Our Evaluation Plan for “T”

1. Our Evaluation Plan for “T” Kristen Eklund & Jolene Hyppa Martin

2. Our Evaluation… ...didn’t happen!

3. Instead of telling you about our evaluation We are going to explain: What we learned since our case history presentation How we developed a customized evaluation for “T” Procedures/Protocols we planned to use Rationale Report

4. Case History Review • “T” • 7 year old boy • Medically fragile • Diagnoses include: • shaken baby syndrome • cerebral palsy • seizure disorder • developmental delay • cortical visual impairment • progressive neuromuscular scoliosis • spastic quadriplegia • reactive airway disease • “T” has a tracheostomy and a g-tube

5. Case History Review • IEP States: • Homebound education • Previous cheek switch use • Current communication: • Totally non-verbal • Two way eye gaze to answer yes/no questions • Development and adaptive skills stable and below a 3-6 month level • “T” does not like clinical settings or unfamiliar adults

6. Dr Mizuko, Kristen & Jolene headed to Hermantown Elementary on May 25th Informational and planning meeting School representatives: Nancy Anderson SLP Nancy Kucera DCD teacher To get more information…

7. What we learned at the meeting: • Cognitive Status: • Both teachers feel that “T” is much higher functioning than his IEP states • Cognitive testing that labeled him as functioning at a “3-6 month level” was not done in person • SLP has witnessed : • requesting, protesting, greeting, providing information, showing interest, playing, showing affection, seeking approval, socializing, agreeing, disagreeing, showing disinterest, and showing that he doesn’t know • “T” explained he didn’t know by using a back and forth eye gaze • “T” protested by closing his eyes and refusing to open them

8. What we learned at the meeting: • Motivating factors: • Wants to “get words” and is excited about the evaluation • Likes Blue’s Clues, books, computers • Recently turned 24 pages of a talking book when OT held a switch by his cheek • Limiting factors: • “T” will not tolerate having his face or eye glasses touched • Can withstand about one hour of assessment/intervention before fatiguing • Can produce about 8-9 consecutive yes/no eye gaze responses before fatiguing • Previous switch use reportedly failed because “T” was absent often and fatigued quickly in school • Limited arm movement • Very serious and kind personality • Doesn’t like joking much & is not motivated by “beating” his aids at games. Rather, he appears to feel bad for them when they lose.

9. What we learned at the meeting: • Educational status: • 90% accuracy in naming colors • Not as good with shapes • Doesn’t know letters or numbers • Vision: • Cannot follow fast moving objects • Photographs are preferred to symbols • Unsure how much his glasses help him, willing to try calibration without them • Peripheral visual field is preferred

10. What we learned at the meeting: • Both teachers agreed that a “T” needs a communication system that he can use sitting up or lying down • Both teachers believe that “T” will learn to use a communication system “quickly” • Neither teacher knows if “T” is able to gaze in more than two directions • Many people are very excited about “T’s” evaluation at UMD! It will be attended by: • Social worker • DCD teacher • School SLP • Foster parents • Vision consultant • Tribal council representative (possibly) • Our classmates • Us • Our professor • And, of course, the STAR of the show, “T”

11. Our Goals After the meeting, we reviewed what we learned & developed these assessment goals: • To determine if T’s current use of two way eye gaze and current reported understanding of colors can be expanded upon to develop a broader and more effective communication system for immediate implementation. • To determine the best means of providing T greater control of his environment. • To determine if T is a candidate for immediate or future use of the ERICA system. • To develop a comprehensive communication system that T can use to communicate as quickly and efficiently as possible with a variety of people (unfamiliar and familiar), in a number of settings, in all positions (sitting or lying down), that will permit functional, educational, and social communicative interaction.

12. The setting • We adapted the evaluation room setting to make it seem more like a play room and less like a clinic • Switched observation and evaluation rooms to accommodate larger crowd • Had a variety of stimulus items ready to go so we could change our protocol online in the event that “T” wasn’t responding to some stimuli • Since you didn’t see the room in action, we have a short video clip

13. Our Evaluation ProceduresPart 1 • Determine “T’s” two way eye gaze reliability in answering yes/no and binary choice questions. • In the hopes of expanding T’s response repertoire, tasks to assess his potential to use three and four way eye gaze were developed and were constructed to indirectly evaluate his knowledge of colors, shapes, body parts and the concepts “same” and “different.” • Rationale: • Provide information about “T’s” current abilities • Suggest ways to quickly expand his current response repertoire • Help us to develop a broader communication system for immediate use

14. Our Evaluation ProceduresPart 2 • Assess T’s ability to use a switch • Switch choices: • Jelly bean • Cheek • credit card • Stimulus choices: • Two Customized talking Books • mechanical animal • cassette player with music • Video cassette player with a children’s video • Rationale: • Tasks were developed to determine “T’s” and Mom’s switch preferences • Suggest which body part might be most effective for switch use • Suggest “T’s” understanding of cause and effect • Suggest “T’s” potential to increase communication and exercise environmental control through switch use

15. Our Evaluation ProceduresPart 3 • Assess ability to use the ERICA system • Customized ERICA to compensate vision impairment, his attention span, and his interests • Developed a simple ERICA-based assessment tool to evaluate ability to control a computer cursor using two- and three-way eye gaze • Rationale: • Results would suggest information about “T’s” potential for being a current and/or future ERICA user

16. Our Evaluation Procedures • Because we still weren’t entirely clear on what to expect from this client, we designed most protocols with a double hierarchy • Allowed us to lower or raise our expectations “on the fly” to get as much information as possible in as little time as possible • For example, during eye gaze protocol: • Look at the one on the top • Correct response • Look at the ones that are the same • Look at the one that is different • Incorrect response • Look at up at the pink circle • Look here (point to pink circle) • Look up (switch to object and use it to direct upward gaze)

17. Our Evaluation Procedures • Parent interview • We used a list of questions from the Augmentative and Alternative Communication Assessment Protocol (Super Duper, 1998). • To work around client’s fatigue level, we elected to leave the parent interview for the end of the assessment. • Parent/child interaction • Video tape • Observation throughout session

18. Our Report • Daily Communication Needs • System needs to enable • Discussion of medical needs • Educational communication • Initiation of feelings and ideas • Environmental control • Social development • System needs to accommodate • Motor abilities • Visual abilities • Positioning requirements

19. Our Report • Summary • “T’s” evaluation was cancelled twice and not able to be rescheduled due to ongoing health concerns • “T’s” mother would like to have him assessed next Fall • “T’s” mother and SLP instructed to contact RFP Clinic or Dr Mizuko to reschedule

20. Our Report • Recommendations • “T” would benefit from ongoing intermittent augmentative and alternative communication assessments that are designed to maximize current communication function, increase communication repertoire, and adapt to changes in his development and life situation. • Recommended assessment areas include: • Assessing eye gaze • Two-, Three-, and Four-way • Assessing switch use • Type of switch • Type of initial stimuli • Assessing ERICA system use

21. Questions? Comments?