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Philip R. Lawrence
40015 Sierra Highway, Building B-145
Palmdale, CA 93550
The purpose of this paper is to explore the assistive technology needs of higher cognitive level augmented communicators, those who are literate. Additionally, we will review how EZ Keys for Windows95 computer-based AAC interventions meet more than just the communication needs of this population.
Our experience with thousands of cognitively intact AAC users over a sixteen-year period has demonstrated that given the opportunity, these users will spend greater periods of time doing things other than typing to talk. Although our experience bears this out across this population, it is particularly true for those who are literate, severely physically disabled, and who spend most of their time at home or in a similar setting with care giver support. Members of this latter segment of the non-speaking population, have a need to both communicate and productively use their time.
Let us first review the communication features of EZ Keys for Windows, and how these features meet the communication needs of the population in question.
Almost without exception, non-speaking, literate AAC users prefer text-based communication systems. Text-based AAC systems provide them with the ability to use and refine their existing literacy skills in their native language. To the extent that a person's existing language capabilities are utilized, learning times on text-based AAC systems are typically shorter than on either static or dynamic display pictographic language-based systems. The literate user simply types out the desired message and the system speaks the message. Typing maybe accomplished directly on the keyboard, or through an alternative input device, such as a switch. AAC users do not have to spend months and sometimes years learning abstract symbol sequencing strategies to quickly communicate simple, novel messages. This writer only found three literate augmented communicators out of approximately 175 individuals, over a four year period, who preferred a symbol sequencing language strategy over a text-based strategy when given the opportunity to choose the AAC system they would prefer to use.
EZ Keys for Windows95 provides the literate AAC user with several very powerful rate enhancing strategies to speed up the communication process. These are: 1) abbreviation expansion, 2) dual-word prediction, 3) Instant Phrases Tm, 4) Reader (for speaking documents), 5) input control, and 6) voice output. There is no other single software program for either Apple or Windowsbased PC platforms that provides all of these features while allowing the literate AAC user simultaneous operation of standard Windows programs. EZ Keys for Windows95, in one software program, provides the functionality of five different programs which must be launched and tied or connected together. EZ Keys for Windows95 is unique in this aspect.
Abbreviation Expansion allows the user to type a series of letters and/or characters, which then expand into a much longer word, phrase, or voice output message. Additionally, this EZ Keys for Windows95 feature allows full macro capability to launch other software programs. The same abbreviation set works across all Windows95 applications that the user is using. This rate enhancement feature is particularly effective for switch input users. We have observed that numerous users of EZ Keys for Windows95, create and use hundreds of abbreviation expansions to speak "quick needs" type of messages. One adult user with cerebral palsy had hundreds of abbreviation expansions designed to allow her to go to the mall and order her favorite food items in the food court. She also used her abbreviations to deliver "ice-breaker" messages.
Dual word prediction is a very powerful rate enhancer for all switch users and for many single finger keyboard typists. Although we do not have any scientifically collected data to offer, our observations in the field have lead us to a rule of thumb that word prediction does not generally speed up the word production rate for those who can make selections from a keyboard at the rate of one character per second or faster. There maybe, however, other strong considerations that will cause a user to use word prediction. Word prediction has been successfully used to increase overall literacy and accuracy as many people can sight recognize words that they cannot spell. Additionally, the keystroke savings that word prediction provides maybe needed to allow extended use of the system due to user fatigue issues resulting from motor skill disorders.
The visual presentation of the word prediction box (list) in EZ Keys for Window95 is such that it minimizes visual search and decision making times of the user. This is accomplished by limiting the visual word list presentation to 6 words ( it can be increased or decreased if desired), displayed alphabetically, in two groups of three words each. This results in the user being able to visually scan the entire presentation list and make the word choice or decision to type the next letter in a shorter period of time. Lastly, EZ Keys for Windows95 adds and maintains new words in its library such that certain keystroke combinations always retrieve the same word. For example, the word "that" can always be obtained by typing the letter "t" followed by the number "2", if "that" is not listed in the word prediction list on the screen. We have found that users learn these patterns for many words. This adds another dimension to rate enhancement and is only found in EZ Keys for Windows95.
David Beukelman, Ph.D., in his keynote address at the 1996 USSAAC conference, highlighted the need for preprogrammed phrases in AAC devices for middle aged, cognitively intact, adults. He further expressed his belief that this was a requirement for most augmented communicators in order to express "ice-breaker", social closeness, types of communication messages. These types of messages are predictable, and need to be delivered in a spontaneous, rapid fashion to have the desired effect of "connecting" with a communication partner. Once the social connection is made, the augmented communicator can discuss the real issues that he or she needs to discuss.
Side Talk with Instant Phrases Tm, in EZ Keys for Windows95 allows the user to create, store and speak any one of a thousand preprogrammed messages with just four key strokes. Messages are stored categorically and retrieved by using the function keys on the computer. Once created and stored, the user can retrieve and deliver the intended "ice-breaker" message rapidly, with very few key strokes. This strategy is also very effective for basic needs and wants that need to be communicated rapidly. The Side Talk screen is also used to speak novel messages with the use of word prediction. EZ Keys for Windows95 lets the user also have multiple Instant Phrase Tm files of thousands of phrases per file to cover a wide array of needs and communication environments.
Pamela Mathy, Ph.D. presented her findings of a study she conducted of adults with progressive neuromuscular diseases and motor neuron diseases relative to best practices to consider in the assessment of AAC interventions for these populations. Communication activities identified were: face-to-face conversation, quick basic needs/wants (call attention/signal emergency), detailed needs and wants, in depth information, personal stories, telephone and writing. Both study groups had 12 patients included for a total of 24. The predominant AAC method used for personal stories, in depth information and written communication were high tech AAC devices, although 6 of 12 patients with bulbar ALS chose handwriting. Additionally, the majority of these 24 patients were using textbased systems or strategies (including handwriting) to communicate (Mathy defined high tech AAC devices as dedicated, electronic voice output and/or computer-based AAC devices).
The above findings appear to collaborate our field experience that literate AAC users prefer text-based AAC strategies/systems. The findings also appear to collaborate that high tech devices are preferred for the types of communication that we spend the most time engaged in..., social closeness and information exchange.
Reader is a strategy in EZ Keys for Windows95 that provides the user with the ability to create and speak documents using any standard Windows95 word processor. This is a very easy way for the users described in the Mathy study cited above to satisfy the need for detailed information exchange and personal story telling. We have found that these types of users have significant amounts of "discretionary" time while their "significant other" is at work. The user can create a document in their word processor listing all of the things that he/she would like the "significant other" to attend to and speak this document to their partner when they come home form work. Another application might be in the case where the user has a friend that is coming to visit and the user has some lengthy communication to share with this friend...a story, or what has been going on since their last meeting. Reader can be used very effectively to meet this communication need. Lastly, Reader can be used in conjunction with Instant Phrases Tm and Side Talk Tm to enable the user to easily move from preprogrammed to novel communication, with word prediction, simultaneously combining the power of both strategies.
EZ Keys for Windows95 has an extensive array of input options for computer access. Single and double switch scanning, head pointing, Head Mouse, 1-3 switch morse code, mouse, joystick and keyboard inputs are all included in the software. Input settings can be tailored to the user's motor abilities to within .05 second incremental rate/speed adjustments. These small, incremental adjustment capabilities, allow the user to tailor the system to ensure optimal operation of the computer, minimizing fatigue and error correction.
One very significant input strategy for switch users is the Radar/Crosshair mouse emulator feature of EZ Keys for Windows95. Users have found this to be a very powerful and fun way to have full mouse capability with a single switch to access the Internet and other mouse intensive applications.
As mentioned in the beginning of this narrative, typing to talk is not the activity we have observed our literate users spending most of their time doing with their computer-based AAC devices. This population has traditionally spent more time writing than "talking" with their system. Writing can be done at the user's own pace and can be used to write letters or documents to speak. All of us need a way to productively use our discretionary time. This need is even more acute for someone who is non-speaking and who also has severe motor impairments limiting their mobility. Entertainment, additional social interaction and education are three such needs that computer-based AAC with EZ Keys for Windows95 fulfills.
Powerful, reliable, laptop Windows computers provide the literate AAC user with a world of possibilities to productively use their time. We point out that the quality of laptop computers has dramatically improved over the past several years. The laptop computer failure rate experienced by Words+ customers on units shipped in the 12 months preceding this writing has been 3.5% with no failures attributable to hard disk of the computer, the item cited by most people as the single biggest area of concern for laptop computer AAC usage. Today's computers are typically warranted for three years as well.
There are many games available that can be accessed with EZ Keys for Windows95. Not only are games entertaining, but playing them can build skill at inputting the computer for those using alternative input methods. Radar/Crosshair mouse lets switch users have full mouse emulation. Our current EZ Keys for Windows95 computer AAC system also comes with telephone software allowing the user to independently operate the telephone when the modem is connected. Paint programs are accessible to switch users. Internet applications are easily accessible to EZ Keys for Windows95 users.
The advent of the Internet provides AAC users, who are severely physically impaired, with a productive alternative to watching television to pass the time. Many of our users have become prolific "surfers" of the Internet. Social interaction can take place in chat rooms and abbreviation expansion dramatically speeds up written communication in the chat room. Web browsers let the user gain information on any topic. Users can access the Internet to shop for items they need, including groceries in some communities. E-mail is being used to communicate instantly with people anywhere in the world. E-mail is taking the place of traditional mail for many of our users. E-mail gives the EZ Keys for Windows95 user an increased level of independence relative to mailing letters.
Computer literacy is becoming a requirement for employment in many industries. Interaction with the computer is becoming a more typical aspect of everyday life. Most literate users of AAC devices have a desire and need to interact with a computer for some aspects of their daily lives. Having the computer as the "engine" of their AAC system seems to be the most logical choice for many of these AAC users. This allows multiple needs to be fulfilled in a single unit costing the same or less than the high tech dedicated AAC device. The computer-based AAC system with EZ Keys for Windows95 software lets the user communicate while satisfying other, more time consuming needs. No other single software package fulfills these user needs while providing rapid text-to-speech communication.
Beukelman, D. (1996) Keynote address, USSAAC, Purdue University,
Mathy, P. (1997) Best Practice Factors to Consider in Assessment: Adults with Progressive Neuromuscular Diseases, Motor Neuron Diseases, USSAAC August 1, 1997
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