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Most clinicians work in settings where at least some clients require alternatives to the traditional mouse and keyboard in order to use a computer. Competency with assistive technologies, including access alternatives, is a valuable clinical skill. Sometimes the client may have augmentative and alternative communication (AAC) needs as well, but often computer access is desirable primarily for rehabilitation, vocational, educational, or recreational purposes. This was the case for Robin, a 41-year-old traumatic brain injury (TBI) survivor.
Robin had mild-to-moderate dysarthria and extremely limited mobility due to bi-lateral upper and lower extremity weakness. She was anticipating a new wheelchair for improved positioning, but meanwhile she came to the clinic to investigate the use of speech recognition for computer control. Her personal goals for computer use included playing computer games, possible Internet access, and personal writing. Several access alternatives were discussed and attempted with Robin, including speech recognition. Robin had difficulty producing speech with clear phonation and consistent articulation. After several trials, Robin agreed that speech recognition was not going to be a usable alternative for her.
Clinicians often do not know enough about speech recognition technology to understand how valuable their input can be in determining good candidates for this technology. Articulation consistency, vocal stamina, breath support, and adequate loudness are some of the key characteristics that predict success with voice recognition technology.
Unfortunately, some assistive technology teams who might recommend speech recognition do not realize how helpful an SLP could be for commenting on these speaker attributes or predicting whether the client's performance in speech recognition activities could be improved through speech treatment or other rehabilitation (such as breathing exercises).
Although speech recognition was not ideal for Robin, it was discovered that she had adequate head control to manage one of the many infrared devices that emulate a mouse. A state assistive technology equipment library provided a device for a trial period. Robin's clinician used the Internet to obtain side-by-side comparisons of features and prices for Robin and her funding sources to consider before purchasing a device. Several clinical computing competencies were involved in managing Robin's case. Her clinician explored computer access alternatives, used computer-based recreational activities as a context for evaluating access as well as articulation practice with Robin, and located information and resources for Robin via the Internet.
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