Transcript Our Evaluation…

Our Evaluation Plan for “T”
Kristen Eklund &
Jolene Hyppa Martin
Our Evaluation…
...didn’t happen!
Instead of telling you about our
evaluation
We are going to explain:
1. What we learned since our case history presentation
2. How we developed a customized evaluation for “T”
3. Procedures/Protocols we planned to use
4. Rationale
5. Report
Case History Review
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“T”
7 year old boy
Medically fragile
Diagnoses include:
• shaken baby syndrome
• cerebral palsy
• seizure disorder
• developmental delay
• cortical visual impairment
• progressive neuromuscular scoliosis
• spastic quadriplegia
• reactive airway disease
• “T” has a tracheostomy and a g-tube
Case History Review
• IEP States:
• Homebound education
• Previous cheek switch use
• Current communication:
• Totally non-verbal
• Two way eye gaze to answer yes/no
questions
• Development and adaptive skills stable and below
a 3-6 month level
• “T” does not like clinical settings or unfamiliar
adults
To get more information…
• Dr Mizuko, Kristen & Jolene
headed to Hermantown
Elementary on May 25th
• Informational and planning
meeting
• School representatives:
• Nancy Anderson SLP
• Nancy Kucera DCD
teacher
What we learned at the meeting:
• Cognitive Status:
• Both teachers feel that “T” is much higher functioning than
his IEP states
• Cognitive testing that labeled him as functioning at a “3-6
month level” was not done in person
• SLP has witnessed :
• requesting, protesting, greeting, providing information,
showing interest, playing, showing affection, seeking
approval, socializing, agreeing, disagreeing, showing
disinterest, and showing that he doesn’t know
• “T” explained he didn’t know by using a back and
forth eye gaze
• “T” protested by closing his eyes and refusing to
open them
What we learned at the meeting:
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Motivating factors:
• Wants to “get words” and is excited about the evaluation
• Likes Blue’s Clues, books, computers
• Recently turned 24 pages of a talking book when OT held a switch by his
cheek
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Limiting factors:
• “T” will not tolerate having his face or eye glasses touched
• Can withstand about one hour of assessment/intervention before fatiguing
• Can produce about 8-9 consecutive yes/no eye gaze responses before
fatiguing
• Previous switch use reportedly failed because “T” was absent often and
fatigued quickly in school
• Limited arm movement
• Very serious and kind personality
• Doesn’t like joking much & is not motivated by “beating” his aids at
games. Rather, he appears to feel bad for them when they lose.
What we learned at the meeting:
• Educational status:
• 90% accuracy in naming colors
• Not as good with shapes
• Doesn’t know letters or numbers
• Vision:
• Cannot follow fast moving objects
• Photographs are preferred to symbols
• Unsure how much his glasses help him, willing to
try calibration without them
• Peripheral visual field is preferred
What we learned at the meeting:
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Both teachers agreed that a “T” needs a communication system that he can use
sitting up or lying down
Both teachers believe that “T” will learn to use a communication system
“quickly”
Neither teacher knows if “T” is able to gaze in more than two directions
Many people are very excited about “T’s” evaluation at UMD! It will be attended
by:
• Social worker
• DCD teacher
• School SLP
• Foster parents
• Vision consultant
• Tribal council representative (possibly)
• Our classmates
• Us
• Our professor
• And, of course, the STAR of the show, “T”
Our Goals
After the meeting, we reviewed what we
learned & developed these
assessment goals:
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To determine if T’s current use of
two way eye gaze and current
reported understanding of colors
can be expanded upon to develop a
broader and more effective
communication system for
immediate implementation.
To determine the best means of
providing T greater control of his
environment.
To determine if T is a candidate for
immediate or future use of the
ERICA system.
To develop a comprehensive
communication system that T can
use to communicate as quickly and
efficiently as possible with a variety
of people (unfamiliar and familiar),
in a number of settings, in all
positions (sitting or lying down), that
will permit functional, educational,
and social communicative
interaction.
The setting
• We adapted the evaluation room setting to
make it seem more like a play room and less
like a clinic
• Switched observation and evaluation rooms
to accommodate larger crowd
• Had a variety of stimulus items ready to go so
we could change our protocol online in the
event that “T” wasn’t responding to some
stimuli
• Since you didn’t see the room in action, we
have a short video clip
Our Evaluation Procedures
Part 1
• Determine “T’s” two way eye gaze reliability in answering yes/no
and binary choice questions.
• In the hopes of expanding T’s response repertoire, tasks to
assess his potential to use three and four way eye gaze were
developed and were constructed to indirectly evaluate his
knowledge of colors, shapes, body parts and the concepts
“same” and “different.”
• Rationale:
• Provide information about “T’s” current abilities
• Suggest ways to quickly expand his current response
repertoire
• Help us to develop a broader communication system for
immediate use
Our Evaluation Procedures
Part 2
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Assess T’s ability to use a switch
• Switch choices:
• Jelly bean
• Cheek
• credit card
• Stimulus choices:
• Two Customized talking Books
• mechanical animal
• cassette player with music
• Video cassette player with a children’s video
Rationale:
• Tasks were developed to determine “T’s” and Mom’s switch preferences
• Suggest which body part might be most effective for switch use
• Suggest “T’s” understanding of cause and effect
• Suggest “T’s” potential to increase communication and exercise
environmental control through switch use
Our Evaluation Procedures
Part 3
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Assess ability to use the ERICA
system
Customized ERICA to
compensate vision impairment,
his attention span, and his
interests
Developed a simple ERICAbased assessment tool to
evaluate ability to control a
computer cursor using two- and
three-way eye gaze
Rationale:
• Results would suggest
information about “T’s”
potential for being a current
and/or future ERICA user
Our Evaluation Procedures
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Because we still weren’t entirely clear on what to expect from this
client, we designed most protocols with a double hierarchy
• Allowed us to lower or raise our expectations “on the fly” to get as
much information as possible in as little time as possible
• For example, during eye gaze protocol:
• Look at the one on the top
• Correct response
• Look at the ones that are the same
• Look at the one that is different
• Incorrect response
• Look at up at the pink circle
• Look here (point to pink circle)
• Look up (switch to object and use it to direct upward
gaze)
Our Evaluation Procedures
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Parent interview
• We used a list of questions
from the Augmentative and
Alternative Communication
Assessment Protocol
(Super Duper, 1998).
• To work around client’s
fatigue level, we elected to
leave the parent interview
for the end of the
assessment.
Parent/child interaction
• Video tape
• Observation throughout
session
Our Report
• Daily Communication Needs
• System needs to enable
• Discussion of medical needs
• Educational communication
• Initiation of feelings and ideas
• Environmental control
• Social development
• System needs to accommodate
• Motor abilities
• Visual abilities
• Positioning requirements
Our Report
• Summary
• “T’s” evaluation was cancelled twice and
not able to be rescheduled due to ongoing
health concerns
• “T’s” mother would like to have him
assessed next Fall
• “T’s” mother and SLP instructed to contact
RFP Clinic or Dr Mizuko to reschedule
Our Report
• Recommendations
• “T” would benefit from ongoing intermittent augmentative
and alternative communication assessments that are
designed to maximize current communication function,
increase communication repertoire, and adapt to changes in
his development and life situation.
• Recommended assessment areas include:
• Assessing eye gaze
• Two-, Three-, and Four-way
• Assessing switch use
• Type of switch
• Type of initial stimuli
• Assessing ERICA system use
Questions? Comments?