Health Technology Case Study Twenty-six: Assistive Devices for Severe Speech Impairments Page: 22
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22 . Health Technology Case Study 26: Assistive Devices for Severe Speech Impairments
nicate) whether the client has receptive language
abilities, to what degree, and how best to utilize
them. Some nonspeaking persons, for example,
are at least temporarily incapable of using the
alphabet, and for them a pictorial language like
Bliss symbols also called Blissymbolics may be
either the best language they can master or a way
station toward later learning to read and spell
(17,24).
Blissymbolics is a graphic, meaning based sys
tem, in use in 15 countries, that enables anyone
who can point to a symbol display, or control a
device that presents these symbols, to communi
cate. Because the user selects and transmits the
meaning elements of the message i. e., the sym
bol he need not know how to read, spell, or ana
lyze words into their phonetic components. And,
because a written word or group of words always
accompanies the message, Blissymbolics can be
understood by any receiver who can read. Other
clients may already know how to read and spell
or may show immediate promise of being able to
learn to do so. Without appropriate optimal as
sessment of such language abilities, the chances
of an optimal match between client and commu
nication system are remote.
It is important to remember, too, that advances
in communication aids are to be expected and that
the needs of nonspeaking persons may change
over time. For those whose disabilities are likely
to be stable e.g., most persons whose lack of
speech is congenital-a trade in or refitting op
tion could enable them to take advantage of tech
nological improvements as they come along. The
communication system that serves a 5 year old
cannot be expected to serve an older child or an
adult. Similarly, persons with such progressive
disorders as multiple sclerosis or amyotrophic
lateral sclerosis (ALS) who today can function
with one kind of communication system may need
quite another kind as their condition deteriorates,
something that can happen in the span of only
a few months. Yet insofar as the author could
determine, few manufacturers of personal com-
munication aids make provisions for trade ins or
component refitting, and there are few loan or
rental banks of these devices organized by hos
pitals, clinics, voluntary groups, or other com-
munity organizations.Thinking differs as to when in the assessment
process it is best to even provisionally expose a
client to a choice of commercially available com-
munication aids. In a study of 16 ALS patients
in Britain, Perry, Gawel, and Rose recommended
"that a 'library' of aids be available to patients
so that a good choice may be offered and, as the
disease progresses and manual dexterity dimin
ishes, they may exchange one aid, which is no
longer appropriate, for another that meets their
needs more realistically" (34). This is also the view
of many workers at U.S. education and rehabilita
tion centers who believe that, whatever the reason
for their clients' inability to speak, having an
array of aids on the premises would not be only
advantageous to them, but would also serve to
familiarize the staff with the devices on the market
and new ones as they are introduced.
There are others, however, who believe such
a "library" of aids requires too much financial
outlay or is undesirable on other counts. For in
stance, Bruce Gans, Director of Patient Services
at New England Medical Center's Rehabilitation
Institute in Boston, believes that "to have an ar
ray of technical equipment is a very restrictive ap
proach to the problem (of assessing nonspeaking
persons because) you immediately presume that
your universe of options is right in front of
you. . . . First of all, one must define what the
patient's real needs are" (14).
At The Children's Hospital in Boston, Howard
Shane, Director of Communication Enhancement,
says that a library of devices would not only be
expensive and unnecessary, but would take up too
much space. Instead, his unit asks distributors to
supply videotapes of what their products look like
and how they operate so that clients (some of the
adults) and their parents can view them. If it is
decided that one or another aid may be appro
priate, a trial period is arranged before a recom-
mendation is made to purchase (41).
Obviously, this is a controversial topic. It
should be reported, therefore, that the Institute
of Neurological and Communicative Disorders
and Stroke (a part of the National Institutes of
Health) has awarded Richard Foulds of the New
England Medical Center a contract "to develop
a prescriptive assessment system to determine the
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United States. Congress. Office of Technology Assessment. Health Technology Case Study Twenty-six: Assistive Devices for Severe Speech Impairments, report, December 1983; [Washington D.C.]. (https://digital.library.unt.edu/ark:/67531/metadc39502/m1/28/: accessed April 24, 2024), University of North Texas Libraries, UNT Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.