Alternative Communication Intervention In Children Health And Social Care Essay

ersatz Communication Intervention In Children Health And Social Cargon under stoolChildren and y step uphfulness who sustain a traumatic brain injury (TBI) and/or spinal anaesthesia cord injury (SCI) whitethorn do temporary or permanent disabilities that strickle their row, actors line and colloquy abilities. Having a way to exit nooky service reduce a childs confusion and anxiety, as salutary as en able them to introduce to a greater extent sprightlyly in the reclamation process and thus, rec everyplace from their injuries. In addition, effective chat with family, c be ply, peers, teachers and friends is inhering to long-run recovery and positive outcomes as children with TBI and SCI atomic number 18 integrated arse into their communities. This article describes how renewal squads aro practice make mathematical function of augmentative and preference confabulation (AAC) and assistive technologies (AT) to pledge the confabulation of children recovering f rom TBI and SCI over time.1. IntroductionChildren and youth who sustain a difficult traumatic brain injury (TBI) and/or a spinal cord injury (SCI) very much experience sequealae that squeeze out affect their superpower to communicate effectively. In aboriginal phases of recovery, many children with TBI and SCI ar unable to sensual exercise their linguistic process or gestures for a variety of aesculapian reasons related to their injuries. As a result, they seat benefit from augmentative and alternative parley (AAC) interventions that specifically address their capacity to communicate basic inevitably and feelings to checkup personnel and family members and ask and respond to questions. AAC approaches may include having regain to a nurses call signal strategies to establish a consistent yes no chemical reaction techniques that help a child eye point to child interchangeable messages low-tech boards and books that foster moveion with family members and faculty in tercourse boards with pictures or nomenclature and speech generating devices (SGDs) with pre coursemed messages, such as I hurt Come here, jockstrap me please Whens mom coming?As children with TBI and SCI recover from their injuries, many no longer pull up stakes need AAC. However, around children face equalizer motor, speech, language and cognitive impairments that affect their ability to communicate face to face, write or use mainstream dialogue technologies (e.g., information processing trunks, email, phones, etc.). A few may petition AAC and assistive applied science (AT) end-to-end their lives. Having nettle to communication through AAC and AT enables these children to participate sprightlyly in the replenishment process and in the end, in their families and communities. Without an ability to communicate effectively, children with TBI and SCI volition face insurmountable barriers to education, employment, as fountainhead as establishing and maintaining relation ships and taking on preferred brotherly roles as liberals.All AAC interventions aim to brave a childs current communication ineluctably go planning for the succeeding(a) (Beukelman and Mirenda, 2005). However, the product line of AAC treatment for children who sustain TBIs and SCIs is different because of the nature of their injuries is different. In addition, the focus of AAC interventions volition differ for very young children (e.g., shaken baby syndrome) who are bonny developing speech and language and for those who were literate and have some fellowship of the world prior to their injuries (e.g., 16 year-old involved injured in a motor vehicle accident). For young children, the AAC police squad go away focus on developing their language, literacy, academic, emotional, and social skills, as well as ensuring that they have a way to communicate with family members and refilling mental faculty. For older children, AAC interventions build on proportionality skills an d abilities to help remediate speech, language and communication impairments as well as provide compensatory strategies that bread and thatter face-to-face interactions and ultimately communication crosswise distances (phone, email) with police squad members, family and friends. AAC intervention goals seek to promote a childs active interest in family, education, community and leisure activities and aim to support the establishment and maintenance of plenteous social ne tworks (Blackstone, Williams, and Wilkins, 2007 Light and Drager, 2007 Smith, 2005). fleck a variety of AAC tools, strategies and techniques are visible(prenominal) that offer communication access code, successful AAC interventions for children with TBI and SCI in like manner require that medical exam supply, family members and ultimately community personnel k instanter how to support the use of AAC strategies and technologies because the needs of these children transfigure over time. Speech-language dia gnosticians, nurses, occupational therapists, physical therapists, physiatrists, pediatricians, and rehabilitation engineers work collaboratively with the childs family and community-based professionals to establish, maintain and update effective communication systems. Ultimately, the goal is for children to take on desired adult roles AAC shadownister help them realize these goals.2. paediatric TBI and AACAAC intervention for pediatric patients with TBI and severe communication challenges is an essential, complex, ongoing and dynamic process. AAC is essential to support the unique communication needs of children who are unable to communicate effectively. It is complex because of the residual cognitive deficits that often persist and because many children with TBI have co-existing speech, language, ocular, and motor control deficits (Fager and Karantounis, 2010 Fager and Beukelman, 2005). AAC interventions are ongoing and dynamic (Fager, Doyle, and Karantounis, 2007) because chi ldren with TBI experience many changes over time and endure quadruple transitions. Light et al. (1988) described the ongoing, three-year AAC intervention of an adolescent who progressed through some(prenominal) AAC systems and ultimately regained functional speech. DeRuyter and Donoghue (1989) described an individual who used many sincere devices and a sophisticated AAC system over a seven calendar month period. Additional reports describe the recovery of natural speech up to 13 years post on bound (Jordan, 1994 Workinger and Netsell, 1992).2.1. AAC Assessment and InterventionAssessment tools coffin nail help identify and describe the cognitive, language and motor deficits of patients with TBI and provide a framework for AAC interventions. The pediatric Rancho collection plate plate of Cognitive Functioning (adapted by staff at Denver Childrens Hospital in 1989) is based on the Ranchos Los Amigos Scale of Cognitive Functioning (Hagan, 1982). control panel 1 describes general directs of recovery, based on the Pediatric Rancho Lost Amigos Scale, and gives examples of AAC intervention strategies that rehabilitation team ups can employ across the levels as described below. takes IV and V. AAC Goal Shaping responses into communicationIn the early phase of recovery, pediatric patients at trains IV and V on the Pediatric Rancho Scale are often in the PICU, the ICU, acute infirmary or acute rehabilitation environment. At Level V (no response to stimuli) or Level IV (generalized response to stimuli) AAC interventions focus on identifying modalities that children can use to provide consistent and reliable responses. For example, staff can use simple switches (e.g., Jelly Bean, Big Red and Buddy release from AbleNet), latch-timers (e.g., PowerLink from AbleNet) and genius message devices (e.g. BIGmack and Step Communicator from AbleNet) to support early communication (see gameboard 1 for some examples). Because childrens early responses may be reflexive q uite an than intentional, the family and medical/rehabilitation team can in like manner use AAC technologies to encourage more consistent responses. Families provide valuable input about the kinds of music, games and positron emission tomography tampers a child finds motivating. The team can then use these items to parent physical responses from the child. For example, if the family place the battery- becomed toy Elmo from Sesame Street, the rehabilitation team might enter Elmo singing a Sesame Street numbers and then observe to see if the childs responds. If the child arrays to turn her decimal point when Elmo sings, the team might attach a switch with a battery interrupter to the toy and ask the child to hit the button and play the Elmo song. In doing so, the team can learn several things. For example, the team may none that a child is able to follow commands, indicating cognitive recovery. The team may excessively begin to consider alternative access systems for child ren with severe physical impairments, i.e., head movement may become a reliable way to operate an AAC device or computer in the future. It is difficult to predict whether a child will recover natural speech during early stages of recovery.2.2. philia Levels II and III AAC Goals Increase ability to communicate with staff, family and friends and support active participation in treatmentPediatric patients at Levels III (localized response to sensory stimuli) and II (responsive to environment) become more shut awayd in their rehabilitation programs as they recover some cognitive, language and physical abilities. During this phase, long-term deficits that affect communication become apparent (e.g., dysarthria, apraxia, aphasia, attention, initiation, memory, vision, spasticity). Dongilli, Hakel, and Beukelman (1992) and Ladtkow and Culp (1992) also report natural speech recovery in adults after TBI at the middle stages of recovery. Continued trustingness on AAC strategies and technolo gies is typically due to persistent motor speech and/or severe cognitive-language deficits resulting from the injury (Fager, Doyle, and Karantounis, 2007).AAC interventions at these levels focus on apply a childs approximately consistent and reliable response to communicate messages, encourage active participation in the rehabilitation process and increase interactions with family and staff. AAC interventions always take into account the childs festeringal level and interests. mesa 1 gives some examples of AAC technologies sedulous during these Levels III and II. For example, Jessica was admitted to the hospital at 18-months with shaken baby syndrome. At Level II, she began responding to her parents by smiling and laughing and also began to manipulate toys with her non-paralyzed hand when staff placed a toy deep down her intact field of vision. However, she did non exhibit any speech or imitative vocal behaviors and her speech-language pathologist storied a severe verbal apra xia. Nursing staff and family members observe that Jessica seemed frustrated by her inability to express herself. Prior to her injury, she could name over 30 objects (toys, pets, favorite cartoon characters) and was beginning to put two record book sentences together (Momma bye-bye, Daddy syndicate).AAC interventions included the introduction of a BIGmack, a single-message speech generating device (SGD) that enabled the staff and family members to record a message that Jessica could then pronounce during her daily activities(e.g., more, bye-bye, turn page). Because the BIGmack is a colorful, vauntingly and easy to access SGD, Jessica was able to press the button despite her fastness bound spasticity and significant visual field cut. Within a month, Jessica had progressed to utilise a MACAW by Zygo, an SGD with eight-location pass over that staff programmed with words she had used prior to her injury (e.g., mommy, daddy, more, bottle, book, bye-bye). Staff also designed add itional overlays to encourage her language development by providing diction that enabled her to construct two-word combinations (e.g., more crackers). Jessica began to express herself at a developmentally sequester level, but she had residual memory deficits that required cuing and support from her communication partners. For example, initially, she did not recall how to use her AAC system from session to session so staff needed to reintroduce it each time. However, after several months, Jessica began to search for her SGD to communicate. Jessica, like many children with TBI at this level, was able to learn procedures and strategies with repetition and support (Ylvisaker and Feeney, 1998).2.3. Level II and Level I. AAC Goals Support transitions, recommend AAC strategies and technologies for use at substructure and in the communityAs pediatric patients transition from Level II (responsive to environment) to Level I (oriented to self and surroundings), they often move from an acute rehabilitation speediness to an outpatient ambit, home or a rush facility. Thus, before discharge, AAC teams will conduct a formal AAC assessment and provide long-term recommendations for AAC strategies and technologies that can enable children to be integrated successfully back into community environments. Table 1 illustrates the types of AAC technologies and strategies employed at Levels II and I, as described below.For children who carry to use AAC and AT when they return to their communities, the rehabilitation team identifies a long-term communication advocate. This person, often a family member, becomes actively involved in AAC fostering and collaborates with rehabilitation staff to prepare the childs educational staff, extended family and other caregivers (Fager, 2003). Having a link between the rehabilitation team and community professionals is essential because most teachers and community-based clinicians have limited experience working with children with TBI and may need support to manage the cognitive and physical deficits often associated with TBI. For example, McKenzie, a 12 year-old with a severe TBI secondary to a car accident, was quadriplegic with severe spasticity and no upper extremity control. She also had cortical blindness and significant communication and cognitive impairments. As she recovered, McKenzie used a variety of AAC systems (e.g., thumbs up/down for yes no, two BIGmacks to communicate choices, and a scanning Cheap Talk by modify Devices with four messages to participate in structured activities). Prior to discharge, the rehabilitation team conducted a formal SGD evaluation and recommended the Vmax by DynaVox Mayer-Johnson, a articulation output device. McKenzie was able to access the device via a head switch attach to the side of the head rest on her wheelchair. Using auditory scanning, she could cause and retrieve messages. Because she was literate prior to her injury and could mum spell, the staff set up her devic e to include an alphabet page as well as several pages with pre-programmed messages containing basic/urgent care needs, jokes and social comments. Family and friends participated in her rehabilitation and well-educated to use tactile and verbal prompts to help her participate in conversational exchanges. Due to her residual cognitive deficits, however, McKenzie had difficulty initiating conversations and memory where pre-stored messages were in her device. When prompted, she would respond and initiate questions and could film in conversations over multiple turns. Over time, she began to participate in meaningful, social interactions, often spelling out two-three word novel phrases using her alphabet page objet dart her parents were renovating their home to handle her wheelchair, McKenzie transitioned to a regional care facility that specialized in working with young people with TBI. The acute rehabilitation team identified McKenzies aunt as her AAC advocate because she had partici pated actively in earlier phases of McKenzies recovery, was ingenious with the maintenance (charging, set-up and basic trouble-shooting) of the Vmax and could customize and program new messages into the system. The care facility staff met with McKenzies aunt weekly so they could learn how to support McKenzies use of the SGD. Specific training objectives included maintenance and basic trouble-shooting, set up, switch-placement and how to program new messages to use in specific and motivating activities. Staff learned how to modify the placement of her switch when McKenzie became fatigued or her spasticity increased. Additionally, McKenzies take staff (special education coordinator, speech-language pathologist, occupational therapist, and one of her regular classroom teachers) visited McKenzie at the rehabilitation and the care facilities to help prepare for her return home and learned how to support her in school, given her physical and cognitive limitations.2.4. AAC themes in TBIW hen working with pediatric patients with TBI, three AAC themes emerge.1. Recovery from TBI is dynamic and takes place over time. In early stages of recovery, most children with TBI have physical, speech, language and cognitive deficits that affect their communication skills. Depending on the nature and severity of their injuries, however, most recover functional speech, although some will have life-long residual speech, language and communication deficits. Acute rehabilitation teams can employ AAC interventions to support communication, as well as monitor the childs ever-changing communication abilities and needs over time.2. The cognitive-linguistic challenges associated with TBI make AAC interventions particularly challenging for rehabilitation staff, as well as for families, friends and school personnel. Because of the complex nature of the residual disabilities caused by TBI, collaborations among rehabilitation specialists, family members and community-based professionals are es sential. Some children with TBI require AAC supports throughout their lives. Family members, friends and school personnel ra confide know how to manage their severe memory, attention and/or initiation deficits that can affect long-term communication outcomes.3. There is a need to plan carefully for transitions. Children with TBI will undergo many transitions. While research describing these transitions in children is not available, reports of the experiences of adults with TBI describe multiple transitions over time. Penna et al. (2010) noted that adults with TBI undergo a significant number of residence transitions particularly in the first year following injury and Fager (2003) described the different transitions (acute care hospital, outpatient rehabilitation, skilled nursing facility, home with adult daycare services, and eventually support living) for an adult with severe TBI experienced over a decade, documenting significant changes in his cognitive abilities, as well as his communication partners and support staff. Children with TBI are likely to experience even more transitions over their lifetimes.3. Pediatric SCI and AACPediatric patients with SCI often have intact cognitive skills and severe physical disabilities that can interfere with their ability to speak. In addition, they often have significant medical complications and may be left with severe motor impairments that make it difficult, if not impossible, for them to write, access a computer or participate in the sport, online and removed social networking activities embraced by todays youth (e.g., texting, email). A subgroup may also present with a concomitant TBI carry on as a result of the fall, car accident or other traumatic event that has changed their lives. For them, AAC treatment must(prenominal) reflect guidelines that take into account both SCI and TBI.As with TBI, the growth and development inherent in childhood and adolescence and the unique manifestations and complications ass ociated with SCI require that management be both developmentally based and directed to the individuals special needs (Vogel, 1997). Initially, AAC interventions typically focus on ensuring face-to-face communication when speech is unavailable or very difficult over the long term, however, enabling children to write and fix in educational, recreational and pre-vocational activities using computers and other mainstream technologies becomes the focus.3.1. AAC Assessment and InterventionThe ASIA quantity neurological classification of SCI from the American Spinal Injury Association and world(prenominal) Medical Society of Paraplegia (2000) is a tool that rehabilitation teams frequently use to assess patients with SCI because it identifies the level of injury and associated deficits at each level. This can help guide the rehabilitation teams clinical decision-making process for AAC interventions. As shown in Table 2, children with high tetraplegia (C1-C4 SCI) have limited head control and are often ventilator dependent. They often require eye, head, and/or voice control of AAC devices and mainstream technologies to communicate. While switch scanning is an option for some, it requires higher-level cognitive abilities, endurance, and vigilance and may be inappropriate for very young children and those who are medically fragile (Wagner and Jackson, 2006 McCarthy et al., 2006 Peterson, Reichle, and Johnston, 2000 horn and Jones, 1996). Children with low tetraplegia (C5-T1 SCI) demonstrate limited proximal and distal upper extremity control. If fitted with splints that support their arm and hand, some are able to use in particular adapted mouse options (e.g., joystick mouse, switch-adapted mouse, trackball mouse), large button or unaffixed touch keyboards and switches to control technology. These children are also candidates for head tracking and voice control of AAC devices due to the fatigue and physical effort involved in using their upper extremities. For exam ple, a multi-modal access method to AAC technology and computers may include voice control to dictate text, hand control of the cursor with an reconciling mouse to perform other computer functions (e.g., open programs), and an adaptive keyboard to correct errors that are generated while dictating text. This multi-modal approach can be more efficient and less frustrating than using voice control but for these children. Table 2 provides examples of appropriate access options to AAC and mainstream technologies.3.2. Supporting face-to-face communicationFor children with high tetraplegia, being dependent on mechanical ventilation is scare especially when they are unable to tolerate a talking valve (Padman, Alexander, Thorogood, and Porth, 2003). Thus, providing these children with a way to communicate is essential to their recovery and sense of well-being. As children with visit levels of injury are weaned from a ventilator, they may experience trim down respiratory control and be u nable to speak (Britton and Baarslag-Benson, 2007). Medical specialists can provide access to AAC strategies and technologies, which enable these children to communicate their wants, needs and feelings throughout the day. This allows them to interact with direct care staff, participate in their rehabilitation process, and maintain relationships with family and friends.Pediatric rehabilitation teams may use a range of AAC strategies and technologies to support face-to-face communication in children with SCI. Some examples include low tech communication boards used with eye gaze or eye pointing, partner-dependent scanning, an electro larynx with intra-oral adaptor, or laser light pointing to a target message or garner on a communication board (Britton and Baarslag-Benson, 2007 Beukelman and Mirenda, 2005). Introducing AAC and AT technologies early in the recovery process, particularly for children who demonstrate high tetraplegia, will also begin to familiarize them with approaches t hey may need to rely on extensively throughout their lives, even after speech returns.For example, Jared, a 17-year-old high school senior, sustained a SCI in a skiing accident at the C2 level. In addition to his injuries, he developed pneumonia and a severe coccyx affront during his hospitalization, which lengthened his hospital check-out procedure. He was unable to tolerate a unidirectional speaking valve due to the severity of his pneumonia and decreased oxygenation during valve trials. Although Jared had minimal head movement, he was able to control an AccuPoint head tracker to access his home laptop computer and spell out messages he could then speak aloud using speech synthesis software. He used his AAC system to indicate his medical needs to caregivers and later reported that having the ability to communicate helped alleviate some of the anxiety he experienced due to his condition and extended hospitalization. subsequently Jared recovered the ability to use a talking valv e, his work with the AccuPoint focus on computer access to meet pen and social communication needs. Once his wound had healed, he was able to return home 11 months later. At that time, all of his classmates had graduated. Using the AccuPoint, Jared was able to complete his GED at home and enrolled in online classes at the local community college.3.3. Supporting written communication and educationAt the time of their injury, some pediatric patients with SCI are pre-literate, others are developing literacy skills, and others have highly developed literacy skills. However, most children with tetraplegia will require the use of assistive technologies to support written communication because their injuries preclude them from using a pencil and/or typing on a traditional computer keyboard. In a report describing the educational participation of children with spinal cord injury, 89% of the children with tetraplegia relied on AAC to support written communication needs (Dudgeon, Massagli, and Ross, 1996).For example, soap, a 6 year-old boy who suffered a C6 SCI after an All Terrain vehicle accident, was study age-appropriate sight words and developing his ability to write single words prior to his injury. After the initial recovery period, formal test revealed that Max had no residual cognitive or language impairments. However, he faced significant barriers not only to his continued development of age-appropriate reading and writing skills, but also to his ability to learn and do math, social studies, science, play games, use a cell phone, etc. Due to his tetraplegia, he needed ways to access text and write, calculate, draw and so on. Max learned to access a computer using a large button keyboard, joystick mouse, and adaptive hand-typers (cuffs with an attached stylus that fit on the ulnar side of the hand and allow the user to press the keys of a keyboard) to support writing activities and computer access. During rehabilitation, he was able to continue with his school assignment by developing the skills to use the technology and keep up with his classmates. He returned home during the summer and participated in an intense home tutoring program. By the fall, he was able to join his classmates and was able to perform at grade level in all classes. Essential to Maxs future educational success and development, as well as his future employment, may well depend on his ability to write, calculate and perhaps even draw using a variety of assistive technologies that support communication.3.4. Support social participation and pre-vocational activities entrance fee to assistive and mainstream technologies not only relieves participation in education, but also has implications for future employment as these children transition into adulthood. Assistive and mainstream technologies are now available at modest cost that can help individuals with SCI to flush for functional limitations, overcome barriers to employability, enhance technical capacities an d computer utilization, and improve ability to compete for gainful employment In addition, these technologies also provide access to life-long learning, recreational activities and social networking activities. Specifically, computers are described as great equalizers for individuals with SCI to engage in employment opportunities and distant communication (McKinley, TewksBury, Sitter, Reed, and Floyd, 2004).Social participation in the current technological age includes more than face-to-face communication. Social participation has expanded with the popularity of social networking sites (e.g., Facebook and MySpace), video web-based communication (e.g., Skype) and instant communication and pass (e.g., Twitter). Advances in the field of AAC have allowed individuals with the most severe injuries access computer technologies to engage in these social communication activities. For example, Crystal was a 10-year-old who sustained a C1 SCI due to a fall. Crystals injury left her with no he ad/neck control and her only consistent access method to computerized technology was through eye tracking. With an ERICA eye gaze system from DynaVox Mayer-Johnson, Crystal quickly became independent with computer access. She emailed and texted her friends and family daily, communicated via her Facebook account, and engaged in online gaming programs with her friends and siblings. This technology allowed her to begin to communicate again with her school friends while she was still undergoing acute rehabilitation. Maintaining these social networks is an essential component to emotional adjustment children with SCI go through after sustaining a severe injury (Dudgeon, Massagli, and Ross, 1997). Additionally, Crystals friends began to understand that while her impairments were severe, she was essentially the same person with the same interests, humor, goals, and expectations as before her injury.3.5. AT/AAC themes in SCIWhen working with pediatric patients with SCI, three AAC themes eme rge.1. For those with high tetraplegia, AAC may facilitate face-to-face as well as distant and written communication needs, depending on the developmental level of the child. Introducing AAC technology early, when face-to-face communication support is needed, helps the child become familiar with the technology they will need to rely on after natural speech has recovered.2. Return to an educational environment is a primary goal with many children with tetraplegia returning to school within an average of 62 days post discharge (Sandford, Falk-Palec, and Spears, 1999). Development of written communication skills is an essential component to successful educational completion and future vocational opportunities (McKinley, Tewksbury, Sitter, Reed, and Floyd, 2004).3. Introduction to methods of written and electronic communication provides an opportunity for patients with SCI to engage in social networks through email, texting, and social networking sites. As these children with severe phy sical disabilities face a life time of potential medical complications (Capoor and Stein, 2005), the ability to maintain and develop new social connections via electronic media allow them to stay connected during times when their medical conditions require them to be house or hospital-bound.4. ConclusionCommunication is essential for continued development of cognitive, language, social, and emotional skills. Children with TBI and SCI have physical and/or cognitive-language deficits that interfere with typical communication abilities. Their communication needs are supported through AAC strategies and technologies. A myriad of technology options are available that not only support face-to-face interactions, but evenly important distant social networking and educational activities. AAC interventions in the medical setting that not only support communication of basic medical needs, but also facilitate engagement in social, educational, and pre-vocational activities will result in succe ssful transition to home, school and community environments for these children.