility</td>
		</tr>
		<tr>
			<td>Sustained attention</td>
		</tr>
		<tr>
			<td>Categorization</td>
		</tr>
		<tr>
			<td>Fluid Reasoning</td>
		</tr>
	</tbody>
</table>
Table 2: Results from studies by Robillard and colleagues1 and Rondeau and colleagues2 that used this methodology.

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Practical Methodology of Cognitive Tasks Within a Navigational Assessment

Children who have complex communication needs can benefit from the use of a speech-generating device (SGD). Cognitive skills were identified as having an impact on the ability to navigate between levels of SGDs. This protocol describes the steps needed for Speech-language Pathologists to assess cognitive skills and navigational abilities.

This paper describes an approach for measuring navigation accuracy relative to cognitive skills. The methodology behind the assessment will thus be ...

practical-methodology-cognitive-tasks-within-navigational

Research

JoVE Journal

Behavior

13.6K Views.  Laurentian University.  Kinderen die hebben complexe communicatiebehoeften kunnen profiteren van het gebruik van een speech genererende apparaat (SGD). Cognitieve vaardigheden werden geïdentificeerd als die van invloed zijn op het vermogen om te navigeren tussen de niveaus van SGDs. Dit protocol beschrijft de stappen die nodig zijn voor spraak-taal Pathologen aan cognitieve vaardigheden en navigatie-capaciteiten te beoordelen. 

Video: Practical Methodology of Cognitive Tasks Within a Navigational Assessment

Using Pharmacological Manipulation and High-precision Radio Telemetry to Study the Spatial Cognition in Free-ranging Animals

An animal&#39;s ability to perceive and learn about its environment plays a key role in many behavioral processes, including navigation, migration, dispersal and foraging. However, the understanding of the role of cognition in the development of navigation strategies and the mechanisms underlying these strategies is limited by the methodological difficulties involved in monitoring, manipulating the cognition of, and tracking wild animals. This study describes a protocol for addressing the role of cognition in navigation that combines pharmacological manipulation of behavior with high-precision radio telemetry. The approach uses scopolamine, a muscarinic acetylcholine receptor antagonist, to manipulate cognitive spatial abilities. Treated animals are then monitored with high frequency and high spatial resolution via remote triangulation. This protocol was applied within a population of Eastern painted turtles (Chrysemys picta) that has inhabited seasonally ephemeral water sources for ~100 years, moving between far-off sources using precise (&#177; 3.5 m), complex (i.e., non-linear with high tortuosity that traverse multiple habitats), and predictable routes learned before 4 years of age. This study showed that the processes used by these turtles are consistent with spatial memory formation and recall. Together, these results are consistent with a role of spatial cognition in complex navigation and highlight the integration of ecological and pharmacological techniques in the study of cognition and navigation.

This paper describes a novel protocol that combines the pharmacological manipulation of memory and radio telemetry to document and quantify the role of cognition in navigation.

An animal&#39;s ability to perceive and learn about its environment plays a key role in many behavioral processes, including navigation, migration, ...

Environment

Using MazeSuite and Functional Near Infrared Spectroscopy to Study Learning in Spatial Navigation

MazeSuite is a complete toolset to prepare, present and analyze navigational and spatial experiments1. MazeSuite can be used to design and edit adapted virtual 3D environments, track a participants' behavioral performance within the virtual environment and synchronize with external devices for physiological and neuroimaging measures, including electroencephalogram and eye tracking.
Functional near-infrared spectroscopy (fNIR) is an optical brain imaging technique that enables continuous, noninvasive, and portable monitoring of changes in cerebral blood oxygenation related to human brain functions2-7. Over the last decade fNIR is used to effectively monitor cognitive tasks such as attention, working memory and problem solving7-11. fNIR can be implemented in the form of a wearable and minimally intrusive device; it has the capacity to monitor brain activity in ecologically valid environments. 
Cognitive functions assessed through task performance involve patterns of brain activation of the prefrontal cortex (PFC) that vary from the initial novel task performance, after practice and during retention12. Using positron emission tomography (PET), Van Horn and colleagues found that regional cerebral blood flow was activated in the right frontal lobe during the encoding (i.e., initial na&iuml;ve performance) of spatial navigation of virtual mazes while there was little to no activation of the frontal regions after practice and during retention tests. Furthermore, the effects of contextual interference, a learning phenomenon related to organization of practice, are evident when individuals acquire multiple tasks under different practice schedules13,14. High contextual interference (random practice schedule) is created when the tasks to be learned are presented in a non-sequential, unpredictable order. Low contextual interference (blocked practice schedule) is created when the tasks to be learned are presented in a predictable order.
Our goal here is twofold: first to illustrate the experimental protocol design process and the use of MazeSuite, and second, to demonstrate the setup and deployment of the fNIR brain activity monitoring system using Cognitive Optical Brain Imaging (COBI) Studio software15. To illustrate our goals, a subsample from a study is reported to show the use of both MazeSuite and COBI Studio in a single experiment. The study involves the assessment of cognitive activity of the PFC during the acquisition and learning of computer maze tasks for blocked and random orders. Two right-handed adults (one male, one female) performed 315 acquisition, 30 retention and 20 transfer trials across four days. Design, implementation, data acquisition and analysis phases of the study were explained with the intention to provide a guideline for future studies.

MazeSuite is a complete toolset to prepare, present and analyze navigational and spatial experiments. Functional near-infrared spectroscopy (fNIR) is an optical brain imaging technique that enables noninvasive and portable monitoring of cerebral blood oxygenation changes. This paper summarizes collective use of MazeSuite and fNIR within a cognitive processing learning paradigm.

MazeSuite is a complete toolset to prepare, present and analyze navigational and spatial experiments1. MazeSuite can be used to design and edit adapted ...

Neuroscience

A Networked Desktop Virtual Reality Setup for Decision Science and Navigation Experiments with Multiple Participants

Investigating the interactions among multiple participants is a challenge for researchers from various disciplines, including the decision sciences and spatial cognition. With a local area network and dedicated software platform, experimenters can efficiently monitor the behavior of the participants that are simultaneously immersed in a desktop virtual environment and digitalize the collected data. These capabilities allow for experimental designs in spatial cognition and navigation research that would be difficult (if not impossible) to conduct in the real world. Possible experimental variations include stress during an evacuation, cooperative and competitive search tasks, and other contextual factors that may influence emergent crowd behavior. However, such a laboratory requires maintenance and strict protocols for data collection in a controlled setting. While the external validity of laboratory studies with human participants is sometimes questioned, a number of recent papers suggest that the correspondence between real and virtual environments may be sufficient for studying social behavior in terms of trajectories, hesitations, and spatial decisions. In this article, we describe a method for conducting experiments on decision-making and navigation with up to 36 participants in a networked desktop virtual reality setup (i.e., the Decision Science Laboratory or DeSciL). This experiment protocol can be adapted and applied by other researchers in order to set up a networked desktop virtual reality laboratory.

This paper describes a method for conducting multi-user experiments on decision-making and navigation using a networked computer laboratory.

Investigating the interactions among multiple participants is a challenge for researchers from various disciplines, including the decision sciences and ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

Medicine

Virtual Reality Experiments with Physiological Measures

Virtual reality (VR) experiments are increasingly employed because of their internal and external validity compared to real-world observation and laboratory experiments, respectively. VR is especially useful for geographic visualizations and investigations of spatial behavior. In spatial behavior research, VR provides a platform for studying the relationship between navigation and physiological measures (e.g., skin conductance, heart rate, blood pressure). Specifically, physiological measures allow researchers to address novel questions and constrain previous theories of spatial abilities, strategies, and performance. For example, individual differences in navigation performance may be explained by the extent to which changes in arousal mediate the effects of task difficulty. However, the complexities in the design and implementation of VR experiments can distract experimenters from their primary research goals and introduce irregularities in data collection and analysis. To address these challenges, the Experiments in Virtual Environments (EVE) framework includes standardized modules such as participant training with the control interface, data collection using questionnaires, the synchronization of physiological measurements, and data storage. EVE also provides the necessary infrastructure for data management, visualization, and evaluation. The present paper describes a protocol that employs the EVE framework to conduct navigation experiments in VR with physiological sensors. The protocol lists the steps necessary for recruiting participants, attaching the physiological sensors, administering the experiment using EVE, and assessing the collected data with EVE evaluation tools. Overall, this protocol will facilitate future research by streamlining the design and implementation of VR experiments with physiological sensors.

Virtual reality (VR) experiments can be difficult to implement and require meticulous planning. This protocol describes a method for the design and implementation of VR experiments that collect physiological data from human participants. The Experiments in Virtual Environments (EVE) framework is employed to accelerate this process.

Virtual reality (VR) experiments are increasingly employed because of their internal and external validity compared to real-world observation and ...

Multimodal Protocol for Assessing Metacognition and Self-Regulation in Adults with Learning Difficulties

Learning disabilities (LDs) encompass disorders of those who have difficulty learning and using academic skills, exhibiting performance below expectations for their chronological age in the areas of reading, writing, and/or mathematics. Each of the disorders making up the LDs involve different deficits; however, some commonalities can be found within that heterogeneity, such in terms of learning self-regulation and metacognition. Unlike in early ages and later educational levels, there are hardly any evidence-based evaluation protocols for adults with LDs. LDs influence academic performance but also have serious consequences in professional, social, and family contexts. In response to this, the current work proposes a multimodal evaluation protocol focused on metacognitive, self-regulation of learning, and emotional processes, which make up the basis of the difficulties in adults with LDs. The assessment is carried out through analysis of the on-line learning process using a variety methods, techniques, and sensors (e.g., eye tracking, facial expressions of emotion, physiological responses, concurrent verbalizations, log files, screen recordings of human-machine interactions) and off-line methods (e.g., questionnaires, interviews, and self-report measures). This theoretically-driven and empirically-based guideline aims to provide an accurate assessment of LDs in adulthood in order to design effective prevention and intervention proposals.

The current work proposes a multimodal evaluation protocol focused on metacognitive, self-regulation of learning, and emotional processes, which make up the basis of the difficulties in adults with LDs.

Learning disabilities (LDs) encompass disorders of those who have difficulty learning and using academic skills, exhibiting performance below expectations ...

Game-Based Exploration: Unlocking Human Spatial Navigation Abilities

Assessing Human Spatial Navigation in a Virtual Space and its Sensitivity to Exercise

Spatial navigation (SN) is the ability to locomote through the environment, which requires an understanding of where one is located in time and space. This capacity is known to rely on the sequential firing of place cells within the hippocampus. SN is an important behavior to investigate as this process deteriorates with age, especially in neurodegenerative disorders. However, the investigation of SN is limited by the lack of sophisticated behavioral techniques to assess this hippocampal-dependent task. Therefore, the goal of this protocol was to develop a novel, real-world approach to studying SN in humans. Specifically, an active virtual SN task was developed using a cross-platform game engine. During the encoding phase, participants navigated their way through a virtual city to locate landmarks. During the remembering phase, participants remembered where these reward locations were and delivered items to these locations. Time to find each location was captured and episodic memory was assessed by a free recall phase, including aspects of place, order, item, and association. Movement behavior (x, y, and z coordinates) was assessed through an asset available in the game engine. Importantly, results from this task demonstrate that it accurately captures both spatial learning and memory abilities as well as episodic memory. Further, findings indicate that this task is sensitive to exercise, which improves hippocampal functioning. Overall, the findings suggest a novel way to track human hippocampal functioning over the course of time, with this behavior being sensitive to physical activity training paradigms.

Author Spotlight: Investigating the Effects of Mind-Body-Movement Practices on Brain Function

Here, we present a novel, brief, and active spatial navigation task that assesses both spatial navigation and episodic memory ability. Importantly, spatial navigation and episodic memory were associated with one another, and this task demonstrated sensitivity to exercise.

Spatial navigation (SN) is the ability to locomote through the environment, which requires an understanding of where one is located in time and space. ...

Implementing Orienteering for Body and Brain Training 

Orienteering as a Tool for Cognitive Research: An Implementation Guide

The sport of orienteering combines physical activity with spatial navigation. Using only a map and a compass, the orienteer must locate a series of checkpoints over unfamiliar terrain using any navigational route they choose and while moving as quickly as possible. Although expert orienteers have superior spatial memory and navigational abilities, even a single session of orienteering can benefit cognition, suggesting that orienteering may be a promising way to train the brain. Research interventions involving orienteering may be especially beneficial for staving off Alzheimer's disease and related dementias that are afflicted by early impairments in wayfinding and spatial cognition. Though orienteering has gained traction in recent literature, certain barriers exist for researchers who are unfamiliar with the sport and wish to implement an intervention. Specifically, a lack of research-based resources for creating orienteering maps and courses may prevent those wishing to study orienteering from designing an intervention. Therefore, this report provides the fundamental information needed to develop orienteering maps and courses and how to implement orienteering interventions in a research setting.

The sport of orienteering is emerging as an effective way to train both the body and brain as it combines physical activity with spatial navigation. The current manuscript offers a guide on how to implement the sport of orienteering in research.

The sport of orienteering combines physical activity with spatial navigation. Using only a map and a compass, the orienteer must locate a series of ...

Eye Tracking During A Complex Aviation Task For Insights Into Information Processing

Eye tracking has been used extensively as a proxy to gain insight into the cognitive, perceptual, and sensorimotor processes that underlie skill performance. Previous work has shown that traditional and advanced gaze metrics reliably demonstrate robust differences in pilot expertise, cognitive load, fatigue, and even situation awareness (SA).
This study describes the methodology for using a wearable eye tracker and gaze mapping algorithm that captures naturalistic head and eye movements (i.e., gaze) in a high-fidelity flight motionless simulator. The method outlined in this paper describes the area of interest (AOI)-based gaze analyses, which provides more context related to where participants are looking, and dwell time duration, which indicates how efficiently they are processing the fixated information. The protocol illustrates the utility of a wearable eye tracker and computer vision algorithm to assess changes in gaze behavior in response to an unexpected in-flight emergency.
Representative results demonstrated that gaze was significantly impacted when the emergency event was introduced. Specifically, attention allocation, gaze dispersion, and gaze sequence complexity significantly decreased and became highly concentrated on looking outside the front window and at the airspeed gauge during the emergency scenario (all p values &#60; 0.05). The utility and limitations of employing a wearable eye tracker in a high-fidelity motionless flight simulation environment to understand the spatiotemporal characteristics of gaze behavior and its relation to information processing in the aviation domain are discussed.

Eye tracking is a non-invasive method to probe information processing. This article describes how eye tracking can be used to study gaze behavior during a flight simulation emergency task in low-time pilots (i.e., &lt;350 flight hours).

Eye tracking has been used extensively as a proxy to gain insight into the cognitive, perceptual, and sensorimotor processes that underlie skill ...

Dual-Task Stroop Paradigm for Detecting Cognitive Deficits in High-Functioning Stroke Patients

General clinical cognitive assessment scales are not sensitive enough to cognitive impairment in high-functioning stroke patients. The dual-task assessment has advantages for identifying cognitive deficits in high-functioning stroke patients and has been gradually applied in clinical assessment and cognitive training. Moreover, the Stroop paradigm has higher sensitivity and specificity for attentional assessment than conventional clinical cognitive assessment scales. Therefore, this study presents the dual-task assessment based on the Stroop paradigm to identify cognitive deficits in high-functioning stroke patients. This study demonstrates a single- and dual-task evaluation based on the Stroop paradigm and confirms its feasibility through case experiments and synchronized functional near-infrared spectroscopy evaluation. The Stroop reaction time and correct rate are used as the main indicators to evaluate the cognitive level of the subjects. This study protocol aims to provide new ideas to figure out the ceiling effect in general clinical assessment failure for high-functioning stroke patients.

Clinical assessment scales are notsensitive enough to cognitive dysfunction in high-functioning stroke patients. The dual-task paradigm presents advantages and potential in the assessment and cognitive training of cognitive dysfunction. The study here proposes a dual-task Stroop paradigm to identify cognitive dysfunction in high-functioning stroke patients.

Practical Methodology of Cognitive Tasks Within a Navigational Assessment

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