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Assistive technology is any device or tool that helps improve a person’s functional ability. Things like wheelchairs, orthotics and power lifts are assistive devices that help people get around, but assistive technology can also be used to help people communicate. In fiscal year 2023, Shirley Ryan AbilityLab speech-language pathologists and occupational therapists assisted 589 inpatients and 841 outpatients with their technology needs.
When people with intellectual and developmental disabilities (IDD) seek out assistive technology, it is often to help with communication issues. Occupational therapist Edward Hitchcock and speech-language pathologist Kathleen Ruppert help connect people to assistive technology at Shirley Ryan AbilityLab, including assistive communication devices and tools.
What kinds of assistive tech do people with IDD typically use?
Edward:
People with IDD use a lot of what’s called augmentative communication. If somebody cannot communicate, whether that’s because of a voice issue or another reason, we try to come up with options that can help them to communicate. Often that takes the form of using paper-based symbols or pictures or words or a combination of those, that people can point to, or computer-based or tablet-based systems that let people pick words, pictures or symbols from a screen to express themselves. We typically start with a few of these symbols or words and then systematically build on them to allow people to access language. Some of our devices include lists of say food choices. And within each type of food category – snacks, lunch dinner. When you touch dinner, then you get more options: pizza, hamburger, sandwich, and so on. These may be paper-based systems or computer-based.
There are other technologies, of course, but the idea is that augmentative communication can be a very high-tech thing, or it can be a relatively low-tech thing.
Kathleen:
Other devices may include a button that a person can press that can say a recorded phrase. We also work with speech generating devices, they're called SGDs, if someone has problems using speech to communicate.
How do you work with people interested in assistive technology?
Edward:
For people who come in seeking technology to assist with communication, we do an evaluation to try to figure out what that person is using for communication already. Most people do have a way of communicating.
Kathleen:
Often our initial evaluations are pretty long because there's so much to get to know about how a person communicates and what their unique needs are. The first thing we look at is how is this person currently communicating and what skills are they currently using? Maybe they can approximate a few words, or maybe they’re using vocalizations. We want to use that and build on that. Sometimes people come to us, and they are already using some paper boards, or maybe they had an app or a communication device some years ago, so we look at what they've tried in the past and what's worked for them. We also often talk with family or caregivers to help identify gaps in communication. Families have a lot to share, so we really tap into that.
We also want to know about the person and their daily life in general so we can customize a device for how they’ll use it. So someone might be in a day program, or go to school, or someone likes to play Bingo, and these are all situations in which they’ll be communicating and that goes into the decision making and customization process.
Edward:
Often, if a client can reach out and point and can see adequately to use paper or computer-based systems where the person points to pictures or words, then we will get started training on those. We usually use both together with clients, not one or the other. Almost everyone has multiple ways to communicate, right? We use our voices, but we can also point and gesture.
Kathleen:
We work really closely with occupational therapists like Edward during the evaluation process. So, if a person has difficulty reaching or touching or trouble with their vision, we're really leaning on the occupational therapist to help us figure out the best ways the person can access their communication system
Edward:
If someone can’t see or point, that’s when I get involved as an occupational therapist and we may get into, say, a head-activated system where the person uses their head to indicate a choice, or maybe an eye-gaze based system where they can look at different choices. The person would then meet with a speech therapist and go over ways to customize a computer-based system with the words or ideas their client uses most.
Kathleen:
A good example is we recently had a young person with cerebral palsy come in for a communication device and she had some difficulty with touching, so we worked with occupational therapist to figure out how to get the device to work with the way her hands work by adjusting the touch settings.
Once you identify assistive technology for a person, what happens next?
Kathleen:
I think there's a misunderstanding that once we give a person a new tool then they can suddenly communicate in the way they want and that’s just not the case. It’s more like that person is learning a new language, so they need time.
The person’s caregiver needs to learn about the new system too – how to set it up, how to troubleshoot, those kinds of things. If it's a high-tech device, we really want to make sure it’s well-programmed so it’s useful for the person and so it’s not typically just a one-time evaluation and here's a solution and go run with it.
We often see people on an ongoing basis, and of course, it will depend on what they need. Some individuals might just need three or four sessions, and they feel good to go. Other people we will see for maybe a few months or on and off over the course of years, and we work on things bit by bit and they keep coming back with the next thing that they want to learn or need.
Beyond stand-alone assistive communication devices, how else do you help people with IDD?
Edward:
Another way we work with clients is to help them use technology they already have, like their smartphone or laptop. I can help people improve accessibility on their computers, or how to use their iPhone to text. We might work with the phone right out of the box, or I can work with someone to customize their iPhone to make it easier for them to use. For people with IDD, a lot of times I’ll set up their phone so that to text or call someone, you just touch their picture instead of going into the text function and then finding the person you want to text and going through a lot of steps. Or we can set it up so that you just touch a photo and the phone calls that person. It eliminates what is usually a multi-step process.
We may also help train people on things like sending a text message or email using the language system on their augmentative communication device.
Kathleen:
I had a young woman who uses a speech generating device, but reading and spelling are hard for her. She can spell some short words, but longer words and sentences are hard to spell. With her device, she can put together phrases, like ‘I want to go swimming,’ but typing those words out on a keyboard is difficult. Because of her difficulty with reading and writing, she was not able to text with her family and friends. She really wanted to be able to text. What we did was connect her cell phone to her communication device so she can listen to a text message she gets from her sister, and then she can write her sister back with her communication program and it gets translated into a text she can send to her sister. She really wanted to be able to text – everybody texts. So we gave her a way to be able to do that.