“Get rid of that pain in my neck!” By Gregor Gilmour, Diana Mountain & Kate McCallum Who we are: • Gregor 3rd year at Beaumont College. He is a keen DynaVox user and strong advocate for people who use AAC. • Kate Speech and Language Therapy Technician specialising in AAC. Qualified as an OT in July 2013. • Diana Speech & Language Therapist Long interest in AAC and person centred working. Where are we from? • Beaumont College was founded in Lancaster in 1977. • We offer both residential and day programmes to Learners. • For young adults aged between 18 and 25 who have both physical and learning disabilities. • Our aim is to empower Learners to take responsibility for their own lives. K The Big Team SLT Family AAC Tech Keyworker Wheelchair Support staff Services Gregor Teachers IT Tech Occupational Therapy Physio G,D Aim of placement Person centred plan to support Gregor‟s plans for the future… 1st year Objectives: included • Develop independence (directing, accessing IT) • decide on the most appropriate access method, after a trial of eye-gaze. 2nd year Objectives: included • continue to play an active role in finding an appropriate access method for communication, environmental controls and IT. D Connect 2 Control Project • • • • Successor to The Wheeltop Project. 3 year research project funded by BT. Increase independence. Through mainstream and „age and disability‟ badged environmental control systems. G 1 Voice – communicating together • • • • • Listen to me Weekends Website Role models 1 Voice – Communicating Together - really how it helped. K,G Gregors AAC History • AAC strategies since the age of 2 – first-pointed to a colourcoded A4 book – hand function was poor – Book became so large, that I needed an alternative. K,G Switch Skills • Learning switching skills using switch toys. • First trialled a high-tech AAC at age 2.5 in 1:1 SLT sessions. • Unable to communicate, frustrated as a small child. K,G Moving to High - Tech • After using symbols for a short time, I quickly established literacy skills (aged 6). • Age of 5 used DynaVox devices, via two head-switches. K,G D After 12+ years of using switches • I thought that this was it! • I have now discovered new access methods, and now (sometimes) use a combination. • The aim of the session will be to share all the ways I was helped to find a new access method to my communication aid. G, D AAC Starting college. Low - Tech - Spelling Board High – Tech - DynaVox V Max - 2 x Head switches (& Eye Max) - Group Scanning - Scanning WordPower G, K Getting a baseline • We used a test sentence. • “I am going to Scotland this weekend. What are you doing?” • Original time Scanning = 1 min, 20 secs D What we did AAC programs (page sets) Options previously tried Gregor‟s movement What was possible Seating, positioning and mounting Access methods AAC equipment available D Evidence Gathering. To share information between people (Gregor, IT, OT ,SLT, technicians) „Access Assessment Progress Recording Sheet‟ Date 31.1.12 Body Type of Activity Part: Switch/Position /Settings / Movement / Timings Eyes DynaVox eye gaze. Dwell. Mount 116 cm from floor to bottom of horizontal part of mount Observations Who Photo Gregor was able to navigate around the letters page and speak and clear messages. He became tired quite quickly today. He was more accurate than when using head mouse and much quicker but told me he preferred the head mouse. His head position was off midline (see photos) SA D All the different methods Need to be considered motivation and fatigue Need word prediction for speed. G, K Language Packs • 1 Voice Role Models • Minspeak – Speed – Cognitive load – Learning – Access • Gateway • Grid • Word Power D, K Scanning Access Option What do we know Possible implications Scanning, 2x head switch, 6 group row Colom. Gregor is a whiz. Fatigue issues and neck pain He‟s a fast scanner. Knows his program Change to auto? inside out. Faster? Anticipation issues? Comments Findings This is Gregor preferred access method for communication and at this moment he does not want to change this. We did not trial different options. Gregor choose to go down other avenues first. K Keyboard Access Option What do we know Possible implications Computer keyboard’s  Standard  Standard with Keyguard  Compact Computer keyboard  Compact Computer keyboard with keyguard  Big Keys  Big Keys with Keyguard  Intelly keys Gregor can point to Accuracy, ability to press words through his keys, trailing fingers. Perspex shield on his Speed. Fatigue. Vmax. Comments Will need mouse access Findings still No keyguard not an option - Miss and accidental hits - Big Keys 3 min.29 sec - Intellikeys - “This weekend I am going to Scotland” (3min). G Joysticks, mice, etc… Access Option What do we know Roller plus Joystick Mini Pointit joystick Gregor drives his chair Grip, control, Accuracy, Switches can be used as a A Mini point it joystick and a heads switch for a left click. with a joystick with a golf Ability to press buttons, left and right click With internal speed setting ball knob. Speed. Fatigue. set to the slowest possible Generally he does this within the windows software. with control and Control sentence complete accuracy. in 2min.50sec Roller ball A Mouse Orbitrack Possible implications Manipulation, control, Accuracy, ability to press buttons, Speed. Fatigue. Grip, control, Accuracy, ability to press buttons, Speed. Fatigue. Manipulation, control, Accuracy, ability to press buttons, Speed. Fatigue. K Comments Findings Switches can be used as a slow and difficult to control left and right click Switches can be used as a slow and difficult to left and right click control Switches can be used as a slow and difficult to left and right click control Wheelchairs All access methods are going to be affected by Gregor‟s seating and positioning. G, K Head Mouse Access Option What do we know Possible implications Comments Headmouse  SmartNav 4 AT  Head mouse xtream Gregor has some Positioning and Head Seating and head rest experience of this though control, Accuracy, ability implications. More success has had limited success. to Dwell/switch to choose in Triton seat. buttons, Speed. Fatigue. Findings Seating issues Hard to isolate and hold movements/ Head position. Needed large target area Vocab reduced D, K Eye gaze Access Option Eye gaze • Eye max • Tobii What do we know Gregor has some experience of this though has had limited success. Possible implications Fatigue, control, tone Positioning, mounting seating Comments Findings Gregors position Using Eye Max -Can‟t calibrate on eye max – most relaxed in triton rep in. chair Gregor struggled to calibrate system without support to hold his head. Mounting complicated by weight of device and distance from him and unintentional movements. Gregor to sell eye max. Tobii PC eye go - Good control using – but tone increasing and fatigue. GDK Touch Screen. Access Option Touching the screen,  using touch enter  Touch exit  Audio touch  Zoom touch What do we know Gregor can point to words through his Perspex shield on his Vmax. Possible implications Accuracy, ability to press keys, trailing fingers. Speed. Fatigue. Language availability due to number of cells maybe compromised. Touching the screen with Gregor can point to Accuracy, ability to press Keyguard. words through his Perspex keys, trailing fingers. shield on his Vmax. Speed. Fatigue. Language availability due to number of cells maybe compromised. Comments Device dependant Findings No keyguard not an option - Miss and accidental hits - E.g. Control sentence complete in 5min.28sec Very few key guards in our Keyguard – PWP 100 stock Control sentence Borrow form Dynavox complete in 58 seconds (Now 26 seconds) G Dual Access • Touch Screen & Scanning. • Combined language packs • Dropped Scanning with a few weeks. D, K Lightwriter Access Option Light writer with keyguard What do we know Gregor can us touch screen and keyboard well. Possible implications Accuracy, ability to press keys, trailing fingers. Speed. Fatigue. Comments OH s**T Dynavox is broken and we‟re in the middle of writing my CM talk. Findings Need a keyguard; Control sentence complete in 1.23 sec K Conclusions Diana: I‟ve learned to • make no assumptions! • retry things • Importance of sharing decision-making with the user. (share & enable this) Conclusions Kate: • A holistic view of a person • Opportunity to actually try out options (not just theory of what should work) • Established method doesn‟t always mean the best method. (needs regular reviewing) K Conclusions • Gregor: I can now talk 3 x faster and people are amazed by the difference and I have got rid of the pain in my neck caused by switching. Switching has been brilliant and I am fortunate that my body has changed so I can now access my communication aid faster. Future Plans…. • Gregor has a 3rd year at college Still lots more to work on… • communication skills (spelling, conversational art, taking responsibility etc.) • physical skills • And a business plan? • Trial new AAC devices & gain funding • Fingers crossed attend ISAAC 2014. D Thanks Questions?