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Assistive Technology for People with Communication Impairments. Melanie Fried-Oken, Ph.D., CCC/Sp Director, Assistive Technology Program Professor, Neurology, Biomedical Engineering, Otolaryngology & Pediatrics Oregon Health & Sciences University Portland, Oregon [email protected]

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Assistive Technology for People with Communication Impairments

Melanie Fried-Oken, Ph.D., CCC/Sp

Director, Assistive Technology Program

Professor, Neurology, Biomedical Engineering, Otolaryngology & Pediatrics

Oregon Health & Sciences University

Portland, Oregon

[email protected]


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Lecture Objectives Impairments

  • Understand the WHO International Classification of Functioning model for disability;

  • Present information on current assistive technology related to employment;

  • Describe augmentative and alternative communication equipment and practice.


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A model of illness and health Impairments

  • Need a way to describe illness or (PC) health&wellness.

  • Need a model to understand relationship between illness and interventions.


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The WHO International Classification of Functioning (ICF) model of illness

  • WHO ICIDH: International ClassificationofImpairments, Disabilities, andHandicaps

  • Developed in 1970s

  • Published first in 1980

  • revised 1995-99; now ICF


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WHO ICF Model of illness model of illness

Four Levels

Three Contexts

Organ(pathology)

Personal

Person(impairment))

Physical

Person in environment

Behavior (activities)

Social

Person in society

Social position (Participation)

Well-being


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WHO ICF model of illness

20 y.o. wm with cerebral palsy

Lesions in the basal ganglia

Organ (pathology)

Person (impairment)

Spastic dysarthria 2° cerebral palsy

Person in environment

Behavior (activities)

Reduced intelligibility

Norman talks less; he eats alone at work, he has no friends; cannot use telephone well; he does not participate in workplace activities because people don’t understand him.

Person in society

Social position (Participation)


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Introduce speech generating device model of illness

Person in environment

Behavior (activities)

Synthetic speech offers 100% intelligibility

Person in society

Social position (Participation)

Norman talks more and is really funny…he tells great jokes at lunch and has friends whom he eats with; he uses the telephone for work; now participates in workplace conversations.


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WHAT IS ASSISTIVE TECHNOLOGY? model of illness

Devices, software, tools, and services that allow people who have physical and/or cognitive limitations to do tasks that would otherwise be significantly difficult for them to do.

  • Rick Creech, Augmented speaker and Resources Coordinator, PA Department of Education


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Tech Act: model of illness

  • Technology-Related Assistance for Persons with Disabilities Act of 1998:

  • Assistive technology is “any item, piece of equipment, or product system, whether acquired commercially off the shelf, modified, or customized, that is used to increase, maintain, or improve functional capabilities of people with disabilities” [P.L. 100-407, 29 U.S.C. 2201, §3(1)].



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A Device: model of illness

  • Any item, piece of equipment, or system that increases, maintains, or improves the functional capabilities of people with disabilities.

  • A.T. devices help people function longer and better.


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A Service: model of illness

Assistive Technology without training is not assistive.

- Rick Creech, A.T. user and advocate


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We all use A.T. model of illness


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WHAT IS AAC? model of illness

Augmentative and Alternative Communication refers to any strategy, technique or tool that enhances, replaces, augments or supplements an individual’s communication capabilities.


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Speech model of illness

Vocalization

Gestures

Eye gaze

Body language

Sign language

Paper and pencil

Communication books

Communication boards and cards

Speaking computers

Talking typewriters

Voice output communication aids

Augmentative Communication Approaches


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AAC GOALS model of illness

  • Temporary means of communication

  • Lifelong means of communication

  • Means to facilitate re-development of communication


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WHO IS AN AAC USER? model of illness

Anyone whose communication is adversely affected by an impairment in speech, language, cognition, and/or physical abilities.


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“Communication competence and the control it brings insures that patients will maintain the ability to guide, direct, and influence the management of medical and personal aspects of their lives.”

Yorkston, Miller, Strand, 1996



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AN EXPRESSIVE COMMUNICATION DISORDER IN ADULTS

A PERMANENT OR TEMPORARY INABILITY TO EXPRESS ONESELF WITH GESTURAL, SPOKEN OR WRITTEN MEANS BECAUSE OF PHYSICAL, COGNITIVE, &/OR LANGUAGE IMPAIRMENTS

BEUKELMAN & GARRET, 1988


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PHYSICAL IMPAIRMENTS IN ADULTS

  • Amyotrophic Lateral Sclerosis

  • Friedrich’s Ataxia

  • Brainstem Stroke (locked in syndrome)

  • Respiratory Insufficiency (intubation/ventilator dependency)

  • Spinal Cord Injury

  • Cerebral Palsy


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PHYSICAL AND COGNITIVE IMPAIRMENTS IN ADULTS

  • Huntington’s Disease

  • Multiple Sclerosis

  • Closed Head Injury

  • Parkinson’s Disease


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LANGUAGE IMPAIRMENTS IN ADULTS

  • Aphasia (usually Broca’s, anterior, or expressive aphasia)

  • Mental retardation/developmental disability


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What is the AAC evaluation? IN ADULTS

  • Needs and environmental assessment

    • Communication partners

    • Communication locations

    • Communication modes

    • Message needs


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4 purposes of communication IN ADULTS

  • Express needs and wants

  • Information exchange

  • Social closeness

  • Social etiquette


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The AAC Evaluation cont’d IN ADULTS

  • Language abilities

    • Language comprehension

    • Language production (vocabulary, grammar, morphology)

    • Spelling and writing abilities

    • Mechanics of writing

    • Speech function

  • Speech function


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Electronic Devices IN ADULTS

  • Speech generating devices (SGDs)

    • Synthesized speech output

    • Digitized speech output

  • Computers

    • Dedicated versus integrated devices

    • Adapted keyboards

    • Touch screens

    • Track balls and joysticks


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4 components of SGD to consider: IN ADULTS

  • Processor

  • Interface or access method

  • Language system (or symbolic representation used for concepts)

  • Output


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The processor: IN ADULTSIntegrated vs. dedicated device


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Access method: IN ADULTSComputer interface


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Purpose of computer access IN ADULTS

  • Written communication (word processing)

  • Emailing

  • Vocation/employment

  • Telecommuting

  • Internet surfing

  • Telephoning


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Written communication options IN ADULTS

  • Keyboard modifications

  • On screen keyboards

    • mouse access

    • head mouse access

    • single switch access

  • Rate enhancement techniques:

    • word prediction

    • abbreviated expansions (macros)



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Keyboard labels IN ADULTS




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JOYSTICK CONTROL IN ADULTS


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Touch window IN ADULTS




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Working while locked in IN ADULTS

Brain-computer interface

Cyber link


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Morse Code IN ADULTS

  • 2 switch option



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Rate enhancement techniques IN ADULTS

  • Generating text with these techniques is

    S…L…O…W…

    Two techniques to enhance rate of production:

  • Word prediction

  • Abbreviated expansion


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Word Prediction IN ADULTS


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abbreviated expansions (macros) IN ADULTS

  • AAC = Augmentative and Alternative Communication

  • 3S = 3 spades

  • 3C = 3 clubs

  • 3H = 3 hearts

  • 3D = 3 diamonds


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Output options IN ADULTS


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Attention Getting Devices IN ADULTS

  • Bicycle horns

  • Cow Bells

  • Battery Powered Doorbell


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Ameriphone XL25s Amplified Telephone with Outgoing Amplificationproduct #: 76563.000

The XL25s™ amplified corded phone, by Clarity®, features Clarity® Power™ technology to make words not only louder, but also clearer and easier to understand. The XL25s™ provides up to 18 decibels of outgoing voice amplification, making it an ideal solution for those with low speech or a mild-to-moderate hearing loss. $99.00

Telephone Options

Available through

PUC TDAP: Telecommunication

Device Access

Program

[email protected]

TTY and

Oregon Relay System

Speakerphone with SGD (available through PUC TDAP)


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Voice Amplification Options Amplification

Microphone

attachments

ChatterVox voice amplifier

JustAMP or JusTalk

JustMED, Inc.

503-524-4223

Voicette and Mini-Vox from Luminaud


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Hard copy print out Amplification

Mayer-Johnson Writing with Symbols


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LCD screens Amplification

Saltillo Chat PC-M3

Assistive Technology, Inc LINK, Mercury


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Bluebird Amplification

MightyMo/MiniMo

Digitized Speech Devices

Macaw Family (9 +minutes)

Chat Box


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Speech Output Amplification

Synthetic speech

Dynavox VMax

PRC Pathfinder

Lightwriter SL40


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“Talking computer” Amplification

  • Next Up Talker

  • Many voices

  • Download program from Internet for $99

  • Speaks out everything written on screen

  • www.talkforme.com


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“Talking Typewriters” Amplification

DynaWrite

Lightwriter SL35

Proloquo2go


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Speech recognition Amplification

  • Dragon-Naturally Speaking

  • Must have consistent speech production

  • Mild-moderate dysarthria is adequate for controlling computer with speech input.


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Assistive Amplification

Technology

The Dilemma: What comes first? The A.T. or the job?

Employment Opportunities

The vicious cycle

Worksite

Participation

Assistive

Technology


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Who are employed AAC users? Amplification

Stephen Hawkings, physicist

Michael Williams, author and journalist

Andy Owens, Inventory specialist at Powell’s Books

India Ochs, Civil Rights Attorney


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Don’t be left in the middle of the lake without any paddles!

AAC offers you the tools to enter, continue or return to the workforce.


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