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 border="0" cellpadding="0" cellspacing="0">
	<tbody>
		<tr>
			<td>iPad</td>
			<td>Apple, 2014&#160;</td>
			<td>MD786C/A</td>
			<td>tablet with dynamic screen</td>
		</tr>
		<tr>
			<td>Proloquo2Go</td>
			<td>AssistiveWare, 2014</td>
			<td>available on iTunes</td>
			<td>applicaiton for augmentative and alternative communication</td>
		</tr>
		<tr>
			<td>SymbolStix</td>
			<td>N2Y inc, 2014</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 &#38; Mille), 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.

Watch this Scientific Journal Video about Practical Methodology of Cognitive Tasks Within a Navigational Assessment at JoVE.com

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 ...

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Behavior

13.5K Views.  Laurentian University. 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.

Video: Practical Methodology of Cognitive Tasks Within a Navigational Assessment

Assessment of Age-related Changes in Cognitive Functions Using EmoCogMeter, a Novel Tablet-computer Based Approach

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognitive functions across the lifespan in a sample of 378 healthy subjects (age range 18-89 years). Consistent with previous findings we found an age-related cognitive decline across a wide range of neuropsychological domains (memory, attention, executive functions), thereby proving the usability of our tablet-based application. Regardless of prior computer experience, subjects of all age groups were able to perform the tasks without instruction or feedback from an experimenter. Increased motivation and compliance proved to be beneficial for task performance, thereby potentially increasing the validity of the results. Our promising findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

We tested the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on cognition. Results show an age-related cognitive decline, thereby proving the usability of our application. Findings underline the great clinical and practical potential of a tablet-based application for detection and monitoring of cognitive dysfunction.

The main goal of this study was to assess the usability of a tablet-computer-based application (EmoCogMeter) in investigating the effects of age on ...

Automated Visual Cognitive Tasks for Recording Neural Activity Using a Floor Projection Maze

Neuropsychological tasks used in primates to investigate mechanisms of learning and memory are typically visually guided cognitive tasks. We have developed visual cognitive tasks for rats using the Floor Projection Maze1,2&#160;that are optimized for visual abilities of rats permitting stronger comparisons of experimental findings with other species.
In order to investigate neural correlates of learning and memory, we have integrated electrophysiological recordings into fully automated cognitive tasks on the Floor Projection Maze1,2. Behavioral software interfaced with an animal tracking system allows monitoring of the animal's behavior with precise control of image presentation and reward contingencies for better trained animals. Integration with an in vivo electrophysiological recording system enables examination of behavioral correlates of neural activity at selected epochs of a given cognitive task.
We describe protocols for a model system that combines automated visual presentation of information to rodents and intracranial reward with electrophysiological approaches. Our model system offers a sophisticated set of tools as a framework for other cognitive tasks to better isolate and identify specific mechanisms contributing to particular cognitive processes.

We describe protocols for training rats for chronic electrophysiological recordings in fully automated cognitive tasks on a Floor Projection Maze.

Neuropsychological tasks used in primates to investigate mechanisms of learning and memory are typically visually guided cognitive tasks. We have ...

Uncovering Beat Deafness: Detecting Rhythm Disorders with Synchronized Finger Tapping and Perceptual Timing Tasks

A set of behavioral tasks for assessing perceptual and sensorimotor timing abilities in the general population (i.e., non-musicians) is presented here with the goal of uncovering rhythm disorders, such as beat deafness. Beat deafness is characterized by poor performance in perceiving durations in auditory rhythmic patterns or poor synchronization of movement with auditory rhythms (e.g., with musical beats). These tasks include the synchronization of finger tapping to the beat of simple and complex auditory stimuli and the detection of rhythmic irregularities (anisochrony detection task) embedded in the same stimuli. These tests, which are easy to administer, include an assessment of both perceptual and sensorimotor timing abilities under different conditions (e.g., beat rates and types of auditory material) and are based on the same auditory stimuli, ranging from a simple metronome to a complex musical excerpt. The analysis of synchronized tapping data is performed with circular statistics, which provide reliable measures of synchronization accuracy (e.g., the difference between the timing of the taps and the timing of the pacing stimuli) and consistency. Circular statistics on tapping data are particularly well-suited for detecting individual differences in the general population. Synchronized tapping and anisochrony detection are sensitive measures for identifying profiles of rhythm disorders and have been used with success to uncover cases of poor synchronization with spared perceptual timing. This systematic assessment of perceptual and sensorimotor timing can be extended to populations of patients with brain damage, neurodegenerative diseases (e.g., Parkinson&#8217;s disease), and developmental disorders (e.g., Attention Deficit Hyperactivity Disorder).

Behavioral tasks that allow for the assessment of perceptual and sensorimotor timing abilities in the general population (i.e., non-musicians) are presented. Synchronization of finger tapping to the beat of an auditory stimuli and detecting rhythmic irregularities provides a means of uncovering rhythm disorders.

A set of behavioral tasks for assessing perceptual and sensorimotor timing abilities in the general population (i.e., non-musicians) is presented here ...

Transferring Cognitive Tasks Between Brain Imaging Modalities: Implications for Task Design and Results Interpretation in fMRI Studies

As cognitive neuroscience methods develop, established experimental tasks are used with emerging brain imaging modalities. Here transferring a paradigm (the visual oddball task) with a long history of behavioral and electroencephalography (EEG) experiments to a functional magnetic resonance imaging (fMRI) experiment is considered. The aims of this paper are to briefly describe fMRI and when its use is appropriate in cognitive neuroscience; illustrate how task design can influence the results of an fMRI experiment, particularly when that task is borrowed from another imaging modality; explain the practical aspects of performing an fMRI experiment. It is demonstrated that manipulating the task demands in the visual oddball task results in different patterns of blood oxygen level dependent (BOLD) activation. The nature of the fMRI BOLD measure means that many brain regions are found to be active in a particular task. Determining the functions of these areas of activation is very much dependent on task design and analysis. The complex nature of many fMRI tasks means that the details of the task and its requirements need careful consideration when interpreting data. The data show that this is particularly important in those tasks relying on a motor response as well as cognitive elements and that covert and overt responses should be considered where possible. Furthermore, the data show that transferring an EEG paradigm to an fMRI experiment needs careful consideration and it cannot be assumed that the same paradigm will work equally well across imaging modalities. It is therefore recommended that the design of an fMRI study is pilot tested behaviorally to establish the effects of interest and then pilot tested in the fMRI environment to ensure appropriate design, implementation and analysis for the effects of interest.

Transferring a paradigm with a history of use in EEG experiments to an fMRI experiment is considered. It is demonstrated that manipulating the task demands in the visual oddball task resulted in different patterns of BOLD activation and illustrated how task design is crucial in fMRI experiments.

As cognitive neuroscience methods develop, established experimental tasks are used with emerging brain imaging modalities. Here transferring a paradigm ...

Performing Behavioral Tasks in Subjects with Intracranial Electrodes

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in different areas of their brain for the localization of their seizure focus and eloquent areas. After implantation, the patient must remain in the hospital until the pathological area of brain is found and possibly resected. During this time, these patients offer a unique opportunity to the research community because any number of behavioral paradigms can be performed to uncover the neural correlates that guide behavior. Here we present a method for recording brain activity from intracranial implants as subjects perform a behavioral task designed to assess decision-making and reward encoding. All electrophysiological data from the intracranial electrodes are recorded during the behavioral task, allowing for the examination of the many brain areas involved in a single function at time scales relevant to behavior. Moreover, and unlike animal studies, human patients can learn a wide variety of behavioral tasks quickly, allowing for the ability to perform more than one task in the same subject or for performing controls. Despite the many advantages of this technique for understanding human brain function, there are also methodological limitations that we discuss, including environmental factors, analgesic effects, time constraints and recordings from diseased tissue. This method may be easily implemented by any institution that performs intracranial assessments; providing the opportunity to directly examine human brain function during behavior.

Patients implanted with intracranial electrodes provide a unique opportunity to record neurological data from multiple areas of the brain while the patient performs behavioral tasks. Here, we present a method of recording from implanted patients that can be reproducible at other institutions with access to this patient population.

Patients having stereo-electroencephalography (SEEG) electrode, subdural grid or depth electrode implants have a multitude of electrodes implanted in ...

Assessment of Social Cognition in Non-human Primates Using a Network of Computerized Automated Learning Device (ALDM) Test Systems

Fagot &#38; Paleressompoulle1 and Fagot &#38; Bonte2 have published an automated learning device (ALDM) for the study of cognitive abilities of monkeys maintained in semi-free ranging conditions. Data accumulated during the last five years have consistently demonstrated the efficiency of this protocol to investigate individual/physical cognition in monkeys, and have further shown that this procedure reduces stress level during animal testing3. This paper demonstrates that networks of ALDM can also be used to investigate different facets of social cognition and in-group expressed behaviors in monkeys, and describes three illustrative protocols developed for that purpose. The first study demonstrates how ethological assessments of social behavior and computerized assessments of cognitive performance could be integrated to investigate the effects of socially exhibited moods on the cognitive performance of individuals. The second study shows that batteries of ALDM running in parallel can provide unique information on the influence of the presence of others on task performance. Finally, the last study shows that networks of ALDM test units can also be used to study issues related to social transmission and cultural evolution. Combined together, these three studies demonstrate clearly that ALDM testing is a highly promising experimental tool for bridging the gap in the animal literature between research on individual cognition and research on social cognition.

Assessment of Social Cognition in Non-human Primates Using a Network of Computerized Automated Learning Device ALDM Test Systems

Fagot &#38; Paleressompoulle1 have published an automated learning device (ALDM) aimed at testing individual cognitive abilities in semi-free ranging monkeys. The main goal of our protocol is to use a network of ALDM test units to study social cognition in non-human primates.

Fagot &#38; Paleressompoulle1 and Fagot &#38; Bonte2 have published an automated learning device (ALDM) for the study of cognitive abilities of monkeys ...

Using Fiberless, Wearable fNIRS to Monitor Brain Activity in Real-world Cognitive Tasks

Functional Near Infrared Spectroscopy (fNIRS) is a neuroimaging technique that uses near-infrared light to monitor brain activity. Based on neurovascular coupling, fNIRS is able to measure the haemoglobin concentration changes secondary to neuronal activity. Compared to other neuroimaging techniques, fNIRS represents a good compromise in terms of spatial and temporal resolution. Moreover, it is portable, lightweight, less sensitive to motion artifacts and does not impose significant physical restraints. It is therefore appropriate to monitor a wide range of cognitive tasks (e.g., auditory, gait analysis, social interaction) and different age populations (e.g., new-borns, adults, elderly people). The recent development of fiberless fNIRS devices has opened the way to new applications in neuroscience research. This represents a unique opportunity to study functional activity during real-world tests, which can be more sensitive and accurate in assessing cognitive function and dysfunction than lab-based tests. This study explored the use of fiberless fNIRS to monitor brain activity during a real-world prospective memory task. This protocol is performed outside the lab and brain haemoglobin concentration changes are continuously measured over the prefrontal cortex while the subject walks around in order to accomplish several different tasks.

Monitoring brain activity outside the lab without physical constraints presents methodological challenges. A fiberless, wearable functional Near Infrared Spectroscopy (fNIRS) system was used to measure brain activity during an ecological prospective memory task. It was demonstrated that this system could be used to monitor brain activity during non-lab based experiments.

Functional Near Infrared Spectroscopy (fNIRS) is a neuroimaging technique that uses near-infrared light to monitor brain activity. Based on neurovascular ...

Event-related Potentials During Target-response Tasks to Study Cognitive Processes of Upper Limb Use in Children with Unilateral Cerebral Palsy

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral motor impairments that are frequently dominated in the upper limb. In addition to a reduced movement capacity of the affected upper limb, several children with unilateral CP show a reduced awareness of the remaining movement capacity of that limb. This phenomenon of disregarding the preserved capacity of the affected upper limb is regularly referred to as Developmental Disregard (DD). Different theories have been postulated to explain DD, each suggesting slightly different guidelines for therapy. Still, cognitive processes that might additionally contribute to DD in children with unilateral CP have never been directly studied. The current protocol was developed to study cognitive aspects involved in upper limb control in children with unilateral CP with and without DD. This was done by recording event-related potentials (ERPs) extracted from the ongoing EEG during target-response tasks asking for a hand-movement response. ERPs consist of several components, each of them associated with a well-defined cognitive process (e.g., the N1 with early attention processes, the N2 with cognitive control and the P3 with cognitive load and mental effort). Due to its excellent temporal resolution, the ERP technique enables to study several covert cognitive processes preceding overt motor responses and thus allows insight into the cognitive processes that might contribute to the phenomenon of DD. Using this protocol adds a new level of explanation to existing behavioral studies and opens new avenues to the broader implementation of research on cognitive aspects of developmental movement restrictions in children.

Several children with unilateral Cerebral Palsy seem to disregard the preserved capacity of their affected upper limb. This Developmental Disregard is extensively described in the literature but the involved cognitive processes have not been studied. To study underlying cognitive factors of upper limb control, an event-related potential protocol was developed.

Unilateral Cerebral Palsy (CP) is a neurodevelopmental disorder that is a very common cause of disability in childhood. It is characterized by unilateral ...

Comparing the Frequency Effect Between the Lexical Decision and Naming Tasks in Chinese

In psycholinguistic research, the frequency effect can be one of the indicators for eligible experimental tasks that examine the nature of lexical access. Usually, only one of those tasks is chosen to examine lexical access in a study. Using two exemplar experiments, this paper introduces an approach to include both the lexical decision task and the naming task in a study. In the first experiment, the stimuli were Chinese characters with frequency and regularity manipulated. In the second experiment, the stimuli were switched to Chinese two-character words, in which the word frequency and the regularity of the leading character were manipulated. The logic of these two exemplar experiments was to explore some important issues such as the role of phonology on recognition by comparing the frequency effect between both the tasks. The results revealed different patterns of lexical access from those reported in the alphabetic systems. The results of Experiment 1 manifested a larger frequency effect in the naming task as compared to the LDT, when the stimuli were Chinese characters. And it is noteworthy that, in Experiment 1, when the stimuli were regular Chinese characters, the frequency effect observed in the naming task was roughly equivalent to that in the LDT. However, a smaller frequency effect was shown in the naming task as compared to the LDT, when the stimuli were switched to Chinese two-character words in Experiment 2. Taking advantage of the respective demands and characteristics in both tasks, researchers can obtain a more complete and precise picture of character/word recognition.

Researchers adopt both the lexical decision task and the naming task to investigate some important topics such as character/word recognition by comparing the frequency effect between these two tasks. This article introduces this approach through two exemplar experiments and elaborates on the underlying logic.

In psycholinguistic research, the frequency effect can be one of the indicators for eligible experimental tasks that examine the nature of lexical access. ...

Investigating the Deployment of Visual Attention Before Accurate and Averaging Saccades via Eye Tracking and Assessment of Visual Sensitivity

This experimental protocol was designed to investigate whether visual attention is obligatorily deployed at the endpoint of saccades. To this end, we recorded the eye position of human participants engaged in a saccade task via eye tracking and assessed visual orientation discrimination performance at various locations during saccade preparation. Importantly, instead of using a single saccade target paradigm for which the saccade endpoint typically coincides roughly with the target, this protocol comprised the presentation of two nearby saccade targets, leading to a distinct spatial dissociation between target locations and saccade endpoint on a substantial number of trials. The paradigm allowed us to compare presaccadic visual discrimination performance at the endpoint of accurate saccades (landing at one of the saccade targets) and of averaging saccades (landing at an intermediate location in between the two targets). We observed a selective enhancement of visual sensitivity at the endpoint of accurate saccades but not at the endpoint of averaging saccades. Rather, before the execution of averaging saccades, visual sensitivity was equally enhanced at both targets, suggesting that saccade averaging follows from unresolved attentional selection among the saccade targets. These results argue against a mandatory coupling between visual attention and saccade programming based on a direct measure of presaccadic visual sensitivity rather than saccadic reaction times, which have been used in other protocols to draw similar conclusions. While our protocol provides a useful framework to investigate the relationship between visual attention and saccadic eye movements at the behavioral level, it can also be combined with electrophysiological measures to extend insights at the neuronal level.

This experimental protocol combined eye tracking and the assessment of presaccadic visual sensitivity in a dual task paradigm, consisting of a free choice saccade task and a visual discrimination task, to investigate the deployment of visual spatial attention before both, accurate and averaging saccades.

This experimental protocol was designed to investigate whether visual attention is obligatorily deployed at the endpoint of saccades. To this end, we ...