AAC CASE STUDIES:
CHALLENGING CASES, POSITIVE OUTCOMES
Presenter(s)
Molly Doyle
CART —
7601
F. Imperial Hwy
Downey CA 90242
Day Phone: 562—401—6800
Email: mdoyle@ladhs.org
Presenter
#2
Stephanie Boles
CART —
7601
F. Imperial Hwy
Downey CA 90242
Day Phone: 562—401—6800
Email:
sboles@ladhs.org
Presenter
#3
Barbara
Phillips
CART
—
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.
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.
Go to previous article
Go to next article
Return to 2006 Table of Contents