Augmentative Communication Aids Research Articles

Case Report: Comprehensive management of Bulbar Motor Neuron disease in an elderly male: A Multidisciplinary case report approaching the treatment

Abstract* Bulbar Motor Neuron Disease (MND), a specific form of amyotrophic lateral sclerosis (ALS) primarily affecting the upper and lower motor neurons in the brainstem’s bulbar region, presents a significant challenge in clinical management. This case report delves into the clinical presentation and management of an 85-year-old male patient with typical symptoms, such as left-sided weakness, dysphagia, and dysarthria, along with a history of aphasia and hypertension, underlining the complexities associated with diagnosing and managing this condition. Methods: The patient underwent a thorough clinical examination, diagnostic investigations, and imaging, leading to a confirmed diagnosis of bulbar MND. Multidisciplinary interventions were employed to addressed the diverse symptoms, including compensation therapy, swallowing function training, physiotherapy, bolus modification, behavioral adjustments, oromotor exercises, postural corrections, and sensory and neurophysiologic stimulation to enhance swallowing safety and comfort. Additionally, interventions for dysarthria and left-sided weakness encompassed speech rate control, strength training, and the use of augmentative communication aids. Results: Over a 30-day follow-up period, the patient showed improvements in dysphagia, dysarthria, and activities of daily living. The treatment strategies effectively addressed the specific challenges associated with bulbar MND, focusing on enhancing the patient’s quality of life and functional abilities. Conclusions: This case report underscores the need for a comprehensive, multidisciplinary approach to manage bulbar MND. It highlights the complexities of diagnosing and addressing the diverse symptoms and difficulties that patients with this condition encounter, emphasizing the importance of a holistic and individualized therapeutic strategy.

Design of Aword to Sentence Generator for Augmentative

Augmentative communication aids are used to assist persons with severe speech and motor disabilities in their natural communication. Motion impaired users operate computer-based communication aids with alternate input methods instead of mouse or keyboard, which makes the communication process slow. A word to sentence generation technique called Compansion was proposed to improve communication rate of augmentative communication users. In Compansion, a sequence of root words was converted to a grammatically well-formed sentence. To perform the conversion, Compansion required significant linguistic knowledge. This requirement limits applicability of Compansion to languages for which such knowledge do not exist. Moreover, the issues of pre(post)position attachment, morphology synthesis and word ordering need to be addressed to apply Compansion to languages other than English. We propose enhancements to make Compansion work for non-English languages. Based on the proposed enhancements, we have developed a word to sentence generator. The word to sentence generator is used in Sanyog – an augmentative communication system in Bengali, a language spoken primarily in Eastern India and Bangladesh. Evaluation of Sanyog shows that our word to sentence generator helps in increasing communication rate without putting significant physical or cognitive load on users. Development and evaluation of our word to sentence generator is described in this paper.

Performance Models for Automatic Evaluation of Virtual Scanning Keyboards

Virtual scanning keyboards are commonly used augmentative communication aids by persons with severe speech and motion impairments. Designers of virtual scanning keyboards face problems in evaluating alternate designs and hence in choosing the better design among alternatives. Automatic evaluation of designs will be helpful to designers in making the appropriate design choice. In this paper, we present performance models for virtual scanning keyboards that can be used for automatic evaluation. The proposed models address the limitations present in the reported work on similar models. We compared the model predictions with results from user trials and established the validity of the proposed models.

User errors on scanning keyboards: Empirical study, model and design principles

Scanning keyboards are used as augmentative communication aids by persons with severe speech and motion impairments. Literature reports two approaches for the design of scanning keyboards; design based on the experience and intuition of designers and user model based design methods. None of these approaches, however, considers user errors in the design process, potentially limiting the practical usefulness of the designs. We have performed experiments in order to study user errors on scanning keyboards. We have found that two types of errors affect performance of scanning keyboard users significantly, namely (a) timing error that occurs when a user fails to select a key at the appropriate time and (b) selection error that occurs when the user selects a wrong key. These errors have been found to increase users’ text entry time by as high as 65% and 35%, respectively. Based on empirical observations, we have developed a state transition model of user behavior during user–keyboard interaction. The model comprises of four states, each of which represents the physical and cognitive state of the user at particular instant of the interaction. The transitions are caused by users’ physical, cognitive and perceptual activities. We have found that the errors could be explained as caused due to the problems in making the transitions properly. In addition to explaining errors, the model has helped us to predict distribution of error probabilities with respect to the distance between keys. We have used the model predicted error distributions to develop principles for scanning keyboard design that aim to reduce user errors. The principles state that the frequently used key pairs should be placed apart by a minimum distance, which has been obtained from the error distributions, in order to reduce errors. The method and results of the study, the user model and the design principles are presented in this paper.

Outcome of recommendations for augmentative communication in children.

Some children with severe motor disorders have unintelligible speech, and may be recommended augmentative communication systems, such as a symbol chart or a voice output aid. The paper reports the outcome after 15-18 months for 35 children of recommendations for augmentative communication. Using structured questionnaires, parents were asked whether equipment was provided as recommended. Their perception of success in children's use of augmentative aids was recorded and related to potentially influential factors. Twenty-five symbol systems, 10 speech output devices and 11 switches were received; 18 symbol systems were used for communication and 10 were used frequently. Seven speech output devices were used for communication but only two were reported to be used frequently. Factors leading to more successful outcomes include early receipt of the aid, perceived adequate local training in the use of the aid, and children aged 6 years or more at initial assessment. The findings also suggest that referring professionals will need to be better informed about the nature and limitations of augmentative communication aids, and that improved local professional input and careful interagency planning and co-ordination are required to achieve optimal outcome.

Computers, assistive devices, and augmentative communication aids: Technology for social inclusion

Assistive technology, in the form of both devices and services, can significantly improve the lives of children with disabilities following traumatic brain injury. A powerful goal of assistive technology is social inclusion, defined as full meaningful inclusion of the child into the social fabric of the culture. A series of recently enacted legislation has made assistive technology for these children more readily obtainable. A needs assessment by a competency-based assistive technology team that includes the family, is environmentally and task specific, and relates to social roles will be more meaningful to the child and family and enhance social inclusion for children with traumatic brain injuries.

Comparison of three computer scanning modes as an interface method for persons with cerebral palsy.

Occupational therapists are becoming increasingly involved with interface assessments. This involvement is improving the ability of persons with physical disabilities to interact with computers, augmentative communication aids, and other devices. The ability to use these devices facilitates participation in activities that would otherwise be much more difficult to pursue, such as communication, education, work, and recreation. The purpose of the present study was to systematically compare three basic modes of scanning--automatic, inverse, and step--with the use of a single-subject experimental design. Six subjects--3 with spastic and 3 with athetoid cerebral palsy--from a local school volunteered for the study. Results indicated that the 3 subjects with spastic cerebral palsy had the greatest difficulty using the automatic scanning mode. The 3 subjects with athetoid cerebral palsy had the most difficulty using the step scanning mode. The results of this study suggest that clients should attempt each scanning mode and that their performance with each mode be compared to ensure the most appropriate recommendations.

An Investigation of the Feasibility of a Video Game System for Developing Scanning and Selection Skills

This study examined the effectiveness of a microcomputer-operated video-game format in training nonvocal students with severe physical handicaps to make scan and selection responses similar to those needed for operating linear scanning augmentative communication aids. The video scanning and selection game systematically shaped scanning on more complex screens by slowly increasing the number of boxes presented simultaneously on the screen (i.e., from one to three boxes). Three children participated in a multiple probe across-subjects design to evaluate the effectiveness of the video game. Results indicated that all three children showed substantial increases in the number of correct scan and selection responses made at all three levels of difficulty. Generalization data indicated that all three children were able to transfer use of the skill to a Zygo 100 communication device. Maintenance of the effects also was demonstrated.

Technology Applications in Occupational Therapy

The products of today's research will be available to clinicians in the future. Many occupational therapists are involved in technology research in rehabilitation engineering and other technical programs. As part of the research teams they are designing new positioning systems and monitoring the effects of these new systems on the posture and skin of people with disabilities. They are designing new interfacing strategies for equipment. They are developing training strategies for accessing computer-based augmentative communication aids. They are providing functional design criteria for the modification of personal vehicles for use by disabled people. They are involved in the development and clinical application of robotics. In summary, the field of rehabilitation technology provides a fertile area for therapists wishing to pursue research careers. RESNA provides continuing education courses with a focus on technology application in conjunction with its annual meeting and encourages regional meetings with educational program components. RESNA is also very concerned with the issues of quality assurance. Only one formal training program for training rehabilitation engineers exists in this country, yet many engineers and others are providing technology in clinical settings. Current legislation is alerting many professionals to the value of technology, and yet there is no mechanism in place to monitor the quality of technical programs or the qualifications of many of the professionals providing the technical services. A major challenge is to address the formal training and quality assurance issues in a sensible way. The application of technology as a component of our clients' rehabilitation is an exciting development.(ABSTRACT TRUNCATED AT 250 WORDS)

Augmentative communication aid use—A follow-up study

The purpose of this study was to collect and analyze comprehensive data regarding use of augmentative communication aids following aid prescription and orientation. The experimenters conducted a telephone survey. Parents or spouses of all nonspeakers fitted with an augmentative communicative aid at Callier Center from 1980 to 1984 served as informants. The survey probed for information concerning percentage of aid use, number of basic communicative functions, place of aid use, and other pertinent variables. Data regarding 24 child and 18 adult nonspeakers revealed that 50% of the children and 17% of the adults used their communication aids more than 25% of their waking hours. Mean numbers of examples cited for use of five basic communication functions were 3.79 and 3.86 for children and adults, respectively. Place of aid use most frequently noted was school or agency for both groups. Significant relationships were noted between age and percentage of aid use and for child subjects, between receptive language quotient and number of communication functions. Analysis of additional relationships and implications for clinical/research applications are discussed.

Electronic Augmentative Communication Aids for the Nonreading Student: Selection Criteria

A discussion of augmentative communication aids for non-reading severely physically handicapped children is presented. Three specific topics are discussed: factors in movement to electronic communication aids, basic components of electronic aids, criteria for selection of aids, and specific training suggestions. The importance of maintaining flexibility is stressed. Augmentative communication aids for this population should reflect a dynamic rather than static philosophy. They must meet the needs and abilities of the student in present and future environments.

Technology in the education of multiply-handicapped children.

The number of technical aids now available has allowed severely multiply-handicapped children to better participate in their education. Project TEACH (Technical-Educational Aids for Children with Handicaps), a 3-year early childhood demonstration project of the Federal Office of Education, provided ten children with seating systems, mobility aids, feeding devices, and augmentative communication aids. The children's performance of academic, motor, daily living, and communication skills as they relate to their educational program is reported as well as the model used to deliver technical services in an educational environment.