Assistive Communication Tools Research Articles

Effectiveness of augmented alternative communication method on physiological parameters among conscious mechanical ventilation patients

Background: Conscious mechanical ventilation patients in intensive care unit experience intense anxiety due to inability to communicate which might also affect their physiological parameters. Aim: to evaluate the effectiveness of augmented alternative communication method on physiological parameters (heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate and SpO2-oxygen saturation) among conscious MV patients in the ICU. Methodology/Design: Quantitative evaluative approach with quasi experimental (pretest, posttest with control group) research design was adopted in the present study.120 conscious mechanical ventilated patients were randomized into two groups, experimental and conventional care group (60 in each group).The experimental group, mechanical ventilation patients who were awake, aware and responsive to verbal communication was served by a simple assistive communication tool ( augmented alternative communication) for continuous three days. In contrast, only routine or usual nursing communication practice or standard care was provided to the control group. The socio-demographic data, clinical profile, communication difficulties self-evaluation questionnaire, patient satisfaction self-evaluation questionnaire, self-rating Face anxiety scale and Physiological parameters was used to measure study parameters.

An Asynchronous Hybrid Spelling Approach Based on EEG-EOG Signals for Chinese Character Input.

In this paper, we presented a novel asynchronous speller for Chinese sinogram input by incorporating electroencephalography (EOG) into the conventional electroencephalography (EEG)-based spelling paradigm. An EOG-based brain switch was used to activate a classic row-column P300-based speller only when spelling was needed, enabling an asynchronous operation of the system. Then, the user could input sinograms by alternately performing P300 and double-blink tasks until he or she intended to stop spelling. With the incorporation of an EOG detector, the system achieved rapid sinogram input. In addition to asynchronous operation, the performance of the proposed speller was compared with that achieved by a P300-based method alone across 18 subjects. The proposed system showed a mean communication speed of approximately 2.39 sinograms per minute, an increase of 0.83 sinograms per minute compared with the P300-based method. The preliminary online performance indicated that the proposed paradigm is a very promising approach for practical Chinese sinogram input application. This system may also be expanded to users whose languages are written in logographic scripts to serve as an assistive communication tool.

Communicating with conscious and mechanically ventilated critically ill patients: a systematic review.

BackgroundVentilator-dependent patients in the ICU often experience difficulties with one of the most basic human functions, namely communication, due to intubation. Although various assistive communication tools exist, these are infrequently used in ICU patients. We summarized the current evidence on communication methods with mechanically ventilated patients in the ICU. Secondly, we developed an algorithm for communication with these patients based on current evidence.MethodsWe performed a systematic review. PubMed, Embase, Cochrane, Cinahl, PsychInfo, and Web of Science databases were systematically searched to November 2015. Studies that reported a communication intervention with conscious nonverbal mechanically ventilated patients in the ICU aged 18 years or older were included. The methodological quality was assessed using the Quality Assessment Tool.ResultsThe search yielded 9883 publications, of which 31 articles, representing 29 different studies, fulfilled the inclusion criteria. The overall methodological quality varied from poor to moderate. We identified four communication intervention types: (1) communication boards were studied in three studies—they improved communication and increased patient satisfaction, but they can be time-consuming and limit the ability to produce novel utterances; (2) two types of specialized talking tracheostomy tubes were assessed in eight studies—audible voicing was achieved in the majority of patients (range 74–100 %), but more studies are needed to facilitate safe and effective use; (3) an electrolarynx improved communication in seven studies—its effectiveness was mainly demonstrated with tracheostomized patients; and (4) “high-tech” augmentative and alternative communication (AAC) devices in nine studies with diverse computerized AAC devices proved to be beneficial communication methods—two studies investigated multiple AAC interventions, and different control devices (e.g., touch-sensitive or eye/blink detection) can be used to ensure that physical limitations do not prevent use of the devices. We developed an algorithm for the assessment and selection of a communication intervention with nonverbal and conscious mechanically intubated patients in the ICU.ConclusionsAlthough evidence is limited, results suggest that most communication methods may be effective in improving patient–healthcare professional communication with mechanically ventilated patients. A combination of methods is advised. We developed an algorithm to standardize the approach for selection of communication techniques.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1483-2) contains supplementary material, which is available to authorized users.

Informed consent in a vulnerable population group: supporting individuals aging with intellectual disability to participate in developing their own health and support programs.

Objective The aim of the present study was to explore the use of complementary consent methodologies to support a potentially vulnerable group of people, namely those aging with intellectual disability, to provide personal input. It was premised on the view that processes to determine capacity for consent, appropriately modified to account for individual capabilities and current circumstances, could facilitate meaningful participation in the development of personal health care plans of people previously excluded from contributing. Methods The present descriptive case study research was undertaken in New South Wales, Australia. A seven-step process for determining capacity for consent was developed, and 10 participants aged between 54 and 73 years with lifelong intellectual disability and health comorbidities were involved. A variety of assistive communication tools was used to support individuals to demonstrate their capacity for giving informed consent. Results After being provided with tailored support mechanisms, seven participants were considered to meet all seven components for determining capacity for consent. Three participants were deemed not to have capacity to give consent regardless of the type of support provided. Conclusions Three critical factors for facilitating personal involvement in decision making for individuals with an intellectual disability were identified: (1) defining consent specifically for the target outcome; (2) outlining the criteria needed for consent to be obtained; and (3) using appropriately modified alternative communication mechanisms as necessary. What is known about the topic? Self-determination is one of the fundamental principles of human rights legislation around the world and, as such, it is considered desirable to have personal input by individuals into the development of their own health care plans. However, this is not always considered feasible if the person comes from a group in the community perceived to be vulnerable to exploitation and viewed as lacking capacity to give informed consent. This results in the use of proxy respondents, who may not accurately represent the desires and life aspirations of the individual. What does this paper add? This paper examines the development and implementation of a targeted program to support individuals aging with lifelong intellectual disability to demonstrate their capacity to provide informed consent. Specifically, it outlines how alternative communications methods, tailored to personal needs and capacity, can assist an individual to both understand and then confirm their understanding of consent in order to participate in developing health care plans. What are the implications for practitioners? People with intellectual disability are now living longer and are increasingly at risk of serious health conditions. The development of long-term health management plans has traditionally not included individuals with more complex needs and moderate intellectual disability, but the present study shows that members of this cohort can successfully understand and consent to participate in health care decision making. By proactively supporting this process, community and healthcare settings may be able to directly facilitate contribution from more individuals, therefore better meeting the goal of person-centred support.

Acceptance of brain-computer interfaces in amyotrophic lateral sclerosis

Brain-computer interfaces (BCI) have the potential to permit patients with amyotrophic lateral sclerosis (ALS) to communicate even when locked in. Although as many as half of patients with ALS develop cognitive or behavioral dysfunction, the impact of these factors on acceptance of and ability to use a BCI has not been studied. We surveyed patients with ALS and their caregivers about BCIs used as assistive communication tools. The survey focused on the features of a BCI system, the desired end-use functions, and requirements. Functional, cognitive, and behavioral data were collected from patients and analyzed for their influence over decisions about BCI device use. Results showed that behavioral impairment was associated with decreased receptivity to the use of BCI technology. In addition, the operation of a BCI system during a pilot study altered patients’ opinions of the utility of the system, generally in line with their perceived performance at controlling the device. In conclusion, these two findings have implications for the engineering design and clinical care phases of assistive device deployment.

The number of mechanically ventilated ICU patients meeting communication criteria

Objectives(1) Estimate the proportion of mechanically ventilated (MV) intensive care unit (ICU) patients meeting basic communication criteria who could potentially be served by assistive communication tools and speech-language consultation. (2) Compare characteristics of patients who met communication criteria with those who did not. DesignObservational cohort study in which computerized billing and medical records were screened over a 2-year period. SettingSix specialty ICUs across two hospitals in an academic health system. ParticipantsEligible patients were awake, alert, and responsive to verbal communication from clinicians for at least one 12-h nursing shift while receiving MV ≥ 2 consecutive days. Main resultsOf the 2671 MV patients screened, 1440 (53.9%) met basic communication criteria. The Neurological ICU had the lowest proportion of MV patients meeting communication criteria (40.82%); Trauma ICU had the highest proportion (69.97%). MV patients who did not meet basic communication criteria (n = 1231) were younger, had shorter lengths of stay and lower costs, and were more likely to die during the hospitalization. ConclusionsWe estimate that half of MV patients in the ICU could potentially be served by assistive communication tools and speech-language consultation.

Eye-GUIDE (Eye-Gaze User Interface Design) Messaging for Physically-Impaired People

Eye-GUIDE is an assistive communication tool designed for the paralyzed or physically impaired people who were unable to move parts of their bodies especially people whose communications are limited only to eye movements. The prototype consists of a camera and a computer. Camera captures images then it will be send to the computer, where the computer will be the one to interpret the data. Thus, Eye-GUIDE focuses on camera-based gaze tracking. The proponent designed the prototype to perform simple tasks and provides graphical user interface in order the paralyzed or physically impaired person can easily use it.

Improving vocabulary organization in assistive communication tools

Navigating a vocabulary consisting of thousands of entries in order to select appropriate words for building communication is challenging for individuals with lexical access impairments like those caused by aphasia. Ineffective vocabulary organization and navigation hurt the usability and adoption of assistive communication tools and ultimately fail to help users engage in practical communication. We have developed a multi-modal visual vocabulary that enables improved navigation and effective word finding by modeling a speaker's "mental lexicon", where words are stored and organized in ways that allow efficient access and retrieval. Due to impaired links in their mental lexicon, people with aphasia have persistent difficulties accessing and retrieving words that express intended concepts. The Visual Vocabulary for Aphasia (ViVA) attempts to compensate for some of these missing or impaired semantic connections by organizing words in a dynamic semantic network where links between words reflect word association measures based on WordNet, human judgments of semantic similarity, and past vocabulary usage.