-------- Original Message --------
Subject: Re: AAC Justification with higher intelligibility
From: Amy Roman <xxxxxx@sbcglobal.net>
Date: Thu, September 26, 2013 6:45 pm
To: xxxxxx@alsa.simplelists.com

Hi Antoinette,
Fortunately, we have research that demonstrates that intelligibility will typically decline precipitously once a person with ALS slows to a speech rate of about 125 words per minute. We don't need to rely on intelligibility alone as justification. I frequently recommend an SGD for someone with intelligibilities in the high 90s if they have a speech rate of 125 and are showing typical decline. Of course there are those with slow progression who may not require an SGD (that’s when clinical judgment comes into play).

Here is a sample of what I might put in my report to justify ordering an SGD for someone with a high intelligibility:

Mr. Lastname's speech rate is severely reduced due to diminished breath support as well as spasticity and weakness of his lips, jaw and tongue. His speech rate is predictive of an imminent, sharp decline in intelligibility. Currently his speech rate is ### words per minute. A slowed speech rate of approximately 100-125 words per minute in patients with ALS is indicative of a precipitous decline in intelligibility usually occurring within the next two months. Research demonstrates that as speaking rate approaches 125 words per minute a patient with ALS should be evaluated for a speech generating device, even if sentence intelligibility remains over 90%. [Ball L., Willis A., Beukelman D., Pattee G. A Protocol for Identification of Early Bulbar Signs in Amyotrophic Lateral Sclerosis, Journal of Neurological Sciences 2001; 191:43-53 & Ball, L., Beukelman, D., & Patee, G. (2002) Timing of Speech Deterioration in people with ALS, Journal of Medical
Speech-Language Pathology, 231-235.]

Sincerely,

Amy Roman, MS, CCC-SLP
Augmentative Communication Specialist

AmyandpALS.Com

Forbes Norris ALS Research and Treatment Center
2324 Sacramento Street
San Francisco, CA 94115
Cell (415)518-0592
Fax (415)600-3778

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On Thu, 9/26/13, Antoinette <xxxxxx@improveability.com> wrote:

Subject: AAC Justification
To: "xxxxxx@alsa.simplelists.com" <xxxxxx@alsa.simplelists.com>
Date: Thursday, September 26, 2013, 2:22 PM

When it comes to justification for
AAC, what amount of speech would disqualify someone?
What is the criteria? If the dx is ALS, do you need to
have no speech?

Antoinette Verdone, MSBME, ATP

Phone: 512-497-6026
Fax: 888-501-1009
xxxxxx@ImproveAbility.com

DARS Provider# 1-274278960-0-000

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