ELECTRONIC assisting technology (EAT) is a field which has been growing rapidly over recent years.
Included in this is augmented and alternative communication (AAC), which encompasses a wide range of measures from simple paper selection boards to the latest high-tech computer-based voice output communication aids, VOCAs.
Touch-screen technology has revolutionised the design of communication aids, allowing greater access to vocabulary and ease of adjustment of the content to the specific needs and cognitive level of the user.
Speech is just one of a range of functions such as internet access, music players, environmental control (EC) and connection to the mobile phone network that the so-called dedicated devices now offer, and those developed on tablets are able to deliver full PC functionality.
VOCAs now offer greater levels of independence but at a price, both financially and in the demands it they place on those who support the equipment.
Industry trend
Increased range of functions is one of a number of benefits derived from an industry trend towards the use of Windows-based platforms. However, as regular users of PCs know, software bugs are a common occurrence reflected in the apparently endless stream of updates to correct one or other problem.
The size and complexity of modern software packages make proper verification and validation of code uneconomic, with a reliance placed on the user to identify errors. The flexibility to allow other software to be installed, and the risks that access to the internet pose, will inevitably lead to some problems occurring which may compromise the device as a communication aid.
Consider those niggling faults on your PC that you neither have the skills nor can justify the time to fix. A simple series of steps for an able user to relaunch a crashed application may be beyond a cognitive/language-impaired individual arising, say, from TBI, leaving them without the ability to communicate or to control their environment.
Add other typical symptoms of behavioural outbursts, inflexibility and increased anxiety, and the risk of equipment damage or disuse rises.
Common complaints levelled by practitioners are the complexity of programming devices and the poor reliability. If the technology presents problems to professionals, you can be assured of the same for the family and carers.
Suppliers offer some initial training, and for those who are technically minded this may appear enough, but replicating what has been delivered in a seminar is another matter. Carers may have little time or opportunity to practise, leading to skills being forgotten or lost through turnover of staff. Failure to resolve problems quickly, or to ensure that the device content stays in step with the needs and interests of the user, are frequent causes of abandonment.
Independence and/or the ability to communicate are causing an impact into other areas, namely:
• Increased care needs
• Loss of involvement
• Isolation from family and friends
• Increased risk of psychological and behavioural problems
• Reduced quality of care due to difficulty to express needs
Successful intervention requires:
• That adequate funds are factored into the claim to source professional support over the client’s life.
• Sourcing professionals with both technical skills and cognitive/language therapy training to program therapy and communication software appropriately for the client’s reading/language abilities.
• Delivery of additional training on an on-going basis.
• A scheduled review of system performance.
• Rapid intervention when things go wrong.
Of course, this is not the start of the process. Unless due care is given to ensure that the wishes and needs of the client are placed foremost in equipment selection, then the prognosis for adoption of equipment in the long term is poor.
Many factors need to be considered when prescribing suitable assistive technology.
Determining a physical match of the equipment to the disability is a far clearer task than assessing the cognitive and psychological issues surrounding the introduction of a device that is to become that person’s new voice and part of their identity.
Inappropriate
A thorough understanding of the cognitive level that the client is functioning at is essential when defining recommendations. The introduction of inappropriate equipment can be more damaging than none at all, as it may dissuade the person from communicating, make them resistant to technology generally and to lose motivation to participate in therapy.
There is a great danger that if the expert report fails to identify adequate funds or to emphasise the need to complete a process of continued assessment, involving consultation and evaluation by the end-user, that inappropriate device acquisition will occur. Close involvement of a specialist speech and language therapist in TBI and AAC will ensure that these issues are appropriately considered.
Technology can transform a disabled person’s life, but the selection, introduction and long-term use requires access to a team with both technology and cognitivelanguage skills if a greater probability of successful implementation is to be achieved. All technology areas, including that for IT, can benefit from this level of support.