Case Presentation David

1
Case PresentationDavid
2
History

• CA - 3900
• Brain Stem Infarct February 2008
• Referral to ACT from OT
• Assessment for AAC, EC and PC access
• Very limited but reliable head movement, good eye
  control and consistent blink
• No functional movement of upper or lower limbs
• Developing control for powered chair ? head
  switches
• Significant Visual Impairment

3
History continued ..

• Has a partner and a young child
• Currently living in a nursing home, waiting for
  discharge home
• Formerly manual worker at a car plant, described
  as a typical lad
• Enjoyed socialising, computer games, good IT
  knowledge
• Has manual chair but developing switch access to
  a powered chair

4
Current Communication

• No speech / limited vocalisations
• 20 questions
• Eye pointing
• Eye blink ? reliable single positive response
  (yes)
• Colour encoded Etran Frame
• Motivated to communicate

5

• Local team have introduced MegaBee

6
Current Communication High Tech

• Whilst in rehab centre the local team trialled
• Scanning LightWriter with jelly Bean switch
• Dynavox EyeMax (Eye Gaze System)
• Client indicated he preferred Eye Gaze as an
  access method
• Successful switch access to a Possum ECS

7
ACT Assessment Process
Opportunities
Reasons
Person
Context
Activity
Means
8
ACT Assessment Process Client / Teams
expectations

• Client asked to prioritise AAC / EC / PC access
• Chose AAC / PC access R O
• Having trialled LightWriter / Eye Gaze client is
  sure of wanting VOCA and prefers eye gaze R
• Deciding on an access methods
• Switch v Eye Gaze M
• ACT referral and provision criteria (affects
  decision making process) M
• Is using switching for chair focus on this
  access method at current time M
• Put a system in place meet ST needs M

9
Factors affecting decision making process

• Partner very motivated O
• In the current NH environment the low tech
  systems / Etrans was working OK O
• Etran / MegaBee practicing skills needed for eye
  gaze M
• Using switches as driving a priority (chicken and
  egg) ? ST access solution (switching / scanning)
  M
• Vision is significant ? unable to demo kit at
  initial ACT appt O

10
Assess for success but be aware of the barriers

• Person factors R
• Environment R O
• Technology ACT provision criteria M
• Realistic goals?? O
• Support of NH limited O
• Very medically unwell M
• Cluttered home environment...plus a toddler
  logistics O
• Varying reactions of friends and family O
• Supportive / integrated local team O

11
A few points

• Complex client complex assessment
• Staged assessment / fluid process
• Rarely a quick solution / system will evolve
• Client has reasons, means and opportunities ?
  variable
• Increasing awareness of technology (double edged
  sword)
• More value on the role of technology
• high v low tech
• Importance of having the right environment /
  contextual factors

12
Plan ..

• Wait until client returns home
• reassess environment in context of MRO
• Demonstrate customised text ? speech systems
• Grid 2
• V Max
• Will MRO balance to enable introduction / success
  of a VOCA
• Switch access initially
• Revisit eye gaze at a later stage once initial
  system has been evaluated
• Look at EC and integrating PC Access to AAC system