Greetings and happy Monday.  I know this AT forum is typically focused on our PALS but I’d like your perspective regarding this challenging patient.

I have a veteran with C1-C4 complete Quadriplegia using a tongue switch to independently operate his Permobil 300. He has a Blom Trach speaking valve system in place although his average utterance length varies from 0 to 5 or 6 words. Many attempts have been made by his first speech pathologist and resp therapist to change his vent settings and increase his utterance length.  He has tried to use a head mouse without success due to limited head ROM. I had him in clinic today to calibrate him for eye gaze – no success. Even with changing the positioning of his bifocals, taking his glasses off, changing the color of the background and dot, changing the size of the calibration dot, and adjusting the lights in the room – no avail.

I’m hesitant to recommend a tongue switch for access to a communication device since he is also using his tongue to operate his Permobil chair (he is in the chair approx. 10-11 hours per day) and he is eating some foods and liquids by mouth. What other access methods could be considered for this patient? 

Thank you so much. I truly value your insight!

Kelli M. Johnson, M.S. CCC-SLP

Speech-Language Pathologist

James H. Quillen VAMC (126)

Mountain Home, TN 37684

Phone: (423) 979-2910

Fax:      (423) 979-3404

His mercies are new each day…