2006 Conference General Sessions

AAC CASE STUDIES: CHALLENGING CASES, POSITIVE OUTCOMES

 

 

Presenter(s)
Molly Doyle
CART — Rancho Los Amigos National Rehab Center Street

7601 F. Imperial Hwy
Downey CA 90242
Day Phone: 562—401—6800
Email: mdoyle@ladhs.org

Presenter #2
Stephanie Boles
CART — Rancho Los Amigos National Rehab Center Street

7601 F. Imperial Hwy
Downey CA 90242
Day Phone: 562—401—6800

Email: sboles@ladhs.org

 

Presenter #3

Barbara Phillips

CART — Rancho Los Amigos National Rehab Center Street

7601 F. Imperial Hwy
Downey CA 90242
Day Phone: 562—401—6800

Fax: 562-803-8892

Email: Bphillips@ladhs.org

An interdisciplinary team will review assessment, recommendations and intervention for several adults with various medical conditions (e.g. brain injury, stroke, ALS) who required AAC.

Introduction
Center for Applied Rehabilitation Technology (CART) at Rancho Los Amigos National Rehabilitation Center enables individuals with physical disabilities to lead more independent lives through the use of assistive technology. CART’s interdisciplinary team provides a full range of services including evaluation, recommendations equipment set up and instruction. Many individuals seen at CART are unable to rely on their speech as a primary means of communication. A proper assessment determines the types of communication approaches that best match a client’s needs, skills and goals. The approaches available range include unaided (e.g. gestures, sign), low technology (e.g. picture communication boards) and high technology (e.g. voice output communication devices). Typically clients use a combination of approaches depending on the severity of their speech, who they communicate with, where and the content of communication.

AAC Evaluation: Purpose and Benefit
In addition to a communication disability, clients referred to CART usually have a physical disability that affects both mobility and physical access. These areas need to be evaluated because they directly influence the types of devices you may trial and the final recommendation. The CART uses an interdisciplinary team approach to augmentative and alternative communication (AAC) evaluation and intervention. This team includes a speech language pathologist, occupational therapist, physical therapist and a technology specialist. The role of the speech pathologist is to evaluate cognition, language and literacy as it relates to using A/-\C strategies. The occupational therapist (OT) evaluates motor control and vision. These results determine how the client will access a communication system (e.g. pointing with his hand, using a switch) and how to configure the system (e.g. size and location of cells, positioning of display) in order to give the client efficient access to the symbols or messages he needs to communicate. Proper positioning in the wheelchair is always obtained prior to conducting an access evaluation. How a person is positioned influences how they move their body. Once properly (and comfortably) seated the client may have several reliable access sites to access a communication system. Without proper eating, access to the communication device, such as pointing with the hand or pressing a switch, may be difficult, fatiguing and even frustrating to the point where the client may decide not to pursue a communication system. This would be avoided with a proper assessment. Another member of the team is the technology specialist. At CART, the technology specialist, provides technical support to the therapists and clients and helps ensure all recommended equipment is compatible. He plays a critical role In AAC set up, delivery and instruction.

Another critical component of the evaluation is determining the client’s needs, goals and preferences. The team also determines the client’s past experience and comfort level with technology. These results along with findings from the clinical assessment (i.e. speech, OT, PT as described above) determine the features a client needs in an AAC system. Once features are delineated, devices with these features are provided for trial. The number of devices provided for trial and the length of the trial depends upon assessment results and the needs and goals of the client. In some cases a device is recommended after one evaluation session; in other cases a client may borrow a device for a few weeks in order to see how useful the device is at home or work. Clients receive instruction before a device is loaned. After the trial period a permanent recommendation is made. Once the client receives the device he may return for several sessions for set up and instruction. Communication goals and expectations, along with the approximate number of instructional sessions required to meet these goals is usually established during the first session. After the last instructional session the client and family are encouraged to contact CART for follow-up should their skills or needs change. During follow-up the AAC system is adjusted to accommodate these changes. It is not uncommon for the CART team to follow clients for several years, making adjustments and changes to their AAC system as they progress through school, obtain work and become more independent in the community.

Case Examples
Although the AAC evaluation and system selection process appears to be straightforward, in reality it can be challenging because each client has unique issues and needs. It is critical that assessment and intervention focus on the individual and identifying appropriate AAC approaches that matches his skills, needs, and goals. Although a “perfect match or fit” (between the client and available AAC technology) is rare, it is important to first focus, on the individual and then the technology.

Several case studies will be presented that posed unique challenges for the CART team.
The team will review assessment results, unique issues or challenges, AAC recommendations, and final outcomes. The case examples will include adult clients with various medical conditions, including brain injury, stroke, and amyotrophic lateral sclerosis. Audience participation will be encouraged.


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