Speech Language Evaluation n Name: Kevin K. n Medical Diagnosis: Amyotrophic Lateral Sclerosis (ALS) n Date of onset: Diagnosis was made approximately 6 years ago n Place of Residence: Home in Duluth, MN

KK Evaluation Cont. n Current Communication Impairment: –No muscle control or movement within speech mechanisms including articulators, respiration, phonation, and resonation suystems. No verbal communication present. –Severe impairment –ALS has caused this client to loose all muscle movement needed for speech resulting in an inability to speak or vocalize

KK Evaluation Cont. n Anticipated course of impairment: –Currently »Kevin is unable to speak and relies on eye gaze and movement in two toes in his left foot to communicate. He is using an E- Tran and a Dynavox. Vertical eye movement is more difficult to use than horizontal eye movement. Stitches have been placed in the outside corners of his eyes to retain more moisture resulting in his eyes being slightly closed. The E- Tran is a faster mode of communication than the Dynavox. Fatigue occurs when using the dynamic displays. Kevin’s ability to communicate is severely compromised at this stage of the disease and will continue to deteriorate.

KK Evaluation Cont. n Prognosis: Prognosis for improvement of communication is very poor. Kevin will continue to require the use of an alternative communication device throughout the course of the disease.

KK Evaluation Cont. n Language skills: Kevin’s language skills are strong, providing the comprehension necessary for device operation. He is able to compose grammatically correct sentences using an AAC device. n Cognitive ability: Kevin possesses the cognitive abilities to effectively use an AAC device to communicate and achieve functional communication skills n Hearing status: Within normal limits

KK Evaluation Cont. n Vision status: Kevin requires the use of glasses to correct his vision. Kevin experiences reduced eye movement which occurs more in vertical movement than in horizontal movement. Kevin has reduced eye movement, but his field of vision is adequate for using the E-Tran and the Dynavox.

KK Evaluation Cont. n Physical status: Kevin must be pushed in a wheelchair to provide mobility. Kevin has no voluntary muscle movement throughout his entire body excluding two toes on his left foot, eye muscles, and slight lip movement. Kevin breaths through a stoma using a respirator. His trachea needs to be suctioned on a regular basis. He has reduced blood circulation and therefore must use heatpads on parts of his body and mittens on his hands to prevent him from getting cold. Kevin is fed through a feeding tube. Kevin requires a personal nurse to be present 24 hours a day to provide care as his is completely dependent on others for his physical care.

KK Evaluation Cont. n Daily communication needs: Kevin lives with his family, where he needs to be able to express the need for overall medical and personal assistance n Ability to fulfill these needs using: –Natural speech: Kevin possesses no natural speech abilities to express his needs –Electronic aids and other non-SGD approaches: Given the E-Tran and Dynavox with a switch activated by the toes on his left foot, Kevin is able to meet all his functional daily communication needs; however he needs assistance using the E-Tran. The use of the dynamic displays on the Dynavox system presents problems of fatigue.

KK Evaluation Cont. n Functional Communication Long Term Goals: –Kevin will be able to communicate independently –Kevin will be able to access and use a computer independently

KK Evaluation Cont. n Functional Communication Short Term Goals: –Kevin will use a semantic compaction system to increase his rate of communicating a message to a rate of words per minute. –Kevin will be able to create a typed message on a computer. –Kevin will be able to “surf” the internet –Kevin will acquire a mode of communication in preparation for when his eye gaze degenerates to a level in which is is unable to use it for communication.

KK Evaluation Cont. n RATIONALE FOR DEVICE SELECTION n Language Requirements: Due to his strength in language comprehension, Kevin should have access to a vocabulary of at least several hundred words n Hardware Requirements: The AAC device should be portable, rechargeable and able to attach to his wheelchair. The AAC device must have a visual scanning system, auditory scanning system and must be able to accommodate control via an external switch

KK Evaluation Cont. n Device Trial and Procedure: DEVICE: Pathfinder from Prentke Romich Company PROCEDURE: Use of the Pathfinder was modeled during the evaluation OUTCOME: Kevin appeared to be able to use the device successfully and inquired about a trial period

KK Evaluation Cont. n AAC devices and accessories recommended: 1. Continue to explore additional alternative communication options such as ERICA, Gemini, or an auditory scanning system 2. Obtain the Pathfinder and the Gemini for a trial period 3. Investigate the use of the Pathfinder to access the computer

KK Evaluation Cont. n Patient/family support of AAC device: Kevin’s spouse and nurse were present during the evaluation periods. They demonstrated an interest in the Pathfinder and in the Gemini and requested more information about the devices.

KK Evaluation Cont. n Treatment Plan: No treatment plan is currently arranged n Functional benefit of upgrade: An increase in the rate of communication and level of independence due to semantic compaction and one overlay page vs several pages on the Dynavox. The Pathfinder offers an auditory scanning system and access to a computer

Options 1) - Gemini (with Speaking Dynamically)/ 1) - Gemini (with Speaking Dynamically)/ Wordpower Wordpower - Discover Software - Discover Software - Long Term Loan of Mac available - Long Term Loan of Mac available 2) - Pathfinder/MinSpeak 2) - Pathfinder/MinSpeak - Access to computer (2 Units) - Access to computer (2 Units) 3) - Pathfinder - Computer with Discover - Computer with Discover