Technology in the Speech Therapy Space

by Tera Tuten on January 10, 2013

Touchscreen technology computers and tablets have revolutionized the way Speech-Language Pathologists (SLP) work. Today, alternative means of communication and education are readily available to the general public.

For people who have trouble with or are incapable of speech, Augmentative and Alternative Communication (AAC) is a way to communicate by unaided (hand signals) and aided (hardware) methods. AAC has been around for as long as communication disorders have, but only in the last century did it become an everyday solution. Beyond sign language, AAC device users grew from people with laryngectomy in the 1950s to people with cerebral palsy, autism, paralysis, and other disabilities today.

A low-tech AAC device might be something as simple as a laminated piece of paper from a book, said Scott Calderwood, an elementary school SLP. These can cost as little as $5. On the other end of the spectrum, incredibly complex AAC systems are operated by the user’s gaze. Eric Sailers, an SLP app developer, said, “Eye gaze systems can be $20,000 when they’re built into a traditional AAC device.”

For people who require AAC devices to communicate independently, it still is a high price to pay. “[A device is] typically $8,000 or more,” said Sailers. The cost goes up with accessories, like switch or eye gaze technology, or mounting and casing.

“Coming from a school that would not pay for AAC devices, unless the parents and the professionals involved and sometimes even the advocates and lawyers could really make a strong case for it… I felt like my administrators would tell me… that I should really be recommending technology that we have in the district that we don’t have to buy,” he said.

But, with the advent of touchscreen technology, notably the iPhone and iPad, therapy and communication shifted.

Speech with Milo. Sonoflex. ArtikPix. Read2Go. Conversation Builder. Proloquo2Go. These apps fall on the wayside to the average person, but for the therapists in the SLP world, they are making waves. Utilizing tablet and mobile touchscreen technology, SLPs are engaging and opening up children who have a difficult time speaking or being understood.

Since these devices run hundreds of dollars cheaper to their dedicated AAC counterparts, an iPad with an app can be used as a viable solution for communication as well as supplementing the person’s therapy. “Most parents, if they can’t get insurance, would much rather prefer to purchase something cheaper. An iPad costing a couple hundred dollars versus a couple thousand and still meeting their kid’s needs,” said Calderwood. Even a device with an app that costs up to $200 looks better than $8,000.

In 2008, Proloquo2go went into testing phase. Developed by a licensed SLP, it lets users build sentences with pictures or by keyboard, which is then read aloud by the app. Sailers, who was a school SLP at the time, signed up as a tester. He gave an autistic student, who had been using a bulky AAC device, an iPod Touch with Proloquo2go on it.

“I was just blown away with what he was doing,” Sailers said, “With how he was able to learn the technology so quickly and put it into use… and how the other kids, the regular ed kids, respond to him and his iPod Touch as an AAC solution. It’s really incredible, because they were coming up to him… like he was the cool kid.”

This year, Bodega, Autism Speaks, and Goodby, Silverstein & Partners produced a short documentary titled “I Want to Say.” The film highlights the promising and hopeful future technology provides for people with autism and a peek into the intense frustration that autistic children face in a verbal world.

The project began as an exploration HP Touch Smart computers. “For us, [this film] started as an HP thing, but it’s so much more than one company. At a certain point we had to pull away and make this thing platform agnostic. It’s not an HP thing, it’s a technology thing,” said Todd Porter, Executive Producer.

In the film, Dr. David Traver, an autism specialist, highlights the ignorance of the general public and profession on the way we view autistic children. “[New technology] is shattering all of our models and constructs of what you can label these children as being. They’re normal. They’re just like us,” he said.

With something as common as an iPad, a Touch Smart computer, or a typewriter, parents describe meeting their child for the first time. “In Kayla’s case,” Porter said, “[she and her parents] went 15 years without ever saying a word, and then suddenly they had a teenager on their hands.” The range of thought they didn’t realize she had poured out in hours-long typed conversations. “They were just gobsmacked,” added Porter.

In the film, Kayla said, “I didn’t feel human and people called me retarded right in front of me.” Using an iPad as an AAC solution, Kayla has graduated from high school and is now attending college. “I want to say I think technology has changed my life,” she said.

Whitney Ferris, Agency Producer, said, “[In the film] you’re going to see a lot of different technologies and different ways that children are using it… an important thing to note is that none of these children only have technology in their life. They have support in a lot of different ways, from speech therapists and dental work.”

Technology has become something of a unifying feature. “With touchscreen technology, it’s the first time we’ve ever seen unique cases where widely different areas of the spectrum react very similarly to the same thing,” Ferris said.

Tablets are not only making waves as an AAC device. They’ve changed the way professionals can do their job. “When we work on a goal, a speech and language goal, a behavior goal, there’s an app for that,” Calderwood said.

“Especially in the school systems, we’re starting to use apps… to work on articulation… to record progress and email parents if need be,” said Calderwood. “I use my iPad every day. Every day. Whether in terms of the speech and language goal itself, as a reward that [the students] work for, but I’ve used my iPad in therapy for two and a half years.” He added that it’s easier to take notes and keep track of data. It also connects the educators and parents to the process.

Sailers’ first app was Percentally, a data collection app for educators and therapists. As a child he had delayed speech, which inspired him to get into the field. “When I was going to therapy back in the early to mid eighties I was using flash cards. When I graduated from my Master’s program in 2005… the materials I got to work on speech sounds with kids were flashcards,” Sailers said. From that, ArtikPix was born to update the method.

“[Therapists] tell me that they’ve almost entirely stopped using flashcards because their students enjoy using my app a lot more,” Sailers said and added, “They tell me how they love how they can no longer lose the speech cards.”

Calderwood sees it in his own students. “The use of the iPad and the technology and the apps and general… it’s given kids a different way teaching goals rather than using a piece of paper. It gets kids more excited to be using the technology because it’s so innovative right now.”

While Sailers was practicing SLP, he described immediately bringing the technology into his therapy. “The kids really respond well to [technology] and I could see that the staff and the parents, although they didn’t take to them right away, they could see the potential there.”

Calderwood has seen the shift that Sailers glimpsed. “Parents are becoming more involved… they see that their speech-therapists have been using iPads to reach goals, so parents have been buying in [to work on their child’s goals at home],” Calderwood said.

Still, iPads and computers cannot take the place of AAC devices entirely. “The traditional devices, for a long time, have had switch access, for somebody who can’t touch something on a screen, they can hit a big button and be able to activate something on the screen. The iPad now has some switch access solutions, but not all apps work with switch access… It’s expensive, but there’s a lot of research that goes into it, it’s a niche market. Eye gaze technology works really well and the iPad doesn’t offer it. And if you need eye gaze, well, what do you do?”

For therapists that are uncertain how to incorporate the new tech in their practices, Sailers says that there are plenty of opportunities for training. He suggested attending conferences like Closing the Gap and the annual American Speech-Language Hearing Association convention or googling technology training in their area.

“[Right now,] it seems like everyone wants a tablet in education and in speech therapy,” said Sailers. “I felt like a lot of [therapists] were kind of hesitant to use the technology… but once they started using it, they realized how easy it was to learn. I feel like those professionals are taking chances more with technology, and I feel like our kids benefit as a result, because they love technology so much.”

Calderwood thinks along the same lines. “Just the flexibility alone from using the technology and the excitement that the kids get from it, I think it’s going to outweigh any old school ways,” he said. “It’s a new way of looking at things. The best way to teach kids is through different modalities, using a piece of paper and a pencil as well as technology.”


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