presentation 204 lisa bruening aac in times of change
DESCRIPTION
The ALS Association 2014 Clinical Conference Phoenix, AZTRANSCRIPT
AAC in Times of Change
Lisa M. Bruening, MS, CCC-SLPThe ALS Association
Northern Ohio [email protected]
en.wikipedia.org/wiki/augmentaive_and_alternative-communication
To move forward….…………Perhaps we need to look back…
1950’s
1960’s
en.wikipedia.com/wiki/aumentative_and_alternative_communication#mediaview/file:patient_operated_selector_mechanism
patient-operated selector mechanism (POSM or POSSUM)
praacticalaac.org Avoiding Insanity AAc & the Pace of Change, Carole Zangari
1970’s 1973: Rehabilitation Act 1975: P.L. 94-142 Knowledge Expansion
Bates and Dore Function over Form
Technology Expansion Microprocessor and switch technology
asha.org/public/speech/disorders/AACthreedecades
1980’s to 2000’s AAC: More Than Three Decades of Growth
and Development by Rose A. Sevcik and MaryAnn Romski “From laptop computers that talk as well as
perform a wide range of other operations (e.g., word processing, World Wide Web access) to computer linked devices dedicated to communication, technological advances during the 1980s and 1990s have produced numerous vehicles for communication.”
Medicare SGD NCD 2001
cue the angel chorus
Medicare SGD NCD 2001 Benefit Category
Durable Medical Equipment
Note: This may not be an exhaustive list of all applicable Medicare benefit categories for this item or service.
http://www.cms.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=274&ncdver=1&NCAId=8&ver=7&NcaName=Augmentative+and+Alternative+Communication+(AAC)+Devices+for+Speech+Impairment&bc=ACAAAAAAIAAA&
Indications and Limitations of Coverage
Effective January 1, 2001, augmentative and alternative communication devices or communicators which are hereafter referred to as “speech generating devices” are now considered to fall within the durable medical equipment (DME) benefit category established by §1861(n) of the Social Security Act (the Act).
They may be covered if the Medicare Administrative Contractor medical staff determines that the patient suffers from a severe speech impairment and that the medical condition warrants the use of a device based on the following definitions.
MAY BE covered if… Being a dedicated speech device,
used solely by the individual who has a severe speech impairment;
MAY BE covered if… May have digitized speech output,
using prerecorded messages, less than or equal to 8 minutes recording time;
MAY BE covered if… May have digitized speech output,
using prerecorded messages, greater than 8 minutes recording time;
MAY BE covered if… May have synthesized speech output
which requires message formulation by spelling and device access by physical contact with the device-direct selection techniques;
MAY BE covered if… May have synthesized speech output
which permits multiple methods of message formulation and multiple methods of device access; or
MAY BE covered if…software that allows a laptop
computer, desktop computer or personal digital assistant (PDA) to function as a speech generating device.
Devices that DO NOT meet definition Devices that are not dedicated
speech devices, but are devices that are capable of running software for purposes other than for speech generation, e.g., devices that can also run a word processing package, an accounting program, or perform other than non-medical function.
Devices that DO NOT meet definition Laptop computers, desktop computers, or
PDA’s which may be programmed to perform the same function as a speech generating device, are noncovered since they are not primarily medical in nature and do not meet the definition of DME. For this reason, they cannot be considered speech-generating devices for Medicare coverage purposes.
Devices that DO NOT meet definition A device that is useful to someone
without severe speech impairment is not considered a speech-generating device for Medicare coverage purposes.
Why Review these definitions?
Effective April 1, 2014,
CMS Classified SGDs
as Capped Rental
So why are we still fighting for access?
Technology Is Empowering, But Only If You Can Afford It
People with Disabilities Are Being Denied Access by New Medicare Restrictions
By Steve GleasonFormer NFL standout and ALS patient and advocatewww.teamgleason.org
Advocacy
200 Members of Congress
Sign Letter to CMS
Demanding Answers to
Questions about SGD
Funding
Keeping Issue in the Media
The Washington PostALS patients face loss of Medicare coverage for devices used to aid speechBy Shefali Luthra October 26, 2014
cue soundtrack: Guns n Roses, "Sweet Child of Mine"
Back to 1999
cue music: Prince "1999"
Feature MatchingFeature Matching is the systematic process by which a person’s strengths, abilities and needs are matched to available tools and strategies (Shane, H., & Costello, J. (1994) Augmentative communication assessment and the feature matching process. Mini-seminar presented at the annual convention of the American Speech-Language-Hearing Association, New Orleans, LA.& Costello, 1994).
AAC Device Features Submitted by AAC TechConnect; Part of the ACES Module
Copyright 2011 AAC TechConnect, Inc
How to decide between Apps and Devices.Submitted by AAC TechConnect; Part of the ACES Module
Copyright 2011 AAC TechConnect
URL: http://guides.mclibrary.duke.edu/ebmtutorial
Balancing Act
Patient needs
Clinical Recommendations
costs
Bulbar onset
yassermetwally.files.wordpress.com
Speech Intelligibility Decreasing
May need to write a specific word to state the topic of conversation
May need to point to letters of words on a letter board
May need to write most of what they are saying with pen and paper, Boogie Board LCD Slate
May need to use texting for face to face and emailing instead of telephone
May begin to use consumer products to supplement or replace natural speech: iPhone, iPad, Android table, Blackberry
May consider AAC device (lightwriter, dynawrite, maestro, etc. for those with limited experience with technology)
May begin to use keyboard text entry via text to speech output on laptop (Read Please, E-triloquist, ect.)
May need to use TTY, speech to speech, or internet relay for telephone conversations
Review iPhone, iPads and Androids
Windows tablets
Pen and paper
White boards/Dry Erase
Boogie Boards- electronic LCD slate
Text-to-Speech Software (Windows)
CHIPSpeaking, FREE, www.chipspeaking.com E-triloquist, FREE, www.etriloquist.com Natural Reader, FREE,
www.naturalreaders.com/download.htm Read Please, FREE, www.readplease.com TextOutloud, $30, www.nextup.com CoolSpeech, $30, www.bytecool.com
There are many others….changing all the time
Limb Onset
ohemassmd.blogspot.com/2014/08/als-amyotrophic-lateral-sclerosis.html
Early Stage Voice Banking: recording messages in
their own voice through the sound recorder on a computer
Begin to develop their own “voice synthesizer” through software such as ModelTalker (http://www.modeltalker.com/)
The system uses representative segments of recorded speech (either from an individual who is losing the ability to speak or from a person chosen by someone who can no longer speak) to create a unique synthetic voice. This synthetic voice is virtually unlimited, meaning it can be used to express almost anything, including words and phrases not previously recorded.
Rate Enhancement Strategies
Different types of keyboards: size, shape, split
Ease of Access: onscreen keyboard, dwell/hover settings
Mouse Hardware settings: changing speeds, button locations
Alternative mouse devices Trackpads, trackballs, foot mouse,
joysticks, switches Camera mouse: tracks body
movement Head mouse devices
Ablenet Tracker Pro Origin Headmosue Extreme Smart Nav
Eye gaze device should be considered last*
* IMHO
Virtual Keyboard, Virtual Mouse Programs and other Input Software
vir·tu·alˈvərCH(əw)əl/adjective
synonyms: simulated, artificial, imitation, make-believe;
COMPUTINGnot physically existing as such but made by software to appear to do so."a virtual computer"
Better Living Through Technology. www.bltt.org/physical/index.htm
Onscreen keyboard Searchhttp://www.bltt.org/software/osk.htm
Charlie Danger: Occupational Therapist, site authorBetter Living Through
Technology
Windows On-screen Keyboard
Allows person to bypass the computer keyboard. Windows Accessibility Features allows a window with a keyboard display to be active on the screen. Text may be selected via mouse or mouse alternative and then placed into the active window or text box of the intended program.
Virtual Mouse Programs Dwell Clicker FREE Point-N-Click FREE The Grid Tobii Communicator EZ Keys
Onscreen Mouse Software
Point-n-ClickVirtual Mouseby Politalwww.polital.com/pnc
But wait! That’s not all…
Eye Gaze Control EyeGaze Edge by LC Technologies
Medicare compliant version; also available in tablet and desktop versions
Tobii Eye Tracking via PCEye Mobile and PCEyeGo (available as an add-on)
EyeTech Digital TM4/Mini, TM5/Mini (available as an add-on)
Eyepro GS (avaialble as an add-on) WordsPlus
EyeTribe- (available as an add-on)
The System Requirements (Tobii)Most add-on eye tracking work best on
Dell Latitude 10 Microsoft Surface Pro Lenovo ThinkPad Tablet 2 Samsung ATIV Smart PC 500T
Require full Windows Operating Systems
System Requirements (EyeTech) Microsoft Windows XP, 7, or 8 OS, 32-bit or
64-bit. USB Port Up to 20 in (50.8 cm) Monitor
Technical Specs (Tobii add-on) Generally, add-on eye tracking works best
if the following minimum specs are met:
CPU: 1GHz, 2 coresRAM: 2GBGPU: 60 MB video RAM, pixel shader version 2.0 or higher
Switch Scanning EZ Keys for Windows NeuroSwitch incoprates Assistiveware
(Mac and Windows) Settings on many other programs allow
switch scanning
Scanning Animation: Step 1
Scanning Animation: Step 2
But Wait! There’s more….
Communication Software for PC (www.oatsoft.com listing of open source AT software)
Tobii Communicator The Grid E-triloquist EZKeys
AAC Software Search http://www.pinterest.com/vsucsd/aac-software/
AAC Resources on the Webhttp://www.pinterest.com/amyandpals/
Case Studies How can we meet communication needs
with consumer products?
Stephen Hawking
The System Lenovo ThinkPad X220 Tablet (2 copies)
Intel® Core™ i7-2620M CPU @ 2.7GHz Intel® 150Gb Solid-State Drive 520 SeriesWindows 7
Speech Synthesizers (3 copies):Manufacturer - Speech Plus (Incorporated 1988, Mountain View, CA)Model - CallText 5010
EZ Keys, written by Words Plus Inc A cursor automatically scans across this
keyboard by row or by column. I can select a character by moving my cheek to stop the cursor. My cheek movement is detected by an infrared switch that is mounted on my spectacles.
This switch is my only interface with the computer. EZ Keys includes a word prediction algorithm, so I usually only have to type the first couple of characters before I can select the whole word.
When I have built up a sentence, I can send it to my speech synthesizer. I use a separate hardware synthesizer, made by Speech+.
Through EZ Keys I can also control the mouse in Windows. This allows me to operate my whole computer. I can check my email using the Eudora email client, surf the internet using Firefox, or write lectures using Notepad.
Steve Gleason
Most pALS must choose btwn:a) silenceb) archaic communication. IE. blinkingc) paying $20k for a system weaker than ur 1980s computer-SG#detAiLS
Online communication via text, voice, video, and social media is a daily requirement. In order to stay engaged in life and be productive, PALS often require all of these communication methods simultaneously. To have hardware up to this task is a necessity and the current “brand name” offerings are severely deficient. Finally, these systems are incompatible with Apple/Mac products.
The current and future generations of pALS are “wired”. We create, edit, stream and share media from everywhere. We meet, communicate and collaborate with friends, family, colleagues, doctors and others online in real time from anywhere. We are productive and we want devices to facilitate our production.
I do not believe in complaining. I believe in doing. I do not believe in calling for change. I believe in making change. If I have my way, this change will happen. In making this change, we will also change the way the rest of the world communicates.
I do not believe in complaining.I believe in doing.I do not believe in calling for change.I believe in making change. If I have my way, this change will happen. In making this change, we will also change the way the rest of the world communicates.
References and ResourcesAAC: Where We’ve Been, Where We Are & Where We’re Headed Nationally David E. Yoder, Ph.D. CCC/SLP
Prof. Emeritus Speech & Hearing Science Director Emeritus/Senior Associate Center for Literacy & Disability Studies School
of Medicine, UNC-Chapel Hill
Learning Guides http://www.makoa.org/computers.htm#guide http://www.aactechconnect.com/ http://
www.assist-it.org.uk/assets/content/switch_access.htm