THE WIZARD AND THE MAGIC OF ASSISTIVE TECHNOLOGY WASHINGTON SPEECH-LANGUAGE-HEARING ASSOCIATION (WSLHA) ANNUAL CONFERENCE 2015

Wendy Woods, MA, CCC-SLP

DISCLOSURES

• I have no financial or non-financial arrangement or affiliation with a commercial interest as defined by the ACCME.

OBJECTIVES

• 1) Identify at least two forms of assistive technology that will allow an individual to maintain independence.

• 2) Describe the benefits of providing an interdisciplinary approach to care when working with assistive technology.

• 3) Advance knowledge across disciplines on available and emerging technology to improve function, safety, and independence for those with ALS and other neurodegenerative diseases.

DEFINITION OF ASSISTIVE TECHNOLOGY Any item, piece of equipment, or product system, whether acquired commercially, modified, or customized, that is used to increase, maintain, or improve functional capabilities of individuals with disabilities.

Assistive Technology Act of 2004 (Public Law 108-364, H.R. 4278), updated from 1998.

INTERDISCIPLINARY/COLLABORATIVE APPROACH: •Reduces gaps and/or redundancies in care

•Improves Veteran and caregiver’s perception of support provided

•Increases knowledge of and implementation of interventions across disciplines

•Optimize utilization and streamline function

CORE MEMBERS OF INTERDISCIPLINARY AT TEAM Occupational Therapist

Physical Therapist

Speech-Language Pathologist

Recreational Therapy

Vocational Rehab

AT CONSULTS

Occupational Therapy

•Electronic Aids for Daily

Living (EADL’s)

•Computer Access

•Environmental Controls

•Power Mobility/Seating

•Home Access/Safety

•Adaptive Driving/Vehicle Accessibility

•Cognitive Devices

Physical Therapy

•Gait Aids

•Transfer Training/Aids

•Mobility Assessment

•Seating/Positioning

•Exercise Programs

•Mobility Dog Prescription

Speech Pathology

•Assessment of swallow function

•Assessment of cognitive & communication deficits

•Prescription of no tech, low tech, high tech AAC and cognitive aids, and swallowing interventions

•Computer access

ASSISTIVE TECHNOLOGY IN ACTION

HAAT MODEL: HUMAN ACTIVITY ASSISTIVE TECHNOLOGY Assistive

Technology

Human

Activity

Human

Activity

Assistive

Tehcnology

Considers the patient within a given context, using AT to gain access, complete an activity and/or facilitate performance

“THERE IS A LOT OF DISCUSSION IN OUR FIELD ABOUT RATE OF COMMUNICATION. GUESS WHAT? IF YOUR PATIENT CAN’T STAND THEIR DEVICE, THE COMMUNICATION RATE WILL BE 0%” –WENDY WOODS, MA CCC-SLP

=expensive

paperweight

OUTCOME MEASURES

Allows us to track success with individual patients and device/applications. Data is tracked locally within our medical center through CPRS templates with established health factors, as well as comparison through a national data database

QUEBEC USER EVALUATION OF SATISFACTION WITH ASSISTIVE TECHNOLOGY- QUEST

Device Characteristics

•Dimension

•Weight

•Adjustability

•Safety

•Durability

•Simplicity of use

•Comfort

•Effectiveness

Service Provided

•Service and delivery

•Repairs and service of the device

•Professionalism of service

•Follow-up services

12 item instrument to assess the satisfaction with a specific assistive device

ASHA NOMS

American Speech-Language Hearing Association National Outcomes Measurement System – tracking 8 areas:

• Attention

• Memory

• Motor speech

• Reading

• Spoken language comprehension

• Spoken language expression

• Swallowing

• Writing

FUNCTIONAL DECLINE FACTORS IN ALS •Decreased UE/LE strength, coordination, ROM

•Neck and Trunk weakness

•Impaired mobility

•Communication impairment

•Swallowing impairment

•Weight loss

•Respiratory impairment

•Cognitive Impairment

•Spasticity/Flaccidity

TECHNOLOGY CONSIDERATIONS FOR ALS

•Most practical access method; need for adaptation as disease progresses

•Keeping up with rapid decline

•Cognition/learning potential

•Willingness to adapt to technology

•Prior experience using technology

•Caregiver supports

•Prognosis- timeline

•Prognosis- predicting areas of functional decline including familiarity with different types or variants of ALS.

TECHNOLOGY CONSIDERATIONS FOR ALS • A common clinical tool for functional measures of person(s) with ALS (PALS) is the ALS Functional

Rating Scale (ALSFRS) This scale has several domains including speech, swallowing, respiratory status, and performance of ADLs (Center for Outcomes Research, University of Massachusetts Medical School).

• Clinical Pathways for speech and swallowing (2002, Duke University Medical Center)

• Bulbar (brainstem or upper motor neurons), spinal cord (lower motor neurons) and mixed (bulbar & spinal cord) are different ways to categorize the types of ALS.

• Continuum of cognitive dysfunction in ALS, ranging from mild cognitive impairment to a progressive dementia of the frontotemporal type (FTD) (in ~3-5% of PALS). Bulbar ALS includes a greater risk for development of cognitive impairment (Strong et al., 2003; Abrahams et al., 2004).

• Bulbar ALS can result in rapid deterioration of speech and swallowing functions. Motor impairments are usually less extensive until much later in the disease process, thus PALS are usually able to control direct selection AAC and computer access technologies using their hands or fingers.

• Spinal ALS is a form of ALS, which refers to predominant involvement of the spine. These individuals may retain normal or mildly dysarthric speech for a considerable period of time, even as they experience extensive motor impairments in their trunks and limbs. For these individuals, the need for environmental controls , computer access and an augmented writing system often precedes the need for a conversational system.

MEET THE WIZARD

Diagnosed with ALS (Brachial Amyotrophic Diplegia variant) in April 2013; established care with our multidisciplinary ALS clinic summer 2014.

Given his prognosis/symptoms, areas of need included: computer access, voice-banking, environmental controls, home modification, seating, adaptive feeding equipment, and transportation.

Demonstrated a high level of personal and professional familiarity and interest in technology (strong preference to stay with a Mac (iOS) system)

Expressed interest in using his unique background in science and technology to explore adaptive equipment and help others with similar diagnoses.

THE WIZARD-VIDEO

IT TAKES A VILLAGE

• Medical Team

• Nursing

• Program Coordinators

• Speech-Language Pathologists

• Physical Therapy

• Occupational Therapy

• Recreational Therapy

• Respiratory Therapy

• Nutrition

• Home Health

• Social Work

• Psychology

• Prosthetics

• Contractors

• Vendors

• Patient Advocates

A SPECIAL THANK YOU TO WSLHA

REFERENCES/RESOURCES

• Beukelman, D.R., & Mirenda, P. (2013). Augmentative and alternative communication: Supporting children and adults with complex communication needs (4th ed.). Baltimore: Paul H. Brookes Publishing Co.

• SLP and Patient Clinical Pathways for Communication and Swallowing Associated with ALS © 2002, Duke University Medical Center (Trautman, Vess, Caves, DeRuyter) http://aac-rerc.psu.edu/index-40110.php.html

• Schlosser, R. W. (2004, June 22). Evidence-Based Practice in AAC. The ASHA Leader

• Creating a Life Legacy. Can help your patients preserve written/spoken/video “legacy” . Works well with “participation model” in AAC: http://www.fvfiles.com/521157.pdf

ADDITIONAL RESOURCES -Neuroswitch (Control Bionics): www.controlbionics.com

- TobiiDynavox: www.tobiidynavox.com (incl. I-15, I-12, T-10)

-Eye Gaze Edge: www.eyegaze.com

-Bluetooth mouse emulation (enables you to use the joystick on certain power wheelchairs as a mouse-works well for windows systems/tablets. Mac module available for additional cost.

-BIGtrack trackball switch: www.infogrip.com

-Traxsys Roller Plus Joystick: www.assist-it.org.uk

-Megabee low tech eye gaze board :

http://www.acciinc.com/megabee-eye-gaze-communication-device/

-Apple and windows existing accessibility features (always improving)

-iPads with communication apps (verbally/proloquo 4 text)

-Dragon Naturally Speaking: www.nuance.com

-The Meal Buddy: www.pattersonmedical.com

QUESTIONS & COMMENTS Feel free to contact me at: wendy.woods3@va.gov