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Speech and A.T. Evaluation Guide—What to Expect
This guide will acquaint parents with the assistive technology evaluation process for speech. The goal is to determine a specific communication system for a consumer, which may include use of an augmentative or alternative communication (AAC) device.
A starting place . . .
Consumers under three years of age are generally referred to Infinitec West or other assistive technology centers by the Early Intervention (EI) Program. A physician would have helped the family identify problems with the child's ability to communicate and contacted Early Intervention for an evaluation. The consumer would then begin a series of therapies. Next, a speech pathologist within the EI program refers the consumer for an assistive technology evaluation.
After age three, a child can be referred through a variety of sources including a teacher, a speech therapist in a pre-school setting, a physician, a private therapist outside the school, or a family member.
The focus of a speech evaluation for assistive technology is access to communication. Expressive language can be facilitated through a computerized device, word, photos or other graphics on paper, or a combination of these things. Therapists try different methods with each consumer to determine what is appropriate and most efficient. If considering a computerized device (high tech), a therapist will typically recommend a paper device (low tech) as a back up.
The process for kids under the age of three, is generally done in one or two two-hour sessions-the most a child that age can tolerate and stay focused; older kids generally undergo a single session evaluation that lasts from three to four hours. After the evaluation, the child may come back weekly for treatment and training for a specific time period. Each child has specific requirements.
Typically, the goal of an assistive technology evaluation is to identify a system of communication that produces speech or voice. Low-tech supports may also be identified to support the primary system of communication, such as communication books, picture symbols, picture schedules, etc. Staff will offer recommendations on how to use all of the materials to support communication in a variety of environments. The assistive technology selected is matched to the consumer and depends on the language level of the consumer, fine motor skills, vision, attention to task, seating and mobility, etc. A device should not be recommended simply because it's what the media is talking about or what other parents say they heard is the best.
But the focus of an assistive technology evaluation is determining an assistive device to augment speech. Assistive technology specialists at Infinitec West and other A.T. centers strive to find an alternative or augmentative communication (AAC) device that enables the consumer to produce language in ways he/she may not be able to achieve naturally. Speech devices can be extremely liberating because they augment speech and motor function, sometimes for the very first time in a child's life!
Sometimes kids have already established a system of communication and they're returning to be re-evaluated for a more sophisticated system with more language.
A Helpful Tool
If a consumer has a higher-tech device, like a Dynavox, NovaChat, Accent or iPad , tablet or smart phone with a communication app for general communication and goes to an event where for some reason he/she can't bring it along, a lower-tech device such as a GoTalk or QuickTalker can be used for quick access to common phrases for communication (e.g., say name, request something, greet people, etc.)
Many types of devices were designed to provide this function. Assistive technology centers like Infinitec West keep up with the newest devices as they become available, and have many of them on hand so consumers can try them out. Some of the device names are Tech/TALK, Tech/Speak, Digicom 2000, Maestro, ECO2 and Tobii M Series. Some of the apps used with iPads or iPhones include Proloquo2Go, Click n' Talk, Go Talk Now, Scene Speak and many more. See the Spectronics website for an up-to-date listing.
After a device is identified to be the most useful to a particular consumer, Infinitec West writes a report and a letter toward funding of the device, depending on the source of the referral. If the school referred the child for evaluation, Infinitec West writes a report for the school and then the school looks at funding. If Early Intervention requested the evaluation, a report, letter of developmental necessity, and letter of medical necessity are sent to the child's case manager at Early Intervention to begin the funding request process. If the family or private therapist/doctors made the referral, the report, letter of medical necessity, and protocol for submission to insurance is sent to the family.
Consumers receive technical training-language therapy with the assistance of a device. Therapy may address vocabulary skills, initiation of interactions, responding in conversation, pragmatics, sentence construction, spelling, identification of letters or sounds, device use, and/or increasing overall interest in communication. Therapists work with the entire family and anyone else who sees the child regularly.
Consumer age range is from birth through high school. High school students are oftentimes returning for a re-check of their system with the possibility of replacing it with newer technology. However, occasionally a non-verbal, high school aged consumer begins an evaluation without any previous training in AAC.
Consumers with speech deficits, such as apraxia or dysarthria, often have a medical diagnosis of cerebral palsy, Down syndrome, developmental disabilities, autism, or congenital syndrome. Apraxia of speech is an impairment in the sequencing of speech sounds. Dysarthia is a speech disorder that is due to weakness or incoordination of the speech muscles.
Children with learning disabilities also benefit from the use of assistive technology. These children generally are verbal but have issues with writing and organization of thought. Therapists look at software and lower-tech equipment to address these issues.
An AAC Device Does More than Speak!
A speech device can also address environmental control. A consumer is trained to use his/her communication device or other technology to operate lighting, media devices, the television, the bed, and virtually anything electrical—even run the blender, if that's what is wanted!
AAC Devices have more Capabilities when used with a Computer
An AAC device can also be used in conjunction with a computer as the keyboard or tool for generating writing. The ultimate goal for a consumer is to be literate, so therapy often addresses literacy skills, as well as communication. A child who can spell out a word letter-by-letter or program in his own sentences can achieve independence in communication.
Overall, the focus of the evaluation and treatment processes is to facilitate functional communication for a child across all environments.
Kelli McKeough, a certified speech-language pathologist at Infinitec West, was our consultant for this guide. Previously, Kelli worked as Computer Systems Analyst, writing software. While doing volunteer work with two of her friends-an audiologist and a speech-language pathologist-Kelli became very interested in speech pathology. So much so, that she went back to school and earned a master's degree in speech-language pathology. Kelli and the entire staff at Infinitec West are specialists in assistive technology.