WEBVTT 00:00:08.107 --> 00:00:12.484 Communication among people with profound intellectual and multiple disabilities 00:00:12,814 - -> 00:00:20,822 What is communication and how does it develop? 00:00:20.866 --> 00:00:22.906 Yes, well, first of all, it's a central issue, 00:00:22.906 --> 00:00:25.566 because it starts even before birth 00:00:25.566 --> 00:00:28.646 and then continues to be an issue until the end of life, 00:00:28.646 --> 00:00:29.646 which is a recurring theme. 00:00:29.646 --> 00:00:34. 146 I think it's important to make it clear 00:00:34.146 --> 00:00:36.546 which definition of communication we're talking about. 00:00:36.546 --> 00:00:39.326 That you have communication, 00:00:39.326 --> 00:00:42.746 that you say communication information transfer. 00:00:42,746 - -> 00:00:46,566 But that is a very abstract form of communication, 00:00:46.566 --> 00:00:49.486 which presupposes many aspects. 00:00:50.082 --> 00:00:51.942 And if you look at 00:00:51.942 --> 00:00:54.322 people with profound intellectual and multiple disabilities, 00:00:54.322 --> 00:00:58.342 they haven't gotten there yet, 00:00:58.342 --> 00:00:59.382 but it's about 00:00:59.382 --> 00:01:01.142 phases of speech development, 00:01:01.142 --> 00:01:05.562 until you reach this level 00:01:05.562 --> 00:01:08.122 communication as a means of conveying information. 00:01:08.122 --> 00:01:08.902 And that doesn't mean 00:01:08.902 --> 00:01:14.782 that this is now better or requires higher skills, 00:01:14.782 --> 00:01:15.682 but it is simply a path 00:01:15.682 --> 00:01:17.922 that has to be taken to 00:01:17.922 --> 00:01:19.618 to get there. 00:01:19.618 --> 00:01:20.698 And if you look at it, 00:01:20.698 --> 00:01:24.258 communication, i.e., the transfer of information, requires 00:01:24.258 --> 00:01:26.638 that a system of signs 00:01:26.638 --> 00:01:28.818 can be used on a symbolic level. 00:01:28.818 --> 00:01:30.798 So I assume that 00:01:30.798 --> 00:01:35.158 when I say something or formulate something in words, 00:01:35.158 --> 00:01:36.918 that certain ideas are associated with it 00:01:36.918 --> 00:01:40.278 and that the other person can also recall this idea 00:01:40.278 --> 00:01:41.938 and that we then have a consensus 00:01:41.938 --> 00:01:42.798 about what we are talking about. 00:01:42.798 --> 00:01:47.338 And that's only possible 00:01:47.338 --> 00:01:48.498 with symbolic understanding, 00:01:48.498 --> 00:01:49.838 i.e. after the first year of life. 00:01:49.838 --> 00:01:52.358 And before that, there are many phases of communication 00:01:52.358 --> 00:01:57.838 where other goals are in the foreground 00:01:57.838 --> 00:01:59.738 or other aspects. 00:01:59.738 --> 00:02:02.478 So very early on, it's about 00:02:02.478 --> 00:02:05.098 to relate to each other at all, 00:02:05.098 --> 00:02:08.478 developing an interest in another person 00:02:08.478 --> 00:02:10.578 and relating to each other. 00:02:10.578 --> 00:02:12.158 The next step is then 00:02:12.158 --> 00:02:13.018 for the child to learn 00:02:13.018 --> 00:02:15.038 I can have an effect on the other person, 00:02:15.038 --> 00:02:18.010 i.e. influence someone, 00:02:18.010 --> 00:02:20.530 in other words, to experience self-efficacy. 00:02:20.530 --> 00:02:22.910 And then that just develops further, 00:02:22.910 --> 00:02:24.490 if I do it often enough, 00:02:24.490 --> 00:02:25.870 then I use it in a targeted way. 00:02:25.870 --> 00:02:28.590 Then I have intentional communication, 00:02:28.590 --> 00:02:32.610 meaning that I specifically influence someone else. 00:02:32.610 --> 00:02:33.610 And all of that happens 00:02:33.610 --> 00:02:34.970 using pre-linguistic means. 00:02:34.970 --> 00:02:36.750 So I don't need language for that yet, 00:02:36.750 --> 00:02:42.950 I don't need any other symbols or signs for that, 00:02:43.362 --> 00:02:46.902 but it's all possible with the repertoire of body language 00:02:46.902 --> 00:02:47.302 and if the 00:02:47.302 --> 00:02:48.862 child understands that, 00:02:48.862 --> 00:02:50.982 then at some point language will come, or 00:02:50.982 --> 00:02:52.462 if speaking is not possible, 00:02:52.462 --> 00:02:57.322 other sign systems then come into play, 00:02:57.322 --> 00:03:00.802 which take on this symbolic function 00:03:00.802 --> 00:03:02.002 and the child then wants what 00:03:02.002 --> 00:03:03.782 what is most effective, and in most cases 00:03:03.782 --> 00:03:04.842 that is spoken language, 00:03:04.842 --> 00:03:05.842 if possible. 00:03:07,234 - -> 00:03:14,580 What special characteristics do people with profound intellectual and multiple disabilities exhibit in communication? 00:03:14.626 --> 00:03:18.606 Yes, and from this perspective, it may be that 00:03:18.606 --> 00:03:22.146 that people with profound intellectual and multiple disabilities 00:03:22.146 --> 00:03:25.146 are in these preliminary stages for a long time 00:03:25.146 --> 00:03:27.926 or perhaps remain there their entire lives. 00:03:27.926 --> 00:03:30.026 But nevertheless, it is meaningful 00:03:30.026 --> 00:03:31.366 because we are social beings. 00:03:31.366 --> 00:03:35.106 So this relating to each other and joy. 00:03:35.106 --> 00:03:37.226 That's how Stern once put it. 00:03:37.226 --> 00:03:38.466 It's about nothing else 00:03:38.466 --> 00:03:40.666 than being with the other person and enjoying that. 00:03:41.186 --> 00:03:43.406 So that alone can, so to speak, 00:03:43.406 --> 00:03:44.946 that's also quality of life, 00:03:44.946 --> 00:03:46.686 that's one aspect of quality of life 00:03:46.686 --> 00:03:49.846 and that is an aspect that is simply very, very important. 00:03:49.846 --> 00:03:51.726 I also think it's important 00:03:51.726 --> 00:03:53.366 that communication 00:03:53.366 --> 00:03:55.466 is not just about functional communication, 00:03:55.466 --> 00:03:58.226 but that small talk is just as important. 00:03:58.226 --> 00:04:00.006 There are studies on this, 00:04:00.006 --> 00:04:02.026 that our form of communication, 00:04:02.026 --> 00:04:04.946 that is, the proportion of small talk, 00:04:04.946 --> 00:04:07.086 that is, essentially meaningless communication, 00:04:07.086 --> 00:04:08.206 but you are in contact, 00:04:08.450 --> 00:04:11.650 predominates over this information portion 00:04:11.650 --> 00:04:13.230 or this functional part. 00:04:13.230 --> 00:04:15.350 I want something, I don't want something. 00:04:15.350 --> 00:04:17.470 So this function. 00:04:17.470 --> 00:04:19.810 And then you also know 00:04:19.810 --> 00:04:24.330 that with people who have a profound intellectual and multiple disability 00:04:24.330 --> 00:04:26.610 often tend to be addressed 00:04:26.610 --> 00:04:27.950 when you want something specific. 00:04:27.950 --> 00:04:29.710 So it's this functional aspect. 00:04:29.710 --> 00:04:31.710 You want to eat with someone now, or you 00:04:31.710 --> 00:04:35.210 want to do this activity, or you want 00:04:35.210 --> 00:04:36.430 someone not to do something. 00:04:37.122 --> 00:04:39.782 And this small talk aspect, 00:04:39.782 --> 00:04:41.722 which is so important to us, 00:04:41.722 --> 00:04:45.362 has only been developed in recent years 00:04:45.362 --> 00:04:46.762 with some approaches 00:04:46.762 --> 00:04:48.562 or some approaches have also been developed to this end, 00:04:48.562 --> 00:04:52.282 that this is just as important or 00:04:52.282 --> 00:04:54.602 perhaps even more important and the basis 00:04:54.602 --> 00:04:57.162 for all other developments to build on. 00:04:57.162 --> 00:04:58.662 A second aspect is 00:04:58.662 --> 00:05:00.702 that, on the one hand, it is of course about communicating, 00:05:00.702 --> 00:05:02.762 that I can express myself in communication. 00:05:02.762 --> 00:05:04.002 The other aspect, 00:05:04.002 --> 00:05:07.026 which is particularly important for people with profound intellectual and multiple disabilities 00:05:07.026 --> 00:05:08.166 is also very important, 00:05:08.166 --> 00:05:10.066 is to understand what is happening. 00:05:10.066 --> 00:05:12.386 So that the people 00:05:12.386 --> 00:05:15.966 who are involved with the person 00:05:15.966 --> 00:05:18.346 have a very important responsibility, 00:05:18.346 --> 00:05:20.406 themselves as individuals, 00:05:20.406 --> 00:05:23.026 but also processes and situations 00:05:23.026 --> 00:05:25.406 predictable and recognizable. 00:05:25.406 --> 00:05:29.926 And that plays an important role for all of us. 00:05:29.926 --> 00:05:32.726 With us, it just happens in a flash, 00:05:32.962 --> 00:05:35.242 we see everything at a glance 00:05:35.242 --> 00:05:37.842 and understand and know who is standing in front of us, 00:05: 37.842 --> 00:05:39.382 recognize someone immediately, 00:05:39.382 --> 00:05:41.302 recognize the situation and 00:05:41.302 --> 00:05:43.242 then act within that situation. 00:05:43.242 --> 00:05:46.022 And with people with profound intellectual and multiple disabilities 00:05:46.022 --> 00:05:47.642 it's just not that easy, 00:05:47.642 --> 00:05:53.802 because they need certain markers, so to speak, and 00:05:53.802 --> 00:05:56.742 first of all, their attention has to be captured. 00:05:57.826 --> 00:05:59.766 that takes time, 00:05:59.766 --> 00:06:00.586 time may also be needed 00:06:00.586 --> 00:06:02.086 for delayed processing, 00:06:02.086 --> 00:06:03.346 it's that pace again, 00:06:03.346 --> 00:06:06.246 that a lot of things happen much too fast and 00:06:06.246 --> 00:06:07.966 then it's not clear to them either, 00:06:07.966 --> 00:06:09.946 so even if it's the same situation, 00:06:09.946 --> 00:06:11.146 but maybe a different person, 00:06:11.146 --> 00:06:11.966 then maybe it's 00:06:11.966 --> 00:06:14.706 a completely new situation or vice versa. 00:06:14.706 --> 00:06:17.246 And they just need a lot 00:06:17.246 --> 00:06:20.526 lots of clues for orientation, 00:06:20.526 --> 00:06:22.426 just this ritualization 00:06:22.42 6 --> 00:06:26.626 and this making things recognizable through 00:06:26.626 --> 00:06:28.986 additional signs, signals, 00:06:28.986 --> 00:06:29.586 then we are already 00:06:29.586 --> 00:06:32.946 back to supporter communication as an input strategy, 00:06:32.946 --> 00:06:34.906 that this is very important. 00:06: 34.906 --> 00:06:39.466 Because otherwise, the person is busy all the time, 00:06:39.466 --> 00:06:40.666 trying to figure out 00:06:40.666 --> 00:06:43.706 what is happening here or, in the worst case, 00:06:43.706 --> 00:06:45.306 yikes, what is happening to me here. 00:06:45.306 --> 00:06:49.386 So, tension rather than relaxation, so to speak. 00:06:49.386 --> 00:06: 52.506 And only when that is clear, the orientation, 00:06:52.738 --> 00:06:54.598 then are we, so to speak, free of resources, 00:06:54.598 --> 00:06:56.378 actually focus on communication, 00:06:56.378 --> 00:06:58.918 that is, on the content aspect of communication 00:06:58.918 --> 00:07:01.558 and the actual exchange. 00:07:01.558 --> 00:07:03.658 So that you free up resources, 00:07:03.658 --> 00:07:11.538 when I'm working on this other point, so to speak, 00:07:11.538 --> 00:07:16.278 that predictability or even building expectations, 00:07:16.278 --> 00:07:17.958 that's also a very 00:07:17.958 --> 00:07:20.478 important point again for communication, 00:07:20.930 --> 00:07:22.750 if I can build expectations about what 00:07:22.750 --> 00:07:23.590 what happens, 00:07:23.590 --> 00:07:27.310 then I can act within the context of this situation. 00:07:27.310 --> 00:07:30.070 And that has a lot to do with participation. 00:07:30.070 --> 00:07:35.970 As long as that orientation is not certain, 00:07:35.970 --> 00:07:40.210 I can't really participate yet, 00:07:40.210 --> 00:07:42.250 because I'm still busy 00:07:42.250 --> 00:07:43.550 with orientation, so to speak. 00:07:44,576 - -> 00:07:53,166 What are the consequences when a person cannot communicate in a generally understandable way? 00:07:53.282 --> 00:07:55.822 So every person 00:07:55,822 - -> 00:08:02,322 who shows and expresses life activity, 00:08:02.322 --> 00:08:06.022 can communicate. 00:08:06.022 --> 00:08:08.662 Or rather, what is a very crucial point, 00:08:08.662 --> 00:08:10.482 is that I have to distinguish 00:08:10.482 --> 00:08:12.962 between partner-dependent communication and 00:08:12.962 --> 00:08:14.822 partner-independent communication. 00:08:14.822 --> 00:08:17.222 And partner-dependent communication, 00:08:17.222 --> 00:08:21.002 that is, that I have to interpret every statement, 00:08:21.002 --> 00:08:21.662 every 00:08:21.662 --> 00:08:24.542 and that also refers to vital expressions, 00:08:24.542 --> 00:08:28.042 such as breathing or heartbeat. 00:08:28.042 --> 00:08:32.602 Of course, it's more difficult with this subtle signal, 00:08:32.602 --> 00:08:35.702 but it is possible to pick up on them 00:08:35.702 --> 00:08:38.022 and attribute meaning to them. 00: 08:38.022 --> 00:08:39.261 And that is what 00:08:39.261 --> 00:08:41.162 communication can develop from 00:08:41.162 --> 00:08:43.782 or how communication is possible. 00:08:43.782 --> 00:08:46.522 And that is always possible 00:08:46.522 --> 00:08:50.782 as soon as someone shows the most basic activities. 00:08:52.034 --> 00:08:54.234 So I would say, roughly speaking, 00:08:54.234 --> 00:08:56.954 that everyone can communicate, 00:08:56.954 --> 00:08:59.334 whether all partners can communicate independently. 00: 08:59.334 --> 00:09:03.894 That means purposefully 00:09:03.894 --> 00:09:08.334 a message or purposefully to another person 00:09:08.334 --> 00:09:10.614 about something, 00:09:10.614 --> 00:09:14.154 for example, that would be intentional communication, 00:09:14.154 --> 00:09:17.394 which may not be possible for everyone. 00:09:17.794 --> 00:09:19.434 But there is no appreciation, 00:09:19.434 --> 00:09:20.394 no evaluation in it, 00:09:20.394 --> 00:09:24.014 that one would be worth more or less. 00:09:24.014 --> 00:09:27.994 Communication is communication. 00:09:27.994 --> 00:09:32.754 This is again closely related to 00:09:32.754 --> 00:09:36.994 these two factors of sensitivity and responsiveness, 00:09:36.994 --> 00:09:40.714 namely the high degree of dependence these people have 00:09:40.714 --> 00:09:42.414 on the people around them, 00:09:42.414 --> 00:09:45.554 how well these people are trained, 00:09:45.554 --> 00:09:50.594 to perceive their smallest, minimal, subtle 00:09:50.594 --> 00:09:57.074 or unusual, or to perceive their signals 00:09:57.074 --> 00:10:00.594 and to perceive them in the first place, to perceive them at all, 00:10:00.594 --> 00:10:06.034 that they are there, and then to interpret these signals, 00:10:06.034 --> 00:10:07.994 to put them into context and 00:10:07.994 --> 00:10:09.694 then respond to them. 00:10:09.694 --> 00:10:13.754 And the difficulty lies in the fact that 00: 10:13.754 --> 00:10:16.974 that these signals are very subtle 00:10:17.602 --> 00:10:21.602 For example, an increase in muscle tone 00:10:21.602 --> 00:10:25.582 or tension expressed in increased muscle tone 00:10:25.582 --> 00:10:29.082 or in a frown or 00:10:29.082 --> 00:10:31.002 perhaps in a change in breathing. 00:10:31.002 --> 00:10:33.002 That's different from when someone, for example, 00:10:33.002 --> 00:10:35.722 could express or does that by screaming. 00:10:35.722 --> 00:10:37.462 It will certainly be noticed and 00:10:37.462 --> 00:10:38.942 there will certainly be a reaction to it. 00:10:38.942 --> 00:10:41.802 But if these are very subtle signs 00:10:41.802 --> 00:10:46.382 that require the person to be very close, 00:10:46.850 --> 00:10:47.870 then it can happen 00:10:47.870 --> 00:10:50.610 that there isn't always a consistent response to it, 00:10:50.610 --> 00:10:51.310 but that 00:10:51.310 --> 00:10:53.310 on one day, the employee is there, 00:10:53.310 --> 00:10:55.750 who is very close to the situation and perceives everything accurately 00:10:55.750 --> 00:10:57.950 and then also creates exactly the conditions 00:10:57,950 that the person needs, or 00:10:59,510 responds to them and makes appropriate changes 00:11:02.610 --> 00:11:06.390 or even offers communication. 00:11:06.390 --> 00:11:08.250 On another day, there may be someone there who 00:11:08.250 --> 00:11:12.810 who is less efficient or less attentive 00:11:12.810 --> 00:11:15.090 and then the signals go unheeded. 00:11:15.650 --> 00:11:16.410 And that means 00:11:16.410 --> 00:11:19.830 that it's much more difficult for these people 00:11:19.830 --> 00:11:23.470 even what you know, 00:11:23.470 --> 00:11:27.350 in other words, contingency, or contingency expectations, 00:11:27.350 --> 00:11:33.330 in other words, building expectations about self-efficacy, 00:11:33.330 --> 00:11:36.050 which is then the basis, 00:11:36.050 --> 00:11:38.290 building expectations about self-efficacy, 00:11:38.290 --> 00:11:40.510 which is the basis for intentional behavior, 00:11:40.510 --> 00:11:43.590 that this basis 00:11:43.938 --> 00:11:45.938 is more difficult to establish, so to speak, 00:11:45.938 --> 00:11:51.858 because it is based on consistent responses. 00:11:51.858 --> 00:11:53.538 So that the child repeats or 00:11:53.538 --> 00:11:56.438 the person repeats the experience, 00:11:56.438 --> 00:11:59.018 aha, this follows that. 00: 11:59.018 --> 00:12:01.738 And because the signals are so subtle, 00:12:01.738 --> 00:12:03.738 it more or less works. 00:12:03.738 --> 00:12:07.498 And they already have a difficult basis, so to speak, 00:12:07.498 --> 00:12:09.738 for building up these expectations. 00:12:12.034 --> 00:12:12.794 The other thing is 00:12:12.794 --> 00:12:14.909 that the signals 00:12:14.924 --> 00:12:18.394 can be misinterpreted more quickly. 00:12:18.394 --> 00:12:20.754 So there are also examples 00:12:20.754 --> 00:12:21.754 so I'm also referring to 00:12:21.754 --> 00:12:22.534 I learned a lot there 00:12:22.534 --> 00:12:24.414 from Flasskamp's books, 00:12:24.414 --> 00:12:29.854 that, for example, a smile does not always mean 00:12:29.854 --> 00:12:30.954 that someone is happy, 00:12:30.954 --> 00:12:32.254 but that a smile can also mean 00:12:32.254 --> 00:12:33.054 I'm in pain. 00:12:33.054 --> 00:12:35.294 So I had an example myself, 00:12:35.294 --> 00:12:38.774 again with children in the area, 00:12:38.774 --> 00:12:39.534 but it doesn't really matter, 00:12:39.534 --> 00:12:41.094 it could just as easily be adults, 00:12:41.634 --> 00:12:47.014 that the person in personal care often smiled 00:12:47.014 --> 00:12:50.114 or laughed and ultimately found out that 00:12:50.114 --> 00:12:51.794 she had a hip dislocation and that 00:12:51.794 --> 00:12:53.274 just caused her pain. 00:12:53.274 --> 00:12:54.754 And those are just the kinds of things 00:12:54.754 --> 00:12:57.594 that, of course, she also laughed, 00:12:57.594 --> 00:12:58.374 when she was feeling well, 00:12:58.374 --> 00:12:59.954 but then the laughter or 00:12:59.954 --> 00:13:01.754 smile looked a little different. 00:13:01.754 --> 00:13:05.654 And if someone doesn't know her that well 00:13:05.654 --> 00:13:07.434 or isn't informed about it, 00:13:07.746 --> 00:13:09.906 then of course you make completely different offers. 00:13:09.906 --> 00:13:11.526 So normally it's just a smile 00:13:11.526 --> 00:13:13.246 an invitation to do more of that 00:13:13.246 --> 00:13:15.486 or I'm enjoying myself 00:13:15.486 --> 00:13:17.846 and then you get in or 00:13:17.846 --> 00:13:21.146 maybe move around or whatever. 00:13:21.146 --> 00:13:24.226 And it's not, so to speak, 00:13:24.226 --> 00:13:29.226 a response to the sign 00:13:29.226 --> 00:13:31.526 that is appropriate. 00:13:31.526 --> 00:13:33.946 Or that doesn't fit then. 00:13:33.946 --> 00:13:36.526 Which, so to speak, is a 00:13:37.186 --> 00:13:42.686 And there are also many behaviors 00:13:42.686 --> 00:13:44.986 that are very unusual for us, 00:13:44.986 --> 00:13:45.466 that is, 00:13:45.466 --> 00:13:48.086 that we have to adjust to first. 00:13:48.086 --> 00:13:50.206 This also includes behaviors 00:13:50.206 --> 00:13:54.406 such as screaming or self-harming behavior 00:13:54.406 --> 00:13:56.706 or aggressive behavior towards others, 00:13:56.706 --> 00:14:00.986 where you first have to ask yourself, 00:14:00.986 --> 00:14:02.226 where you don't know exactly, okay, 00:14:02.226 --> 00:14:05.586 is it an epileptic seizure or is it 00:14:05.890 --> 00:14:07.490 a deliberate action, so to speak, 00:14:07.490 --> 00:14:09.010 so you have questions like, 00:14:09.010 --> 00:14:10.170 how should one classify it, 00:14:10.170 --> 00:14:12.410 that we lack the concepts 00:14:12.410 --> 00:14:14.030 to classify certain behavior. 00:14:14.030 --> 00:14:15.970 And that also has the consequence 00:14:15.970 --> 00:14:18.890 that many uncertainties arise, 00:14:18.890 --> 00:14:21.490 on the part of the caregivers. 00:14:21,490 - -> 00:14:23,250 One uncertainty, for example, is 00:14:23.250 --> 00:14:24.350 that you say, 00:14:24.350 --> 00:14:25.690 okay, I can't know for sure 00:14:25.690 --> 00:14:27.230 what this sign means. 00:14:27.230 --> 00:14:29.890 How am I supposed to attribute meanings to it? 00:14:29.890 --> 00:14:32.950 And that it's then more likely not to be done. 00:14:32.950 --> 00:14:37.598 And then there's no development, so to speak, 00:14:37.598 --> 00:14:39.238 but that it's important 00:14:39.238 --> 00:14:40.998 to proceed in a hypothesis-driven manner, 00:14:40.998 --> 00:14:44.578 to exchange ideas about it and to say, 00:14:44.578 --> 00:14:48.358 okay, always in this context you see this and that behavior, 00:14:48.358 --> 00:14:50.738 that could mean this and that, and then you agree, 00:14:50.738 --> 00:14:53.058 okay, we'll go this way for a while 00:14:53.058 --> 00:14:54.938 and then just see 00:14:54.938 --> 00:14:57.278 if anything changes or if, so to speak, 00:14:57.278 --> 00:14:58.438 that it's confirmed. 00:14:58.438 --> 00:15:00.138 And actually, it's always a search for 00:15:00.610 --> 00:15:01.690 how to proceed. 00:15:01.690 --> 00:15:03.170 And that's also a process 00:15:03.170 --> 00:15:05.390 where the environment also has to get involved, 00:15:05.390 --> 00:15:06.710 to these uncertainties, 00:15:06.710 --> 00:15:08.970 but then still not to say, 00:15:08.970 --> 00:15:10.270 not to start at all, 00:15:10.270 --> 00:15:11.930 but to start anyway. 00:15:11.930 --> 00:15:16.130 And that's what I think, 00:15:16.130 --> 00:15:19.010 that there is a lot of potential 00:15:19.010 --> 00:15:23.610 could still be exploited, so to speak, 00:15:23.610 --> 00:15:26.710 if we just got started. 00:15:26.710 --> 00:15:29.610 Or also that some people 00:15:30.498 --> 00:15:32.318 with the profound intellectual and multiple disabilities, 00:15:32.318 --> 00:15:34.858 that a routine develops, 00:15:34.858 --> 00:15:36.918 that the same offers are always made, 00:15:36.918 --> 00:15:39.798 that it is no longer questioned. 00:15:39.798 --> 00:15:40.578 So that's another example 00:15:40.578 --> 00:15:41.778 of something like basal stimulation, 00:15:41.778 --> 00:15:45.338 ten years of basal stimulation at school and yes, 00:15:45. 338 --> 00:15:46.738 what are the development prospects, 00:15:46.738 --> 00:15:47.858 where is it actually going, 00:15:47.858 --> 00:15:49.578 that this is not questioned at all 00:15:49.578 --> 00:15:51.978 and that also has something to do with the fact 00:15:51.978 --> 00:15:55.258 that it's difficult to recognize, 00:15:55.258 --> 00:15:58.554 but also with making the effort 00:15:58.554 --> 00:15:59.774 perhaps systematically, 00:15:59.774 --> 00:16:01.854 just as I described earlier with music, 00:16:01.854 --> 00:16:04.734 systematically over several weeks 00:16:04.734 --> 00:16:06.974 to try out different offers 00: 16:06.974 --> 00:16:10.834 and to look more closely, 00:16:10.834 --> 00:16:12.234 to look even more closely, 00:16:12.234 --> 00:16:14.514 in order to perceive these small differences 00:16:14.514 --> 00:16:15.754 in behavior, 00:16:15.754 --> 00:16:18.434 which may then express preferences or aversions 00:16:18.434 --> 00:16:21.974 or recognition or orientation.