I agree that using the wheelchair controls may be a good option. I would recommend using the input/output module with the Tecla Shield as this can be used for iOS, Android, PC or Mac control - more options and has the flexibility to be used away from the chair.

What about a proximity switch or SCATIR switch for getting away from the tongue switch? You say he has limited head movement, but does he have enough for a pillow switch? What do you mean by tongue switch? Could he use a mini joystick? I have had clients that have no head movement, but they are able to use the mini joystick.

You mentioned that you tried adjusting the lighting in the room. If there are fluorescent lights, that can be a problem. Try in a room with no fluorescent light at all. I assume that you could calibrate in the room? That might be a clue as to why it won't calibrate.

Just some thoughts.

Sincerely,

Antoinette Verdone, MSBME, ATP

Owner, Rehabilitation Engineer

ImproveAbility, LLC

Office: 512-522-1705

Cell: 512-497-6026

Email: xxxxxx@improveability.com

Web: www.improveability.com

Fax: 888-501-1009

Address: 7301 Burnet Rd, Suite 102-265, Austin, TX 78757

"One cannot consent to creep when one has the impulse to soar" -- Helen Keller

On Oct 20, 2014, at 2:18 PM, Johnson, Kelli M. <xxxxxx@va.gov> wrote:

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…