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Presenter(s)
Kimberly Bond Thompson, MS, OTR/L, ATP
Enable
1603 Court Street
Syaracuse, NY 13208
(315) 455-7591 x247
Sue Ellen Maxfield, M.S., CCC-SLP
Enable
1603 Court Street
Syaracuse, NY 13208
(315) 455-7591 x250
When a person with a disability faces a challenging activity, the need for assistive technology may arise in order to facilitate independence. This is never more evident than with a fundamental skill such as communication.
There are many models that exist for the discussion of the Assistive Technology assessment process including the SETT, HAAT and HETI frameworks. They express how the pieces come together, but do not express how to practically apply them to the assessment process. Studies have shown that in order for a successful match to be made and to preclude abandonment of a device, the individual needs to be intimately involved in the procurement and training process and long-term needs must be identified.
Enable, a not-for profit agency whose mission is to provide individualized services for individuals with disabilities, located in Syracuse, NY has been completing Augmentative and Alternative Communication (AAC) evaluations for over 10 years. Over this time, a thorough assessment process has been developed which has been assisting over 17 local counties and their residents with their communication needs.
Anyone who has attempted to purchase Assistive Technology knows that the process is often lengthy. To come to the end of it all and be dissatisfied is quite disheartening. Therefore, emphasis at Enable has been placed on achieving optimal match from the beginning of the process. Through a combination of the many frameworks as well as direct application of clinical reasoning and an understanding of the decision tree for AAC technology to the context and the individual, a successful match can be made for purchasing a speech-generating device.
The AAC decision tree is a comprehensive model which takes into account all of the attributes of the devices under consideration as well as the skills and needs of the individual and the context(s) for communication. From an individual standpoint, cognition (including literacy skills), visual/perceptual skills, neuromuscular status, progress to date and disability prognosis are at the forefront. Contextually, support systems in place, environments for use and probable communication partners need to be identified. The AAC devices under consideration then need to be looked at for possible access methods, type of speech produced (digitized vs. synthesized,) display type, size and portability, color and size of possible symbol types, as well as the ability to produce text to speech or utilize word prediction capabilities.
Once these areas are identified, the starting point on the decision tree is located. From there, a creative, motivating evaluation needs to be completed in order to establish success or failures with devices and to continue to rule out device options as well as to further clarify expectations. At any juncture in the decision making process, the evaluators will find themselves at the periphery of the "tree." Based on the data collected to that point, a natural jump may be made to a different pathway and the process continued. Eventually, a natural end will follow. From this end, however, additional questions need to be answered before a purchase can be recommended. The performance of the individual during the evaluation is but a snapshot of his or her potential. Based on this potential, a plan can be formulated to promote ultimate success with the SGD across all environments.
The AAC evaluation process can sometimes seem daunting. In order to help make appropriate selections, an evaluator will look to the needs of the individual, which are often complicated, but provide the starting point for selection. From there, a myriad of manufacturers all claim that their technology will meet every individual's needs. To simply choose from a catalogue is challenging and often does not lead to successful implementation of technology. By identifying the skills and specific attributes of each unique individual and pairing them with the specific device that meets those needs, a successful evaluation can be completed.
Thus, a solid basis for justification for the device is established.
References
Cook, A. M. & Hussey, S. M. (2002). Assistive Technologies: Principles and Practice. (2nd ed.). St. Louis: Mosby, Inc.
Phillips, B. & Hongxin, Z. (1993) Predictors of Assistive Technology Abandonment. AT Journal. (Vol 5.1) RESNA Press.
Scherer, M. & Weilandt, T. (Aug 2004). Reducing AT abandonemtn: Proposed priciples for AT selection and recommendation. [On-line]. Available:
http://e-bility.com/articles/at_selection.shtml
Reimer-Reiss, M.L & Wacker, R.R. (2000, July-September). Factors Associated with Assistive Technology Discontinuance Among Individuals with Disabilities. Journal of Rehabilitation.
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