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December 28, 2016

Assistive Technology Device Provides a Voice for Craig Patients

Craig Hospital’s Assistive Technology Lab is the place where new technology meets patients with daily living or communication needs. Specially trained occupational and speech therapists provide hands-on education and training to help patients and their families through therapy and prepare for life at home.

Imagine not being able to speak. You have things you want to say, but no way to verbalize your thoughts. This was the situation Miguel Garcia Vazquez, 22, was in following a brain injury.

“He can say “ahh.” He really can’t verbalize anything else, but his language and cognition are intact,” said Sarah Foley, a speech pathologist in Craig’s Assistive Technology Lab. In addition, Miguel’s physical abilities were limited to head movement.

When he first arrived at Craig, Miguel’s team started communicating with him by having him nod yes or no.

Eventually therapists introduced him to an Augmentative and Alternative Communication (AAC) device, the Tobii Dynavox I-Series. An AAC device is a computer with specialized software that allows the person to select pre-programmed words and phrases or letters on an on-screen keyboard; the computer speaks these responses once they are selected. Initially Miguel was able to use a switch and row-column scanning to select what he wanted to say. Miguel’s switch was attached to the headrest on his wheelchair. The first time he had access to an entire keyboard; he spelled out, “hablar.” He wanted to talk.

“He was able to do it the first time we introduced it to him. He’s been able to pick things up just like that,” said Sarah. But the process of selecting things with a switch was arduous. It involved scanning through each option to get to one letter at a time.

Working closely with Miguel’s occupational therapist to monitor his improvements in eye movement, Sarah and the rest of Miguel’s team decided to have him try a different way to choose what he wanted to say – eye-gaze selection. With this method, a camera in the computer reads Miguel’s eye movements and calibrates them with what he is looking at on the screen. Miguel was immediately able to spell out his thoughts with much greater efficiency.

Craig currently has four of the Tobii I-Series devices in the hospital. One is used for therapy and for patients like Miguel who are unable to communicate verbally. The other three are part of a pilot project, called HIP (Healthcare Integration Program) and are on loan from Tobii Dynavox to use as temporary communication devices for people with high-level spinal cord injuries.

“Many of our patients who come to Craig on ventilators are unable to speak when they first arrive. We offer the HIP program devices as a temporary solution until they are able to vocalize again,” said Jill Baldessari, OTR/L, ATP, assistive technology specialist and supervisor of Craig’s Assistive Technology Lab. Many of these patients are able to speak within a week or two of arriving and do not need the assistance of the device for long.

For Miguel, the Tobii Dynavox I-Series allows him to speak in English to his therapists and Spanish to his parents. He uses it in therapy to communicate his needs and wants and outside of therapy he surfs the Internet and text friends, like other 22-year-olds.

“He wanted to show us a YouTube video, but we had an old version of the browser on the computer. He upgraded Mozilla with his eyes,” said Sarah. She’s impressed with his ability to adapt to the technology so quickly.

“It’s been pretty special to watch,” she said.