2001 Conference Proceedings
Go to previous article
Go to next article
Return to 2001 Table of Contents
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
Go to previous article
Go to next article
Return to 2001 Table of Contents
Return to Table of
Proceedings
Reprinted with author(s) permission. Author(s) retain copyright.