Some individuals demonstrate severe communication challenges and are unable to express themselves using words, sentences or form the sounds of speech. The degree of impairment of the verbal aspects of their communication will determine whether this individual is in need of or will benefit from a tool, device or method to support their communication by providing a means to enable them to express their thoughts and intentions. Speech Pathologists call these non-verbal communication systems …Alternative and Augmentative Communication (A.A.C) systems.
There are a vast range of communication challenges and conditions in individuals that would benefit from a non-verbal communication system to enable them to communicate. Some of these conditions may include:
- Down Syndrome
- Childhood Apraxia of Speech/ Dyspraxia
- Cerebral Palsy
- Head injury
- Locked in Syndrome
- Motor Neurone Disease
Navigate your way to find more information by clicking on the underlined links below to find more information about each system as it is a complicated field. I have also provided information regarding the frequently asked questions and methods employed when determining on and deciding on the most appropriate device or system for yourself or your family member.
There are an array of methods, tools and tricks that Speech Pathologists can employ to enable individuals to communicate. These are divided into categories such as : Gestural systems and low and high technology aids. Let’s have a look at what these entail.
There are natural hand gestures that we all use to communicate, however, there are also many formal signed systems employed around the world whereby in Australia. Click on the link to find out more.
Low tech communication devices include any non-technological system that is built around the needs of the client to support their ability to express their ideas, intentions and needs. There are a vast range of methods and equipment that can be developed or purchased commercially to support an individual using low technology methods. Below are some examples of methods employed by Speech Pathologists following an assessment of capability to prescribe the most effective device. They can be so simple as a notebook and pen to elaborate systems with cascades of concepts offering communication diversity.
- a magnadoodle-commercially available
- an alphabet grid
- a page with symbols and words being built for a specific activity or task. This can be done from your own drawing talent, capturing web image- art, using compic, rhebus symbols or using a commercially developed program such as Boardmaker.
The trick is the skill of the designer to develop the low tech communication system that works for the client with the communication impairment. Hence why Speech Pathologist are specialised professionals trained for that particular job. Click on the links to learn more about low tech communication devices and how to take steps to develop a system suitable for you or your family member with a communication disability.
High tech communication aids
High tech communication aids vary extensively in cost, functionality and complexity. This is a specialised field to understand the breadth and depth of equipment that is available and you will need a therapist who has these skills to support you in getting the best fit for you or your child’s communication impairment based on many factors such as their language, literacy, physical and cognitive capabilities just to begin with.
High tech communication aids are also called Speech Generated Devices. Click on the link to understand more about speech generated devices.
SGD devices are not just handed out like purchasing them from Harvey Norman. These devices are specifically designed for a population of individuals with multiple challenges and need integrated therapy support and programs to enable the accurate assessment, prescription, training and integration of the device followed by teaching of other support team members in the effective use of using the device with the communication impaired individual to transfer this into their daily life…thus achieve their goal of COMMUNICATION.
Considerations for financial resources
My experience as a Speech Pathologist has seen too many low tech and high tech pieces of elaborate alternative and augmentative equipment sit in cupboards and not be used by clients and their families despite the arduous hours invested by their Speech Pathologists in developing them, applying for funding and providing the integration lessons. In respect to this, this highlights the importance of having the family on board and fully understanding the role, purpose and benefits of the equipment before taking steps in this direction. Plans should be designed to enable this teaching, practice with the device and training of other teaching personelle such as school teachers, therapy aids, kindy teachers and family members to ensure they are confident in using the device.
What do I do if I or my child needs a Speech Generated Device?
Step 1: Assessing the individual for the Speech Generated Devise
The Speech Pathology Assessment
If you are considering a device for an individual with a communication impairment, then you will need a comprehensive assessment from a Speech Pathologist with training in this area of assessing suitability for alternative and augmentative communication aids. Sometimes you may need a referral from a General Practitioner or a Specialist (Neurologist, Paediatrician) as part of a medical team or to claim Medicare support for the Speech Pathology service. Betterstart and Autistic packages may entail this as part of the therapy sessions given that the child is known by the clinician already. However, the assessment can not be claimed under these packages. There are a number of SGD devices available and they do differ in their functionality and capabilities. A client needs to be evaluated in respect of their:
- Language capabilities: Both receptive and expressive language capabilities
- Literacy capabilities: reading, spelling, writing and comprehension
- Visual capabilities
- Cognitive or intellectual capabilities
- Physical capabilities for posture and dexterity and ability to access the device eg. point/ eye looking
- Portability and practicality in respect to their lives and activities
- behaviour, care of the device and safety
Step 2: Prescribing the Speech Generated Device
Their evaluation will then enable the Speech Pathology to prescribe the most suitable SGD . There are multiple companies supplying technology and the price range needs to be considered in respect to the clients families budget or funding available for that individual. The speech pathologist will need to have knowledge of what is currently available (due to ongoing developments in technology) and the pricings to make a plausible recommendation to the family. The Speech Pathologists recommendation may be a combination of multiple devices to work within the requirements of that individuals life activities.
A school aged child with verbal dyspraxia and Cerebral palsy may be prescribed 3 methods for communication.
1. First they may be recommended with a high technology Device with symbols and pictures and a vast semantic web frame for diverse vocabulary functionality for language and the device may need to be rugged enough to withstand the school day with protective case included. It may also need specialised PODD software purchased with the device at an additional cost.
2. Secondly, this student may also benefit from a low tech PODD Book of symbols for when his high tech is not available for use to be used in any place at any time.
3. Thirdly, The Board maker program could be purchased to enable development of communication activities around specific needs to simplify the practice of talking with the aid. Board maker symbols can be developed for specific activities and laminated and blue tacked in that area of the house (eg. brushing teeth/ washing face on bathroom window).
It is the combination of various methods that increases functionality, transference and then usability which in turn enables the impact to be made on the individuals communication capability with the help pf the family and support team.
Step 3: Funding the Speech Generated Device
There are multiple sources for funding communication devices wher-eby the families purse can be and usually is one of them in many cases. Some clients have specific funding based on their insurance (eg. CTP motor vehicle insurance) or the organisation that is supporting them. The governments do provide funding for SGD by means of the MASS funding scheme.
Mass funding is funding that is provided by the government to support the expense of purchase of Communication Devices or speech generate devices (SGD). The speech pathologist will need to assess for this and undertake the completion of the funding documents.
For your information, MASS does not operate a loan scheme currently. However, they do have a second hand stock pool. For further information regards this, follow the link to http://www.health.qldlgov.au/mass/docs/resources/comstocklist.doc whereby there is a list of devices currently available on their website. Your Speech Pathologist can communicate directly with MASS stock pool when they have an understanding of the device that you are needing. If this is a good match to one in the pool, then it can be forwarded to the Speech Pathologist to pass onto the client but it can not be for a trial for a future submission for a new device.
In the event that the individual needs to be “fitted” for the device for best match prior to purchase, your Speech Pathologist can arrange for trial of SGD devices through specific supply companies or arranging an appointment with LifeTec where a client can get to see several devises during one visit. This is useful to narrow the field. In terms of applications for a new device, MASS fundig support expects that the client with collaboration with the speech pathologist would hav etrialed at least 2 devices for 2 weeks each. So in respect to the visit to Life Tec, this would only be the first step in the process towards an application for funding.
Hints to smooth sailing to getting a Speech Generated Device (SGD):
Try not to expect that you can simply waltz into your appointment with any “yellow pages Speech Pathologist” with the downloaded forms from the government website requesting for them to fill it so you can then post it in the mail and get the device couriered to the door…or you will be very disappointed. Allow for the cost of assessment for prescribing the most suitable device. The speech pathologist may also invoice your for the communication with suppliers and completion of relevent documentation which can be quite extensive for time. You will also need to have a booking to visit Life Tec or they can visit you at the Speech Pathology Centre like at our centre at Optimal Communications Speech Pathology on the Gold Coast. Once trial SGD’s are ordered, you will then be trained in their use to trial for a 1-2 week period and turn up for a review consultation to evaluate the suitability. Be aware though that a child does not just pick one up and GO FOR IT! It is a facilitated device with the family member and the speech therapy is about training the child how to use it effectively over time.
What do I do if I am unsure about getting a Speech Generated Device (SGD)?
There are many reasons why families have uncertainty about Speech Pathologists recommendations for a SGD. Some concerns that may arise are:
- Families may be still managing their grief and coming to terms with their child’s communication disability, the degree and permanency of the communication disability and a device may be too unsettling for them at their stage of their support program.
- The child’s family may misunderstand the Speech Pathologist or may be concerned that the recommendation for the SGD device may be a suggestion that there will be no attempts towards the development of verbal expression and speech. This is by no means the case and in most speech therapy programs, the SGD devices is an integrated tool into the therapy process and supports the development of language skills for non-verbal and written communication in addition to providing a means for the child to communicate whilst undergoing extensive speech therapy.
- The child’s family may have been provided with misleading, inaccurate or outdated information based on the implementation, purpose and benefits of a SGD device which may have confused them as to their decision, especially in the occasion that they are providing personal funding for this or are having to make important decisions about prioritsing the funding that they have between much needed multi-disciplinary therapy and equipment.
My advise as an experienced clinician is to trust your speech pathologists recommendations as coming from an expert trained and holding degree qualifications in making the best decisions in the interests of the individual with the communication impairment. Some aspects of coming to terms with a family member can be challenging and even gritty to swallow and it can be easy to get confused and even lost within the medical and educational world of experts who are all offering advise and support. I suppose consider it like this, if you approached your heart surgeon and asked what is the best form of treatment for your condition and they recommended a specific device to be implemented following a careful assessment process to enable the best fit for your condition with a follow up care plan to manage this on a long term perspective…it would be highly unlikely that you would not pay attention and consider their advise.
Step 4: Trialing the SGD before you buy it
The speech pathologist can then work with you to arrange a trial assessment with a device to evaluate the suitability. This is just like a test drive of a car before you buy it given the costs of these devices are expensive as they are technology-with a limited consumer group. They have been specifically developed for individual with communication impairments in addition to other impairments.
Tips for success in assessing for, purchasing and implementing a Speech Generated Devise (SGD)
1. Allow time to learn the device and receive training from your Speech Pathologist or therapist as part of the technology provider. This will need to be budgeted into your speech therapy plan if seeing a private speech pathologist.
2. Allow time for the Speech Pathologist to work directly with the key teaching team to train them in the use of the device. This will also need to be part of the therapy plan budget. In my experience, failure to use the device is sometime fear of technology and breaking or mucking up the software frame. Strategically and simply step out the lessons of how to teach the device to key people and shoe them great examples in an actual activity of how to integrate thsi device. For instance you could be placing food items in a trolley in therapy and you open the device to the food section and press the words for each item you place in the trolley to orientate the child to where the food item lives on the device, to hear the spoken word, see the symbol and read the word with the symbol. It has to be seen as simple for integration to be made by others.
3. Always have a low tech option to communicate. We seem to be all glassy eyed with the wonder of technology and “buttons” that whirl and “bing” however high tech devices do come with limitations. They need batteries, they need adapters that can be damaged and left at home and they also can be broken and need repair. Technology also doesn’t much like having a shower or food thrown all over it and when you are working with kids, it is amazing how creative they can be with expensive items…especially mobile phones and toilets! So in respect to this, always have a back up plan. LOW TECH COMMUNICATION DEVICE. This may be an alphabet spelling board, a pen and paper, a magnadoodle, a PODD Book with strategically organised symbols or a photographic book. The device, again, will need to be developed around the individuals capabilities. It is funny that one long standing client of mine who did have the financial capability to have any technological device he wanted, has preferred to use his alphabet grid with a mouth pointer as it gives him the most flexibility and no fuss with new carers.
4. See the integration and daily usage of the device as the actually therapy. What I love about complex communication device’s with many symbols that are arranged in categories with subsets based on their definitions (eg. Animals – wild animals – tiger- paw) is that they enable a solid semantic frame to be developed in the individuals mind. What I mean by this is that the device shows the individual how words live in categories and are linked to each other which assists in the building of the “word library” in a logical and well organised manner based on a functioning language system. When working with many individuals and seeing thei runiquely developed words frame developed inside their device, such as from simple to complex, we start