Clinically Speaking

TEAMwork: Together, Everyone Achieves More

One of my favorite sayings is “Teamwork makes the dream work.” For me there is no better energy than the one that comes from a group of people working together for one common goal.

When I was in school, I absolutely loved group projects, because each person brought something different to the table from which I could learn. The first assistive technology (AT) team I was a member of was at a pediatric transitional care and rehabilitation hospital. Our team consisted of an occupational therapist (OT), a physical therapist (PT), a recreational therapist, a special educator, and a speech-language pathologist (SLP). Each member brought a unique perspective to every situation, which allowed our team to think outside of the box by tapping into all of our collective expertise. In my experience, it is not uncommon for a PT to join in on an augmentative and alternative communication (AAC) device evaluation or for an SLP to consult on a power mobility evaluation.

In this season of my career, my role has shifted quite a bit from the days of working full time in a hospital to serving more as a consultant and educator; however, I often find myself pulling ideas from past experiences to assist a client.

Powers of Observation

A few months ago I was in an elementary school brainstorming power mobility ideas for a student with the student’s mother, her 1:1 aide, her school PT, the complex rehabilitation technology (CRT) supplier, and a Sunrise Medical account manager. About two minutes into our discussion, something on the young lady’s manual tilt-in-space wheelchair caught my eye.

It was a small pillow speaker tucked directly behind her headrest. Based on my experience, I had a sneaking suspicion that this young lady utilized an AAC device, because pillow speakers are often used in conjunction with AAC devices to allow the user to hear an auditory preview of a message when using single- or two-switch scanning to activate the device. When I asked what the speaker was used for, her 1:1 aide confirmed that the young lady had recently started using an AAC device during her speech therapy sessions. Due to that bit of new information, our evaluation paused for a few minutes while the aide went to get the SLP and the AAC device, because I knew the SLP could likely provide us with some game-changing information in areas that included access, cognition, preferences and receptive language skills.

After our session with the student was complete, the PT and CRT supplier thanked me for having a keen eye. I simply smiled and said, “I would not know as much about seating & mobility as I do today without the wisdom imparted on me by phenomenal SLPs over the years.” With puzzled looks on their faces, both individuals requested that I share a few more tips I have learned from my SLP colleagues.

Do Your Homework

As a part of the intake process, I highly recommend asking the client’s caregivers and/or therapy team to provide you with written reports from anyone and everyone on the client’s team. Whether formal therapy evaluations or a brief summary of the client’s current status, other professionals — including behavior specialists, 1:1 aides, nurses, OTs, PTs, recreation therapists, special educators and SLPs — can provide you with valuable nuggets of information you may not uncover during your evaluation.

Provide a Voice

Imagine for a moment that you are unable to speak. Does your desire to communicate and express yourself disappear? I am guessing your answer is no. If a client utilizes any type of communication system, from picture symbols to a single message voice output device to an 84-location dynamic screen AAC device, he/she should be provided with the opportunity to utilize the system during your appointments. Not sure what to do? Ask the caregiver to set up the client’s communication system or request that the SLP pop into your session for a few minutes to assist you.

Provide a Choice

Selecting the perfect color of wheelchair frame is the most important part of ordering a wheelchair to many of our clients. Unfortunately for our clients who are non-verbal, have visual impairments and/or motor impairments, expressing their preferred color choice is next to impossible. Present the color chips to the client in a smaller field (e.g., present two at time), cut up the brochures to separate the colors, or ask your friendly SLP to program the client’s AAC device with the color options so the client can tell you what he/she prefers.

Don’t Reinvent the Wheel

Switch or AAC device mounts on a client’s wheelchair, Velcro squares on a lap tray, and pillow speakers are all tell-tale signs that an individual uses a communication system. Before you spend an hour trying to identify the best access point for a specialty input device on a power wheelchair, find out what other technology the client is using and how he/she is accessing it. There is no point in reinventing the wheel if the SLP has already found the client’s sweet spot for switch activation.

Decrease Complexity

When teaching a client to drive a power wheelchair, it is common to use words such as “left,” “right,” “turn,” “forward,” and “reverse.” Whether the client is verbal or non-verbal, the concepts of those words can be very abstract. Instead of relying on directions or even color coding, try taping images of familiar items such as cartoon characters, family members or animals to a switch. Google Images and Scotch Tape were my best friends when teaching a client with a traumatic brain injury how to drive a power wheelchair.

At the end of the day, no matter what the letters after our names stand for or what our job titles read, we all have the same mission: to improve the lives of the clients with whom we work. Remember, you should never stop learning. Ask an SLP to eat lunch with you to learn more about the receptive language skills of a mutual client, check out a Webinar on AAC devices or sit in on a session at a conference that is being taught by a discipline other than your own.

And most importantly, never be afraid to ask a question… because odds are you just might learn something.

This article originally appeared in the October 2014 issue of Mobility Management.

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