Page 217 - Handbook of Electronic Assistive Technology

Chapter 7 • Alternative and Augmentative Communication 205

mount which was attached to the rear of the chair and required a significant amount of
adjustment to swing into place, including the use of Allen keys. At referral, Nikhil’s local
team wanted to consider options for AAC software, the possibility of using eye-gaze access
technology and, if this were not possible, how his current head switches could be adapted
or replaced for more efficient access. A request was also made for any eventual system to be
mounted to his wheelchair to support access to AAC across a range of contexts.

Assessment and Outcome
At an initial appointment the team discussed goals for AAC with Nikhil, his family and his local
team. A number of motivating factors were identified, including his wish to talk with family
and peers about his favourite sport. His local team were keen to focus on expanding his lin-
guistic skills by allowing him to construct novel utterances using grammatical elements. It also
transpired that Nikhil was keen to make use of his hands as an access method. He also reported
to the team that he did not like the way the existing head switch set-up looked and functioned.
His language was assessed using an adapted language assessment which was conducted
through partner-assisted scanning (where the clinician pointed to each item in turn and
Nikhil indicated when his choice was highlighted in this way) and it was determined that
his language was at approximately a 4–5 year level. The outcome of the language assess-
ment and observation of his use of some introductory AAC software during this initial ses-
sion guided the team’s thinking regarding the vocabulary that would be required on an AAC
device. It was agreed that he would benefit from symbol support and that he would ben-
efit from exposure to a ‘core’ language approach which would allow the flexibility to build
utterances from grammatical elements such as prepositions, verbs and categorised nouns.
Of equal importance was the access method that Nikhil would use to make selections
on the device and the hardware that would form the base of the system. Since his vision
was described as being broadly within normal limits, it was agreed that a standard size
tablet (13″ screen) would be most practical to take into account requests to mount the final
system. The team also trialled a number of different access methods with Nikhil to ensure
that the vocabulary could be organised and accessed in an efficient way. Eye-gaze tech-
nology was trialled, although this was rejected as issues with various cameras accurately
tracking his eyes meant that it was not possible for Nikhil to control a system with enough
accuracy to permit the amount of cells he would likely require on each page. Ensuring
that Nikhil’s wish to try using his hands was respected, the team trialled direct access to a
touchscreen with a variety of modifications such as delayed activation and the addition of
a touchguard. However, the use of a touchscreen resulted in a high number of accidental
activations and was noted to be tiring and frustrating for Nikhil, so it was discussed with
him that perhaps an alternative access method should be identified.
The team looked at the use of head switches and found that Nikhil’s head control was
sufficient to control and use bilateral head switches, which allowed him a high level of con-
trol over the speed of his scanning. It was also identified that, with practice, Nikhil could
make use of column/row scanning to further enhance his selection rate and could make
use of an additional cancel function if he needed to restart the scan. With this in mind,
the team constructed a smaller, more adjustable and discrete head switch array for Nikhil,