Technology for Speech, Language, and Voice Impairments

1. Technology for Speech, Language, and Voice Impairments Carrie Bruce, M.A., CCC-SLP, ATP CATEA at Georgia Tech

2. Communication • Provides a window into our inner selves • Permits a person to express • Basic wants, needs, and desires • Thoughts and feelings • Knowledge • Provides a basis through which others perceive who we are

3. What is it like to not be able tospeak?

4. Communication--a process of exchanging ideas and information: • Talking/Listening • Reading/Writing • Body gestures • Showing your feelings Receptive Language Sensory Expressive Articulation Language Voice

5. Why Communicate? • Request • Accept • Reject • Comment • State • Express emotion • Get attention • Greetings Basically, we communicate to get our needs met

6. If you want to know what it’s like to be unable to speak, there is a way. Go to a party and don’t talk. Play mute. Use your hands if you wish, but don’t use paper or pencil. Paper and pencil are not always handy for a mute person. Here is what you will find: people talking; talking behind, beside, around, over, under, through, and even for you. But never with you. You are ignored until finally you feel like a piece of furniture. Rick Kreech p. 104 in Musselwhite & St. Louis (1998),

7. Doreen Joseph (1986), who lost her speech following an accident, wrote: “Speech is the most important thing we have. It makes us a person and not a thing. No one should ever have to be a thing.”

8. Ruth Sienkiewicz-Mercer, a woman with severe physical disabilities who has never spoken, wrote “If I were granted one wish and one wish only, I would not hesitate for an instant to request that I be able to talk if only for one day, or even on hour.” From Sienkiewicz-Mercer & Kaplan (1989)

9. What is AAC • An area of clinical practice that attempts to compensate (either temporarily or permanently) for the impairment and disability patterns of individuals with severe expressive communication disorders (ASHA, 1989, p.107).

10. Historical Overview • Ancient civilizations • American Indians • Manual communication and individuals with hearing impairments • Early interface technologies first appeared in Europe

11. Historical Overview Cont. The F. Hall Roe's communication board consisted of letters and words printed on Masonite, and it was the first widely available communication aid.

12. Historical Overview Cont. Perhaps the earliest electric communication device was the POSM (Patient Operated Selector Mechanism) Reg Maling in 1960

13. Historical Overview Cont. The Patient Initiated Light Operated Telecontrol (PILOT) allowed people to control typewriters by simply pointing a beam of light (1967)

14. Historical Overview Cont.

15. Historical Overview Cont. “The Talking Brooch,” a wearable communication aid, was designed for individuals who could not talk but could type on a keyboard held in the hand.

16. Historical Overview Cont. The Tufts Interactor Communicator (TIC) used scanning to provide access to display and printers and later introduced changing the scanning letter arrangement dynamically based on the most probably next characters to by selected.

17. Historical Overview Cont. The Auto Monitoring Communication Board (AutoCom) was a user programmable communication/control aid designed to allow users with severe motor impairments to directly select words and phrases to communicate and write. First portable communication (and later, computer access) aid where the user had the freedom to change their own vocabulary and rearrange the letters, words, and phrases

18. Historical Overview Cont. The Portaprinter was a portable printing communication aid built into a thick briefcase like box with a scanning display and strip printer.

19. Historical Overview Cont. The Canon Communicator was the world's smallest printing communication aid and was particularly useful to people who were ambulatory.

20. The term augmentative was chosen to help offset a perception that communication boards and other similar devices were only to be used when there was no hope for speech. • Speech pathologists at the time, in fact, were sometimes fired if it was discovered that they provided a communications board to one of their speech therapy clients—even if the individual had been in speech therapy in excess of a year and still was unable to utter a single intelligible word.

21. Federal Legislation • Section 504 of Rehab Act (1973) • US PL 94-142 (1975) IDEA • US PL 99-457 (1986) Preschool • US PL 100-407 (1988) Tech Act • ADA (1990)

22. Who Has Speech, Language, and Voice Impairments? According to the National Institute on Deafness and Other Communication Disorders, approximately 14 million individuals have a speech, voice, or language disorder.

23. Speech Language Pathology and AAC • 1999 ASHA Survey reports that 69% of SLPs reported that they served individuals who have AAC needs • This is more than either voice or fluency clients

24. Etiology Congenital Acquired Disease Natal Trauma Genetic Malformation Injury Disease/Health Condition Age-Related Changes stroke, accident, tumor, anoxia, cancer, ALS, MS, burns, nerve damage, SCI, etc.

25. Common Processes or Disorders Affecting Speech, Language, and Voice • ALS- Amyotrophic lateral sclerosis (ALS), sometimes called Lou Gehrig's Disease, is a progressive neurological disease that attacks the nerve cells (neurons) that control voluntary muscles. • Aphasia- The most common cause of aphasia is stroke, but gunshot wounds, blows to the head, other traumatic brain injury, brain tumor, and other sources of brain damage can also cause aphasia. Aphasia can affect speaking, listening, reading and writing depending on the location or extent of the damage. • Apraxia-A motor speech disorder caused by damage to the parts of the nervous system related to speaking. It is characterized by problems sequencing the sounds in syllables and words and varies in severity depending on the nature of the nervous system damage. People with apraxia know what words they want to say, but their brains have difficulty coordinating the muscle movements necessary to say those words and they may say something completely different, even nonsensical. • Dysarthria- Occurs after a stroke or other brain injury. Muscles of the mouth, face, and respiratory system may become weak, move slowly, or not move at all. • Spasmodic Dysphonia- Movement of the vocal cords is forced and strained resulting in a jerky, quivery, hoarse, tight, or groaning voice. Vocal interruptions or spasms, periods of no sound (aphonia), and periods when there is near normal voice occur. • Stuttering- Stuttering is a disorder of speech fluency that interrupts the flow of speech.

26. Speech and Language Impairments May Present As: • An inability to produce speech • The use of “made-up” words • An inability to find the right word • Slurred or slowed speech • Stuttering or dysfluency • An inability to follow commands • Problems with appropriately answering questions • Speech that is too soft to be understood • An inability to understand what others say

27. Individual may or may not be literate. Individual may or may not be able to type or directly access equipment. Individual may or may not live with others. Individual may or may not have normal cognitive skills. Individual may or may not work or go to school.