Prescribing Assistive-Technology Systems: Focus on Children With Impaired Communication

Abstract

This clinical report defines common terms of use and provides information on current practice, research, and limitations of assistive technology that can be used in systems for communication. The assessment process to determine the best devices for use with a particular child (ie, the best fit of a device) is also reviewed. The primary care pediatrician, as part of the medical home, plays an important role in the interdisciplinary effort to provide appropriate assistive technology and may be asked to make a referral for assessment or prescribe a particular device. This report provides resources to assist pediatricians in this role and reviews the interdisciplinary team functional evaluation using standardized assessments; the multiple funding opportunities available for obtaining devices and ways in which pediatricians can assist families with obtaining them; the training necessary to use these systems once the devices are procured; the follow-up evaluation to ensure that the systems are meeting their goals; and the leadership skills needed to advocate for this technology. The American Academy of Pediatrics acknowledges the need for key resources to be identified in the community and recognizes that these resources are a shared medical, educational, therapeutic, and family responsibility. Although this report primarily deals with assistive technology specific for communication impairments, many of the details in this report also can aid in the acquisition and use of other types of assistive technology. Pediatrics 2008;121:1271-1280 BACKGROUND Communication skills are ranked as the concern of highest priority for adults with physical disabilities and, therefore, should be of paramount importance for children with impaired communication and their families. 1 Nearly 5 million children in the United States (approximately 15%) have some type of disabling condition. 2 Among children with disabilities who are attending school, Ͼ20% have significant communication impairments that are not attributable to impaired hearing. 3 Conditions that can cause communication impairment include cerebral palsy, autism spectrum disorders, traumatic brain injury, and several genetic syndromes (eg, DiGeorge syndrome).Many children and youth with special health care needs can improve day-to-day functioning with the aid of assistive technology, including alternative or augmentative technology. "Assistive technology," the more general term, describes systems and devices that help alleviate the effects of a disability and, thus, improve function. An example is the use of orthotics (braces) for a child who has L4 paraplegia attributable to spina bifida. "Alternative technology" substitutes for functional impairments related to a disability (eg, adapted power wheelchairs for children who have quadriplegia). Lastly, "augmentative devices" are those that augment a deficient area of functioning but for which residual abilities remain. An example of this would be an electronic voice-output communication aid (VOCA), sometimes called a speec...

Remote assistive technology training in Newfoundland and Labrador’s rural schools: Is there a need? | Perceptions des enseignants quant au besoin de formation en technologie d’assistance dans les écoles rurales de Terre-Neuve et du Labrador

“…In NL, AT is referred to as equipment; however, this equipment includes software (NL Ministry of Education & Early Childhood Development, 2017). Low-tech items typically require little training and are non-electronic (e.g., visuals, pencil grips, adaptive furniture; Alkahtani, 2013;Desch & Gaeblre-Spira, 2008). Medium-tech refers to electronic devices that require little training to use (e.g., adaptive keyboards, digital recorders, electronic dictionaries; Alkahtani, 2013).…”

“…Medium-tech refers to electronic devices that require little training to use (e.g., adaptive keyboards, digital recorders, electronic dictionaries; Alkahtani, 2013). High-tech devices are electronic and require significant training but also have a great capacity for individualization (e.g., word prediction software, hearing aids, listening devices; Alkahtani, 2013;Desch & Gaeblre-Spira, 2008). Prevalent high-tech AT used in schools include interactive whiteboards, text-to-speech / text-to-speech software, and classroom amplification systems (Sider & Maich, 2014;White & Robertson, 2015).…”

“…Without mandatory and/or focused course exposure to AT technology within their training, teachers may struggle to find ways to include AT in their lesson planning. Subsequently, up to 75% of AT devices are not used effectively and a majority are abandoned soon after being obtained (Desch & Gaeblre-Spira, 2008). Teachers report difficulties in keeping up with AT trends, thus, struggling to effectively use up-to-date AT within the classroom (Edyburn, 2004;Sider & Maich, 2014).…”

“…1). Assistive technology (AT) has shown to help students with LDs improve their growth and level of functioning (Desch & Gaeblre-Spira, 2008;Smith & Smith, 2004). For example, since 2009, US public policy and standards have undergone a noteworthy shift, putting AT the forefront of the national agenda for individuals with disabilities (Gray & Silver-Pacuilla, 2011).…”

Benefits of the use of ICT in school activities by students with motor, speech, visual, and hearing impairment: A literature review

“…However, the literature has emphasised that ICT, as a computer-based ATD has the potential to enable children with physical disabilities to participate more fully in everyday activities, e.g. access to the class curriculum (14,(16)(17)(18). The World Health Organization (WHO) for example stresses that ATDs are one strategy that can be used by children with disabilities to improve functioning and minimize the impact of environmental barriers to their participation in everyday life, such as school activities (19).…”