Page 206 - Handbook of Electronic Assistive Technology

194 HANDBOOK OF ELECTRONIC ASSISTIVE TECHNOLOGY

Health Condi on
(disorder or disease)

Body Func ons Ac vity Par cipa on
& Structure

Environmental Personal
Factors Factors
FIGURE 7-3 International classification of functioning, disability and health framework�

writing. However, in recent years there has been an increasing interest in the use of the
International Classification of Functioning, Disability and Health (ICF) (World Health
Organisation, 2001a) and the subsequent adaptation for children and young people
(World Health Organisation, 2001b) as frameworks for guiding the assessment process,
supporting structured clinical decision-making and summarising results using a common
language (Adolfsson et al., 2011; Fried-Oken and Granlund, 2012; Rowland et al., 2012).
The model focuses on a person’s functioning, especially their participation, aiding in the
identification of barriers and facilitators to AAC use. Since the ICF operates as a theoretical
framework of related domains it is an ideal tool to reflect the potential impact of inter-
related factors on AAC intervention (Fig. 7-3). The domains of the ICF are used in the fol-
lowing discussion of key points that should be considered during an assessment for AAC.
Assessment for AAC systems will always be a highly individualised process and it would not
be practical to describe every permutation of such an assessment in this chapter. The assess-
ment of children with congenital disabilities will clearly differ vastly from the assessment of
adults with acquired physical or neurological disabilities. However, the ICF framework has
offered a framework of considerations when approaching assessment for an AAC system.

Body Functions and Structure

Key to any AAC assessment is the understanding of the user’s physical abilities and the
functional impact that any impairments may produce. It is reasonable to assume that
these assessments will include as a starting point the assessment of speech and oromo-
tor function. Assessment of speech will help highlight the need for AAC and may include
assessment of speech clarity, articulation, consistency and rate. In addition to this, the
various subsystems related to speech, including respiration, phonation, resonance and
articulation, should also be assessed. A person who, for example, can produce speech with
relative clarity only in short utterances due to respiratory difficulties may have a need for
AAC to support the production of longer utterances. Similarly, optimising a person’s pos-
ture or seating may help to increase the utterance length and reduce fatigue, leading to
improved use of a person’s natural speech.
A person’s sensory functions must also be fully understood when considering design
and provision of an AAC system. Principally, a person’s vision, ocular motor function
and visual function should be assessed, since most AAC systems rely primarily on the use