Can we use the whistles and Bells

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Can we use the whistles and Bells? PC based VOCAs
in the real world.
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Introductions

• Chris Sherlock
• Speech and Language Therapist
• Access to Communication and Technology
• Phil Palmer Occupational Therapist and Lead
  Clinician
• Access to Communication and Technology
• Contributions from Lynne Rogers Occupational
  Therapist and Vicky Lundie Speech and Language
  Therapist ACT
• Who are you?

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Introduction to Access to Communication and
Technology (ACT)

• Helpline 0121 472 0754 Website
  www.actwmids.nhs.uk
• Email format Firstname.Secondname_at_sbpct.nhs.uk
• Main phone number 0121 627 8235
• Address ACT, WMRC, 91 Oak Tree Lane, Selly Oak,
  Birmingham. B29 6JA
• Regional NHS Tertiary Assistive Technology
  Service all ages and conditions Mission
  statement
• To work with patients / clients and their local
  teams to assess for and provide techniques and
  technologies which optimise the potential for
  communication, mobility and control.
• Staff OT, SLT, Clinical Scientists, Workshop
  Team, Administrators about 30 people.
• Other teams in UK are similar but each is unique
• NB WM AAC Care pathway version 3

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Introduction to ACT
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Why are discussing this topic?

• Including format for this session
• This topic is very current for ACT at the moment.
  
• We are a purchasing service
• Suppliers of high tech VOCAs are emphasizing the
  features of PC based devices e.g. at training, in
  advertising.
• Choices of powerful aids that are not full PC
  based are effectively decreasing
• Advocating organisations are pointing out the
  high tech and ICT features of PC based aids and
  potentially levelling affect for AAC users
• Local teams continue to be technologically over
  faced by even the more basic VOCAs along side all
  the other aspects of AAC
• ACT has to support an increasing range of aids
  platforms and software need to be understood,
  repaired and knowledge updated

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Why are discussing this topic?

• Learning outcomes

• After attending this presentation participants
  will have considered
• Considered some pros and cons of full PC based
  VOCAs for different types of client
• Participated in debate about provision of these
  aids
• ???contributed to some key messages to be shared
  with manufacturers and other stakeholders

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Case study 1 Marie

• Marie aged 43
• Athetoid Cerebral Palsy
• No usable speech
• Good nonverbal communication
• Comprehension within normal cognitive range
• Enjoys social interaction with family, friends
  and carers
• Regularly gives presentations and facilitates
  discussion at user groups
• Fully literate
• Lives alone at home
• Has 24 hour carers and an advocate who plays a
  key role
• Previously was using a DeltaTalker

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Marie

• Low tech
• DeltaTalker
• Mixture of icons and spelling
• EC assessment

• EC through DeltaTalker. Why?
• All day in wheelchair
• Continual use
• No bedtime EC needs
• Not safety critical
• Few EC needs
• DeltaTalker will do it

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I
Switch
Marie
P
AAC
EC
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Marie

• Wheelchair switching using four switches on a
  tray
• She wanted to control DeltaTalker through the
  same access method
• Moved home and her EC needs changed
• Stopped using powered mobility
• DeltaTalker beyond repair
• Review

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Marie

• Powerbox with GRID (Word power) software issued
  2006
• Nervous about having full access to computer
• Remote link to desktop pc
• Had Freeway but stopped using it
• Powerbox failed and was beyond repair

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Marie

• December 2007 issued with a Motion tablet PC
  GRID2
• With StarTalker
• and Bluetooth connection
• Enables mobile phone use
• Company supported the set up and training
• Reverted back to her old grid sets because of
  familiarity and technologically complex training
  with did not meet her needs
• Still uses partner assisted scanning through an
  alphabet chart
• Only works well with familiar communication
  partners

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A motion tablet PC with Star Talker
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Star Talker screen shot.
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Marie

• Has a pc based device and therefore
• Independently switch between all the different
  functions of the integrated system
• Communication aspect of GRID 2 (StarTalker)
• Computer controls aspect of GRID 2 for computer
  access
• Texting making and receiving texts
• Potential for environmental control if needs
  change

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Marie

• Switching
• Moved from using her hands, slow
• Using a Possum chin switch very fast access
• At last review wanted to explore options for
  mouthstick or headpointer
• Headmouse access discussed and will be trialled
  at next appointment
• Computer controls training at ACT

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Marie

• Why has this pc based system been successful for
  her?
• Able client able to advocate for herself
• ACT is an assessment and provision service
  intra-disciplinary team
• Appropriate levels of support from companies and
  ACT
• Good local team
• Good access method

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Case study 2 Sam

• Male, 39 years old
• ASD, learning difficulties, dyspraxia and mild
  to moderate visual impairment.
• Very little useable speech
• Limited facial expression
• Comprehension of communication situationally good
  to about 4 I.C.W.. level for motivating topics.
  Internal language not well evaluated.
• Likes to interact on his terms, interested in a
  range of activities e.g. Laser Quest, cars and
  discos.
• Not literate but some familiar word/logo
  recognition if font large enough

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Case study 2 Sam

• Lives with his parents and brother
• Brother technically minded and willing to
  programme
• Family advocate for him strongly.
• He attends day centre and learning placements
  most of the week
• Respite for 7 nights at a time about once per 6
  weeks to 2 months.

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Case study 2 Sam
Had a 3100 DynaVox with bespoke programming for
10 years Looked after it and used it a great
deal S and family had come to rely on it
behaviour and family life changed hugely as a
result of Augmentative and Alternative
Communication Liked the animation helped him
see the buttons voice out put and colour screen
also helped. Direct access Carried it himself
everywhere got it out of the bag and turned on
when he needed to or way asked. The 3100 died
needed a new aid 3100 pages transferred to a
DynaVox V max with extra pages for photos etc
i.e. programming very familiar spatially,
visually, symbol type.
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DynaVox 3100
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Case study 2 Sam
S quickly rejected the V max Reasons seemed to
be Very slow turn on even from hibernate for
someone who is habituated to on and off On/off
button is a PC one and could not cope with heavy
handed approach particularly as he pressed again
and again for it to come on as boot screen is
dark or not DynaVox Someone in the
environment criticized the V max as big and
slow. Mixture of photos, animation and speech
did not seem to work and speech booted late when
buttons pressed. No interest in out reach
communication aspects of aid as communication
is in the here and now/near future and past.
Very small circle of communication partners who
are on hand
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A DynaVox V Max
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The debate

• How we are going to do this?
• A line up
• Take the main themes and present both sides of
  the arguments.
• To touch on some of the theory

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Lets us try a line up.
Most high tech AAC users should have dedicated
aids
Most high tech AAC users should have PC based
VOCAs
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Theme 1 Expectations and Reality

• Pros
• CM and others who advocate for AAC users as well
  as potential users are keen to have systems that
  offer very all round communication options that
  match what is commonly used.
• Promotion for PC based aids can understandably
  emphasize the possible multiple uses of the
  devices.
• PC based VOCAs can allow a user to talk, email,
  text and phone, control the environment, use the
  internet and other PC software

• Cons
• Many people see technology as offering solutions
  without a full appreciation of the amount of hard
  work will be needed to make use of it. It is new
  it must be better
• Setting up systems to perform many functions can
  be fiddly, time consuming and technically
  challenging to many people.
• PC based VOCAs do not offer a route to a quick
  chat from a standing start.

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Theme 2 Assessment issues
Pros PC based devices are very versatile and can
be adapted to clients needs.
Cons Setting up a complex PC based device to do
exactly what is needed for the client on the
hoof Some PC based aids cope with 4 way switches
better than others
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Theme 3 Provision Issues

• Pros
• Some teams cope well with true PC/windows devices
  as they are used to this sort of system
• Some environments and homes are set up for
  accessing internet etc e.g. with Wifi networks.
• Clients can be locked out of PC aspect

Cons PC based VOCAs are expensive and the
technology ages rapidly ACT team need to
understand the features of wide range of aids
and their tricks and foibles. And there is a
LOT of stuff in the box. Client could use aid
for none public service tolerated activities on
NHS PCs A potential hazard Locking client out
rasies potential ethical questions
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Theme 4 On going support and use

• Cons
• Battery charge duration can be reduced and the
  boot is much slower.
• Lack of anti virus software and updates could
  leave AAC aspect at risk. Even more of a problem
  when teams do not back up consistently. We can
  not make people protect and back up
• Suppliers are not always completely aware of all
  folibles and needs of their devices
• PC based aids can be more vulnerable when
  carried/have more ports. Be less likely to have
  good intergral desk stands
• Confusion between unreleated kit e.g. mobile
  charger put with VOCA

• Pros
• Suppliers helplines can be good and on line
  manual etc can be accessed
• Some clients get really good at their own
  devices
• Devices are more likely to fit with other systems
  in the clients world e.g. USB sticks

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Theme 5 Training issues

• Pros

cons
Training from suppliers can be very focussed on
technological aspects rather than getting going
with spoken communication There is a lot to get
through over time. Teams can not usually give
this much time. Training can be costly and
limited when there is a lot to learn. Teams can
be very over faced by training.
Training from suppliers is readily accessed and
can be in the price. Training can be other than
face to face e.g. DVDs which can be revisited
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Theme 6 What pays for what?

• Pros
• It is great that the playing field for people
  with disabilities can be levelled by technology
  for some people.
• The priority for some people is not face to face
  communication but easier access to communication
  over longer distances e.g. Texting

Cons Should ACT an NHS funded service pay for
equipment and training and ongoing support for
clients to do what everyone does when the aid is
to support them mainly for face to face
communication
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A discussion of the line up

• Which features of which clients would lead you to
  consider or avoid PC based/dedicated VOCAS for
  High tech AAC?

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Summing up

• What might be the three key messages we would
  give to manufacturering colleagues about PC based
  VOCAs in our real world?

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Title here
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Title here
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The last one