2001 Conference Proceedings

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INTERDISCIPLINARY TEAM APPROACH TO AAC ASSESSMENT AND INTERVENTION

Carlene MacBride, MA CCC
Speech Pathologist
Las Floristas Center For Applied Rehabilitation Technology
at Rancho Los Amigos National Rehabilitation Center

Bruce Fleming, BMSE ATP
Rehabilitation Engineer btfleming@dhs.co.la.ca.us 
Las Floristas Center For Applied Rehabilitation Technology
at Rancho Los Amigos National Rehabilitation

Bobbi Jean Tanberg, COTA
Occupational Therapy Assistant
Las Floristas Center For Applied Rehabilitation Technology
at Rancho Los Amigos National Rehabilitation

ABSTRACT

We will present several case studies that highlight the roles of interdisciplinary team members in setting up and promoting independent AAC use.

SUMMARY

Candidates for augmentative and alternative communication (AAC) often benefit from services provided by an interdisciplinary team. Each team member has expertise that helps determine an optimal system of hardware, software, and strategies required to promote independent communication. The client and family are integral members of the team. The types of professionals on the team may vary depending upon the location of the AAC program and the types of clients it serves. For example, an AAC program within a school may include a teacher on its team, whereas a community-based program serving adults with vocational needs may include an assistive technology specialist. For programs serving adults with physical disabilities, teams should include, at a minimum, a speech pathologist (SLP), occupational therapist (OT), physical therapist (PT) and rehabilitation engineer. This group is instrumental through all phases of the service delivery process. Specific duties for each professional may vary from program to program. In many cases, teams function in a transdisciplinary (versus interdisciplinary) fashion. For instance, during an assessment at CART, the PT will address the client’s position for comfort and function while the OT will evaluate access. At the same time, the rehabilitation engineer considers electronic integration and compatibility and mounting issues, while the speech pathologist obtains preliminary information on cognition and language. During device delivery, the rehabilitation engineer mounts all equipment and provides technical support to therapists for device set-up. The OT assistant designs communication overlays and programs devices, consulting with the speech pathologist or OT regarding cognitive or access issues that may influence design or set-up. The OT assistant and speech pathologist provide clients and families with instruction in device usage as well as strategies to maximize use. Depending upon the device being used, the rehabilitation engineer, speech pathologist or OT assistant will provide technical support and follow-up.

Team Member Roles Through Case Studies

Each team member will discuss his or her role in promoting independent AAC use through a discussion of case studies. Four to five case studies will be presented. The following is one example.

Bob is a 35 year old man with cerebral palsy, who uses a wheelchair for mobility. He was referred to an assistive technology center for augmentative communication and computer access evaluations. Bob consulted with the team for assistance in replacing his LightTalker (Prentke Romich Co.) communication device, which he operated with an Optical Headpointer (OH). Bob has used the LightTalker for nearly 8 years. The device frequently malfunctioned and the technology is now outdated. Bob relies on spelling and occasionally stored messages to convey his needs. Trials with Unity were provided. Bob had more success with a standard text-based keyboard and preferred text in conjunction with word prediction to generate novel messages. In terms of physical access, the OH was very efficient, however the OH itself interfered with driving the power chair with headrest mounted switches. The optimal position of the OH was on the right side of the head, which was the same location as 1 of the switches used to control the chair. Of course, Bob needed independent mobility as well as independent access to a communication system. Trials with head-controlled mouse systems were provided.

The two leading head-controlled mouse systems (Madentec’s Tracker2000, and Origin Instrument’s HeadMouse) were configured for Bob to test for comparison on desktop computers (which simulate laptop- and tablet-based integrated AAC/computing systems) and a dynamic-display (DynaVox 3100, Vanguard) AAC device. This final testing session helped the team validate their predictions and concerns with Bob participating and making the final choices. For example, while the Tracker2000 appeared from demonstrations and literature to have the optimal features of operation and packaging (small size, easy mounting, less parts) to fit the client’s needs for simple, portable function, the trial showed that the device had poor performance (latency or “sluggishness”) that proved physically taxing.

The HeadMouse allowed for more efficient access. Also, Bob had recently enrolled in a computer class and was using the HeadMouse for access. His familiarity with a head-mousing product through practice and experience helped Bob make a more definitive choice.

Bob and the team also noted that the HeadMouse operated better on a computer than a dedicated device, due to slower refresh rates on the dynamic-display and sub-optimal dwell selection parameters on the AAC devices. Given this insight, coupled with the fact that Bob needed computer access for his research and writing and did not have a computer, the team was considering an integrated system. An integrated system had additional benefits and was more cost effective than purchasing a dedicated device and a desk top computer. Mounting and configuring the system to meet Bob’s AAC and computing requirements is currently in the planning stages and will be discussed in depth at CSUN.

About CART

The Las Floristas Center For Applied Rehabilitation Technology at Rancho Los Amigos National Rehabilitation Center has been serving persons with disabilities of all ages for over 10 years in the greater Los Angeles, California, USA area. Assistive Technology teams address needs for seating and wheeled mobility, augmentative and alternative communication, computer access, and environmental control. For more information, call CART at (562) 401-6800, or visit our website at http://www.rancho.org/cart


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