Australian parents' experiences of speech generating device (SGD) service delivery

Comparing and contrasting barriers in augmentative alternative communication use in nonspeaking autism and complex communication needs: multi-stakeholder perspectives

Augmentative alternative communication (AAC) devices or systems are often prescribed to minimally verbal or nonspeaking autistic individuals and other individuals with complex communication needs to facilitate communication or as an alternative to spoken language. AAC use can result in communication gains and improved quality of life for minimally verbal or nonspeaking individuals. Despite this, AAC abandonment is high, limiting societal participation of the individual on the autism spectrum with complex communication needs. Our study is a novel exploration of the barriers of AAC use from a multi-stakeholder perspective, and a qualitative analysis of similarities and differences between stakeholders. We conducted semi-structured interviews and focus groups with 30 parent-carers, educators and clinicians currently supporting AAC users in Western Australia and analysed the data using reflexive thematic analysis. Barriers from each stakeholder group were coded, resulting in 17 subthemes forming five main themes common to all stakeholders: Stakeholder Knowledge, Stakeholder Attitudes and Stigma, Resources, AAC User Engagement, and Device Fit. Contrasting perspectives included actual and perceived stigma associated with AAC use (parent-carers vs clinicians); different struggles with resources and knowledge (parent-carers vs clinicians and educators); and a lack of clinician communication in the processes that determined AAC-fit for school environments (educators only). Findings are discussed in the context of improving inter-stakeholder collaboration and capacity building in Australian health service and practice to better support minimally verbal or nonspeaking autistic individuals and individuals with complex communication needs. Suggestions are also offered for communication partner training.

A Comprehensive Scoping Review of Caregivers' Experiences With Augmentative and Alternative Communication and Their Collaboration With School Professionals

PURPOSE

Parent engagement and involvement is essential for the successful implementation of augmentative and alternative communication (AAC) systems in the home. The purpose of the current study is to gain a deeper understanding of caregivers' experiences with AAC systems and their collaboration with school professionals during the implementation of AAC, which may have led to subsequent abandonment.

METHOD

This review intentionally included qualitative studies that employed semistructured interviews, focus groups, and ethnographic investigations that documented the experiences and perceptions of families implementing AAC at home. Electronic database search, ancestral search, and forward search procedures resulted in a total of 27 peer-reviewed studies portraying the voices of 319 caregivers.

RESULTS

An inductive analysis was conducted to record recurring themes into codes. The codes were thematically synthesized into three main themes: (a) the family unit, (b) the service providers, and (c) the AAC system.

CONCLUSIONS

The results emphasized the need for participatory practices of family involvement in co-constructing a collaborative AAC service provision. Future research directions should implement this practice and explore the outcomes of this process to validate its efficacy.

Therapy services for children and youth living in rural areas of high-income countries: a scoping review

PURPOSE

To identify and describe therapeutic services provided to children and youth with disabilities living in rural areas of mid- and high-income countries and to summarize the benefits, positive outcomes, and challenges related to these services.

METHODS

This scoping review involved a systematic search of four academic electronic databases: MEDLINE, EMBASE, CINAHL, and Psych INFO, using a combination of subject headings and keywords related to (1) child disabilities; (2) rehabilitation: occupational therapists, speech-language pathologists, physiotherapists, audiologists, and recreation therapists; (3) multidisciplinary care team; (4) rural areas. Charting involved an iterative process whereby the full text articles meeting the inclusion criteria were abstracted using the charting form by two independent reviewers.

RESULTS

Thirty-seven articles from seven high-income countries were included in the analysis. Twenty-seven articles reported on in-person services, and 19 on telepractice (nine evaluated in-person and telepractice). In person services included outreach programs and specialized on-site programs. Positive outcomes and challenges of in person and telepractice services in rural areas are described.

CONCLUSIONS

Findings of this review highlight the need for further research on service delivery models offered in rural areas of upper middle and high-income countries, especially those focusing specifically on the rural communities, with a clear description of services. IMPLICATIONS FOR REHABILITATIONThis scoping review helps to advance the understanding of how therapy services are offered in rural areas of high-income countries.Telepractice was found to enhance ease of access to services for families living in rural areas.The findings of this review suggest that telepractice may be an effective means of providing therapy services to children and youth with disabilities living in rural areas of high-income countries, pending families' access to technology.

Using Communication Assistants in Qualitative Health Research

Qualitative health research is hampered by narrow constructs of human communication that privilege participants with access to spoken and written (normative) language. With limited awareness of such things as augmentative and alternative communication (AAC) or the rights of people with complex communication access needs, qualitative research becomes a 'picker and chooser' of whose voices are included in studies and whose are not. In order for 'voices' to be heard, adaptations are required which include the acknowledgement and support of communication assistants (informal and formal) who can help provide a communication bridge between people with complex communication access needs and researcher(s). Yet little is known of who qualifies as a communication assistant nor the scope and limitations of this role in health research. Beginning with communication diversity arguments the article compares communication assistants with language interpreters before discussing practice and implications for health research.

Perceptions of families with adolescents utilizing augmentative and alternative communication technology: A qualitative approach

PURPOSE

Although family involvement is critical to successful augmentative and alternative communication (AAC) device utilization, little is known about how families adapt to technology. The aim of this qualitative study was to explore parent-reported factors contributing to family adaptation among families with adolescents diagnosed with autism and/or Down syndrome (DS) utilizing AAC technology. This study describes families' experiences related to several interacting variables of the Resiliency Model, including demand, type, appraisal, resources, and problem-solving/coping, that helped shape the outcome of adaptation to AAC technology. Nurses are well-positioned in a variety of practice settings to assess vulnerable families and assist with identifying resources and navigating complex service systems.

DESIGN AND METHODS

Semi-structured interviews were conducted with eight parents of adolescents with autism and/or DS (aged 13-18) recruited through online research registries, support organizations, and a social networking site. Recorded interviews were transcribed, and two independent reviewers coded and analyzed the data. Comparisons across all families' thematic summaries were examined for patterns.

RESULTS

Five themes described aspects of family adaptation: Contextual Strains and Influences, Continuum of Person-First Approach, Opening Doors, Facilitators of Support, and Planning Is Key.

CONCLUSIONS

Findings highlighted the challenges and demands associated with raising an adolescent using an AAC device, as well as the attributes, resources, perceptions, and strategies that either contributed or hindered family adaptation.

PRACTICE IMPLICATIONS

AAC technology is readily available for adolescents with developmental disabilities. It is essential that nurses assess key adaptation components to support families in integrating and using the technology.

Barriers and facilitators of assistive technology service delivery process (AT-SDP) in South Korea

PURPOSE

To describe the barriers and facilitators of the assistive technology service delivery process (AT-SDP), based on the perspectives of assistive technology service professionals (ATPs) and assistive technology (AT) service users.

METHODS

We conducted semi-structured interviews with nine AT users and eight ATPs in South Korea. The data were analyzed using a constant comparative approach based on the grounded theory.

RESULTS

AT users and ATPs identified common barriers in the assessment, matching, and implementation of the AT-SDP. In the assessment process, the preparation of detailed selection criteria was suggested for assistive technology devices (ATDs). Insufficient linkages on assessments among institutions providing AT services was a reported barrier, and standardized evaluation tools were suggested to address this issue. In the matching process, to meet users' needs, versatility in the characteristics or type of ATD was highlighted. In the implementation process, participants emphasized the need to shorten the time required during the delivery process. Along with these facilitators, institutional support, including staffing securement, the establishment of AT centres, and funding policies were recommended to facilitate the AT-SDP.

CONCLUSIONS

Our results highlight the importance of government support and considering realistic funding levels to overcome the barriers reported by AT users and ATPs.

Parent perspectives on augmentative and alternative communication in Sri Lanka

Parental support is an important part of introducing an augmentative and alternative communication (AAC) system to a child. Professionals providing AAC services to children with complex communication needs should practice family-centered service provision. The aim of this study was to explore Sri Lankan parents' perspectives on AAC and their lived experiences. Semi-structured interviews were conducted with 10 parents of children with complex communication needs. Thematic analysis was used to analyze the findings, with the following themes identified: (a) External Systems, (b) Impact on the Family, (c) Impact on the Child, and (d) Communication (including AAC). Findings from this study provide important information for speech-language therapists providing services to families from low- and middle-income countries. In particular, parents reported several positive aspects of AAC. However, parents also reported challenges, including speech-language therapist's lack of knowledge of and training in AAC.

Parents’ Perceptions and Experiences with Their Children’s Use of Augmentative/Alternative Communication: A Systematic Review and Qualitative Meta-Synthesis

Augmentative and alternative communication (AAC) consists of any method of communicating that supplements or completely substitutes oral and/or written language when it is impaired. Therefore, it enables children with complex communication needs to develop their full communicative potential. However, despite the many benefits of AAC and its widespread use, several review studies have underscored the problems faced by parents and children who use AAC in their daily lives. The general objective of this systematic review and qualitative meta-synthesis is to provide a complete overview of parents’ experiences and perceptions with their children’s use of AAC. Specifically, it aimed to identify common themes and subthemes of interest and to analyze the research quality of the selected studies. An exhaustive literature search was carried out using different electronic databases. Nineteen studies were included, involving 297 parents. A thematic synthesis was undertaken. Three main themes and nine subthemes were identified: service support (accessibility, providers and coordination); characteristics of AAC systems (usability and acceptability, features, cost and funding); and integration of AAC in daily life (family, school, social and community). Findings raise a need for more services that support children with complex communication deficits in different contexts, more functional use of AAC systems at school and in real-world situations, as well as service assistance over an extended time period.

Decision-Making Is in the Making! Aspects of Decision-Making in the Area of Assistive and Welfare Technology-A Qualitative Study

Assistive and welfare technology (AT/WT) has been introduced as a way of facing an ageing population and providing support for older adults in their daily lives. There is much research concerning the assessment and recommendation of AT/WT to individual end-users. However, few studies have explored AT/WT decision-making from a managerial perspective. This study explores what aspects influence decision-making in assistive technology organizations concerning new technology procurements. The study is based on interviews with 24 managers engaged in assistive technology organizations, representing 13 of 21 regions in Sweden. The interview data consisted of the participants’ experiences deciding on AT/WT procurement. A reflexive inductive thematic analysis was used to identify aspects that influenced decision-making. The main findings show that decision-making is in the making, meaning that decision-making is a constant on-going managerial process. Furthermore, the findings show that managers experience uncertainty in the decision-making, sometimes make ad hoc decisions and request an evidence-based, person-centred approach to improve decision-making. The study concludes that supportive, technology, patient, and knowledge aspects influence managers’ decisions.

Caregivers', teachers', and assistants' use and learning of partner strategies in communication using high-tech speech-generating devices with children with severe cerebral palsy

Communication with speech generating devices (SGDs) with children with severe physical, communicative and cognitive impairments, such as children with cerebral palsy (CP), can be difficult. Use of partner strategies facilitates the communication and instructional approaches such as feedback and role play facilitate communication partners' learning in how to use partner strategies. To describe communication partners' use and learning about partner strategies in SGD-mediated communication with children with severe CP. Questionnaires (n = 65) were sent to caregivers (n = 30), teachers (n = 17), and teaching or personal assistants (n = 18) of children with severe CP. Response rate was 80%. To ask open-ended questions was the most frequently used partner strategy and aided augmented input the least frequently used partner strategy. Most commonly, participants learned partner strategies from speech and language pathologists (SLPs) who used verbal instructions when teaching partner strategies but seldom or never feedback, role play or video examples. Communication partners' learning about partner strategies in SGD-mediated communication is inadequate and needs to be improved. SLPs, who are the main prescribers of SGDs and responsible for training and support in using them, should consider using instructional approaches when teaching communication partners about partner strategies in communication with an SGD.

The Effects of an Online Training on Preservice Speech-Language Pathologists' Use of Family-Centered Skills

Purpose Despite the recognition that family-centered services are best practice in augmentative and alternative communication services, many speech-language pathologists (SLPs) are lacking in their acquisition and implementation of family-centered skills. The purpose of this study was to evaluate the effects of online instruction in a family-centered, relational skills strategy on preservice SLPs use of family-centered skills. Method A switching replications design was used to evaluate the effects of an online training on the use of family-centered behaviors by 15 preservice SLPs who were randomly assigned to two groups. The online training taught the students a four-step relational skills strategy (summarized by the acronym LAFF): (a) Listen, empathize, and communicate respect; (b) Ask questions; (c) Focus on the issues; and (d) Find a first step. Participants were videotaped during interactions with simulated parents before and after the training. Results After an average of 61 min of instruction via the online module, all of the preservice SLPs significantly improved their demonstration of relational skills. Additionally, one parent of a child who used augmentative and alternative communication viewed the video recordings and chose 14 of the 15 postinstruction role plays as more family-centered. Conclusion The findings from this study provide support for the use of an online environment to teach preservice SLPs family-centered relational skills. In order to prepare future SLPs and ensure the delivery of family-centered services, future research is necessary, including investigations to determine whether other family-centered skills can be effectively taught through an online environment. Supplemental Material https://doi.org/10.23641/asha.12462344.

Participant reported outcomes of a community of practice about social participation for speech-language pathologists in aphasia rehabilitation

Purpose: Because of their communication difficulties, persons with aphasia are at risk of not fully participating in significant activities after rehabilitation. Speech-language pathologists can contribute to support optimal social participation in rehabilitation. A community of practice (CoP) was designed to provide motivated clinicians with opportunities to acquire knowledge and reflect on social participation within aphasia rehabilitation. The aim of this study was to describe the outcomes of this CoP according to the perspectives of speech-language pathologist participants.Methods: Semi-structured individual interviews were conducted 4 to 10 weeks after the end of the CoP with 13 speech-language pathologist participants. Analyses were guided by grounded theory.Results: Participants perceived that the CoP experience contributed to a better alignment of their practice with the ideal end purpose of optimizing social participation. A sense of community emerged among CoP members, who collectively reflected on their practice. Participants stated feeling equipped to adopt new practices, adopting new practices for optimizing social participation, and/or advocating for better services for persons with aphasia. They felt increased confidence, motivation, well-being, and/or energy towards their practice.Conclusions: CoPs can help speech-language pathologists to more confidently practice with the goal of optimizing the social participation of persons with aphasia.Implications for rehabilitationSpeech-language pathologists in aphasia rehabilitation, as a result of being involved in a community of practice (CoP) about social participation, may offer more evidence-based services aiming at optimizing the social participation of persons with aphasia.Markers of a successful CoP may include participants' increased feelings of confidence, motivation, well-being, and/or energy towards their practice.CoPs can be used for continuing education purposes and support the development of clinical expertise among professionals, such as speech-language pathologists in aphasia rehabilitation.

Adaptation to Technology Use in Families of Children With Complex Communication Needs: An Integrative Review and Family Theory Application

Families with children who have developmental disabilities and complex communication needs (CCNs) face challenging demands affecting family adaptation. Many children with CCNs use augmentative and alternative communication (AAC) devices to support communication, yet little is known about family adaptation to such technology. To fill this gap, an integrative review, guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation was conducted to assess conceptual foundations and the state of the science of family adaptation among children utilizing AAC. Web-based searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Mixed Methods Appraisal Tool. Thirty-three studies met eligibility. Findings demonstrated that to enhance the science underpinning family adaptation to AAC use, future research should be grounded conceptually and address important components of the Resiliency Model. Work in this emerging area will identify and facilitate nursing efforts to assist families as they adapt to communication technology.

A survey on the awareness, accessibility and funding for augmentative and alternative communication services and devices in Saudi Arabia

PURPOSE

To develop and distribute a survey to obtain information on the awareness, accessibility and funding for augmentative and alternative communication (AAC) services and devices within the Kingdom of Saudi Arabia (KSA).

METHOD

The survey targeted three groups of people which included individuals with disabilities and their families, healthcare providers such as medical doctors and nurses and the third group included community members. Survey preparation and administration were performed online via a survey website in order to access a wide range of participants across KSA.

RESULTS

Results revealed different awareness levels for AAC among the three groups (χ² = 45.053, p < .001) with healthcare providers showing a higher degree of awareness compared to the remaining two groups. Moreover, AAC services and devices were found to be accessible within KSA, with no differences in obtaining AAC services and devices among different regions (χ² = 14.204, p = .164).

CONCLUSION

Although numerous AAC users were able to obtain AAC devices, they identified barriers including a lack of sufficient awareness of the importance, associated expenses, funding constraints and a lack of Arabization of AAC devices. Implications for RehabilitationAugmentative and alternative communication (AAC) methods allow individuals with communication difficulties to interact and socialize with those around them.The general authority of statistics in Saudi Arabia has shown that Saudi Arabia has an increased number of individuals suffering from severe to extreme communication disorders compared to other countries around the world. Consequently, the need for AAC in Saudi Arabia cannot be underestimated.This study demonstrates the importance of the awareness of AAC among different stakeholders in Saudi Arabia including AAC users, healthcare providers and community members so that individuals with communication problems can receive maximum benefit from AAC.Given that most healthcare providers in Saudi Arabia are prescribing non-tech and low-tech AAC methods indicates the importance of training on AAC for healthcare providers serving patients with communication disorders.

"You have to argue the right way": user involvement in the service delivery process for assistive activity technology

PURPOSE

This article critically examines user-involvement in the service delivery process for assistive activity technology.

METHODOLOGY

Data were collected in semi-structured interviews with 44 end users of assistive activity technology and in focus group interviews with 11 professionals at Norway's Assistive Technology Centre. Data was analysed according to a stepwise deductive-inductive approach.

FINDINGS

Flawed organisational principles like division of responsibility, unclear regulations, and a lack of competence with assistive activity technology among service professionals have hindered user involvement in the service delivery process.

CONCLUSION

A missing knowledge of assistive activity technology among professionals and the current organisation of services creates barriers for a positive collaboration with users in the service delivery process of assistive activity technology.IMPLICATIONS FOR REHABILITATIONThe spread of information among users and courses for professionals should be expanded to ensure the necessary competence with assistive activity technology within the service delivery process.In developing the service delivery process for assistive activity technology, professionals should act less as guardians of traditional functional requirements and more as active providers of different technological solutions.The service delivery process for assistive activity technology should allow long-term testing to identify relevant social and physical factors affecting the use of this type of technology, before delivery.Guarantees and complaint systems should be established in the service delivery process for assistive activity technology.

Preliminary Investigation of the Perspectives of Parents of Children With Cerebral Palsy on the Supports, Challenges, and Realities of Integrating Augmentative and Alternative Communication Into Everyday Life

Purpose To ensure long-term adoption and use of augmentative and alternative communication (AAC) technologies, they must be designed to support children to participate within everyday activities and routines that are prioritized by families. The aim of this study was to gain parent perspectives on how AAC technologies were integrated into everyday life. Method Nine parents of children with cerebral palsy who used AAC technologies participated in semistructured interviews to provide their perspectives on how AAC technologies were integrated into the functional contexts of everyday life. Results Five major themes emerged from the discussions: (a) integrating AAC into life, (b) AAC technologies, (c) child needs and skills, (d) parent responsibilities and priorities, and (e) AAC process and decision making. Children were able to use AAC technologies within a variety of everyday contexts with various partners; however, challenges included access to technologies within care routines and outdoor activities as well as partners who lacked knowledge regarding operational competencies and effective interaction strategies. To integrate AAC technologies into life, parents prioritized technology features including ease of programming, improved physical design, features to enhance efficiency and ease of access, and availability of multiple functions and features (e.g., games and leisure activities, environmental controls). Conclusion AAC manufacturers and mainstream technology developers should work to ensure that technologies are responsive to the supports, limitations, and ideal features identified by parents. Future research should seek input from a larger group of stakeholders and use longitudinal methods to examine perceptions of AAC technologies over time. Supplemental Material https://doi.org/10.23641/asha.11625543.

Key word signing: Parents' experiences of an unaided form of augmentative and alternative communication (Lámh)

Parents' experiences of using Lámh, a key word signing approach used in Ireland, were captured through in-depth face-to-face interviews with parents of children with a range of intellectual disabilities. It emerged that Lámh provides child users with one of the rudiments of inclusion, that is, a means of engaging with others. A number of factors can potentially influence the engagement achieved, namely ongoing family commitment to the sustainment of Lámh, available communication partners, accessibility, appropriate Lámh training, speech and language therapy support and the existence of a Lámh signing environment external to the home. The child's family, education and community need to commit to Lámh in order to support a child user become an active member of their community.

Parent Empowerment in Pediatric Healthcare Settings: A Systematic Review of Observational Studies

BACKGROUND

Parent empowerment is often an expressed goal in clinical pediatrics and in pediatric research, but the antecedents and consequences of parent empowerment are not well established.

OBJECTIVE

The objective of this systematic review was to synthesize potential antecedents and consequences of parent empowerment in healthcare settings.

ELIGIBILITY CRITERIA

The inclusion criteria were (1) studies with results about parent empowerment in the context of children's healthcare or healthcare providers; and (2) qualitative studies, observational studies, and systematic reviews of such studies.

INFORMATION SOURCES

We searched the databases of PubMed, Web of Science, and Google Scholar (2006-2017) and reference lists.

INCLUDED STUDIES

Forty-four articles met the inclusion criteria.

SYNTHESIS OF RESULTS

We identified six themes within consequences of empowerment: increased parent involvement in daily care, improved symptom management, enhanced informational needs and tools, increased involvement in care decisions, increased advocacy for child, and engagement in empowering others. Six themes summarizing antecedents of empowerment also emerged: parent-provider relationships, processes of care, experiences with medical care, experiences with community services, receiving informational/emotional support, and building personal capacity and narrative. We synthesized these findings into a conceptual model to guide future intervention development and evaluation.

STRENGTHS AND LIMITATIONS OF EVIDENCE

Non-English articles were excluded.

INTERPRETATION

Parent empowerment may enhance parent involvement in daily care and care decisions, improve child symptoms, enhance informational needs and skills, and increase advocacy and altruistic behaviors. Parent empowerment may be promoted by the parent-provider relationship and care processes, finding the right fit of medical and community services, and attention to the cognitive and emotional needs of parents.

CLINICAL REGISTRATION NO

PROSPERO 2017:CRD42017059478.

Satisfaction with assistive technology device in relation to the service delivery process-A systematic review

The service delivery process (SDP) of assistive technology devices (ATDs) is attracting interest, as the provision of ATDs is critical for the independence and participation in society of individuals with disabilities. The purpose of the current study was to investigate what impact the SDP has on satisfaction with ATDs in individuals with disabilities in relation to everyday activities. A systematic literature review was conducted, which resulted in 53 articles included. The results showed that there are factors in almost all the different steps of the SDP that affect the satisfaction with of the devices, which can lead to underutilization and abandonment of ATDs. Only a few studies have been conducted with a design robust enough to generalize the results; therefore, more research is needed. Therefore, the conclusion is the SDP as a whole contributes to the satisfaction with and usability of ATDs in individuals with disability in relation to achieving the desired goals of participation in everyday activities, for the articles included must be deemed as moderate. A client-centred approach in the process is advocated, and was found to be an important factor for an effective SDP and satisfied users.

Gaze-based assistive technology in daily activities in children with severe physical impairments-An intervention study

OBJECTIVE

To establish the impact of a gaze-based assistive technology (AT) intervention on activity repertoire, autonomous use, and goal attainment in children with severe physical impairments, and to examine parents' satisfaction with the gaze-based AT and with services related to the gaze-based AT intervention.

METHODS

Non-experimental multiple case study with before, after, and follow-up design. Ten children with severe physical impairments without speaking ability (aged 1-15 years) participated in gaze-based AT intervention for 9-10 months, during which period the gaze-based AT was implemented in daily activities.

RESULTS

Repertoire of computer activities increased for seven children. All children had sustained usage of gaze-based AT in daily activities at follow-up, all had attained goals, and parents' satisfaction with the AT and with services was high.

DISCUSSION

The gaze-based AT intervention was effective in guiding parents and teachers to continue supporting the children to perform activities with the AT after the intervention program.

Consumer Satisfaction with Telerehabilitation Service Provision of Alternative Computer Access and Augmentative and Alternative Communication

Telerehabilitation (TR) services for assistive technology evaluation and training have the potential to reduce travel demands for consumers and assistive technology professionals while allowing evaluation in more familiar, salient environments for the consumer. Sixty-five consumers received TR services for augmentative and alternative communication or alternative computer access, and consumer satisfaction was compared with twenty-eight consumers who received exclusively in-person services. TR recipients rated their TR services at a median of 6 on a 6-point Likert scale TR satisfaction questionnaire, although individual responses did indicate room for improvement in the technology. Overall satisfaction with AT services was rated highly by both in-person (100% satisfaction) and TR (99% satisfaction) service recipients.

Satisfaction of users with assistive technology service delivery: An exploratory analysis of experiences of parents of children with physical and multiple disabilities

OBJECTIVE

To describe experience of assistive technology service delivery (ATSD) by parents of children with physical or multiple disabilities (aged 3-18 years).

METHOD

Forty-seven of 115 parents participated in a postal survey assessing satisfaction with the ATSD process, employing the QUEST 2.0 and the KWAZO scales. Six of these participated in two focus groups. Descriptive statistics were used for satisfaction scores. The focus group transcripts were coded and combined with survey results by two independent researchers.

RESULTS

Low satisfaction scores were reported for follow-up, AT delivery, maintenance services, access to services, coordination, and efficiency of ATSD. Several barriers to and facilitators of ATSD were mentioned and solutions to improve ATSD quality were identified.

CONCLUSION

Evaluation of parents' service experience is central for identifying shortcomings in ATSD. Health professionals are advised to utilize validated instruments and strategies to assess effectiveness of technological interventions and to assure ATSD quality.

Percepções de pais/responsáveis de crianças com desvio fonológico acerca do desvio fonológico e da terapia fonoaudiológica

RESUMO: Objetivo: investigar a percepção de pais/responsáveis de crianças com desvio fonológico em relação ao próprio desvio e terapia fonoaudiológica aplicada. Métodos: a amostra foi composta por 23 pais/responsáveis de crianças com diagnóstico de desvio fonológico, atendidas em um ambulatório de Fonoaudiologia. Para a análise das entrevistas coletadas utilizou-se a Análise de Conteúdo. Resultados: em síntese, merecem atenção: (a) a aceitabilidade ao atendimento fonoaudiológico, inclusive, em muitos sendo de própria iniciativa dos pais/responsáveis a procura pela fonoterapia; (b) esses referem perceber a dificuldade linguística de seus filhos, bem como, as evoluções na sua fala; (c) enumeram, com maior ocorrência, os problemas escolares e o bullying como dificuldades relacionadas ao desvio fonológicoe, também, como sua preocupação decorrente do mesmo; (d) sugerem mais frequentemente a busca pelo atendimento fonoaudiológico a outros pais; (e) dizem contribuir no ambiente familiar para com a terapia fonoaudiológica e; (f) mesmo não tão frequente, alguns mencionam ter dúvida quanto ao tempo de terapia. Conclusão: desse modo, os pais/responsáveis expuseram suas concepções acerca de sua experiência relacionada à dificuldade de fala e à terapia fonoaudiológica. Acredita-se em uma contribuição para a reflexão dos procedimentos terapêuticos adotados na fonoterapia, bem como, para o amadurecimento da relação terapeuta-paciente e terapeuta-pais. Por esse motivo, incentiva-se a inclusão e aproximação dos cuidadores na terapia, com o intuito de ampliar a adesão e contribuição desses para a superação da dificuldade de fala.

Alternative service delivery models for families with a new speech generating device: Perspectives of parents and therapists

PURPOSE

Research has revealed limitations in the provision of in-person services to families with a new speech generating device (SGD), both in Australia and overseas. Alternative service models such as parent training, peer support and telepractice may offer a solution, but their use with this population has not been researched to date.

METHOD

Using interviews and focus groups, this study explored the experiences and opinions of 13 speech-language pathologists and seven parents regarding alternatives to in-person support and training for families with a new SGD. Data were analysed using grounded theory. Themes explored in this paper include the benefits and drawbacks of alternative service models as well as participants' suggestions for the optimal implementation of these approaches.

RESULT

Participants confirmed the utility of alternative service models, particularly for rural/remote and underserviced clients. Benefits of these models included reduced travel time for families and therapists, as well as enhanced information access, support and advocacy for parents.

CONCLUSION

Participants viewed the provision of ongoing professional support to families as critical, regardless of service modality. Additional issues arising from this study include the need for development of organizational policies, resources and training infrastructure to support the implementation of these alternative service models.

iPods and iPads as AAC Devices for Children with Developmental Disorders

The Apple iPod Touch™ and iPad™ are increasingly used as augmentative and alternative communication (AAC) devices. This chapter discusses the use of iPods™/iPads™ loaded with software applications that enable speech output and thereby transform them into speech-generating devices (SGD). While a popular mode of communication for children with developmental disorders (DD) who have little or no spoken language, assessment of the effectiveness of such new technology to enhance communicative functioning is necessary. Research on the use of iPods™/iPads™ was evaluated to assess whether they are (a) effective as AAC devices, (b) at least as effective as other AAC interventions, and (c) effective at the individual level of implementation. Findings suggested that the use of iPods™/iPads™ as AAC devices is promising, also in comparison to other AAC systems. Children typically preferred using iPods™/iPads™. Selection of an AAC system based on the child's preference coupled with appropriate instructional strategies may lead to the enhancement of communicative functioning for children with DD.

Parents' Perspectives on Tele-AAC Support for Families with a New Speech Generating Device: Results from an Australian Pilot Study

Telepractice is rapidly gaining popularity as a cost-effective and convenient alternative to in-person services for a range of speech-language pathology (SLP) applications. To date, there has been little research investigating the use of telepractice to support families with a new speech generating device (SGD). This paper reports on the outcomes of a novel online training and support program, trialed with 4 underserviced Australian families of children with a new SGD. The program consisted of 6 video-narrated lessons on SGD use, along with an online supervision and practice component conducted via videoconference. Semi-structured interviews were undertaken with parents following their completion of the program. Parents noted the telepractice support model offered a range of benefits, including convenient service access and flexible learning options. Challenges included technology limitations and increased pressure on parents to coordinate home practice. Overall, parents reported that the telepractice program was a positive experience for them and their children. Findings indicated that telepractice is a promising mode of service delivery for those learning to use a new SGD. Further research in this area is warranted.