Primer izveštaja – Izveštaj za Noru
Example of final report – Nora
Full Name of Child: Nora
Date of Birth:
Chronological Age on the last session:
Address:
Date and Venue of last sessions:
13.03.2019 –
26.03.2019 –
8.10.2019 – AT/AAC clinic
TEAM MEMBERS:
Expert speech and language disabilities
Expert motor disabilities
Mother
(Mother).
ABBREVIATIONS:
AT: ASSISTIVE TECHNOLOGY
AAC: AUGMENTATIVE AND ALTERNATIVE COMMUNICATION
EAT: ELECTRONIC ASSISTIVE TECHNOLOGY
BACKGROUND INFORMATION:
Nora is a 8-year-old girl presenting with a diagnosis of a prenatal asphyxia, cortical visual impairment and global developmental delay. Nora is known to AT/AAC Unit since October 2018. In 2018, a report was issued in by previous therapists with recommendations for objects of reference, environmental control units, single voice output communication devices, cause and effect software and pressure adjustable switch for the computer. In the meantime, the mother introduced Nora to the Listen to Me AAC device which has 12 raised buttons that can take voice recordings. She was able to press the button with for example ‘I want music’ recording whenever she goes in the car and ‘I want a drink’ when thirsty. Recently her hand movements deteriorated and a review of her AAC has been requested by her speech and language therapist.
This report is based on assessments carried out in our AT/AAC clinic in the presence of her mother, and communication with her SLT, and class teacher. This report summarises the findings and recommendations because of a review of Nora’s AAC system.
ASSESSMENT RESULTS
PAST AAC SYSTEMS
Nora has used in the past the i-talk 2 to make choice between two. She used to first listen to the options then make the choice. No information was given on the implementation of object of reference. She has is currently using the Listen to Me, which is now not much accessible for Nora due to the deterioration in her hand movements. Previously she was using all words on her device appropriately according to the mother and staff.
She had the following 12 messages on the Listen to Me:
I want to eat Mami I want Music
I want to drink Daddy Yes
Hello Linda No
Bye Hailey I want to sleep
CURRENT COMMUNICATION SKILLS
Comprehension
Nora has been observed to respond to her name by turning her head to the sound source or changing her facial expression. She is also able to understand basic and contextual commands and single word understanding.
Current expression
Nora expresses herself mainly through the use of her body and facial expressions. She does not vocalize.
To indicate that she is enjoying an activity/object/person Nora smiles and laughs. To indicate dislike Nora spits out food. She opens her mouth to indicate she wants more of food and closes her mouth if she does not want more .
Nora uses her Listen to Me AAC Device, both at home and school. Teachers have reported that she uses her system to express basic needs like ‘I want to eat’, ‘I want to listen to music’ as well as greet others using ‘hello’ and ‘bye’. However, they reported that Nora is not using the AAC system much lately because of her hand deterioration.
Functional Communication Needs
Nora would benefit Ca strategies to establish the following:
- Requesting desired objects and activities
- Requesting cessation
- Getting attention Commenting
ADDITIONAL AAC RELATED SKILLS
Seating and Positioning
Nora uses a buggy for mobility purposes and requires the assistance of an adult for propulsion of the buggy.
Sensory Abilities
Nora presents with cortical visual impairment. She reacts in dislike to bright lights. She seems to react to objects when presented in a dark room. Hearing is adequate.
Physical Abilities
Nora presents with very limited movement in her upper limbs due to her increased muscle tone. She is able to slide her left hand to find the switch positioned on the left hand side of her wheelchair. She uses her ulnar side of her left hand to press the switch. In hand manipulation skills and finger isolation are not present. She is able to move her head form left and right and tend to keep her head in flexion. She has kyphosis and scoliosis.
She is currently using a head switch in ICT sessions mounted on her left hand side to operate music or switch adapted toys in a multisensory room. The left side was used as it was identified as having least impact on her spine.
Cognitive Skills
Recent psychological reports are not available. Ca observations of Nora operating a head switch to put on and off music it can be established that she has mastered cause and effect. Additionally, she was also observed that associate words to actions as observed Ca her use of the Listen to Me and anticipate actions e.g. stops whining when she hear the liquidiser operating as she realises that food is being prepared.
HIGH TECH AAC ASSESSMENT RESULTS
In view of the above characteristics, the assessment process involved a thorough discussion with the mother, an extensive online search about the most appropriate high-tech systems available on the market and a trial period.
Since Nora is familiar with head switching this method was identified as a possible access method for Nora. In order to be able to access the possible options she is used to auditory scanning was trialled with Nora. In view of this the new AAC system features had to include switch accessibility, private auditory scanning (in order for Nora to be able to hear these through her headphones) with public voice output and allowed for vocabulary growth. As a result, a number of apps were shortlisted and these are Go Talk Now, Sounding Board and PASCO. Analysis of these apps indicated that the best option was the Go Talk Now app as it not only allowed better navigation between the pages, but also included all the features and specifications that Nora required. As a result, the mother was recommended to download a Lite version of this app so that this could be viewed at home. This was configured to a 4 by 3 layout to replicate the options on the Listen to Me. A trial of a month long was carried out and the mother, SLT and educators were adviced to fill in feedback on trial diary. A long trial was required for Nora to learn and get familiar with auditory scanning. At the end of trial date, the mother had good feedback. Nora understood auditory scanning concept and was able to request her basic needs similarly to what she was doing with the Listen to Me. The educators also commented that Nora was communicating more during the day.
RECOMMENDATIONS:
Following positive feedback Ca the mother and eductors, it was concluded that this system was the most fitting. Therefore, the following software and hardware recommendations are being made.
Product:
Go Talk Now
Description:
A communication application with containing the essential AAC features Nora required in order to have an effective communication system. It contains fully adjustable page layouts, customizable navigation, recorded and text-to-speech capabilities, and an included symbol set.
Product:
Apple iPad 9.7” (6th Gen)
Description:
The hardware needed for Nora’s communication app. The team decided to opt for an iOS system since the communication app is only available on this operating system.
Product:
TobiiDynavox iPad Speech case
Description:
This case is equipped with extra loud speakers, and an ergonomic and durable design, making it ideal for classroom and other noisy situations.
ACTU will provide support for implementation of the system in school and class after purchase as well as technical support.