Assistive Technology for People with Communication Impairments

1. Assistive Technology for People with Communication Impairments Melanie Fried-Oken, Ph.D., CCC/Sp Director, Assistive Technology Program Professor, Neurology, Biomedical Engineering, Otolaryngology & Pediatrics Oregon Health & Sciences University Portland, Oregon friedm@ohsu.edu

3. A model of illness and health Need a way to describe illness or (PC) health&wellness. Need a model to understand relationship between illness and interventions.

4. The WHO International Classification of Functioning (ICF) model of illness WHO ICIDH: International Classification ofImpairments, Disabilities, andHandicaps Developed in 1970s Published first in 1980 revised 1995-99; now ICF

8. WHAT IS ASSISTIVE TECHNOLOGY? Devices, software, tools, and services that allow people who have physical and/or cognitive limitations to do tasks that would otherwise be significantly difficult for them to do. Rick Creech, Augmented speaker and Resources Coordinator, PA Department of Education

9. Tech Act: Technology-Related Assistance for Persons with Disabilities Act of 1998: Assistive technology is “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of people with disabilities” [P.L. 100-407, 29 U.S.C. 2201, §3(1)].

10. A.T. is a device or a service

11. A Device: Any item, piece of equipment, or system that increases, maintains, or improves the functional capabilities of people with disabilities. A.T. devices help people function longer and better.

12. A Service: Assistive Technology without training is not assistive. - Rick Creech, A.T. user and advocate

13. We all use A.T.

14. WHAT IS AAC? Augmentative and Alternative Communication refers to any strategy, technique or tool that enhances, replaces, augments or supplements an individual’s communication capabilities.

15. Augmentative Communication Approaches Speech Vocalization Gestures Eye gaze Body language Sign language Paper and pencil Communication books Communication boards and cards Speaking computers Talking typewriters Voice output communication aids

16. AAC GOALS  Temporary means of communication Lifelong means of communication Means to facilitate re-development of communication

17. WHO IS AN AAC USER? Anyone whose communication is adversely affected by an impairment in speech, language, cognition, and/or  physical abilities.

18. “Communication competence and the control it brings insures that patients will maintain the ability to guide, direct, and influence the management of medical and personal aspects of their lives.” Yorkston, Miller, Strand, 1996

19. DIAGNOSES LEADING TO EXPRESSIVE COMMUNICATION DISABILITIES IN ADULTS

20. AN EXPRESSIVE COMMUNICATION DISORDER A PERMANENT OR TEMPORARY INABILITY TO EXPRESS ONESELF WITH GESTURAL, SPOKEN OR WRITTEN MEANS BECAUSE OF PHYSICAL, COGNITIVE, &/OR LANGUAGE IMPAIRMENTS BEUKELMAN & GARRET, 1988

21. PHYSICAL IMPAIRMENTS Amyotrophic Lateral Sclerosis Friedrich’s Ataxia Brainstem Stroke (locked in syndrome) Respiratory Insufficiency (intubation/ventilator dependency) Spinal Cord Injury Cerebral Palsy

22. PHYSICAL AND COGNITIVE IMPAIRMENTS Huntington’s Disease Multiple Sclerosis Closed Head Injury Parkinson’s Disease

23. LANGUAGE IMPAIRMENTS Aphasia (usually Broca’s, anterior, or expressive aphasia) Mental retardation/developmental disability

24. What is the AAC evaluation? Needs and environmental assessment Communication partners Communication locations Communication modes Message needs

25. 4 purposes of communication Express needs and wants Information exchange Social closeness Social etiquette

26. The AAC Evaluation cont’d Language abilities Language comprehension Language production (vocabulary, grammar, morphology) Spelling and writing abilities Mechanics of writing Speech function Speech function

27. Electronic Devices Speech generating devices (SGDs) Synthesized speech output Digitized speech output Computers Dedicated versus integrated devices Adapted keyboards Touch screens Track balls and joysticks

28. 4 components of SGD to consider: Processor Interface or access method Language system (or symbolic representation used for concepts) Output

29. The processor:Integrated vs. dedicated device

30. Access method:Computer interface

31. Purpose of computer access Written communication (word processing) Emailing Vocation/employment Telecommuting Internet surfing Telephoning

32. Written communication options Keyboard modifications On screen keyboards mouse access head mouse access single switch access Rate enhancement techniques: word prediction abbreviated expansions (macros)

33. Keyboard modifications

34. Keyboard labels

35. On screen keyboards

37. MOUSE OR TRACKBALL ACCESS

38. JOYSTICK CONTROL

39. Touch window

40. HEAD MOUSE ACCESS

41. single switch access

42. Working while locked in

43. Morse Code 2 switch option

44. Language representation: Symbol sets and systems

46. Orthography Spelling Typing Words & phrases

48. Rate enhancement techniques Generating text with these techniques is S…L…O…W… Two techniques to enhance rate of production: Word prediction Abbreviated expansion

49. Word Prediction

52. abbreviated expansions (macros) AAC = Augmentative and Alternative Communication 3S = 3 spades 3C = 3 clubs 3H = 3 hearts 3D = 3 diamonds

53. Output options

54. Attention Getting Devices Bicycle horns Cow Bells Battery Powered Doorbell

55. Telephone Options

56. Voice Amplification Options

57. Hard copy print out

58. LCD screens

59. Digitized Speech Devices State that one of the Message Mates fits into more than the 8 minute category (more than K2). State that one of the Message Mates fits into more than the 8 minute category (more than K2).

60. Speech Output Synthetic speech

61. “Talking computer” Next Up Talker Many voices Download program from Internet for $99 Speaks out everything written on screen www.talkforme.com

62. “Talking Typewriters”

63. Speech recognition Dragon-Naturally Speaking Must have consistent speech production Mild-moderate dysarthria is adequate for controlling computer with speech input.

64. The Dilemma: What comes first? The A.T. or the job? The vicious cycle

65. Who are employed AAC users?

66. Don’t be left in the middle of the lake without any paddles!