Myth:
Equipment to access the communication device is not necessary -
only the communication device is required
Providing someone with a communication device, but not giving them access to that device is the same as placing a person in front of a locked door without a key . The equipment required for an individual to successfully use a communication device is like a key to this door. For people with complex communication needs, device access equipment is essential for communicating physical, medical, social and emotional needs.
Photo by Maria Ziegler on Unsplash
Access methods
Dowden and Cook (2002) describe the access method, also known as the selection technique, as “the way in which the user interacts with the device in order to operate and communicate with it ; the method an individual uses to select items for communication."
There are two types of access methods for communication devices: direct (or direct) selection and indirect (or indirect) selection.
We all use direct selection every day . We use our fingers to press the buttons on the phone or parts of the screen on the tablet. Sometimes we use additional equipment for direct selection, for example we use the mouse to control the cursor on the screen to do something on the computer.
Direct selection is used by many people with complex communication needs. Some use fingers to select the desired option. Others use a gaze-tracking camera or a head-mounted pointer to select the desired option.
Photo by Tobii Dynavox
Indirect selection means that the individual does not directly touch what he wants to select. Instead, there are intermediate steps that allow him to make a choice (Cook and Hussey, 1995). The closest example of this in everyday life is listening to the options on an answering machine (eg giving a reading of electricity consumption) and entering the corresponding number when we hear the choice we want. Another example is talking to a child who is still in the crib about the clothes he wants to wear. We ask him: "Do you want to wear this...or this...and this?" and we wait for the child to say "yes" to an item of clothing. We call this scanning(or search). It is an indirect method of selection. The desired choice is not selected directly by pointing to it, but by listening until we hear it, and then signaling in some way (eg by pressing the appropriate number or confirming with the answer "yes").
Scanning in the Grid 3 program
Indirect selection methods are primarily used by people with motor disabilities. Choices are most often displayed visually, by marking each option, but they can also be displayed as sound reproductions of terms on the screen. Individuals using indirect selection on their communication device view and/or listen to the offered selections and make their selections by activating the switch. There are many different switches , depending on the motor skills of the individual.
When is a selection method recommended?
The method of selection is determined as part of the assessment for assisted communication and is supplemented during additional use and therapy. Some people have more than one method of selection, depending on their position (eg in bed or in a wheelchair), their state of fatigue, and other factors. Assessment protocols and academic articles dealing with aided communication state the necessity of determining appropriate selection methods. You can find some of them in the literature at the end of this article.
The U.S. Medicare program, as well as other funding sources in the U.S., which use Medicare guidelines, require speech therapists to pay attention to the issue of access when evaluating the possibility of using an assisted communication device: the speech therapist must state whether the individual has the "physical abilities to effective use of the selected device and accessories for communication".
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Just as drugs come in different forms and dosages, depending on the individual's needs and response to treatment, access equipment is chosen based on the individual's motor abilities and needs . This results in an appropriate individualized recommendation.
What equipment might be recommended for access?
Equipment for direct and indirect selection can be recommended. You could see both selection methods in the previous photos. A person using the direct selection method uses a gaze tracking camera. A person using the indirect selection method uses a switch. Additional examples of equipment include:
Why is this equipment necessary?
For individuals with complex communication needs, a communication device is considered necessary because it gives them the ability, in addition to many other communication functions, to express physical and emotional pain, to show needs and desires, or to report abuse and neglect. If these individuals also have motor difficulties or they develop gradually, they can use a communication device using equipment for direct or indirect selection. Without such equipment, they would not be able to communicate, and the problems and risks that make a communication device medically necessary for them still remain. A medical aid, i.e. a communication device, would be enabled, but not the way in which a person can use it.
Stands for communication devices
If the person has major motor difficulties, it is necessary, in addition to the selection method, to use stands on which the communication device will be mounted and/or its selection method, i.e. access. When the person is in a hospital bed and is not mobile, then it is necessary to place the stand on a certain surface (on the hospital floor, on the table next to the bed or on the bed itself) so that the communication device (and access method, e.g. eye tracking camera) is in optimal position for use . In addition to the position, the angle at which the device is placed should also be taken into account. This is especially important if there is also a gaze tracking camera on the stand. Depending on the type of difficulty, the type of stand should be chosen. If someone is in a wheelchair, they will use a stand that can be placed on the wheelchair, and if someone is in bed most of the time, then they will use a different type of stand (eg one that can stand on its own on the floor or one that is mounted on a flat table surface or cabinet).
Photo by Tobii Dynavox
Through the mentioned methods of selection and types of racks, we see that the communication device itself is sometimes not enough . Consideration should be given to the way in which the person will access the device, but also where and how the device will be placed.
Just as our speech communication depends on the interaction of several factors, so communication with an assisted communication device depends on several factors that must be taken into account.
LITERATURE:
Beukelman, D., Garrett, K., & Yorkston, K. (2007). Augmentative communication strategies for adults with acute or chronic medical conditions. Baltimore: Paul H. Brookes Publishing Co.
Beukelman, D. and Mirenda, P. (2003). Augmentative & alternative communication: Supporting children and adults with complex communication needs. Baltimore: Paul H. Brookes Publishing Co.
Cook AM and SM Hussey. (1995). Assistive technologies: Principles and practice. St. Louis, MO: Mosby-Year Book, Inc.
Dowden, P. and Cook, A. (2002). Choosing effective selection techniques for beginning communicators. In J. Reichle, Beukelman, D. and Light, J. Implementing an augmentative communication system: exemplary strategies for beginning communicators. Baltimore: Paul H. Brookes Publishing Co.
Reichle, J., York, J. and Sigafoos, J. (1991). Implementing augmentative and alternative communication: Strategies for learners with severe disabilities. Baltimore: Paul H. Brookes Publishing Co.
