Speech Language Pathology Augmentative Communication Evaluation

Transcription

1 Speech Language Pathology Augmentative Communication Evaluation Request for Speech Generating Device (SGD) Funding: Name: DOB: Address: Medical Diagnosis: Date of Onset: Birth Medicaid/Medicare/Insurance Number: Primary Contact Person/Phone: Speech/Language Pathologist/Phone: Physician/Address/Phone: Date of SLP Evaluation: Date of Report: Evaluating Team/Credentials 1. Pertinent Background Information: 1. Medical diagnosis 2. Significant medical history and medications 3. Communication disorder(s)/diagnosis and severity of diagnosis 4. Past speech/spoken language treatment 5. Consumer s history, vocational status 6. Living environment Example: Client presents with a severe expressive language disorder secondary to a medical diagnosis of Autism. Client has received speech and language services throughout his/her life and is currently receiving speech times a week. Although speech therapy has resulted in improved receptive language skills, Client continues to be severely limited in expressive language. Client currently lives at home with his parents and siblings and attends school at School in, NY. 2. Speech, Language and Communication Abilities: (include the following) 1. Cognition as related to SGD uses (e.g. cognitive-language pre-skills evident; cause and effect). 2. Documentation to establish cognitive level allows for functional and appropriate use of the device. 3. Associated behaviors needing consideration (e.g. attitude/motivation, memory, ability to focus/attention to task, reasoning skills, learning, concept/vocabulary knowledge) 4. Reading, spelling skills

2 Describe oral-motor ability, speech, auditory reception skills (follows conversation, 2- step directions, etc), reading (pre-emergent, limited to a few sight words, reads at the sentence level), ability to combine words using pictures, and spelling ability. Rule out writing as a main mode of communication (can t spell functionally, impaired motor abilities make it impossible). Provide results of any standardized tests. Example of cognitive abilities: Client is able to sustain attention for activities using pictures, and is able to make simple requests when presented with pictures. Client demonstrated understanding of cause/effect, and demonstrated new learning during the evaluation by remembering how to navigate pages to locate needed vocabulary. Behaviors: Frustration level with not being understood-- attitude and motivation during the trial with the SGD. Example Client s frustration level would increase when he is not understood. During the trial with the SGD his level of frustration decreased significantly. This SGD opened a whole new world for Client. Include a statement like this: Client possesses the cognitive/linguistic abilities to effectively use a SGD to communicate and achieve functional communication goals. 3. Limitations of Current System and Communication Needs 1. Summary of the limitations of current methods of communication (e.g. inadequate ability to express known vocabulary) Examples: Gestures, sign language, writing, and communication boards 2. Communication environments during a typical day- Examples: Home, School, Day programs, and Medical appointments 3. Primary communication partners, including special challenges (e.g. visual impairment, wheelchair user, second language) and exchange needs (e.g. group, face to face) 4. Message modes (e.g. attention getter, print, telephone) 5. Consumer preferences (e.g. consumer opinions about devices and peripherals) 6. Communication needs over next two years (e.g. large vocabulary access, spelling capability, communication with groups) Remember to list all the client s customary communication environments (home, school, sheltered workshop, therapy, etc.) as well as situations (participate in conversations, direct care, interact with teachers and peers at school, express medical needs, get attention from another room, etc.) Include a statement like this: Client s daily functional communication needs cannot be met using natural communication methods or low-tech/no-tech AAC techniques because (be specific).

3 Examples: Communication symbols, communication boards and PECS These methods limit communication to the symbols provided in a book or board. Managing these symbols and having them readily available to the individual during communication opportunities presents a challenge to independent, easily accessible communication. Navigating through pages of language and/or individual symbol cut outs (usually with the assistance of others) slows down or completely stops the communication process. Picture boards and PECS have been used and not found to be an effective means of communication. The focus inevitably shifts to managing the communication system at the cost of the individual independently communicating preferences, wants and medical needs. Furthermore, these systems have no voice output, nor are they able to create novel messages. Without voice output an individual cannot independently call for help or direct attention to medical needs with someone who is not familiar with the system. Communication is limited to communication partners who understand the symbols, and even then, the communication partner is left to determine the intent behind an individual touching a particular picture symbol. Sign language Sign language is not a viable option for communication due to the physical limitations of (Name) and the inability of most communication partners to understand this method of communication This is not an adequate form of communication for (Name) as (he/she) is limited in (his/her) acquisition of signs, and most people in his everyday environment are not competent in sign language. This limits (his/her) communication partners and renders (him/her) unable to meet (his/her) daily communication needs. 4. Sensory Functioning 1. Visual ability as related to SGD system (e.g. visual tracking abilities, acuity for symbol size, material on screens) Include the following elements if/when pertinent to SGD use/selection: acuity, visual tracking, visual field, size of symbols, size of font, number of words or symbols and spacing. If there are no special visual needs, you may simply state that vision is corrected with glasses, for example. Include a statement like this: Client possesses the visual abilities to effectively use a SGD to communicate functionally. 2. Auditory ability as related to SGD system (e.g. speech feedback) Example: Client s hearing appears to be within normal limits, and he/she responds to requests made at normal conversation levels. Client is able to hear and understand synthesized speech on an SGD. If a hearing loss is present, include information about aids, and a recent audiogram if possible. Include a statement: Client possesses the hearing abilities to effectively use a SGD to communicate functionally.

4 5. Postural and Motor Abilities 1. Mobility status (e.g. ambulatory, wheelchair user-manual/power) 2. Primary postures/positions across a typical day and % of time in position (e.g. wheelchair, bed, stander) 3. Information on positioning needs with regard to the communication device should be included (trunk and head position; needed supports) 4. Need for integration of mobility related equipment with communication system (e.g. with walker, power wheelchair controls) The greater the physical impairment, the more information needed. Include this statement: Client possesses the physical abilities to effectively use a SGD and required accessories to communicate. 6. Access/Selection Techniques 1. Description of optimal selection technique(s), the physical movement(s) used and any pointer, guards, etc. needed (e.g. direct selection with light pointing via head movements; group-item scanning, size of symbol needed to scan accurately) 2. Ability to use selection technique(s) (e.g. movement quality, range of motion, endurance) 3. Need for multiple techniques in device (e.g. progressive disease; use in chair/bed) 4. Optimal placement and set-up of system (e.g. optimal height and angle of device/manual display, mounting system(s), optimal switch site(s)) 5. Alternative access methods explored, length of trial/training, education/training provided, and specific reason(s) why ruled out Describe how the person will access the SGD (direct selection, scanning, Headmouse, eye tracking) and the person's access requirements. It is especially important to document all access method trials, and for how long the client used them. For access using eye tracking, discuss why all other access methods were ruled out. This is extremely important! Example: This client requires the use of an eye tracking system because eye movement is the only reliable body part over which he/she has volitional control. Client is unable to use extremities for switch access due to (describe in detail: spasticity, paralysis, inability to perform repetitive movements needed to activate a switch all day long, due to fatigue). Client does not possess the head control to use head tracking due to (describe in detail: inability to keep the head in an upright position, compromised neck muscles due to ALS, lack of ROM for vertical and lateral movements required for head tracking ).

5 7. Symbol Form 1. Ability to use various graphic and auditory symbol forms (e.g. photographs, line drawings, spoken letters or words for auditory scanning, sight words, alphabet for spelling List necessary symbol type, like color PCS, access to visual scenes, real photos, etc., as well as the need for a keyboard if appropriate. 8. Vocabulary Storage and Rate Enhancement Techniques 1. Vocabulary storage/rate enhancement techniques considered (e.g. semantic and letter coding; pages/pop-up pages; word prediction) 2. Ability to use specific techniques under consideration 3. Rate/storage options deemed appropriate Examples: Client needs a device with large storage capacity, categorical vocabulary organization and the ability to use/create visual scenes for contextual cues. Client has had experience with PCS symbols in low-tech classroom settings and is familiar with them. Client demonstrates early literacy skills and would benefit from word prediction since he/she often gets the first letter correct. 9. Delineation of Features of Communication System 1. Summarize required device features. This may include, but is not limited to; Memory needs for vocabulary storage Symbol form(s) Communication output(s) (e.g. paper printer, visual display(s), digitized or synthesized speech, etc.) Selection technique(s) and related adaptations (e.g. direct selection with medium sized keyboard; keyguard) Mounting system and stabilizers (e.g. mount to hold device; switch) Vocabulary storage and rate enhancements techniques (e.g. levels; word prediction) Portability (e.g. weight, size) Durability (as related to environment, mounting, transportation, etc.) Special needs (e.g. integration with other technologies such as computer or power wheelchair, ability to interface with environmental controls)

6 Examples: Client requires a system with extensive vocabulary, portability for independent transport, dynamic display touch screen with access to pre-stored messages as well as single-word vocabulary for combining symbols into novel utterances. The system must have adequate battery life to get through the day. Because of his tendency to select the wrong target due to fine motor problems, the system must support a keyguard. It must also provide Client with an on-screen keyboard, and be able to provide multiple sets of vocabulary arrangements to meet growing needs. 10. Communication Systems Considered and Ability To Functionally Utilize 1. Communication devices considered as related to needed features 2. Comparisons of systems capabilities as related to user needs 3. Optimal device from among those considered; how this meets communication needs and it s components for meaningful communication 4. Discussion of the less costly alternative devices (including SGD software/programs for beneficiary owned equipment and lower level devices) pursued with specific justification why they were ruled out. Include results of any trials including length of trial, education/training provided, and specific reason(s) why they were ruled out 5. If possible, consumer s opinion of SGD device selected 6. Include data collected on simulated/trial device 11. Goals and Trial Results 1. Functional communication goals for trial (time framed, measurable, and functional) prior to trial 2. Goals achieved at the completion of the trial. Must include quantitative measures of functional communication outcomes and goals. 3. Length of trial, location(s) of trial, frequency/duration of use during trial period Example: A. Document what length of trial period has taken place and with what device, what the goals were during that trial period and how the user met those goals. Make sure the goals are attainable and relate to communication and medical issues. List at least 5 goals and detailed description of how each goal was met. Document client showing independent use of trialed SGD in ALL environments.

7 Address if the client can show: 1. Create novel messages? 2. Was the device used in community with unfamiliar communication partners in a functional manner, provide examples. 3. Discuss progress made for each goal at the end of trial period. 4. Is the client independently managing and using the features on the device? 5. Is the client independently navigating pages/screens in a timely and functional manner? B. If a mount was trialed with the device, include length of the trial and success with the accessory or mount. Example: If you are recommending a ConnectIT Mount over a Daessy, please make sure that it is documented as to why and how the ConnectIT Mount can be positioned in a way that the Daessy Mount cannot. You need to physically describe how the Connect It Mount is placed so the reviewer can visualize the positioning problems that are being accommodated for. C. If using an alternate access method for selection (such as the HeadMouse or EyeMax) list the goals that were set and exactly how they were accomplished. 4. Long term goals should be provided when the minimum coverage criteria are met and the beneficiary s plan of care calls for a more advanced level of proficiency in the future (e.g.: first time users, children). Example: Document 2-3 goals that correspond to specific daily functional communication and medical needs in each of the following areas Linguistic, Operational, Social and Strategic competencies, and illustrate how the patient will benefit from the acquisition of and training on the SGD. If you are unsure of long range goals refer to the goals from the AAC Goal Grid. Linguistica. Will combine two or more symbols to indicate medical status, needs or emotional state. b. Will tell or retell a story related to a particular event or context with minimal assistance. Operationala. Will turn device on in preparation for communication b. Will navigate to page contextually relevant page to access communication

8 Social a. Will use humor during social interaction b. Will spontaneously use greetings and farewells with by incorporating quickfires and my phrases. Strategic a. Will select from 1 or more messages to prevent communication breakdown After signaling a misunderstanding, will utilize 2 or more strategies to repair misunderstanding. 12. Environmental Supports 1. Capacity and need of family/caregivers/staff/friends to assist in care and maintenance of SGD device (e.g. charging; daily set-up) 2. If applicable, need of family/caregivers/staff/friends to participate in necessary training and facilitate use of SGD device 3. Availability of clinical support in the consumers immediate area 13. Communication System Ordered 1. Documentation as to how this system meets the beneficiary s medical needs for functional communication in all customary environments. 2. Description of device and all components and accessories 3. Benefits to user over other possible systems 4. Intended location(s), frequency, and duration of use 5. Indication of purchase or rental with statement of justification 14. Implementation and Follow-up Plan 1. Initial treatment plan for implementing use of device. This may include but is not limited to: (Include the name of person/agency currently responsible for services if possible; if not provide a plan for establishing these services) 2. Initial set-up of system (e.g. initial check, setting up mounting system) 3. Establishing and implementing a treatment plan (e.g. goals for language and communication; device operations) 4. Initial vocabulary analysis and selection, display lay-outs and programming 5. Training significant partners (e.g. care and maintenance, facilitating interaction 6. If rental is indicated, include goal plan initiated at the beginning of the rental period and objective measures achieved upon completion 7. Probable modifications within ordered system that will require future funding (e.g. switch for individual with ALS, additional memory) 8. Agency/Individual responsible for follow-up evaluation and recommendations

9 15. Upgrade or Replacement of a Previously Provided Device 1. Upgrading devices is considered when an unanticipated change occurs in the beneficiary s needs, capabilities, or potential for communication. When upgrading devices, the documentation must establish what significant changes have occurred in the beneficiary s physical or linguistic abilities, or social environment, and how these changes impact the beneficiary s ability to functionally communication with the current SGD. The documentation must address the specific improvement in functional communication and reduction of disability to be achieved by the ordered device that cannot be achieved with the current device. 2. When replacing an existing device with same or similar, the documentation must establish the reason(s) why the existing device is no longer medically appropriate and why replacement is required. 16. Signatures 1. The speech language pathologist must sign the evaluation, provide his/her license number and pertinent contact information, and Non-conflict statement. 2. All other professionals directly involved in the evaluation should sign and provide their license numbers, NPI, and contact information.