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
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?
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
"One cannot consent to creep when one has the
impulse to
soar." Helen Keller
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
I think this is the link for Allied
Professionals
Forum
Ron
Hankins
Ron Hankins, M.,A., CCC-SLP
Speech Language Pathologist
Banner Good Samaritan Medical
Center
Neuroscience Clinics
(602) 839-4150
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