“Get rid of that pain in my neck!”

By Gregor Gilmour, Diana

Mountain & Kate McCallum

Gregors AAC History

• AAC strategies since the age of 2– first-pointed to a colour-

coded 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

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

Aim of placementPerson 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.

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

The Big Team

Gregor

SLT

SLT Tech

Wheelchair Services

AT

PhysioOT

Teachers

Keyworker Support

staff

Family

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)

Gregor’s movement

Options previously

tried

Seating, positioning

and mounting

What was possible

AAC equipment available

Access methods

D

Evidence Gathering.To share information between people (Gregor, IT, OT ,SLT, technicians)‘Access Assessment Progress Recording Sheet’Date Bod

y Part:

Type of Switch/Position / Movement / Timings

Activity /Settings

Observations Who

Photo

31.1.12 Eyes DynaVox eye gaze. Dwell. Mount 116 cm f rom floor to bottom of horizontal part of mount

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

ScanningAccess Option What do we know Possible implications Comments Findings

Scanning, 2x head switch, 6 group row Colom. 

Gregor is a whiz.He’s a fast scanner.Knows his program inside out.

Fatigue issues and neck pain

Change to auto?Faster?Anticipation issues?

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

KeyboardAccess Option What do we know Possible implications Comments Findings

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 words through his Perspex shield on his Vmax.

Accuracy, ability to press keys, trailing fingers. Speed. Fatigue.

Will still need mouse access 

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

K

Joysticks, mice, etc…Access Option What do we know Possible implications Comments Findings

Roller plus JoystickMini Pointit joystick 

Gregor drives his chair with a joystick with a golf ball knob.Generally he does this with control and accuracy.

Grip, control, Accuracy, Ability to press buttons, Speed. Fatigue.

Switches can be used as a left and right click 

A Mini point it joystick and a heads switch for a left click.With internal speed setting set to the slowest possible within the windows software. Control sentence complete in 2min.50sec

Roller ball 

  Manipulation, control, Accuracy, ability to press buttons, Speed. Fatigue.

Switches can be used as a left and right click 

 slow and difficult to control

 A Mouse  

  Grip, control, Accuracy, ability to press buttons, Speed. Fatigue.

Switches can be used as a left and right click

  slow and difficult to control

Orbitrack 

  Manipulation, control, Accuracy, ability to press buttons, Speed. Fatigue.

Switches can be used as a left and right click

  slow and difficult to 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 Findings

Headmouse SmartNav 4 AT Head mouse xtream

Gregor has some experience of this though has had limited success.

Positioning and Head control, Accuracy, ability to Dwell/switch to choose buttons, Speed. Fatigue.

Seating and head rest implications. More success in Triton seat.

Seating issuesHard to isolate and hold movements/ Head position.Needed large target areaVocab reduced

D, K

Eye gaze Access Option

What do we know

Possible implications

Comments Findings

Eye gaze• Eye max

• Tobii

Gregor has some experience of this though has had limited success.

Fatigue, control, tonePositioning, mounting seating

Gregors position most relaxed in triton chair

Using Eye Max -Can’t calibrate on eye max – rep in. 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.

G D K

Touch Screen.

Access Option What do we know Possible implications Comments FindingsTouching the screen, using touch enter Touch exit Audio touch Zoom touch 

Gregor can point to words through his Perspex shield on his Vmax.

Accuracy, ability to press keys, trailing fingers. Speed. Fatigue.Language availability due to number of cells maybe compromised.

Device dependant No keyguard not an option- Miss and accidental hits- E.g. Control sentence

complete in 5min.28sec

Touching the screen with Keyguard.  

Gregor can point to words through his Perspex shield on his Vmax.

Accuracy, ability to press keys, trailing fingers. Speed. Fatigue. Language availability due to number of cells maybe compromised.

 Very few key guards in our stockBorrow form Dynavox

Keyguard – PWP 100 Control sentence complete in 58 seconds(Now 26 seconds)

G

ConclusionsDiana: 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.