I have heard different things about when one can order a device, given progressive nature of disease, (do they have to wait until they are 60% intelligible, 80% or what?) But the vendor who works with the insurance source can probably answer that.

Regardless, if the person is ready/willing (and many people are not at this level of acceptance at this point in the disease process), we often recommend that they receive an AAC device eval, and get the device if funding will supply it. That way, they can use the device for EADL and computer access as appropriate. (My own inclination is to have them use the device to get used to it, while they are still able to communicate by voice, versus waiting until they have to use the device and then have to learn a complex one without the use of their voice. I know this may not be without controversy.) In some cases, especially for people who come from a distance, we have completed evaluation, made a recommendation for the device, and then submitted to the insurance company down the road when intelligibility had decreased.

Many of my folks cannot afford to purchase a separate EADL and or computer access package that may only be useful for a relatively short term. We make use of our lending library, but again, seems best if they can just use their own purchased equipment.

If they are basically intelligible (or even minimal intelligibility difficulties), Dragon on the PC or on the iPad should be usable options. They really do need to know how to use corrections strategies for the PC version; or it will not ultimately work, particularly if their voice is even a little bit impacted. But as Antoinette states, without knowing the progression of the disease, it is always hard to say. They should definitely be pursuing other strategies.

Ed Hitchcock OT/L.

Technology Center

Rehabilitation Institute of Chicago

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Antoinette
Sent: Wednesday, May 04, 2011 8:25 AM
To: xxxxxx@xxxxxxxxxxxxxxxxxxxx
Subject: Options for person with speech

You say she has good speech, so I don't know when it is appropriate to go for AAC - others on this list can answer that.

With regard to the wheelchair, assuming she has had the chair for a while, it may be possible to investigate alternate drives. Depending on what kind of wheelchair she has, upgrading her electronics may give her some ECU capabilities. For example, with Quantum chairs, when you get a display (needed for alternate controls) there are ECU capabilities built in. If her progression is such that it is probable that she will lose hand function soon, this should be an easy argument to make (but of course that is all up to the ins co).

For computer access, this is a hard one. Without knowing her progression, it is a difficult call to make. If we are talking about PLS, the voice recognition may be a useable option for a while. You could also look into a head mouse with on screen keyboard - maybe your ALS chapter has one in their loan closet?

Some other alternatives:

http://www.rjcooper.com/eadl-package/index.html

Also, there are a number of iPad apps that will function as a remote and control X-10.

Let me know if this answers your questions.

Antoinette Verdone, MSBME, ATP

ImproveAbility, LLC

512-522-1705

xxxxxx@xxxxxxxxxxxxxxxxxx

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

On May 4, 2011, at 7:58 AM, "Gizzi, Nancy" <xxxxxx@xxxxxxxxxxxxxxx> wrote:

We have a patient with ALS who has good speech but now is barely able to use her stronger, left hand. She is switching the joystick to her left hand for operation of her wheelchair, but questions how long this will be functional. She frequently uses her computer, but this has become difficult. She has the Dragon voice recognition program for her computer and a version for her iPad as well. Apparently she has not mastered use of the Dragon program on the computer. She does find the iPad version easier and helpful.

She is now wondering about her best options. Should she work harder to learn the Dragon program? She would like to set up environmental controls so that she can operate doors, etc. She wonders about getting a speech device to allow for alternative access so that she can have environmental controls, access to email, the internet, etc. But if that is the case, I don't think we can write it up as an AAC evaluation...correct?

I look forward to your input.

Nancy Gizzi, M.S., C.C.C.-Speech Language Pathology
Lee Center For Sports Medicine & Rehabilitation
Campus of Cape Coral Hospital
Lee Memorial Health System
Phone: 239-424-3572
Fax: 239-424-4035
Pager: 239-930-4613

From: xxxxxx@xxxxxxxxxxxxxxxxxxxx [mailto:xxxxxx@xxxxxxxxxxxxxxxxxxxx] On Behalf Of Hankins, Ron
Sent: Tuesday, May 03, 2011 3:10 PM
To: 'xxxxxx@xxxxxxxxxxxxxxxxxxxx'; 'Alisa Brownlee'
Subject: Allied Professionals Forum

I think this is the link for Allied Professionals Forum

http://www.mndnsw.asn.au/index.php?option=com_content&view=article&id=160:international-symposium-on-alsmnd-and-allied-professionals-forum&catid=82:workshops-and-conferences&Itemid=173

Ron Hankins

Ron Hankins, M.,A., CCC-SLP

Speech Language Pathologist

Banner Good Samaritan Medical Center

Neuroscience Clinics

(602) 839-4150

xxxxxx@xxxxxxxxxxxxxxxx

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