Abbagale Gonzales slightly lifts the corners of her Cupid's-bow lips and looks upward with soft, brown eyes.
That is the way she says, “Yes.”
Her language consisted primarily of those subtle movements until just a few months ago.
The 3-year-old's mind is agile but she's trapped in a nearly motionless body, her words seemingly forever lost in an unforgiving tangle of ventilator and tracheotomy tubes made necessary by a disorder called spinal muscular atrophy.
But now technology is helping Abbagale find her voice.
Abbagale is a patient living at The Children's Center in Bethany, where teachers recently began incorporating iPads into patients' therapy to enhance learning and communication.
The disorder causes progressive muscular weakness that prevents movements such as grasping. So slings hang from the top of Abbagale's hot pink wheelchair, supporting her elbows and wrists so her hands can move enough to use an iPad.
“She doesn't have the strength to use a computer keyboard or to grasp a crayon,” said special education teacher Mindy Cash.
Scribbling helps children learn to communicate, she explained. But that early step is often lost to children like Abbagale who can't hold a crayon or tap a keyboard.
Yet with her wrists in slings, Abbagale can draw or “turn” the pages of an alphabet book by lightly sliding a fingertip across the iPad screen.
Her teacher asked if she wanted to draw. The child turned those big eyes upward, meaning yes.
Smiling almost imperceptibly as the app for drawing sprang to life, Abbagale moves her right hand so two fingers could softly draw a jagged oval and some lines across the sensitivity-adjusted iPad screen lying on her wheelchair table.
After a few moments, Cash noticed a meaningful glance from Abbagale.
“So you want to choose a color to draw with,” she said.
Cash pointed to dots of various colors on the screen of a communication device called a MyTobii P10, situated about a foot above the child.
Abbagale gazed at a pink circle on the screen and her scribbles on the iPad turned pink. Seconds later, she chose a new color to draw with by gazing at a purple circle.
“I like that big smile,” Cash told Abbagale.
“This is allowing her to be independent ... to give her communication,” she said. “It's so engaging. It just captivates them.”
Bethany Public Schools initially loaned five iPads to the center for use in classrooms like the one Abbagale daily shares with Fletcher Burns, 7, and Azon Meyers, 3. In the past few weeks, the nonprofit hospital was able to buy 15 iPads through a grant.
Since its release in the spring of 2010, the iPad has become a popular technology used by those with disabilities, though no one has tracked statistics on those uses. Along with the new iPads, the MyTobii, and the Xbox 360 with Kinect app are just a few of the high-tech tools the hospital incorporates into the children's therapy.
“These are exciting ways to push the communication of these kids further than we ever imagined,” said Dr. Darin Brannan, The Children's Center medical director.
“Often, you can tell the kid wants to say something but their body or language betrays them,” he said.
Thanks to the technology, a cacophony of sounds bubble up in The Children's Center classroom where patients with complex medical and physical disabilities speak with great difficulty or not at all.
With a favorite iPad app, Abbagale hears the word “Dolphin,” when the letter “D” appears on a page or “Iguana,” when she swipes the screen so the virtual page turns to the letter “I.”
Though her condition will always require a ventilator that allows her to breathe but prevents her from speaking, Brannan said Abbagale eventually will be introduced to an iPad voice synthesizer that will take her language beyond touch.
The iPads can be customized not only for facial recognition and the screen sensitivity but also for the user's different environments, he said.
For example, applicable pictures and material would be available to a child going into a therapy session, compared with material more applicable to watching a movie with family members or visiting a public schools classroom.
“It's really exciting that things like this can benefit someone like Abbagale, whose dependence on technology is going to continue,” Brannan said.
In a wheelchair next to Abbagale, curly-mopped Azon Meyers, 3, becomes a one-man band as he presses repeatedly on the corner of an iPad, making it spout out sounds of whistles, bells, crying babies, clapping, yodeling and more while stars, clouds, triangles and other shapes prance across the iPad lying on his wheelchair table. With help from his teacher, the little music guy's iPad becomes a guitar one moment and a xylophone the next.
Azon sits next to Fletcher Burns, 7, who quickly points out his new blue jeans to visitors. From his miniature wood chair, Fletcher swings tiny feet clad in black and white tennis shoes as his teacher asks him to get his pointer finger out. Fletcher, who knows sign language, holds up his right index finger and looks down at the iPad.
“Where's the triangle?” lead teacher Stephanie Delk asks Fletcher.
He looks at the screen a couple of seconds and then touches the correct shape, prompting the iPad to say “Yippee!”
Delk said the iPads offer teachers a new tool that is well received by youngsters like Fletcher.
“I think it creates more independence for him. I'm not holding up the shapes,” she said.
“And it's a lot more fun for him by it giving feedback by saying, ‘Yippee!' or whatever.”
DID YOU KNOW?
The Children's Center
Residents: About 120 medically fragile children live in The Children's Center and receive treatment.
Current services: Today, the hospital offers medical services, rehabilitative care and social services to children in long-term care, children in short-term rehabilitation after experiencing trauma such as a brain or spinal cord injury, and several thousand outpatients who visit the hospital and the pediatric clinic. Clinical treatment ranges from general pediatrics for typically developing children to specialized medicine for children with complex disabilities.
Ages: Ranging in age from birth to 17, patients have disabilities resulting from birth defects, complications at birth, accidents and illnesses.
Numbers: The Children's Center has more than 475 employees and an operating budget of about $24 million.
Compiled by SONYA COLBERG,